Knee-high Dispensing
Fitting two- to five-year-old patients can be a piece of cake—depending on your knowledge of this group's special needs combined with practical yet fun frame and lens solutions.
By Karlen McLean, ABOC, NCLC

For children from two to five years old, wanting to be a part of things is a big deal. And when they don't understand what's going on, they can get frustrated or scared.

Your duty as an eyecare professional goes beyond fitting them with frames that will be attractive and functional and lenses that withstand wear and tear. Patience, knowledge, and skills to please both child and parent are critical to working with this market.

Here's how three professionals work with small fries to ensure the best frame fit, the best lens choice, and the highest satisfaction.

FRAME FIT

Strength, comfort, and appearance are top considerations with frame selections at any age, but there are special to-dos for the preschool set.

"We typically use a plastic frame with cable temples and spring hinges," says Joe Black, LDO, of Eye Associates of Boca Raton, Fla. "The temples are rubberized for a firmer grip and comfort. The frame comes in both bright and pastel colors, so the colors cover every taste."

	Fit, fashion, and function are keys for fitting children. (top) FlexonKids style 691 for Marchon. (middle) Trilogy Trivex lenses from Younger Optical are sturdy for kids; (bottom) Fisher Price frame style Teddy Bear for ClearVision. Below: Baby sunwear style Looping from Julbo

"We carry mostly adult-like styles for kids, because that's what most kids want. And we carry different children's sizes so we can get the best fit," says Cliff McLean, vice president of Dietz-McLean Optical with eight retail locations in San Antonio, Texas.

"Some of these shapes are shallow and wide and require adjustable pads and customized cable temples. We're very successful with flexible titanium frames for kids," he adds.

"Spring hinges are essential on all non-flexible metal frames to help absorb the abuse when eyewear is removed incorrectly and to help keep the frame in proper adjustment," notes Katheryn Dabbs Schramm, ABOC, president of A Child's View, Inc., with four locations in Southern California.

Key elements in kids' frames are:

Metal. Have appropriately sized nosepads, guard-arms, and end pieces with cable temples.

Plastic. A saddle bridge that conforms to the child's nose, or a keyhole bridge that distributes weight evenly on the sides of the nose, and spring hinges and cable temples are essential.

"Metal and plastic frames  require sufficient vertical depth to center the eye," says Dabbs Schramm.

"Typically, small kids have virtually no bridge," McLean notes. He recommends compensating by adjusting the nosepads wide to align with the frame front.

"As kids grow, their noses change, and pad adjustment can be a huge factor," he says. "Experienced staff that are creative with nosepad adjustments is the key to comfort."

SPECIAL SPECS

A primary concern for children's lenses is safety. Consider your duty to warn and choose poly or Trivex. Scratches can lessen impact resistance, so scratch-resistant coating is another safety concern.

Don't forget where kids spend a good part of their lives—outdoors. UV protection is critical for children's developing eyes and skin. With all of the focus on eye health as a key component to overall health, UV leads the way in consumer- and ECP-driven recommendations.

Today's extra-tough anti-reflective coatings cut down on glare outdoors and stand up to daily wear-and-tear.

Another reflection cutter is polishing lens edges lightly rather than with a high gloss. This creates eyewear with a jewel-like finish while reducing or eliminating distracting reflections sometimes caused by highly polished edges.

In addition to selecting lenses for durability and safety, eyecare practitioners should be prepared to work mostly with plus-power corrections, as well as irregular Rxs. "Very astigmatic kids are common," Black notes.

In those cases, it's best to look for lenses that accommodate plus Rxs in style, comfort, and safety. That usually means utilizing aspheric designs in polycarbonate or Trivex material.

"We use a combination of regular poly and aspheric poly to balance the appearance of an Rx for amblyopia,"  says Dabbs Schramm. "It's amazing."

A Child's View has also been successful using short corridor PALs on children over age three who have accommodative esotropia.

Maintaining good communication with pediatric optometrists and ophthalmologists is important, McLean observes.

"With therapeutic bifocals, we always call the doctor to find out where they want the segment placed—above, at, or below pupil level," he says.

Lenses for kids need to withstand child's play. Shown here: Essilor LiteStyle Kids IQ lenses

MAKE OR BREAK

A strong eyewear warranty is also an essential part of pediatric practice.

"We offer a two-year breakage warranty and a one-year scratch-resistant warranty," Black says.

On the doctor's side, at Eye Associates of Boca Raton, "kids have high-quality eyewear with a warranty and extended service for under $200," Black adds.

Dietz-McLean Optical's warranty covers two years of unconditional wear, whether the eyewear is broken, scratched, or outgrown. Rx changes are covered for six months. If it's lost, eyewear is replaced once at half price.

Of course, the best warranty is the one that never has to be used. "Teach parents and kids how to take off and put on their glasses properly, and how to clean and care for them," Black says. "Most kids understand that they see better with their glasses on, don't want to take them off, and treat them carefully."

Tailored for Tyke Takes

Here are specific challenges our experts face when fitting tiny eyewear and how they work both inside and outside the system to solve even the toughest tyke's needs. 1. When measuring for pediatric bifocal placement, the bifocal line should bisect the pupil. Take monocular seg heights, since many children require different seg heights to see properly from the lenses. 2. Some practices use a puppet, others use characters on a video screen, but getting a little one's attention and holding it is key to being able to take the right measurements. To polish your technique, have a colleague or a trusted patient bring in their toddler for practice. 3. Always consider the Rx. With kids, it can often be irregular (e.g., plano in the right eye, +5.00D in the other). Irregular monocular PDs may exhibit in atypical Rxs. Confirm with the examining doctor to verify Rx and PD, and practice taking atypical PDs with a PD ruler. 4. In addition to frame front measurements, be sure to carefully inspect temple fit and measure for appropriate length in order to provide the best-fitting temple. Be especially careful when measuring the length of cable temples. Be aware that manufacturers' stamped-on-the-temple lengths may vary, and supply your own measurements for accuracy. 5. For ideal frame front fit, plus the best visual acuity, the child's eye should align in the exact center of the frame.