What are visual impairments?
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Visual impairments are present when a child cannot see well enough to interact with others and participate in daily child care or school activities (at her developmental level).
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Partially sighted, low vision, and legally blind are terms used to describe the different levels of visual impairment related to a child’s needs in child care or another educational setting.
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A child who is
partially sighted has a visual problem that requires some special accommodations in child care and school. These children may need glasses at an early age. -
A child with
low vision has a severe visual impairment. They can see shapes and people around them, but most everything will be fuzzy, even with glasses. They require a fair amount of accommodation and assistance, and may need to be taught to read using braille. An infant or a young child would need specialized or expert care in a child care setting. -
A child who is
legally blind has very limited vision or a severely constricted visual field, and might not see anything at all. Students who are totally blind learn via braille or other nonvisual means, usually in special settings or with one-on-one assistance. Students with a severely constricted visual field may be able to read but still need special accommodations in child care and school.
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How common are they?
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The rate at which visual impairments occur in children aged 0 to 18 years is 12.2 per 1,000.
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Severe visual impairments (legally or totally blind) occur in children aged 0 to 18 years at the rate of 0.06 per 1,000.
What are some characteristics of children with visual impairments?
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Children with visual impairments usually have many eye and other conditions. Often, it is those conditions that led to visual impairments.
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These problems include retinopathy of prematurity, albinism, cataracts, glaucoma, tumors, congenital infections and disorders, and diabetes.
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The effect of visual problems on a child’s development depends on the severity of the problem, level of visual impairment, age at which the condition appears, and services offered to the child.
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Children who have visual impairment as one of multiple disabilities may have significant developmental problems.
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If a child with a visual impairment is diagnosed in infancy and treatment begins early, he will most likely do well and learn to use his other senses to adapt to his environments.
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Because a child who has severe visual impairments cannot see his parents/guardians, caregivers/teachers, or peers, he may not imitate social behavior or understand nonverbal cues. This can make it harder to become self-sufficient and independent. Because children’s sense of self-worth develops during the years they may be in child care and school, it is extremely important that others who interact with a child with a visual impairment support that child and help him to feel good about what he can do, celebrate his accomplishments, and value him as a whole person.
Who is the treatment team?
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The treatment team for a child with a visual impairment can include the primary care provider in the medical home, a pediatric ophthalmologist (an eye doctor who mostly works with children), developmental and behavioral pediatricians, vision specialists, and child development experts or early childhood educators.
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A young child with visual impairment may not explore her environment in the same way a child who can see would. Special accommodations and
early intervention are important and necessary.-
Early intervention is a state-funded system of services to support infants and toddlers with disabilities and their families.
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Therapists and other professionals that are part of the early intervention system can work with caregivers/teachers to incorporate exercises and equipment into the day-to-day lives of these young children.
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For children 3 years and older,
special education and related services are available through the public school to provide therapies necessary for school achievement.
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Often the local Commission for the Blind works with the child and family to assist with specific home, child care, and school adaptations.
What adaptations may be needed?
Dietary considerations
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There are no special dietary considerations, but it is helpful to establish consistent place settings and expectations around eating.
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Help children anticipate that there may be spills and teach them how to handle this themselves, as well as to ask for help when they need it.
Physical environment
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Provide plenty of light.
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Keep the furniture and supplies in the same place in the classroom. Sharp objects such as scissors and art supplies should be kept in an enclosed container. Also maintain a very consistent routine. This will help all children, especially those with a visual impairment, to feel more comfortable because they will know what to expect and where things are.
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Provide a safe environment by keeping drawers and cabinet doors closed as well as keeping traffic patterns free of toys, throw rugs, electrical cords, or other objects that might be hard to see or move around. Orient the child to locations of steps and stairs. Teach the child to use handrails.
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Establish barrier-free routes in the area where the child spends time and within the facility, such as from the classroom to the bathroom. Use contrasting colors, such as a green plate on a white tablecloth. (It is difficult to see a white plate on a white cloth.)
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Use sounds and auditory cues to help children understand what is going on and what will happen next; eg, say what you are doing, use songs or music for transitions from one activity to another. Model for the other children in the classroom how they can do this in a sensitive way too.
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Directly supervising children by sight and sound is best, especially in child care programs. However, if you have to leave an older child with a visual impairment alone, have the child stand near a wall, railing, chair, or something else to hold on to until you return. Leaving the child alone in an open space may create anxiety and confusion. Again, explain what you are doing as you do it.
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Allow children to experience leadership opportunities within the classroom, as this will foster self-confidence and independence.
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A Care Plan for a child with a visual impairment may include specific information for caregivers/teachers or the child to help emphasize listening skills, communication choices, ways to handle new situations or settings, and moving from one place to another.
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Technology such as computers and low-vision optical aids and videos may enable children with visual impairments to participate more fully in classroom activities.
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Use books in braille as well as those with large print or on a tape.
What should be considered an emergency?
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There are not many medical emergencies that children with visual impairments would typically experience, but extra time and supervision will be necessary in the event of an evacuation for a programmatic emergency such as a fire. This should be taken into consideration in emergency planning, and all children should know what to expect and how they can help the child with visual impairments and each other.
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Children with visual impairments are at greater risk for falls and non-intentional injuries (eg, banging into furniture, tripping). Prevention of these events is a crucial component of the Care Plan.
What are some resources?
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Blind Childrens Center, 323/664-2153,www.blindchildrenscenter.org
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National Association for Parents of Children with Visual Impairments, 800/562-6265,www.napvi.org
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Commission for the Blind (in various states; contact local health resources for more information)
Source: Managing Chronic Health Needs in Child Care and Schools: A Quick Reference Guide.
Products are mentioned for informational purposes only. Inclusion in this publication does not imply endorsement by the American Academy of Pediatrics.
Listing of resources does not imply an endorsement by the American Academy of Pediatrics (AAP). The AAP is not responsible for the content of external resources. Information was current at the time of publication.
The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.