BABY WATCH EARLY

INTERVENTION VISION SCREENING

TRAININGSection I

HISTORY

BABY WATCH EARLY

INTERVENTION VISION SCREENING

TRAININGPart A: Child’s History

Part A: Child’s History

The child’s history provides information that is very pertinent to determining the need for more vision testing.

Medical and parent reports.

It is important to be aware of the parent’s ability to be a good historian about the child’s health.

Use methods appropriate to determine the most accurate information.

Low Birth WeightPrematurity

Most of the premature children should have already been tested by an Ophthalmologist

Make sure that testing has occurred!

Low Birth WeightPrematurity

Retinopathy of Prematurity (ROP):

Occurs in some premature babies Growth of abnormal blood vessels in the retina Generally begins during the first few days of life May progress rapidly to blindness over a period of weeksThe eye is rapidly developing during gestational weeks 28-40.The blood supply to the retina starts at the optic nerve blood vessels grow out toward the edges until birth.

Retinopathy of Prematurity (ROP)When a baby is born prematurely, normal vessel growth stops, new abnormal vessels begin to grow.

Fibrous scar tissue attaches to the retina and the vitreous gel that gives the eyeball its shape.

The ring may extend 360 degrees around the inside of the eye.

If enough scar tissue forms, it can begin to pull the retina, detaching it, and in some cases cause blindness.

For further information http://www.tsbvi.edu/Outreach/seehear/winter98/rop.htm

Retinopathy of Prematurity (ROP)

Due to modern medical procedures, only 400 babiesa year go blind from this condition.

In the 1950's the number of babies blind from (ROP) reached epidemic proportions. For further information:

http://www.99main.com/~charlief/vi/disorders.html

Diabetes Mellitus

Scene viewed by a person with diabetic retinopathy

Diabetes Mellitus, (general term) refers to disorders characterized by excessive urine excretion; a metabolic disorder of carbohydrate metabolism.

Diabetic Retinopathy is a complication that can cause loss of visual acuity (restricted vision or blindness).

Diabetes Mellitus

For further information, The National Eye Institute: http://www.nei.nih.gov/health/diabetic/retinopathy.asp#1http://www.retinadoc.com/services/diaret2.stm

Diabetes damages the normal circulation of the body, including legs, kidneys, heart, brain and eyes.

Initially, diabetes causes the retinal vessels to leak resulting in retinal swelling (macular edema) and vision loss. The leaking vessels can be sealed with a laser to resolve the swelling and prevent further vision loss. Significant macular edema may be present even if vision is excellent.

DIABETESDiabetic children can Diabetic children can develop blurred vision, develop blurred vision, and sometimes cataracts, and sometimes cataracts, due to fluctuating blood due to fluctuating blood sugars, the fragility of sugars, the fragility of blood vessels behind the blood vessels behind the eye, which break easily eye, which break easily and bleed, scarring then and bleed, scarring then develops on the retina. develops on the retina.

Glaucoma and retinal Glaucoma and retinal

detachment are additional detachment are additional problems.problems.

MENINGITISENCEPHALITIS

Meningitis is an infection of the three membranes

that envelop the brain and spinal cord.

Meningitis can cause inflammation of the

cornea and pink eye.

Encephalitis is an inflammation of the brain, usually viral.

The infection can cause damage to the vision center of the brain.

For further information

http://www.no-smoking.org/may99/05-12-99-3.html

MENINGITISENCEPHALITIS

Did your child ever have an infection in his brain or spine (back)?

Make sure a health care provider made the diagnosis and get information about how severe the case was, such as length of time and incapacity following illness.

HEAD TRAUMA/TUMOR

For further information

http://www.visionhelp.com/brain.htm

A brain injury due to a significant illness or injury, can cause one or a combination of the following:

a decrease in visual acuity, a decrease in visual field, a strabismus or crossing of the eyes, cortical visual loss, optic nerve atrophy, double vision, blur, eyestrain, difficulty with visual judgments in space, and impaired visual memory.

HEAD TRAUMA/TUMOR

Any time there is damage to the brain or a growth in the brain, the occipital nerve could be involved.

Has your child ever had any surgery on his head?

