Facial gestures and non-verbal cues

Vision impaired children and young people may miss out on social cues such as facial gestures, body language and other non verbal gestures. The child may not be able to ‘read’ a situation. Verbal turn-taking can be difficult. This should be considered and worked on by teaching staff and professionals involved with the child. In some cases it may also be beneficial for children to have cards / photos of faces and for the expressions to be explained.

How to contact a QTVI

Each local authority has a specialist service for vision impairment to assess, give advice and support parents, early years settings, the vision impaired child or young person and later on, schools and colleges.

The title for vision impairment services differs across local authorities. Search for your service on the Local Offer page of your local authority’s website.Referrals to a QTVI can also be made by an Ophthalmologist or Heath Visitor.

It may be worth trying different search words on your Local Offer page:

  • Inclusion Team (check it covers vision impairment)
  • Sensory Service(s)
  • Vision Impairment service
  • Visual Impairment service

Alternatively search RNIB Sightline which is the RNIB directory for services aimed at helping blind or partially sighted people.

Learning through vision

Approximately 80% of learning is through the visual channel. (Naish et al 2003). Over 40% of the brain is devoted to visual function. (Professor Gordon Dutton, Consultant Paediatric Ophthalmologist, Royal Hospital Glasgow).

Incidental learning

It can be more difficult for children with vision impairment to gather information from their environment. Fully sighted children are able to use their vision for incidental learning which is fundamental to concept development.  Children with vision impairment may miss these opportunities. This should be considered and worked on by teaching staff and professionals involved with the child.

RNIB Information Guide for Parents

RNIB Information Guide for Parents

Part 1 contains general information on vision impairment.

Part 2 focuses on vision impairment in the Early Years.

Part 3 focuses on school years and it also has a section on ‘into adulthood’ plus additional resources and a glossary.

The information relevant to Early Years covers:

  • Understanding vision impairment
  • The development of vision in infants and young children
  • Who can help including health, education, social care professionals
  • Learning to communicate, listen and read
  • Developing the senses and lighting and visual stimulation
  • Objects and toys and making play and learning fun
  • Mobility and safety
  • Choosing a school

Practical strategies to try at home

  • Offer your child toys with good colour contrast and books with clear uncluttered illustrations.
  • If a toy rolls out of reach, encourage your child to reach towards it to encourage independent exploration.
  • Give your child longer to explore new toys and activities.
  • Offer your child activities that make use of and include all the senses.
  • Give constant verbal feedback.
  • If you want your child’s attention then always start a sentence / instruction with their name.
  • Encourage your child to turn towards you when you are speaking to them.
  • Try to give your child lots of experiences of everyday noises, for example, washing machines, phones, cars, ambulances, animals.  Perhaps give your child a photo / model of an animal to connect with the sound.
  • When outside, explain unfamiliar noises: sirens, cars, buses, trains, music. Don’t worry if your child is uncomfortable initially; the more experience they have, the more relaxed they may feel.
  • Try to allow your child time to explore lots of different materials and / or textures. Slime and spaghetti play are great fun. But never force your child’s hand into a new mixture! Try guiding their hand by moving their elbow – this way your child will still feel in control.
  • If your child has a field loss, encourage them to look and feel for objects on the side where the vision loss is. This will encourage them to be aware that there are things there even though they may not see them initially.

The Developmental Journal for Babies and Young Children with Visual Impairment (DJVI)

When you are in touch with your QTVI, ask them whether they consider it appropriate (it may not be depending on your child’s sight) for you to complete The Early Years Developmental Journal (DJVI) for children with a visual impairment.

The DJVI is an early childhood intervention programme for babies and young children with severe visual impairment. It was developed by clinicians and clinical researchers from the Developmental Vision Programme at Great Ormond Street Hospital for Children NHS Foundation Trust and UCL Great Ormond Street Institute for Child Health (main authors Dr Alison Salt and Dr Naomi Dale). In 2005 it was commissioned by the English central government to be disseminated as the national early intervention framework for children with visual impairment and their families.

The DJVI is a systematic framework tracking developmental and vision progress from birth to three years of age (or equivalent developmental age).

It aims to:

  • help parents and practitioners track and understand the child’s achievements, progress and development
  • support goal setting and guidance to promote vision and general development
  • support interdisciplinary and interagency working
  • support information sharing between parents and the practitioners they meet
  • identify areas of difficulty early where more help would be useful.

What is a Functional Vision Assessment for a very young child?

Visual function is how a child functions visually within the everyday environment. A functional vision assessment (FVA) is carried out by a QTVI and provides ‘real life’ information on how a child uses their sight, for example at home or in an early years setting. The test will involve some clinical test materials and informal observations.

In the early years, a QTVI can work with parents at home and also in early years settings. During the sessions, the focus may be on visual enhancement but all information gathered will help formulate a FVA. With babies it may be as simple as do the eyes react when the light is put on, can they fix and follow an object?

A functional vision assessment may include information such as:

  • Child A can follow a 5 cm yellow ball from left to right at 50 cm.
  • Child A was observed responding to Mum as she stood silently in door way 3m away.

More standardised functional vision assessments in the early years include:

  • Cardiff Acuity Test (Cardiff Cards) which is a preferential looking test.
  • Hiding Heidi – this is a contrast test and can assess near and distance acuity.
  • An assessment called BUST for near vision testing.

