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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Hearing

Images_deafDuring the last 3 months spent in utero, your baby would have been exposed to a variety of noises. When a baby is born; they will already be familiar with their mother's voice, the beating of her heart, and the sound of the amniotic fluid that they have been floating in. Healthy babies are able to hear almost as well as adults at birth.

How to determine if your child has hearing loss:

Parents and grandparents are often the first to discover hearing problems, because they spend the most amount of time with the baby. If you suspect that your baby's having hearing difficulties, discuss it with your doctor and he may suggest that your child's hearing is tested by an audiologist. Your baby's hearing can be professionally tested at any age and will not cause them any pain. In contrast, if your child does have hearing loss, delayed diagnosis could affect speech and language development. It is through hearing others speak that your baby will eventually learn to form the words, that will become part of their early vocabulary. Your baby will begin to understand what others are saying, long before they able to make the noises themselves; if he or she has a hearing defect, this knowledge and the eventual ability to speak will be affected. Since children rely on their hearing from the very beginning, it is crucial to identify and remedy problems as early as possible. Experts agree that children with hearing loss should receive help before 6 months of age, to prevent not only language delays but reading difficulties and problems with social skills.

The following acts as a guideline, to determine whether or not your child might have hearing loss, or whether they have a higher than average chance of developing hearing difficulties. Hearing loss can occur at any time, and it can lead to delays in a child's ability to learn.

INDICATORS FOR HEARING LOSS- CHECK EACH ITEM THAT APPLIES TO YOU, YOUR FAMILY OR YOUR CHILD:

During pregnancy:
  • Mother had German measles, a viral infection or flu.
  • Mother drank alcoholic beverages.

My newborn (Birth-28 days of age):
  • Weighed less than 3.5 pounds at birth.
  • Has an unusual appearance of the face or ears.
  • Was jaundiced at birth (yellow skinned) and had an exchange blood transfusion.
  • Was in the NICU for more than 5 days.
  • Received an antibiotic medication intravenously.
  • Had meningitis.

My family
  • Has one or more individuals with progressive or permanent hearing loss that developed or was present early.

My infant (29 days-2 years)
  • Received an antibiotic medication intravenously.
  • Had meningitis.
  • Had a neurological disorder.
  • Had a serious injury involving a fractured skull with or without bleeding from the ear.
  • Had recurrent ear infections with fluid in the ears for more than 3 months.

Response to the environment
Newborn (Birth-6 months)
  • Does not startle, move, cry, or react in any way to unexpected loud noises.
  • Does not awaken to loud noises.
  • Does not respond to sounds, music or voices.
  • Does not freely imitate sounds.
  • Cannot be soothed by voice/ soft sounds alone.
  • Does not change expressions at the sound of a voice or loud noise when he's in a quiet setting.
  • Does not turn his or her head in the direction of my voice.
  • Does not make vowel sounds like "ooh" by 2 months.
  • Does not become quiet at the sound of familiar voices, by 2 months of age.

Young infant (6-12 months)
  • Does not point to familiar people or objects when asked.
  • Does not turn his head or eyes towards a sound he can't see.
  • Does not enjoy playing with rattles, shakers, ringing bells, or squeezing noise makers.
  • Does not babble, babbling has stopped, or does not vary his pitch when babbling.
  • Does not make several different consonant sounds when babbling (m,p,b,g, etc.).
  • Does not respond to "no" or changes in tone of voice.
  • Seems to hear some sounds but not others.
  • Does not understand simple phrases, such as "wave by-bye" or "clap hands" by listening alone, by 1 year of age.
  • Does not respond to simple commands, like "come here".
  • Does not understand the words for common items, like "shoe".
  • Does not say single words, like "ma-ma" or "dada" by 1 year of age.

My infant (13 months-2 years)
  • Does not accurately turn their head in the direction of a soft voice on the first call.
  • Is not alert to environmental sounds.
  • Does not respond to sound and is unable to discern where sound is coming from.
  • Does not imitate and use simple words for familiar things and people around the house.
  • Does not point to express a desire.
  • Does not enjoy games like patty-cake.
  • Does not respond to music.
  • Does not sound like or use speech like other children of a similar age.
  • Does not listen to TV at a normal volume.
  • Does not enjoy being read to.
  • Does not show consistent growth in the understanding and use of words to communicate (between 12-18 months; this includes the ability to use at least 2 words, to point to simple body parts or look at familiar objects when asked, and respond to simple commands and imitate simple words) (between 19 and 24 months; your child should be able to use more than 5 words, point to at least 2 body parts when asked, respond 'yes' or 'no' to a question or command, can commonly identify common objects, such as 'cat' or 'ball', mixes babble with some intelligible speech, and understands simple phrases such as 'under the table' or 'in the box')

My baby (25-29 months)
  • Does not respond to two-part commands such as, "sit down and eat your supper".
  • Cannot answer "who" or "what questions".
  • Cannot form simple two-word sentences, such as "I go".
  • Is not interested in simple stories.
  • Does not understand action words, like "walk", "run" or "sit".

My baby (30-36 months)
  • Does not understand possessive terms such as "mine" or "yours".
  • Cannot make selections on the basis of size, such as "big" or "little".
  • Does not use any plurals or verbs.
  • Does not ask open ended questions, such as 'why", "where", or "what".
  • Does not understand "not now" or no more".

(Partially replicated from http://www.hearingexchange.com and http://www.babycenter.com)

Signs for hearing loss can be different for different babies and the extent of the hearing impairment can vary. On their own, these signs may not be a cause for concern- some babies have colic, others can't be calmed no matter what, while others are very sound sleepers- but you should contact your medical practitioner immediately if you notice any of the above red flags.

