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Wednesday, December 31, 2008

Babies and Toddlers: Tips for the Early Years


Introduction

Parents and workers with vision impaired people have a great opportunity to help a young vision impaired child towards good mobility and orientation. The following are a few basic suggestions of areas in which a child could be helped. As a result of this basic work, mobility training is easier and more meaningful, as many mannerisms and postural faults do not arise in later life.

Suggestions:



  1. When a sight disorder is first diagnosed in a young child, parents often can only think of all the things that their vision impaired child will be able to do. It is important to encourage positive thinking. Begin by assessing the situation. Long delays in diagnosis, difficulties in understanding medical terms and long separation due to hospitalisation can make this hard. However, having constructive tasks to do helps to overcome some of these problems.
  2. Try to assess how much the baby can see. Is there any residual vision? Can the small baby follow it's mother or father's face or movements at all or is it relying entirely on a sound stimulus? For the vision impaired baby, the overall shape of the face will be more important than the detail. For example, a mother with a bushy hairstyle approached the baby's crib with wet hair after a shower. The baby cried because he thought it was a stranger. The overall shape was what the baby was recognising.
  3. As the father carries the baby over his shoulder, does the baby react to the light coming in from the window? If the baby seems to show some response, then tell the baby each time the window is passed and interpret other sources of light within the house.
  4. "Normal" sight in babies is not at all precise at the beginning. Like everything else, it needs practise. Babies in the early stages make a crude performance at focussing and co-ordination. Objects cannot be seen clearly. Vision too can fluctuate in the vision impaired baby. A child with Albinism can be blind at birth, have the appearance of normal vision at two years but by school age the vision may be subnormal. Some eye disorders present at birth may show some improvement and others not.
  5. A baby who is vision impaired can and must feel and hear the love of others for it. Premature babies who start their days in an incubator experience very little touch from others. They may have to be taught to like to be held. Such babies may first show displeasure when handled but this gradually turns to joy. Early mother/child relationships can be at risk, as eye contact is lost and there may be no smiling response to the mother's presence.

Parents should try to design a programme of a few tasks that they can do together with their baby to help it learn about its environment and become physically fit.

Suggestions



  1. Begin by putting the baby on its stomach on a mat on the floor. From about 4 months the baby may be able to raise its head clear of the ground. Parents should get down on the floor too and talk to reassure the baby very near to its face. Put the baby on its stomach for a little while at least twice a day. This strengthens the back and develops the hands to be useful feelers. Objects of interest - a bell, toy, brick, and teaspoon - can be placed in front of the baby who will soon learn to reach out and find what is there. When a new physical activity is introduced the baby will usually cry against the activity, but do persevere. It is just the strangeness of the activity that the child doesn't like in the beginning.
  2. Parents should try and sing and talk to the baby as much as possible. If a parent is very pressed for time, one suggestion could be to use the nappy changing time for a useful purpose. Language development depends on clear speech. The parent's face is near to the baby's during this activity, which means that a child with limited vision will be able to see their parent's lips as well as hearing very clearly. Make all the sounds of the alphabet, sing little rhymes, speak loudly and softly, in a high and low voice. The parent can take the baby's hand and put onto their mouth. Turn the baby's head towards the sound. Let the baby know its own name and commands like "Yes" and "No". Games with the child on the parent's lap and songs with repetitive actions are good also. The child will need to be shown the movements, as they cannot learn by imitation.
  3. When dressing, changing or washing the baby, take a little extra time to run hands over the different parts of the baby's body, talking about all the different areas - e.g. "this is your foot, here is your other foot". Smooth the baby with talc, cream or oil - all different experiences of touch and smell. Relate different parts of the baby's body to the parent's body - e.g. "this is your hand; this is Daddy's hand".
  4. When feeding the baby with a bottle, place the baby's hands on the bottle too. The baby will learn where the milk is coming from and will gradually be able to hold the bottle itself. The baby should be held in the mother or father's arms when feeding so that a warm relationship develops. When drinking from a cup, show the baby the cup empty first, then fill with liquid so that the baby can hear it filling and then drink it. Let the child experiment with feeding itself. Don't worry is the child is getting messy. A child must be able to find out and experiment with touching and feeling.
  5. Do little physical exercises with the baby from very early on - of course, supporting the baby as much as possible. Totally blind babies often do not crawl, as the baby soon learns that this activity brings its head into contact with too many solid objects. As this part of development is missed, the baby may not flex its ankle and foot correctly when it begins to walk. Perhaps some part of the house and garden could be made safe, with no obstacle and piles of cushions for the baby to have some rough and tumble play.

Vision impaired children often have a diminished drive and lack opportunities to take risks and be daring. Children's reasons for moving around are to see friends and play games. Blind children may only move when they feel it is really necessary.