Has your child ever had a head injury?

CEREBRAL PALSY

Cerebral Palsy is an abnormality of motor function-- as opposed to mental function, is usually acquired at less than a one year of age, is due to a non-progressive brain lesion; (a persistent motor disorder due to non progressive damage to the brain).

CEREBRAL PALSY Approximately 40% of all children with CP palsy have some abnormality of vision or oculomotor control, and at least 7% have a severe visual deficit Commonly encountered visual impairments include, nearsightedness, amblyopia, (lazy eye), loss of vision in segments of the visual field, and cortical blindness (caused by abnormalities of the brain). Many of the visual and oculomotor problems in children with CP can be remediated with corrective lenses, eye patching, or surgery.

http://www.pbrookes.com/store/books/dormans-322x/excerpt.htm

CEREBRAL PALSY

Did a doctor every say that your child has a type of brain damage or problem with brain cells?

If a child has a diagnosis of spastic diplegia or quadriplegia or hypertonia (stiffness) or hypotonia (floppiness), they probably have cerebral palsy.

Knowing the severity of the cerebral palsy would be very helpful.

HYDROCEPHALY Hydrocephaly - an abnormal accumulation of cerebrospinal fluid in the brain.

The fluid is often under increased pressure which can compress and damage the brain, dilatation of the cerebral ventricles with accumulation of cerebrospinal fluid.

hhttp://www.deafed.net/publisheddocs/sub/9906KAh.htm

MICROCEPHALY

Microcephaly - An abnormally small head due to failure of brain growth--usually associated with developmental delays. In precise terms, microcephaly is a head circumference that is more than 2 standard deviations below the normal mean for age, sex, race, and gestation. Microcephaly may limit the ability of the infant to have a normal brain size and structures.

HYDROCEPHALY

Has the doctor ever said that your child has water on the brain?

Because of the chances of visual disturbances with these conditions, the child should be referred for further visual evaluation.

SYNDROME

Syndrome is a set of signs or a series of events occurring together that often point to a single disease or condition as the cause        Has your child been diagnosed with any

specific condition?         What is it called?        What do you know about it?

BRAIN BLEED

 

Did your child ever have bleeding on the brain?

Intraventricular hemorrhage is the medical term for brain bleed.

For children with a grade I or II bleed, the parent/caregiver may not remember or may not have been told this.

For the possibility of a brain bleed, refer to medical report, if available.

BIRTH TRAUMA

 

Do you know if your child had trouble breathing at birth?

Caregivers may not know how long or if there was a lack of oxygen so ask about what was done and how long before breathing was normal.

BIRTH TRAUMA/LACK OF OXYGEN

The greatest issue for a baby who has suffered a traumatic birth with a significant amount of time without oxygen usually relates to what is referred to as Cortical Visual Impairment.

Other problems which may been seen are optic nerve atrophy, strabismus, and amblyopia.

SEIZURES

Seizures that are uncontrolled are frequently accompanied by vision problems and any documented seizure problem (even if controlled by medication) could make the child at higher risk for vision problems.

Find out about diagnosed seizures. Has your child ever had convulsions or uncontrollable movements?

SEIZURESThe critical visual issues for children with a seizure disorder are the problems that are a result of the medications given to control the seizure activity.

Blurred vision, double vision, color vision disturbances, decreased visual acuity, visual field constriction, nystagmus and ptosis are just a few of the problems that may manifest due to many of the different seizure medications.

SICKLE CELL ANEMIA

When tiny blood vessels in the eye become blocked with sickle-shaped cells, vision problems and even blindness can result. Some children with sickle cell disease may need regular eye exams. When eye problems occur, laser treatment often prevents further vision loss.

Has your child been diagnosed with sickle cell anemia?

http://www.marchofdimes.com/professionals/6811221.asp

JUVENILE RHEUMATOID ARTHRITIS

Juvenile rheumatoid arthritis causes joint inflammation and stiffness for more than 6 weeks in a child 16 years or younger. Inflammation causes redness, swelling, warmth, and soreness in the joints, although many children with JRA do not complain of joint pain. Any joint can be affected and inflammation may limit the mobility of affected joints.

http://www.niams.nih.gov/hi/topics/juvenile_arthritis/juvarthr.htm#2

JUVENILE RHEUMATOID ARTHRITIS

One type of JRA can also affect the internal organs. Doctors classify JRA into three types - by the number of joints involved, the symptoms, and the presence or absence of certain antibodies found by a blood test. Eye inflammation is a potentially severe complication that sometimes occurs in children with JRA. Eye diseases such as iritis and uveitis often are not present until some time after a child first develops JRA.

