Cognitive skills are the foundation for a child’s development. Cognitive skills can’t develop in isolation but are dependent upon interaction and experience. Experience is influenced by the child’s sensory perception and motor abilities. Therefore, it is necessary to foster the interrelationship of cognitive, language, social, and motor skills for the child to acquire an understanding of his world.
 
According to Piaget there are two major stages in the intellectual development of preschool-age children. During the sensori-motor period, which occurs during the child’s first two years, he develops basic concepts about object permanence, spatial relationships, means for attaining desired ends, causality, imitation, and schemes for relating to objects. The feedback loop between sensory input and motor output is crucial.  Sensory input includes vision, hearing, smell, taste, touch, kinesthesia (body awareness, body image and directional concepts), and haptic perception (the ability to perceive object characteristics when using the hands to explore). During this stage it is very important for the child who is blind or has a visual impairment to have many authentic, concrete, and language rich sensory experiences. 
 
Around two years of age, the child begins to define his concept of the world by creating organizational systems for the people, objects, and events in his life. He develops the ability to classify objects by shape, size, color, and function. Number and measurement concepts begin to emerge and a refinement in his understanding of spatial relationships develops. Language becomes the structural underpinning of the acquisition of concepts.  Concepts which are vision dependent (facial expressions or the size of an elephant) need to be explicitly presented using concrete and meaningful experiences which compensate for what he cannot see.  

Put your cheek against the top of baby's head. Stroke the back of his hand while nursing. Bathe the baby by soaping in smooth and continuous motions. Touch all body parts with the washcloth or sponge. Speak to the baby as you do this, naming his body parts. Massage him with lotion or baby oil. Occasionally, rub parts of his body with a variety of textures: velvet, corduroy, satin, burlap.

Vary the "background noise" in the child's environment. Do not play the T.V. or radio constantly. Introduce a variety of sounds but also enjoy the silence. Use wind-up plush animals placed next to the child in his crib, wind chimes hung outside his window, cradle gyms which move and play music hung above his crib -- all are good options. Babies’ booties with sound-makers are available or attach a bell to the bootie once in a while. Present sound toys like rattles or squeakers. Choose toys which make very soft sounds. Pet squeak toys frequently have a less harsh sound than children's squeak toys. When you are introducing new sounds, try not to surprise or startle the baby.

Play a sound awareness game. Shake a bell or crinkle some paper about eight inches from the baby's chest, to the left, and then to the right of his head. Make the sound two or three times. Watch for a response. The baby may widen or shift his eyes, become very still, or increase his body movements. Help the baby feel the toy to reinforce the concept that the object is what is making the noise.

Sing to the baby. Say poems or nursery rhymes. Vary your tone of voice. This is more important than the words used at this time.

Carrying the child using a front snuggle sling allows the child to experience motion and comfort simultaneously. At other times, support the child’s head while he is sitting on your lap in a face-to-face fashion or rock him in a comfortable rocking chair. Rock him in your arms and sing to him.

Place mobiles with black-and-white patterns over the baby's crib. Offer roly-poly toys which rock back and forth and make music when moved. Place them within reaching range so that an accidental or purposeful movement will start them moving.

Buy or make jingle bracelets that attach to the baby's arm with elastic or Velcro straps. One or two small bells (not too loud) sewn to the strap are adequate. As an alternative, secure the toy to an ankle instead of a wrist.

Buy or make "bat-mobiles:” objects strung across the crib in "swiping" distance which may be purchased or home-made. Aluminum pie tins may be filled with a few dried beans and sealed

together with glue or tape. Empty plastic eggs are available in craft stores. Fill them with paper clips, rice, or a button. Seal all the edges and suspend them together in a line. String three to five bells together and fasten the string to the bottom of a non-breakable clothes hanger.

Gather odd fabric scraps (fake fur, ribbon, "lace" hem binding) and trim the edges with pinking shears so the edges don't ravel. Attach them to the same hanger. Be sure the hanger is "baby-proofed" (no loose strings or items that can be pulled off) before hanging it over the crib.

Place a soft, squeaky toy under the child's body or under a pillow beneath the child's head.

If the child does not spontaneously mouth own hands, gently guide one hand to the mouth for a few moments to aid oral exploration. Guide her hand by moving her forearm or elbow. If there is resistance, don't push; try again later.

Side-lying is a good position to keep hands accessible for mouthing and sucking. Alternate lying on left or right side to promote use of both hands.

Gently cover and uncover the child's mouth with her hand when she is making sounds so that she can feel the vibration and moving air. Bring her hand to your mouth and make sounds.

Teething rings and soft rubber toys (can be found in pet stores) are good objects to begin oral exploration. Begin by holding the object for the child as she mouths it. Later, help her close her fingers around the toy and bring it to her mouth.

Call the child's name and tell him you are coming whenever you approach him. Walk naturally. The sound of your footsteps will reassure the baby.

Talk about the various sounds and smells which occur during the day: "That's the microwave bell. I think your bottle is ready. It's time to eat now." Although the young child doesn't understand the words, repetition and association are what make things meaningful.

