Infant Massage for a Child with Vision Impairment

RNIB supporting blind and partially sighted people Effective practice guide

Social inclusion and mobility and independence in the early years

This guide explores the impact that vision impairment has on social development in the early years as well as looking at ideas to encourage blind and partially sighted young children to socialise and make friends. It includes advice on infant massage, social bonding and social inclusion in the nursery. There is also information on movement in the early years and ideas to help you with teaching daily living skills for this age group.

This guide is part of our Supporting Early Years Education series. At the end you will find the full series listed, and details of where to find them.

Contents

1. Infant massage for a child with vision impairment 2. Social inclusion – Social bonding 3. Social inclusion – Early years 4. Mobility and independence: Early years 5. Further guides

Registered charity number 226227 1. Infant massage for a child with vision impairment

This section explores the use of infant massage to support the development of children with vision impairment.

It draws on the practice and principles of the International Association of Infant Massage (IAIM), a non-profit making organisation whose mission is to ‘promote nurturing touch and communication through training, education and research so that parents, caregivers and children are loved, valued and respected throughout the world community’.

Its theory, curriculum and focus are unique and have been carefully developed and refined through research and practical experience since first introduced in 1976.

Contents

1.1. What is infant massage? 1.2. Why use infant massage? 1.3. Benefits of infant massage 1.4. Benefits of infant massage for a child with a visual impairment 1.5. Points to consider during infant massage 1.6. Contacts 1.7. Further reading

1.1. What is infant massage?

Infant massage is an ancient tradition in many cultures throughout the world, which is being re-discovered in the Western world. Research shows that loving, nurturing contact between caregiver and infant has a positive impact on their development. Infant massage is something that every caregiver can do and it provides benefits to both child and carer. There are a number of organisations that train instructors in infant massage. These qualified instructors then go on to teach the principles of infant massage to parents themselves.

1.2. Why use infant massage?

A cuddle and close contact is a basic human need and the beginning of learning. Visual information informs and helps us interpret much of our sensory experiences, including touch. Touch and tactile exploration may be more challenging and sometimes more difficult for a child with a vision impairment to interpret. A sighted child will hold out their hand. They will see it, see the movement they have made, see the reaction from the adult, see the adult reach for their hand and finally, using their sight, they will see the hands meet. The result is having a hand to hold and making physical contact. This very simple movement leading to touch is reinforced by visual information and the whole process can often be done using vision as the only tool to make contact with another person.

Due to information being lost through decreased vision, babies who have a vision impairment can benefit from more input through senses such as touch, smell and sound and so infant massage routines may be of particular benefit to these children.

1.3. Benefits of infant massage

The International Association of Infant Massage outlines key benefits of infant massage for both the child and parent/s, or caregiver:

Stimulation Tactile, nervous system, digestion, circulation, muscle tone, immune system, respiration, communication

Relaxation Regulates sleep patterns, breathing, reduces stress, produces calming hormones Relief Colic, sinus, wind, constipation, teething discomfort, poor circulation

Interaction Bonding, communication, reading cues, responding to needs

1.4. Benefits of infant massage for a child with a vision impairment

For a child with a vision impairment, infant massage can support tactual sense, body awareness, and the use of hands. Importantly it can help to establish the strong bond of trust between caregiver and child. Many early learning skills require the development of tactual sense. The awareness of our hands and fingers for example, is a vital skill for exploring objects and our environment. The early experience of massage can support a child’s understanding and acceptance of positive touch and be of immense help for other times when you might want to sensitively guide the child's hands for learning and play. Infant massage can enhance your interactions and also support the childs developing sense of kinesthesia (body awareness produced by movement). Massage can also encourage the child’s purposeful movements. For example, transitions from lying to rolling and then to propping up on arms and hands.

