Pediatric Services Pediatric Services: An intervention team serving children with developmental delays.

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Professional Corner

Visual loss considerations
in developmental assessment

Foundation for the Junior Blind Infant Family Program

The child with a visual impairment and especially one with additional special needs will be at risk for delays in development, including gross and motor skills and social and self-help skills. It is important to understand why these responses are delayed, how to encourage them and how they differ from the responses of sighted peers.

GROSS MOTOR

Area of Possible Delay: Head Control

Reason: Head control must be encouraged because the visually impaired child may not become visually interested in his environment.

Strategy:

  • speak to the child to encourage head lifting
  • activate toys above the child’s head or to the sides of the child’s head
  • use a penlight flashlight to attract attention
  • mirrors can be used for children with some vision

Assessment note: encourage head control with a consistent sound or continual voice

Area of Possible Delay: Trunk Control

Reason: Visually impaired children prefer to lie on their backs. However, trunk control requires that the child must experience the prone position and learn how to roll from stomach to back and back to stomach.

Strategy:

  • use wedges, rolls, and prone boards
  • encourage rolling by providing a motivating person or sound to roll toward

Area of Possible Delay: Reaching on Stomach

Reason: Because the visually impaired child does not like to be on his stomach, reading in prone may be delayed. Especially important is the connection between weight-bearing and learning to use the hands.

Strategy:

  • for those children with some vision, use a mirror to encourage pushing up on forearms
  • present musical toys that make a continual sounds such as a radio or music box

Assessment note: make sure child is comfortable and motivated to reach for toy. Familiar favorite toys are best.

Area of Possible Delay: Crawling

Reason: A blind child will not begin to crawl without help and encouragement. Objects have no meaning for the child who does not see them, unless they make a sound or have an odor. Crawling gives children the change to practice hip rotation, and children who do not have hip rotation tend to "waddle walk".

Strategy:

  • encourage with voice or toys
  • place a pillow or bolster under the abdomen for stability
  • put you hand behind their feet and give a little push
  • show the child how it feels to crawl by moving his arms and legs for him
  • try a scooter board

Assessment note: not all visually handicapped children crawl before they walk; some children may scoot instead of crawl to get around.

Area of Possible Delay: Standing

Reason: the visually impaired child is insecure when first standing because not much of his body is in contact with a surface.

Strategy:

  • arrange an area with a defined space (crib, playpen)
  • play near table top and encourage grabbing of bright sound toys on the table

Area of Possible Delay: Walking

Reason: It takes the visually impaired child longer to walk than the sighted child because he often lacks the confidence and desire to move about.

Strategy:

  • provide open space and opportunities
  • the child must first reach for sound objects or people before walking
  • hold out your hands and help the child step toward you
  • make sure the child experiences walking on even and uneven surfaces
  • make games out of balance activities
  • use a hula hoop

FINE MOTOR

Area of Possible Delay: Regard

Reason: Due to a loss of vision, an infant may not look at, listen to, or handle an object.

Strategy:

  • help child develop auditory rather than visual regard by repeatedly bringing sources of sound to him
  • eliminate auditory overload (background noise like radios, talking)
  • a child may not exhibit regard by looking, but may still or quiet movements as an indication of interest

Area of Possible Delay: Prehension (reaching, grasping, and release)

Reason: The child with a visual impairment has to be taught and encouraged to use his hands since he cannot watch his hands at midline.

Strategy:

  • weight-bearing on hands is a crucial first skill for developing grasp and manipulation
  • massage the arms and hands with lotion or powder, moving from the shoulders down the arms, into the palm, and to the tips of the fingers
  • faces and toys need to be close so that they are easily bumped into and create a sound or movement
  • toys may need to be placed on the hand, foot, etc. to prompt or reach and grasp

Assessment notes:

  • a visually impaired child may not exhibit reaching without a consistent sound cue
  • grasping a block may not have meaning, whereas presenting mom’s or your finger may trigger the grasping response
  • to encourage release of an object, help the child identify a surface such as a table top or tray, or a container

Area of Possible Delay: Manipulation

Reason: The child who is visually impaired must learn through touch and coactive manipulation what the sighted child learns through watching.

Strategy:

  • put objects in the child’s hands and assist with feeling, exploring and manipulation
  • provide varied toys with texture, sound, movement, smell

Assessment note: assess manipulation with objects familiar to the child.

SELF HELP

Area of Possible Delay: Feeding

Reason: The child with a visual impairment may have difficulty understanding the feeding routine: where the food is coming from, when the spoon is coming, how to scoop food from a bowl. It is therefore sometimes difficult to persuade children who have been fed to feed themselves.

Strategy:

  • present utensils for exploration before they are presented as eating tools
  • encourage exploration of food with hands
  • help guide the utensils from behind the child

Area of Possible Delay: Dressing

Reason: The child with a visual impairment cannot see to imitate the act of dressing.

Strategy:

  • repeated trials are necessary
  • have him put hands on yours as you dress him
  • encourage him to raise his arms and legs as you dress him
  • make clothes loose and simple

SOCIAL EMOTIONAL

Area of Possible Delay: Smiling

Reason: A lack of vision interferes with the social interaction that leads to reciprocal smiling. Although the visually impaired child will smile less than the sighted child, early on, he will recognize the voices and touch of his parents. However, he probably will not show anxiety over separation because contact is sporadic and he many not be aware of the absence or presence of a parent.

Strategy:

  • create an individual linking mechanism such as a special kiss or pat, a smell or greeting

Area of Possible Delay: Early Communication

Reason: Sometimes parents of a visually impaired or multiply disabled baby may anticipate their child’s needs a bit too much, and not allow their baby to cry or show through other behaviors what he wants or needs.

Strategy:

  • do not over anticipate a child’s needs, but do respond to efforts to communicate
  • rely on what you are hearing and feeling rather than waiting for eye gaze when turn-taking

Area of Possible Delay: Later Communication

Reason: Although it is not known exactly how important a role vision plays in learning to talk, it is known that older babies with normal vision pay particular attention to adults’ mouths as they are talking.

Strategy:

  • give the child lots of opportunities to touch the people he cannot see very well
  • name toys as the child plays with them, and expand on just naming by saying, "Oh, that’s your sound ball. It’s soft and round and fuzzy."
  • Make connections between where the child may have seen or touched the object before. Point out the similarities between the objects.
  • Quiet time is just as important as listening time.
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Last modified: January 26, 2013