Take advantage of natural opportunities during the day. When a sound is heard, explain it and respond to it: "I hear Snoopy barking. Let's go let him in."

Put your arms out for a few seconds before you pick the child up, and tell him what is going to happen: “I’m going to pick you up now.” For the child with little or no vision, it may be helpful to use an auditory cue ("Do you want up?") before picking the child up. Try to consistently provide the results the baby anticipates within a few moments of the cue.

Present small objects for the child to hold by offering them to the palm side of the hand. If he doesn't grasp it right away, tap his palm with the toy and wait for him to close his fingers around it. At this age grasp is not secure. The baby may frequently drop his toy by accident even though he still wants it. Be patient. You may need to pick it up for him many times.

Talk quietly to the child from the right and left sides of her body. Encourage her to turn her head toward your voice and touch your face during these conversations.

Talk to the child from a stationary position across the room and encourage her to turn toward the location of your voice. If she doesn't turn right away, add a fun novel sound (such as clicking your tongue) to help her.

Play sound localization games using a few toys with different sounds: a rattle, a dinner bell, a squeaky toy, crumpled cellophane. Hold the noise-maker 8 to 15 inches from the baby's head, toward one side or the other. If the child does not turn toward the toy, touch or tap the side of her cheek closest to the sound, and make the sound again. Move the child's hand to locate and hold the noisemaker as you activate it again. Play this game in different positions: on her back, in an infant seat, sitting supported in your lap.

Play body awareness games after bath or diaper change. Name body parts as you touch and stroke them. Infant massage is relaxing and promotes body awareness.

Place mittens or socks on the baby's hands, and make a game of taking them off. The best way to ensure that the child can reach hands and feet is to hold him in a cradled position, supported sitting in your lap, or in his infant seat.

Play games by attaching bells to a strip of cloth loosely tied around an ankle. Help the child reach for the bells.

Make or purchase a baby quilt with several different textures: soft, furry, ribbed, smooth, crinkly, nubby. Choose fabrics for visual as well as textural appeal. Example: smooth, bold black-and-white striped cotton next to nubby red terry cloth. Place small rattles or noisy toys at several points on the blanket, where baby’s hand may come in contact. Encourage the child to explore the quilt and objects as his hands detect them.

Make a play bib out of fabric or a terry cloth towel. (This bib is worn by the adult!) Sew on several interesting little toys: a rattle, a braided loop of cord, a square of leather, a large jingle bell, small curtain or shower rings, bead necklaces. Wear the bib when you hold the baby and encourage him to use his hands to explore as he sits with you.

While the child is on his back, place objects of various weights and textures on his tummy. Help him to locate and examine them. Encourage him to bring them to his mouth and explore. Young babies have very sensitive mouths and this is an important method of learning for them.

Although sound play is usually found in the language section, it is imitation which is the goal. Children with visual impairments may need direct instruction in motor imitation but should not need instruction in vocal imitation.

 
Play sound games with your child. After they make a sound, imitate it, wait and see if the child repeats the initial sound. Repeat the interaction back and forth with the child.

When sitting quietly with your child, make an interesting noise or sound that you have heard the child make before. Listen for her to repeat your sound. Continue to play the interaction. If she doesn’t respond verbally, try touching her lips with your fingers and repeat the sound. Also try placing her fingers at your lips while making the sound again.

Although children with normal vision begin looking back and forth between two objects offered simultaneously as early as three or four months, in this item, "choosing" is interpreted to mean stares at, or fingers, or shows an interest in one item for a longer time than the other item. Children who are blind do not acquire this skill (tactually going back and forth between two objects offered) until six or eight months of age.

Present a toy for the child to look at and touch. After she has examined it for a few moments, present a second toy, without removing the first one. It helps if the objects are visually and tactually very different and if they each have (different) sounds. Activate the sound of the second toy, then the first one again. Be sensitive to the child’s “choice” behavior.

Banging is one way to interact with objects. Give the child an object which will make a sound when banged against a floor or table. If he accidentally discovers how to bang, playfully say "bang, bang, bang" to the rhythm of the sounds he makes. If he needs help, provide gentle physical guidance for two or three bangs.

Demonstrate a new way to use a toy (shaking). Introduce different toys for the child to play with in new ways. Encourage the child to play with an object in a variety of ways.

The child should have already learned how to use many separate actions with a toy or object: hold, look, bring to mouth and chew on it, pat it, shake it, bang it, squeeze it, examine it with eyes or fingers, etc. This item does not suppose that the child is going to acquire any new skills. Rather, it indicates that the child can and does actively play with a toy in many different ways. Many objects are considered toys to the child. Banging a cup or bottle is as fun as any toy.

Introduce a variety of toys and watch how the child interacts with them. Play games where you help the child attempt to shake, bang, or squeeze a toy. Talk about what happens – some toys are hard to squeeze but fun to bang. Lots of games and discussion all help the child discover concepts regarding what play scheme works best with particular toys.