A guide to Early Learning at Home – Guide Dogs Children and Young People’s Services

A guide to Early Learning at Home – Guide Dogs Children and Young People’s Services

This guide advises that parents should not feel that they have to spend hours using special programmes to help development for your baby/toddler, there are specialists who can advise and support you through early development programmes, just enjoy your baby and use the times you are feeding, changing a nappy or bathing to stimulate and play with him/her. It might take your baby longer to pick up a skill, but once they have it, it will be for life. Don’t get despondent if your friends’ babies are smiling, sitting up, rolling over, while your baby is lying still. Babies who have additional needs may need more intervention.

RNIB Play Guide

This Play Guide outlines the importance of play for children with vision impairment. It describes different types of play and provides information on choosing toys and creating play environments to support children in their play:

Please see our Assistive Technology section for information on Guide Dogs Access Technology team which gives advice on choosing the most appropriate technology to help children and young people with a vision impairment study and play. Assistive or adaptive technology and sensory toys can make a difference in how a child with sight loss learns and plays.

Choosing an early years setting

Contact your QTVI when you are considering starting at a childminder, nursery, school or playgroup and discuss with them the options and help available. They can help you make choices and also help staff at the setting to understand your child’s needs. Your QTVI may also provide direct support for some children at playgroup or nursery. The section below has detailed and specific information and advice on choosing settings.

Physical school environment

Ask your QTVI or habilitation officer to do a whole school premises check including the playground, to ensure ACCESSIBILITY AND SAFETY for a vision impaired child

For example:

  • Outline step edges in yellow.
  • Highlight pillars and other vertical hazards and ensure all highlighting is near eye level.
  • Provide handrails on both sides of stairs.
  • Provide controllable lighting and blinds at windows to minimise glare.

Other physical environment considerations

  • Give the child time to get to know and become familiar with the physical environment.
  • If appropriate give the child an individual tour of the school environment and show where resources are kept.
  • Don’t change the room around too often.
  • Does the classroom for a young vision impaired child need to be upstairs or can classes be swapped so class is on ground floor.
  • Give vision impaired child a 5 minute pass to enable him or her to go up and down stairs before or after the crowd or to access the cloakroom without a crowd.
  • Make wall displays accessible height-wise. Show them to the child 1:1.
  • Choose a locker at eye height.
  • Be mindful of trip hazards – computer cables, bag straps poking out from desks.
  • Lights should not be turned off in areas of only occasional use.
  • Put coat peg at end of row.
  • Use a bright colour to differentiate the child’s sports and boom bag from other bags of the same colour.
  • Secondary school – 2 school lockers may be needed for enlarged work files. Make sure lockers are accessible & not in a classroom as child may need to use locker more often than others.
  • Use a brightly coloured padlock for locker.
  • Plan and practice 1:1 procedure for fire alarm practice.

Practical strategies and ideas for early years settings

  • Ask your QTVI or habilitation officer to conduct a premises / environment check (as below).
  • The child will need time to get to know and become familiar with the physical environment, other children, staff, routines and rules.
  • Child to sit near the front for story time.
  • Use the child’s name to secure attention before giving instructions.
  • Do not give too much information at once or offer too many options.
  • Give a verbal explanation of what is happening and describe what you are doing if necessary and appropriate.
  • Use The Developmental Journal for children with a Visual Impairment to track visual progress and development and find next steps.
  • If introducing a new concept or story, give the child time for pre-learning so that they can explore the story or object before it is presented to the rest of the group.
  • Give 1:1 demonstrations of tasks or activities.
  • Give the child time to explore new toys and activities.
  • Offer the child toys with good colour contrast and books that have clear, uncluttered illustrations.
  • Child to have own book and not share with others.
  • Transitions between activities can require preparation and planning. Give the child notice of a change of activity and of routine.
  • Offer the child activities that make use of and include all the senses.
  • Consider providing a secure, familiar place to play.
  • Check lighting issues in room. Use blinds or curtains to minimise glare.
  • Give the child an individual tour of the room and show where resources are kept.
  • It may be advisable for the child to go up and down stairs before or after other children.
  • Watch out for trip hazards – computer cables, bag straps.
  • Make wall displays uncluttered and colourful. Show them to the child 1:1.
  • Don’t change the room around too often.
  • Allocate a peg at the end of a row for coat and bag so that it’s easy for the child to locate.
  • Use a bright colour to differentiate the child’s bag from other bags of the same colour.
  • Make sure the play dough isn’t the same colour as the table.
  • Help the child move between rooms / toilet initially.
  • Try not to over protect the child to the extent of becoming a barrier between them and other children.
  • Plan ahead for trips out of school for accessibility and health and safety issues.
  • Plan and practice 1:1 procedure for fire alarm practice.

Premises / environment audit

Ask for an early years premises /environment check including the playground, to be undertaken by your QTVI or habilitation officer to ensure the premises are accessible for a vision impaired child.

  • Outline step edges in yellow
  • Highlight pillars and other hazards and ensure highlighting is near eye level
  • Provide handrails on both sides of stairs
  • Provide controllable lighting and blinds at windows
  • Lights should not be turned off in areas of only occasional use
  • Be mindful of securing trip hazards – e.g. computer cables