My child keeps bumping into things: eyesight, side vision or coordination?

He walks into the door frame. She trips on the same step every day, knocks the cup off the table, or misses the chair when she sits. Other adults say "just clumsy" and you wonder whether the eyes are the reason. A child who bumps into things is a common worry, and it is a fair reason to book an eye visit, because the eyes are one of the few causes that can be checked quickly and, if found, helped.

This page sets out what the first eye visit checks, how an eye doctor tells poor sight from a gap in side vision, when the picture points to coordination rather than the eyes, and which signs mean going sooner. Many children who bump into things turn out to have healthy eyes, and the visit is how you find that out.

Why does my child keep bumping into things?

There is no single reason, and the eyes are only one of several. A child may be looking at something else while walking, may be moving fast, may have blurred sight that has never been corrected, may be missing part of the side vision, or may have a movement-planning difficulty that is nothing to do with the eyes. Which one is at work is not something you can tell by watching at home.

That is why the useful question is "what should be ruled out first?" and the answer is the eyes, because that check is quick and painless, and what it finds is often correctable: a child who needs glasses usually sees better with them. The action: note when the bumping happens (indoors or outdoors, bright or dim light, left side or right side, near or far) and bring that note to the visit. It helps more than any description of "clumsiness".

What does the first eye visit check?

It checks how well each eye sees, whether either eye needs glasses, whether the eyes line up, how the child sees to the sides, and the health of the back of the eye. These are the standard parts of a children's eye examination, and none of them needs the child to read.

• Visual acuity. How sharp each eye sees, with pictures or symbols suited to the child's age. The American Academy of Ophthalmology describes testing with age-appropriate symbols in young children.
• Refraction. Whether the child needs glasses. In children this is usually measured with a light and lenses (retinoscopy), often after dilating drops, so the child does not have to answer.
• Alignment. Whether the eyes point in the same direction and work as a pair. A squint can make it hard to judge depth, so a step or a table edge is misjudged.
• Side vision. A check, done in a way that fits the child's age, of whether the child notices things to the left, right, above and below. Side vision is part of a fuller assessment whenever a problem with it is suspected.
• The back of the eye. With the pupil widened by drops, the doctor looks at the retina and the optic nerve, to check that the part that sends the picture to the brain looks healthy.

For more on how these tests are done with young children, how we test children's eyes goes through them one by one.

Could poor eyesight or glasses be the reason?

Yes, and it is the first thing to rule out. A child with a strong prescription, with a big difference in power between the two eyes, or with a squint that blunts depth perception can trip and misjudge distances. Children rarely complain, because the blur is their normal and they have nothing to compare it with.

A school screening can miss some of these problems, so a child who bumps into things deserves a full examination and not just a chart. Signs that suggest the eyes are involved include screwing up the eyes, holding objects very close, tilting the head, covering one eye, or being clumsy mainly with distant or fast-moving things. How to tell if your child needs glasses lists the signs that are worth acting on, and what your child's teacher notices covers what shows up in class.

Could my child be missing part of the side vision?

It is possible but less common, and it can only be confirmed by an eye doctor. A gap in the side vision means a child may not see what is coming from one side, so he walks into the door frame on that side every time. Pattern is the clue: the same side, again and again.

Younger children cannot report what they cannot see, because they do not know it is missing. So the doctor checks, using the child's attention to targets coming in from the side, and, if something looks wrong, arranges more formal testing as the child becomes old enough. The action: if the same side is always the side that gets hit, say so at the visit. It is one of the most useful things you can tell the doctor.

When does it point to coordination instead of the eyes?

When the eyes are healthy and see well, and the child is still clumsy with tasks like catching a ball, using scissors, fastening buttons or handwriting, the cause may be developmental coordination disorder (DCD). DCD is a recognised condition of movement and coordination in childhood that the eyes do not explain. International clinical practice recommendations, published in Developmental Medicine and Child Neurology in 2019, cover how it is defined, diagnosed and assessed.

It is not something the eye examination can diagnose, so the eye doctor's role here is to clear the eyes and, when the picture fits, to suggest the child be seen by a paediatrician or a therapist team who assess movement. That is a referral, not a verdict. Seeing the eyes first is still the right order, because a child with an uncorrected prescription can look uncoordinated for a reason that glasses can correct.

What about cerebral visual impairment?

Cerebral visual impairment, CVI, is a different cause: the eyes work, but the brain has trouble making sense of what they send. The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) puts it simply: "the eyes work fine and take pictures of what you see.

But the brain can't understand the pictures." A review by Philip and Dutton describes it as visual malfunction due to problems in the brain's visual pathways, and says it is common in children with cerebral palsy and can be identified if a structured history is taken.

AAPOS lists signs such as taking a long time to react to what is seen and having trouble seeing in busy places with a lot to look at. It is usually linked to a known cause such as being born very early, a lack of oxygen to the brain, or a brain infection or injury.

For a child with a known condition of that kind, eye checks for children with cerebral palsy or developmental delay goes into CVI in more detail, and it is not repeated here. If your child has no such history and the eyes are healthy, CVI is far less likely, and the eye doctor will say if it needs to be looked into.

Which signs mean seeing an eye doctor sooner?

Book an eye examination soon, rather than at the next routine check, if the bumping is new, is getting worse, or comes with other signs. Go the same day if the change is sudden or follows a knock to the head.

• The bumping started suddenly, or the child's vision seems to have changed over days or weeks.
• It follows a knock to the head, a fall or a serious illness. After a head knock the eyes should be checked.
• One eye turns in or out, the head tilts, or the child closes one eye.
• The trouble is mainly in dim light or at night.
• The child always hits the same side, or does not seem to notice people or objects on one side.
• There are headaches with vomiting, or the child seems unusually sleepy or unsteady.
• The child was born very early, or has a known brain or nerve condition and has never had an eye check.

The action for everyone else: if the clumsiness has been there a long time and the child has never had a full eye examination, book one. If the eyes are healthy, you have ruled out the most fixable cause, and the doctor can point you to the next step.

Common questions

References

1. Philip SS, Dutton GN · Identifying and characterising cerebral visual impairment in children: a review (Clin Exp Optom 2014) · pubmed.ncbi.nlm.nih.gov
2. Blank R et al · International clinical practice recommendations on developmental coordination disorder (Dev Med Child Neurol 2019) · pubmed.ncbi.nlm.nih.gov
3. AAPOS · Cerebral visual impairment · aapos.org
4. American Academy of Ophthalmology · Eye screening for children · www.aao.org
5. American Academy of Ophthalmology · Procedures for the evaluation of the visual system · www.aao.org
6. AAPOS · Dilating eye drops · aapos.org

By Dr Chan Li Yen. General information only. It does not replace a consultation. If you are worried about your child's eyes or vision, please see an eye doctor.