yec

659121
research-article2016
YECXXX10.1177/1096250616659121Young Exceptional ChildrenVisual Impairments in Young Children / Thompson and Merino

Visual Impairments in Young

Children: Fundamentals of
and Strategies for Enhancing
Development

A
lthough it has proven to be a Information is available to help

“
rough journey, Julia wouldn’t understand a vision diagnosis
trade her two beautiful (Anthony, 2014); however, there is
children, Chelsea and Matthew, for little about practical techniques to
...VIs are ranked as the the world. When Julia served in the stimulate vision and therefore
military, she was prescribed a drug enhance the child’s overall
she believed may have caused serious development.
fourth most common complications during her pregnancy. According to information from
While she would later find she had the World Health Organization, the
been wrong about the drug itself worldwide rate of children with a VI
disability in the United causing complications, she had been is higher than that of the United
right about their presence. After her States, at nearly 19 million diagnosed
States and are viewed first child, Chelsea, was born, Julia
noticed a gray cloudiness in her
(American Optometric Association
[AOA], 2010). Moreover, 5% of
daughter’s eyes. Julia’s doctor children under the age of 4 years in
as the most common suggested Chelsea undergo a red the United States have a visual
reflex screening. The doctor soon disability (Erickson, Lee, & von
diagnosed the infant with congenital Schrader, 2015). With this seemingly
restricting condition during cataracts. When Julia gave birth to low percentage, it is interesting to
her second child, Matthew, she note that VIs are ranked as the
noticed the same gray muddiness in fourth most common disability in the
childhood his eyes. It wasn’t long before United States and are viewed as the
Matthew was also diagnosed with most common restricting condition

” congenital cataracts. Julia, a single

mother, watched helplessly as her
12-month-old and her 2-month-old
struggled in confusion and a lack of
during childhood (AOA, 2010).
It has been reported that 17% to
25% of school-aged children have
some degree of a vision problem,
awareness of the world around them. thus interrupting their potential to
Julia was like many parents as reach optimal growth and learning
she prepared for the arrival of her in school. This is mostly due to
first baby. She read informative the lack of professional eye care
books, decorated a nursery, and many children receive (AOA).
purchased necessary items for her
new infant. However, she had to
Stacy D. Thompson, PhD make modifications to these DOI: 10.1177/1096250616659121
Sarah Merino, MS arrangements when she learned of http://yec.sagepub.com
Southern Illinois University Carbondale Chelsea’s visual impairment (VI). © 2016 Division for Early Childhood

Vol. XX, No. X, Month 2016  YOUNG EXCEPTIONAL CHILDREN 1

 Visual Impairments in Young Children / Thompson and Merino

Consequently, early intervention (EI) (IDEA; U.S. Department of

and stimulation for these children Education, 2004), is an “. . .
can greatly aid in their overall impairment in vision that, even with
development and success upon correction, adversely affects a child’s
entering school. educational performance. The term
The family’s first resource is includes both partial sight and
typically the pediatric blindness” (Regulations: Section
ophthalmologist (PO), who provides 300.8). Underneath the umbrella of
information regarding the child’s VI, there are different terms that
visual acuity, diagnosis, and describe the levels and degree of
continued management. A correct vision loss. Low vision (LV) is “a
evaluation of visual acuity, or the visual impairment that is severe
overall clarity of one’s vision, is the enough to impede an individual’s
foundation for diagnosis and ability to learn or perform visual
treatment of an eye condition (Leone, tasks of daily life” (Huebner, 2000,
Mitchell, Kifley, & Rose, 2014). p. 60). An individual with LV will
Families receive an evaluation, a have a visual acuity that can range
range of services depending on the from mild to severe and will not be
child’s developmental needs, and are considered completely blind, as he or
provided services through EI. EI is a she still has some degree of vision.
key component to ensuring optimal A second impairment on the
development (Hatton, Ivy, & Boyer, spectrum of VI is functional
2013). An EI specialist may be blindness (FB). This is “the absence
offered as a source of intervention of any vision which is often recorded
who works with parents on specific as light perception when the presence
ways of visually stimulating the of light can be detected but its spatial
infant’s eyes during interaction, distribution cannot be determined”
especially when a vision specialist is (Huebner, 2000, p. 59). An individual
on the EI team. The child’s with FB must significantly modify
developmental outcome will be everyday tasks to compensate for
greater if the parents integrate their severely weak vision.
learned strategies into their daily The final impairment under the
lives (Alimović, Katušić, & Mejaški- range of VI is blindness (BL). This is
Bošnjak, 2013; Anthony, 2014). The a “complete absence of vision, which
goal of this article is to provide more is often recorded as no light
information for parents and perception (NLP)” (Huebner, 2000,
professionals on VIs as well as ways p. 59). As there is a complete absence
to ensure a typical developmental of vision, an individual diagnosed
trajectory in children through the use with BL would be considered
of practical techniques. completely without sight to any
degree. This article will focus on
infants and young children with
VI some degree of vision, rather than
total vision loss.
When a child has a VI, her vision Of the routine examinations to
cannot be entirely corrected with check for overall well-being of an
glasses or contact lenses. A visual infant post birth, the red reflex
impairment, as defined in Individuals screening is one of the most
With Disabilities Education Act important for overall visual

