Tips for helping partially sighted infants see
*This article is based on our own experience with children with vision disorders, and conversations with doctors, ophthalmologists, and vision therapists, as well as extensive independent research on the subject. However, it has not been reviewed by a doctor and is not to be considered medical advice or a substitute for consulting with a physician.*
Visually impaired babies and children have a unique set of requirements for furthering their development. Below we discuss some of the common causes of vision impairment in children and some of the methods parents, doctors, and visual therapists have used to help improve their vision.
Common vision problems in babies and children
CVI – Cortical Vision Impairment: A visual impairment resulting from a brain injury. Unlike vision problems that arise due to physical problems with the eyes, CVI is a failure of the eyes and brain to communicate properly. Consequently, it can be hard to diagnose as the structure of the eye and optic nerves may initially seem to be normal, although they are not functioning properly. This condition is sometimes referred to as neurological visual impairment or cortical blindness, but will hereafter be referred to as cortical vision impairment or CVI within this article. Depending on the study, between 3.6 and 21% of children with vision impairments have cortical vision impairment, making it the leading cause of vision impairment in children.
Characteristic features of cortical vision impairment include preference for a certain color (usually, but not always, red and yellow), delayed recognition of an object, a preference to look at moving objects or familiar objects, trouble looking at visually complex objects, staring or non-purposeful gazing (particularly at light), nearsightedness, absent blink reflex, and trouble reaching for objects. Luckily, recent research indicates that with appropriate intervention 97% of highly motivated parents helped their child with cortical vision impairment reach near normal vision in an average of 3.7 years.
DVM – Delayed Visual Maturation: substandard visual attentiveness in early infancy, but with a possibility for subsequent improvement in vision as the child ages. The child will present with a normal eye exam but abnormal visual behavior. With proper intervention, substantial improvement in visual acuity and visual behavior can be achieved. Characteristics include nystagmus (repetitive, uncontrolled movements of the eyes, often in a back and forth pattern), visual inattentiveness, and poor visual fixation. It may present with diverse ocular symptoms, but there is usually no observable damage to the eye or nerves.
DVM may simply be related to a delay in the infant’s cortical maturation. According to the reports of many parents, children afflicted with delayed visual maturation sometimes behave as if “a switch is turned on”, and vision, attentiveness, and responsiveness rapidly improve without warning; however some improve much more gradually. Research varies on the subject, although anecdotal evidence suggests that a child is more likely to improve more quickly if they are continuously exposed to visual stimuli, particularly those that make sounds and that the infant is able to easily hold.
ROP – Retinopathy of Prematurity: immature vasculature in the eyes, with mild or no visual defects, most commonly seen in premature babies. There is a risk of neovascularization (new blood vessels forming), which can turn into retinal detachment or blindness. An ophthalmology consultation is necessary for diagnosis, and depending on the degree of retinal findings, cases may resolve on their own, or require extensive medical or surgical intervention.
Intravitreal bevacizumab, cryotherapy, laser photocoagulation, or other surgeries may be used to treat ROP. Regular eye exams and periodic evaluation by an ophthalmologist are necessary. It is unclear the extent to which the child benefits from increased attention to visual stimulation.
ONH – Optic Nerve Hypoplasia: a congenital condition that presents as damage, immaturity, or complete absence of the optic nerve; often in conjunction with possible cerebral and endocrine abnormalities. ONH may be referred to as Septo-Optic Dysplasia or DeMorsier’s Syndrome, and is typically diagnosed by the discovery of small or particularly pale optic nerves during the ophthalmologist’s ocular examination. Often, there is no obvious identifiable cause. Characteristics include vision impairment, which can range from mild to very severe, nystagmus (repetitive, uncontrolled movements of the eyes, often in a back and forth pattern), and sometimes strabismus (inward or outward misalignment of the eyes).
Kids with optic nerve hypoplasia may be at increased risk for seizure disorders, developmental delays, and hormone deficiencies, and will typically be evaluated by an MRI (a brain scan using magnetic resonance imaging) and have a consultation with an endocrinologist. While there is no medical or surgical treatment for ONH, early supportive intervention by vision therapists and special attention from the parents may be correlated with optimal outcomes in terms of vision improvement.
*This is not a complete list, merely an overview of some of the conditions causing blindness or vision impairment in children. If you suspect that your child has vision problems, please seek out a pediatric ophthalmologist or ask your regular pediatrician to refer you to one.
Children with some (but not all) vision problems can benefit greatly from early intervention, and the results are often much more positive the earlier treatment begins. Below we have included some tips and resources for helping partially sighted or visually impaired infants learn to improve their vision.
Toys to help develop baby’s vision
With appropriate and early intervention, dramatic improvement can be possible for some, but not all vision conditions. Every child’s circumstance is unique, but we strongly believe that it is the responsibility of the parent to attempt every possible method of improving the child’s vision. If opportunities to improve a child’s vision are incorporated into their daily life, the chances of their vision improving may be greatly increased. While you should always consult with your pediatrician and ophthalmologist, below we have included some suggestions for toys that have been reported to be effective in helping to improve the vision of partially blind infants with certain conditions. Check out our favorite toys for visually impaired kids:
Toys for vision improvement in children with cortical vision impairment
Babies with cortical vision impairment in particular can benefit from simplicity and repetition.