Suggestions:



  1. A parent and baby swimming class can greatly help. Begin by taking the baby into the water in your arms. Don't worry if the child cries for the first few visits to the pool; it is a new experience and very noisy. Progress the child to holding your shoulders, faces in contact, talking all the time to reassure.
  2. Some toys can be great help to mobility. A slightly weighted wooden truck to push means that the toy reaches obstacles first. Other toys in this group might include - a baby walker, a hula-hoop, a sweeping brush.
  3. Try not to develop a preoccupation with the physical safety of the child. Provide circumstances in which movement can be encouraged safely. All children get bumps and have little accidents - try not to be over-protective. Fear is natural for the child and parents, but this has to be overcome by repetition and practice.
  4. Take a little time with the child to learn the dangers around the house. What sounds and smells mean danger and which sounds and smells are harmless, eg. the sounds of frying and of water boiling, the odours of cooking and the significance of smoke and fire. It is important for parents to help a blind child to monitor its behaviour.

Babies and toddlers constantly adjust their behaviour by the effect that it has on others. Does mother notice when we do something? What happens as a result of that behaviour? Approval or disapproval?

Here is an illustration: An integrated blind toddler in a pre-school group had a habit of pinching any child that came near during play activity time. As a result all the other children would avoid the vision impaired child leave him alone. As the aim of the parents was for integration, this situation could not continue. The adults explained that pinching hurt, even a little demonstration was needed. In this particular case, the teacher was very reluctant to scold the blind child, and the support worker had to provide support, advice and reassurance for the teacher.

Small children love helping around the house and doing tasks, which they know other members of the family, are managing themselves. Many early mobility skills can be incorporated in this type of play experience. Strengthening fingers and thumbs, for example, can be achieved when dressing oneself. Begin by taking clothes off, as this is easier then putting clothes on. Buttoning and zipping take practise and take time to learn. Always arrange clothes in an orderly fashion. The blind child needs a place of its own, with its own coat and hat peg, a place in the cupboard for its clothes, a box for its toys and its own bed. Get the child to put away his things and to make decisions about what to wear. When choosing clothes try to pick articles that are distinctive to feel and talk to the child about the features, design and colour combinations of his clothes.

Let the child help with the clearing and setting of the table, getting the mail, bringing in packages, washing a small quantity of dishes and washing its own body. Begin by first washing face and hands and build up in easy stages. In play, the child can wash dolly's clothes, or give dolly a bath - lego, plasticine, play-dough, putting on bottle tops, all help to strengthen hands and fingers.

Practise listening to sounds around the house, locating and identifying them. For example, listen to the bathroom sounds, tap dripping or running, toilet flushing, shower and wash basin. Lounge sounds - clock ticking, T.V., radio, fan heater, telephone ringing. Identify the sound, and talk about and discover the exact position of the source of the sound. Listen to sounds outside as well as inside. Can the child begin to recognise voices and footsteps of regular visitors to the house, different car engines that come up the front drive, milk bottles rattling, traffic sounds in the street. The child can practise following mother around the house by sound alone - audible hide and see! Play 'hide and seek' with other sound sources also.

Take a little time to think about the baby's feet. If possible have the feet bare. The feet give another tactile, information gathering surface. Loose socks are better than tights or baby-grows because they do not pull on the toes altering the natural position of the soft toe bones. Try and do little exercises to strengthen and mobilise the feet - moving the toes independently, picking up objects with the toes.

Hopping, skipping, bouncing and jumping should be encouraged and activities that include these skills are of great benefit e.g. Jumping from the last stair to the ground, firstly into parents' arms, then onto a soft large cushion and then on the ground, all of these activities accompanied by plenty of verbal encouragement.

Stairs will have to be shown to a vision impaired child. Begin by going up stairs on all fours and coming down sitting on its bottom, taking one step at a time. Progress to both feet on one stair at the same time using the rail as a guide to indicate the beginning and end of the stairs.

If a child has no guiding sight, there will be occasions when a small child will need to be guided by a parent or friend. It is best to let the child take the elbow of the guide and for the child to remain slightly behind the guide. This position is preferable to holding hands. The steady point of reference of the elbow held against the body of the guide provides warning in advance. Baby reins are useful for an active young toddler together with the elbow hold. Normally, the child should be led rather than push from behind.

Parents have the opportunity to cover many of the basic mobility skills that are needed by a young vision impaired child.

Copyright (c) NCBI 2006

About NCBI

The National Council for the Blind of Ireland (NCBI) is a not for profit charitable organisation which offers support and services nationwide to those experiencing difficulties with their eye-sight.

NCBI provides a range of services to almost 10,000 vision impaired people living in Ireland. These services include the provision of information, advice and support via a nationwide network of over 70 rehabilitation, mobility and community resource workers and training in the use of adaptive technology. They also provide an employment support unit and job seeking skills programme.

NCBI is committed to offering people the choice of services in their own homes or in a centre based setting. To facilitate this they have 10 regional resource centres and run low vision services throughout the country.

As well as services administered by their community based staff, NCBI's Libraries in Dublin and Cork provide a national talking book service, as well as a wide range of newspapers, popular Irish magazines and journals on tape to over 4,000 subscribers.

As well as providing services to vision impaired people and their families, NCBI also provides a range of services to public and private organisations in relation to technology, access and awareness and media conversion services.

Click this link to visit the National Council for the Blind of Ireland website: http://www.ncbi.ie.

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