Safeguarding children

The scenario

Hema, resident optometrist

“I am an optometrist who has been working as a resident in an independent practice for 15 years. I have recently experienced a parent refusing glasses for their child who I strongly feels requires spectacles. I have tried to explain the benefits of wearing spectacles and the long-term impact that not doing so will have on their child. Can you advise?”

The advice

Henry Leonard, head of clinical and regulatory at the AOP

Safeguarding children, young people and vulnerable adults is a professional duty for registered optical practitioners and practices, in the same way as it is for all other health and social care practitioners and providers. As registered practitioners, we have insight into the possible implications for a child who is denied proper vision correction, especially if this takes place within their visual development period. A parent who is refusing to provide their child with spectacles despite there being a clear clinical need could amount to a safeguarding issue in itself, but may also be indicative of wider neglect.

A parent who is refusing to provide their child with spectacles despite there being a clear clinical need could amount to a safeguarding issue in itself, but may also be indicative of wider neglect

Firstly, it’s important to ensure the parents understand what you found during the examination, what action you have recommended, and why this is important. If the child’s visual acuity is still developing, or they are at risk of becoming strabismic, it’s important to explain the possible long-term implications of delaying treatment. Aside from the everyday risks of a child not being able see clearly, you may need to explain how this could impact on the child’s academic and social development.

It may be helpful to ask the parents why they don’t want their child to wear spectacles, to gain a better understanding of their concerns. For example, the parents may be surprised to learn that most children are quite happy to wear glasses and generally adapt quickly to wearing them. There is now a wider range of attractive frames than ever before, and less stigma about wearing glasses than there may have been when the parents were at school.

If the parents are worried about the cost, you can reassure them that financial assistance is available for all children in the form of optical vouchers towards the cost of optical appliances.

It may also be a good opportunity to discuss the possibility of contact lenses, as many parents may not have considered this as an option for their child. If the child enjoys a particular sport for example, you can explain the benefits of vision correction, and which type may be most suitable.

It may be helpful to send them some information in writing, so they can make an informed decision in their own time

Next steps

If the parents still don’t accept the need to correct their child’s vision, it may be helpful to send them some information in writing, so they can make an informed decision in their own time.

If you have concerns about the possible implications for the child should their parents decide not to follow your advice, you should ensure you follow this up within an appropriate timeframe.

In some cases, it may be necessary to write to the parents again, to explain that you have a duty of care towards their child, and you are concerned that their continued refusal to follow your advice may have serious implications for the child’s welfare. It’s important to get the tone of the letter right; you don’t want to upset the parents unnecessarily, but you may need to make it clear that you have a duty of care toward their child, and you will take action to safeguard the child’s wellbeing if this becomes necessary, which may include referring the matter to your local safeguarding team, in the best interests of the child.

The AOP’s clinical and regulatory team can offer advice on safeguarding issues of this nature on a case-by-case basis, considering factors such as the child’s age, refractive error, visual acuity and binocular status to help AOP members reach a decision on how best to address these types of issues when they arise. If you’d like to discuss a case you’ve encountered in practice, please contact [email protected]