During infant massage the following areas might be enhanced:

Awareness of touch Infant massage is a non-intrusive touch. It can help a child to become less tactile defensive and reduce hypersensitivity to touch. It is a beneficial way for a young infant to learn about their body and its layout and can also support a child’s tolerance of lying in prone position (on tummy). As a child’s back, front, legs and arms are massaged they will experience tactile feedback about the dimensions of their body, developing an understanding of where their body begins and ends. Awareness of the body through movement Infant massage aids in the development of muscle tone, co- ordination and suppleness. During a massage session, routines such as pedalling legs or bringing feet together heighten the child's awareness of their body and help them to develop a better understanding of how their body is connected from top to bottom, as well as finding these gentle movements pleasurable.

Identification of body parts The child’s awareness of their body is developed when body parts are explored in the calm, motivating and relaxing atmosphere that massage offers. It can help to develop awareness of individual body parts, especially if each part of the body is named during massage. For example, which parts of my body are still and which are moving? Where is the pressure on my body from a supporting surface? (the floor, or carer's lap, for example).

Bonding and communication processes Bonding has been described as a “unique relationship between two people that is specific and endures through time” or “a dance that builds trust and intimacy”. This close and responsive time you spend with a child during massage supports the child’s overall development, self-esteem and well being, and whilst you and the child are involved in this closely shared experience, it offers a springboard for the child’s early interactions. In this way infant massage can be a communication tool, a two way process. It allows you to observe closely and further understand the child’s signals and cues, further developing your skills to interpret these in a non-distractive environment. It allows time to observe movements, reactions and vocalisations, and enhances the sort of communication that is involved in the earliest stage in turn taking conversations. Close visual proximity helps a child to make use of any vision and gives close odour contact. The child’s focused attention on you also increases the opportunity for eye contact or face to face interaction, which can increase the quality and quantity of the child’s vocalisations. During infant massage the communication is directly related to the experience and so similar to shared visual attention, such as pointing and looking together, which is also a facilitating factor in early communication with young children.

Sleep patterns Some children with very little or no vision experience disturbed sleep patterns. For example, they can confuse night with day. Routine use of infant massage along with other sleep time routines can promote better sleep patterns.

1.5. Points to consider during infant massage

 Always make optimum use of the child’s available vision, move in close to encourage face to face contact.  Be aware of lighting conditions. Avoid placing the child directly under a strong overhead light which may distract them and will put your facial features into silhouette.  During massage describe what you are about to do and comment on what you are doing, keeping language simple.  You may find you will need to break down the massage routine into smaller stages and build slowly. Remember this is a time for mutual pleasure. Cue into the child and go with what is comfortable for both of you.  Try to start and end the session the same way each time. This will support the child’s understanding of what is about to happen, what is going to happen next, and also develop their understanding of when massage is about to end.  Above all, enjoy infant massage!

1.6. Contacts

International Association of Infant Massage (IAIM) Address: IAIM-UK OFFICE 88 Copse Hill Harlow Essex CM19 4PP Website: www.iaim.org.uk Email: [email protected]

Many health visitors run massage classes. Contact your local Child Development Team, Sure Start Children's Centre or Health Care Trust to find out more.

Information originally compiled by Nicky Joseph, Formerly RNIB Early Years Inclusion Officer.

1.7. Further reading

McClure, V (2001) “Infant Massage: A handbook for loving parents” Souvenir Press Ltd, ISBN 028 5636 170

Leboyer, F (1997) Loving Hands-The Traditional Art of Baby Massage” Newmarket Press, ISBN: 155 7043 140

Montagu, A (1986) “Touching-The Human Significance of the Skin” Harper Collins, ISBN 006 0155 353 2. Social inclusion - Social bonding

Here we look at social bonding. We explore the impact that vision impairment has on social development, as well as looking at some ideas to encourage blind and partially sighted young children to learn to socialise and make friends.

This guide is part of our Supporting Early Years Education series. At the end you will find the full series listed, and details of where to find them.

Contents

2.1. What impact does vision impairment have on social development? 2.2. Bonding 2.3. Reading the signals 2.4. Raising young children's awareness of the world outside 2.5. Helping young children make friends 2.6. What next? 2.7. Ensuring young children have the opportunity to interact

2.1. What impact does vision impairment have on social development?

Children and young people with vision impairment are at greater risk of developing low self esteem than their sighted peers. Findings from the literature highlight that this may be the result of the added pressure in their lives.

