My Baby's Eyes Sometimes Cross (Intermittent Strabismus)
Medically reviewed by Dr. Michael Okonkwo, MD, FAAP · Board-Certified Neonatologist
Content reviewed against published AAP, AAP, Mayo Clinic guidelines
Last reviewed:
If your baby has been diagnosed with or you suspect eyes sometimes cross (intermittent strabismus), here is what the evidence says.
The short answer
Occasional, brief eye crossing in babies under 3-4 months is very common and almost always normal as their eye muscles and coordination develop. By 4 months, the eyes should be consistently aligned. If crossing persists intermittently beyond 4 months, or if one eye consistently drifts outward (intermittent exotropia), a pediatric ophthalmology evaluation is recommended to prevent vision problems.
Key takeaways
- Occasional, brief eye crossing in babies under 3-4 months is very common and almost always normal as their eye muscles and coordination develop. By 4 months, the eyes should be consistently aligned. If crossing persists intermittently beyond 4 months, or if one eye consistently drifts outward (intermittent exotropia), a pediatric ophthalmology evaluation is recommended to prevent vision problems.
- Usually normal when: Brief, occasional crossing in a baby under 3-4 months that comes and goes randomly and does not persist
- Call your doctor if: One eye is constantly turned in any direction at any age (not just intermittently), as constant strabismus requires prompt evaluation to prevent permanent vision loss from amblyopia
- Varies by age — see the age-by-age breakdown below
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What Parents Should Know
According to AAP, Mayo Clinic guidelines, occasional, brief eye crossing in babies under 3-4 months is very common and almost always normal as their eye muscles and coordination develop. By 4 months, the eyes should be consistently aligned. If crossing persists intermittently beyond 4 months, or if one eye consistently drifts outward (intermittent exotropia), a pediatric ophthalmology evaluation is recommended to prevent vision problems. At 0-3 months, intermittent eye crossing in newborns is extremely common and usually a normal part of visual development. The muscles that coordinate eye movement are still maturing, and it takes time for the brain to learn to control both eyes together. Pseudostrabismus (the appearance of crossed eyes due to a wide nasal bridge and prominent epicanthal folds) is also very common and can make normally aligned eyes look crossed. During this period, it is important to distinguish between intermittent crossing (which is usually normal) and constant crossing in one direction (which should be evaluated at any age). It is generally considered normal when brief, occasional crossing in a baby under 3-4 months that comes and goes randomly and does not persist. However, you should contact your pediatrician promptly if one eye is constantly turned in any direction at any age (not just intermittently), as constant strabismus requires prompt evaluation to prevent permanent vision loss from amblyopia.
Normal vs. Concerning
By Age
What to expect by age
0-3 months
Intermittent eye crossing in newborns is extremely common and usually a normal part of visual development. The muscles that coordinate eye movement are still maturing, and it takes time for the brain to learn to control both eyes together. Pseudostrabismus (the appearance of crossed eyes due to a wide nasal bridge and prominent epicanthal folds) is also very common and can make normally aligned eyes look crossed. During this period, it is important to distinguish between intermittent crossing (which is usually normal) and constant crossing in one direction (which should be evaluated at any age).
3-6 months
By 4 months, eye alignment should be consistent. If intermittent crossing is still occurring, it warrants a closer look. Your pediatrician can perform a simple cover-uncover test and a corneal light reflex test to assess alignment. If there is any concern, a referral to a pediatric ophthalmologist is appropriate. Early evaluation is important because strabismus, if left untreated, can lead to amblyopia (lazy eye), where the brain begins to suppress input from the misaligned eye.
6-18 months
Intermittent exotropia (where one eye occasionally drifts outward) may become apparent at this age, often most noticeable when the child is tired, sick, daydreaming, or looking at distant objects. While mild intermittent exotropia may initially be observed, it often progresses and eventually requires treatment. A pediatric ophthalmologist can monitor the frequency and magnitude of the drift and recommend intervention (patching, glasses, or surgery) when appropriate.
18 months+
Any new onset of eye crossing in a toddler or older child should be evaluated. Accommodative esotropia (crossing caused by farsightedness) commonly presents between ages 2-3 and is treated with glasses. Intermittent strabismus that is becoming more frequent or more pronounced over time suggests the condition is worsening. Treatment options depend on the type and include glasses, vision therapy, patching, and sometimes surgery. The goal is to maintain equal vision in both eyes and, if possible, restore binocular (3D) vision.
What to Tell Your Pediatrician
- Describe when you first noticed eyes sometimes cross (intermittent strabismus) and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if intermittent crossing or drifting persists beyond 4 months of age, even if it is not constant.
- Mention if you notice one eye drifts outward, especially when your child is tired, looking at something far away, or staring off in the distance.