2 YOUNG EXCEPTIONAL CHILDREN  Vol. XX, No. X, Month 2016

 Visual Impairments in Young Children / Thompson and Merino

competence. The current maturational process (Alimović et al.,

recommendation is that a screening 2013). During gestation, the globe of
by a primary care physician be the eye forms during the 12th week
performed at birth and again at 6 (Kolb & Whishaw, 2009). One third
months of age for early detection and of the eye’s growth occurs within the
prevention of VI. This is one of the first year, and the eye is completely
first of additional screenings to take grown by 3 years of age (Holbrook
place for an infant eye assessment & Koenig, 2000). Even though the
(AOA, 2010; Fry & Wilson, 2005). eye is a well-developed organ, sight is
During the red reflex examination, the least developed sense at birth and
light from an ophthalmoscope is needs time, patience, and stimulation
positioned on the optic axis of the for maturation (Alimović et al.,
patient’s dilated pupil. The examiner 2013). The massive speed of growth
looks closely to see a clear reflection the eye undergoes after birth makes
of the light projected back from both it vital for intervention and the
eyes. When the reflection is either stabilization of vision to occur
partially or completely prevented, quickly if an issue is detected (Lowth,
and spots or shadows are present, 2014).
this may be an indication of an According to Lewis (2014),
illness or disorder of the eyes, and visual acuity at birth is 20/400. A
thus a VI (Lewis, 2014; Mussavi, person with this vision must be
Asadollahi, Janbaz, Mansoori, & within 20 feet to see what a person
Abbasi, 2014). with 20/20 vision is able to see at

“
Children with a VI will
Causes and Risks
According to Gogate, Gilbert,
400 feet. A newborn’s vision is
limited to the distance between his
eyes and the face of the person
holding him (8-10 inches; Fantz,
1963). However, infants are born
and Zin (2011), VIs in infants
not experience the develop at 2 distinct times, either
with the ability to accommodate.
They can adjust their eyes to focus
during the prenatal or postnatal
on objects. As the eyes adjust, they
periods, and different causes of a VI
developmental trajectory are based on these periods of
demonstrate fixation, which is the
ability to retain a gaze on a light
development. Refer to Table 1 for
source or object. Visual searching is
more information regarding factors
of the eyes discussed which place an infant at high risk for
developed in combination with the
development of an infant’s fine
the development of a VI (AOA, 2010;
motor abilities over time. At 1 year, a
above, demonstrating Chong & Dai, 2014; Gogate et al.,
2011; Siatkowski, Good, Summers,
child’s visual acuity is typically
around 20/50 and will develop
Quinn, & Tung, 2013).
further with continual exercise and
very important differences engagement.
Children with a VI will not
Typical Visual
of which one should be experience the developmental
Development trajectory of the eyes discussed above,
demonstrating very important
cognizant At birth, the infant’s eye is the differences of which one should be

”
most fully developed organ in the cognizant (see Table 2; Elisa et al.,
body and will continue to mature 2002; Fazzi, 2002; Haibach, Wagner,
after birth through a complex & Lieberman, 2014; Hatton, Bailey,

Vol. XX, No. X, Month 2016  YOUNG EXCEPTIONAL CHILDREN 3

 Visual Impairments in Young Children / Thompson and Merino

Table 1
Risks Associated With Development of a VI in Infancy
Association Risk VI anomalies

