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Signs of Vision or Hearing Problems

Amanda Sahadi was lucky. Born profoundly deaf, the 14-month-old from Brooklyn, New York, can hear her big sister's voice and can say words such as "mama" and "more" -- a startling achievement for someone who couldn't even hear a door slam when she left the hospital nursery.

Amanda hears and speaks today thanks to a law requiring hearing screening for all newborns in her state. This early diagnosis helped Amanda's parents act quickly to get her help. She now wears a cochlear implant, a small electronic device that provides a sense of sound to people with severe to profound hearing loss.

Kids like Amanda are benefiting from early diagnosis, and it's not just hearing that's getting attention. Last year, the American Academy of Pediatrics (AAP) issued an extensive policy statement on the correct way for doctors to screen newborns for cataracts, drooping eyelids, and other vision problems at each well-baby visit.

You should also keep an eye on your child's vision and hearing health. Learn how the two most important senses develop in your child's first year and what may indicate a problem.

Each year, approximately 1 in 300 babies is born with a degree of hearing impairment. About 4,000 of these children are considered profoundly deaf, making hearing loss the most common birth defect in America, according to the AAP.

For these children, timing is everything. The earlier a hearing loss is detected, the more likely it is that interventions such as hearing aids, cochlear implants, and speech therapy will help that child build speech and language skills and be mainstreamed into regular education classrooms. "Cochlear implants and hearing aids can be fitted for babies as young as 6 months old," says J. Thomas Roland Jr., MD, codirector of the Cochlear Implant Center at New York University Medical Center.

The first three years of life usher in the busiest period of language development, with the early months being the most critical. In fact, baby's sense of hearing is fully developed at birth. By about the sixth month of pregnancy, your unborn baby is able to hear sounds, and after he's born, he will recognize his mother's voice. He may even seem to recall a song or other sounds he heard before birth.

Your newborn will react to a loud sound by startling -- jerking his arms and hands outward. And he'll respond by quieting down when you speak to him. Talk, sing, and coo to your baby, who craves the sound of your voice. Babies are most attracted to human voices, and they prefer high-pitched ones like Mom's. Use baby rattles and music to stimulate hearing, and expose her to everyday sounds such as cooking noises, vacuuming, and the sound of older siblings at play. By 6 to 7 months, your baby should begin babbling -- repeating simple sounds like "ga" or "da."

As she gets older, your baby will get better at tracking where sounds come from. In the first few months, she'll only look for a sound when it originates in front of her. By 3 months, she'll turn to a sound on her right or left side. Later she'll be able to look for a sound coming from behind her.

If your baby is not responding to sounds or not developing age-appropriate language skills, there may be a problem. Remember that every child is different and will reach milestones at his own pace. Nevertheless, consult with your pediatrician about any concerns, especially if your newborn wasn't screened for hearing loss at birth. Don't delay: One study from the University of Colorado found that children whose hearing losses were detected by 6 months of age had normal language skills when tested at age 3 compared to children identified later, who were behind.

Risk factors for hearing loss include family history and premature birth. Your child is also at risk if you had a virus such as measles, mumps, or rubella, or infection with toxoplasmosis, syphilis, or herpes during pregnancy. After birth, bacterial or viral meningitis and frequent and untreated ear infections can also raise your child's odds of a hearing problem.

About half of all cases of hearing loss are genetic in nature, with recessive genes largely to blame, says Cliff Megerian, MD, director of otology and neuro-otologic surgery at Rainbow Babies & Children's Hospital in Cleveland. That means Mom and Dad may have normal hearing, but if they both carry a recessive gene that causes hearing loss, their children could be born hearing impaired.

When James Ryan was 10 months old, his mother, Eileen, noticed a slight crossing of his left eye that would come and go throughout the day. She brought it to the attention of her pediatrician, who referred James to a pediatric ophthalmologist, a physician who specializes in treating eye conditions in children. The diagnosis: strabismus, a condition in which the eyes are misaligned, crossed, or wandering -- the result of the muscles being weaker on one side. Left untreated, strabismus causes permanent vision loss.

Now 2 years old, James wears eyeglasses to correct the problem, but his doctor hasn't ruled out the use of an eye patch or even surgery at a later date. While the prospect of surgery makes his mom nervous, she's glad she caught the problem early. "Don't assume that the doctor is going to notice everything," says Ryan of Cleveland Heights, Ohio. "In our case, James's eye wasn't crossing all the time and never in the doctor's office. But once we pointed out the problem, he didn't hesitate to refer us to a specialist."

While it's not normal for an older baby's eyes to cross, you will probably notice that your newborn's eyes will cross or wander. In fact, because young babies can't yet focus their eyes together when looking at an object, they actually see two images of everything.

They'll outgrow this (and the accompanying eye crossing) within the first few months as eye coordination improves. Babies also enter the world with weak vision -- ranging from 20/1,200 to 20/1,600. That means a newborn can only make out light, movement, and high-contrast colors such as black and white (he can't see in color yet), but not fine details. During the first few months, you'll notice that your baby will focus on your hairline, eyes, and mouth features where there's a big contrast in color from the surrounding area.

Your infant can see up to a foot in front of him, which is just about right for studying your face during those late-night feedings. Your baby prefers human faces to all other forms of visual stimulation, so be sure to give him plenty of face time throughout your day.

Surround him with interesting objects that have bold patterns and highly contrasting colors such as a black-and-white crib mobile or a blanket with a geometric pattern. He won't be able to see those baby pastels just yet -- but he'll be drawn to deep primary colors like red.

By 3 months, your baby will begin to follow a moving object with his eyes, and not just watch a toy or other item directly in his line of vision. Your baby's ability to perceive the full range of colors comes in at around 4 months. His sense of depth perception and understanding that things get bigger when you get closer to them (and smaller when you're far away) comes when he begins to crawl.

