By Pamela Miller, OD, FAAO, JD, FNAP
Dec. 7, 2022
Children and teens are an important part of many practices. They require the same level of attention to eye health and vision as adult patients. Here are key points to remember to ensure you are giving these young patients all the care they deserve, and generating families of returning patients in the process.
Ask the Child, Not Just the Parent, Questions
Even a young child can give you helpful information about their eye health and vision. I ask all patients, including children, why they are visiting my office for care. A few ways I might begin this conversation: “Why are we seeing you today?” “How are you doing?” Or “Why are you here today?”
I ask those questions of the child before I ask them of the parent. If you ask the parent first, you have corrupted the information you will get, as children will often take a cue from their parent, parroting what the parent says in response to questions. If you ask the child first, you get the unadulterated, unedited response of what the child is really experiencing versus what the parent thinks they are experiencing.
Only after I have gathered information directly from the child do I move on to the parent to ask if there is anything else they would like me to know, beyond what the child has expressed. They might tell me that the school nurse recommended that the child get their eyes checked or that the child is not doing well in school.
Don’t Talk Down to Children or With Less Seriousness Than You Would to Adults
I speak to children the same way that I speak to adult patients, respecting them as intelligent individuals. “How are you doing in school?” I ask children patients. If they only say, “good,” or “OK,” I follow-up with: “What kinds of grades are you getting?” I also ask what the child does after school for activities and fun. For older children, in high school, I ask what they think they’ll do after they graduate from high school. In addition to letting you know about more about their visual needs, you can get a sense of child’s or teen’s overall well-being knowing how full their lives are with activities and whether they have a plan for themselves after they graduate.
Ask About Digital Device Use & How Much Time Outdoors
I always ask the child how many hours they think they spend using their computer, phone and and any other digital device. This gives me an opportunity to educate children and their parents about digital eye fatigue syndrome, the possible negative impact of blue light and how there are lenses that can be put into the child’s glasses to minimize the impact of blue light.
With the link between myopia progression and time spent indoors versus outdoors now established as a correlation, I also ask about how much time the child spends outside. I encourage children and their parents, if possible, to devote time everyday to being outdoors.
Ask the Child If they Enjoy Reading
Asking if the child enjoys reading gives me important information about the possibility of accommodative insufficiency and whether the child needs visual help to read proficiently. Visual acuity isn’t everything in determining the impact of vision on a child’s reading ability. You also have to assess eye tracking and near point convergence.
If the child tells me they don’t enjoy reading, the reason could be due to reasons outside of their vision, such as coming from a family in which the parents don’t read, so they don’t have an example to follow.
Keep the Mood in the Exam Room Calm
Sometimes a parent will overreact during a child’s exam, such as when it is evident that they are significantly myopic. “Oh, my child is blind,” a parent might exclaim before thinking.
“Actually, John is doing well. He can see the big “E” or can see how many fingers I am holding up. Now, we’re going to see if we can make it even better.”
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Many children are more mature than their parents and won’t get upset until their parents do. Keeping the parent calm often also keeps the child calm.
Trial Frame Prescription & Get Commitment from the Child
I trial frame most of my patients because if you put that prescription in front of child and they say they see better without it, you’re kidding yourself if you think child going to wear their new glasses. If elect to hold off on a prescription, I explain to both parent and child why I feel it’s not necessary yet for the child to wear glasses.
It’s always important to get the child’s commitment to wearing glasses. For example, I might say to a child, “How does that sound to you? Is that OK? We’re going to go ahead with glasses and I want you to wear them when you’re going to read or when you’re at school.” You want to get that commitment or agreement from the child, but also address the parent at this point, so, at the same time, you are answering the parent’s question of when the doctor recommends the child wear their new glasses.
This is also the time to set out a game plan for the future, including the possibility of contact lenses, vision therapy, computer glasses, etc., while also making the appointment for their next vision examination. This reinforces your commitment to the patient and their parent or guardian, while giving them additional options for their vision care needs, both now and in the future. It also allows for any questions they might have that you didn’t answer.
Only when the child is fully on board with what their doctor and parents feel is the best course of action will you get the best care outcomes.
Pamela Miller, OD, FAAO, JD, DPNAP, has a solo optometric practice in Highland, Calif. She holds a law degree and a therapeutic license, is California State Board-certified and glaucoma-certified to prescribe eye medications, and offers comprehensive vision care, contact lenses, visual therapy and low vision services. To contact her: drpam@omnivision.com.