Prenatal development and Infection during pregnancy Congenital anomalies

birth Rubella, toxoplasmosis Anophthalmos (almost no ocular tissue)
Venereal disease, herpes Microphthalmos (reduced eye size)
HIV, cytomegalovirus Coloboma (hole in eye structure)
Prematurity Congenital cloudy cornea
Low birth weight Retinopathy of prematurity (abnormal growth of blood vessels)
Low Apgar scores Congenital cataracts (obscuring cloudiness of eye lens)
Prolonged supplemental oxygen Infantile glaucoma (fluid pressure damaging optic nerve)
Difficult or assisted labor Retinal dystrophies (chronic retinal disorder one is born with)
Fetal distress Cortical VI (eye impairment caused by the brain, rather
Grade III or IV intraventricular hemorrhage than eyes)
Myopia, albinism, or nystagmus Optic nerve hypoplasia (improper development of optic nerves)
Microphthalmia (abnormally small eyes)
Anaphthalmia (the absence of eyes)
Family history and Past experiences and background are Retinoblastoma (cancer in the retina of the eye)
background important to consider Congenital cataracts
Metabolic or genetic diseases
Visual conditions in mother Current issues with vision in the mother or High refractive error (eye shape prevents focus)
or infant infant at the time of birth may impact the Strabismus (improper alignment of eyes)
child’s risk for further VI Anisometropia (two eyes with differences in vision)
Developmental disability or Children with a preexisting developmental Cerebral palsy
condition disability or condition have a much higher Dysmorphic features (any noticeable difference in body
risk of developing a VI structure)
Hydrocephalus (buildup of cerebral spinal fluid on brain)
Central nervous dysfunction
Seizures

Note. VI = visual impairment.

“
when vision loss occurs in
Burchinal, & Ferrel, 1997; Heyl &
Hintermair, 2015). It is critical for
parents and professionals to view
each individual child’s needs as
to vision loss, they must be
consistently involved with the
environment and the people within it.
Julia fought to know which steps
infancy, the development unique and to be aware of periods in
overall development. The key sense
to take after the diagnosis of her
children’s VIs. Her doctor insisted
for learning and primary source for that Chelsea undergo surgery in an
of cognitive, motor, and sensory input is vision. The majority attempt to remove the cataracts
of a child’s learning is gained through when she was just 6 weeks old. While
the senses. Therefore, severely LV will the surgery improved Chelsea’s
social skills are altered, have a powerful effect on an eyesight to some extent, it could not
individual’s development (Alimović completely fix it. However, the slight
et al., 2013). When vision loss occurs change sparked hope in her mother.
often diminished in infancy, the development of Julia began to notice Chelsea’s

”
cognitive, motor, and social skills are increasing sensitivity to light.
altered, often diminished. To Eventually, the cloudiness in her eyes
compensate and make sure children started dissolving, revealing the
with VIs do not miss out or lag on beautiful blue tint Julia often
important developmental stages due received compliments for herself. The

4 YOUNG EXCEPTIONAL CHILDREN  Vol. XX, No. X, Month 2016

 Visual Impairments in Young Children / Thompson and Merino

Table 2
Developmental Differences in Infants and Young Children With a Visual
Impairment
Domain Differences

Physical Lagging gross motor skills (crawling, standing, walking)

Lagging fine motor skills (grabbing, holding)
Delays in object permanence leads to later development of reaching
Differences in overall movement and mobility
Typically less active
Variances in appearance of the eyes and face
Cognitive Language differences
Types of words acquired
Use of words
Difficulty with reciprocity, pragmatics, and referencing nouns
Experience difficulty with executive function
Delays in communicative competence
Lags in achievement of object concept/permanence
Rely more heavily on auditory, olfactory, tactile, and kinesthetic senses
Socioemotional Experience more frequent emotional or interpersonal maladjustment
Issues with attachment process with primary caregivers
Difficulty engaging in socialization
Struggle to interpret facial cues and body language
Require extra support and encouragement from caregivers

doctor warned that future surgeries Matthew as they were for his older
may be required to help develop sister, this was something Julia could
Chelsea’s eyesight even more. But at do to help him in the meantime.
that moment, Julia was thankful for
the success so far, even if Chelsea’s
vision had only improved from Corrective Measures
20/200 to 20/100.
Throughout Julia’s pregnancy It is important to provide infants
with Matthew, she knew he might and young children with a VI, a
face similar complications to his strong foundation for an efficient
sister’s. Matthew, being born with visual system by exploring options
cerebral palsy and having also been for corrective measures, which can be
diagnosed with congenital cataracts, done to improve vision. Possible
similarly underwent surgery at 7½ corrective measures include glasses,
weeks old. His surgery was not quite eye patches, medicine, and/or
as successful as Chelsea’s because he surgeries to correct or improve vision
still had a vision of 20/200 after the (Center for Parent Information and
procedure to remove the cataracts. Resources [CPIR], 2015). An
Yet, there was still good news; example of a surgical measure is the
Matthew’s right eye showed a removal of cataracts for a child who
slightly stronger visibility than his is born with congenital cataracts, as
left, and the family’s doctor suggested with Chelsea and Matthew.
covering Matthew’s right eye so the Corrective surgeries are suggested
left would develop strength. While within the first 2 months of life to
future surgeries were possible for help the brain process visual input