 Some may experience greater feelings of failure, particularly in relation to sport and exercise.  Some may be less accepted by their peer group and have fewer friends which is likely to impact on their self esteem.  Some may have difficulty in observing and imitating their peers which can impact on the development of positive self esteem.  Some tend to be more dependent on their parents in many areas, which may adversely affect the development of a sense of independence, one of the most important factors in relation to their self esteem and adjustment.

For some, the growing realisation of the restrictions that their vision impairment may impose upon them, usually in comparison to their sighted peers, may be a trigger for a series of negative emotions, and leave them vulnerable to psychological stress, frustration and even depression.

In addition, the perceptions of others may impact on their self esteem. For instance, parents of teenagers with vision impairment can exhibit over-protective or permissive behaviours which can prevent young people from learning what they should and should not do, adversely impacting on their self esteem.

Also, people may have inappropriate expectations about what children and young people with vision impairment can see and do, and thus self esteem may be negatively affected when the child or young person is unable to meet expectations.

Being aware of some of these issues helps to support children and young people with vision impairment in an appropriate way, and this must start from birth.

In the following sections, we draw on the insights of Marilyn Webb, Teacher of Children with a Visual Impairment and Counsellor, around social bonding of children with a sight problem.

2.2. Bonding

One of the ways communication occurs immediately after birth is that the baby can follow her mother's eyes. This eye to eye contact contributes to bonding. In the first few days of a baby's life, he can interact by mimicking the facial expressions of others, such as putting out their tongues. These are just two of the intensely visual aspects of the bonding process which are absent from a blind baby's repertoire of early communication skills. A little later on, when a mother looks at her baby and her baby smiles back, the attachment is strengthened. She interprets the smile that the baby is contented and that she is a good mother. Blind babies smile at the sound or touch of their mother, but this responsive smile usually develops later and can be more fleeting than in sighted babies. Mothers may need to talk about this and express their feelings to others who have had similar personal experiences.

2.3. Reading the signals

Perhaps the main difference between young blind children and their sighted counterparts is seen in the different behavioural response to what interests them. If the child is very young and cannot ask for what she wants, a sighted child may turn, point, move towards the object of interest. Blind children, on the other hand, will probably do the complete opposite. When interested, they may be still. Though they are listening intently and enjoying or trying to make sense of what they are hearing or feeling, this very 'stillness' may often be interpreted by others as a lack of interest.

Consider this example:

'In our playgroup, after a period of settling in, the children sit in a circle with their parents behind them and we sing the Hello song. When the song starts it is quite amazing how all the children are 'still'. While most are too young to join in, they all listen intently and appear to recognise the song. We notice how, with repetition and routine, some are beginning to smile when their name is called, while some of the older ones listen for their name and are able to tap their chests when they hear the words 'Here I am'. The parents then see how the 'stilling' exhibits intense concentration in all the children, rather than boredom or any other negative emotion. They learn to interpret signals like this, which are different from the general behaviour exhibited by sighted children.' 2.4. Raising young children's awareness of the world outside

As a starting point for relating to others, a blind child needs to be aware of his/her own body. There are lots of songs naming body parts, for example, 'Round and Round the Garden'. Playing this on a child's hand, then encouraging them to play it on another child's hand, can be useful. It is vital that a blind child knows the name of the child or adult that he is with. Always say your name and the names of the other children in the group, and of course, always remember to say the child's name when talking to him.

