Are children with developmental delays more likely to develop a squint? 

Children with developmental delays or neurological conditions are statistically more likely to develop a squint (strabismus) compared to children with typical development. This increased risk exists because the coordination of eye movements is a complex neurological process that involves multiple areas of the brain, including the visual cortex, the brainstem, and the cranial nerves. When there is a delay in overall neurological maturation, the delicate balance required to keep the eyes aligned and working as a pair is often disrupted. In the UK, healthcare providers and specialist orthoptists monitor children with developmental delays closely, as early identification of a squint is essential to prevent secondary complications like a lazy eye and to support the child’s broader learning and motor skill development. 

What We’ll Discuss in This Article 

• The neurological connection between brain development and eye coordination. 

• Why conditions like cerebral palsy and Down’s syndrome increase squint risk. 

• The impact of global developmental delay on the “binocular fusion” process. 

• How a squint can further complicate a child’s developmental milestones. 

• The role of the multidisciplinary team in managing vision for high-risk children. 

• Specialist NHS screening protocols for children with additional needs. 

The Neurological Basis of Eye Alignment 

To maintain perfectly straight eyes, the brain must perform an incredible feat of real-time data processing. It receives two slightly different images from the eyes and must merge them into one 3D picture while simultaneously sending perfectly timed electrical impulses to the twelve extraocular muscles. This process, known as binocular fusion, is highly dependent on the integrity of the brain’s “wiring.” In children with developmental delays, the pathways responsible for this coordination may be less robust or slower to mature. 

If the brain’s ability to fuse images is compromised, it may not exert the necessary effort to keep the eyes aligned. This results in one eye drifting, especially when the child is focusing on a difficult task or is physically tired. According to the NHS, squints are more common in children with certain conditions, such as cerebral palsy or Down’s syndrome, due to the way these conditions affect the muscles and the brain. For these children, the squint is often a symptom of the underlying neurological difference rather than a problem with the eyes themselves. 

Understanding that the squint has a neurological basis is important for management. Treatment for these children often requires a more tailored approach, as they may have different levels of focus or muscle control than typically developing children. Specialist orthoptists in the UK are trained to adapt their testing methods to ensure they get an accurate measurement of the squint, even if the child has communication or motor challenges. 

High-Risk Conditions and Strabismus 

Certain specific developmental conditions have a well-documented association with a higher incidence of squints. For example, it is estimated that a significant proportion of children with Down’s syndrome will develop a squint, often linked to high degrees of long-sightedness or a lack of focus (accommodation). Similarly, children with cerebral palsy frequently experience misalignments because the condition affects the motor control of all muscles, including those that move the eyes. 

Other groups at higher risk include: 

• Children born prematurely (especially those with low birth weight). 

• Children with global developmental delay or learning disabilities. 

• Children with hydrocephalus (excess fluid around the brain). 

• Children with certain genetic syndromes that affect facial or ocular structure. 

Clinical evidence indicates that children with neurodevelopmental disabilities have a much higher prevalence of strabismus and refractive errors, necessitating early and frequent vision screenings. Because these children may already be facing other challenges, ensuring they have the best possible vision is a priority. Clear, aligned vision helps them engage more effectively with their environment, which is crucial for their overall progress and therapy outcomes. 

How a Squint Impacts Further Development 

While a developmental delay can cause a squint, the presence of a squint can also further hinder a child’s progress. Vision is a primary driver for many other developmental milestones. For instance, a child with a squint often lacks depth perception (3D vision). This can make it much harder for them to develop fine motor skills, such as picking up small objects, or gross motor skills, like learning to walk steadily or navigate stairs safely. 

If a child is already struggling with coordination due to a developmental delay, the added difficulty of poor depth perception can be very frustrating. They may appear more “clumsy” or hesitant than they otherwise would be. By identifying and treating the squint early whether through glasses, patching, or surgery the clinical team can remove one of the barriers to the child’s development. Straightening the eyes and improving the vision can provide a significant boost to a child’s confidence and their ability to participate in school and play. 

