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Why kids need vision tests

With childhood vision problems ranking as the fourth-largest class of disability and hearing problems considered the most common congenital condition in the United States, getting kids screened early is critical, experts say.

Not surprisingly, missing such problems can lead to a host of misdiagnoses and missed chances to correct ailments in young children.



"These things are interconnected and if they’re detected early, it will be related to the way a child develops," said Dr. Gloria Riefkohl, a pediatrician with Miami Children’s Hospital and chief physician for its mobile Health on Wheels clinic.



The American Academy of Pediatrics recommends children begin formal vision and hearing screenings at their four-year checkup. And all newborns undergo hearing tests before they leave the hospital — what’s called a "brainstem auditory evoked response" — to ensure the brain’s circuits are working correctly.



But subjective screenings can begin far earlier, explained Dr. Gary Kramer, a Coral Gables-based pediatrician.



"There are a lot of things that parents will observe," he said. "The cues you might use to pick up on a problem aren’t always the things you’d think they’d be, like a speech delay might be a hearing deficit. Parents say, 'They won’t hear me when I speak from the left, but from the right they hear me,' or, 'they’re not responding to their name,' " he said. "With vision, they might present with headaches because they’re straining or they’re doing poorly in school because they can’t see the front of the classroom."



Other clues to look for include repeating words, acting distracted, bumping into things, sitting too close to a television or holding a video game close to the face.



Because younger kids may not be able to follow instructions with an interactive test, physicians rely heavily on what parents or preschool teachers observe. And if a parent does detect a problem, early intervention can be critical.



"A lazy eye is an example," Riefkohl explained. "This is something that can progress and the child may lose vision in that eye."



The most common problem she sees is refractive error, an error in the eye to focus light.



"If there’s a family history, if the mother or father has a problem, the chances are the child will need glasses," she said.



Doctors are also increasingly seeing learning disorders and behavioral problems misdiagnosed because of hearing and vision problems, particularly since many of the behaviors presented in poor hearing and vision are the same exhibited in a child with Attention Deficit Hyperactivity Disorder.



"It happens all the time," Kramer said. "A kid is doing poorly in school and [the parents] want to put him on Adderall and don’t want to bring the child in. And when they do, you find out the child has horrible vision. I get calls every week. People say my kid is not doing good in school and should be put on some Ritalin, and that’s not the way to do it."



As many as 60 percent of the children labeled as having learning problems or ADHD have undiagnosed vision problems, according to Davis Vision, a New York-based managed healthcare organization that recently hosted free screenings through the Miami-Dade County Public Library System. Combine that with the critical importance of good vision once a child starts school — the American Optometric Association reports that 80 percent of a child’s learning is based on vision — and good screening takes on particular urgency.



But with jobless rates soaring and a recession seemingly unchecked, healthcare experts say many families are putting eyes and ears at the bottom of their needs list.



For example, more than half the children on Medicaid in nine states, including Florida, received none of the vision or hearing screenings required, the U.S. Department of Health and Human Services reported in May 2010.



Ronnie Oller, who founded Nova Southeastern University’s "A Day for Children" eight years ago, has seen the need firsthand. Since it started, the fair has provided medical services – which include not only screenings by health experts, but exams from specialists — for more than 10,000 children. This year’s fair will be held from 11 a.m. to 4 p.m., Sept. 18, at the University’s Davie campus.



"The whole reason for having this is people can’t and are not able to get these things," Oller explained. "So we combined a health fair with a community affair. We have food and entertainment. We have 125-plus who come to us to give out information and how to access care."



In June, Davis Vision’s screenings at four Miami-Dade libraries drew 537 children, Davis spokeswoman Kiera Mickus said. Of those, 30 percent tested for some vision problem and were given vouchers for free testing by local optometrists and, if needed, one free pair of glasses.



One child, reported library spokeswoman Victoria Galan, "went to a Homestead branch, was able to get glasses that day and come back and check out a book."

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