Vision Problems and School-Age Children

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Middle childhood is a common time for the recognition of vision problems, especially when children first have assigned seats in classrooms. Your child may tell you that he cannot read the blackboard unless he squints or moves to a front-row seat. Or you may notice that when he watches television, he sits close to the set. Less commonly, your child may complain that the words on the pages of books are blurry. All of these suggest a focusing problem and call for an examination by an eye doctor.

Myopia, or nearsightedness, is the most common vision problem among school-age children, often developing between age 6 and adolescence. With this condition the eyeball has an elongated shape, and thus light passing through the lens of the eye is focused in front of the retina rather than on it. As a result the child cannot clearly see distant objects.

Children with hyperopia, or farsightedness, have the opposite problem. Because of the shorter shape of their eyeballs, images are focused behind the retina, causing them to be blurry. These children cannot clearly see objects that are close to them without making an effort to focus, although this effort may not be a conscious one.

Both of these conditions can be inherited. Myopia and hyperopia may require eyeglasses to correct the poor vision. Most doctors recommend that active children wear shatter-resistant plastic lenses to minimize the chances of serious accidents. Some children prefer contact lenses, but because the lenses require diligent care, doctors often discourage their use prior to adolescence. Laser surgery to correct myopia is not done until adulthood, when the eye has finished growing.

Some children also have an astigmatism, in which the front of the eye is shaped more like a football than a basketball. As a result, the vision may be similar to that seen when looking in a mirror with a wavy surface, like a fun-house mirror that makes you seem too tall, too wide or too thin. Astigmatism is usually inherited, may be present at birth, and may remain little changed throughout life. Normally, the blur from astigmatism is corrected with glasses or contact lenses. Small amounts of astigmatism are common and do not require correction.

Points About Your Child’s Vision

Here are some points to remember about your child’s vision:

  • Even though visual difficulties can sometimes cause headaches, this pain is most often associated with problems unrelated to the eyes.
  • If your child wears glasses and participates in competitive sports, the glasses should be secured in place by attaching a strap that connects the two earpieces and stretches behind the head. Also, special sports glasses are available.
  • Some optometrists recommend eye exercises to help treat learning disorders like dyslexia. However, carefully controlled studies have failed to demonstrate any benefits from these eye exercises — or from wearing colored lenses — to treat these disorders.


Most parents call it pinkeye, but when doctors talk about it, they use the term conjunctivitis. It is an inflammation of the mucous membrane on the inner side of the eyelids. Although it is common and usually not a serious condition, parents understandably become anxious when their child develops symptoms such as bright pink eyes and yellow-green pus that can make the eyelids stick together, particularly upon awakening in the morning.

A number of different bacteria — including staphylococcus and streptococcus — can cause conjunctivitis. Viruses and allergies also may be responsible for pinkeye. Both the bacterial and viral infections are contagious, so make sure your child does not share towels, washcloths and pillows with other family members. Careful hand-washing is the most important preventive measure.

These viral infections tend to clear up on their own in a few days. Your doctor may prescribe an antibiotic — either eyedrops or an ointment — for bacterial conjunctivitis; make sure your child uses the antibiotic for the prescribed time period, even if the symptoms disappear. Two adults may be needed to administer the drops: one to hold the eye open and reassure the child while the other adult actually puts the drops in the eye. Also, periodically wash the eyelids, using a cotton ball soaked in warm water, to keep them from sticking together. Keep your child home until her eyes no longer have a discharge.

Excerpted from Caring for Your School-Age Child: Ages 5 to 12, Bantam 1999

© Copyright 2000 American Academy of Pediatrics