How the world comes into focus during the first year.

baby wearing big glasses
Credit: Angela Waye/

A Whole New World

One of the many joys of being a pediatrician is smiling into a baby's eyes, making "baby talk," and watching his face light up as he smiles back and squeals with delight. We're getting to know one another, and this helps me gain some important information about the baby's vision and hearing.

Normal vision and hearing are essential for a baby's development. He needs to see well to explore new objects or take those first baby steps. And for normal speech to develop, he must first hear the sounds and words we use to communicate. Indeed, there is strong evidence that early intervention for babies with hearing or vision problems can make all the difference in their development. But identifying problems often requires acute observation from both doctors and parents. And understanding how babies see and hear will help you know when something "just isn't right."

What Can My Newborn See?

Newborns can't see clearly at birth. In fact, vision is about 20/400, making the first days of sight very blurry, like a camera out of focus. But within a week, a baby can focus on objects about 8 to 12 inches from his face. Conveniently, this is about the distance between a mother and baby's face during feeding, making it a great time for getting to know each other. As for the age-old question of how colorful a newborn's world is, we now know that babies can see color right from the start if the color is very bright.

Is My Baby's Vision Normal?

A great test of vision is just having some up-close and personal time with your baby, who by 4 to 6 weeks of age should be gazing intently into your eyes and mimicking your facial expressions. Open your mouth and stick your tongue out, and watch your baby do the same. By 3 months her vision is closer to 20/40. This means she can see almost everything in her field of vision. As a result, you'll notice your infant watch the world more and more intently with each passing day. Your baby can now see colors in different hues and has improved depth perception, which will be evident as she gazes at the colorful mobile circling over the crib. Just don't expect your child to appreciate a pastel-colored toy before about 4 to 6 months. By 4 months, you'll also notice her staring at her hand, and after 6 months she may be able to see well across any room with 20/20 vision.

What Can I Do to Stimulate My Baby's Vision?

It will develop naturally, but you can make sure he has something interesting to see. Infants love looking at faces and respond best to contrasting patterns and bright colors, so place these types of toys and pictures in your baby's line of sight. As your baby grows, keep changing his scenery by taking walks and visiting new places. A trip to an art museum can be a feast for his eyes as well as yours.

What Does the Doctor Look For?

With sophisticated research tools, 20/20 vision has been documented in toddlers, once the shape and size of their eyeballs have fully matured. However, measuring sight with an eye chart depends on communication skills and cooperation, so your pediatrician won't be able to test for visual acuity until your child is at least 3 years old.

In the meantime, your pediatrician will closely examine your baby's eyes for problems, starting from birth. She'll check both the physical shape and size of the eyes and eyelids. And although newborns don't want to open their eyes to bright light, she'll use the light from an ophthalmoscope to check for the "red reflex," a reassuring red color that is reflected off the back of a baby's eyes, giving them a red glow. If this is absent, it could indicate the presence of a cataract, glaucoma, or a congenital eye defect. She'll also look for common problems, such as blocked tear ducts. If your child was premature or if there is a family history of congenital eye problems, the pediatrician will recommend that your baby be examined by a pediatric ophthalmologist in the nursery or soon after discharge.

In addition, at each well-child visit you'll see your baby's doctor dangling an object over her face to see how well she "tracks" it 180 degrees. And to make sure her eye muscles aren't weak, the doctor will shine a light at her eyes, checking that the reflection is at corresponding locations on each pupil.

What Should I Look For?

Before 6 months, it's common for a baby's eyes to appear "crossed," but after 6 months his eyes should begin to work together to focus on an object. If you notice one of baby's eyes drifting off to the side, especially when he is tired, call your pediatrician and let her know. Other signs of vision problems are tilting his head to see an object or bringing it very close to his eyes, sensitivity to light, chronic redness, and tearing. Older kids may complain of headaches.

Sweet Sound

What Can My Baby Hear?



When and How Is My Child's Hearing Checked?




How Can I Use Sound to Get Her to Talk?



Parents' To-Dos

Time for an Eye Exam

By age 3, both the American Academy of Pediatrics and the American Academy of Pediatric Ophthalmologists recommend formal vision screening using charts to help identify vision impairment. This will take place in your pediatrician's office, but if there are any special concerns or a strong family history of eye or visual problems, it's a good idea to visit an ophthalmologist.

During the preschool years, in addition to checking the visual acuity of each eye using eye charts for young children, your doctor will be looking for weakness of one of the eye muscles. It is very important to identify and treat this condition early with patching of the good eye to force the weaker eye to work harder. If treatment occurs before age 5 or 6, it can prevent a form of blindness in the weak eye called amblyopia (also known as lazy eye).

Safeguarding Baby's Sight

The best thing you can do to protect your baby's vision is to protect her eyes. Be careful when baby proofing: pad sharp edges on furniture, and keep sharp objects or toys away from your child. Also have your baby wear sunglasses with UV protection when she's in the sun. When your child gets older and plays sports, make sure she wears protective eye gear.

Hearing Loss

Profound hearing loss is found in 1 to 6 children out of every 1,000 births, and the number of infants with less severe hearing loss is probably higher. Fortunately, most states have mandated universal hearing screening for all newborns. Check with your hospital to make sure that this screening is being done. If it isn't performed routinely in your state, ask your pediatrician what your options are. This is important because we now have clear evidence that early treatment with hearing aids (they can be used as early as when a baby is a few weeks old) and cochlear implants (which can be surgically implanted at 1 year) will improve the outcome of hearing and speech for many babies with hearing impairment and even profound deafness.

If your baby fails the otoacoustic emissions (OAE) screening, which uses a probe to measure acoustic signals generated in the inner ear, he doesn't necessarily have a hearing problem. In this instance, your pediatrician will refer you to an audiologist, who will use an auditory brainstem response (ABR) test to assess how sound is transferred from the inner ear to the brain. When OAE is followed by ABR, there are fewer false-positive results.

Mary Ann LoFrumento, MD, is an attending physician at Goryeb Children's Hospital, in Morristown, New Jersey, and the founder of


American Baby