When looking at child and adolescent health in New South Wales (NSW), a significant number of problems and limitations become evident. The expectations placed on children today are becoming greater, with social and peer group pressures ever increasing. The health status and expectations of a child are closely linked to such factors as socio-economic and employment status, geographical location and education levels. An orthoptist is trained to assess the eye and ocular problems, however embracing family dynamics and looking at the larger picture assists in orthoptic outcomes. This paper highlights these issues, how they are being addressed by one organisation and how the orthoptist must acknowledge them for optimal results.