As we lovingly stare at our newborns we expectantly await the time when they will look back at us. However, for some kiddos this is a task that may not come very easily. Some kiddos will eventually be diagnosed with CVI, Cortical or Cerebral Visual Impairment. This is a condition caused by damage or abnormalities in the brain. Because of this, children with CVI may pass a newborn eye exam because the structure of their eyes looks normal, it is how the brain processes what they see that is altered. Oftentimes parents report that their kiddo can’t have a visual impairment because they watch them walk across the room. However, upon further investigation, it is observed that the kiddo is picking up on something else like the sound of Mom or Dad’s voice rather than actually watching them walk. This condition is not corrected with glasses, however children with CVI can improve their functional vision over time with intervention.
Let’s start with some characteristics that may be worth further investigation:
- Your child prefers toys and objects of a certain color, often red and yellow but can be other bright colors as well.
- Your child is only or primarily interested in moving objects, such as pinwheels or shimmering balloons.
- When you offer something near your child’s face for them to look at, they may take some time to look toward it. This is called visual latency or delayed visual processing.
- Your child may have difficulty looking at a toy on a surface busy with multiple toys and colors and may look away. This is described as visual complexity.
- Your child is often found staring at the light out windows or in ceiling fans. This is called light-gazing. Children with CVI may also stare off into space without purpose.
- Your child may not blink when toys or items are brought near their eyes. This is called the blink response but in many children with CVI this automatic response is missing or delayed.
- Your child struggles to look at a toy/item while reaching for it, instead they look away.
- Your chid may look at an object easier when it is held in a specific location, i.e. to the right or lower than the middle of the eye.
CVI is not very well known in the general realm of pediatrics because the eye structures are normal and the issue comes from the brain interpreting the information the eyes are seeing. If your child is exhibiting one or more of the behaviors listed above you should reach out to your pediatrician and ask for referral to a specialist such as a pediatric ophthalmologist, a pediatric neuro-ophthalmologist, or a pediatric neurologist. You may also be able to find a center or school in your area that supports children and students who are blind. Using this as a starting point you may be able to get connected with a Teacher of Students with Visual Impairments (TVI). A TVI might be able to perform a Functional Visual Assessment (FVA) and give you a better idea of how your kiddo is using their vision and be able to give you strategies about what to do next.
If you have some concerns about your child’s vision, here are some strategies that you can try.
- If your child does gravitate toward a certain color, such as red, place toys and objects of that color within eyesight throughout the day. Have a red toy near the changing table and use a red cup during mealtimes. Tie a red string or ribbon around the car seat or wheelchair handle. The more frequently these items are seen, the more familiar they become and the easier they are to recognize and so your kiddo will use their vision to seek them out.
- Learning to use your vision is hard for kiddos with CVI. We often use toys and objects to interest a child while they are learning a new skill such as rolling or sitting. However, for kiddos with CVI this may be too much for them. We may need to focus on one task at a time. When we are helping our kiddo practice using their vision, they may need to be well supported, whether in our arms or on the floor so that they can focus all of their attention on using their eyes. Over time, as they get better at this task, we can encourage them to look at things in more challenging positions such as sitting.
- To start encouraging kiddos to use their vision, offer single-colored toys on a contrasting-colored background, one at a time and without other sensory stimulus such as noises and movements.
- Because visual latency can be an issue, offer extra time for your child to process what they are seeing. This may be a few seconds or a few minutes and can be longer than usual with new items. For some kiddos this may be seen when they look at an object then look away for a while before returning to the object. Sometimes it may be the first glance at an object that is delayed. Be patient and what your kiddo’s response when offering toys.
- It is best to start with offering simple objects of a single, bright color. Movement can be easier to see and shiny objects give the impression of movement and so a red, mylar balloon might be a great object to try to get them to look at. You can also draw a kiddo’s attention to an object by shining a light on it to see if it helps them pay attention to the toy.
You may have been suspecting there was a problem or the diagnosis of CVI may have been unexpected. Either way, one of the most important things you can do is spend time watching your child play, explore, and learn. There is a commonly shared phrase that “one child with CVI is one child with CVI.” Although we try to give some general things to look for, each child with CVI is very unique and so learning what works and what doesn’t for your child is invaluable information for figuring out how best to help them.
If your kiddo has recently been diagnosed with CVI and you would like some help with how to support your kiddo’s growth and development reach out for an evaluation. Our therapists at Kid Physical have over 34 combined years experience offering specialized, holistic healthcare for children of all ages. Our top priority is providing support for both caregivers and children so that they can reach their highest potential.