2.5. Helping young children make friends

We cannot expect a very young blind child to initiate contact with others, so we need to devise activities which replicate the developmental stage of 'playing alongside one's peers'. The difference is that we ensure that they can interact through sound and touch. A popular activity is the foot-spa. Two children sit on chairs in close proximity to one another with their feet in the water. As they move their feet, they touch and splash one another. They listen to adults talking and laughing as they (the adults) get wetter. The children not only enjoy the activity, but learn about being with others, which opens up a whole new world. Other activities include:

 Encourage two children sitting with legs apart, feet touching to roll a sound producing ball to each other.  In circle time, ensure that two children sit together with an adult on the opposite side so that the children can interact freely with one another between the adults.  Encourage children to partner up for activities, particularly when exploring big apparatus, such as slide, tunnels, climbing frames - be aware that some activities, like see-saws, do not necessarily encourage social interaction because a blind child may not have any awareness that another child is involved in the movement. 2.6. What next?

When a child is familiar with the routine and environment and they are used to playing with other children, parents and teachers are often able to take a step back. It is then useful if the adult focuses attention on the other children in the group. The adult can encourage the more confident blind and partially sighted children, or their sighted siblings, to involve a less confident blind child in play by:

 describing their activities verbally; the adult may need to prompt this by saying 'Tell Jack what you are doing'  asking the child to join in an activity  physically leading them to the activity  talking to them whilst involved in the activity.

The main aim by this stage is for a child to feel confident enough to take the first step to join in. When a child says "What are you doing? Can I play?", it is a great achievement.

2.7. Ensuring young children have the opportunity to interact

Young blind children will find it very difficult to forge strong social links with their peers and others unless informed adults prepare the way for them. They may remain isolated unless they know they are part of a group and on-going help is available throughout each session. This will at least give them the opportunity to respond and interact with their peers. The whole process takes a lot of time and commitment from both teachers and carers. It is this extra input from adults which constitutes the basic difference between socialisation of blind and sighted very young children. This extra input is so important to give children the opportunity they deserve to become sociable and independent children and adults. 3. Social inclusion - Early Years

In this section we explore social inclusion at Nursery level. We look at the case study of Carys, which highlights the difficulties that young blind children can experience in accessing play and therefore in developing important social skills. This guide draws on the insights of Annie Bearfield, a qualified teacher of children with a visual impairment.

Contents

3.1. Development of social skills and interaction 3.2. Case study: Supporting Carys 3.3. Further reading

3.1. Development of social skills and interaction

The early patterns of communication, social interaction and exploration form the foundation for what children carry into their futures. Lasting and important attitudes to life and learning are therefore shaped early. Young children learn social skills by playing with friends, and skills such as empathy, negotiation, listening and influencing are learnt incidentally by sighted children as they observe those around them interacting.

Making and sustaining friendships are important parts of social development. Children who have friends are:

 more socially competent than those who do not have friends  more likely to find it easier to adapt to new situations  usually happier, more self assured and valued

Blind children are vulnerable in terms of making and sustaining friendships. Probably the two most important factors that impinge on the social development of blind children, including making friends, are the lack of access to non-verbal communication and the role of adult support.

Empathy and understanding the feelings of others are key to the development of friendships amongst children, and depend to a great extent on non verbal communication - in order to give blind children insight into the significance of facial expressions and gestures we need to raise awareness and develop their insight from a very early stage.

3.2. Case study: Supporting Carys

About Carys At the time of this case study, Carys was a very bright and bubbly toddler aged 2 years 9 months who was blind. She attended a private day nursery in Birmingham. Carys did not have a member of staff assigned to her there, but did have a key worker, called Caroline. Carys also received a weekly support session from Sue, a QTVI, or Rachel, an Early Years Inclusion Officer.

Observations of Carys playing in her nursery group and discussions with the staff there and her mum, highlighted the difficulties that young blind children can experience in accessing play and therefore in developing important social skills:  play is largely motivated, triggered and sustained by visual clues  play can be fast moving - situations change from one moment to the next, which requires quick responses  play involves lots of free flow movement like running and jumping around.

Ways to support The concepts of 'Commenting,' 'Connecting' and 'Creating' can help a parent and teacher support a child's development. This is illustrated by working with Carys: Commenting Putting into words the events and experiences that are happening.

 Describe your own and other's actions, interactions, expressions and feelings - what the other children are up to.  Verbalise Carys' feelings and expressions.  Tell Carys what she looks like each day and also what everyone else looks like.