Vol. XX, No. X, Month 2016  YOUNG EXCEPTIONAL CHILDREN 5

 Visual Impairments in Young Children / Thompson and Merino

accurately and encourage plasticity that of their mother’s soothing

“
For a child with a VI,
and improved recovery of
impairment (Alimović et al., 2013).
A clear visual axis, the imaginary
line passing from the object seen
singing at night.

Purpose and Principles

through the structure of the eyeball of EI
(“Visual Axis,” 2016), with a
one of the main goals properly focused image, must be For a child with a VI, one of the
accomplished during the first 6 to 8 main goals is to help him learn how to
is to help him learn weeks or permanent VI can result
(Dale & Sonksen, 2002). If Chelsea’s
interact with the environment and
develop specific ways to address
and Matthew’s individual surgeries sensory information. The IDEA Part C
how to interact with the to remove the cataracts had been refers specifically to the purpose and
done after the 6- to 8-week period, benefits of EI programs for infants and
the cataracts may have been young children, birth to age 2, as well
environment and develop successfully removed, but visual as their families. The policy itself
acuity for both infants may not have supports helpful relationships and
improved. Corrective surgery can family-centered care for individuals
specific ways to address prove extremely promising. However, with disabilities. IDEA provides strong
it is merely one form of EI to evidence to support the significance EI
sensory information. promote optimal development of a
child with a VI.
can have on overall financial and
health outcomes for individuals with

”
As months passed, Chelsea and disabilities (Adams & Tapia, 2013).
Matthew received regular visual tests The purpose of EI is to provide the
and attended therapy twice a week. necessary supports for both the child
The children’s doctor told Julia that and family to lessen the effects of the
when the children were slightly older, delay or impairment (Anthony, 2014).
she could look into glasses and With effective intervention, the overall
corrective lenses for them. Although long-term resources an individual with
Julia was troubled to recognize there a disability might need from the
was no definitive chance of a community are likely to be greatly
breakthrough for her children, she reduced.
felt hope when her doctor referred A key finding is that caregiver
Julia to a pediatric vision specialist. involvement and support is a
Julia found her vision specialist, significant factor in EI effectiveness
Mona, to be of great help as she (Hatton et al., 2013). The goal of EI
recommended engaging in EI with is for parents and professionals to
the children. Mona encouraged her work together to identify, develop,
to support the development of her and provide learning experiences,
children’s vision through continuous which promote the infant’s
stimulating activities, such as Julia development. EI can guide parents on
verbally telling Chelsea and Matthew how to effectively interact with young
what she was about to do before children to encourage sustained
making physical contact, always engagement with the environment.
providing plenty of light, and When an infant or toddler learns to
teaching them to touch many actively take part in his surroundings,
different textures. The children were growth and development are likely to
also exposed to many different noises flourish. The authors have
and sounds, the most frequent being collaborated and assembled a list of

6 YOUNG EXCEPTIONAL CHILDREN  Vol. XX, No. X, Month 2016

 Visual Impairments in Young Children / Thompson and Merino

Table 3
Preparing to Interact With Young Children With Visual Impairments
What Why How

The environment Encouraging visual stimulation in the environment is Increase or decrease lighting in the room.
vital. Preparing the child’s surroundings will ensure Use task lighting or highlight materials with a flashlight or
stimulation while interacting with objects and headlamp.
people. Be sure to avoid glare on windows, boards, and so on.
Provide contrasting backgrounds (i.e., dark sheet under a
toy, striped wallpaper)
The child Scheduling routines for caretaking tasks will increase Make sure child’s position laying, sitting, or standing
likelihood of a successful interaction. Choose a provides stability.
time when child is well rested, fed, and able to Switch child’s position often.
stay alert and responsive. Ensure position offers comfort and many different views
and perspectives.
Continually move to keep the child motivated.
The caregiver Similar to the environment, people within the Dress in bright and contrasting colors to attract the child.
environment can be a very crucial visual simulation Wear bright colored lipstick to draw attention to
tools. movement of the mouth.
Use very engaging and exciting facial expressions and
tone of voice.
The materials Evaluating size and type of materials to fit the child’s Consider which angle is best for objects and materials.
needs will help him or her stay focused and Choose different angles from which to display objects or
attentive to cues within the environment. position child to offer diversity.
Carefully choose colors of objects/materials (consider
black, white, and red).
Allow plenty of time for child to explore and show
response to materials.
Change materials when child does not seem interested.
Consider materials child enjoys most (i.e., parent’s faces,
own hands and feet).

