Health: Vision testing for kids

Health: Vision testing for kids

By Janet Correia

When your child enters a room, does he bang into the chair or trip on the toys on the floor? Does he spill his milk because he misjudged while reaching for it? Can he read a line starting at the left and track all the way to the right? Does your child struggle with math aligning the numbers up and down or diagonally to perform a multiplication problem? If so, maybe a vision evaluation should be scheduled to check your child’s eye muscles. 

Every school year, the school nurse typically tests each student for “acuity.” Acuity testing will determine if a child can see, in midline, letters or numbers at a distance and close up. Vision charts are used to determine if the child can see letters or objects from a distance (20 feet) or close up (13 to 15 inches).  

Both tests are typically performed while the child sits or stands. Charts are placed on a wall in midline. One eye is covered, and the child is directed to read the smallest line possible. A normal result for the distance test is recorded as 20/20, meaning he can see the letters or objects 20 feet away. If his results come in at 20/40, it means he can see the letters or objects at 20 feet compared to someone who sees with normal vision at 40 feet. Having good acuity is one aspect of vision skills. There are many more vision skills needed in order for a child to be proficient in reading, writing and math. 

If your child is looking for a book on the shelf and it is in the far right corner, his binocular skill allows him to look to the right to find the book. If he can’t locate the book it may because his eyes are weak and cannot move over to the right. Our eyes have the ability to move in a horizontal field of 180 degrees (looking side to side) and a vertical field (looking up and down) of 120 degrees. If your child’s eyes move right to left and up and down and he still cannot see, he may have a field loss.

Picking a book for your child to read will depend on his age and skill level. Books for young readers typically have one picture per page; the next level is one word with a picture. As skills develop, book designs change, adding more words in a line, smaller print size and more lines on a page. For your child to read several words on a line or many lines on a page, he needs the skill of visual pursuit. This is the ability to smoothly move his eyes to the left and to the right, moving in a straight line without jumping up or down to the lines above or below. The skill also allows him to focus on each word as he moves across the line, preventing him from going too far ahead or not far enough as he reads. 

Near-far focus shifts help your child read for an extended period. It also allows him to quickly shift focus when he looks from near to far while performing classroom work, (looking at the teacher, looking to his notes or books on the desk, and looking up at the board). 

Can your child recognize words that are similar, like “was” and “saw”? Both words have the same letters but in different places, making them different words. This skill is known as visual discrimination. 

Does your child have trouble finding his red car in the toy box or locating his green socks mixed in with other clothes? If so he may have challenges with figure-ground skills — the ability to recognize figures embedded within other items. 

If you feel your child has visual concerns, evaluation testing can be completed by a pediatric occupational therapist. If further concerns are noted, a pediatric optometrist can perform additional testing.

Janet Correia is the co-founder of OT in Motion, a pediatric occupational therapy clinic located in Sunapee, N.H. Learn more at

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