Connecting Pointing out links and providing structure.

 Making connections in her world, where people and toys are.  Linking previous experiences with what is happening now and what will happen next.  Explaining why children are behaving the way they are.  Explaining appropriate social behaviours and the consequences of inappropriate behaviours - for example not "looking" at a friend/adult or turning her back on other children.

Creating Creating opportunities to maximise social interaction.

 Creating secure and manageable small groups - an element of family grouping may help, for example a 4 year old will have more advanced language skills and may be more sensitive to the communication and play needs of a blind child.  Encouraging children to interact directly with Carys and not through an adult.  Where children are able, encourage them to tell Carys what they are doing.  Allow Carys to play on her own - allowing space for her peers to approach her.  Encourage lots of functional play - using toys or objects for pretend play and dramatic role play.  Prompt Carys to verbalise preferences, share toys, choose friends to share activities with and put feelings about other children into words.  Encourage Carys to imitate her friends by describing their actions and helping her to copy them - modelling of actions may be needed.  Be one of the kids! - get involved, when appropriate, in role play by way of prompting/supporting Carys.

Create more opportunities to learn about feelings, expression and gesture by:

 encouraging Carys to feel expressions on yours and her face (mouths & eyebrows are important)  using dolls with facial features/expressions that can be felt with hands  creating tactile art work to create expressions  drawing attention to feelings of others - in role play, books and stories  teaching non-verbal skills and manners - waving, shaking head and nodding for yes/no, to say "excuse me" when bumping into friends.

Talking to Carys' Mum

What are your hopes and fears for Carys? "What I want is for her to be able to live without me. I want her to be able to hold her own. She'll always need some help and assistance, but already she knows her own mind and how to get what she wants! She has her strops like a normal 2-year-old, but it is a balancing act between helping her to be assertive without letting her manipulate us all! Although she can be independent, like when she is walking around, she needs reassurance. She needs to know we are still there for her.

On the microcephalic website I read a teenager's story about a girl who had found it difficult making friends in her mainstream school and had gradually withdrawn into her books and become isolated - I don't want Carys ending up as that child."

What got you through in the early days? "The first people that I spoke to, and who helped me, were Vision Aid in Bolton. We have a caseworker, Jo, who is a mum with two kids and is registered blind. It is so reassuring to talk to Jo because she is blind and copes so well. When I went up to Vision Aid I knew that Jo was blind, but my family did not - Jo answered the door and made us all a drink, then this guide dog bounded in and my dad could not believe that she was blind! You are sitting there with a six month old baby who is blind and you think that there is no hope, and there is this woman who is blind living as normal a life as you can. It gave me hope!"

How did you decide on the nursery? "I had to go back to work and my younger sister was on placement at a local nursery and was happy there. I met Caroline, the nursery nurse in charge of the toddler room, and myself and Carys took to her straight away. She was so enthusiastic about Carys and did more than she needed to, to find out about how she could help, and still does. I had a gut feeling that Carys would be happy there. I wanted them to be as normal as possible with Carys, but also to be a substitute for me, not to be afraid to give her kisses and cuddles. I did not want her to be isolated or to have everything done for her - she was coming up to two and was already starting to manipulate people!"

How are you making the decision about school? "I really always wanted Carys to go into a mainstream school. I know that this would be hard, but the sooner she is accepted in society, the better off she will be. I have however always got that girl's story in my head and I do not want to force Carys into a situation where she may feel isolated. I am therefore also considering Priestley Smith school (which is a special school on a mainstream school site) where I feel she could be guaranteed the specialist support she requires and inclusion into the mainstream school. This is the hardest decision that I have ever had to face in my life…..and my worry is that if it turns out to be the wrong decision, from my knowledge of how the statementing process works, it will be hard trying to correct it."