Visually complex items are initially confusing to an infant with CVI. They are much more likely to respond to a simple, familiar item. Using trial and error, determine if your child has a color preference (often red or yellow, but sometimes bright blue, green, or pink), and find a simple, single colored toy in that color. A ball, LED light-up balloon (with supervision only!), or single colored stuffed animal are fantastic toys for cortical vision impairment. For contrast, it may help the baby focus to put a solid black sheet of paper behind the item, which helps to reduce the clutter and visual noise around it.
-Visual latency means that a child may have a delayed response when looking at objects. They are also more likely to look away from a toy and return their gaze, rather than gaze continuously. Be sure to give your child plenty of time to look at and recognize the toy, even if it takes longer or they look away at first.
-The best toys for cortical vision impairment are toys that are easily recognized by the child. Keep a familiar object with your child throughout the day.
-Determine a position in which your child can comfortably look at the object. If they tire themselves from holding the position, they have less energy to spend on focusing their gaze.
-Introduce shiny, bright, and highly saturated toys. A pinwheel, miniature disco ball, bubbles, or a baby mirror can be a good way to stimulate vision in kids with CVI.
Toys for vision improvement in children with delayed visual maturation
Toys presented to a child with delayed visual maturation should be simple in form and color, high contrast, and presented one at a time. Experiment with natural and artificial light (both incandescent and fluorescent) to determine what is most helpful for your child. Try utilizing a multi-sensory approach (for example, toys that combine visual and auditory cues) It is important that the child is able to observe the relationship between the physical action and the sound. Toys that provide tactile input are also usefu for DVMl: incorporate different textures into play. To avoid fatigue, work with your child in short bursts, and divide longer tasks into manageable increments.
Toys for vision improvement in children with optic nerve hypoplasia
Carefully observe your child to determine the smallest size toys that they are capable of seeing and playing with, and initially only expose them to toys only of this size or larger. Similarly, experiment to determine at what distance they can accurately decipher facial expressions, then take care to communicate with them from that distance or closer. Be sure to assist children with tasks but do not complete tasks for them. The best toys for optic nerve hypoplasia are high contrast and easy to see. Begin with visually simple, easy to track toys and gradually increase the difficulty. Sound toys, keyboards, or synthesizers can be very useful in keeping their attention engaged.
Best books for developing vision of children with visual impairment
Because 2-dimensional images are often more challenging for infants with cortical vision impairment to focus on, and kids picture books are often visually complex and busy, it can be challenging to find an appropriate book for the child with vision impairment. Keep in mind that books with visually simple pictures that feature highly saturated colors are best.
Best tactile board books for babies with visual impairment
Books that include different textures and tactile input are uniquely able to hold the attention of a visually impaired infant. The longer the book can keep the child entertained, the more opportunities they have to see and learn.
Life-skills building books for visually impaired babies
Books that help children explore the world while developing motor skills, resourcefulness, and creativity
Piqipi quiet books encourage learning through playing – each Quiet Book is handmade from textiles, features 12 pages full of activities buttons, laces, zipper, studs, matching colors, counting numbers, puzzles and more… Each function helps to develop important life skills, as well as fine motor skills.
In addition, for every Quiet Book sold, Piqipi donates books and money to partner organizations across Africa which help children to make the most of their potential, no matter their circumstances. Click to buy
Ideas for activities for visually impaired infants
Simple play activities that visually stimulate a low vision infant can not only encourage their eye development but promote speech, balance, motor skills, social skills, and more.
-Give your child plenty of time to observe a toy, moving it occasionally to attract interest. Familiar toys are best, so it is not necessary to have a large quantity of toys, which may overwhelm the child.
-Use a lightbox (if recommended by your pediatric ophthamologist) with supervision to provide additional contrast and illumination.
-It is typically recommended to limit or avoid screen time for children under 2. However, for a blind infant it may be beneficial to watch colorful, visually stimulating programs such as Baby Einstein or Baby Mozart while you are doing other activities.
-Use opportunities to create a visually stimulating environment in your home: make a mobile out of old CDs , tie strips of mylar (for example, from an old balloon) to a dowel and place in front of a fan, create a stained glass window with colored cellophane paper, or put colorful tape on your ceiling fan.
-Wear vibrant, colorful gloves to gesture to and play with your baby.
Thank you for reading our tips for the best toys and books for visually impaired babies! Also never forget that holding, cuddling, rocking, carrying, touching, and talking to a visually impaired infant or child is equally as important as any other toy or resource!
More you may enjoy:
American Academy of Optometry
University of Houston, College of Optometry
California Deafblind Services
World Health Organization (WHO) Childhood Blindness Project
American Association for Pediatric Ophthalmology and Strabismus