American Action Fund for Blind Children and Adults
Future Reflections Special Issue: The Individualized Education Plan (IEP) EARLY CHILDHOOD
Orientation and Mobility for Babies and Toddlers: A Parent's Guide
by Merry-Noel Chamberlain
From the Editor: When a young child is blind or visually impaired, parents play a crucial role in promoting movement and exploration, or mobility. They also help their child with orientation, a basic understanding of the environment. For new parents unfamiliar with blindness, questions abound. In this article Merry-Noel Chamberlain draws upon her extensive experience as an instructor of orientation and mobility to answer many of the questions she hears from the parents of young children.
If you are the parent of a blind or visually impaired baby or toddler, you probably have a host of questions. How will your baby learn to move around? Will she or he ever be able to crawl or walk safely? How can you help your baby to be an independent traveler? What steps can you take right now, or is it too soon to begin? When is it time for your child to learn to use a long white cane? If your child has some usable vision, will he need a cane someday? I have heard these questions many times from parents who are new to having a child with a visual impairment. I developed this guide as a way to share answers I have provided to parents throughout my years as an instructor of orientation and mobility (O&M).
Parents and other members of the blind child's Early Childhood Special Education (ECSE) Team (also known as the Early Intervention Team) often turn to the teacher of the visually impaired, or TVI, for answers to questions about orientation and mobility. However, many TVIs are not certified in O&M, so their answers may not be accurate. It is important to go directly to a certified O&M instructor for answers. A person who is certified in O&M teaches individuals orientation (what is around him or her) and mobility (how to maneuver within that space by using a long white cane).
Two types of O&M certification are available to professionals, which means that there are two distinct philosophies regarding instructional techniques. One certification is called Certified Orientation and Mobility Specialist (COMS), and the other is National Orientation & Mobility Certification (NOMC). Many COMS instructors do not provide O&M training to young children until they are able to walk. NOMCs, on the other hand, have the philosophy that young children need to be introduced to the cane as early as possible. Due to these differing philosophies, parents and early intervention professionals can become confused regarding when to begin O&M instruction. It is best to communicate with your O&M instructor so you are in agreement as to what is best for your child. This article mainly focuses on the NOMC approach to O&M, as that is my own philosophy and certification background.
At What Age Should My Child Learn to Use the Long White Cane?
This question often pops up when a child has passed the baby stage and has entered the toddler phase. The answer to that question may be surprising. The time to introduce a toddler to the long white cane is now. Don't delay!
You are your child's first teacher, the one who will guide him through the toddler years to childhood and then help with the transition to adulthood. In the beginning, parents teach their children all the basics, such as how to pick up finger foods, play with toys, and listen to stories. Parents are teachers without formal teaching degrees. In no way does this mean that you, as a parent, cannot teach. It just means you have not attended classes to receive a formal certificate. You have been teaching your child already, though perhaps you didn't even know it, and you will be teaching your child for many years to come. According to The Parent Institute (1998), from the day a child is born to the day he graduates from high school, 85 percent of his life is spent outside of the school setting. During that 85 percent of your child's life, you will have ample opportunities to help him perfect his O&M skills.
Babies with Canes?
The infant sections in department stores display racks of nonskid socks for babies from birth to six months of age. How many babies have you met who are walking at six months? Nevertheless, for a variety of reasons, babies regularly wear socks with rubber grips. The socks keep the child's feet warm and clean, they are cute with matching outfits, and they help form the foot. We do not wait for the child to walk before putting socks on her feet. The same reasoning holds true when it comes to placing a cane in the blind child's hands.
Some O&M instructors believe a child need not be given a cane until she begins to walk. Just as a baby wears socks before she starts walking, she also can benefit when she is provided with a cane before she takes her first step. If children who are blind or have low vision are not given the tools to help them move forward, they won't do so.
Toddlers with visual impairments wear socks for the same reasons sighted children do. By the same token toddlers with visual impairments need to be introduced to the child-size long white cane.
As I mentioned, some O&M instructors do not begin actual cane instruction until the child is walking. However, some mobility activities can be done before your child takes her first step. The cane is going to be with your child for the rest of her life. If the cane is introduced to her now, it will become a natural part of her, just as she is aware that she needs to wear socks. However, if the cane is not introduced until she is older—perhaps not until middle school—it often will be rejected because the child fears looking different from her peers. The younger your child is when the cane is introduced, the more successful she will be in accepting it as a tool for life and mastering the skills of orientation and mobility.
If you want your child to be an independent traveler—to go where she wants to go without depending on a human guide—the very best thing you can do is to introduce her to the cane at an early age, encourage her to accept the cane as a tool for life, and insist that she use the cane at every walking opportunity outside her home environment. Whew! That's a huge statement based on a deep philosophy that you must hold securely in your heart. Most of the successful blind travelers I have known were introduced to the cane at a very young age. This guide will help you get started.
Baby's First Cane
There are two main types of canes from which to select: canes with golf grip handles and canes with cylinder handles. Considering the very small hands of babies and toddlers, the cane with a cylinder handle is the best. This type of cane is available free of charge from the National Federation of the Blind at https://nfb.org/free-cane-program. The smallest cane available for young children is 25 inches long. (For older toddlers, order a cane that reaches from his toes to his nose.) In addition to the handle being small enough for little fingers to wrap around it, here are two more reasons why this is the best first cane:
1. The cane tip is made of metal, which offers superb auditory feedback.
2. The cane is lightweight and easy for a small child to maneuver.
Before the cane arrives, you have most likely introduced your child to some cause-and-effect activities. Perhaps you placed a toy rattle in your baby's hand. Rattles make wonderful pre-cane devices. As the baby swings the rattle around, it may strike the floor or the side of the crib. The sound lets the child know that something is there. This activity also can be carried out with straws, spoons, or any other cylindrical object.
When the cane arrives, introduce it to your child. The introduction need not be a big deal. When he is lying safely on a blanket with his toys around him, simply place the cane within his reach so he will discover it on his own. If he is not exploring, lay the cane handle in the palm of his hand. He will most likely wrap his fingers around the handle, just as he does around your finger. If he shows interest, it will not last long, as babies have very short attention spans. Don't prolong the activity, and don't get discouraged. At this point, the cane is simply being introduced.
Try to introduce the cane to your baby at least once a day. Odds are, your baby may touch it and try to put it in his mouth or lick it. These are very normal responses.
When your baby begins to sit up on the blanket, continue to introduce him to the cane. Now he may begin to pick it up and move it about. Be careful not to hover too close, for he may swing the cane around in the air. This is his way of exploring with the cane. At this stage there is no right or wrong way for him to use the cane, just as there is no right or wrong way for him to play with most toddler toys. Please do not discipline him or take the cane away if he swings it in the air. A harsh voice or removal of the cane may interfere with positive O&M development. Just be careful that other children are not too close.
Another good time to give the cane to your child is when he is in the high chair. Yes, he will drop it, and you may need to play the drop and pick-up game with him. Think about the great auditory information he gathers from this game. He is learning about echolocation plus cause and effect.
Do not introduce the cane when your child is in a confined area such as the crib or pack-n-play. This can reduce movement of the cane and may cause frustration or actual harm to your child.
Standing and Cruising
When your child begins to stand on her own for a second or two, introduce the cane to her again. At this stage parents of both sighted and blind children generally offer physical support. As your child learns to stand with the cane, you will need to monitor its location carefully, as she may swing it around. Again, attention will be short-lived, so move on to something else as needed. You know your child best, and you can judge when to transition to another activity.
When your child begins cruising around the couch, place the cane on the edge of the couch so she can discover it. She may check it out and then drop it onto the floor. Place the cane at another location on the couch to be discovered again. Repeat as needed. If your child tries to pick the cane off the floor, encourage her to do so. Have fun!
Some parents elect to decorate the cane handle with duct tape or ribbons. Be mindful that toddlers put things into their mouths. Decorating the cane is not necessary at this age. Remember that the majority of the cane needs to be white.
From Cruising to Walking
From cruising around the couch, your child may take a step or two toward a familiar voice. Again parents, grandparents, and older siblings provide physical support to help the child build strength and balance. When your child can take a step or two, occasionally have him hold the handle of the cane for support instead of your finger. Do this several times a day.
When you carry your baby or toddler, even around the house, give him opportunities to carry his cane. Try to do this often, as it connects the cane with movement. You can also build this connection by giving the cane to your toddler when he is being pushed in a stroller. Attach the cane to the stroller, using an elastic strap, so it can be retrieved when he drops it.
To encourage movement, place the cane just beyond the toddler's reach and encourage him to crawl to it. Let your child swing the cane around him. This is a way for him to "look around." Naturally, keep fragile items (as well as people and pets) out of harm's way. Your toddler does not mean to smack the cat! He just has not yet learned how to fine-tune his movements. He will perfect his movements as he gets older.
When toddlers play with toys, they sometimes toss them aside. At this stage your toddler considers the cane to be another toy, and he will toss it along with the rest. When this happens, it is important for you to refrain from always picking things up for him. If he wants something badly enough, he will be willing to work for it. He will crawl in search of the toy or cane, and crawling leads to walking.
Use directional terms when you talk to your child.
- Right from left: "I'm holding your right hand." "I'm tickling your left foot."
- Front from back: "The door is in front of us." "The car is behind us."
- Top from bottom: "The doll is on top of the couch." "The truck you want is in the bottom bin."
As your child begins to explore his environment, encourage him to do so with his cane. Put the cane in his hand and let him be the guide. If he taps the cane on the floor, briefly praise the sound he created. Ask him to repeat the sound: ("I love the sound you are making. Can you do that again, please?") Now and then you might comment about the echo from the cane tip.
Some children need assistance with holding and moving the cane. This assistance can be provided in several ways. Gently place your hand over your child's hand as he holds the cane, or simply place the cane in the palm of his hand. When he is holding the cane, sometimes with your hand over his, use your free hand to maneuver the cane. Tap on the floor, wall, or furniture. It is important not to prolong this demonstration, or else your child may pay more attention to the feel of your hand over his than to the tactual and auditory information provided via the cane.
Some children may be resistant to holding the cane or any other object. If this is the case, there are a couple of things you can do.
- Hold the cane and have your child place his hand over yours as you tap it on the floor.
- Begin with push toys that have cylinder handles. These include cylinder noise-making toys, empty paper towel rolls, and drumsticks. Basically, provide your child with toys that extend his reach and touch objects away from his body.
First Steps
At this point your child is beginning to take her first steps with support. Parents of blind and sighted children often provide physical support with those early steps. They hold the child's hands or torso as she wobbles forward. It can be a tricky business to provide physical support to a toddler while giving positive reinforcement for using the cane. The best approach is to walk behind your child and hold both her hands. One of her hands will be holding the cane, so you will need to assist her with holding the cane, too. Be careful not to hold so tightly that you cause discomfort to the hand with the cane. As you encourage her to step forward, move the hand holding the cane left and right in front of her. Continue to walk forward, moving the cane tip left and right. With luck, the cane will tap on a different surface. For example, you may move from carpet to linoleum or from bare wood to carpet. Be excited about the different sound. Say how wonderful it is that the cane found the new flooring for her. Carpeted areas will not yield the best auditory results. Kitchen, bathroom, or hardwood floors have better echo options. Perhaps the cane tip will find the fridge or the lower cupboard in the kitchen. Again, be excited: "Wow! Your cane found the fridge!"
When your child begins to hold the cane independently, you can still help her move it from side to side. This is literally going to be back-breaking work for you, but it's well worth it for your child. As she gets stronger at walking, your involvement can decrease. However, still encourage her to use the cane in the house for at least thirty minutes a day.
Take the cane on every walking excursion outside the home environment. This may mean that your child needs two canes, one in the diaper bag and one at home. Just as you grab your wallet, glasses, or purse before you walk out the door, be sure to grab the cane. You are modeling for your child, and at this point it is your responsibility to show her great cane habits. As your child gets older, she will remember the cane herself.
Little by little your child will discover that the cane is a tool. Be patient. The time will come.
As your child becomes an independent walker, insist she walk to and from the car with her cane.
Teaching Canes for Parents
The National Organization of Parents of Blind Children (NOPBC) holds a conference each year in July in conjunction with the National Federation of the Blind (NFB) National Convention. The conference is a wonderful opportunity for you to meet and learn from other parents of blind children. During the conference a Cane Walk is offered to participants. An instructor will be more than happy to provide you with a private lesson. It is important for you to be a positive role model for your child.
The Cane Walk is an opportunity for children of all ages, including toddlers, and their parents to receive a lesson in O&M from a certified instructor. Lessons can range from introducing the cane to solving advanced problems. If a child needs a cane, he can obtain a free one at the Cane Walk or purchase one during the NFB National Convention.
Parents, too, may obtain free canes at the Cane Walk. This in no way means that the parent is blind. Rather, this cane is used as a teaching cane for parents.
The philosophy behind the teaching cane for parents is quite simple. Children want to be like their parents. When you use a cane, your child is more willing to use a cane, too. You need to know the basics of cane use in order to assist your child. By knowing the basics, you can identify when he is using the cane correctly, and you can compliment him when he is.
You may not need a teaching cane now, but keep this information in mind. More information about how to get in touch with NOPBC is at the end of this article. If possible, make an effort to attend the next NOPBC conference.
Home Services
If you are reading this article, you have discovered that your child is blind or visually impaired. Now it's time to move to the next step. Contact your child's school district to let officials know that a child with a visual impairment is entering the educational system. A coordinator from the ECSE team will contact you to set up a home visit. From there, a TVI and an O&M instructor may be informed about your child. Many members of the ECSE team will do assessments. You have the right to request special assessments from the TVI and O&M instructor, and your child has a right to receive these services. Remember, some O&M instructors may want to hold off on providing instruction until your child is walking. That cannot stop you from helping your child by following the suggestions in this article. On the other hand, some O&M instructors may wish to begin right away.
If the O&M instructor begins work with your child right away, he or she may suggest many of the ideas in this article. Even with the instructor's help, your toddler will not become an independent traveler overnight. The instructor may simply relay information or provide pointers on how you can assist your child to crawl. Perhaps the O&M instructor will provide literature or recommend that you read Independent Movement and Travel in Blind Children: A Promotion Model by Joe Cutter (2007).
O&M for Toddlers with Additional Disabilities
For toddlers who are blind with additional special needs, it is important to note that any of the above suggestions may or may not apply. The only way to know for sure what will work is to try. Each child with additional needs is unique, so instruction needs to be individualized. It is vitally important to consult your child's O&M instructor for assistance.
Pre-canes
People do not receive pre-pencils when they learn to write, so why introduce a pre-cane to a child? Specially designed pre-canes can be confusing to a child; they can be heavy and cumbersome. By using the steps above, your child can be introduced to a lightweight tool that grows with your child. As your child grows, a new cane needs to be ordered. Measurement needs to be from the toes to the nose.
When a pre-cane device is introduced to the young child, she first must learn to use the pre-cane device, and then learn to use the long white cane she will use for life. Why add the unnecessary pre-cane step?
If you feel that a pre-cane is necessary, many children, blind and sighted, enjoy push toys such as child-size grocery carts and lawnmowers. These toys make wonderful pre-canes, and they are age- and stage-appropriate. They are lightweight and the perfect size. Like the cane, the push toy or pre-cane explores the surface ahead of your child and informs her whether the path is clear of obstacles so she may venture forward.
Learn from Your Child
Let your child lead the way. He may drag his cane along as he crawls or cruises around the room. At times the cane may need to be moved to another area of the room where he is playing.
Children will maneuver the cane all around them, even waving it in the air. Consider this as a means of looking around. Yes, there are good times and bad times to look around with the cane. A good time is when nobody is nearby.
It may seem natural to stress to your child that the cane tip must be down on the ground. Remember that the toddler is exploring with his cane, and this is a good thing. He is doing exactly what is needed and expected. At times you may want to show him how high a ceiling or doorway is, and the cane can be used to touch the ceiling. If you show something to your toddler in this way, why can't he explore something that is over his head another time? This type of exploration will discontinue as your child gets older. However, from time to time it is interesting to check how low a ceiling is, such as on a field trip to the aquarium tunnel at the zoo. As the toddler matures and O&M skills become more firmly established, having the cane tip in the air will decrease.
Some children with additional disabilities may have particular difficulty with the concept of keeping the cane tip down. Consult your O&M instructor for assistance.
Adapt the Environment?
Because you have a toddler, you have most likely childproofed your home. A home need not be overly childproofed because the toddler is blind. Everything that is done for a sighted toddler will also benefit the blind or visually impaired child. For example, when you place a gate across the stairs so the toddler does not fall down them, that is a standard childproofing strategy.
Falls are bound to happen. Toddlers who are sighted will fall. Toddlers who are blind will fall, too. Toddlers learning to walk will wobble and fall down. When this happens, as with any child, you need to evaluate the situation. Is your child hurt? If so, tend to the injury. If not, carry on. Whatever you would do for a sighted toddler, do the same for your blind toddler.
As your child gets older, it may be in her best interest to learn how to fall safely. This may sound silly, but it is true. Some people with physical limitations learn to fall so they can recover with the least amount of physical harm or damage. Depending on your child's physical ability, he may need to learn to fall, too.
You can help your child develop balance skills. Hold his hands as he walks on the bed. Perhaps get a small trampoline with a support bar for him to jump on. Parents can also request a physical therapist (PT) to help their toddler strengthen his ankles and build up his balance skills. A PT may have to evaluate your child in order for you to get this service.
Low Vision vs. Blind
If you are reading this article and your child has low vision, you already may have concerns regarding her safety when she walks independently. Consider the cause of your child's vision loss. Is it a progressive condition, one that is known to get worse? If you do not know the answer, ask the ophthalmologist. If her vision loss is known to be progressive due to a condition such as retinitis pigmentosa, your child needs to use the long white cane. Begin instruction now. If you wait until your child is in middle school and can no longer see well at dusk, her acceptance of the cane may be nil.
O&M Games for Toddlers
Toddlers love games, or anything they think is a game. Games can be very, very simple. Here are some ideas:
- Walk around the house with your child and see how many different sounds the cane can make by tapping the metal tip on different surfaces: the kitchen floor, bathroom floor, closet floor, front sidewalk, etc. This game also can help teach your toddler problem-solving skills. Tap something with the cane tip and say, "I wonder what that is. Do you know what makes that sound?" Then check it out together.
- Collect carpet samples with different textures. Have your child find them with his cane and walk on them barefoot.
- Buy a roll of packing bubbles. Unroll the packing bubbles and have your child follow the path with his cane, then walk on it barefoot.
- Create a path for your child to walk on by taping strips of cardboard together. Be sure to add corners and curves. Another option for "Follow the Path" can be found at: http://www.pdrib.com/pages/omgames.php#followthepath
- Stand in a doorway and have your child tap both sides of the doorframe and sing: "Left and right, Left and right, Swing your cane from side to side."
- Play "Red Light, Green Light" (http://www.pdrib.com/pages/omgames.php#redgreenlite)
- "Go Fishing" is a good game to work on keeping the cane tip down. (http://www.pdrib.com/pages/omgames.php#gofishing)
- Get a long wrapping paper tube and walk around the house as though the tube were a cane. Compare the sounds from the cane tip with the sounds from the tube.
Human Guide for Preschool Children
In human guide technique, someone (in this case, an individual who is blind) is led to a targeted location by another person. At this age, the child holds the hand of another person. Keep in mind that this is different from when a child holds the hand of a parent, guardian, or teacher, which is typical for many children at this age. Human guide is conducted when there is a specific location to which the blind or visually impaired individual needs to travel. Often the adult believes that your child is unable to travel to the location without assistance. However, it simply may be the case that your child has not yet learned how to travel to that location.
A parent walking hand-in-hand with a preschooler is not considered human guide. This is age- and stage-appropriate.
Preschool Services
Your toddler has grown taller and steadier on her feet; now comes the transition to preschool. Many preschools offer opportunities for children to visit ahead of time. Such visits help with the transition for all students, not just those with special needs. Check with the preschool for play dates and open houses, or simply schedule an appointment with the preschool department or teacher to visit the school and classroom.
Use this opportunity to help your child explore the classroom. This is most effective when your child discovers the art center, playhouse area, trucks and building blocks area, etc., herself. When your child makes the discovery herself, mental mapping begins to form. This is an important skill for your child to develop, and she will build upon it for the rest of her life. If she is constantly led to an area via human guide, mental mapping cannot develop easily. She will be dependent on others to take her to a specific location every time, even when that location is within the same room.
Final Notes
In the beginning, a toddler or preschooler is not going to be perfect with the cane, for he is still at the scribbling stage. This is quite normal. Toddlers and preschoolers do not have the physical coordination to walk in step with the cane, and they do not have the dexterity to hold the cane in a pencil grip. Don't worry. Your child will perfect his cane skills soon enough.
Resources
National Organization of Parents of Blind Children: http://www.nopbc.org
Connect via Facebook: https://www.facebook.com/nopbc
Orientation and Mobility for Children: http://www.pdrib.com/pages/omkids.php
Articles
Chamberlain, MN. (2017) "The Orientation and Mobility Goal Bank," Future Reflections, 36:2. https://nfb.org/ images/nfb/publications/fr/fr36/2/fr360206.htm
Chamberlain, MN. (2017) "Teachable Moments: How Parents of Blind and Visually Impaired Children Can Reinforce Lessons in Orientation and Mobility," Future Reflections, 36:1. https://nfb.org/images/ nfb/publications/fr/fr36/1/fr360106.htm
Thorp, MJ. (2007) "The 'Teaching Cane'," Future Reflections, Winter/Spring, 26:1. https://nfb.org/images/nfb/ Publications/fr/fr25/fr07spr10.htm
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