Early Childhood Intervention
Identifying infants and young children with visual impairments
by Holly Cooper

Did you know that vision is involved in 90 percent of the learning that occurs in early childhood? Babies and young children learn by looking at toys and objects and watching what people around them are doing. They watch their own hands and feet, they look at pictures, and they imitate others.

But what if a baby doesn’t see well, or doesn’t see at all? Having a visual impairment can slow a child’s acquisition of skills and understanding of the world. But with special teaching techniques and tools, children with a visual impairment can largely keep up with their peers. One of the most important things you can do is to recognize that a child has a vision problem so that treatment can begin.

Early care and education professionals aren’t trained eye doctors, but they do spend many hours a day watching and caring for infants and young children. Watching a baby’s eyes can give you a lot of information about how the little one sees the world.

Does the baby look at your eyes and face when you talk? Do the eyes look unusual? Does the baby squint or seem sensitive to light? Young children who rub their eyes, have excessive tearing, or tilt their head to look at something may have problems with their vision. Both eyes should look directly at a person or object by the time a baby is 3 or 4 months of age. When looking at something, the eyes should be still, and not drift or wiggle.

Infants and young children who have medical conditions or other health problems are at a higher risk for vision impairment. Babies who were premature or who had head injuries, strokes, or other conditions that cause oxygen deprivation can lose vision or the ability to cognitively process visual information. A baby who has had cataracts or glaucoma, even if it has been treated, may still have a permanent loss of vision.

Albinism or lack of pigmentation of the skin usually affects the pigmentation of the eyes, causing visual impairment and light sensitivity. Genetic conditions, such as Down syndrome and CHARGE syndrome, can come with visual impairment. Other conditions such as cerebral palsy and optic nerve hypoplasia often are accompanied by vision impairment.

In some cases, children can have surgery or wear glasses and have their resulting vision corrected to the normal range. For others, treatment may improve their vision but still not result in typical sight.

Here are some vision milestones that happen in typical development:

At birth
Focuses on objects 8-10 inches away
Has difficulty using both eyes together
At 3 months
Visually follows moving objects
Looks around with eyes that are beginning to work together
Shows the beginning of a visually directed reach
At 6 months
Turns head to see objects
Uses an accurate reach
Has good color vision, may have a favorite color
Sees at greater distances
Picks up dropped toys
At 12 months
Shows interest in pictures
Points and gestures
Places shapes in frame
Judges distances
Recognizes own face in mirror
At 18 months
Recognizes familiar objects
Scribbles with crayons or pens
Shows interest in exploring

If an infant or young child you work with looks or behaves in a way that causes you to wonder if there is a problem with vision, talk to your supervisor to learn about the process of referring a child for an eye examination and later educational testing. Even a child who wears glasses may still not see the way as other children see and may benefit from special services.

Early intervention is important. In the early years, every month counts. Children with vision problems often show delays in development. A child who is not identified in the early years may later have problems paying attention to the teacher in school, learning to read, and learning from what a teacher is writing on the board or screen, playing sports, and socially interacting with other children.

A visual impairment is a significant disability, and helping a child and family access educational services during the earliest years can make a big difference in learning throughout childhood and later life.

If you suspect a child has a vision problem, refer the family to your local Early Childhood Intervention (ECI) program. To find a local ECI program, access the DARS website at www.dars.state.tx.us/ecis/searchprogram.asp.

Additional vision resources
Blind Babies Foundation fact sheets, www.blindbabies.org/learn/diagnoses-and-strategies/
CHARGE Foundation, www.chargesyndrome.org
Eye Find brochure for distribution, www.esc11.net/cms/lib3/TX21000259/Centricity/Domain/187/Eye%20Find%20Brochure%202013%202014%20SLSBVI%20SFASU.pub
Perkins Scout: Visual Impairment in Early Childhood, www.perkinselearning.org/scout/early-childhood
Texas School for the Blind and Visually Impaired, Infant and Toddlers with Visual Impairment or Deafblindness, www.tsbvi.edu/outreach/4083-infants-toddlers-preschoolers-vi and www.tsbvi.edu/outreach/4058-infant-preschool-services-db

About the author
Holly Cooper, Ph.D., is a deafblind early childhood specialist at the Texas School for the Blind and Visually Impaired. She collaborated with ECI staff on this article.