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Children's Medical Services - Special services for children with special needs
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Infant Toddler Development Training
Module 6, Lesson 3

Family Options and Effect on the Family

If a child has low vision or is blind the family must always be thinking of ways to incorporate vision and tactile stimulation activities into their everyday routines. The ITDS can assist the family to think differently about how they go about their daily activities. For example, the parent may have the child hold an object while the parent talks about it and describes its characteristics. Everything must be touched and described: the toothbrush, the hairbrush, even the toilet.

little boy laughingThe parent or caregiver becomes the eyes for the child during these precious early years and as the child grows. The caregiver needs encouragement to use words that describe color, shape, and size and not to veer away from the "seeing" words. The family has to ensure that they describe what they are going to do to with their child or what will touch the child prior to taking the action. This is because the child cannot see the approach. Remember, trust is the major developmental task during the first year of life and it is hard to trust if the caregiver approaches in ways that make the child fearful.

The family can be taught additional strategies such as to:

  • use a light colored background on which to place the child's toys.
  • make sensory toys from everyday objects such as using beans in a well-sealed potato chip can.
  • make textured items.
  • use a light box to get objects to show better.

The Florida School for the Deaf and Blind has excellent books and toys for visually impaired children. The American Printing House for the Blind also has good books for parents about visual impairments and blindness. Additional websites can be found in the website section at the end of this lesson that include information on developmental optometry and the use of prisms.

Referral Requirements for Vision

Children who are at high risk for eye problems should be evaluated early. The Early Steps Workgroup on Visual Impairments identified high risk populations for follow-up. They include infants who:

  • are very premature.
  • have family histories of congenital cataracts and/or retinoblastoma.
  • have metabolic or genetic diseases that are associated with eye abnormalities.

To qualify for services from the local Early Steps program due to significant sensory impairment in the visual area, the following criteria must be met:

  1. Bilateral lack of fix and follow OR an approximate visual acuity of 20/70 or less in the better eye after best possible corrections
  2. Constricted peripheral field that could interfere with daily mobility or activities or bilateral central scotoma involving the perimacular area (<20/80)
  3. Bilateral Stage III, IV, or V retinopathy of prematurity with evidence of affect on visual performance
  4. Bilateral progressive loss of vision which may affect the child's ability to function in his or her natural environments
  5. Evidence of Cortical Visual Impairment (CVI)
  6. Strabismus that requires patching of the better eye with approximate visual acuity of 20/70 or less in the un-patched eye after best possible correction

(Early Steps Part C Criteria Specifying Visual Impairment Considered to be a "Significant Sensory Impairment", 2004).

Consider this scenario.

The ITDS will note that an eye care specialist, who is usually the ophthalmologist, makes the diagnoses of significant vision impairment.

What can the ITDS do to assist the family in the process?


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