Professional Corner
Visual loss considerations
in developmental assessment
Foundation for the Junior Blind Infant Family Program
The child with a visual impairment and especially one with additional
special needs will be at risk for delays in development, including
gross and motor skills and social and self-help skills. It is
important to understand why these responses are delayed, how
to encourage them and how they differ from the responses of
sighted peers.
GROSS MOTOR
Area of Possible Delay: Head Control
Reason: Head control must be encouraged because the
visually impaired child may not become visually interested in
his environment.
Strategy:
- speak to the child to encourage head lifting
- activate toys above the child’s head or to the sides of
the child’s head
- use a penlight flashlight to attract attention
- mirrors can be used for children with some vision
Assessment note: encourage head control with a consistent
sound or continual voice
Area of Possible Delay: Trunk Control
Reason: Visually impaired children prefer to lie on
their backs. However, trunk control requires that the child
must experience the prone position and learn how to roll from
stomach to back and back to stomach.
Strategy:
- use wedges, rolls, and prone boards
- encourage rolling by providing a motivating person or sound
to roll toward
Area of Possible Delay: Reaching on Stomach
Reason: Because the visually impaired child does not
like to be on his stomach, reading in prone may be delayed.
Especially important is the connection between weight-bearing
and learning to use the hands.
Strategy:
- for those children with some vision, use a mirror to encourage
pushing up on forearms
- present musical toys that make a continual sounds such as
a radio or music box
Assessment note: make sure child is comfortable and
motivated to reach for toy. Familiar favorite toys are best.
Area of Possible Delay: Crawling
Reason: A blind child will not begin to crawl without
help and encouragement. Objects have no meaning for the child
who does not see them, unless they make a sound or have an odor.
Crawling gives children the change to practice hip rotation,
and children who do not have hip rotation tend to "waddle
walk".
Strategy:
- encourage with voice or toys
- place a pillow or bolster under the abdomen for stability
- put you hand behind their feet and give a little push
- show the child how it feels to crawl by moving his arms
and legs for him
- try a scooter board
Assessment note: not all visually handicapped children
crawl before they walk; some children may scoot instead of crawl
to get around.
Area of Possible Delay: Standing
Reason: the visually impaired child is insecure when
first standing because not much of his body is in contact with
a surface.
Strategy:
- arrange an area with a defined space (crib, playpen)
- play near table top and encourage grabbing of bright sound
toys on the table
Area of Possible Delay: Walking
Reason: It takes the visually impaired child longer to walk
than the sighted child because he often lacks the confidence
and desire to move about.
Strategy:
- provide open space and opportunities
- the child must first reach for sound objects or people before
walking
- hold out your hands and help the child step toward you
- make sure the child experiences walking on even and uneven
surfaces
- make games out of balance activities
- use a hula hoop
FINE MOTOR
Area of Possible Delay: Regard
Reason: Due to a loss of vision, an infant may not look
at, listen to, or handle an object.
Strategy:
- help child develop auditory rather than visual regard by
repeatedly bringing sources of sound to him
- eliminate auditory overload (background noise like radios,
talking)
- a child may not exhibit regard by looking, but may still
or quiet movements as an indication of interest
Area of Possible Delay: Prehension (reaching, grasping,
and release)
Reason: The child with a visual impairment has to be
taught and encouraged to use his hands since he cannot watch
his hands at midline.
Strategy:
- weight-bearing on hands is a crucial first skill for developing
grasp and manipulation
- massage the arms and hands with lotion or powder, moving
from the shoulders down the arms, into the palm, and to the
tips of the fingers
- faces and toys need to be close so that they are easily
bumped into and create a sound or movement
- toys may need to be placed on the hand, foot, etc. to prompt
or reach and grasp
Assessment notes:
- a visually impaired child may not exhibit reaching without
a consistent sound cue
- grasping a block may not have meaning, whereas presenting
mom’s or your finger may trigger the grasping response
- to encourage release of an object, help the child identify
a surface such as a table top or tray, or a container
Area of Possible Delay: Manipulation
Reason: The child who is visually impaired must learn
through touch and coactive manipulation what the sighted child
learns through watching.
Strategy:
- put objects in the child’s hands and assist with feeling,
exploring and manipulation
- provide varied toys with texture, sound, movement, smell
Assessment note: assess manipulation with objects familiar
to the child.
SELF HELP
Area of Possible Delay: Feeding
Reason: The child with a visual impairment may have
difficulty understanding the feeding routine: where the food
is coming from, when the spoon is coming, how to scoop food
from a bowl. It is therefore sometimes difficult to persuade
children who have been fed to feed themselves.
Strategy:
- present utensils for exploration before they are presented
as eating tools
- encourage exploration of food with hands
- help guide the utensils from behind the child
Area of Possible Delay: Dressing
Reason: The child with a visual impairment cannot see
to imitate the act of dressing.
Strategy:
- repeated trials are necessary
- have him put hands on yours as you dress him
- encourage him to raise his arms and legs as you dress him
- make clothes loose and simple
SOCIAL EMOTIONAL
Area of Possible Delay: Smiling
Reason: A lack of vision interferes with the social
interaction that leads to reciprocal smiling. Although the visually
impaired child will smile less than the sighted child, early
on, he will recognize the voices and touch of his parents. However,
he probably will not show anxiety over separation because contact
is sporadic and he many not be aware of the absence or presence
of a parent.
Strategy:
- create an individual linking mechanism such as a special
kiss or pat, a smell or greeting
Area of Possible Delay: Early Communication
Reason: Sometimes parents of a visually impaired or
multiply disabled baby may anticipate their child’s needs a
bit too much, and not allow their baby to cry or show through
other behaviors what he wants or needs.
Strategy:
- do not over anticipate a child’s needs, but do respond to
efforts to communicate
- rely on what you are hearing and feeling rather than waiting
for eye gaze when turn-taking
Area of Possible Delay: Later Communication
Reason: Although it is not known exactly how important
a role vision plays in learning to talk, it is known that older
babies with normal vision pay particular attention to adults’
mouths as they are talking.
Strategy:
- give the child lots of opportunities to touch the people
he cannot see very well
- name toys as the child plays with them, and expand on just
naming by saying, "Oh, that’s your sound ball. It’s
soft and round and fuzzy."
- Make connections between where the child may have seen or
touched the object before. Point out the similarities between
the objects.
- Quiet time is just as important as listening time.
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