Pediatric and Teen CL Care

Twelve Tips to Improve Your Pediatric Contact Lens Fitting

By Christine W. Sindt, OD, FAAO

Fitting children with contact lenses can be rewarding, but it's important to remember that kids are not just small adults. Here are some time-tested tips for improving the experience.

Tips for Pediatric Fitting

1.Talk directly to children. Children like to feel that they're part of the process, even if their lenses are medically necessary and not what they want. Address children's questions or fears before bringing a lens into the room.
2. Encourage lens handling. Children, like many adults, are afraid of the unknown. To minimize anxiety, have the child play with a contact lens to become familiar with it.
3. Exude confidence. Children reflect the anxiety in the room. If you radiate confidence, children will trust you. Remember that you are driving the bus.
4. Have children wash their hands with you. Chat about the importance of hand hygiene. Ask children whether they know how long they should wash their hands (many children are taught this in school), and then sing the ABC song or “Happy Birthday” while you both scrub.
5. Teach breathing exercises. It's amazing how a few slow, cleansing breaths—in through the nose, out through the mouth—before applying a lens can reduce anxiety, not only for the children, but also for their parents and you. Be sure to maintain your breathing and keep children focused, even when the going gets tough.
6. Give children some control. For example, let children pull down the lower lid while you apply the lens. They will rise to meet your expectations.
7. Rinse lenses with preservative-free saline. Rinse both soft and GP lenses before applying them. Packing solutions and multipurpose solutions contain preservatives and buffers that may cause irritation. If the first lens burns, subsequent lenses will be difficult to apply.
8. Have children practice touching their eyes. If a child is anxious about having someone touch his eye, place a drop of viscous lubricant on his fingertip and have him place it on the conjunctiva. In some cases, you may want to have parent and child practice this at home and return at a future date. If the lubricant is kept in the refrigerator, the child will have the sensation of a cool lens being placed on the eye.
9. Reward success. After a lens has been applied successfully, rush the child over to the treat drawer (Figure 1). A well-stocked drawer of parent-approved treats will go a long way toward alleviating anxiety.

Figure 1. Choosing a treat afterward may ease the anxiety of the fitting.

10. Teach lens removal first. I have found it is easier for children to learn how to remove lenses before they learn how to apply them. Being able to remove a lens builds confidence for the application process.
11. Schedule kids' appointments in groups. Children like to know that other children wear contact lenses. Parents also like to talk to other parents who have been through the process.
12. Don't give up. I have been bitten, kicked, scratched, and cussed at by the same little children who now sit on my lap and cuddle. Knowing I'm (eventually) going to be successful keeps me focused and confident. CLS

Dr. Sindt is a clinical associate professor of ophthalmology and director of the contact lens service at the University of Iowa Department of Ophthalmology and Visual Sciences. She is the past chair of the AOA Cornea and Contact Lens Council. She is a consultant or advisor to Alcon Vision Care and Vistakon and has received research funds from Alcon. You can reach her at christine-sindt@uiowa.edu.