BUILDING CRITICAL MIILESTONE SKILLS FOR A VISUALLY IMPAIRED INFANT/TODDLER

Although the VI teacher may have other ideas for intervention, the following suggestions may help in getting started. Only the major milestone skills have been addressed; consult with the VI teacher for expanded suggestions. Include parents and other specialists on the planning team; each has invaluable experience and knowledge to contribute.

To help achieve head control:

Provide several short periods daily of supervised prone position.
While the infant is on his/her stomach, gently lift the child's head with one hand under the chin and the other behind the head; stroke the back of the neck, and talk in soothing tones to the infant; withdraw manual support gradually, as the infant is able to lift his/her head independently.
Continue brief periods of prone position, to allow practice of head lifting.
As head control increases, provide trunk support with a rolled towel under the child's chest; begin positioning child's forearms under his/her upper torso, providing support and preparation for independent lifting of head, neck, and chest.

To help achieve "reach:"

Securely suspend objects with interesting and varied sounds and/or textures within arm's reach of infant, so that accidental "swipes" will make contact with them.
Guide the infant's hands toward the objects if necessary, to let him/her know they are there.
To help encourage hand use:
Encourage mid-line hand use by placing the child's hands on the bottle; play "patty cake"; play with baby's hands at midline.
When facing baby, place his/her hands on caregiver's face and talk to him/her.
Put sticky-tape on the child's fingers; he/she will try to get it off. (This is a supervised activity only; never leave a child with anything that can be put into the mouth and swallowed.)
Place tactually interesting objects in the child's hands for exploration and manipulation. If the child has any useful vision, objects should be high contrast (black and white) for the first few months; colors are not as interesting until about 3-5 mos. and then red, yellow, orange are the most appealing.

To encourage rolling over:

From stomach to back: (about 3-4 mos.) When child is on hi0wr stomach, tuck his/her bent arm under his/her chest and assist with roll-over; praise and practice daily.
From back to stomach: (about 5-6 mos.) When child is on his/her back, extend one of his/her arms up, next to his/her head; gently roll baby's head over this arm (towards the floor) while lifting the same-side leg, with the knee bent and crossing over the other leg; gently press knee to floor and hip should follow; roll baby over to stomach; praise; practice daily.

Note: Check with the Physical Therapist before doing these exercises if the child has orthopedic impairments.

To encourage independent sitting:

From about 3 mos., prop infant with pillows in the comer of a chair, couch, infant seat, or crib - for only a few minutes at a time; infant should not be totally vertical until head control is achieved and back muscles are mature; a backwards leaning is preferable at first.
Around 6 mos. (if torso and head control are present), place child in a sitting position between adults legs (child's back to adult's stomach); gently place child's hands, palms down, in front of him/her, to provide independent support; praise, and practice daily; as balance improves, place toys in front of the baby, between his/her legs, and encourage him/her to play with the toys; provide cushions or pillows for support until baby can sit without them (may take several months).

To encourage standing:

Around 10- 11 mos., put baby in a standing position next to a couch or heavy overstuffed chair; put toys on the chair or couch, within reach; encourage the child to play with the toys while standing (leaning on the couch or chair); limit time to only a few minutes at first, extending time as the child is able; child may need assistance in sitting down; practice daily.

To encourage walking:

Around 11- 12 mos. , place child in standing position, next to a couch or low table; place toys just out of reach, to the left or right of the child; encourage him/her to "side-step" to attain the toys; practice daily.
Place child in a standing position, with back against the wall; offer a hand or finger to the child, for support; keep physical assistance minimal, and remove gradually as the child gains in confidence. A small chair, cardboard box, or walker (to push) might be used as practice supports; some toddler push toys (e.g., shopping cart, lawnmower, wagon) can also be used as "bumpers" for toddlers who are blind or have low vision.

To build language:

TALK (constantly) to the visually impaired infant and toddler; describe what you're doing (and what he/she is doing) and how (whether the child understands or not; intonation and syntax may be imitated later); repeat sounds the baby initiates. A radio or TV is not the same as the caregiver's direct situational conversation. Do not use a radio or TV to provide meaningful sounds for the VI child.
Name things and actions (e.g., "This is a spoon."). If the child is blind, put objects into his/her hands as you name them Let the child explore the objects before taking them away.
Give the child time to absorb what is being said; it may take many repetitions for meaning to be attached to labels.
As expressive language begins to emerge ("talking" begins), make extra effort to associate labels and objects; let the child manipulate as many things as possible, and encourage him/her to name them. Meaningful language requires direct experience for visually impaired children; it is critical because it will be the basis of formal reasoning later.
Remember that it is difficult to learn while someone is talking. A VI child may stop an activity to listen; allow quiet time' occasionally, when thinking & problem solving can take place.

To encourage social interaction:

For infants and toddlers who are blind, or who have low vision, it is important to provide extra tactual and - auditory contact (nuzzling, cuddling, conversation); hands-on social contact must be substituted for eye contact and facial expressions.
Social behaviors that are normally observed visually and imitated (e.g., waving bye-bye, shaking head "yes" or "no," shaking hands) must be physically demonstrated to the visually impaired child.

To build cognitive ability:

Build meaningful language, both receptive and expressive. Language will be the medium of learning later - the means to manipulate ideas, and to "think" - so be sure every word the child learns has meaning to him/her.
Make extra effort to answer questions, not so much with words as with demonstrations ("Let me show you.")
Many visually impaired children do not know how to ask questions, because the situation or conditions they would ask about are based on visual observation. The caregiver must try to anticipate what the child may not understand, and "show him/her."
If you can't bring the world to the child, take the child to the world. Insofar as possible, provide participatory experiences. The visually impaired child should not just hear about the world; he/she must interact with it.
Pay special attention to cause-effect situations; demonstrate, or provide hands-on involvement. Every time there is a "What happens when " situation, remember that the visually impaired child does not see "what happens when" and must learn the result first-hand.
Talk about sequences. As you prepare dinner, describe what you are doing (e.g., "First we have to get the pan out, then we put water in it; now we can put the potatoes in the pan."). There are many sequential events daily (e.g., getting ready for bed, taking a bath, getting dressed); watch for them, and talk about them. Sequence will be important later, as events are organized in a story, a chapter, or an outline.
Don't be too quick to solve a problem for your child; sometimes, give the child time to figure out a solution for him/herself. (Waiting for the child to devise solutions to problems can be frustrating for the caregiver, but it is essential if independence is to be encouraged.) Something as simple as how to get around an obstacle in his/her path can provide a problem solving experience for a child. He/she will have many occasions to use this skill later, and the earlier it is learned and practiced, the better it will be when needed.
Enjoy your child. Play games with him/her. Beginning with very simple hiding games (even "peek - a - boo"), progressing to guessing games ("What Am I" and then giving clues), and on to memory games ("What did we do when...?") . Encourage the child's brain to work, and the earlier the better!

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Last Revision: September 4, 2007