NICE guidelines emphasize that for children with additional needs, a comprehensive eye assessment is a vital part of their holistic care plan to support their sensory and motor development. This integrated approach ensures that the child’s vision is not treated in isolation but as a key component of their overall well-being. Specialist teams work closely with parents, teachers, and therapists to ensure the child’s visual needs are met in all settings. 

Specialist Testing for Children with Additional Needs 

Testing the vision and eye alignment of a child with developmental delays requires specific expertise and patience. Standard letter charts may not be appropriate if a child has limited verbal communication or a shorter attention span. In these cases, UK specialists use “objective” testing methods that do not rely on the child’s feedback. This includes using special lights (retinoscopy) to check the prescription and observing the child’s natural eye movements and light reflexes. 

Orthoptists often use “preferential looking” tests, where the child’s gaze is monitored as they look at patterns of varying detail. They may also use colourful, high-contrast toys and lights to keep the child engaged. These adaptations ensure that even children with complex needs can have a thorough and accurate eye examination. Most hospital eye departments in the UK have dedicated paediatric clinics staffed by professionals who are experienced in working with children with a wide range of developmental profiles. 

If a child finds the hospital environment overwhelming, some areas provide community-based specialist screenings. The goal is always to make the process as stress-free as possible for the child and the family while still obtaining the necessary clinical data. If glasses are prescribed, the specialist will work with the family to find frames that are comfortable and durable, which is particularly important for children with sensory sensitivities. 

The Role of the Multidisciplinary Team 

The management of a squint in a child with developmental delays is usually a collaborative effort involving a multidisciplinary team. This team may include: 

• The Orthoptist: To monitor eye alignment and treat lazy eye. 

• The Optometrist: To provide the correct prescription for glasses. 

• The Paediatrician: To coordinate the child’s overall health and developmental care. 

• Occupational and Physiotherapists: To help the child adapt to their visual changes in their daily movements. 

• Specialist Teachers: To ensure the classroom environment supports the child’s visual needs. 

In the UK, this joined-up approach ensures that everyone involved in the child’s life understands their visual diagnosis. For example, if a child is undergoing patching therapy to treat a lazy eye, the school and the therapists need to know so they can support the child during the hours the patch is worn. This communication helps to maximize the success of the treatment and ensures the child feels supported across all aspects of their life. 

Regular reviews are a standard part of this care pathway. Because a child’s neurological and physical state can change as they grow, their visual needs must be reassessed frequently. The NHS provides this ongoing care to ensure that any improvements or new challenges are addressed promptly, giving the child the best possible foundation for their future. 

Long-Term Outlook and Support 

The long-term outlook for children with developmental delays and squints is generally positive, provided they receive consistent and early support. While the underlying neurological condition may remain, the squint can often be successfully managed to improve both the appearance of the eyes and the quality of the vision. Achieving the best possible visual acuity in both eyes is a significant achievement that pays dividends throughout the child’s life. 

For parents, navigating the complex needs of a child with developmental delays can be challenging. The hospital eye team is there to provide not only clinical care but also guidance and reassurance. They can offer practical tips for encouraging a child to wear their glasses or patch and can connect families with support groups for specific conditions. Being proactive about eye health is one of the most effective ways to support a child’s journey toward independence and successful learning. 

As the child reaches school age, the universal vision screenings provide an additional check, but for most children with developmental delays, their care will already be well-established within the hospital service. This continuity of care ensures that their visual development remains a priority as they grow and face new educational and social demands. 

Conclusion 

Children with developmental delays are more likely to develop a squint due to the neurological complexity of eye coordination. Conditions such as cerebral palsy and Down’s syndrome significantly increase this risk. A squint can further impact a child’s motor skills and coordination, making early specialist assessment and multidisciplinary care a priority within the NHS. With the right support, most children can achieve significant improvements in their vision and alignment. If you experience severe, sudden, or worsening symptoms, call 999 immediately. 

Authority Snapshot 

This article provides medically safe UK patient education regarding the link between developmental delays and childhood squints. 

The content is produced by the Medical Content Team and reviewed by Dr. Stefan Petrov, a UK-trained physician with experience in paediatrics and ophthalmology. 

All information is strictly aligned with the clinical pathways and diagnostic standards managed by the NHS and NICE.