Talking to Early Years Educator, Caroline Paulou

"We felt a bit reassured as Lorna, Carys' aunty, was here at the beginning. We did panic though about what activities we could do with Carys. Lisa, Carys' mum, gave us guidelines to begin with. We also watched how she was with Carys - she is a very supportive mum and she never fusses. Between the two of us, we kind of meet in the middle. Lisa put a lot of trust in us, which really helped! To begin with we watched Carys all of the time, but now we tend to verbally guide her from where ever we are. We have also kept the room layout the same since Carys started here. Knowing that Sue (QTVI) and Rachel (RNIB Early Years Officer) come in weekly, and can advise and support us, is very reassuring."

How does Carys mix with the other children? "Because she is advanced in her language development mixing is made a bit easier….she will call out to her friends when she hears them. We are now encouraging the other children to interact with Carys and help her more. The training we received has made us realise that Carys should be treated the same as the other children, and it has made us think more about how she is feeling. We need to make sure that Carys is with the other children, and not to interrupt opportunities for her to be with her friends. We have also talked about her being with some of the older children as they may help her a lot more."

A CD-Rom about social competence in children with sight difficulties is available from Bartimeus in Holland. The CD-Rom is entitled 'Stimulation of social competence in children and young people with a visual impairment: a guide for upbringing and education'. The CD-Rom is in English. It can be purchased my mailing [email protected] 3.3. Further reading

What can you see? Gail Bailey (2009)

This book sets out practical approaches to making and maintaining friendships. These include individual support for young people with vision impairment, activities with peers and working with parents. For friendship to succeed it is crucial to have peers who can empathise, so this book also provides fun resources that help sighted people gain a better understanding of the impact of vision impairment. These activities are suitable for primary and secondary school learners and the adults who work with them, both in and after school. It is available from the RNIB shop at: rnib.org.uk/shop 4. Mobility and independence: Early Years

In this section, you will find information on movement in the early years for children with vision impairment, which suggests ways of encouraging mobility from babyhood onwards, including for children with complex needs. We also cover some ideas and tips to help you with teaching daily living skills for this age group.

Contents

4.1. Movement in the early years 4.2. Mobility - how to help 4.3 Daily living skills - teaching activities 4.4. References

4.1. Movement in the early years

In this section we explain how principles of how movement develops in the early years can be useful when considering children with complex needs and vision impairment.

Babies and movement

Learning through the senses and movement is a recurrent theme in early childhood education. Reaching out to explore in play is a key principle recognising the value of movement in all learning. Jean Piaget is one of the pioneers who defined the sensory-motor period in the first two years of life. Penny Greenland describes his work in this way:

"A child's ability to understand the world around, to communicate with others, and to establish a strong sense of self is grounded in the early sensory and motor experiences available to them. Sensory motor learning is the ability to take in, sort out, process and make use of information from the world around us." (Greenland, 2006) She states that for a developing baby the key issues are:  where do I begin and end?  where is this body part in relation to that?  how much force is too much?  how do I fit into the space around?  what does it feel like to be a body?

She describes this as developing embodiment, where children start:  feeling comfortable in their own bodies  having a sense of control over their movements  developing a sense of wellbeing.

How and why children move

So why is movement important? Take a moment to try something. Think of something you wish to communicate to another person; now try to do it - without any kind of movement.

All human communication requires some form of movement. So how do we know that children can communicate if they do not move, even in the slightest way? How do we know what they have learned?

According to Macintyre and McVitty, movement has three elements: planning, organising and doing. Children have to know what they want to do; they then have to sequence actions; and they have to know how, when and where to move. But we have to separate out two aspects of this process - learning to move, and moving to learn.

Learning to move Learning to move involves the development of a child's independent movement, the steady progress of co-ordination and control of body movements and the growing understanding of "how I work". The second involves an understanding of what movement can achieve, of how the world works, both social and physical. Moving to learn In moving to learn, "the infant must realize, first, that the toy (or bottle or mommy) is somewhere out there. Secondly he must have the motivation or desire to secure that object. And third he must realise that he can influence whether or not he actually does secure it - that the choice is his" (Ferrell, 1986)

Movement in children with a vision impairment

But what if the child has a vision impairment? While there will be great variety in children, it is likely that there will be:  less experience of movement, as some blind babies tend to lie quietly or 'still' when listening so there is potentially less experience of how different body parts move  less motivation to move, with the result that movement skills may develop more slowly  dislike of being on their tummy, which has implications for upper body strength and crawling  little incentive to lift their head without vision as a stimulus  more help needed to recover balance, as saving responses may be slower to develop  more wariness about being upright and unsupported  more difficulty in navigating round obstacles.

