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How to Get Your Child to Wear a Patch

If your child has a visual impairment, they might have a prescription for eye patching. An eye patch is either an adhesive sticker or a cloth patch that’s worn over one eye. You may be wondering, “How on earth am I ever going to convince my child to wear a patch over their eye?”

The teachers from A Shared Vision get this question all the time. They provide strategies and support for families who have very young children, from birth to age three, with blindness, visual impairments, and vision concerns.

Why Does My Child Have to Wear a Patch?

If your child has been prescribed a patch, it is because they have a condition called amblyopia, where one eye has not developed vision as fast or as completely as the other eye. The eye with the poorer vision is called the amblyopic eye, commonly referred to as “lazy eye.” Amblyopia is a common eye diagnosis, affecting two or three out of 100 people. Amblyopia can be caused by strabismus, which is when the eyes are misaligned, crossed, or when one eye “wanders.” Amblyopia can also be caused by a refractive error, or anything that blocks vision during the critical period of visual development, such as a cataract or a droopy eyelid. Over time, the brain may permanently “turn off” input from the misaligned eye to avoid double vision, leaving a child without any vision in the weaker eye.

To develop better vision, the child must be made to use the weaker eye. A pediatric ophthalmologist will prescribe patching, or covering, the stronger eye for a period of time each day. Patching the stronger eye forces the brain to rely on the weaker eye and ultimately encourages the weaker eye to develop better vision over time. In children who are unable to patch reliably, amblyopia may be treated by blurring the vision in the better eye with eye drops or occluded lenses. Your child’s eye doctor will work with you to determine the best course of treatment.

Very young children can be resistant to wearing a patch because it will be harder for them to see once their stronger eye is covered with an eye patch. That’s where your Early Intervention Teacher of the Visually Impaired (EI-TVI) can help you and your child carry out a successful patching routine. They can explain what the patching is trying to accomplish and offer many helpful strategies for developing a patching routine. Most of all, they’re there to support you and celebrate successes, even small ones.

Here are some pointers on how to get your child to wear a patch. We also found some tips on the For Little Eyes website, a community forum for parents who have children that wear glasses, patches, or contacts.

Putting on the Patch

Adhesive patches sit directly on your child’s skin, covering the eye. They are sometimes more effective than cloth patches because the child can’t peek around the patch.

Like Band-Aids adhesive patches are disposable and for one use. They can be plain or decorated. Like Band-Aids, they can also be irritating to your child’s sensitive skin.

Reduce the strength of the patch adhesive prior to applying it to your child’s face by sticking and then removing the patch from your shirt or arm. You can also apply a dab of Milk of Magnesia with a Q-tip on the skin to be covered by the patch. Allow the liquid to dry and then apply the patch. The dried powder helps minimize the contact of the adhesive with the skin to reduce irritation.

Here are some other tips for putting on or taking off the patch.

• Try putting the patch on during mealtime when your child is hungry. Food may take priority over removing or resisting the patch.
• Try the “first, then approach.” For example, “I know you want to go outside and play. First, we put on your patch, then we’ll go outside.”
• When it’s time to take the patch off, teach your child that only mom or dad can remove it. Take it off from the inside to the outside because the outside skin is less sensitive.
• Some families have success placing the patch on their child while they are sleeping so their child wakes up with the patch on. Remember, the patching “clock” cannot start until the child is awake and using their vision. This strategy will not work for all children, as some may find it distressing to wake up with limited functional vision. Try discussing the pros and cons of this strategy with your EI-TVI.

Patching Pointers

• Successful patching is all about what works best for your child. What motivates your child to wear a patch might be different than someone else’s child. So here are some suggestions that you can try out. Feel free to experiment with different distractions or incentives. Most of all, create a routine and keep patching time fun.
  
• Reserve a fun, engaging activity or toy for patching time, and only let them do the activity while patching. Sometimes activities which allow your child to use their vision up close are more engaging and less visually demanding, like puzzles, coloring, play dough, or tablet time.
  