What causes hearing problems:

There are 2 types of hearing loss - congenital (meaning it was present at birth) or acquired (meaning the baby lost hearing sometime after birth).

* Sometimes a hearing impairment is inherited, even if both parents have normal hearing.
* A baby's hearing may be damaged if the mother had an infection during pregnancy, such as German measles, toxoplasmosis, or herpes.
* Some children are born with hearing difficulties due to a low birth rate, prematurity, or abnormal inner ear development.
* In some cases, the cause is unknown.

* After birth, hearing loss may be the result of damage caused to the nerves of the inner ear, due to injury, tumour or infection (chicken pox, meningitis, flu, or mononucleosis).
* Medication such as chemotherapy agents, salicylates, loop diuretics and certain intravenous antibiotics, may also cause hearing loss.

* A build up of fluid in the inner ear, following infection or because of poor ventilation in the ear, may result in temporary hearing loss. Permanent hearing loss from an accumulation of fluid is rare, but it can occur in children who's problem is left untreated, resulting in structural problems to the eardrum or the hearing bones.
* If your child suffers from recurrent ear infections, your doctor may recommend a hearing test and in some cases, the surgical insertion of grommets may be advisable.
* Ear wax or foreign objects in the ear, can also result in temporary hearing loss.

Effects of hearing loss on development:

1) It causes delays in the development of receptive and expressive communication skills.

* Vocabulary develops slower in children who have hearing loss and they are unable to catch up with their peers, without intervention. Children with hearing problems tend to learn concrete words, like 'cat' and 'five' more easily than abstract words ('before', 'equal to', and 'jealous') or function words, like 'the', 'an', and 'are'. They also have difficulties understanding words with multiple meanings.
* In terms of sentence structure, children with hearing loss; often have difficulty understanding, producing or writing complex sentences and they often cannot hear word endings, such as -s or -ed. This leads to misunderstandings and the misuse of verb tense, pluralization and possessives.
* Children with hearing problems often cannot hear quiet speech sounds, such as 's', 'f', 'k' and 't', and therefore do not use them in their speech. As a result, their speech may be more difficult to understand. This is possibly compounded by their inability to hear their own voices. They may speak too loudly or softly, in a very high pitch, or they may sound like they are mumbling due to poor stress, poor inflection, or poor rate of speaking.

2) The language deficit causes learning problems that result in reduced academic achievement.

* Children with hearing loss have difficulties in all areas of academic achievement. This is particularly evident in their reading level and ability to understand mathematical concepts.
* Without appropriate intervention, children with severe to profound hearing loss, are unable to achieve skills higher than 3rd or 4th grade level.
* A hearing impaired child's level of achievement is directly correlated to the degree of parental involvement and the quality, quantity and timing of treatment interventions.

3) Communication difficulties frequently lead to social isolation and low self esteem.

* Children with hearing loss frequently report feeling lonely, isolated, without friends and unhappy in school; especially when their interactions with other children with hearing loss is limited.

4) Hearing loss may have an impact on vocational choices.

How are hearing difficulties assessed and treated?

See our medical A-Z section: under the subsection ear infections, there is a list of tests performed by audiologists to test hearing.

If you child has hearing loss, there are a number of intervention options, that will improve their ability to understand what others are saying and to make them better understood:

1) Hearing devices- there are various tools available to assist a child with hearing problems, to communicate with the hearing and non-hearing world. One of the most common, being the hearing aid, a device worn in and behind the ear that magnifies sound. Hearing aids can be used for mild to severe hearing loss, even in babies as young as 1 month old. Consult a paediatric audiologist to select the correct hearing aid for your child that fits properly and is correctly set.

In children with severe hearing impediments, your doctor may suggest cochlear implants- an electronic device that converts sound into electrical signals and carries them passed the non-working part of the inner ear into the brain. Cochlear implants can help children learn to recognize sounds and understand speech. They can be fitted by an otolaryngologist in children over the age of 1.

2) Language and communication considerations- children who are deaf or hard-of-hearing can learn to communicate in a number of ways. Speak to your paediatrician, audiologist and otolaryngologist about the choices available, and select an approach that will allow for maximum communication between you and your child. Some of the options include:
* American sign language- a distant language with its own grammar and syntax that uses hand signs and gestures, body movements and facial expressions, to represent words and phrases.
* Cued speech- involves a combination of natural lip movements and hand shapes representing phonetic sounds, to provide visual cues, so that sounds such as 'p' and 'b', or 'f' and 'v' are distinguished.
* Auditory-verbal approach- this helps strengthen a child's listening skills.

3) Assistive approach- devices are available to help people with hearing loss communicate in certain environments. For example, a personal FM amplifier uses a microphone to convert a classroom teacher's voice into radio waves that are transmitted to a receiver worn by the child. Special decoders are built into most television sets. Most television programs and some movie theatres offer closed captioning for viewers with hearing loss.

Helping your child with hearing loss:

For children, speech and hearing are the cornerstones of successful learning, playing and the development of social skills. Children learn how to communicate by imitating others. If they suffer from hearing loss and it is undiagnosed or untreated, they miss much of the speech and language around them. This results in delays in speech and language development, social problems and academic difficulties.

The most effective treatment for hearing loss involves; early diagnosis, the early fitting of hearing aids, and an early start on special education programs. This will help to maximize your child's hearing and gives them the best chance for successful speech and language development.


Mackonochie, A. (2010).The practical encyclopedia of Pregnancy & Babycare. Anness Publishing Ltd.: London.
http://www.nidcd.nih.gov/
http://www.babycenter.com/
http://www.hearingexchange.com
http://www.asha.org
http://www.pamf.org