What Happens at a Toddler Eye Checkup

Just like every other part of your toddler's oh-so-active body, his eyes need to be checked early and often.  Here's how a kids' eye doctor or pediatrician makes sure those adorable eyes stay healthy. 

Although your tot may not see an actual kids’ eye doctor while he’s still a toddler, his pint-sized peepers probably get examined more often than yours even before he checks in at the eye doctor.  That’s because your pediatrician is keeping an eye on your toddler’s eyes at every “well” visit. 

The eye-exam regimen may vary a bit from doctor to doctor, but they’re all designed to check for the same basic abilities and potential toddler eye problems.  Here’s a look at what goes down during a toddler eye exam during a visit to the doctor. 

Ocular history.  The doctor will ask if you’ve noticed anything out of the ordinary about your child’s eyes (like whether he holds objects close to his face to look at them or if one of his eyelids ever droops), as well as your family history (are there any eye problems that run in your or your partner’s family?).  If there are hereditary eye conditions, the doc may suggest your toddler sees a specialist regularly to check on his eye development (and he'll probably provide a recommendation for a kids' eye doctor). 

Vision assessment.  Since your tyke’s too young to use a standard eye chart like the ones you see at the eye doctor, the pediatrician will check how well he sees in other ways.  Some offices have special charts with pictures, or there may even be some toys involved.  For instance, the doctor may ask your child to fix his gaze on an interesting object, like a toy boat or a rubber duck, and follow it with both eyes and then one eye at a time.  Your child’s peripheral vision may be tested by having him focus on, say, the duck, and then flashing a light at the very edge of his vision to see if he notices.  For these tests, it’s important that your toddler is alert and pays attention — if not, the results may be inaccurate.  Pediatricians, in general, are pros at getting their patient’s attention, but yours would likely appreciate a heads-up if your little one isn’t feeling cooperative that day. 

External inspection of the eyes and lids.  With the help of a penlight, your doctor will check your child’s eyelids, eyelid lining, iris (the colored part of the eye), cornea (the clear outer layer of the eyeball) and everywhere else in eye-land to make sure those peepers are in peak condition.  The doctor will also be on the lookout for excessive tears or discharge (be sure to speak up if you notice this at home), which may point to allergies, an infection or a blocked tear duct. 

Ocular motility assessment.  That’s the scientific term for a test that ensures your toddler’s eyes move properly.  The doctor may shine a light in your little one’s eyes to see if the reflection from both is the same (if it is — and that’s quite likely — his eyes are properly aligned) and may also have your child focus on an object and then cover each of his eyes alternately (a “cover test”) to evaluate the eyes’ movement.  If his peepers don’t work as a perfect pair to fix on or follow an object, you may be told he has a lazy eye (amblyopia).  Usually, a consultation with a kids' eye doctor and a temporary eye patch or special glasses can solve the problem. 

Pupil examination.  At most checkups the pediatrician will check your child’s pupils, which should be round and both respond the same way to light, widening when it’s dim and shrinking when it’s bright. 

Red-reflex examination.  You know how your camera flash can make your child’s eyes look red in a photo?  That’s actually a sign of a healthy eye.  In this test, the “red reflex” should be the same when a light is flashed in your child’s eyes (if the doc sees red and not white, it could indicate a cataract, while black might indicate a tumor). 

If your pediatrician picks up anything unusual during these tests, you’ll likely be referred to a specialist for a more intensive eye exam.  Pediatric ophthalmologists are experts at dealing with pint-sized patients, but you don't necessarily need a kids' eye doctor — many regular ophthalmologists also take kids.  When making the appointment at the eye doctor, make sure to mention your child’s age so there are no surprises when you show up. 

From the What to Expect editorial team and Heidi Murkoff, author of What to Expect the Second Year.  Health information on this site is based on peer-reviewed medical journals and highly respected health organizations and institutions including ACOG (American College of Obstetricians and Gynecologists), CDC (Centers for Disease Control and Prevention) and AAP (American Academy of Pediatrics), as well as the What to Expect books by Heidi Murkoff.