considerations for support when with a VI recognize the touch of his

preparing to interact with an infant mother’s face or respond to his
or young child with a VI (refer to father’s voice? In general, sensory
Table 3; M. Baxter, personal stimulation should be provided
communication, August 25, 2013). within natural contexts by using real,
preferred, and meaningful stimuli.
Meaningful stimuli can include
Sensory Stimulation people, sounds, objects, toys, and
other familiar objects, which
When EI providers work with encourage the infant to look, listen,
infants and young children with a VI, and touch when appropriate.
it is vital to observe how the child Reducing overly stimulating
responds to familiar sensory background noise and visual clutter
stimulation. Sensory stimulation, in will allow the child to attend to
the most basic sense, is the arousal of critical features. Following the child’s
any one of the five senses. This is interests and adding words or cues to
helpful to determine whether or not actions when appropriate will also
the child understands the sensory prove meaningful and heighten
input. For example, does the child chances of a successful interaction.

Vol. XX, No. X, Month 2016  YOUNG EXCEPTIONAL CHILDREN 7

 Visual Impairments in Young Children / Thompson and Merino

Table 4
Additional Strategies for Support and Encouragement of Visual Stimulation
What How

Give voice cues often Frequently call out child’s name. Help him or her become accustomed to many voices and
to become aware of sounds associated with different activities.
Determine preferences Determine color, size, and shape preferences. Using the child’s preference will increase the
chance of a successful interaction.
Give choices Present child with different tools to accomplish a task. Help him or her learn that there are
many different tools to assist in completing a task.
Teach prepositions Read books and play games to help child begin to learn words such as in, out, around,
under, and over. This will support the child in his or her more limited management of the
environment.
Make a path Use a rope to create a game out of finding ways around the child’s environment. Give
praise and use encouraging, guiding words along the way.
Let them help clean up Help the child learn where things go. Teach to continually familiarize self with materials and
objects within the environment.
Play “Where’s the . . .?” Help the child learn a new environment and build confidence by identifying where objects
are in the room frequently.
Play “What’s gone?” or “Hide and seek” Help the child learn how to rely on his or her memory and own ability to notice a missing
or hidden object.
Make predictions Give the child opportunities to predict where certain objects will be within the environment.
Play “How does it feel?” Let the child feel and familiarize self with materials before an activity, discussing how each
object feels.

Source. Adapted from Sparling and Lewis (1979).

Encouraging Visual Stimulation During Feeding:

Sit near a light or window so
When planning activities to
faces are illuminated and
encourage visual stimulation,
more likely to be seen
remember to look at the child’s
Use brightly colored utensils
individual degree of vision loss,
to allow visual tracking and
needs, likes, and temperament. This
fixation
will help in the selection and success
Use a solid colored, high
of the activities (refer to Table 4), for
contrasting placemat to
further suggestions of support and
increase focus on food
encouragement while interacting with
Place food in different
an infant or young child with a VI.
locations on tray or plate
It is also important to consider
the visual skill being reinforced as
well as the child’s daily routines During Play or Other Routine
when adding a stimulation activity. Care:
For example, as a newborn spends Shine light on the child’s
the majority of the day sleeping, hands or feet while playing
eating, and being diapered, these are with them to draw attention
perfect opportunities to integrate Put wrist rattles on the child’s
visual stimuli to increase engagement wrists or ankles to encourage
during interactions. Consider the fixation on hands and feet
following suggestions during routine Use movement toys that
care of an infant or young child: will elicit tracking, such as

