By Drs. Sally Robinson and Keith Bly
Hearing loss in infants and children is not a common occurrence, but the effects, when it occurs, may devastate parents.
Repeated temporary interruptions in hearing during the intense period of development in the six months after birth can have permanent effects on language facility later in life. Infants need to receive auditory feedback if they are to learn the speech motor skills involved in talking.
Some signals that a child may have hearing difficulties are:
- If he or she has a speech or language delay.
- Uses gestures to communicate instead of speech.
- Watches you closely when you talk.
- Does not wake up to loud sounds.
• Has a change in voice quality.Middle-ear infections are one of the most common risk factors associated with hearing impairment. Additional risk factors include other viral and bacterial infections, conditions such as low birth weight that lead to a stay in the newborn intensive care unit or a family history of permanent childhood hearing loss.
Parents with a child who has had repeated bouts of otitis media should ask their pediatrician if the disease may have impaired the child's hearing.
Keep in mind that this condition occurs in only a small number of children. But because the first six months of life involve important developmental changes, the American Academy of Pediatrics Task Force on Newborn and Infant Screening recommends that all newborns have screening before they reach 1 month of age, with audiologic confirmation of significant hearing loss by the time they are 3 months and intervention by 6 months. Infants who have failed the first hospital screening should have had a second screening to determine whether the baby needs to be seen by an audiologist.
Parents who may have missed this second screening or are concerned that a child's hearing, speech or language usage does not seem appropriate to the milestones described in most baby books should consult with their baby's doctor without delay.
Parents who have moved recently, who have no regular pediatrician or have changed pediatricians should be certain that they have faithfully given family histories to the new doctor. If you have questions, your pediatrician will explain the importance of hearing to your child's full development.
In many cases, mild temporary hearing loss causes no lasting problems. In others, prompt intervention by medical caregivers and speech therapists can do much to alleviate or compensate for hearing loss.
Children with more serious hearing loss can usually develop a proficiency in spoken language by means of using a personal hearing device. Though many toddlers accept a hearing device, it is not unusual for children to resist having something in their ears. Parents should practice understanding of a small child's rebellion.
In serious cases with permanent hearing damage, parents will have to consider either learning visual sign language along with their child, or in appropriate case having a cochlear implant, inserted into the middle ear to transmit sound waves.
Dr. Sally Robinson is a pediatrician in the division of children's special services at the University of Texas Medical Branch at Galveston. She teaches medical students about caring for children with chronic medical conditions. Dr. Keith Bly is a hospitalist and assistant professor of pediatrics at UTMB. This column is not intended to replace the advice of a physician.
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