Friday, 24 August 2018

A squint, also called strabismus, is where the eyes point in different directions

It's particularly common in young children, but can occur at any age.

One of the eyes may turn in, out, up or down while the other eye looks ahead.

Picture of a child with a squint
This may happen all the time or it may come and go.

Treatment is usually recommended to correct a squint, as it's unlikely to get better on its own and it could cause further problems if not treated early on.

When to get medical advice
Get advice if:

your child has a squint all the time
your child is older than three months and has a squint that comes and goes – in babies younger than this, squints that come and go are common and aren't usually a cause for concern
you have any concerns about your child's vision – signs of a problem can include regularly turning their head to one side or keeping one eye closed when looking at things
you develop a squint or double vision later in life
Your GP, health visitor or local opticians service can refer you to an eye specialist for some simple tests and treatment if necessary.

Treatments and surgery for a squint
The main treatments for a squint are:

Glasses – these can help if a squint is caused by a problem with your child's eyesight, such as long-sightedness.
Eye exercises – special exercises for the muscles that control eye movement may sometimes help the eyes work together better.
Surgery – this involves moving the muscles that control eye movement so the eyes line up correctly. It may be recommended if glasses aren't fully effective on their own. Read more about squint surgery.
Injections into the eye muscles – these weaken the eye muscles, which can help the eyes line up better. But the effect usually lasts less than three months.
If your child has a lazy eye as a result of their squint (read about possible further problems below), it may need to be treated first.

Treatment for a lazy eye usually involves wearing a patch over the unaffected eye to help improve vision in the affected eye.

Problems that can occur if a squint isn't treated
It's important not to ignore a squint that happens all the time or occurs after three months of age.

It could lead to further problems if left untreated, such as:

persistent blurred or double vision
a lazy eye – where the brain starts to ignore signals coming from the affected eye, so your child doesn't develop normal eyesight
embarrassment or low self-esteem
Surgery can help improve the alignment of the eyes even if a squint has been left untreated for a long time, but any vision problems may be permanent if they're not treated at a young age.

Causes of squints
The exact cause of a squint isn't always known.

Some people are born with a squint and others develop one later in life. Sometimes they run in families.

In children, a squint is often caused by the eye attempting to overcome a vision problem, such as:

short-sightedness – difficulty seeing things that are far away
long-sightedness – difficulty seeing nearby objectsStammering – also sometimes referred to as stuttering – is a relatively common speech problem in childhood, which can persist into adulthood.

What is stammering?
Stammering is when:

you repeat sounds or syllables – for example, such as saying "mu-mu-mu-mummy"
you make sounds longer – for example, "mmmmmmummy"
a word gets stuck or doesn't come out at all
Stammering varies in severity from person to person, and from situation to situation. Someone might have periods of stammering followed by times when they speak relatively fluently.

Read more about how stammering can affect you.

Types of stammering
There are two main types of stammering. They're known as:

developmental stammering – the most common type of stammering; it occurs in early childhood when speech and language skills are developing rapidly
acquired or late-onset stammering – is relatively rare and occurs in older children and adults as a result of a head injury, stroke or a progressive neurological condition; it can also be caused by certain drugs or medication, or psychological or emotional trauma
This topic focuses on developmental stammering.

What causes stammering?
It isn't possible to say for sure why a particular child starts stammering, but it isn't caused by anything the parents have done.

Developmental and inherited factors may play a part, along with small differences in how efficiently the speech areas of the brain are working.

Speech development
Speech development is a complex process that involves communication between different areas of the brain, and between the brain and the muscles responsible for breathing and speaking.

When every part of this system works well, the right words are spoken in the right order, with correct rhythm, pauses and emphasis.

A child learning to construct simple sentences needs practise to develop the different speech areas in the brain and lay down the neural pathways ("wiring") needed for the different parts to work well together.

Talking problems can occur if some parts of this developing system aren't quite co-ordinated. This can cause repetitions and stoppages, particularly when the child has lots to say, is excited, or feeling under pressure.

As the brain continues to develop, some of these problems resolve or the brain is able to compensate, which is why many children "grow out" of stammering.

Sex differences and genes
Stammering is more common in boys than girls. Differences in brain development between the sexes might make boys more vulnerable to speech and language difficulties.

Genes are also thought to play a role. Around two in every three people who stammer have a family history of stammering, which suggests the genes a child inherits from their parents might make them more likely to develop a stammer.

When to get help
You should get advice if you have any concerns about your child's speech or language development.

Treatment for stammering is often successful in pre-school age children, so it's important to get referred to a specialist as soon as possible.

Contact your GP or health visitor to discuss your concerns with them. If necessary, they may refer your child to a speech and language therapist (SLT) for an assessment.

In many areas, you can phone the children's speech and language services directly and refer your child yourself.

The British Stammering Association (BSA) website has information and advice for parents, and a helpline you can call on 0845 603 2001 to find out about the services available in your area.

If you're an adult who stammers and it's having a significant impact on your social and work life, you may want to ask your GP to refer you to an SLT.

Treatments for stammering
There are different speech and language therapy approaches that can help people who stammer speak more easily.

You'll work together with a therapist to come up with a suitable plan tailored to you or your child.

This may involve:

creating an environment where your child feels more relaxed and confident about talking
strategies to increase fluency and develop communication skills
working on feelings associated with stammering, such as fear and anxiety
Electronic devices to reduce stammering are also available and can help some older children and adults, but they're not usually available on the NHS.

Read more about treating stammering.

Who's affected
Studies suggest around 1 in 20 young children go through a phase of stammering.

Around four in five children who stammer will grow out of it, although it's difficult to predict when this will happen in a particular child.

It's estimated stammering affects around 1 in 100 adults, with men being around four times more likely to stammer than women.
astigmatism – where the front of the eye is unevenly curved, causing blurred vision
Rarer causes of a squint include:

certain infections, such as measles
some genetic conditions or syndromes, such as Down's syndrome
developmental delays
cerebral palsy
other problems with the brain or nerves
A squint can also sometimes be a symptom of a rare type of childhood eye cancer called retinoblastoma. Take your child to see your GP if they have a squint to rule out this condition.

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