Your Child's Eye-Q
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Digital Natives and Digital Immigrants
You likely first saw your child as a digital scan in your doctor's office. At that juncture, your child's eyes were still forming. The eyes are an extension of the brain and develop in utero. Vision develops after birth when a baby's eyes react to visual stimuli.

Your child was born as a digital native, a citizen of a world in which computers have always been an everyday fact while parents are digital immigrants. We are settlers from the Old World of analogue technology who have immigrated to the digital world. Although we are digital immigrants, it is our job to protect the vision and eye health of our digital native children. Protecting our children's vision means being informed about general eye health, as well as the impact of digital technology on the eyes.

Barbara L. Horn, O.D., trustee for the American Optometric Association, advises: "Since technology use is expected to continue to climb, we need to make sure that both children and parents take the proper precautions with technology to avoid eye and vision problems."

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Your Child's Vision in the First Year of Life

Your child was not born with all the visual abilities needed in life. Vision and the way the brain uses visual information are skills that your baby will need to learn. During your baby's first year of life, eyes provide information about the world and stimulation that is important for development. Vision changes over time. The greatest amount of change occurs during the first year of life.

Just as your baby takes time to grab, crawl and walk, babies learn to see over a period of time. During the first several months of life, babies will learn how to focus and move their eyes to respond to their surroundings. Your baby will learn how to use visual information the eyes send to the brain in order to understand the world. All of these vision milestones will allow your baby to interact appropriately with the world.

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The American Optometric Association (AOA) recommends that children should receive their first eye exam from an optometrist (eye doctor) between six and 12 months of age. Yet the 2015 AOA Eye-Q survey reveals that only one in five parents knows that children should receive their first comprehensive eye exam at this juncture from an eye doctor.

This is a critical time for a trained professional to detect and treat eye and vision problems that are not part of your child's exams at the pediatrician's office. A child's first eye exam between the ages of six and 12 months of age is available at no cost through the AOA's public health program called InfantSEE. Subsequent annual comprehensive eye exams through age 18 are covered by the Pediatric Essential Health Benefit in the Affordable Care Act. As infants are unable to speak, optometrists perform several non-invasive tests that allow them to evaluate overall eye health as well as the ability of the eyes and brain to work together.

Don't use digital devices to amuse or babysit your child. Instead, take steps to stimulate your child's visual development. Mobiles, rattles, squeak toys and activity mats designed for infant play from birth through five months of age, will help stimulate your baby's sense of sight. Children aged six months to a year will enjoy visual interaction with stuffed animals, floating bath toys and sturdy cardboard books. Take-apart toys, snap-lock beads, blocks and stacking/nesting toys, will help develop or sharpen your child's general eye movement skills and eye-hand coordination skills.

Beyond the First Year: Your Digital Native Child's Annual Eye Exam

Children need annual comprehensive eye exams prior to the start of each school year. Just as you buy school supplies to help your child learn, make sure your child's vision is ready to meet the demands of tasks in school.

The AOA's 2015 American Eye-Q survey reveals that almost 9 out of 10 parents mistakenly believe that the vision screenings offered in schools and at doctors' offices are effective tools in detecting vision problems in infants and children. Doctors of optometry (ODs), are the independent primary health care professionals for the eye. You eye doctor has extensive and ongoing training to examine, diagnose, treat and manage disorders, diseases and injuries that affect the eye and visual system.


Annual comprehensive eye exams will either confirm healthy vision, or diagnose a problem and allow for early intervention. Even if a child shows no signs or symptoms of issues, vision problems may still be present. An optometrist will dilate your child's eyes to have a better view of the back of the eye, assisting in early diagnosis of common diseases and disorders. This is a safe practice that allows for early detection and intervention.

Failure to detect and treat diseases and disorders can impair your child's ability to reach important developmental milestones. This is a serious health issue, and can also create lifelong learning and social problems for your child.

The Digital Native and Eye Health

Technology is now a constant presence in the lives of American children both at home and in the classroom.
The AOA's 2015 American Eye-Q survey found that almost seven in 10 American children currently own their own smartphone or tablet. The AOA and other organizations recommends that parents limit TV and computer use in young children. Yet 41 percent of the parents participating in the AOA's 2015 American Eye-Q survey report that their kids spend three or more hours using these digital devices each day.

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These digital devices span the worlds of entertainment, communication and education. Parents see the devices as opening up new worlds of information and creativity for their children. But parents also need to see the devices as machines that can impact their child's vision and eye health.

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Digital Eye Strain: What to Watch Out For

Since vision is developing in children, the visual stress caused by close viewing of computer screens can induce changes in the structure and function of the eyes. Our eyes are actually hardwired for distance seeing. This allowed our ancestors to sight game in the distance and see an enemy approaching from afar. These far distance survival skills in the natural world have been replaced by near distance tasks associated with digital devices.

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Parents and caregivers should look for signs of digital eye strain in children. Burning, itchy or tired eyes are some of the signs of digital eye strain. Children may also complain of blurred or double vision, headaches, fatigue, loss of focus and head or neck pain.

When it comes to protecting children's eyes and vision, the 20-20-20 rule can help avoid these symptoms. Teach your child to take a 20 second break every 20 minutes and view something 20 feet away.

"Sleep deprivation is also among the effects of screen use by children that prompted the American Academy of Pediatrics to recommend questions about media use as part of the well-child visit to the pediatrician," explains Mary Rothschild, director of Healthy Media Choices. Sending your child to bed means sending your child to sleep. It shouldn't mean sending your child to bed for more unsupervised computer time.

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Sunlight vs. Blue Light and the Effects on Your Child's Eyes

Electronic devices give off high-energy, short-wavelength, blue and violet light. Early research shows that overexposure to blue light may affect vision and eye health and contribute to eye strain and discomfort.

Increasingly, digital native children are interacting with technology for entertainment, instead of exploring and playing outdoors as their parents did. Optometrists are carefully monitoring the link between a lack of exposure to natural light and an increase in the number of cases of myopia, or nearsightedness, in children. Optometrists have long associated nearsightedness with close work such as engagement with digital devices.

"New studies suggest that a lack of exposure to sunlight could also affect the growth and development of a child's eyes and vision. Natural light may play a role in reducing the likelihood of nearsightedness." Dr. Barbara L. Horn, O.D., a trustee for the AOA, explains: "A child's eyes are still changing. Therefore, during this time, the distance between the lens of the eye and the retina are still changing. When the distance between the two lengthens we see an increase in the instances of nearsightedness."

Your Child's Future Eye Health

Kids entering kindergarten this fall will graduate high school as the class of 2028. By that date, they will have been exposed to thousands of hours of classroom and home computer time. Schools will continue to rely increasingly on computer simulations for instruction. Some educators predict that virtual worlds will actually be incorporated into school curricula.

Advances in technology may enhance learning, but many digital devices are relatively new. The longer-term effects of these devices on young eyes are still being determined. We expect our children to fully embrace digital technology at a young age. This means that we must also be informed of the associated health effects of digital devices on their vision and development and visit an optometrist on an annual basis to detect and address problems.

Parents looking for the latest research on children and digital devices can find information on sites devoted to this issue including Healthy Media Choices. The Center on Media and Child Health at Boston Children's Hospital features a blog hosted by Michael Rich, MD, called Ask the Mediatrician, an online forum where parents can submit questions about their child's health and media use. To find an optometrist in your area, visit the American Optometric Association.

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