Crossed Eyes (Strabismus) in Babies

Content reviewed against published AAP, AAO, AAPOS guidelines

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Strabismus is a condition where the eyes do not align properly — one or both eyes may turn inward (esotropia), outward (exotropia), upward, or downward. Intermittent eye crossing in newborns under 3-4 months is normal as eye muscles mature. Persistent or constant misalignment after 4 months needs evaluation, as early treatment is important to prevent amblyopia (lazy eye).

Key takeaways

  • Strabismus is a condition where the eyes do not align properly — one or both eyes may turn inward (esotropia), outward (exotropia), upward, or downward.
  • Most common cause: Normal newborn eye muscle immaturity (under 4 months)
  • Emergency: Sudden onset of eye misalignment with vomiting, headache, or lethargy (possible neurological emergency)
  • Home care: Take photos when you notice misalignment to show the doctor

Possible Causes

Normal newborn eye muscle immaturity (under 4 months)common
Pseudostrabismus (wide nasal bridge creating illusion of crossing)common
Infantile esotropia (true inward turning)uncommon
Accommodative esotropia (farsightedness causing crossing)uncommon
Cranial nerve palsyrare
Retinoblastoma (eye tumor)rare
Brain tumor or neurological conditionrare

When to Seek Help

Emergency — Call 911 or go to ER:

  • Sudden onset of eye misalignment with vomiting, headache, or lethargy (possible neurological emergency)
  • White pupil reflex (leukocoria) noticed in one or both eyes
  • New strabismus after head injury

Urgent — See doctor today:

  • Sudden onset of constant eye crossing in a child who previously had straight eyes
  • Eye deviation with drooping eyelid (ptosis) or unequal pupil size
  • New onset double vision (child reports "seeing two" or covers one eye)

Same-day appointment:

  • Persistent eye crossing in a baby over 4 months of age
  • Parents noticing one eye frequently drifting in or out
  • Constant head tilt that may indicate eye misalignment

Monitor at home:

  • Intermittent brief eye crossing in a baby under 4 months (normal development)
  • Wide nasal bridge making eyes appear crossed (pseudostrabismus — normal)
  • Already under ophthalmology care with stable alignment

By Age

0-3 months

Normal: Intermittent eye crossing is very common and normal in newborns. Eyes may briefly cross or drift outward as the visual system matures. A wide flat nasal bridge can make eyes appear crossed when they are not (pseudostrabismus).

Worry if: Constant, fixed eye crossing (never straightens), one eye always deviated, or abnormal red reflex (white pupil in photos instead of red).

3-6 months

Normal: By 4 months, eyes should be well-aligned most of the time. Occasional brief drift may still occur but should be infrequent.

Worry if: Any persistent misalignment after 4 months of age requires evaluation. Also concerning: one eye consistently turns in or out, eyes do not track together.

6-12 months

Normal: Eyes should be consistently aligned. Baby should be tracking objects with both eyes moving together smoothly.

Worry if: Any eye turning noticed at this age is abnormal and needs referral to pediatric ophthalmologist. Constant head tilting to see may indicate eye alignment issues.

1-3 years

Normal: Eyes should remain well-aligned. Children at this age are developing depth perception and fine visual skills.

Worry if: New-onset eye crossing (especially if sudden), squinting, head tilting, or closing one eye in sunlight. Accommodative esotropia commonly presents between 2-3 years.

Home Care

  • Take photos when you notice misalignment to show the doctor
  • Use the flashlight test: shine a small light at baby's face and check that the reflection appears in the same spot on both pupils
  • Encourage visual tracking with toys moved slowly side to side
  • Do not delay evaluation — early treatment prevents vision loss from amblyopia
  • If prescribed, ensure patching therapy is followed consistently
  • Ensure good lighting during play to observe eye alignment

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Frequently asked questions

What causes crossed eyes (strabismus)?
Normal newborn eye muscle immaturity (under 4 months) (common); Pseudostrabismus (wide nasal bridge creating illusion of crossing) (common); Infantile esotropia (true inward turning) (uncommon); Accommodative esotropia (farsightedness causing crossing) (uncommon); Cranial nerve palsy (rare); Retinoblastoma (eye tumor) (rare); Brain tumor or neurological condition (rare)
When is this an emergency?
Sudden onset of eye misalignment with vomiting, headache, or lethargy (possible neurological emergency). White pupil reflex (leukocoria) noticed in one or both eyes. New strabismus after head injury
What can I do at home?
Take photos when you notice misalignment to show the doctor. Use the flashlight test: shine a small light at baby's face and check that the reflection appears in the same spot on both pupils. Encourage visual tracking with toys moved slowly side to side. Do not delay evaluation — early treatment prevents vision loss from amblyopia. If prescribed, ensure patching therapy is followed consistently. Ensure good lighting during play to observe eye alignment
When should I call the doctor?
Persistent eye crossing in a baby over 4 months of age. Parents noticing one eye frequently drifting in or out. Constant head tilt that may indicate eye misalignment

Sources

AAPAAOAAPOS

All content follows our editorial policy and is reviewed against published clinical guidelines.

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Related Symptoms

swollen eyelidwatery eyes

Bottom line

Most cases of crossed eyes (strabismus) in babies are not emergencies. However, seek immediate care if sudden onset of eye misalignment with vomiting, headache, or lethargy (possible neurological emergency).

Trust your instincts. If something feels wrong, reach out to your pediatrician. Worrying about your baby means you care — that is a good thing.