11. PD II - Introduction to Paediatric Optometry

Question 1

What are the milestones for 0-6months?

Physical
* ... reflex
* ...
* ...
* ...
Intellectual
* ...
* understands that ...
Emotional
* ...
* ...
Social
* ...
* ...

Answer 1

What are the milestones for 0-6months?

Physical
* suck and grasp reflex
* needs to be held
* can follow and focus
* lots of sleep
Intellectual
* vocalises
* understands that can cry for response
Emotional
* attached to caregiver
* comforts self with thumb/dummy
Social
* recognises caregiver
* smiles when caregiver arrives

Question 2

What are the milestones for 6-18months?

Physical
* ...
* ...
* ...
* ...
Intellectual
* ...
* ...
* ...
Emotional
* ...
* ...
* ...
Social
* ...
* ...
* ...

Answer 2

What are the milestones for 6-18months?

Physical
* feeding self
* sitting
* stands and walks
* stacks 2+ blocks
Intellectual
* 1-2 words (mama/dada)
* points
* curious about environment
Emotional
* hugs parents
* separation anxiety
* shows emotions but can't identify
Social
* games
* extends attachment
* some independence

Question 3

What are the milestones for 18months-3years?

Physical
* ...
* ...
* ...
* ...
Intellectual
* ...
* ...
Emotional
* ...
* ...
Social
* ...
* ...

Answer 3

What are the milestones for 18months-3years?

Physical
* bladder and bowl control
* climbing stairs
* holds crayon and draws circle
* hand-eye coordination
Intellectual
* drawing develops
* sentences begin and understood half the time
Emotional
* verbally expresses emotions
* separation anxiety improves
Social
* plays with children
* tests boundaries

Question 4

What are the milestones for 3-6 years?

Physical
* ...
* ...
* ...
* ...
Intellectual
* ...
* ...
* ...
* ...
Emotional
* ...
* ...
* ...
Social
* ...
* ...
* ...

Answer 4

What are the milestones for 3-6 years?

Physical
* can hop on one foot
* skip and dance
* draw square
* draw some letters
Intellectual
* complete puzzles
* understandable when speaking
* has likes and dislikes
* engages in discussion
Emotional
* identifies happy and sad
* imitates caregiver
* can be overwhelmed by emotions
Social
* un/dresses self
* role play games
* follows rules

Question 5

What are the milestones for 6-12years?

Physical
* ...
* ...
* ...
Intellectual
* ...
* ...
* ...
Emotional
* ...
* ...
Social
* ...
* ...
* ...

Answer 5

What are the milestones for 6-12years?

Physical
* energetic
* increased appetite
* continued height/weight growth
Intellectual
* highly verbal
* fact-oriented questions
* understand past/present/future
Emotional
* personality more defined
* guided by family/school
Social
* playing/working with others
* same sex play
* learns to achieve and compete

Question 6

What are the milestones for 12-18years?

Physical
* ...
* ...
Intellectual
* ...
* ...
* ...
Emotional
* ...
* ...
* ...
Social
* ...
* ...
* ...

Answer 6

What are the milestones for 12-18years?

Physical
* growth spurts
* puberty
Intellectual
* able to think/reason
* think abstractly
* imagine to solve problems
Emotional
* independence needs exerted
* mood swings
* often feel misunderstood
Social
* parttime work
* social activities with friends
* conflict with parents

Question 7

What is the Parent Evaluation of Development Status questionnaire and is it effective? What is the main criticism of this screening tool?

Answer 7

It’s a short questionnaire asking parents about their child’s development. Research suggests that if parents are asked the right questions, they are very accurate observers of their child’s strengths and weaknesses.

Main criticism is that they tend to be performed in isolation without taking into account the socio-cultural context in which a child grows up and without systematic input from parents.

Question 8

Why is a child’s examination different to an adults?

(5 points)

Answer 8

• Parents get concerned with anything associated with their child, can be emotional. Wearing glasses is stressful for parents
• Examining a child, buts its almost like having two patients
• Children tire and bore easily
• Children want to please and get worried if they think they did something wrong
• Children and parents know if we don’t care

Question 9

How can understanding that a child’s examination is different to an adult’s assist in the examination?

(6 points)

Answer 9

• Modify approach according to parent’s/child’s body language/non-verbal cues/expression
• Be creative in the examination; could get on the floor with the child, get the parent involved, play with the child
• Can’t stick to a script
• Don’t stay on one test for too long, children will bore
• Don’t show disappointment
• Be interested!

Question 10

Why are questionnaires useful before/during examination of children?

(3 points)

Answer 10

• Allows a focused and concise history
• Parent can think about what to share before entering the room, less likely to forget critical information
• Allows kids/parents to express concerns clearly

Question 11

What should a questionnaire include?

(7 main points)

Answer 11

• Demographics
• Presenting complaint
• POH, FOH, GH
• Developmental/education history
• Previous treatment
• Adjunct surveys
• Other professionals involvement?

Question 12

How do you structure an examination for children?

(4 points)

Answer 12

• Offer parents a seat and leave child with parents initially to get comfortable
• Don’t turn back to either parent/child
• Develop a rapport with child/parent
• Assure that there are no right or wrong answer, we are interested in what they notice

Question 13

What are the critical points for a child’s examination?

(8 points)

Answer 13

• Need to be quick
• Need to be creative
• Have a tonne of toys/targets
• Objective tests are the most important
• Always observe the child
• Lots of verbal reinforcement
• Use the family
• Make sure the child is comfortable

Question 14

What are typical testing protocols for birth-3years?

(8 points)

Answer 14

• Cover test (maybe use a thumb)
• Hirschberg test
• Bruckner’s test
• Ocular motility
• Watch hand-eye coordination and fixation when playing
• Refractive/accommodative tests: ret (dry/wet) and MEM/Mohindra before wet
• Pupil reactions
• Internal exam (Direct Ophthal) - parent cradles kid in arm and we approach

Question 15

What are the typical testing protocols for 3-6years?

(6 points)

Answer 15

Tests for birth-3 years +

• Vision: matching tests if prior to school age, letters if older than that
• Colour vision - unlikely in preschool
• Stereopsis - unlikely in preschool
• Binocular vision test - worth 4 dot, prism doubling, phorias, unlikely in preschool
• Accommodation-convergence evaluation - unlikely in preschool
• Slit lamp/tonometry on indication - dependent on age

Question 16

What are the typical testing protocols for 6+years?

(5 points)

Answer 16

Tests for birth-6 years +

• Comprehensive BV evaluation
• Quantitative ocular motility
• Subjective refractions can be more easily evaluated
• Blur functions are effective
• From 8 onwards, subjective visual judgements are much easier

Question 17

What are communication tips for children’s examination?

(12 points)

Answer 17

• Listen carefully and observe closely
• Body language is key
• Communicate effectively!
• Get on the same level as the child
• Get to know them first; talk about their day/likes/dislikes, might need to open up first
• Remain interested in the child throughout the examination
• Listen to everything being said/how it’s said by kid; ask parent for confirmation about symptom
• Include parent in discussion
• Keep questions open-ended
• Maintain control of any discussion; make sure both child and parent understand that they’ll be listened to but we prefer the child to also give their perspective
• Don’t be afraid to ask the same question twice
• Keep channel of discussion open throughout exam