Early Support developmental journal The Early Support developmental journal for babies and children with vision impairment is a helpful resource to support development in young children from birth to three years. The section on early movement and mobility explores:

 body awareness  learning to develop voluntary movement by being given the opportunity for movement experience, sensory experience such as on skin and touch experience through hands  position in space: developing orientation in the 3D area of space with a growing awareness of the importance of the vestibular sense (balance) and proprioception (muscles/joints)  exploring the environment: lying, rolling, crawling, creeping, walking, extending in space  extending movement and co-ordination through parental play.

Early reflex actions, which babies are born with, are replaced in the early months by purposeful and controlled movement. As the authors of the journal state in the General Overview of Development:

"Children are motivated to make voluntary movements when they are interested in things beyond their own body and when they understand that they can reach and obtain these things even when they are not in direct contact with them." (DfES 2006)

Motivation, a growing interest in and understanding of things in the environment, and regular practice through play are all vital to help the child control the movements they make and become more independent.

4.2. Mobility - how to help

You can encourage a child to have a growing interest in, and understanding of, things in the environment. Regular practice through play helps children to control the movements they make and become more independent. You can do this by providing activities which include:  floor play, tummy and back play, rolling over and over  belly crawling and crawling  spinning, tipping, tilting and falling (be safe)  pushing, pulling, stretching, hanging and sliding.

Mobility officers

Some services for children with vision impairment are able to put you in touch with a mobility officer if a child would benefit from specific support. They can advise you on how to encourage children to move around the environment, both indoors and outdoors, more independently. Some children also use canes and squeaky shoes to help with mobility. Opinions vary as to when to introduce early cane skills, but some people think that it is good to introduce children to long canes as soon as they can walk, and that parents should be actively involved. The child uses the long cane as part of everyday life not just in mobility lessons.

One parent introduced her daughter to a cane when she was 3 years old and says that it was the best decision she could have made: her daughter took to it straight away and her concentration and behaviour improved immediately. She is relaxed and her cane provides the information to react to changes and hazards herself rather than waiting to be told.

A shoe with a squeak may also motivate a young child with a sight problem to take those first independent steps. Two mums tried out "Squeaky Shoes" with their daughters.

4.3. Daily living skills - teaching activities

Advice for using the activities

This section was compiled with the help of Nita Walker, Priestley Smith School. These activities are really skills for life and should, therefore, begin as early as possible and involve everyone working with the child. There should be a 'commonality' of approach (which is best discussed with as wide an audience as possible) and of language used with the child, so that, for example, directional instruction remains the same. This avoids confusion for everyone involved. The skills fall into three main categories; toileting skills, eating skills and dressing/undressing skills.

Toileting

 Encouragement - in any form - is okay. Keep a packet of Smarties or similar on hand, or use taped songs or favourite toys, anything that constitutes a reward.  Use the same routine every time on entering and leaving the toilet. Think about a simple route in and out and add any tactile points in the room that the child may understand (bells on the door, an elastic band on the handle etc).  Be flexible about the use of the potty or toilet. A lot of blind and partially sighted children fear sitting on a toilet. Do not leave them on their own, and offer lots of talk and support such as holding hands. Singing aloud helps too.  Some children need to 'look' at what they have done and where it is. Don't be too squeamish about it, although this can be discouraged as the child develops the skill.  Use the flush system as a reward. Most children love to hear it and to do it for themselves.  Be sure the child always does the whole process, including hand washing, every time.  Make a huge fuss at every success - accept accidents (there are likely to be many). Take the child to the bathroom to change wet clothes so that the act becomes associated with the appropriate places.

