How Would You Handle This Challenging Scenario?

A Technician Gives I&R Training to an Anxious Child With an Overbearing Parent

How Would You Handle This Challenging Scenario?

A Technician Gives I&R Training to an Anxious Child With an Overbearing Parent

"Hold your hand palm-side up and your pointer finger up like this," explained technician Stacey Johnson for the fifth time, as she instructed 8-year-old Kevin Garvin to insert and remove a contact lens. "Pick up the lens and place it on your pointer finger and slowly insert it into your eye. You almost did it perfectly before," she assured him. "Practice makes perfect."

As Kevin was about to insert the lens, he blinked his eye rapidly, and the lens fell onto his shirt. "I can't do this," Kevin sighed, stomping his foot. "Maybe we should schedule another visit and try again then," Stacey suggested.

"Kevin, you have to keep your eye open!" exclaimed his mother, Denise, a long-time contact lens wearer. "Otherwise you'll never get the lens in!"

"Not all children get this on the first visit," Stacey calmly explained. "Some kids need more time."

"Well, that's one thing I don't have is time!" Denise snapped.

"Kevin, you've seen mommy do this a thousand times," Denise continued. "It's really easy. Try it again," she insisted.

"OK Kevin," Stacey sighed. "You can do this. Hold your finger up like this. Keep your eye open. No, don't blink …"

"Kevin, you're not paying attention," Denise interjected, rising from her seat. Denise stood behind Kevin, grabbed his finger and held his eye open. Suddenly, tears spilled down Kevin's cheeks as he sobbed. "Alright, I give up," Denise said, taking the box of lenses from Stacey. "I'll insert and remove the contact lenses at home myself if I have to."

Stacey's eyes widened.

If you were Stacey, what would you do or say next?

► K. Heather Power, F.C.L.S.A., contact lens certified optician, owner of Contact Lens Services, Winnipeg, Manitoba, Canada

I would've pulled Kevin's mother aside as soon as she began interrupting the training session and said, "We need to let Kevin work at his own speed, or he'll continue to get frustrated and give up. There's a great coffee shop around the corner, or you can go shopping for 20 minutes, so I can work with Kevin alone. I'll see if I can calm him down, so he'll be more relaxed and better able to perform the procedure."

It's often difficult for a child to learn insertion and removal while a parent is watching and interrupting. It can make them more nervous and anxious, which hinders the process. The child needs to do well with inserting and removing lenses, and this is more likely without distractions.

► Vickie S. Portis, N.C.L.C.-A.C., F.C.L.S.A., advanced certified CL technician, Vistar Eye Center, Roanoke, Va.

If I were Stacey, I'd tell Kevin's mother that the blink reflex isn't a voluntary reaction. And you can't immediately train someone to control it, either. Generally, girls have an easier time with I&R, especially if they've been applying eye makeup.

I'd have Kevin practice by touching his lower eyelid with a clean finger without blinking. He'd be training the blink reflex to relax. If I were able to insert a lens and let Kevin remove it, I would be able to tell him that he was halfway there, which would've boosted his confidence.

Of course, with Kevin's mother upset, I might've asked her if I could work with him one-on-one while she sat outside in the waiting area. I'd tell her that doing the insertion and removal herself is not an option. What would happen if he slept at a friend's house and wasn't able to insert the lens himself?

► Vicky Sheppard, F.C.L.S.A., contact lens program manager, Vision Essentials by Kaiser Permanente, Los Angeles

Most of these situations are preventable. At the beginning of I&R training, I tell parents and children that it takes trial and error to master these skills. I also tell them not to get discouraged if they don't get it on the first, second or even the third try. Saying this up front usually puts kids and parents at ease, and prevents a frustrating interchange between them.

When parents want their children to insert and remove contact lenses the way they do, as in this case, I let kids try it their parents' way. I stay calm and open to hear what parents have to say because, in some cases, their methods actually help the child. If they don't help, however, and mom sees that her way of inserting and removing contact lenses isn't working for her child, I go back to what works best. If tension builds and escalates – as it did between Kevin and his mother – I'd speak to the parent privately, explain the process again and perhaps suggest that we try it at a later date during a follow-up visit when the child is calm and more likely to succeed. ■