Squint in children: red flags and when to refer
The short answer
Refer any child with a squint that is constant, or that persists beyond the first few months of life, so that amblyopia and an underlying cause can be looked for. A squint with a white pupil reflex, a new squint with headache or other neurological signs, or a squint that appears suddenly needs the same week or the same day.
Refer a patientMedically reviewed by Dr Debo Odulana, Founder and Chief Executive, Mezo. Last reviewed . This page is general information, not a diagnosis. Care is decided with you after an examination.
Who to refer
- Babies whose eyes still turn after the first few months, and any child with a constant squint at any age.
- Children whose eye turns some of the time, or when tired or unwell, that a parent has noticed more than once.
- Children who turn their head or close one eye to look at things, or who have reduced vision in one eye.
- Children with a family history of squint or lazy eye who have any of the above.
How urgently
Same day
A sudden new squint with headache, vomiting, double vision, drowsiness or any other neurological sign. Send the child to an emergency service now.
Soon
A white or absent red reflex in either eye (retinoblastoma must be ruled out), a new squint in an older child, or reduced vision in one eye. Within the same week.
Routine
A long-standing squint in a well child with a normal red reflex.
What to send with the referral
- The child's age, and when the squint was first noticed and by whom.
- Whether it is constant or intermittent, and which eye turns, in or out.
- The red reflex in each eye, and visual acuity if it could be measured.
- Any refraction you have done, and any glasses already prescribed.
- Birth history, development, family history of squint, lazy eye or childhood eye cancer, and any neurological symptoms.
Do not wait for it to go away
A squint in a child is not something to watch over months. An eye that turns can stop developing its sight, and that window closes as the child grows. Treatment for lazy eye works best when it starts young.
Check the red reflex every time. A white pupil, or a difference between the two eyes, can be the first sign of retinoblastoma.
What you get back
- An acknowledgement email with the referral reference as soon as you submit.
- A loop-back letter from the receiving clinician once the patient has been seen: what was found, what was done and the plan.
- The patient returned to you for ongoing care, with the plan in the letter, so you keep the person you looked after.
- A named specialist and a care coordinator who calls the patient, so the referral does not sit unanswered.
Mezo pays nothing for referrals: no fee, credit, points or discount per patient, to anyone. You refer because it is the right place for the patient, and you hear back how it went.
Refer a patient
For squint surgery, strabismus or an assessment. No Mezo account needed. The receiving specialist and a care coordinator take it from here.
Common questions
Should a child with a squint always have surgery?
No. Many squints are treated with glasses, patching or drops for a lazy eye, and some never need an operation. The specialist assessment decides.
Will the child come back to me?
Yes. You receive a letter with the diagnosis and plan, and the child returns to you for glasses checks and ongoing care between specialist reviews.
Does Mezo pay referrers?
Mezo pays nothing for referrals: no fee, credit, points or discount per patient, to anyone. You refer because it is the right place for the patient, and you hear back how it went.
Guides to send your patient
Patient health guides
The treatment
More referral guidance
Sources and further reading
The guidelines and patient information this page is checked against. Care in Nigeria follows the same evidence; what differs is the price and where it is done.
- Esotropia and Exotropia Preferred Practice Pattern. American Academy of Ophthalmology, 2022. Clinical guideline.
- Amblyopia Preferred Practice Pattern. American Academy of Ophthalmology, 2022. Clinical guideline.
- Squint. NHS. Patient information.
Links last checked 23 October 2026.