8 YOUNG EXCEPTIONAL CHILDREN  Vol. XX, No. X, Month 2016

 Visual Impairments in Young Children / Thompson and Merino

bubbles or brightly colored routines. The integration of these

scarves exercises throughout the day can
Give simultaneous verbal have soothing effects on the young
description of activities in child, promote interaction with the
which the child is engaged caregiver, and encourage the child’s
Try mirror play for social use of sensory stimulation to process
gaze and smiling his or her surroundings (Hertenstein,
2002). Tactile activity ideas are
During Care Giving: discussed below:
Position the child at different
ends of crib or bed so that he •• Use fingers to stroke child’s
or she will turn toward light skin when feeding, diapering,
Allow the child to play with changing, holding, or playing
materials before using them •• Vary stimulation during
in the care giving activity contact by altering pressure of
Give many auditory cues fingers and hands
before use, such as, “Mommy •• Place child on different
is going to wash your face” textured surfaces such as
and “Do you hear that bird carpet, hard floors, or
singing?” (adapted from textured squares
American Foundation for the •• Provide toys and blankets
Blind & M. Baxter, personal with different materials such
communication, August 25, as silk, cotton, or fleece
2013) •• Blow on the child’s face,
fingers, toes, or belly, and vary

“
the intensity
Integrating Multiple Senses •• Bring child’s hands and fingers
to your face for contact
All children must learn to When working with young
children with a VI, it is crucial to
•• Run various materials on
child’s hands, arms, legs, or
encourage development through feet like a spoon or soft
integrate sensation, but stimulation of multiple senses. All blanket
children must learn to integrate •• Describe what you are doing
sensation, but even more so children and items the child is touching
even more so children with a VI, because their sense of sight to help him better “see” them.
can limit the development of other
senses. Encouraging children with
with a VI, because their VIs to use other senses, such as the
olfactory, kinesthetic, and tactile
Reading Signals and
sense of sight can limit senses, will help them learn how to Cues
access and process their environment
through multiple means. For a young child with a VI, the
the development of other Contrary to vision, touch is one awareness and response to
of the most developed of the senses intervention are two components to
as an infant experiences a successful interaction. A key
senses. responsiveness to touch at a mere 8 reaction to look for, and by far the
week’s gestation (Hertenstein, 2002). most challenging to recognize, is the

”
Parents and professional caregivers child’s signal that he or she is not
have the opportunity to integrate seeing an item. Are the child’s eyes
many tactile strategies into daily open and looking around? Does the

Vol. XX, No. X, Month 2016  YOUNG EXCEPTIONAL CHILDREN 9

 Visual Impairments in Young Children / Thompson and Merino

child blink when he or she sees the young child holds a book or toy
item or in response to light? Does the unusually close to her face often, and
child become quiet when light or an excitement increases, which is
object is presented? Does the child observed in “jabbering” or giggling
increase or decrease a behavior at the more when the object is closer, the
presentation of an object or light? It child would likely benefit from
is important to watch for head tilting having books or toys held in closer
or righting, head turning, visual proximity (American Foundation for
reach, swiping at or grasping objects, the Blind, n.d.). A child with a VI
and any other movements toward may also seem unusually “clumsy”
light and/or objects. These are motor by unintentionally hitting items or
responses which are indicators of bumping into objects as she becomes
whether or not the child sees the mobile, often causing short cries that
object and should be closely reflect frustration; to help keep the
monitored. child safe and to encourage her
In addition, when working with mobility, make sure the most
a child with a VI, it is critical to learn frequented areas of the child are
to read signals during an activity. baby proof and comfortable for her
Watching for signs of frustration, (CPIR, 2015). Because of the
fatigue, excitement, or pleasure from frustration that comes with any task
the child are all key components to a that would involve typical visual
successful intervention. There are abilities, such as self- or spoon
signs and strategies which can help feeding, children with a VI may cry
with this task, such as knowing the (CPIR, 2015). Being aware but
visual acuity of the infant and patient with the child at meal time or
evaluating the size, distance, and during a typically visually demanding
location of the object. If any of these activity and helping her by being
three conditions are not right for the more vocal could encourage her to
child, one can assume he or she is not complete the task. Another behavior
seeing the item and the caregiver to watch for that demonstrates
should make adjustments in the frustration is whether a child
environment to help the child. Some consistently rubs her eyes (CPIR,
observations to help understand 2015).
what the child may or may not be
seeing are described. For example,
find a toy that the infant often
Guidance for
studies to watch for tracking of the Practitioners
toy; if the child follows the toy, she is
likely seeing the object. However, if It is equally crucial for
the child no longer follows the toy or professionals working with children
becomes irritable by crying or with VIs to be aware of strategies to
moving her head, she may be having help support overall development.
trouble seeing it. For younger infants, Practitioners must be knowledgeable
following a human face may work in regard to the disability and be
better than following a toy (Rappo ready to modify the environment,
et al., 1996). Another way to assess materials, and everyday routines to
whether the infant is visualizing the best meet the needs of the child
activity is to watch her reaction with (Anthony, 2014). As the child grows
a book or toy she enjoys. If the and enters out-of-home care, he is