Has your child been diagnosed with juvenile rheumatoid arthritis?

SHAKEN BABY SYNDROME

The brain rotates within the skull cavity, injuring or destroying brain tissue.

When shaking occurs, blood vessels feeding the brain can be torn, leads to bleeding around the brain.

Blood pools within the skull, sometimes creating more pressure within the skull and possibly causing brain damage.

Retinal (back of the eye) bleeding is very common

SHAKEN BABY SYNDROME

   Has there been any type of brain damage from injury or shaking?

  This syndrome has a high risk for vision problems.

SIGNIFICANT ILLNESS

Has your child had any type of severe illness or hospital stay?

What was the reason for the illness or stay in the hospital?

HEARING LOSS

Some hearing loss is genetic and can be accompanied by vision problems. Whatever caused the hearing loss may have also affected vision.

Is there any concern about how well your child can hear?

CONGENITAL CMV Congenital cytomegalovirus is caused when an infected mother passes CMV virus to the fetus through the placenta.

Many infected children are born with inflammation of the retina which can lead to vision loss. It can affect vision abilities 80 to 90% of the time.

CONGENITAL CMV

Has the doctor ever said that your child has had CMV or Cytomegalovirus infection?

Has your child been tested to see if he/she is shedding CMV?

MEDICATIONS

Corticosteroid use for 4-6 months for Asthma, chronic lung disease

Must be chronic systemic steroid therapy oral or IV for 6 months

BABY WATCH EARLY

INTERVENTION VISION SCREENING

TRAINING• Part B: Exposures during pregnancy

RUBELLA

Congenital rubella:

The most common congenital defects are cataracts, heart disease, sensori neural deafness, and mental retardation.

        

                                                                         

HERPES

Can cause severe brain damage, eye disease, such as inflammation of the retina (chorioretinitis), and skin lesions

HERPES

TOXOPLASMOSIS

Most infants who are infected in the womb have no symptoms at birth

But they may develop symptoms such as blindness or mental retardation later in life.

A small percentage of newborns have serious eye or brain damage at birth.

http://www.womens-health.co.uk/toxo.asp

http://www.cdc.gov/ncidod/dpd/parasites/toxoplasmosis/factsht_toxoplasmosis.htm#risk

TOXOPLASMOSIS

Has the child’s mother had an infection that she got from changing a cat box or eating raw or partially cooked meat?

ALCOHOL/DRUGS

Did the child’s mother use alcohol or drugs during pregnancy?

About how often did she use them?

ALCOHOL When a pregnant woman drinks,

alcohol passes swiftly through the placenta to her baby. In the unborn baby’s immature body, alcohol is broken down much more slowly than in an adult’s body. As a result, the alcohol level of the baby’s blood can be even higher and can remain elevated longer than the level in the mother’s blood. This sometimes causes the baby to suffer lifelong damage.

ALCOHOL

Fetal alcohol syndrome consists of the following abnormalities: •Intrauterine growth retardation: growth deficiency in the fetus and newborn in all parameters -- head circumference, weight, height) •Delayed development with decreased mental functioning (mild to severe) •Facial abnormalities including small head (microcephaly); small maxilla (upper jaw); short, up-turned nose; smooth philtrum (groove in upper lip); smooth and thin upper lip; and narrow, small, and unusual-appearing eyes with prominent epicanthal folds •Heart defects such as ventricular septal defect (VSD) or atrial septal defect (ASD) •Limb abnormalities of joints, hands, feet, fingers, and toes (http://www.shands.org/health/information/article/000911.htm)

DRUGS

Cocaine use during pregnancy can cause premature birth, low birth weight which increase the risk of disabilities like mental retardation, cerebral palsy, vision and hearing problems, stroke, which can result in irreversible brain damage, heart attack, serious birth defects or death. Cocaine-exposed babies also tend to have smaller heads, which may indicate a smaller brain.