- Bring a list of any questions or observations you want to discuss at the appointment.
What Should You Do?
When to take action
- Brief, occasional crossing in a baby under 3-4 months that comes and goes randomly and does not persist
- Eyes that appear crossed but are actually aligned normally due to a wide nasal bridge (pseudostrabismus) - your pediatrician can confirm this with a simple light test
- Both eyes track objects and faces smoothly together most of the time
- Intermittent crossing or drifting persists beyond 4 months of age, even if it is not constant
- You notice one eye drifts outward, especially when your child is tired, looking at something far away, or staring off in the distance
- Your child tilts or turns their head in an unusual way, squints frequently, or closes one eye in bright light
- One eye is constantly turned in any direction at any age (not just intermittently), as constant strabismus requires prompt evaluation to prevent permanent vision loss from amblyopia
- A sudden new onset of eye crossing in any child, especially if accompanied by headache, vomiting, a head tilt, double vision complaints, or a change in the appearance of the pupil - seek same-day evaluation as this can rarely indicate a neurological problem
What You Can Do at Home
- Keep track of when you notice eyes sometimes cross (intermittent strabismus) — noting the time of day, duration, and any triggers can help your pediatrician.
- Remember that brief, occasional crossing in a baby under 3-4 months that comes and goes randomly and does not persist — this is generally within the range of normal.
- At 0-3 months, focus on observation rather than intervention unless your pediatrician advises otherwise.
- Follow any care instructions from your pediatrician. Keep a written log of symptoms to bring to appointments.
- While monitoring at home, seek immediate care if one eye is constantly turned in any direction at any age (not just intermittently), as constant strabismus requires prompt evaluation to prevent permanent vision loss from amblyopia.
Related Resources
Milestone Checklists by Age
Track your baby's developmental milestones from birth to 5 years with age-specific checklists.
Month-by-Month Development
Detailed monthly development guides from birth through 24 months.
When to Call the Doctor
General guide on when to call the pediatrician, visit urgent care, or go to the ER.
Frequently asked questions
Is eyes sometimes cross (intermittent strabismus) normal?
When should I call the doctor about eyes sometimes cross (intermittent strabismus)?
When is eyes sometimes cross (intermittent strabismus) normal?
What causes eyes sometimes cross (intermittent strabismus)?
What should I mention to my pediatrician about eyes sometimes cross (intermittent strabismus)?
Is eyes sometimes cross (intermittent strabismus) normal at 0-3 months?
Is eyes sometimes cross (intermittent strabismus) normal at 3-6 months?
Should I go to the ER for eyes sometimes cross (intermittent strabismus)?
Does eyes sometimes cross (intermittent strabismus) go away on its own?
References
- [1]HealthyChildren.org. Strabismus (Crossed Eyes). AAP
- [2]Donahue SP, et al. Procedures for the Evaluation of the Visual System by Pediatricians. Pediatrics, 2016. AAP
- [3]Mayo Clinic. Strabismus: Symptoms and Causes. Mayo Clinic
Doctor Visit Checklist
Bring this checklist to your next pediatrician visit to discuss My Baby's Eyes Sometimes Cross (Intermittent Strabismus).
Things to mention
- Describe when you first noticed eyes sometimes cross (intermittent strabismus) and how it has changed over time.
- Note your baby's current age and which age-specific patterns you are seeing.
- Mention if intermittent crossing or drifting persists beyond 4 months of age, even if it is not constant.
- Mention if you notice one eye drifts outward, especially when your child is tired, looking at something far away, or staring off in the distance.
- Bring a list of any questions or observations you want to discuss at the appointment.
Observations to share
- Intermittent crossing or drifting persists beyond 4 months of age, even if it is not constant
- You notice one eye drifts outward, especially when your child is tired, looking at something far away, or staring off in the distance
- Your child tilts or turns their head in an unusual way, squints frequently, or closes one eye in bright light
Urgent signs to report immediately
- One eye is constantly turned in any direction at any age (not just intermittently), as constant strabismus requires prompt evaluation to prevent permanent vision loss from amblyopia
- A sudden new onset of eye crossing in any child, especially if accompanied by headache, vomiting, a head tilt, double vision complaints, or a change in the appearance of the pupil - seek same-day evaluation as this can rarely indicate a neurological problem
My notes
From ismybabyalright.com — free, evidence-based baby health guides
All content follows our editorial policy and is reviewed against published clinical guidelines.
2,705 evidence-based guides6 authoritative medical sources5 medical advisory board members
Related Resources
Bottom line
Most cases of eyes sometimes cross (intermittent strabismus) are normal. Talk to your pediatrician if one eye is constantly turned in any direction at any age (not just intermittently), as constant strabismus requires prompt evaluation to prevent permanent vision loss from amblyopia.
Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.
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