Bounce the child rhythmically on your knee or rock back and forth a few times. Pause during this activity to see if the child will try to rock or bounce her body, or give a vocal signal to indicate, "Do it some more!" If the child gives no signal for more, prompt her by moving her body a little, and asking if she wants some more. Resume the game. Sometimes you have to be an excellent observer to notice the baby’s signals. It may be that she catches her breath for a second or tenses her muscles slightly. Some signals are very subtle.

With the help of another adult, swing the child in a large towel or small blanket as you sing a favorite song, Keep the blanket close to the floor as you swing. The movement may be side-to-side or forward-to-back. Simultaneously stop singing and swinging. Wait for a signal that the child wants to continue.

Many babies enjoy vigorous play with their parents: being gently tossed an inch or so in the air, jiggled from side to side while the parent repeats babbling sounds. If the family has some games they enjoy with the baby, ask them to pause a moment, and say "Do you want more?"

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Many people think children with visual impairments are not capable of any kind of imitation except vocal imitation. In fact, children who are totally blind enjoy games of "motor imitation" -- as long as there is a sound component. Imitation is a necessary prerequisite for all those skills which will be introduced later -- like finger plays and physical education exercises.

Imitate the child's movements or play interactions to help her get an idea of imitating others. Clap hands when she claps, slap the table when she does, crinkle paper if that's what she's playing with.

Choose an action you have seen the child do independently during play: ring a bell, bang a spoon on a pot. Initiate the action with sound and then encourage the child to do it. Some children find this easier if they do not have to wait for you to trade the object back and forth, but have a duplicate object in their hands when you are doing your action.

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The child begins using a systematic strategy for performing particular actions with specific toys. This indicates that the child understands some toys make a great sound when you shake them, while others make no sound when you shake them. On the other hand, a toy which makes no sound when you shake it is absolutely delightful when you bang it on the table. Some toys are good for both actions! This item indicates that a child will run through several play schemes until she finds the one which works best for that toy. She may then spend several minutes playing with the toy in that manner.

Provide a few toys that produce interesting sounds when shaken. Introduce each toy and allow the child to explore it. They may shake, bang, or mouth it, but the toy’s most appealing characteristic should be produced when shaken.

Provide other toys that work best when squeezed. Allow the child ample opportunities for exploration and discovery. If the child has difficulty, model the “best” scheme for that particular toy.

The child should be turning or wriggling his body slightly to obtain a toy that is just slightly out of reach before he is asked to move in space to get it. He should be reaching for sound toys in all directions while sitting or when lying on his back. Auditory permanence is a skill acquired later for the child who is blind.

While the child is sitting on the floor, engage him in a play activity with a toy that emits a sound. Place the toy just barely out of his reach. Help him lean and move his body toward the toy to grasp it. Continue playing the game with the toy.

Place the child on his stomach with his arms extended forward. Touch one hand with a favorite sound-producing toy, then move the toy just out of reach. (The toy should continue to make noise.) Help the child move forward by commando-crawl (on his belly) or on all fours (creep).

Most children take everything out of a container for a while before they learn to drop objects into containers. Then they may fixate on the IN and OUT concept, putting a single object in and then taking it out of a container many times before they learn to place several objects into a container.

Children should be allowed time to play with empty containers and the objects that could go into them before introducing the concept of placing objects INTO. Ideas for containers: empty (and clean) plastic margarine tubs, plastic cups, empty boxes without lids, coffee cans. Ideas for items to fill containers: blocks, large toy pop beads, clothespins, large empty thread spools, or plastic film containers

Use daily activities as time to introduce this concept. Put the child's finger foods in a plastic margarine tub at meals. During bath time, give him small plastic cups to fill and dump. Set up a special toy basket which stays in a certain corner of the living room with two or three of the child's toys to take out, play with, and put back in again.

The child goes through stages in understanding of cause-and-effect. Early in life, the child thinks that everything can be magically re-started by moving her body or making a sound. Later she learns to activate a toy by pushing down on its top or pulling out a string. Still later she learns that some toys are activated in a way too complex for her to manipulate, and she needs adult help.

Introduce a variety of toys that the child enjoys but can’t operate on her own. After listening to the music from the music box, it stops and the child wants more. She needs to hand it to the adult to have it play again. Commercially available toys might be wind-up music boxes, talking toys which require pulling a string or pushing a lever, hand-held massagers which require pushing a button, handles that turn on a jack-in-the-box. Another activity which requires adult help is listening to music tapes or CDs. If the child doesn’t hand you the item but clearly indicates she wants more, assist her by asking, “Do you want help?” You can also say, “Give me the music box and I’ll wind it up for you.”

The child should have guided play opportunities so that she can begin "pretend" play. Take a sip from an empty cup and say "Yummmmm." Feed mom and the dolly a bite from an empty spoon. Give the doll a bath.

Use a comb or brush to "make yourself beautiful."

Brush the pet dog or cat.

Brush the baby bear’s teeth and then tuck him into bed.