Signs your child may need an eye test

The moment you start to wonder

It is often something small. Your six-year-old has started screwing up their eyes to see the TV. The teacher mentions your child keeps asking to sit at the front. Homework ends in tears and headaches more often than it should. Or the B4 School Check letter came back saying "refer" and you are not sure how worried to be.

You are the person most likely to notice. KidsHealth NZ points out that children with a vision problem may not know anything is wrong, and the American Academy of Ophthalmology notes that children can be subtle about it and not tell you about the trouble they are having. This guide lists the signs official sources agree on, explains what the school-age screens actually check, and helps you decide whether to book now or keep watching.

Signs worth noticing at home and at school

KidsHealth NZ, the American Academy of Ophthalmology and the American Optometric Association list overlapping signs. None of them proves a problem on its own, but any of them is a reason to have the eyes checked.

How the eyes look:

• The eyes do not look in the same direction, or one eye drifts in or out, even some of the time.
• One or both pupils look unusual or white in photos or in bright light. KidsHealth NZ says to see a health professional about this.
• The eyes are constantly watering or discharging, or one eye looks different from the other.
• What your child does: screws up their eyes to see, tilts or turns their head to one side, sits close to the screen, or holds books and puzzles very close to their face.
• Rubs their eyes a lot, blinks a lot, or covers or closes one eye to look at things.
• Loses their place when reading, avoids reading, drawing and other close-up tasks, or seems to lose interest in them quickly. The Academy calls these the hidden signs, because they look like a short attention span.
• Is clumsier than usual for their age, or has reading and learning difficulties that nobody can quite explain.
• What older children say: headaches, sensitivity to light or glare, needing to sit at the front, or simply "I can't see the board".

What the B4 School Check vision screen does and does not do

Every child in New Zealand is offered a free B4 School Check when they turn four. The vision and hearing part is done by a trained vision and hearing technician, and the Ministry of Health's National Vision and Hearing Screening Protocols set out exactly what happens: as soon as possible after the fourth birthday, your child matches letters on a chart from four metres away, one eye at a time. A child who misses it is screened in their first year at school. A child already under the care of an optometrist or ophthalmologist does not need it.

The protocols are clear about the purpose. The screen exists to find children who may have amblyopia (lazy eye) at an age when it can still be treated, and to measure distance vision and refer children who cannot complete the test. That is a narrow job. It does not test near vision, it does not measure a prescription, and it does not look at the health of the eye. KidsHealth NZ says plainly that the screening does not find all vision problems, and Healthify NZ adds that it may not tell you whether your child needs glasses.

A pass is good news about lazy eye. It is not a clean bill of health for everything else, and it is not a reason to ignore the signs above. The next screen is a distance vision check at school in Year 7, when your child is 11 or 12. Our post on children's eye exams versus in-school screening goes into what a full exam adds.

When to book, and when you can wait

Book soon if you have seen any of the signs above, if the B4 School Check referred your child, if a teacher has raised it, or if your child already wears glasses and the prescription seems to be changing. KidsHealth NZ recommends a full eye test, rather than screening alone, for children who have a squint or lazy eye, needed strong glasses at an early age, were born at 30 weeks or earlier, or have developmental delay. It also suggests an eye check where there is a family history of squint, lazy eye or early strong glasses, and notes that between about two and a half and three years is a good age for an accurate first check. Our post on when it is time to take your child to the optometrist covers the same ground.

You can usually wait, and keep watching, if your child passed the screen, has no symptoms, no family history, and is reading and playing happily. In that case a routine check is still worthwhile: Healthify NZ suggests children and teenagers have an eye examination every one to two years, and KidsHealth NZ advises a yearly check for children who already wear glasses.

Both of our optometrists see children, from infant eye exams through to teenagers, and no referral is needed. If you are short-sighted yourself and your child is squinting at distance, it is worth reading what myopia is before the appointment, because that is the most common finding at school age.

What a child's eye exam looks like

Parents often hold off because they think a child who cannot read letters cannot be tested. They can. The tests for young children use matching, pictures and instruments rather than reading, and a child who cannot answer questions can still be examined. Healthify NZ describes a comprehensive eye examination as covering history, vision and prescription, eye muscle and pupil checks, eye pressure where appropriate, and a look at the inside and outside of the eye.

If glasses are needed, the Enable New Zealand children's spectacle subsidy may help with the examination, frames and lenses for children aged 15 and under whose family holds a valid Community Services Card, or who hold a High Use Health Card. The claim goes through the optometrist, and the current amounts are on the Enable page. Our consultation fees page lists the children's exam fee. The guide on preparing your child for an eye exam covers what to tell them beforehand.

When an optometry appointment is the wrong place

Some eye problems in children cannot wait for an appointment. Healthify NZ says to seek medical care immediately, or call 111, if a strong chemical such as bleach or oven cleaner gets in the eye, if something has pierced the eye, if vision is blurred or lost after an injury, or if your child cannot open or move the eye. For a chemical splash, flush the open eye with clean running water for at least 15 minutes first, then go to the nearest hospital emergency department.

A red, painful eye that cannot tolerate light, a sudden loss of vision, or a sudden shower of floaters with flashes also needs same-day care rather than a routine booking. A white pupil, or eyes that have started pointing in different directions, should be seen promptly by a GP or optometrist rather than left for the next school screen. If you are unsure where to go, Healthline on 0800 611 116 can advise.

Everything else on this page, from squinting to headaches to a referral letter, is a routine optometry appointment. In New Zealand you do not need a GP referral to book one.

What to do next

If anything above sounded familiar, book a children's eye exam. Bring the B4 School Check result if you have it, any current glasses, and a note of what you have noticed and when. Our post on recognising childhood vision problems describes the common conditions an exam can pick up, including lazy eye, squint and short-sightedness.