Thank you to Dr. W.C. Maples — who quoted mama during his presentation at COVD’s annual meeting to remind us of the importance of prevention in health care.  Dr. Maples was discussing infantile esotropia: an eye that turns inward that presents at a very early age, usually at about 4-6 months of age.  When the eye turns in, the young child begins to make significant adaptations and changes in the way he or she processes visual information.  Often the child is diagnosed with a triad of clinical conditions:  esotropia (inward turning eye), anisometropia (difference in the refractive status between the eyes) and amblyopia (reduced visual acuity and visual skills in the turned eye).  Treatment of this triad of visual dysfunctions is based on the development of binocularity:  teaching the child to use both eyes together.  The development of binocularity will create a cascade that also reduces the anisometropia and amblyopia.

But what if we could prevent the development of the esotropia and the associated amblyopia and anisometropia?  Dr. Maples conducted research that reviewed the medical records of children with infantile esotropia.  He and his colleagues were able to identify 26 risk factors that predispose children to develop esotropia at this early age.  These risk factors include premature birth, a family history of esotropia, cardiac or other systemic disease, low birth weight and maternal high blood pressure during the pregnancy.  If your baby has any of these risk factors, you can provide visual stimulation to your baby and reduce the likelihood that your baby will develop an esotropia.

What types of activities should you be doing with your baby?  Engage in face-to-face activities with your baby, and make sure you do these activities in all different directions.  Babies love human faces.  Talk to your baby and move slowly to one side and then the other.  Make a mobile to hang over the baby’s crib with black and white photographs of faces.  Move the baby’s crib to different parts of the room.  Find a crib bumper with checkerboard or other high contrast patterns.   Movement should be a big component of playtime with baby.  Even if your baby cannot yet sit up or roll, make sure the baby has plenty of room to move arms and legs.  As the baby matures, be sure to provide enough room to freely move about and explore the environment.  Take field trips to the mall, the park, grandma’s house and down the city streets to provide a diversity of visual stimulation from all directions: over, under, in front, behind, left and right.  At home (or at the beach), place your baby on top of a beach ball and gently roll the beach ball, to get the vestibular and visual systems talking to each other.  Basically, play with your baby and keep things moving!  In fact, this is good advice for all parents, not just those with babies with a higher risk of developing infantile esotropia.  Visual experience is a critical component of every baby’s development.

Dr. Maples pointed out that there are three components to child development:  genetics, maturation, and experience.  There is little that can be done to change genetics and maturation.  By focusing on the experience, we can shape a child’s development and perhaps prevent the onset or lessen the impact of many dysfunctions and disorders.  Mama is right – an ounce of prevention is worth a pound of cure.

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