• Wear a patch in solidarity with your child. Even siblings, favorite stuffed animals, or dolls can wear a patch.
• Use reward charts and stickers to motivate your child to wear their patch. If you’re using adhesive patches, those patches can be used as stickers, too, once they have been removed for patching purposes.
• Draw the trunk and branches of a patching tree on a poster board and add a patch leaf to the tree at the end of each day to show your child wore their patch. This is just one of the great ideas you can find on forlittleeyes.com.
• Decorate the next day’s patch together. Or have friends and family decorate patches for your child, and let your child choose the patch for each day.
• Read books about children who wear patches. Here are a few ideas:
  • The Patch by Justina Chen Headley;
  • Matilda's Eye Patch: A Positive Guide to Children's Eye Patching by Aimie Strachan; and
  • Jacob's Eye Patch by Beth Kobliner & Jacob Shaw.
• Create a photo book with family members and friends wearing glasses and/or patches. Look at the book regularly.
• Create a patch-free zone such as your child’s bedroom so they develop a sense of autonomy. When your child leaves their room, the patch must be on.
• Don’t call the patch a “patch.” As one patch blogger wrote, “The patch will consume your conversation with everyone you know and every time your child hears that word, their little hand will shoot straight up to pull at it. We call our son’s patch the ‘cougar.’ I have no idea why, but it works. Once he figures that one out, we will switch to a new word.”

Getting Around with a Patch

It can feel scary and disorienting for a child to lose a portion of their functional vision when beginning a patching routine. They will not be able to see with both eyes (stereovision), and consequently they will not have depth perception. Depth perception allows your child to see things in three dimensions: length, width, and depth. It also allows your child to judge how far away objects are in space. They miss drop-offs, bump into things, or trip when they’re wearing the patch. Here are some tips for traveling with a patch on.

• It is OK to hold your child’s hands! You want them to feel safe while wearing a patch and moving from Point A to Point B.
• Familiarize your child with their environment so they can anticipate distances and heights as they move about. Allow your child to reach down and feel the depth of a drop-off, the height of a stair, or a crack in the sidewalk.
• When you’re on a play structure, drop rocks or chips from the top and listen for the sound of it hitting the ground. Talk about how far the wood chip fell and how high up you are.
• Teach your child to search for and use handrails.
  

Patching Works!

Even though it’s hard, many families have established a successful patching routine with their child. Keep your sense of humor and remember these last tips.

• Validate your child’s emotions. Rather than saying, “Stop fussing. You have to wear this patch!,” try “I see how mad and sad this patch makes you feel. I know you don’t like it when I put your patch on, but we’ll get through this together.”
  
• Set a timer that you can both check during the patching period. It’s reassuring to know there’s a definite end to the patching routine.
• Prioritize the development of your patching routine so your child learns what to expect each day. Children thrive when their day is predictable and routines based.
• Build up to the prescribed time for patching. Start in small increments and celebrate the little victories.
• If adhering to a patching routine is extremely difficult, discuss alternatives such as Atropine eye drops or glasses with opaque lens with your pediatric ophthalmologist.
• Ask your EI-TVI for help and even join in the patching routine during a home visit. They will cheer you along every step of the way.

Helpful Resources

• Krafty Eye Patches.  You can order “Krafty Eye Patches” in bulk from this website. They are latex-free and hypo-allergenic. The adhesive doesn’t rip skin or pull out eyebrows when removed, either. The patches are also reusable if your child patches more than once a day.
  
• Patch Pals. Patch Pals has been making cloth eye patches for 25 years. Their custom patches come with many design options including embroidery, iron-on images, decorative stickers, and jewels. They can be worn over eyeglasses or directly over the eye. You can order them through their website or on Amazon. You can even join a Patch Pals Club and meet other families who are eye patching.
• American Association for Pediatric Ophthalmology and Strabismas (AAPOS).  -- This website has a page on patching tips for parents. The website also explains many other common eye terms and conditions.
  

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photos: For Little Eyes