A question that invariably comes up during the first couple of newborn visits is, “How well does my baby see?” This is understandable, as most newborns spend a good portion of the day sleeping and do not seem to regard objects or actually “see”. The truth of the matter is that newborns do have vision at birth, albeit it is not very good. It is on the order of 20/200, and they are nearsighted which means that they see things better if they are close. It is reported that the optimal focusing for a newborn is about 8 – 12 inches. It seems more than coincidence that when baby is on mom’s breast, the distance between mom’s face and the baby’s is about that exact distance.
At birth newborns can probably only see in black and white, or possibly gray. But by one week of age they can see red, orange, yellow and green. It is felt that by two weeks old the pupil enlarges which increases their ability to experience broader ranges of different shades of light. Newborns respond best to patterns that have stark contrast such as black and white. Thus they are more likely to regard striped objects or bull’s eye targets. They are less likely to regard pictures with a mixture or blend of colors. As a general rule, by one month of age newborns should be able to regard faces at three feet away. The baby should not only be able to lock on an object, but should be able to track and follow an object from right to left at two months of age.
Another question that makes for lively discussion around the dinner table is, “What color will his/ her eyes be?” This is a bet that I wouldn’t take. What determines the color of one’s eyes is the amount of melanin that they have. Melanin is a pigment that is made from cells called melanocytes. These cells are found in the skin as well as in the iris which is the muscular part of the eye that provides its color. The pupil is in the middle of the iris; the size of it is determined by the constriction or dilation of the iris. Most newborns have blue or gray eye color. This is because, while in-utero, they are not exposed to light. Babies of dark-skinned people may actually have darker eyes at birth. Over the next six-to-nine months, as the baby is exposed to more direct light, the melanocytes are stimulated to produce more melanin which is a brown pigment. The more melanin that is produced, the darker the eyes will become. The amount of melanin that may be produced is genetically determined. Therefore, infants that have little melanin will most likely keep their baby blues. Those with slightly more melanin may have greenish eyes, followed by hazel and then brown eyes. This eye color change may not be evident until after six months and could continue all through the first year of life. Genetics is what drives the ultimate color of one’s eyes. Even if both parents have blue eyes, it is not a given that the baby will also have blue; parents with brown eyes may actually have a baby with blue. Before trying to “guestimate” what the eye color will be, it is helpful to know what color the grandparents’ eyes are, and even then, all bets are off.
A concern of many parents is the fact that when their two-to-three month old is focusing on an object the eyes cross. This is very disconcerting to all—quite frankly, it caused me some pause with my own sons. This is NOT uncommon or abnormal within the first four months of age as long as it is intermittent and self-resolving. Remember, the vision center is actually in the brain. When a young infant sees an image, the image is transmitted from the eye to the brain via the optic nerve. This nerve has a tract that goes to the same side of the brain, but it also has a pathway that crosses to the other side of the brain. It takes a while for the infant’s brain to learn to coordinate and integrate the image into one distinct image. Therefore, it is not uncommon to have a three month old look at an object and have the eyes cross briefly. By four months of age this should no longer be the case. If it persists this would warrant an evaluation by a pediatric ophthalmologist.
Most parents are not aware of another concern of the RED REFLEX. Pediatricians will examine the baby’s eyes during the very first visit and look for this with the opthalmoscope. When one takes a flash picture with a camera and gets the pictures developed, the person looking directly at the camera will have obvious orange eyes where the pupils are located. This is because the light is reflected off the retina. When a pediatrician looks at a newborn’s eyes with the opthalmoscope he should be able to see this red reflex. This is an important normal finding and should be part of EVERY newborn exam. While it is rare, babies can develop a retinoblastoma (as malignant eye tumor) while developing in-utero, and can be born with this tumor. If so, the red reflex will not be seen or will appear pale and not normal. Babies can also be born with cataracts. This, too, can distort the normal red reflex. The red reflex is easy to check, and again, this should be part of EVERY well-check exam in all children.