Vision develops gradually -- in fact, most children don't attain 20/20 vision until the ages of 3 to 5, says Craig A. McKeown, MD, a pediatric ophthalmologist with the Bascom Palmer Eye Institute at the University of Miami.

Your baby's first eye exam occurs right in the hospital nursery when your pediatrician checks for general eye health and problems such as retinoblastoma, a rare cancer affecting the light-sensitive retinal cells that make vision possible.

High-risk newborns, including premature infants and those with a family history of eye problems, should be examined by a pediatric ophthalmologist.

Otherwise, all children are screened at each well-baby visit for eye issues. The doctor checks baby's ability to fixate on and follow a light; the anatomy of the eye; and whether anything is clouding the lens. Then children will have their first complete vision exam around their third birthday, or between 12 months and 18 months if there's a family history of strabismus, says Dr. McKeown. If this is the case, ask your pediatrician for a referral to a pediatric ophthalmologist.

Other vision problems affecting newborns and young children include:

Amblyopia: Good vision requires both eyes to see the same clear image. Amblyopia, also known as "lazy eye," happens when one eye has weak vision, prompting the child to rely on the "good" eye for sight. Amblyopia is caused by anything that blurs vision or results in the eyes being crossed such as strabismus, cataracts, or a droopy eyelid. Typically, a child needs to wear an eye patch over the stronger eye for months or longer in order to force her to use and strengthen the weaker eye. If the condition is not diagnosed and treated, the brain will choose to ignore the eye that sees poorly, and permanent vision loss -- uncorrectable with eyeglasses or contacts -- will eventually result.

Cataracts: Cataracts are not just problems for AARP members. Like older adults, babies can suffer from cataracts, a clouding of the eye's lens, which is normally clear. Early detection and swift treatment are critical so that children don't miss out on the early period of vision development. "The eye is like a camera. If light isn't getting in, then your baby can't see out," says D.M. Alcorn, MD, associate professor of ophthalmology in pediatrics at Stanford University in California. Most cataracts are surgically removed soon after they're discovered.

Glaucoma: A condition in which there's too much pressure inside the eye, glaucoma is relatively rare in children, occurring in about 1 in 25,000 babies in this country. It may be caused by the overproduction or poor drainage of tears. Warning signs include an enlarged eye, excessive tearing, and extreme sensitivity to light. Most children with glaucoma will need surgery. Without it, glaucoma may cause blindness.

Excessive tearing: This may also be a sign of a minor and more common problem, blocked tear ducts, which occur in about 6 percent of babies. It happens when the normal drainage system for tears fails to open or becomes blocked, preventing the flow of tears from the eyes into the nose. Tears accumulate and overflow onto the cheek, even when baby isn't crying. Other symptoms include mucus discharge at the inner corner of the eye and swollen and red eyelids. Consult your pediatrician, who will show you how to massage the tear duct and apply compresses to encourage it to open. He may also prescribe antibiotics if the ducts get infected. Fortunately, 90 percent of babies outgrow this problem by their first birthday, says Dr. McKeown. If the problem doesn't clear up, surgery may be required to open the tear duct.

In fact, any time you suspect your baby has a problem, call your child's doctor. With early treatment so critical to baby's eye and hearing health, it pays to follow your instincts, says Dr. McKeown, who has plenty of stories about moms like Eileen Ryan who correctly noticed something "different" about their baby's eyes. "A good pediatrician will listen to your concerns and take them seriously," he says. Sometimes, Mom really does know best.

Birth-3 Months

  • Startles or cries at loud sounds
  • Soothed by caretakers' voices

3-6 Months

  • Reacts to the sound of your voice
  • Turns eyes and head in the direction of sounds

6-10 Months

  • Responds to own name
  • Attempts to imitate and match sounds, especially human voices

10-15 Months

  • Locates or points to familiar objects when asked
  • Understands simple sentences like "Where's the kitty?"

15-18 Months

  • Identifies things, such as parts of the body, in response to questions
  • Uses a few single words
  • Follows simple spoken directions

Birth

  • Infant blinks in response to bright light
  • Stares at object 8 to 10 inches away

1 Month

  • Attracted to faces and pictures with contrasting black-and-white images
  • Watches parent closely

2-3 months

  • Begins to see an object as one image
  • Looks at hands
  • Follows light, faces, objects

4-5 months

  • Begins to reach for objects; may bat at hanging objects
  • Looks at self in mirror
  • Looks at own hand

5-7 months

  • Picks up dropped toy
  • Turns head to see object

7-11 Months

  • Develops depth perception
  • Plays peekaboo

11-12 months

  • Can watch fast-moving object

Thanks to state laws mandating universal newborn hearing screening, the percentage of babies screened for hearing loss at birth has risen from a dismal 25 percent in 1999 to a record 89.8 percent this year, according to the Washington, D.C.-based World Council on Hearing Health. (To see how your state ranks, go to wchh.com and click on "Newborn Hearing Health Report.")

Hospitals use one of two quick tests to screen for hearing loss: auditory brain stem response (ABR) and otoacoustic emissions (OAE). Both are painless and pose no risk to babies, who often sleep through them.

Earwax, fluid in the middle ear, and movement or crying during testing can cause babies with normal hearing to fail a test. As many as 10 percent of babies don't pass the first time, yet less than 1 percent actually have hearing loss. However, always be sure to follow up on a negative test result.

Ask your pediatrician if your child's hearing was screened at birth. If you live in an area that doesn't do mandatory screening, you may have to pay out of pocket (the tests cost between $35 and $50). It's well worth it.

Julie Evans is a mother of two in Cleveland.

Originally published in American Baby magazine, November 2004.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.