Ages & Stages - November 2011

What you should know about your child's vision AND Whooping cough vaccine

the EYES have it

Making the most of what your child can see is a huge key to learning, whether your child is an infant, grade schooler, adolescent or college student. That’s why proper screenings and eye exams are so critical to your child’s future.

If your young one is in school, he or she may already have had a vision screening. But even though your child’s result may have been normal, keep in mind these screenings are basic. A full eye exam will test your child’s near and distance vision, eye movement, focusing ability and peripheral awareness.

There’s good reason to be concerned. Vision problems are common among kids, affecting one in four kids. About 4 percent of preschoolers have myopia (nearsightedness), 21 percent have hyperopia (farsightedness), and 10 percent have astigmatism (irregular curvature of the eye), according to a recently released study funded by the National Institutes of Health. The largest of its kind, the study identified related risk factors for vision problems, including age, ethnicity, exposure to smoking, and access to health insurance.

Uncorrected refractive errors, such as myopia, hyperopia, and astigmatism are the most common causes of vision impairment in children. Caused by slight irregularities in eye shape, refractive errors affect how light focuses on the retina, the part of the eye that converts light into signals the brain perceives as images. Refractive errors are correctable with eyeglasses, but uncorrected they can lead to lasting vision problems such as strabismus (misalignment of the eyes) and amblyopia (decreased vision in one or both eyes that cannot be corrected with eyeglasses).

The study identified misalignment of the eyes in about 2 percent of children and amblyopia  — also known as “lazy eye” —in about 5 percent of children. It also noted that the risk of these conditions increases with mild refractive errors — a potentially important finding because strabismus and amblyopia can become permanent if not treated during childhood.

The American Academy of Ophthalmology and the American Association for Pediatric Ophthalmology and Strabismus recommend the following exams:

• Newborn. A pediatrician, family doctor or other trained health professional should examine a newborn baby’s eyes and perform a red reflex test (a basic indicator that the eyes are normal). An ophthalmologist should perform a comprehensive exam if the baby is premature or at high risk for medical problems, has signs of abnormalities, or has a family history of serious vision disorders in childhood.
• Infant. A second screening for eye health should be done by a pediatrician, family doctor or other trained health professional at a well-child exam between six months and the first birthday. To assess whether your baby’s eyes are developing normally, the doctor typically will test pupil responses to evaluate whether the eye’s pupil opens and closes properly in the presence or absence of light. The doctor will also determine whether your baby’s eyes are able to fixate on and follow an object such as a light as it moves. Infants should be able to fixate on an object soon after birth and follow an object by the time they are 3 months old.
• Preschooler. Between the ages of 3 and 3½, a child’s vision and eye alignment should be assessed by a pediatrician, family doctor, optometrist, orthoptist or person trained in vision assessment of preschool children. If the child is not old enough to use an eye chart, photoscreening is another way to check visual acuity. If misaligned eyes (strabismus), “lazy eye” (amblyopia), refractive errors (myopia, hyperopia, astigmatism) or another focusing problem is suspected, the child should have a comprehensive exam by an ophthamologist. It’s important to begin treatment as soon as possible to ensure successful vision correction and life-long benefits.
• School age. Upon entering school or whenever a problem is suspected, children’s eyes should be screened for visual acuity and alignment by a pediatrician, family doctor, optometrist, orthoptist or person trained in vision assessment of school-aged children, such as a school nurse. A child who is unable to see print or view a blackboard can become easily frustrated, leading to poor academic performance.

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A Shot of Protection for Precious Cargo

You may have a hard time convincing the in-laws, but if you have a new baby either at home or on the way, the grown-ups may need to get a shot.

The U.S. Centers of Disease Control and Prevention is urging adults to be immunized against whooping cough, if they come in regular contact with infants. It’s more about protecting the children than the grown-ups, however.

Many of us received the Pertussis vaccine as children, but that immunity may have worn off, making it possible to infect infants who don’t receive their first shot against the illness until they are six months old.

Pertussis — also known as whooping cough — is a serious, easily transmitted infection that causes severe and violent coughing episodes. Often transmitted by family members, it can cause death to young infants.

The CDC and American Academy of Pediatrics have revised previous recommendations for the use of the Tdap vaccine in children and adults. To make sure everyone in the family is protected, the AAP advises a single dose of Tdap should be administered to children 7 through 10 years of age who were under immunized or who have an incomplete vaccine history. The recommendations also call for vaccination of adolescents and pregnant women. In addition, a single dose should be given to adults who have contact with infants, even if they are older than 65.

Yes, that means grandparents.