Vision disturbances can be irritating impediments for children and adults who are perfectly capable of voicing their symptoms and discomfort. But for toddlers, who have a harder time explaining particular physical difficulties, even simple vision problems can go untreated – and escalate. Certain eye conditions and diseases do affect small children and are best treated at an early age so that the problems associated with them do not progress.

According to the American Academy of Opthalmology (AAO), although newborns are born with the ability to see, their vision improves during the first few months of life and continues to develop during the early childhood years. If, however, "a child does not use his or her eyes normally, vision does not develop properly and may even decrease. After the first nine years of life, the visual system is usually fully developed and usually can not be changed," according to the AAO's Eyenet.com, the organization's official Web site. For these reasons, it's a good idea for parents – especially those with a history of specific eye conditions and diseases – and those who wear glasses, to be aware of any indication that a toddler is having trouble seeing.

As a general rule, your child's first vision screening will be performed by his pediatrician at a well baby visit by 3 months of age. Pediatrician Dr. Herbert Krantman explains that this initial screening involves the "red reflex" test, where a light is shined into the baby's eyes so that the doctor may see if there are any cataracts or any other type of visual obstructions. The "corneal light reflex" test is also performed. The physician shines a light onto the baby's cornea to see if the light is reflected back from the same part of the cornea. This checks for any possible misalignment. The doctor also will examine the baby externally to see if there are any structural defects that would indicate a problem.

Between 6 and 12 months, the red reflex and corneal light reflex tests are performed again, and the physician will carry out an occlusion of each eye separately. In this test, the physician will place a patch or a hand over each eye in turn and see how the baby reacts. If the baby has a weak eye, he or she will presumably show some sign of discomfort or annoyance when the stronger eye is covered, limiting vision. At this age a "fixation and following" test is also performed: the physician places a toy or image several inches from the baby's face and moves it in different directions in an effort to notice whether the baby is able to fixate on and follow the image.

The next series of vision screenings is performed at approximately 3 years of age. Again the red reflex and corneal light reflexes are tested, and a "visual acuity" test will also be carried out, where the child uses each eye separately to identify pictures and "E"s facing in different directions – difficult even for toddlers with no vision problems. Dr. Krantman stresses that it is very important that the child be made aware that no matter how he or she performs on these tests, it is OK – there should be no pressure involved. The parents and physician should make equally sure that the child does not peek while taking this exam.

These examinations, recommended and endorsed by the AAO and AAP, are carried out at well baby checkups, assuming that the child has normal vision from one series of tests to the next. If at any point any irregularities are noticed, the physician will most likely advise the parents to make an appointment with an opthalmologist.

There are certain warning signs that a parent or caregiver can look for. Dr. Michael Redmond, a pediatric opthalmologist, speaking on behalf of the American Academy of Opthalmology, notes that "most parents are quite observant as to whether or not their children seem to be seeing as they expect," but parents should ask themselves:

• Does your toddler have straight eyes and straight head position when looking at things?
• Is there uncontrolled eye jiggling?
• Does your toddler exhibit unusual light sensitivity?
• Are your toddler's pupils clear and not white?
• Do the eyes tear frequently?

If your toddler does have an eye condition and glasses are suggested to you by your opthalmologist, there are a number of things to consider that will probably ease the process for both you and your toddler. Dr. Redmond suggests glasses with cable temples – a flexible metal piece, which wraps around the back of the ear. This will help your toddler to keep them on. He also emphasizes that parents "be consistent with the requirement that the children wear their glasses," and to be generous with positive support. Wearing glasses will take some getting used to, and supportive and encouraging behavior on the part of the parents and older siblings is really important.

If the need for glasses is great enough, your toddler may make no argument about wearing them at all. Kate* noted that her toddler's glasses were the first thing he reached for in the morning and the last thing he put down before sleep, so greatly was his vision improved by them. This toddler, who also had eye-hand coordination difficulties as a result of his vision problem, was also encouraged by his parents to participate in activities that would help him build up the coordination, while not threatening his self-esteem (martial arts and computer-related activities). Rachel*, the mother of a particularly active little girl, could barely get her daughter to remove the glasses because she was finally able to participate, with skills that she was until then unaware of, in a range of energetic activities.

Although eye diseases and conditions, depending on their severity, may be somewhat difficult to deal with, you are doing your children a great service through your awareness of symptoms and early detection of possible problems. If you need help, consult the AAO's list of support groups at Eyenet.com. Your attentiveness may help to ensure your child's good health and greater quality of life.

* names have been changed