A cross-eyed baby whose eyes wander now and then during the first few weeks is, in most cases, nothing to worry about. The NHS, the UK’s health service, explains that a squint that comes and goes is common before 3 months. An eye that turns all the time, however, or a squint that persists after 3 months, should be checked by a doctor.
A squint (strabismus) is when the eyes are not aligned: they don’t look in the same direction. It is common in young children. The earlier it is spotted, the better it can be treated, because vision develops during the first years of life.
Why does a newborn sometimes look cross-eyed?
At birth, the visual system is still immature. The muscles that move the eyes and the brain that combines the two images learn to work together over the weeks. During this period, one eye may briefly drift towards the nose or outwards, then return to its place.
These passing wobbles are part of normal development. They often appear when the baby is tired, when they focus on something very close or as they fall asleep. Our article on your baby’s vision development from 0 to 12 months describes the stages of this process.
Cross-eyed baby: at what age should you see a doctor?
The NHS guidance is simple. Get medical advice if your child:
- has a squint all the time, whatever their age;
- is over 3 months old and has a squint that comes and goes;
- seems to have trouble seeing, for example by often turning their head to one side or closing one eye to look at things.
Before 3 months, a squint that comes and goes is common and is usually not a cause for concern. The NHS is clear, though: a constant squint, or one that appears after 3 months, should not be ignored. If in doubt, it is always best to mention it at a routine check-up.
In France, the family doctor, the paediatrician or the PMI (Protection maternelle et infantile, the French mother and child health service) can carry out a first examination and refer you to an ophthalmologist. Our article on the first PMI appointment explains how these visits work.
Pseudostrabismus: when the eyes look crossed but aren’t
Many babies appear to be cross-eyed when their eyes are in fact perfectly aligned. Ophthalmologists call this pseudostrabismus, or false squint. The American Association for Pediatric Ophthalmology and Strabismus (AAPOS) describes it as very common in babies.
The cause is anatomical. A baby’s nasal bridge is still wide and flat. Small folds of skin, called epicanthic folds, cover the inner corner of the eyes. Less white shows on the side nearest the nose, so the eye seems to turn inwards. The effect is more noticeable in photos, when the child looks to the side.
How the doctor tells the difference
The doctor shines a small light into both eyes. If the reflection falls in the centre of both pupils, the eyes are aligned. They may also do the cover test: covering one eye, then the other, and watching whether the uncovered eye moves to re-centre itself.
Pseudostrabismus needs no treatment and often fades as the face grows. However, AAPOS points out that a baby with pseudostrabismus can develop a true squint later on. Regular check-ups are therefore still worthwhile.
Why a squint needs early treatment
When the two eyes do not look in the same direction, the brain receives two different images. To avoid double vision, it may end up ignoring the image from the turned eye. That eye then develops less well: this is amblyopia, often called “lazy eye”.
The NHS stresses that vision problems can become permanent if they are not treated at a young age. So the issue is not about appearance. The aim is to allow each eye to develop normal vision while the visual system can still adapt.
Possible causes of a true squint
In children, a squint often occurs because the eye is trying to compensate for a vision problem: short-sightedness, long-sightedness or astigmatism. AAPOS notes that it frequently appears in children who are otherwise perfectly healthy. It is more common in children with certain conditions, such as cerebral palsy or Down’s syndrome.
More rarely, a squint can be a sign of an eye disease, such as retinoblastoma. This is one of the reasons why the NHS recommends having any child with a squint examined.
What are the treatments for a squint in young children?
Treatment depends on the cause and the child’s age. The ophthalmologist starts by testing the child’s eyesight, often after widening the pupils with drops. The options described by the NHS and AAPOS are as follows:
- Glasses, when the squint is linked to a vision problem. Sometimes they are enough to realign the eyes.
- An eye patch, for amblyopia. The stronger eye is covered to make the brain use the other one.
- Eye exercises, for certain types, when prescribed.
- Surgery on the eye muscles, if glasses are not enough. It repositions the muscles to align the eyes.
AAPOS explains that related problems, such as amblyopia, are usually treated before any surgery. The NHS adds that a lazy eye may need to be treated first.
Helping a toddler accept glasses or a patch
An 18-month-old wearing glasses? It’s perfectly possible. Soft children’s frames with an elastic strap stay on well. Offer them at calm, pleasant moments, during a story or a game. The eye patch goes down better when it becomes a short ritual at a set time, rather than something to negotiate every time.
What can parents look out for day to day?
Parents are often the first to notice a squint. A few observations are worth noting down for the appointment:
- which eye turns, and whether it turns towards the nose or outwards;
- whether the squint is constant or appears mainly in the evening, when your child is tired;
- whether your child tilts their head, closes one eye in the sun or often rubs one eye;
- whether the flash reflection looks different in each eye in photos.
A photo or short video taken when the eye turns is a great help to the doctor, as an intermittent squint doesn’t always show up during the examination.
Can visual games correct a squint?
No. No game replaces an eye examination or prescribed treatment. Everyday activities do, however, support normal vision development: following an object with the eyes, grasping a toy, looking at contrasts, gazing at faces up close.
Hand-eye coordination develops alongside vision. Our article on the age when babies start grasping objects shows how these two skills progress together. For the first few months, see also our play ideas for 0 to 6 months.
Key points to remember
- A baby who looks cross-eyed now and then before 3 months is common and usually nothing serious.
- A constant squint, or one that persists after 3 months, should be checked by a doctor.
- Pseudostrabismus, caused by the shape of the nose and folds of skin, is very common and needs no treatment.
- An untreated true squint can lead to amblyopia, which is why acting early matters.
- Glasses, eye patch, exercises or surgery: the treatment depends on the cause.
- A photo or video of the squint helps the doctor during the appointment.
Sources
- NHS, “Squint”, page reviewed on 02/05/2023.
- American Association for Pediatric Ophthalmology and Strabismus (AAPOS), “Strabismus”, updated on 07/10/2020.
- American Association for Pediatric Ophthalmology and Strabismus (AAPOS), “Pseudostrabismus”, updated in October 2023.
