Preparing your child for an eye exam

Your child does not need to read

The worry most parents bring is practical: she is three and does not know her letters; he will not sit in a strange chair; she gets upset by bright lights. None of those stops a children's eye exam, because the tests were designed around children who cannot or will not answer.

The key test is retinoscopy. The American Association for Pediatric Ophthalmology and Strabismus describes it as a way of finding out whether someone needs glasses by shining a light into the eye and watching the reflection while lenses are changed. It needs no answers at all, so it works for babies and for children who cannot say which lens looks clearer. For vision itself, the NHS describes using pictures instead of letters for a child who can talk but cannot read, and watching whether a baby's eyes follow an interesting object.

The picture to carry into the room: your child on your lap or in a big chair, looking at a cartoon or a light on the far wall, while the optometrist moves lenses and watches. Our children's eye exam page and infant eye exam page describe how NVISION does it, including the handheld measurement used for very young children.

What to expect at each age

The tools change with age; your optometrist adapts to the child in front of them.

• Babies and toddlers (under three). Kidshealth NZ says a baby's eyes are checked soon after birth for the red reflex. At an eye exam the optometrist watches how each eye follows a light or toy, checks that the eyes line up and move together, and uses retinoscopy, often after dilating drops, to measure the focus.
• Preschool (three to five). Vision is measured with pictures, shapes or a matching card: your child points to the matching picture on a card in their hand rather than naming anything. The optometrist checks eye alignment, how the eyes work together, and the focus with retinoscopy. Drops are often used to relax the focusing muscle so the measurement is accurate.
• School age (five to twelve). Letter charts come in once a child knows letters, along with 3D vision, eye movement and tracking, and sometimes colour vision. If a prescription is found or is changing, the optometrist may measure the length of the eye to track myopia over time.
• Teenagers. The exam looks much like an adult's. Screens, sport and contact lenses come up, and if short-sightedness is increasing year on year, the conversation turns to myopia control.

Dilating drops for children

Drops are a normal part of many children's exams. The American Association for Pediatric Ophthalmology and Strabismus says drops are usually given before retinoscopy because they enlarge the pupil so the optometrist can see better and stop the eye focusing on its own, which makes the result more accurate. The drop goes in like any eye drop: a tilt of the head, a blink, a tissue.

Afterwards near vision is blurry and bright light feels harsh. The American Academy of Ophthalmology says the effects of dilating drops last a few to several hours and that in children and young adults they can last longer. Bring a hat or sunglasses and, if the appointment is on a school day, ask whether reading will be hard that afternoon so you can tell the teacher.

Tell your child what the drop will feel like before it goes in: cold and a bit funny for a second. A surprise is worse than a warning.

Screening is not an exam

In New Zealand, Kidshealth NZ says most children have a vision screen at the B4 School Check around age four, and again in Year 7. The Ministry of Health's screening protocol describes the four-year-old screen as a distance vision test using a letter-matching chart, aimed at finding reduced vision and possible amblyopia (lazy eye), and the Year 7 screen as a distance check for myopia. It is done by a vision and hearing technician, not an optometrist.

Kidshealth NZ is plain that the screening does not find all vision problems. It recommends a full eye test for every child with a squint or lazy eye, who needed strong glasses at an early age, who was born at 30 weeks or earlier, or who has developmental delay, and an eye check where there is a family history of those things. It also says the ideal time for a full check is between two and a half and three years, when a child can do an accurate test and problems can still be treated early.

If your child passed the B4 School Check but you have noticed squinting, sitting close, head tilting or losing their place when reading, book an exam anyway. Our guide to signs your child needs an eye test lists what to watch for, and the older posts on whether it is ever too early, why children's eye exams matter and recognising childhood vision problems cover the same ground.

Autism, anxiety and sensory needs

If your child is autistic, non-speaking, anxious about new places or sensitive to light and touch, say so when you book. It changes how the visit is run: how much is explained first, whether the lights stay low, whether the chin rest is skipped, how long is allowed, which time of day is quietest. Two of NVISION's Google reviews describe eye tests for non-speaking autistic children, one aged eleven and one aged three and a half, and both parents describe the optometrist as patient and careful.

Useful things to tell the practice: what your child likes to look at, what they find distressing, whether they can point or match pictures, whether they will tolerate a drop, and whether a parent holding them on a lap helps or makes it worse. A favourite toy, tablet or snack for the waiting room is welcome.

What to tell your child the night before: short and true. "Someone is going to look at your eyes with a little light and show you some pictures. You sit on my knee. It does not hurt." If drops are likely, mention them. Avoid promising there will be no drops if you do not know.

What to bring, and the subsidy

Bring any glasses your child already wears, the result letter from the B4 School Check or a school screen if you have it, and a note of what you have noticed and when. The full what to bring checklist covers the rest.

If your family holds a Community Services Card, or your child holds a High Use Health Card, bring it. Enable New Zealand's children's spectacle subsidy is for children aged 15 or under who meet its clinical guidelines; the optometrist submits the request and is paid directly. NVISION administers this subsidy. The current amount is on Enable's page and the details are in our child glasses subsidy guide. Fees for child and infant eye exams are on the fees page, and the insurance and funding page explains Southern Cross Easy Claim.

When this practice is the wrong place

An eye exam is for problems that have crept in. Some things in a child need the emergency department or 111 the same day: a chemical splash, anything that has gone into the eye, an injury followed by blurred or lost vision, or a sudden loss of vision. Healthify NZ lists all of these as reasons to call 111 or get care immediately, and says to flush a chemical with clean, cool running water for at least 15 minutes before heading to the emergency department.

A white rather than red glow in a pupil in a photo, or an eye that has suddenly turned in or out, needs a prompt appointment with an optometrist or your GP rather than a wait-and-see. Kidshealth NZ says your doctor may refer your child to a hospital eye clinic, and an optometrist can refer as well. If you are unsure, Healthline on 0800 611 116 is free and open 24 hours a day.