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If my toddler needs glasses, how do I get him to wear them? Add to ...

The question: My son is 2. How do I know if he’ll need glasses? And how do I choose the right ones that he’ll like?

The answer: At this young age, it will be difficult to predict if your child will need glasses in the future. Your instincts to be proactive in identifying visual problems, however, are spot on.

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As many as 10 per cent of preschool children will have eye problems that, if left untreated, could cause problems later in life. The children at highest risk of needing glasses are those with a positive family history of nearsightedness (myopia) or farsightedness (hyperopia). Other high risk groups include children who were born prematurely, those with Down syndrome and infants with chronic neurological problems like cerebral palsy.

Expect your family physician or pediatrician to conduct basic visual screening tests at well-child visits. Young infants should be able to focus on and follow faces and brightly coloured objects, with eyes that appear to be well-aligned. Signs that an older child may have vision problems include repeatedly bumping into objects, difficulty with reading books and sitting close to the TV. Infants who present with any visual concern should be evaluated by an ophthalmologist or optometrist with experience in evaluating children.

A particularly common problem is the “lazy eye” that tends to drift in or out, or that doesn’t appear to be aligned. This condition is known as strabismus. While strabismus can occur normally in the first few months of life, a lazy eye that persists past six months of age should always be investigated.

If strabismus is left uncorrected, it can lead to permanent visual problems. Although many provinces have preschool screening programs in place to detect strabismus and other visual concerns, parents shouldn’t wait for screening if they suspect a problem. Early recognition of eye diseases improves the probability of a good outcome.

Young infants who need glasses can be challenging. In my clinic we often see families who are struggling to get their preschool child to wear their new glasses or keep their eye patched. Persistence does pay off, however, and the vast majority of children do get used to their new eyewear over time.

In my experience, punishing children for refusing to wear glasses is not helpful, although some do respond to simple reward systems. Depending on the age of your child, getting them involved in the eyewear selection process can be very helpful. Finding glasses that your child finds both comfortable and stylish will improve compliance with wearing them.

For otherwise healthy children, I recommend a professional eye exam before school entry. This is typically done between ages 3 and 5 by an ophthalmologist or optometrist. It is important to remember that children rarely complain when they have visual troubles, and as such should be evaluated even if there are no obvious concerns.

Dr. Michael Dickinson is the head of pediatrics and chief of staff at the Miramichi Regional Hospital in New Brunswick. He’s a staunch advocate for children’s health in Atlantic Canada through his involvement with the Canadian Paediatric Society.

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