(http://www.marchofdimes.com/professionals/681_1169.asp)

SIGNIFICANT ILLNESS

Did the child’s mother have any type of illness that could have changed the vision of the baby?

Try to identify what the illness was and how severe it was.

OCULAR TERATOGENICMEDICATIONS

 

Drugs which can cause ocular defects to the fetus during pregnancy

  Phenytoin (Hydantoin/Dilantin)-

anticonvulsant

       Trimethadione (TMO, Tridione-

anticonvulsant

       Valproic acid(Depakote)- anticonvulsant

       Retinoic acid (Accutane)- acne treatment

       Warfarin (Coumadin)- blood thinner

OCULAR TERATOGENICMEDICATIONS-Dilantin

• In addition to the reports of increased incidence of congenital malformations, such as cleft lip/palate and heart malformations, in children of women receiving phenytoin and other antiepileptic drugs, there have more recently been reports of a fetal hydantoin syndrome. This consists of prenatal growth deficiency, microcephaly and mental deficiency in children born to mothers who have received phenytoin, barbiturates, alcohol, or trimethadione. However, these features are all interrelated and are frequently associated with intrauterine growth retardation from other causes.

• There have been isolated reports of malignancies, including neuroblastoma, in children whose mothers received phenytoin during pregnancy.

(http://www.rxlist.com/cgi/generic/phenyt_wcp.htm)

TRIMETHADIONE

• Increased risk of birth defects in the fetus, including a cleft palate and abnormalities of the heart, face, skull, hands, or abdominal organs (the risk is 70% with trimethadione and 1% with valproate)

Valproic Acid

• The use of valproic acid during pregnancy has been associated with fetal abnormalities such as spina bifida. The risk of spina bifida in the offspring of mothers taking valproic acid during pregnancy is 1-2%. Valproic acid also may cause reduced clotting in the mother and baby. Because of the risk of harm to the newborn, valproic acid should only be used by pregnant women when its benefits outweigh the risks.

Retinoic Acid• Retinoic acid is teratogenic in humans at very

low doses. The critical exposure time is 3-5 weeks of pregnancy, often before the woman knows she is pregnant. Exposure to retinoic acid during pregnancy may result in malformations of the fetus such as craniofacial alterations, cleft palate, neural tube defects, cardiovascular malformations, thymic aplasia, psychological impairments, absent or defective ears, small jaw, and kidney alterations. Of affected children, 50% have an intelligence quotient (IQ) score of less than 85. An average IQ score is 100-110.

(http://www.emedicine.com/med/topic3242.htm)

Retinoic Acid• A pattern of birth defects occurs in approximately 25-35% of infants of women

exposed to Accutane during the first trimester. This pattern includes craniofacial defects (ears, eyes, and bone development), heart defects, and central nervous system defects (brain abnormalities). Occasionally, defects of the thymus gland and limb abnormalities are seen. Many difficulties such as mental retardation, learning difficulties including problems with attention, hand- eye coordination, and visual-perception.

(http://www.otispregnancy.org/pdf/accutane.pdf)

Warfarin

• Fetal warfarin syndrome; skeletal defects (nasal hypoplasia and strippled epihyses), limb hypoplasia (particularly in distal digits), low birth weight (<10th percentile), hearing loss and opthalmic anomalies; CNS defects with exposure after first trimester; dorsal midline dysplasia (agenesis of corpus callosum and Dandy-Walker malformations) or ventral midline dysplasia

OCULAR TERATOGENIC MEDICATIONS

Drugs which may cause ocular defects to the fetus during pregnancy but evidence less certain

       Carbamazepine (Tegretol)-

anticonvulsant (few cases reported)

       Phenobarbital- anticonvulsant

       Diazepam(Valium)- sedative

       Flunitrazapam (Hypnodorm or Rohypnol)-

sedative

       Oxazepam (Serepax, Murelax or Alepam)-

sedative

 

Carbamazepine• significantly smaller fetal head circumference at birth• low birth weight and decreased fetal growth• twenty percent showed developmental delays, • 11% showed craniofacial dysmorphology. • Congenital heart defects, nail hypoplasia and

urogenital defects were also seen in some cases exposed to carbamazepines in utero

• a possible risk of up to 1% for neural tube defects• When carbamazepine is used in polytherapy,

especially with Valproic acid, the risk of malformation is increased.

