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My child skips lines when reading. Could it be their eyes?

It's one of the most common things parents tell us. Here's what happens when a child loses their place, and how to tell whether vision is part of it.

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Reviewed by Dr. Maciej Suwala, Optometrist · Published

The short answer

Sometimes. Skipping lines can come from how the eyes move and work together. It can also come from a child who is still building reading skills, from attention, or from a learning difficulty. Vision is worth ruling out because these problems are common, a standard eye chart doesn't test for them, and they can be treated.

What the eyes do when your child reads

Reading feels smooth, but the eyes actually move in quick jumps. They stop briefly on a word, jump ahead, stop again, and work their way along the line[1]. At the end of each line, they make one long sweep back to the start of the next line. That return sweep is the hardest jump to get right. Even in skilled adult readers, it often lands a little short and needs a small correction[2].

If the return sweep lands on the wrong line, a child skips a line or reads the same one twice. At the same time, both eyes have to stay aimed at the same word and keep it in focus. When any of these skills is weak, or tires quickly, the page gets harder to follow.

Typical reading

Typical reading: the eyes hop along a line in short jumps, then make one long sweep back to the start of the next line, often landing slightly short and correcting.

Losing place

Losing place: the long sweep back overshoots and lands on the line below, so a whole line is skipped.
Dots show where the eyes stop. Short arcs are the jumps along a line; the dashed line is the long sweep back to the next line. In the second example the sweep lands one line too low, so a line is skipped.

Vision problems that can make a child lose their place

  • Eye teaming (convergence insufficiency). The eyes have trouble turning in together and staying aligned up close. Words can blur, double or seem to move. In one study of fifth and sixth graders, about 13% had definite or suspected convergence insufficiency[3]. "Do you lose your place while reading?" and "Do you have to re-read the same line?" are both questions on the standard symptom survey used in research on this condition[4].
  • Focusing. The eyes have trouble keeping print clear up close for long periods. Reading starts fine, then gets blurry or tiring after a few minutes.
  • Eye movement control. The jumps along the line and back to the next one are less accurate, so a child loses their place even when each word looks clear.
  • An uncorrected prescription. Farsightedness or astigmatism can make close work tiring. This is checked at a regular eye exam.

If your child has been diagnosed with convergence insufficiency, that page explains how we assess and treat it.

Reasons that aren't about vision

A child who is still learning to sound out words will lose their place more often, especially when the text is above their reading level. Attention difficulties and dyslexia can look similar.

Vision problems don't cause dyslexia, and treating a vision problem doesn't treat dyslexia. The two can exist side by side, though. Ruling out vision tells the rest of your child's support team what they're working with.

Signs that point toward vision

  • Uses a finger or a ruler to keep their place
  • Reads well at first, then gets worse the longer they go
  • Rubs their eyes, gets headaches or gets tired during homework
  • Says the words blur, double or "move around"
  • Covers or closes one eye, or tilts their head to read
  • Understands a story better when it's read to them
  • Avoids reading and other close work, but focuses well on activities that aren't up close

One sign on its own doesn't mean much. Several together, especially ones that build as reading goes on, are worth getting checked.

What treatment can and can't do

The best-studied treatment is for convergence insufficiency. In the Convergence Insufficiency Treatment Trial, 221 children aged 9 to 17 were randomly assigned to one of four treatments. After 12 weeks, 73% of children who had office-based vision therapy with home exercises were successful or improved, compared with 35% of those who had placebo therapy[5].

A later trial asked whether that treatment also improves reading. Office-based therapy again improved the children's eye teaming more than placebo did. Symptoms improved by a similar amount in both groups[6]. After 16 weeks, scores on standardized reading tests improved no more with therapy than with placebo[7].

In practice, vision therapy treats the eye-teaming problem itself. It isn't a reading program, and reading skills still come from teaching and practice. We tell families this up front.

Where to start

  1. Book a regular eye exam with your child's optometrist. In Ontario, OHIP covers an annual eye exam for children and youth under 20[8]. It checks eye health and whether your child needs glasses.
  2. If the exam is fine and your child still struggles, ask about a binocular vision assessment. It tests eye teaming, focusing and eye movements, which an eye chart doesn't. At our clinic, a children's assessment with Dr. Suwala takes about 90 minutes, and no referral is needed. See vision therapy for children for what's involved.
  3. Not sure yet? Our short symptom check can help you decide.

Common questions

My child passed a vision screening. Does that rule this out?

Not necessarily. Screenings and the eye chart mainly check how clearly a child sees at a distance. Eye teaming, focusing and eye movements up close need different tests.

Should my child use a finger or a reading guide?

It's fine to use one while you sort out the cause. If your child needs one all the time, mention it at their assessment. It's one of the signs we ask about.

What age can you assess?

There's no minimum age. Most children we see are school age, when reading demands go up.

References

  1. Rayner K. Eye movements in reading and information processing: 20 years of research. Psychological Bulletin. 1998;124(3):372–422. doi:10.1037/0033-2909.124.3.372
  2. Slattery TJ, Parker AJ. Return sweeps in reading: processing implications of undersweep-fixations. Psychonomic Bulletin & Review. 2019;26(6):1948–1957. doi:10.3758/s13423-019-01636-3
  3. Rouse MW, Borsting E, Hyman L, et al. Frequency of convergence insufficiency among fifth and sixth graders. Optometry and Vision Science. 1999;76(9):643–649. doi:10.1097/00006324-199909000-00022
  4. Borsting EJ, Rouse MW, Mitchell GL, et al. Validity and reliability of the revised Convergence Insufficiency Symptom Survey in children aged 9 to 18 years. Optometry and Vision Science. 2003;80(12):832–838. doi:10.1097/00006324-200312000-00014
  5. Convergence Insufficiency Treatment Trial Study Group. Randomized clinical trial of treatments for symptomatic convergence insufficiency in children. Archives of Ophthalmology. 2008;126(10):1336–1349. doi:10.1001/archopht.126.10.1336
  6. CITT-ART Investigator Group. Treatment of symptomatic convergence insufficiency in children enrolled in the Convergence Insufficiency Treatment Trial–Attention & Reading Trial: a randomized clinical trial. Optometry and Vision Science. 2019;96(11):825–835. doi:10.1097/OPX.0000000000001443
  7. CITT-ART Investigator Group. Effect of vergence/accommodative therapy on reading in children with convergence insufficiency: a randomized clinical trial. Optometry and Vision Science. 2019;96(11):836–849. doi:10.1097/OPX.0000000000001442
  8. City of Toronto. Vision health for school-age children. toronto.ca
Vision therapy for children Convergence insufficiency Binocular vision dysfunction All articles

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