Is strabismus normal in a 9-month-old infant?

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Last updated: April 11, 2025View editorial policy

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From the Guidelines

Strabismus, or misalignment of the eyes, is not typically normal in a 9-month-old baby. According to the most recent study by Hutchinson et al. 1, by 6 months of age, children should have normal binocular alignment. This suggests that any noticeable misalignment at 9 months could be a sign of an underlying issue.

Key Points to Consider

  • Newborns may have occasional eye misalignment in their first few months due to immature eye muscle coordination, but this should resolve by 4-6 months of age.
  • Untreated strabismus can lead to amblyopia (lazy eye) or vision development problems, emphasizing the importance of early intervention.
  • Treatment options depend on the specific type and cause of strabismus but may include prescription glasses, eye patches, eye exercises, or in some cases, surgery, as noted in studies such as 1 and 1.
  • The brain develops visual pathways rapidly during the first few years of life, making early detection and treatment of strabismus crucial for normal visual development and proper depth perception.

Recommendations for Parents and Caregivers

  • If you notice your 9-month-old has eyes that cross, drift outward, or appear misaligned, consult with a pediatrician or pediatric ophthalmologist promptly.
  • Regular vision screenings are essential for detecting potential issues early, and parents should follow the recommended screening schedule as advised by their healthcare provider.
  • Be aware of the signs of strabismus and amblyopia, and do not hesitate to seek medical advice if you have any concerns about your child's vision or eye alignment.

From the Research

Strabismus in 9-Month-Old Infants

  • Strabismus, also known as misalignment of the eyes, can occur in infants and children 2.
  • It is a risk factor for impaired visual development, including visual acuity and stereopsis 3.
  • There is no specific information available on the normalcy of strabismus in 9-month-old infants, but it is known that strabismus can occur in infants and children 2, 3, 4.

Prevalence of Strabismus in Children

  • The prevalence of strabismus in children varies, with one study finding that 2.3% of 7-year-old children had manifest strabismus 5.
  • Another study found that strabismus occurs in up to 4.8% of children aged 1 to 6 years 3.
  • The prevalence of strabismus may be higher in children from lower socioeconomic backgrounds 5.

Detection and Diagnosis of Strabismus

  • Strabismus can be detected using various tests, including the cover-uncover test, the alternating cover test, and the simultaneous prism cover test 3, 4, 6.
  • The cover-uncover test is a reference test used to detect strabismus in children 3.
  • Automated photoscreeners can also be used to detect strabismus, but their sensitivity and specificity may vary 3.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Tests for detecting strabismus in children aged 1 to 6 years in the community.

The Cochrane database of systematic reviews, 2017

Research

Evaluating squints in children.

Australian family physician, 2013

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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