Vision/Hearing exams on preschool age children

[peaceful2100, BSN, RN]

Anyone else work with children as young as preschool? I work in a school with children as young as 3 years old through 6th grade. I use to work in a High School. I LOVE High school, but in the best interest of my Daughter I had to switch to a school where hours are better. Finding before school care for school age children that open early enough  in my area is incredibly hard. 
 

Anyway, preschool-6th grade is growing on me. However, something I truly struggle with and feel extremely uncomfortable with is getting vision and hearing exams on the younger children.

They either do not cooperate or they simply can’t read the chart. Even just the symbol chart, and tumbling E chart. 
 

With hearing they will not sit still or won’t follow directions. I will tell them when they hear the noise to clap their hands. 
 

Anyone have any ideas/tips? I’m sure the school psychologist is starting to think I am not doing the exams when I told her I attempted, but was not able to get cooperation or they was unable to do so. I do try. ?

[Flare, ASN, BSN]

I just had this discussion with a neighboring SN.  I tend to make my assessments rather broad on the littles.  I use the kindergarten picture chart.  Depending on the kid, I will usually have them look at it and tell me what they think the picture is.  Most don't know what to call the sailboat and they usually all call the flag a house and the plus an X or they just make the shape.  Hearing is tricky.  I have been mulling over getting an OAE for the little guys and also for my ESL students.  It's hard to explain to a student that only speaks Arabic to press the button when they hear a beep.  Occasionally, for very non compliant students, I'll just test for gross hearing.  

[lifelearningrn, BSN, RN]

With hearing I look at facial expressions. rather than have them faced away from me I have them face me. Most of the time, they'll look to the side with their eyes, or make a face (sometimes they look curious, or a bit surprised by the sound).    

[Bulldogs, CNA, EMT-B]

We call in the lions club with photo screeners for the 2-4 year olds.  However I still do hearing on all of them the best I can and the ones that are uncooperative or no response are referred

[k1p1ssk, BSN, RN]

My biggest tip for Pre-K/K is to do it early enough in the day that they have the energy to sit through a screening. And probably do it over a couple of days, where they are only performing one task per day (hearing one day, vision another). Some of them will never cooperate until they are older. I usually screen in the fall, I try to get the whole school done by the end of October. The kids that aren't cooperative in these younger grades get rechecked in March/April. If they still won't cooperate with 5months of school under their belts, then they get referred. I've only had one or 2 students in the last few years who ended up in that boat...

Ultimately, just do your best! 

[ro2878, ADN, BSN]

if you make a game out of hearing and vision testing, preK kiddos typically cooperate. 

If students won’t raise a hand when hearing a tone, have them kick their foot, drop a block or ball into a bucket, or give them a stuffed animal and tell them to raise the animal’s paw when hearing the tone.  You can also, as stated in another reply, watch the kiddo’s expression - you can usually tell if student is hearing the tone.  OAEs do work great with this age group.  The problem is the cost of the ear pieces. I found that the squishy, marshmallow type ones work best but they are single use and a bag of them is not cheap.  I just use an audiometer and have never had a problem unless it is a special ED student.

The Lea shape chart works best for vision screening preschoolers. If you can’t get them to successfully cover one eye/they “cheat,” you can order a set of screening glasses.  If you have never seen them, one pair has the left eye darkened and the other pair has the right eye darkened. Or, you can have their teacher stand behind the student and cover one eye. 
 

Again, if you make a game out of screening and be goofy/silly with the kiddos, they will be successful but if you can’t get a student to complete screening then just document that and send notice to parent. I love screening this age group!

[Eleven011]

I am very lucky in this respect.   We have a full time SLP, and she handles all the hearing exams.   As for vision, we have our Lions club come in with their SPOT screener and do all PreK - 5th grade.    I only do H/W/BP on the kids.  

[BrisketRN, BSN, RN]

We do HOTV with our preschoolers and have the teachers practice with them as a playing game in the days before their screenings.  We have the letters printed on cards and they pick the card up as it's lit.  For hearing exam we "play" the raise your hand with the beep game the day of the screenings.  I got to work with an awesome school nurse who has actually made a business out of doing hearing/vision screenings, and she had so many great ideas.  For some kids "jump when you hear the beep" or "drop the ball in the bucket when you hear the beep" works best.

[AutumnDraidean]

I know of a nurse who has both an OAE and an audiometer, she uses the audiometer first and only resorts to the OAE when the audiometer isn’t working out. 
 

When I worked at a head start I used an OAE, it had one big flaw, as far as I was concerned, if a child had a recent ear infection that ear would refer for some weeks afterwards, even if the infection had been found and treated. It was the bane of my existence. 

[nursekoll, BSN, RN]

I use the lions club photo screener for vision and play a game with them for hearing. Most do pretty well with putting pegs in a board or monkeys in the barrel each time they hear the beeps. Make it fun!

[ihavealltheice]

For the super littles like PreK, I have involved the teachers in the past to help me condition them during their circle time. I have used Youtube videos that play the tones, they practice listening to the tones and responding. 

Rather than "raise your hand" or "put the toy in the bucket" as they teach  you in the certification course, I ask them to say beep or for the high energy ones, I ask them to give me a high five. Sometimes, I can see their facial expressions. The screening is so complicated for them, why complicate it even further?

As far as vision, I use the HOTV machine for both PreK and Kindergarten and even some older kiddos in special ED. The tumbling "Es" are again too complicated in my opinion and in both of those grades, we're just screening for visual acuity anyway. I ask them to match the shape or if they know their letters, tell me the letter. Also, if your state allows the spot screener, use it. It is amazing and takes so much guess work out of screening. 

[icepackstat, BSN, RN]

I wait until December to do Pre-K.  A few months of school can really help!  We are a bi-lingual school at that makes it harder for me. I did make these glasses for little ones so they don't have to hold anything.  It helps!  And then I tell myself that this is a "screening" not an exam!  It is my best nursing judgement that I can make!