Tips for tots

Optometrists urged to test children under school age and especially those with a disability

Dr Maggie Woodhouse

Practice owners were urged to enter their practice one morning on their hands and knees to see what it looks like from a child’s point of view.

The unusual suggestion came from Dr Maggie Woodhouse (pictured), in her CET presentation Tips for toddlers – examining infants and young children, which was given at the UK’s largest optical trade show.

To illustrate her suggestion, the Cardiff University lecturer showed the packed main stage area at 100% Optical (ExCeL London, 4–6 February) a picture of a typical practice reception desk.

She then showed the same shot from a young child’s view pointing out that all they could see was the front of the reception desk towering above them and just the tops of the people’s heads behind it.

“Is your practice really child-friendly?” she asked delegates. A slit lamp looks frightening to a child and it can prevent them from concentrating on their sight test, Dr Woodhouse pointed out, suggesting that a cloth be used to hide it before a child entered the room.

“Are keyboards and remote controls things to play with?” she added, also recommending that they be put out of sight for young patients.

Dr Woodhouse suggested adapting the look of the practice to suit children, for example by putting pictures on waste bins, or using removable pictures on walls.

Turning to the optometrist’s appearance, “What impression is your clothing giving a child?,” she asked the audience, recommending fun clothing such as a Hawaiian shirt to put children more at ease.

Turning to the more serious topic of child protection, she urged practitioners to know their local child protection policy. “Don’t see a child alone, ask a member of staff to be with you and leave the door open,” she advised. She also recommended warning the child before making any physical contact.

Dr Woodhouse urged practitioners to talk to the child, not above them. “Note the parent’s major concerns and come back to them at the end of the sight test using the same language,” she advised.

Delegates were warned that 50% of children with a learning disability also have hearing impairment and that special needs children need longer to process instructions.

“Use simple sentences and gestures,” said Dr Woodhouse, adding: “Give the child time to do what you want. If you rush them, they will get flustered.” She recommended allowing extra appointment time, or even two separate appointments if needed.

She advised optometrists to avoid asking the child questions. “A child will always say what they think is the right answer,” she explained.

Dr Woodhouse advised optometrists to decide what was essential to measure during the eye examination and recommended that they observe the child’s behaviour for their confidence level and mood, as well as their parent’s, for indicators on how to proceed.

“Fit the test to the child, not the child to the test,” she recommended. “You need a variety of tests to hand. If the child can’t name a letter, use something else. If the child is said to hold a book too close, give the child a book,” Dr Woodhouse suggested.

Emphasising the importance of retinoscopy, she urged optometrists to keep up their skills. “Retinoscopy is the only means of refracting a young child,” she explained.

At the end of the test, Dr Woodhouse advised explaining the results to the child, addressing their parent’s concerns. She told practitioners: “Send a written report to their parents and especially to their school. Tell the teacher if the child needs to wear spectacles, and if so, when.”

Emphasising the importance of testing children under the school age, Dr Woodhouse highlighted that the earlier a problem is discovered, the better the prognosis for putting it right and improving the child’s learning abilities.

“The prevalence of amblyopia in children is reported to be 2.95%, nearly 3%, but following treatment that reduces to 1.9% so the earlier you start treatment, the better the outcome,” Dr Woodhouse told delegates.

With strabismus the prevalence is 2.9%, she reported, but in children with Down’s syndrome it is 32% – over 10 times higher – and in children with cerebral palsy, it is 54%, Dr Woodhouse told shocked practitioners.

Dr Woodhouse added that 6% of primary schoolchildren in the UK need refractive correction, but in those with Down’s syndrome that rises to 60% and in those with cerebral palsy, it is 40%. 

“Children with a disability really, really need us,” she concluded.