Try fitting E style or large round seg bifocal with segment tops just 1mm below pupil,reason for this high fitting is to ensure that the child does not use upper portion of the lens for close work,and in the event if his/her spectacles get loose.Also use specially designed spectacle frames for very small childern which have loop-end sides thru which a ribbon can be passed and tied at the back of the head to secure spectacles.With hyperactive small childern use frames fitted with bridle.For older childern frames with curl ends serves the purpose well.
If the child does not accept glasses, try experimenting with different positioning of segment tops, keeping in mind that he is required not to look from distance portion of segment for close work.
by SHABBIR KAPASI
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