A 5-day-old male came to clinic for his health supervision visit. He was breastfeeding and eliminating well. His parents noted that he was more alert than they remembered his older sister at the same age.. The past medical history showed a full-term infant with no prenatal or natal complications. He received all his normal newborn care including passing his hearing screening. His neonatal screen was negative also. The family history and review of systems were negative including no history of visual problems other than older family members needing reading glasses.
The pertinent physical exam showed an alert male infant who was 3.468 kg (down 5% from birth weight) with normal vital signs and growth parameters. He was mildly jaundiced in the face and sclera only and the rest of his examination was normal. The diagnosis of a healthy male infant was made. During the interview his parents said they had a mobile that had black and white cards for a newborn and colored cards for an older infant and they wanted to know when to switch the cards. The pediatrician said that infants were born with relatively clear vision of only a few inches (distance between holding the newborn in a cradled elbow to parent face) and that they developed the ability to see red colors within a couple of weeks. He did not know when the other colors became clear, but said he would try to look it up and tell them at the next visit. The pediatrician also discussed safety issues including using a mobile in the infant’s crib and when to take it out of the crib.
Infants are hyperopic (farsighted) at birth because of the relatively short axial length of the globe and ocular optics. Astigmatism occurs in 15-30%. These refractive errors are gone for most infants by 9-12 months. Newborns can fixate at birth but accurate visual fixation occurs by 6-9 weeks. Accommodation (fixating on near objects) is also evident at birth but is not accurate until about 2-3 months. Visual acuity (defining fine details) is normal by 6-8 months. Stereopsis (3-D vision) has a rapid onset at 3 months and is normal around 6 months.
Contrast sensitivity (the ability to detect brightness differences or shades of grey) occurs by 10 weeks.
Color vision begins as early as 2 weeks (red) and by 3 months is normal.
Questions for Further Discussion
1. List signs that may indicate a serious vision problem.
2. How common are color vision problems?
3. How could color blindness affect a child’s education?
4. What items are considered safe to be in a newborn’s crib and when should they be removed?
- Disease: Color Vision | Eye Diseases.
- Symptom/Presentation: Health Maintenance and Disease Prevention
- Specialty: Ophthalmology
- Age: Newborn
To Learn More
To view pediatric review articles on this topic from the past year check PubMed.
Evidence-based medicine information on this topic can be found at SearchingPediatrics.com and the Cochrane Database of Systematic Reviews.
Information prescriptions for patients can be found at MedlinePlus for this topic: Eye Diseases
To view current news articles on this topic check Google News.
To view images related to this topic check Google Images.
Hamer RD, Mirabella G. What Can My Baby See? Smith-Kettlewell Eye Research Institute.
Available from the Internet at http://www.ski.org/Vision/babyvision.html (1990, cited 11/30/09).
Rudolph CD, et.al. Rudolph’s Pediatrics. 21st edit. McGraw-Hill, New York, NY. 2003:491.
Monitoring Visual Development. Texas School for the Blind and Visually Impaired.
Available from the Internet at http://www.tsbvi.edu/Education/infant/page7.htm (rev. 9/4/2007, cited 11/30/09).
ACGME Competencies Highlighted by Case
1. When interacting with patients and their families, the health care professional communicates effectively and demonstrates caring and respectful behaviors.
2. Essential and accurate information about the patients’ is gathered.
3. Informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment is made.
4. Patient management plans are developed and carried out.
5. Patients and their families are counseled and educated.
8. Health care services aimed at preventing health problems or maintaining health are provided.
10. An investigatory and analytic thinking approach to the clinical situation is demonstrated.
11. Basic and clinically supportive sciences appropriate to their discipline are known and applied.
12. Evidence from scientific studies related to the patients’ health problems is located, appraised and assimilated.
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital