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{\phpg\posx1440\pvpg\posy7012\absw7623\absh252\f5\fs22 Severe respiratory distress and/or prolonged mechanical ventilation (10 days or more)\par}

{\phpg\posx1053\pvpg\posy7444\absw204\absh275\f5\fs24 {\f0\bullet} \par}

{\phpg\posx1440\pvpg\posy7444\absw2711\absh264\f5\fs23 Neurodegenerative disorders\par}

{\phpg\posx1053\pvpg\posy7876\absw204\absh275\f5\fs24 {\f0\bullet} \par}

{\phpg\posx1440\pvpg\posy7876\absw9827\absh529\f5\fs23 \li2594 \fi-2594 Childhood infectious diseases such as mumps and measles \par\sb0\fi0 (Hearing, Speech and Deafness Center website, , June 2001)\par}

{\phpg\posx720\pvpg\posy8668\absw9784\absh505\f9\i\fs22 \li333 \fi-333 Behavioral Indicators \par\sb0\fi0 \i0 {\f0\bullet} The child does not stop moving, does not quiet in response to speech, and/or does not arouse from light\par}

{\phpg\posx1305\pvpg\posy9352\absw2637\absh264\f5\fs23 sleep to sudden loud noises.\par}

{\phpg\posx1053\pvpg\posy9784\absw9848\absh758\f5\fs22 \li252 \fi-252 {\f0\bullet} At about 4-7 months, the child does not turn to sounds and voices or give an indication of detecting a sound source by eyes widening or blinking, fussing or quieting, increasing or decreasing overall activity level, changes in breathing or sucking patterns.\par}

{\phpg\posx1053\pvpg\posy10792\absw9770\absh241\f5\fs21 {\f0\bullet} There is a lack of babbling, cooing, grunting, or the child stops these behaviors and does not progress to speech.\par}

{\phpg\posx1053\pvpg\posy11224\absw9957\absh505\f5\fs22 \li252 \fi-252 {\f0\bullet} The child does not respond to familiar sounds (such as mom\rquote s and dad\rquote s voices) by cooing/gurgling when he cannot see them.\par}

{\phpg\posx1053\pvpg\posy11944\absw9751\absh505\f5\fs22 \li252 \fi-252 {\f0\bullet} The child does not use speech at an age when most children are beginning to use speech (approximately 9- 12 months).\par}

{\phpg\posx8925\pvpg\posy12592\absw2290\absh264\f5\fs23 (SKI-HI Institute, 1998)\par}

{\phpg\posx720\pvpg\posy13024\absw1553\absh551\f3\b\fs24 Vision Loss \b0 \i At Risk Factors\par}

{\phpg\posx1053\pvpg\posy13816\absw5325\absh241\f5\fs21 {\f0\bullet} Family history of vision loss (Retinoblastoma or Albinism)\par}

{\phpg\posx1053\pvpg\posy14248\absw3971\absh252\f5\fs22 {\f0\bullet} Malformation of the ear, nose, and throat\par}

{\phpg\posx1053\pvpg\posy14680\absw4627\absh252\f5\fs22 {\f0\bullet} Prematurity and low birth weight less than 3 lbs.\par}

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{\phpg\posx6180\pvpg\posy14946\absw300\absh275\f5\fs24 30\par}

{\phpg\posx1413\pvpg\posy748\absw2614\absh252\f5\fs22 {\f0\bullet} Birth trauma/head trauma\par}

{\phpg\posx1413\pvpg\posy1180\absw1000\absh252\f5\fs22 {\f0\bullet} Anoxia\par}

{\phpg\posx1413\pvpg\posy1612\absw1717\absh264\f5\fs23 {\f0\bullet} Cerebral Palsy\par}

{\phpg\posx1413\pvpg\posy2044\absw10038\absh505\f5\fs22 \li252 \fi-252 {\f0\bullet} Congenital viral or bacterial infections (Rubella, CMV, Syphilis, Group B Streptococcus Infection, Toxoplas- mosis, Chicken Pox, HIV)\par}

{\phpg\posx1413\pvpg\posy2764\absw5452\absh252\f5\fs22 {\f0\bullet} Meningitis, Encephalitis, Hyperthyroidism, Microcephaly\par}

{\phpg\posx1080\pvpg\posy3340\absw5692\absh505\f9\i\fs22 \li333 \fi-333 Behavioral Indicators \par\sb0\fi0 \i0 {\f0\bullet} The child does not have eyes or eyelids that look typical.\par}

{\phpg\posx1413\pvpg\posy4168\absw9323\absh505\f5\fs22 \li252 \fi-252 {\f0\bullet} The child does not recognize caregivers\rquote faces or smile in response to their smiles around the age of 3 months.\par}

{\phpg\posx1413\pvpg\posy4888\absw7466\absh252\f5\fs22 {\f0\bullet} He does not get excited when he sees his bottle or other familiar objects he likes.\par}

{\phpg\posx1413\pvpg\posy5320\absw9004\absh252\f5\fs22 {\f0\bullet} At 4-6 months, the child\rquote s eyes do not seem to move together when following an object or person.\par}

{\phpg\posx1413\pvpg\posy5752\absw7557\absh252\f5\fs22 {\f0\bullet} The child may turn or tilt his head in unusual positions when looking at an object.\par}

{\phpg\posx1413\pvpg\posy6184\absw4918\absh252\f5\fs22 {\f0\bullet} The child may hold an object very close to his eyes.\par}

{\phpg\posx1413\pvpg\posy6616\absw9610\absh252\f5\fs22 {\f0\bullet} The child may over-reach or under-reach for objects (accurate reaching usually occurs around 6 months).\par}

{\phpg\posx1080\pvpg\posy7264\absw2280\absh264\f3\b\fs23 WHAT DO YOU DO?\par}

{\phpg\posx1080\pvpg\posy7672\absw10185\absh2172\f5\fs21 \fi287 If there is a concern about vision or hearing, your ECI program should make a referral to the appropriate medical professional. We would like to encourage ECI personnel to work closely with their Teacher of the Visually Impaired, Teacher of the Deaf and Hearing Impaired, and/or TCB Children\rquote s Caseworkers in helping the families prepare for the doctor visits. These professionals have much to offer to the process. They can usually share the names of doctors, audiologists, and vision specialists who have more experience working with disabled children. Often they can guide the ECI professional and parents in compiling a list of concerns related to the way the child uses his vision and hearing. More importantly, they can provide parents with information about the types of testing that may be done and how to help prepare the child for testing. This level of support can be provided before an actual vision or hearing referral has been made.\par}

{\phpg\posx1080\pvpg\posy10552\absw10345\absh919\f5\fs20 \fi287 Parents and professionals must keep a close watch on a child\rquote s progress related to vision and hearing. Hearing and \par\sb0\fi0 vision issues must not be ignored, especially if the child has other disabilities. When a problem is suspected, no time \par should be lost in following up on the concern. We owe it to our children not to lose that critical window of time between \par birth and age three. When early intervention can make such major differences in life-long functioning, they can\rquote t afford to wait.\par}

{\phpg\posx1080\pvpg\posy11992\absw3777\absh275\f3\b\fs24 REFERENCES AND RESOURCES\par}

{\phpg\posx1080\pvpg\posy12443\absw10319\absh505\f5\fs22 \fi287 Hearing, Speech and Deafness Center website, , June 2001. Early identification of hearing loss. From {\i Communication Update}, published on HSDC Website, copyright 1996-99.\par}

{\phpg\posx1080\pvpg\posy13105\absw10327\absh529\f5\fs23 \fi287 Moss, Kate. {\i Syndromes which often result in combined vision and hearing loss}. Texas School for the Blind and Visually Impaired website, , 2001.\par}

{\phpg\posx1080\pvpg\posy13768\absw10511\absh551\f5\fs24 \fi287 SKI-HI Institute, 1998. Auditory development. {\i Understanding Deafblindness: Issues, Perspectives, and} \i Strategies{\i0 . SKI-HI, Utah State University, Logan, Utah, p. 21.}\par}

{\phpg\posx1080\pvpg\posy14428\absw10509\absh529\f5\fs23 \fi287 Texas School for the Blind and Visually Impaired website, , June 2001. {\i Primary identified etiology - deafblind.}\par}

{\phpg\posx549\pvpg\posy8149\absw257\absh23\f11\b\i\fs2 SYNDROMES/CONDITIONS\par}

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{\phpg\posx5820\pvpg\posy14946\absw300\absh275\f5\fs24 31\par}

{\phpg\posx4809\pvpg\posy758\absw2643\absh355\f4\b\fs31 Off to a Good Start\par}

{\phpg\posx1454\pvpg\posy1135\absw8988\absh310\f7\fs27 By Phil Hatlen, Superintendent, Texas School for the Blind and Visually Impaired\par}

{\phpg\posx720\pvpg\posy1756\absw10188\absh965\f5\fs21 \fi287 I\rquote ve \ldblquote stolen\rdblquote the title of this short paper from the Blind Babies Foundation in San Francisco. I was once their Executive Director, and I think they\rquote ll forgive me for using this title, which, I think, describes what we all want for our infants. Using such a descriptive title leaves me with the responsibility of providing some content that will be helpful to parents and teachers. This time, I want to talk directly to parents of babies and toddlers.\par}

{\phpg\posx720\pvpg\posy3196\absw10437\absh758\f5\fs22 \fi287 What do I want to say to parents of blind and visually impaired infants? First of all, I want to say to you that those of us who have not walked in your shoes have only the slightest idea of what it feels like, and what it is like, to be the parent of a blind child. It is, therefore, with much humbleness that I share with you the following thoughts:\par}

{\phpg\posx1053\pvpg\posy4132\absw9909\absh758\f5\fs22 \li252 \fi-252 {\f0\bullet} Love, cuddle, and completely enjoy your baby. He may not be what you expected and wanted, and you may still be grieving, or be in shock, but from the moment of birth your baby needs your body, your warmth, your love.\par}

{\phpg\posx1053\pvpg\posy5140\absw9883\absh505\f5\fs22 \li252 \fi-252 {\f0\bullet} Try to notice the wonderful attributes of your baby. It\rquote s easy and natural to dwell on the disability, but your joy in parenthood will really start growing when you begin to discover the many wonderful things about her.\par}

{\phpg\posx1053\pvpg\posy5860\absw9895\absh758\f5\fs22 \li252 \fi-252 {\f0\bullet} Seek out professional help as soon as possible after diagnosis. Pediatricians, ophthalmologists, social work- ers, and generalists in early childhood are all valuable allies, but the one person you really, really need is an experienced expert in the effects of visual impairment on early growth and development.\par}

{\phpg\posx1053\pvpg\posy6868\absw9753\absh758\f5\fs22 \li252 \fi-252 {\f0\bullet} Maintain close physical contact with your blind baby. For example, a back- or front-pack can be far better than a buggy or stroller, because, while the surroundings may hold no interest for your child, the warmth, contours, and movement of your body will.\par}

{\phpg\posx1053\pvpg\posy7876\absw9607\absh505\f5\fs22 \li252 \fi-252 {\f0\bullet} Have the same developmental expectations for your baby as you would for any child, but know that your direct involvement in her development will be essential.\par}

{\phpg\posx1053\pvpg\posy8596\absw10110\absh1516\f5\fs22 \li252 \fi-252 {\f0\bullet} If your baby is blind or has severe visual impairment, remember that incidental learning through observation will not occur. When my son Lucas was a baby, I observed him laying prone on his tummy in our living room. He pulled himself up so his head was raised, his arms straight, and moved his head as far as he could in both directions. As I watched him, it became clear that what he was doing was visually organizing his environment. How do blind babies do this? It is not difficult, but it must be taught. Your \ldblquote expert\rdblquote in visual impairment will help you learn how to do this.\par}

{\phpg\posx1053\pvpg\posy10468\absw9982\absh1010\f5\fs22 \li252 \fi-252 {\f0\bullet} The blind child\rquote s world is the length of her arm. This is essential and fundamental to remember as you begin to find ways to assist in your child\rquote s development. Sounds and smells beyond arm\rquote s reach cannot be identi- fied by the blind child, so expansion of his world is up to you and the good advice and suggestions you receive.\par}

{\phpg\posx1053\pvpg\posy11764\absw9930\absh1263\f5\fs22 \li252 \fi-252 {\f0\bullet} In order to creep, to crawl, to cruise, and to walk, there must be a reason for the blind child to move. Something must be beyond arm\rquote s reach that he wants. This sound or smell must be associated with a past pleasant experience. An enjoyable toy that makes a distinct sound, mother\rquote s voice that is out of reach, the smell of something good to eat - these are the experiences that motivate blind and visually impaired babies to walk.\par}

{\phpg\posx1053\pvpg\posy13348\absw9992\absh1263\f5\fs22 \li252 \fi-252 {\f0\bullet} Be prepared for developmental differences between your child and a non-disabled child. Sometimes walking doesn\rquote t occur until the baby is 12-15 months old or older. If other areas of motor development seem okay, don\rquote t worry. Your baby is simply learning other things and postponing walking. Talk with your expert on visual impairments about differences in developmental patterns, how you might help, and whether you should be concerned.\par}

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{\phpg\posx1413\pvpg\posy748\absw9973\absh1768\f5\fs22 \li252 \fi-252 {\f0\bullet} If your baby is likely be a braille reader, consider early introduction to braille as a system for pairing sym- bolic language with real objects. You may wish to put braille labels on every object in your home - the walls, the floor, the toilet bowl, the dresser, etc. When your baby encounters these strange dots, you don\rquote t need to begin reading instruction. Just tell him that the jumble of dots represents the word \ldblquote wall\rdblquote (or whatever), and \ldblquote wall\rdblquote is the object that the word is attached to. It seems to me a shame that some braille readers don\rquote t see their first word until formal school, while sighted infants and preschoolers are surrounded by print from the time they can remember.\par}

{\phpg\posx1413\pvpg\posy2908\absw9841\absh2172\f5\fs21 \li252 \fi-252 {\f0\bullet} Teachers of visually impaired students have many stories to tell about blind and visually impaired children who were not ready to learn when they came to school because they lacked real, concrete experiences. These \par\sb0\fi0 young children are lacking in {\i experiential learning.} What this means is that they arrived at school without \par the background of experiences with the real world that adds meaning to learning. Your baby and preschool child needs {\i direct, physical experience} with his environment in order to learn in a meaningful way. The story in the reading book about a brother and sister at the grocery store will have little or no meaning for the blind child who has not experienced \ldblquote grocery store.\rdblquote This experience has to happen in a grocery store, and must include verbal information and first-hand tactual experiences. Your baby and preschooler must have a comprehensive exposure to the world, and information for understanding that world, if school is to be successful.\par}

{\phpg\posx1080\pvpg\posy5860\absw10453\absh1768\f5\fs22 \fi287 Well, I could go on, but I think I\rquote ll stop now. Babies are precious - they deserve the very best we can give them. They don\rquote t know what they need - parents must know and offer the experiences, the love, and the caring required by a blind or visually impaired child. Parents won\rquote t always know what to do - they need a competent, creative teacher of the visually impaired or early childhood caseworker who {\i knows} early childhood growth and development to help them. So you see, the parent/child/professional team must begin when the child is an infant. There are so many essential learning and developmental experiences required by the blind baby that this partnership must begin as soon after diagnosis as possible.\par}

{\phpg\posx1368\pvpg\posy8164\absw9189\absh252\f5\fs22 Parents: Don\rquote t delay - find yourselves a qualified and creative expert in visual impairment right away!!\par}

{\phpg\posx1080\pvpg\posy8740\absw10449\absh505\f5\fs22 \fi287 Teachers: Don\rquote t delay - if you\rquote re not feeling qualified to help parents through the critical growth period of birth to five, then find classes and readings that will prepare you for this crucial role.\par}

{\phpg\posx1368\pvpg\posy9604\absw8404\absh252\f5\fs22 Parents and Teachers - have fun with babies, and help babies to have fun with you and others!!\par}

{\phpg\posx4075\pvpg\posy10612\absw4776\absh345\f4\b\fs30 Help and Hope, One Child at a Time\par}

{\phpg\posx2378\pvpg\posy10992\absw7843\absh310\f7\fs27 By Terry Murphy, Executive Director, Texas Commission for the Blind\par}

{\phpg\posx1080\pvpg\posy11610\absw10103\absh1206\f5\fs21 \fi287 One of the hardest, but most rewarding, aspects of working at the Commission is calling on parents who have just learned that their long-awaited babies will never clearly see the loving faces holding them. It's hard, because this is an emotional time for everyone - even for those of us who have chosen the field of blindness and visual impairment as our life's work. It never gets easier seeing the initial fear in parents who are still trying to absorb the medical facts behind their baby's visual impairment when we are asked to call on them.\par}

{\phpg\posx1080\pvpg\posy13338\absw10206\absh965\f5\fs21 \fi287 I think I speak for all of us at the Commission when I say I wouldn't mind losing my job for lack of customers. But, that's not likely to happen in my lifetime. Based on the 2001 Annual Registration for Students With Visual Impairments published by the Texas Education Agency, there are 6,719 students ages 0 to 21 in Texas today who fall within TEA's definition of visually impaired. We serve an even broader range of children, so there is much work to be done.\par}

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{\phpg\posx720\pvpg\posy748\absw10180\absh1448\f5\fs21 \fi287 Our reward in calling on parents of newborns and young children comes from being able to plant early seeds of help and hope. Help first comes in the simple form of a caseworker's business card. Although a parent seldom reads the words Texas Commission for the Blind with enthusiasm, we're accustomed to the reaction. It's okay. This isn't the time to wow parents with all the great things individuals who are blind or visually impaired are doing today. Instead, it's the time to listen and answer questions. Hope is planted with just a few straightforward words: "The Blind and Visually Impaired Children's Program is here to help when you're ready."\par}

{\phpg\posx720\pvpg\posy2764\absw10208\absh758\f5\fs22 \fi287 Walter Anderson, the editor of Parade, the magazine insert in many U.S. Sunday newspapers, says in his book, \i The{\i0 }Confidence Course: Sevens Steps to Self-Fulfillment,{\i0 \ldblquote True hope dwells on the possible, even when life seems} \i0 to be a plot written by someone who wants to see how much adversity we can overcome."\par}

{\phpg\posx720\pvpg\posy3916\absw10368\absh1689\f5\fs21 \fi287 Although written for all ages, Anderson's words are especially appropriate for the parents we meet. When a baby \par\sb0\fi0 is born with visual problems or a child acquires a severe visual impairment, the whole family begins a challenging journey. Because the primary source of information for most children is vision, family members of children with vision losses are immediately called into action to fill in some missing or incomplete information. This is unfamiliar territory for most parents. The Commission's job is to provide them with a map that ultimately leads to a fuller and richer life for their child. The map we draw is full of "possibility thinking" check points as we encourage parents to dwell on the possible for their child.\par}



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