pediatric and teen cl care

Good Communication is Key When Fitting Young Patients

BY MARJORIE J. RAH, OD, PHD, & JEFFREY J. WALLINE, OD, PHD

When fitting young children with contact lenses, you should know that some kids cry. Some may cry before you come near them with a contact lens. Others cry when they become anxious as you try to apply a contact lens or when they become frustrated while trying to apply their own contact lens. However, a child crying during the initial visit does not indicate a poor success rate for contact lens wear. In fact, most children who cry during the initial contact lens visit generally become successful contact lens wearers within one week.

As you gain experience in fitting children with contact lenses, fewer and fewer will cry, possibly because of better communication skills with children or better selection of the best candidates for lens wear.

Developing Rapport With Kids

Communicating with patients gives you 90 percent or more of what you need to know to successfully conduct an examination. Communication is the key to success, and the rest of the puzzle comes together with the results of the testing procedures.

In that sense, working with children is no different from working with adults, but the topics of communication are sometimes very different. Consider watching animated movies, reading books about young wizards and witches, or viewing Saturday morning cartoons. You might find these activities refreshing, and they will give you something to talk about in establishing rapport with young patients. Being able to engage a child in conversation helps to create a comfort level prior to approaching him with a contact lens.

You should also speak directly to the child, as opposed to speaking about the child with the parent, when conducting the examination. Let children know what to expect. Tell them that it's okay to be nervous. Assure them that applying and removing contact lenses isn't meant to be easy and that in fact, the natural reflex of the eye is to blink when a foreign object approaches. Limit the initial training session to 45 minutes or an hour to avoid elevated frustration levels. A second training session is usually much more productive than an over-extended first training session.

Improved Patient Selection

While not unique to fitting children, selecting the best candidates for contact lens wear is a key part of the fitting process. Spend a little time at the beginning of the initial visit speaking directly to both the child and parents. If a child does not seem ready for contact lenses, this is the time to have that discussion with both parent and child.

However, it's important to understand that tears at the initial visit do not necessarily mean that a child is not ready for contact lenses. When children become anxious or frustrated, they often cry. Once a child gains confidence with contact lens wear, anxiety and frustration are allayed and the child is likely to be a successful contact lens wearer. Many factors such as maturity, hygiene and motivation are better predictors of success than are tears at the initial visit.

So, begin fitting children with contact lenses, and don't be frightened by a few tears. CLS

Dr. Rah is an assistant professor at the New England College of Optometry where she works primarily in the Cornea and Contact Lens Service in patient care, teaching and research. Dr. Walline is an assistant professor at The Ohio State University College of Optometry, where he conducts studies of pediatric contact lens wear.