Milestones for children with visual impairment?
ayram
member
I posted a while back about a 3 year old boy that I am providing full-time child care for who was born with no eyes. I found some good resources for helping his development, but I'd like to ask a few questions.
He is not walking yet, and Mom says it's just because he doesn't see, and never had any motivation to learn to walk. But it's not just that he doesn't walk - he doesn't crawl, stand, or even go from lying down to sitting up. He can't put his soother in his own mouth, and only talks with two or three quick words together.
I know that he may be later to hit some of these milestones, but this seems odd to me. Mom is very protective of him, and puts his soother in his mouth when he needs it (whereas I put it in his hands and make him do it himself). I don't want to push him too hard, but I think he needs a bit of a push here and there.
He does do some sort of OT or Pt, and has braces to help him stand, but I haven't been told of any other underlying issues aside from his vision.
Any thoughts? Any suggestions for building muscle, helping him stand?
Thanks again for your help!
Re: Milestones for children with visual impairment?
i don't want to assume because it's the last thing a parent of a child with special needs wants/needs is for someone else to "think" they know about the situation BUT being visually impaired does not mean he does not have the motivation to want to do these things. the real question is if there are other things going on that prevents him from being able to do these things. every kid with special needs would not get to a milestone had it not been for some "pushing" aka making them do things. i know sometimes at the end of the day it is easier to do things FOR them than challenge them. i'll be the first to say i'm guilty of that after a day of work and daycare when all anyone in my house wants to do is eat and go to bed.
anyway, all that being said, an exercise ball is great to use for a workout. it can help him stand and also provides sensory feedback with the "bouncing" of it. you can use a regular one but there's also textured ones out there too. you can place his feet flat on the floor inbetween your legs and then lean him against the ball; while holding him steady just do a little bouncing. or sit him on the ball and also bounce while holding him. a wedge in good too. he can be on his tummy but this will keep him somewhat off of the floor and make him work some. most people use this for head control exercise but it will also help him to get other areas of his body moving. i can't remember how old he is but (even though lots of dr's hate them) a johnny jump up/jumparoo is actually great for short periods of time. it helps them use their legs. i use it with my son and he has very low tone.
you may also want to check out the facebook page "thinking outside the lightbox". i'm sure they will have lots of ideas for stimulation.
just curious, does he get any services for his visual impairment?
hope that helps!
That's a great idea with the exercise ball - we'll try that. He is beyond the weight limit for the Jumperoo - but he used to love it. I'm pretty sure he recieves some services from CNIB (Canadian National Institute for the Blind), but Mom doesn't suggest much to me - I've asked, but she doesn't offer much.
I think I'm just going to make as much of an effort as I can to challenge him, since he's here for most of the day. Just yesterday, we had a small victory with his soother - he found it, and (after much encouragement) put it into his mouth.
Thanks for your input!
Adge-- I wasn't familiar with the lightbox group--thanks!
Ayram-- I'm sure you're figuring out that this isn't a cut and dry issue. It is certainly possible for children who are completely blind to develop the same motor skills that a child who sees has. With that said--there are so many grey areas around that, the progress may look different, there may be other underlying special needs that you are unaware of that contribute to this picture. As I parent I hate to say this, but there's also the sad truth that some people (parents and professionals alike) just don't see how a child who has vision impairment or blindness can do things. And because they've ruled their abilities out before giving them a chance, they may not see things for what they are. This has definitely been a hard thing for us to learn. Things look different coming from kids with sensory impairments, but that doesn't mean there's a cognitive impairment. Hopefully that isn't the case here, but it strikes me as odd that this information wouldn't be shared openly with you if you are doing his care full time. If you've worked with him full-time I'm guessing you've met his therapists/teachers? Can they give you guidance?
As far as motivation, it sounds like you're already finding ways around his lack of visual motivation through auditory input. We got our daughter to crawl pretty much solely through use of vibration and tactile feedback--ie patting the floor in the direction we wanted her to follow so she could feel the vibration. Rubbing a massager on her arm and then trying to coax her into "chasing" it. We also use lots of light stimulation.That's probably not an option for him, though. Other things you can do . . . tummy time is amazing no matter how old you are. You can also get the baby arch toy and hang auditory/tactile toys from it to try to get him reaching. In the beginning hang the toys down low and then remove links to gradually raise them up so that he has to "find" them. Maybe he's developmentally beyond this point if he has (consistent?) 2-3 word phrases though? His language may be behind simply because he might not be getting the feedback to have things to talk about.
What kinds of activities do you do with him now? What kinds of things does he talk about? How can you take advantage of his favorite things to help him learn?Not necessarily to make a structured lesson out of, but just to motivate him to go more in depth with.
Motorically, is he able to sit independently? The motor transitions are very hard to learn without being able to visually reference your surroundings, but its possible. We started with isolated skills and are slowly working up to transitions between the skills. For standing, we started against the couch in a forward facing direction with motivating toys in front. I had to support her in the beginning and it only lasted a second. Today she did 20ish minutes independently. She didn't want us to be done! When we go into and out of standing I show her how she got there instead of "plopping" her anywhere. We talk about it and I take her step by step with body parts. Ie. I move one leg forward, then the other, then bend a knee, then the other, then pivot forward, etc. You get the idea.
There are SO many things you can do to help this little guy. Without knowing where he is now, though, its hard to tell you where to go. In general, talk talk talk to him. Don't stop talking. Don't stop describing things. Give him as many experiences as you possibly can. As you're going through regular daily activities (going on walks or to the park, fixing lunch, toileting, etc.) try to have him do as much as possible. If he's not used to joining in, he might be resistant at first, so I wouldn't JUMP right into the deep end, but maybe instead choose one or two things to focus on that will produce something exciting for him and then gradually up the ante a bit.
For cognitive development, you can still work on things like simple puzzles or shape forms. We also have books in braille. We count the beads on the abacus for fun and then feel the swooooosh! and hear the "clicks" as we spin them back and forth quickly when we're done. We sing songs all the time, especially songs with activities--like row your boat.
I'm sure that his Mom is aware of this, but just in case. Each state has a school for the blind. You don't necessarily have to go to the school, but they can serve as a good point of contact for learning how to help him. Or if you have a day off you could schedule an observation to see how they teach the kids in say the preschool class to get some good ideas of what things look like. Most of all, though, I think if it were me, I'd sit down with the Mom and very politely tell her that you care about her little guy and really want to be able to help him. Ask if she can show you the things they do in therapy or if you can sit in on a therapy session. I can't speak for her, obviously, but wow--would I love that kind of initiative from a Nanny. Children with special needs are eligible for "early intervention" until three. After that they become eligible for public pre-school--this is free and would provide some level of vision services.
Hope that helps!
I just looked back and noticed that you were in Canada, so disregard that last paragraph. George Brown College, which I think is in Toronto has an amazing program for deafblindness. A two year program. I've spoken with a few of the professors from there and they were very willing to help out. I wonder if you or the Mom could contact them for resoures as well? . . .
Thank you so much for your help. I appreciate it all, and am looking forward to working more with this little boy. I'm hoping to be able to talk a little more with Mom, too, so we can be on the same page.
All the best with your little one!