New Parent’s Vision Guide – A Call For Awareness
Written by Guest Blogger: Jessica Zwilling COVT
In 1959, Arnold Gesell, MD wrote:
“The child is never a miniature adult. He is not even a pocket edition. He is an ever-changing, growing organism. His main task in life is to grow up, to mature, to develop. His well being depends on how his growth potentials are realized and organized.”
When I first came to work at my current office in 2004, I was 4 months pregnant with my first child. I had already been in the field of Behavioral Optometry for almost 10 years and yet I knew little to nothing about child development, let alone, visual development of babies and toddlers. I had not worked with that population yet in VT.
One day, I was assigned the task of filing and organizing copies of vision articles, many written by Dr. Martin Birnbaum who was the founder of the practice. I came across a real gem and have held onto a copy of it in my own personal files at home. Interestingly, when I went to look for it this week, I had not filed it with my other VT papers. I found it filed with my prenatal info and articles. At first, I thought that was strange, but really, every first time parent-to-be should have educational material like this made available to them. New parents have an overwhelming amount of concerns right from the start. Is the baby eating enough? Sleeping enough? Warm enough? Counting wet and dirty diapers. Why is he crying?! I didn’t even know how to change a diaper until the nurse gave me a quick demo in the hospital before taking my first-born home! Monitoring some aspects of child development just requires a little common sense from mom and dad, but true preventive care requires a professional team effort.
Dr. Birnbaum’s Home Guide To Child Development For The First Year Of Life really opened my eyes. Some of the suggestions to parents are things that most moms and dads have instinctively done with their babies for ages such as playing “peek-a-boo.” As an almost new mom, though, I had no idea that the presence, placement, and type of a crib mobile could have such an impact on an infant’s vision development. It seems so silly to say now, but to me, a crib mobile was just another thing I was supposed to add to my registry for the sake of tradition.
Dr. Birnbaum compiled and adapted this home guide from Mommy and Daddy – You Can Help Me Learn to See by J.N. Getman, OD and J.W. Streff, OD (1959). The guide opens with the following:
“Vision care is usually sought once a problem arises. In the light of current knowledge and research, it is now possible to apply vision care preventatively. Preventive care, however, can be as long and cumbersome as development itself. Proper preventive action attempts to anticipate the stages of development and guide the child through them. It attempts to integrate vision with all the other systems of the body and to insure the leading position that vision should have in such integration. Lags in early visual development cast their effects on both learning ability and performance skills. Exposure to enriching visual-motor and visual-perceptual experiences at the proper time and place are the building blocks for the establishment of percepts, concepts, relevance, decision-making, problem-solving, problem-seeking, and cognition in the growing child. There is no substitute for a professional optometric visual examination at any age even if visual difficulty is not suspected. There are many things, however, that parents can do at home to help in the visual growth of their children.”
We need more doctors and professionals in all fields to be providing this kind of information to new parents. In a perfect world, it would be included in the prenatal classes that many couples put themselves through in an attempt to prepare for their new baby. Vision problems would be detected more often and at an earlier age if more parents were aware of at least two crucial concepts – that vision must be in the lead in order for all the other systems to integrate properly, and that vision screenings at the pediatrician are not enough. I have a wonderful pediatrician that I actually listen to most of the time (which is rare for me). At each check-up, I got the questions asking if certain milestones had been reached such as cooing, smiling, making eye contact, and turning the head toward noises, but that’s as far as it ever went. Through three children, we have never had any discussions about preventive care for proper vision, motor, speech, or hearing development. We never talked about how to play with my baby to ensure optimal overall development. Pediatricians cannot possibly fit all of that information in addition to a thorough health check into insurance companies’ allotted time slots. Many of the patients that we see in our office have parents that fill out the birth and development portion of our intake form and don’t understand why we need to know if, when, and how long their child crawled. Nor should we expect them to know these things if the information is not brought to their attention by someone who knows.
Proactive parents who try to do their own research are met with conflicting information. Those who ask the question, “When should I take my child for their first eye exam?” will find a mixed bag of answers. Major medical insurance companies, Web MD, the CDC, and the American Academy of Pediatrics all recommend that vision screenings be done by the pediatrician as part of the annual well-child visit from birth until age 5 when they are ready to start school. At that time, these influential organizations still recommend eye health, acuity, and alignment screenings to be done by the pediatrician or family doctor. Only if a problem is detected, the child should be referred to a vision specialist, and of course, the AAP specifically states that the parent ask to be referred to a pediatric ophthalmologist. The AAP then goes on to state:
“Learning disabilities are quite common in childhood years and have many causes. The eyes are often suspected but are almost never the cause of learning problems. Vision Therapy will not improve a learning disability. Your child’s doctor may refer your child for a thorough evaluation by an educational specialist to find the cause.”
Statements like this make me sick to my stomach. All of the mainstream parent magazines, books, and websites will have similar guidelines in print next to pictures of cute, healthy babies, and new parents who are trying to educate themselves by reading up on the topic become grossly misinformed. Vision insurance plans such as Eye Med and Davis Vision don’t even recommend a comprehensive eye exam until the child is ready to start school. Vision Service Plan proves to be the exception as they follow the American Optometric Association guidelines which recommends vision exams with an optometrist at 6 months, 3 years, and then again before the child starts school (age 5-6).
It’s not all doom and gloom out there for babies and toddlers. In the optometric community we have wonderful people doing wonderful things for public vision awareness. COVD, OEP, and AOA (to name just a few) have all been busy advocating for better vision requirements for children entering school and “making vision therapy visible.” Private practitioners work hard within their communities to “get the word out” and educate other professionals around them. In addition, the InfantSEE program has taken preventive infant vision care to a whole new level. It is definitely getting better. It just seems that a good portion of the major medical and education communities still do not either recognize or acknowledge the impact that vision development has on a child’s life. All of the parenting and child health public organizations, books, magazines, and websites recommend that a child should visit the dentist as soon as the first tooth sprouts (typically 6-9 months) and then every 6 months after that. Shouldn’t a baby’s vision development be considered equally if not more important than dental health?
Stay tuned for future installments as I will progress through the ages and stages of vision development by sharing more wisdom from pioneers in child development. Sixty-plus years ago, these guys really knew what they were talking about. In such a high-tech, fast-paced world, it is easy to forget the simple things that can be done with children to ensure proper development. I leave you with more wise words from Dr. Gesell taken from Vision: Its Development in Infant and Child (1949):
“Vision, therefore, may become a key to a fuller understanding of the nature and the needs of the individual child. He sees with his whole being. Eye care involves child care. The conservation of vision, particularly in the young child, goes far beyond the detection and correction of refractive error.”