10 YOUNG EXCEPTIONAL CHILDREN  Vol. XX, No. X, Month 2016

 Visual Impairments in Young Children / Thompson and Merino

faced with many new obstacles. Julia has had to learn how to
Being aware of the support strategies improve her home for both children.
and activities used in the child’s With the advice from her vision
home setting and implementing them specialist, Julia has made changes
in the out-of-home-care setting can such as adding more lighting to the
have extremely positive effects. It is places in the house that the children
critical for parents and professionals frequent the most, as well as giving
to collaborate to support the child in both Chelsea and Matthew bracelets
every way possible. The that consist of small jingle bells. This
aforementioned considerations and has helped keep Julia aware of where
approaches to successful sensory both children are during playtime. To
stimulating activities should also be keep improving Chelsea’s and
used in the child care setting. Matthew’s sight, Julia continues to
More than anything, it is buy toys that offer sensory
important to meet children with VIs stimulation, such as a toy pig that
where they are developmentally, will play a song and vibrate if its
implement appropriate practices, set snout is pressed. Toys like the pig
them up for success, focus on the have caused Chelsea and Matthew to
positive, and continually monitor use their stronger senses (feeling the
and report progress to families. This vibration of the toy and hearing the
strong and collaborative effort music) to engage their sight. One of
between families and practitioners Julia’s favorite ways of spending time
will be what ultimately helps the with Chelsea and Matthew is in front
child with a VI to achieve optimal of her bathroom mirror, where the
development (Kesiktas, 2009). children delightfully squeal as they
Even though the children’s vision can move themselves as close as
has improved somewhat, Julia still needed to better examine details of
finds herself constantly trying to their own faces. To both Julia’s and
invent ways in which she can create their vision specialist’s joy, Julia has
an environment that will offer the noted that the distance of her
best help to her now 24-month old children’s face seems to move farther
and her 14-month old. Both Chelsea away from the mirror each day as
and Matthew are now walking, and their vision continues to improve.

Authors’ Note
You may reach Stacy D. Thompson by e-mail at stacyt@siu.edu.

References
Adams, R. C., & Tapia, C. (2013). Early intervention, IDEA Part C services,
and the medical home: Collaboration for best practices and best outcomes.
American Academy of Pediatrics, 132, e1073-e1088.
Alimović, S., Katušić, A., & Mejaški-Bošnjak, V. (2013). Visual stimulations’
critical period in infants with perinatal brain damage. NeuroRehabilitation,
33, 251-255.
American Foundation for the Blind. (n.d.). Promoting your baby’s growth and
development. Retrieved from http://www.familyconnect.org/parentsite.asp?
SectionID=75&TopicID=350&DocumentID=3900

Vol. XX, No. X, Month 2016  YOUNG EXCEPTIONAL CHILDREN 11

 Visual Impairments in Young Children / Thompson and Merino

American Optometric Association. (2010). Optometric clinical practice guideline:

Pediatric eye and vision examination (2nd ed.). St. Louis, MO: Author.
Anthony, T. L. (2014). Family support and early intervention services for the
youngest children with visual impairments. Journal of Visual Impairment &
Blindness, 108, 514-519.
Center for Parent Information and Resources. (2015, July). Visual impairment,
including blindness. Retrieved from http://www.parentcenterhub.org/
repository/visualimpairment/#signs
Chong, C., & Dai, S. (2014). Cross-sectional study on childhood cerebral visual
impairment in New Zealand. Journal of AAPOS, 18, 71-74.
Dale, N., & Sonksen, P. (2002). Developmental outcome, including setback, in
young children with severe visual impairment. Developmental Medicine &
Child Neurology, 44, 613-622.
Elisa, F., Josee, L., Oreste, F., Claudia, A., Antonella, L., Sabrina, S., & Giovanni,
L. (2002). Gross motor development and reach on sound as critical tools for
the development of the blind child. Brain & Development, 24, 269-275.
Erickson, W., Lee, C., & von Schrader, S. (2015). Disability Statistics from the 2013
American Community Survey (ACS). Ithaca, NY: Employment and Disability
Institute, Cornell University. Available from www.disabilitystatistics.org
Fantz, R. L. (1963). Pattern vision in newborn infants. Science, 140, 296-297.
Fazzi, D. L. (2002). Social focus. In R. L. Pogrund & D. L. Fazzi (Eds.), Early
focus: Working with young children who are blind or visually impaired and
their families (2nd ed., pp. 188-217). New York, NY: American Foundation
for the Blind.
Fry, M., & Wilson, G. A. (2005). Scope for improving congenital cataract
blindness prevention by screening of infants (red reflex screening) in a New
Zealand setting. Journal of Paediatrics and Child Health, 41, 344-346.
Gogate, P., Gilbert, C., & Zin, A. (2011). Severe visual impairment and blindness
in infants: Causes and opportunities for control. Middle East African Journal
of Ophthalmology, 18, 109-114.
Haibach, P. S., Wagner, M. O., & Lieberman, L. J. (2014). Determinants of gross
motor skill performance in children with visual impairments. Research in
Developmental Disabilities, 35, 2577-2584.
Hatton, D. D., Bailey, D. B., Burchinal, M. R., & Ferrell, K. A. (1997).
Developmental growth curves of preschool children with vision impairments.
Child Development, 68, 788-806.
Hatton, D. D., Ivy, S. E., & Boyer, C. (2013). Severe visual impairments in
infants and toddlers in the United States. Journal of Visual Impairment &
Blindness, 107, 324-336.
Hertenstein, M. J. (2002). Touch: Its communicative functions in infancy. Human
Development, 45, 70-94.
Heyl, V., & Hintermair, M. (2015). Executive function and behavioral problems
in students with visual impairments at mainstream and special schools.
Journal of Visual Impairment & Blindness, 109, 251-263.
Holbrook, M. C., & Koenig, A. J. (2000). Foundations of education: Vol. 1.
History and theory of teaching children and youths with visual impairments.
New York, NY: American Foundation for the Blind.
Huebner, K. M. (2000). Visual impairment. In A. J. Koenig & M. C. Holbrook
(Eds.), Foundations of education: Instructional strategies for teaching
children and youths with visual impairments (2nd ed., Vol. 2, pp. 55-76).
New York, NY: American Foundation for the Blind.
Kesiktas, A. D. (2009). Early childhood special education for children with visual
impairments: Problems and solutions. Educational Sciences: Theory &
Practice, 9, 823-832.

12 YOUNG EXCEPTIONAL CHILDREN  Vol. XX, No. X, Month 2016

 Visual Impairments in Young Children / Thompson and Merino

Kolb, B., & Whishaw, I. Q. (2009). Fundamentals of human neuropsychology

(6th ed.). New York, NY: Worth.
Leone, J. F., Mitchell, P., Kifley, A., & Rose, K. A. (2014). Normative
visual acuity in infants and preschool-aged children in Sydney. Acta
Ophthalmologica, 92, e521-e529.
Lewis, M. L. (2014). A comprehensive newborn examination, Part I: General,
head and neck, cardiopulmonary. American Family Physician, 90, 289-296.
Lowth, M. (2014). Detecting developmental delay. Practice Nurse, 44(5), 24-28.
Mussavi, M., Asadollahi, K., Janbaz, F., Mansoori, E., & Abbasi, N. (2014).
The evaluation of red reflex sensitivity and specificity test among neonates in
different conditions. Iranian Journal of Pediatrics, 24, 697-702.
Rappo, P. D., Cox, E. O., Green, J. L., Herbert, J. W., Hodgson, E. S., Lustig,
J., . . . Atkins, J. R. (1996). Eye examination and vision screening in infants,
children, and young adults. Pediatrics, 98, 153-158.
Siatkowski, R. M., Good, W. V., Summers, C. G., Quinn, G. E., & Tung, B.
(2013). Clinical characteristics of children with severe visual impairment
but favorable retinal structural outcomes from the Early Treatment for
Retinopathy of Prematurity (ETROP) study. Journal of AAPOS, 17, 129-
134.
Sparling, J., & Lewis, I. (1979). Learning games for the first three years: A guide
to parent-child play. New York, NY: Walker.
U.S. Department of Education. (2004). Regulations: Part 300. Sec. 300.8 child
with a disability. Retrieved from http://idea.ed.gov/explore/view/p/%2Croot
%2Cregs%2C300%2CA%2C300%252E8%2C
Visual axis. (2016). In The medical dictionary. Retrieved from http://www
.medicaldictionary.thefreedictionary.com/visual+axis

Vol. XX, No. X, Month 2016  YOUNG EXCEPTIONAL CHILDREN 13