(http://www.fetal-exposure.org/SEIZURE.html)

Phenobarbital

• cleft palate, cardiovascular defects, and facial dysmorphology

• growth reduction, especially head circumference and postnatal weight gain,

• delays in psychomotor development • other associated malformations included

congenital heart defects, such as VSD, ASD and PDA

(http://www.fetal-exposure.org/SEIZURE.html)

Benzodiazapines

• http://www.rch.org.au/emplibrary/wads/drugs_in_pregnancy_and_lactation.pdf

• Can cause respiratory depression, hypotonia, decreased feeding and lack of weight gain, and withdrawal

Diazepam

• Chance of birth defects

Flunitrazapam

• This medicine should be avoided during pregnancy as it may be harmful to the developing baby. This is particularly important during the third trimester of pregnancy and prior to or during labour.

• http://www.tiscali.co.uk/lifestyle/healthfitness/health_advice/netdoctor/archive/100003943.html

Flunitrazapam• Benzodiazepines cross the placental barrier and can

accumulate in the unborn child. Studies to date show no birth defects from normal prescribed doses of benzodiazepines taken during pregnancy. Concerns have been voiced, however, about learning and behavioral difficulties in children whose mothers took benzodiazepines throughout pregnancy.

• Babies whose mothers have taken moderate to large amounts of benzodiazepines during pregnancy often have a withdrawal syndrome following birth. The withdrawal is characterized by respiratory distress, irritability, disturbed sleep patterns, sweating, fever and feeding difficulties. The withdrawal can last for a number of weeks or even months. Babies whose mothers have taken high doses of benzodiazepines may also have floppy infant syndrome, with poor muscle tone and sucking response.

• http://www.tranx.org.au/benzodiaz.html

• An increased risk of congenital malformations associated with the use of minor tranquilizers (chlor-diazepoxide, diazepam, and meprobamate) during the first trimester of pregnancy has been suggested in several studies. Oxazepam, a benzodiazepine derivative, has not been studied adequately to determine whether it, too, may be associated with an increased risk of fetal abnormality. Because use of these drugs is rarely a matter of urgency, their use during this period should almost always be avoided. The possibility that a woman of childbearing potential may be pregnant at the time of institution of therapy should be considered. Patients should be advised that if they become pregnant during therapy or intend to become pregnant they should communicate with their physician about the desirability of discontinuing the drug.

• http://www.rxlist.com/cgi/generic3/oxazepam_wcp.htm

Oxazepam

Oxazepam

• Serax (oxazepam) is in the FDA pregnancy category D, which means that this medication is known to harm an unborn baby.

• Do not take Serax (oxazepam) without first talking to your doctor or therapist if you are pregnant or planning on becoming pregnant.

BABY WATCH EARLY

INTERVENTION VISION SCREENING

TRAINING• Part C: Immediate Family History

Immediate Family History of Childhood Vision Loss

Includes:

parents brothers & sisters grandparents cousins aunts & uncles on either side of the family

Strabismus/Amblyopia

Is there a family history of lazy eye, patching, or crossing?

Congenital Cataracts:

Did a family member have eye surgery soon after birth?

Do they have artificial lenses?Has any family member had cloudy or milky

appearance of their eyes?

Congenital glaucoma: Is there a family member that has had excess

pressure, or bulging eyes?

RETINAL DYSTROPHY/DEGENERATION

Has a family member had degeneration of rods or cones, or retinal degeneration?

                                                          

              

GLASSES IN EARLY CHILDHOOD

Which family members wore glasses at an early age?

Why?

SICKLE CELL DISEASE

Did a family member have anemia with sickle shaped red blood cells?

Systemic syndromes w/ocular manifestations:

Has any family member had a condition that caused vision problems as part of the condition?

Other:

Are there any other conditions that occurred in childhood in close relatives associated with visual function?

•