Pediatric light sensitivity or photophobia is often overlooked but has no less profound an impact on younger patients than it does on adults. The fact is children may experience persistent sensitivity to light for a variety of reasons, but most often it can be attributable to a chronic condition—from migraine to concussion or even glaucoma. In this post, we explore how pediatric photophobia can develop as well as its effect on kids and adolescents.
Causes of Pediatric Photophobia
Headache Disorders and Migraine
Children are not immune to the effects of headache disorders and migraine, especially given that many experts believe there is a genetic link to its onset. That makes understanding and treating the unique symptoms of the approximately 10% of kids with migraine an important part of ongoing care.
The frequency of photophobia in children with migraine varies; however, one study showed that more than half of children with the disorder experienced strong light sensitivity during their attacks.1 In addition, similar to their adult counterparts, bright light exposure is a common trigger for migrainous symptoms too. In fact, nearly 53% believed intense lighting had previously instigated attacks, putting it right in line with other triggers like stress, lack of sleep and loud noises.2 And light sensitivity is comparable for other headache conditions like:
Concussion and Post-Concussion Syndrome
Perhaps as many as 3 million children annually experience a concussion or head injury—whether it be from falling, sports or other physical activity. While many symptoms go away within a few days as a result of proper rest and care, almost one-third may develop persistent issues or post-concussion syndrome.
Visual and neurological abnormalities have long had a connection to concussion-related injuries, with photophobia as one of the leading complications. After the initial trauma, more than 40% of pediatric patients have to deal with sensitivity to light; not surprisingly, a greater percentage of children may begin to notice these sensitivities AFTER the first few days (but usually within a week), suggesting that there can be a delay before it appears. And nearly 10 percent still had symptoms of light sensitivity four weeks later.3 In addition, photophobia is a core symptom of the post-concussion period as well and could last for months or years.4
We also cannot discount the impact of chronic headaches and migraines after a concussion given that they typically feature the same hallmark symptoms, which includes light sensitivity and photophobia.5
Developmental and Sensory Disorders
The millions of children with developmental and sensory disorders may also be at risk for experiencing negative reactions to light. For these patients, light sensitivity typically does not manifest as pain but it still can exacerbate symptoms of their condition. Furthermore, there is mounting evidence that conventional fluorescent lighting is particularly disruptive due to its invisible flickering and bright, blue light emittance. In separate studies, this type of light (particularly prominent in school settings) increases the visual stress and stereotypical behaviors of both autism spectrum disorder and attention deficit hyperactivity disorder (ADHD).6,7
There is a unique form of light-sensitive epilepsy called photosensitive epilepsy, with the majority of those diagnosed being children and teenagers. Those pediatric patients with the seizure disorder tend to be more sensitive to flickering and flashing light sources, such as:
- Video games, computer screens, television and movies
- Strobe-like lighting, such as from concerts or emergency vehicles
- Sunlight, particularly through trees or bright reflections
- Fluorescent lighting
In particular, it is the combination of high-contrast and flickering light along with the overall brightness that is believed to trigger the photosensitivity and photophobia experienced by epileptic children.
The eye-brain connection is crucial in the onset of photophobia, so it makes sense that ocular problems can also introduce unwelcome sensitivities for children. We know that kids will be kids, which could mean occasionally injuring their eye or scratching their cornea. When this happens, they can feel the discomfort of watery eyes, redness, irritation and sensitivity to light.8 Even in the absence of direct trauma, eye conditions that are diagnosed in younger patients can bring about an intolerance for bright lighting. For example, there is a unique type of childhood glaucoma that only develops in younger patients and causes pupil enlargement and photophobia.
Meningitis occurs when there is swelling in the membranes that surround the brain and spinal cord. Along with symptoms of nausea, neck stiffness and severe headache, those with meningitis can also experience sensitivity to light. In fact, at least two-thirds of those pediatric patients with suspected meningitis have reported painful responses to light.9 But why does this occur? Anytime swelling in and around the brain is present, neurological complications can develop. This includes post-infection symptoms like chronic headaches, which may also have migrainous features like photophobia.
