Have you noticed that your child is hesitant or slow to master skills such as catching and throwing a ball, riding a bike, or climbing and descending stairs? Sometimes it is a functional vision issue that is holding your child back in areas like these.

If you suspect your child has a vision issue you should have him/her seen by an ophthalmologist — an eye doctor. It is the best way to determine if eye disease or refractive visual disturbances may be affecting the child’s vision.

Often times, the anatomy and functioning of the eyes are fine. Many parents will not explore the issue any further after an ophthalmologist tells them that their child’s vision will improve with time. To a degree this is true, but for many children their functional vision impairment is persistently affecting their ability to explore their environment and keep up with their peers. In my experience as a pediatric and neurologic clinical specialist, most children see significant gains when functional vision is addressed through exercises given by a physical therapist, occupational therapist or an optometrist. (Here is a link that explains what types of visual disturbances can occur that affect children.)

I believe there are two main reasons children and young adults who can safely walk on their own may still have difficulty with other physical actions such as riding a bike. The first is low muscle tone and diminished core strength, and the second is diminished functional vision. This blog is about the second issue.

Depth Perception

Difficulty with depth perception is manifested in having difficulty or being overly cautious on stairs, not being able to catch a ball, and being cautious in outdoor situations like playgrounds. The main reason for impaired depth perception is convergence insufficiency.

Here are some activities you can do with your child to help them gain control of their depth perception:

Using a glow stick, move it first toward your child’s nose and then away. Ask them to look at it. You can put a finger puppet or rattle on it to make it more interesting if need be. It is a somewhat annoying activity, so let your child know that you want them to watch it only about eight times and then you will be done. But do it daily to strengthen their eyes.
Play catch using an 8 to 12-inch ball while sitting on the floor, legs apart (even with an older child or teen), about 8 feet away from each other. If the ball has a bell inside or makes noise, all the better — we always use vision and hearing together. You can find these in infant or pet departments. Your child may blink, look away, grimace, squint, etc. Roll the ball slowly at first. Once they are able to watch the ball and catch it, change the parameters one at a time: roll the ball faster, use a smaller ball, add a bounce, sit on a chair, stand up, stand and face each other while walking sideways. A variation of this is to use a toy car that easily slides across the floor or accelerates forward after pulling it backward.

Visual Tracking

Being able to follow something as it moves across in front of their visual field is an important skill for children to master. Many children don’t stay with this task, they follow it part way, or lose it and find it again at the end.

Here are some visual tracking exercises:

Move a glow stick on an X and Y axis (algebra, its finally useful!) and have your child follow it.
Use a stomp rocket, flying fairy, ball, or bubbles (only blow a few bubbles at a time so they can focus on tracking just one) and have your child track their flight paths.
Use a flash light in a darkened room to scan for their bed, a toy, clothes, books, etc. Make sure they are following the beam of the light as it slowly moves around the room hunting for the object. Let them try it. Use a ball or push-and-go toy and keep the light on it as it moves across the room.

With these exercises, have your child start in a sitting position and work up to kneeling, half kneeling, standing, and finally walking and running. Ideally, they would progress to running while visually tracking a moving ball.

Visual Scanning

Many children look down and do not scan their environment. When doing a moving activity like riding a bike, they may be overwhelmed by everything they see, especially as it starts moving by so rapidly. When he or she is riding a bike, one option is to place a visor on your child’s head under their helmet to see if minimizing their visual field helps.

You can help improve visual scanning by playing certain games with your kids. One option is to play “I Spy”, where you identify an object that you both can see through clues such as color, shape, or proximity to other objects and have your child guess what it is. Again, think about progressing from easy to hard — i.e. sitting in the living room to walking down the street.

Another game to play is where you move their snack around each day and make a game of finding it. You can do this with any daily activity: find their shirt, pajamas, toothbrush, etc. Don’t hide it, just move it from its usual place to another place in the same room.

Gaze Stability/Fixating

This is when the eyes just aren’t as stable in the head as we would like. Even a small amount of eye movement side-to-side or up and down while walking, running, or biking can be very disconcerting. This tends to be present if the vestibular system is still maturing. It leads to balance issues, clumsiness and lack of desire to run around and play.

Here are some exercises to improve gaze stability:

Hold a glow stick or shake a ball and ask them to move their head side to side but keep looking at the glow stick.
Ask them to look at something as they are swinging, the object may be right in front of them, or to either side. Or talk to them while they are swinging, and make sure they are looking at you. You should be at their side.
Ask them to look at you as they go down the slide. You can be in front of or on the side of the slide.

Shifting Gaze

Many children on a bike will shift their gaze to something and their body follows, causing the bike to follow. They then run into a post or tree they were hoping to avoid. They need to learn to shift their gaze to the tree, and back to the path.

Here are several ways to improve this skill:

When in a store, ask your child to push the carriage down the aisle while looking for a certain product and trying not to crash into anything.
Go for a walk and point things out to your child — “look at the purple flower/red tree/yellow dog” — but keep walking. This could be another version of the “I Spy” game.
Set up stickers or pictures on the walls in the hallway of your home and have your child crawl, walk, or use a scooter on their stomach or sitting, and name what they see as they move down the hall. You can further challenge them by then rearranging and changing the stickers.
Use a standing scooter outside and have your child practice moving down the driveway and looking for things that you call out.
Sledding: This can be done any time of year on a flying saucer. Tie a string to it, and pull it around on the grass or your carpet as you ask them to find things or point to objects you name as they are moving.
Obstacle courses: These can be a great way for your child to practice all their visual skills together. Use stools, steps, railroad ties at the playground, inclines such as hills, soft surfaces like pillows, tunnels, etc.
Modified T-ball: Hang a ball on a string from a tree, swing set, basketball hoop, or any crossbar you might have. Give your child a soft foam bat or short pool noodle and ask them to hit the ball but to avoid being hit by the ball as it flies back at them. Stop the ball every few swings. You can also play catch back and forth with this hanging ball. A tether ball game will also work well.

Many children will do a visual activity three to five times and then experience eye fatigue — evident by their losing interest in the task, eye rubbing and perhaps increased clumsiness for a short period of time. That is fine; their endurance to these activities will increase with practice.

Many optometrists work with functional vision impairments. You can find them online and if you feel your child has school-related visual issues, it might be worth your time to have your child evaluated. They will have different ideas more closely related to fine motor activities and reading.