What additional clinical finding may support the suspicion of strabismus in a 4-year-old?

Frequent squinting can be a significant clinical finding that supports the suspicion of strabismus in a 4-year-old. Strabismus, which is often characterized by misalignment of the eyes, can lead to difficulties in proper visual focus and binocular vision. Children with strabismus may squint as an involuntary response to try to improve their visual acuity, align their eyes, or reduce double vision. This behavior indicates that they are experiencing challenges with eye coordination and clarity of vision, which aligns well with the characteristics of strabismus.

While complaints of headaches, difficulty in focusing, and turning the head excessively might also occur in children with visual issues, they are not as direct an indication of strabismus as frequent squinting. Complaints of headaches can be more general and related to various causes beyond just visual misalignment. Difficulty in focusing could be associated with several other conditions, including refractive errors. Turning the head excessively often indicates a compensatory strategy for gaze alignment, which can be seen in conditions such as nystagmus or other ocular motility disorders, but does not specifically point to strabismus. Thus, frequent squinting serves as a more immediate and observable reaction reflecting the challenges posed by strab