Photophobia in Children: Special Considerations
Diagnosing and treating photophobia in children can provide some unique challenges.
- Struggle communicating symptoms: Younger kids may have trouble expressing their light sensitivity to caregivers or doctors, which can cause additional frustration and difficulty in providing relief.
- Effects on girls versus boys: Migraine and concussion in particular are more likely to affect girls and young women, which not only may create greater burden for female pediatric patients but may also increase the risk for photophobia as well.
- Pharmaceutical treatments: There may be special concern with drug medications as a treatment for kids with chronic conditions because of the side effects. In addition, some medications may actually worsen light intolerance, such as methylphenidate (e.g. Ritalin) for ADHD.10
- Burden of pediatric photophobia: With the vision and neurological issues associated with light sensitivity, young children may be susceptible to challenges in school, struggles with the use of technology (e.g. smartphones) and/or problems with social stigma or isolation.
All of these considerations must be taken into account with pediatric patients, and their care team must work to overcome them for the long-term betterment of the child.
Lastly, there are specialty-tinted glasses designed for photophobia that cut down on the light that is making it worse for kids. TheraSpecs is the leader in therapeutic eyewear and even offers a highly-protective wraparound style exclusively for pediatric patients and adolescents. Click here to learn more about Petite Wrap.
You can also get additional tips for reducing your child’s light sensitivity by clicking below.
Read more about light sensitivity:
1Francis MV. Brief migraine episodes in children and adolescents-a modification to International Headache Society pediatric migraine (without aura) diagnostic criteria. Springerplus. 2013;2(1):77. doi:10.1186/2193-1801-2-77
2Neut D, Fily A, Cuvellier JC, Vallée L. The prevalence of triggers in paediatric migraine: a questionnaire study in 102 children and adolescents. J Headache Pain. 2011;13(1):61–65. doi:10.1007/s10194-011-0397-2
3Eisenberg MA, Meehan WP, Mannix R. Duration and course of post-concussive symptoms. Pediatrics. 2014;133(6):999–1006. doi:10.1542/peds.2014-0158
4Swanson MW, Weise KK, Dreer LE, et al. Academic Difficulty and Vision Symptoms in Children with Concussion. Optom Vis Sci. 2017;94(1):60–67. doi:10.1097/OPX.0000000000000977
5Babcock L, Byczkowski T, Wade SL, Ho M, Mookerjee S, Bazarian JJ. Predicting Postconcussion Syndrome After Mild Traumatic Brain Injury in Children and Adolescents Who Present to the Emergency Department. JAMA Pediatr. 2013;167(2):156–161. doi:10.1001/jamapediatrics.2013.434
6Howe FEJ, Stagg SD. How Sensory Experiences Affect Adolescents with an Autistic Spectrum Condition within the Classroom. Journal of Autism and Developmental Disorders. 2016;46:1656-1668. doi:10.1007/s10803-015-2693-1.
7Ott JN. Influence of Fluorescent Lights on Hyperactivity and Learning Disabilities. Journal of Learning Disabilities - J LEARN DISABIL. 9. 417-422. 10.1177/002221947600900704.
8Aguilera ZP, Chen PL. Eye Pain in Children. Pediatr Rev. 2016 Oct;37(10):418-425.
9Amarilyo G, Alper A, Ben-Tov A, Grisaru-Soen G. Diagnostic accuracy of clinical symptoms and signs in children with meningitis. Pediatr Emerg Care. 2011 Mar;27(3):196-9. doi: 10.1097/PEC.0b013e31820d6543.
10Ghanizadeh A, Aghakhani K. Photophobia and methylphenidate. Psychopharmacol Bull. 2008;41(1):171-3.
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