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Sound Advice for Children's Ears

Every year, 12,000 babies are born with some degree of hearing impairment, making this the number-one birth defect in America. And it's hard to know whether your child is at risk, because an estimated 90 percent of hearing-impaired babies are born to parents with normal hearing. Often the problem isn't discovered until the child is about 2 1/2 years old, with milder losses frequently unrecognized until kindergarten. That can have lasting consequences, because the infant brain begins to develop the capacity for language shortly after birth. Fortunately, 37 states have now mandated that hearing tests be standard for newborns. The National Institute on Deafness and Other Communication Disorders, in Bethesda, Maryland, recommends this schedule to make sure your baby gets the screenings she needs.

DURING PREGNANCY: Check the screening policy at the hospital or birthing center where you plan to deliver. If hearing isn't part of standard newborn screenings, request the test.

AFTER BIRTH: If you don't know whether your baby was screened, call your pediatrician and ask to see a copy of your child's records. If the test wasn't done, make sure to schedule one before your baby is 1 month old.

BY 3 MONTHS: Newborn screening only detects possible hearing loss, so if the test red-flags any problems, your baby's hearing will need to be fully tested before she's 3 months old by an audiologist. This follow-up evaluation will confirm whether your child has a hearing problem and, if so, the type and severity of her disorder.

BY 6 MONTHS: If your child does have a hearing impair-ment, it's crucial to begin treatment as soon as possible. Studies show that children with hearing loss who receive intervention by 6 months usually develop good language and learning skills. Even babies can be fitted with hearing aids, and cochlear implants (electronic devices that replace the function of the inner ear) are proving remarkably effective for children with profound deafness. Though the implants are currently approved by the Food and Drug Administration only for children 12 months and older, waivers are often granted for younger children. And you can start teaching sign-language skills now too.

By age 3, 66 percent of all children will have endured this common infection, and many will have had repeated bouts. As recently as five years ago, antibiotics were considered the gold standard for getting rid of ear infections. But that approach is changing. The reason: Research shows that frequent antibiotic use can lead to drug-resistant bacteria, making ear infections harder to treat. While experts agree that some ear infections warrant antibiotics immediately, don't be surprised if your doctor writes out a "safety-net" prescription, to be filled only if your child's symptoms don't subside within 48 hours. "About 80 percent of ear infections get better on their own," says Richard Rosenfeld, M.D., cochair of a middle-ear infections sub-committee for the American Academy of Ped- iatrics. In most cases, painkilling eardrops, ibuprofen, or acetaminophen should ease your child's discomfort. So when are antibiotics the best treatment for ear infections?

GIVE ANTIBIOTICS IMMEDIATELY:

  • If your child is under 2 years old. (Young children need help fighting off even mild ear infections due to their immature immune system.)
  • If he has severe ear pain or a fever over 102°F.
  • If he has had an ear infection within the past month.
  • If he has ear tubes that are giving him problems.
  • If he also has another bacterial illness, like strep throat.

HOLD OFF ON ANTIBIOTICS:

  • If your child has moderate or mild ear pain.
  • If she has a low or no fever.
  • If she's able to sleep through the night.
  • If she has no other current illnesses or health problems.
  • If your doctor isn't sure whether it's a bacterial ear infection. (Antibiotics are useless for colds and other viral infections.)
  • If your child has problem-free ear tubes. (Antibiotic drops may be used instead of oral medications.)

Those little openings on the sides of your child's head can be pretty tempting hiding places, which is why he might end up with a foreign object lodged in his ear. Here's how to handle common emergencies.

Foods such as peas, beans, and corn kernels are generally too soft and small to puncture the eardrum or cause permanent damage, but call your pediatrician right away if the food doesn't fall out when your child tilts her head to the side.

A crayon will most likely get stuck in the ear canal, which can temporarily muffle hearing or cause a minor infection. Have your doctor remove it—trying to dig the crayon out on your own could force it in deeper.

A watch battery is more serious—moisture in the ear could actually cause a painful current. Get medical help immediately to prevent burns and scars in the ear canal.

If an insect flies or crawls into your child's ear, shine a flashlight into the ear opening. The insect should move toward the light and out. Or put a few drops of baby oil inside—the bug may float out.

Flying can be hard on little ears. Babies and young children are especially vulnerable to ear pain during takeoffs and landings because their tiny eustachian tubes, which connect the middle ear to the back of the throat and keep air pressure stable in the ear, are easily compressed, says Rose Mary Stocks, M.D., an associate professor of pediatric otolaryngology at the University of Tennessee, in Memphis.

To ease the pain:

  • Breast- or bottle-feed your baby, or offer a pacifier during takeoff and landing. Sucking and swallowing will open up her eustachian tubes, equalizing pressure in the inner ear.
  • Let children older than 4 chew gum, which will relieve the pressure, or encourage them to eat or drink something. Yawning or pinching the nose and trying to blow also helps.
  • Some pediatricians recommend giving an over-the-counter decongestant before the flight to clear out the ears, especially if your child has a cold.

Exceptionally large or protruding ears rarely cause hearing or health problems, but fixing this hereditary condition can help your child feel less self-conscious. Not only is it possible to pin back ears, but they can also be reshaped, reduced in size, or made more symmetrical. The surgical procedure, known as otoplasty, is relatively simple and has a short recovery time. For the best results, have the correction done as soon as your child's ears reach full size, usually at age 6, says Seth Thaller, M.D., chief of plastic surgery at the University of Miami School of Medicine, in Florida. The average cost is around $3,000, which is usually not covered by insurance. To find a board-certified pediatric surgeon, contact the American Society of Plastic Surgeons (at 888-4752-7842 or www.plasticsurgery.org, or ask your pediatrician for a referral to a plastic surgeon who works with children.

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While some babies are born with hearing loss, others develop impairments as they grow older due to injuries, ear infections, or other diseases. Even if your newborn was tested, watch for the following signs of normal hearing. Failure to meet these milestones could be a sign of hearing impairment.

BIRTH TO 3 MONTHS: Your child should: Startle or wake to loud noises; appear soothed by your voice; turn her head and smile when you speak to her.

3 TO 6 MONTHS: Your child should: Play with rattles and other noisy toys; look upward or turn to a new sound (doorbell, ringing phone); respond to changes in your tone of voice; repeat speech patterns like "ba-ba."

6 TO 10 MONTHS: Your child should: Babble frequently even when alone; respond to his name; look at objects and pictures when someone talks about them; recognize words for common things (cup, shoe) and sayings ("bye-bye").

15 TO 18 MONTHS: Your child should: Follow simple directions; use two- to three-word sentences; know ten to 20 words and use them often; enjoy being read to and playing games like peekaboo.

Copyright © 2004. Reprinted with permission from the November 2003 issue of Parents magazine.

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.