Eating

 Fingers were invented before forks, so concentrate on them first.  Many blind and partially sighted children develop preferences which are usually in favour of hard-edged foods like burgers, chips. They dislike foods with poor definition, such as yogurt with bits in. They like to have a commentary about what you are offering.  A Dycem mat (or damp cloth) under plates keeps them still and in the same orientation.  Try to use rimmed plates with a good contrast to the table, such as blue on yellow.  Use hand on hand technique when starting to use tools, and begin with a spoon and fork. Some cutlery has enlarged grips and may be useful.  Be prepared for mess and clear the child up at the very end. State what you are doing.  Don't comment about refused foods. Try again another time.  Let the child feel your own jaw when chewing and listen to you eating crunchy foods. They will enjoy this.

Dressing and undressing

 Try to insist on easy clothes like track suit bottoms. All fastenings are a problem and can be frustrating for everyone. Avoid getting heads stuck.  Begin by letting the child do as much or as little as he/she can, which may be pulling off a sock. Give praise even for small successes.  Arrange clothing on a chair, where the child can return to dress again. Place items over the back in the order they come off, and place socks and shoes underneath the chair.  The backs of clothing can be marked with a small button, or piece of Velcro on the label at the neck. Choose Velcro wherever you can - children love the sound of it. They also love zips.  Coats nearly all have hoods, and these can be placed on the back of the head to start putting the coat on. Add extra length to zips with a safety pin or paper clip to ease movement up and down.  Have a variety of fastenings on pieces of good quality cloth to play with in spare time.  Be patient and praise every time. Occasionally, try to put the child in a position where time does not matter for dressing and undressing.

4.4. References

DfES (2006) Early Support Developmental Journal for babies and children with visual impairment. Nottingham: DfES

Ferrell, K A (1986) Infancy and Early Childhood in Scholl, G T (ed) Foundations of Education for Blind and Visually Handicapped Children and Youth. New York, American Foundation for the Blind Greenland, P (2006) Physical Development in Bruce, T (ed) Early Childhood. London, Sage

Macintyre, C and McVitty, K (2004) The Importance of Movement for Learning in Early Education Autumn 2004 5. Further guides

The full Supporting Early Years Education series of guides includes:

 What to look for in an early years setting  Early Years Foundation Stage  Learning through play in the early years  Social inclusion and mobility and independence in the early years

In addition, you may also be interested in the following series of guides, all of which are relevant to children, young people and families:

 Supporting Early Years Education series  Removing barriers to learning series  Complex needs series  Further and Higher education series

We also produce a Teaching National Curriculum Subject guide, and a number of stand-alone factsheets, on a range of topics. Please contact us to find out what we have available

All these guides can be found in electronic form at rnib.org.uk/educationprofessionals For print, braille, large print or audio, please contact the RNIB Children, Young people and Families (CYPF) Team at [email protected]

For further information about RNIB

Royal National Institute of Blind People (RNIB), and its associate charity Action for Blind People, provide a range of services to support children with vision impairment, their families and the professionals who work with them. RNIB Helpline can refer you to specialists for further advice and guidance relating to your situation. RNIB Helpline can also help you by providing information and advice on a range of topics, such as eye health, the latest products, leisure opportunities, benefits advice and emotional support.

Call the Helpline team on 0303 123 9999 or email [email protected]

If you would like regular information to help your work with children who have vision impairment, why not subscribe to "Insight", RNIB's magazine for all who live or work with children and young people with VI.

Information Disclaimer

Effective Practice Guides provide general information and ideas for consideration when working with children who have a vision impairment (and complex needs). All information provided is from the personal perspective of the author of each guide and as such, RNIB will not accept liability for any loss or damage or inconvenience arising as a consequence of the use of or the inability to use any information within this guide. Readers who use this guide and rely on any information do so at their own risk. All activities should be done with the full knowledge of the medical condition of the child and with guidance from the QTVI and other professionals involved with the child. RNIB does not represent or warrant that the information accessible via the website, including Effective Practice Guidance is accurate, complete or up to date.

Guide updated: May 2014