Just after birth, your baby's ears should be in almost perfect working order. But in some cases they're not, and that's why experts say we should listen up from the very beginning. If your baby has undiagnosed hearing loss, it can trip up his speech development and lead to later struggles in school if, for example, he can't hear a teacher's voice above the buzz of classroom activity. Learn more about spotting problems and helping your baby's hearing.
Daniel Knowsley's parents were told not to worry when he failed a hearing screening the day after birth. False positives -- failures among hearing babies -- are common, and rescreening usually brings relief. However, Daniel failed a repeat the following day and again a week later. An audiologist diagnosed severe to profound hearing loss in the baby's left ear and moderate to severe in his right. "We were completely devastated," says mom Cyndi of Tuttle, Oklahoma. "We had no idea he was at risk." Daniel got his first hearing aids at 5 weeks; now 6, he's thriving in regular classrooms.
Daniel's parents are among the 1 in 32 people carrying a defective hearing gene. Because it's recessive, both Mom and Dad can hear fine, but the abnormality has a 1 in 4 chance of showing up in a child. Hearing loss also occurs with some genetic syndromes, such as Down syndrome. In fact, faulty genes account for 50 to 75 percent of hearing loss in newborns.
Genetics isn't the only risk. Prematurity, low birth weight, jaundice, and delivery problems such as lack of oxygen may also cause hearing loss. So can congenital cytomegalovirus (CMV), a common infection that up to 80 percent of Americans get by the time they reach age 40. It feels like a mild cold and is usually harmless -- but in a pregnant woman it can have devastating consequences for a growing baby, including potential hearing loss. Sidestep CMV with diligent handwashing, especially after changing diapers or wiping kids' noses.
All states have laws to help ensure hearing screening for all babies, although standards vary: many mandate it, but others simply require that parents be informed about screening. Some states (such as Ohio) pick up the cost, while others (like West Virginia) require insurers to do so. Be sure your baby receives the screening -- ask your OB if it'll be done at the hospital right after birth. If not, schedule it within a month.
Hospitals will use one or two tests, each no longer than 10 minutes. One test probes the ear for damage or blockage, and another measures brainwaves in response to sound. If you're advised to see an audiologist about a suspected problem, don't delay. "The brain develops fast in the first 12 to 18 months, and sensory input plays a big role," says Betty Vohr, MD, medical director of the Rhode Island Hearing Assessment Program. "If hearing isn't stimulated for a prolonged period, babies don't learn language." Addressing the problem by 6 months with, say, hearing aids helps keep language skills almost on par with those of peers.
Every well visit should include a hearing check, but you can also keep tabs by tallying baby's first words. She should babble or imitate voices by 12 months, use single words by 18 months, and say at least 10 words by 2 years, says Gordon Hughes, MD, program director of clinical trials for the National Institute on Deafness and Other Communication Disorders (NIDCD).
Of course, it's hard to track the word count of a rapidly growing vocabulary, so take notice if your child constantly uses the words "huh?" or "what?" Here are other red flags: "A child who studies your face for more information, sits close to the TV, or switches a phone back and forth between ears may be struggling to hear better," says Joy Peterson, manager of audiology at the Center for Childhood Communication at the Children's Hospital of Philadelphia.
"Fluid trapped behind the eardrum is the most common cause of reversible hearing loss in children," says Joshua Gottschall, MD, chief of pediatric otolaryngology at Kaiser Permanente Oakland Medical Center. "Parents are often surprised and feel guilty when they find out that what they thought was a listening or behavior problem is actually a hearing problem." Many times, fluid builds up even when there hasn't been an ear infection: "The child feels fine, so it goes unchecked until there's a problem with delayed speech."
When your child does have an ear infection, it usually clears quickly and causes no lasting damage to hearing. (Meningitis, a source of permanent deafness, is now rare, thanks to the pneumococcal vaccine.) But sometimes fluid remains months after the pain and fever subside, and a child misses out on a long stretch of key listening opportunities.
Don't assume a suddenly inattentive child has developed selective hearing -- it could be muffled hearing. The same goes for a kid who begins talking more loudly. Even if there are no signs of ear pain, like irritability or sleeplessness, see your pediatrician, who can check for fluid in the middle ear and perhaps refer you to an ear, nose, and throat specialist (called an otolaryngologist or ENT). Then sit tight. By three months, 90 percent of fluid resolves on its own. In the meantime, let teachers and caregivers know your child's hearing may be impaired for a while.
Fluid that remains longer than three months might be there to stay and can affect language skills, a situation that may call for tympanostomy tubes. Tiny and inserted into the eardrum, these allow air to flow in and fluid to flow out; they usually fall out naturally after about 14 months. The procedure is so common that parents often refer casually to kids "getting tubes" -- but it requires surgery and carries all the usual drawbacks, including anesthesia risks. The American Academy of Pediatrics and the American Academy of Otolaryngology Head and Neck Surgery recommend reserving tubes for fluid that hasn't budged for three or four months straight.
In a recent study, however, researchers found that 75 percent of 682 kids who received ear tubes in New York City hospitals had fluid for less than a month and a half. "This is much earlier than experts deem necessary," says study author Salomeh Keyhani, MD, assistant professor of health policy at Mount Sinai School of Medicine. "The risks and benefits should be balanced. If the child could get better on her own, why do surgery?" Dr. Keyhani speculates that parents take a pediatrician's referral to an ENT as mandate for surgery. Be sure to discuss the necessity of tubes with all doctors involved.
Convinced that the overwhelmingly loud crowd sounds at kiddie hangouts like Chuck E. Cheese must be truly deafening? Actually, they're harder on the nerves than the ears. "Noise levels can seem higher due to the annoyance factor," says pediatric audiologist Lisa Hunter, PhD. "Chuck E. Cheese's would rate high on noise annoyance but is unlikely to damage hearing unless kids regularly go there for eight hours a day."
The real danger may be in your child's own playroom. Some really rattling rattles and shrieking squeaky toys exceed 100 decibels (dB), according to a study done in the United Kingdom. Rockin' Guitar Elmo might look innocent, but he's potentially harder on hearing than a motorcycle roaring by. "A noisy toy is usually safe if used at certain distances, but it's risky when it's held to the ear, which many children do," says Hamid Djalilian, MD, associate professor of otolaryngology at the University of California, Irvine, where researchers tested the decibel levels of several toys when held up to the ear or 10 inches away (see "Hearing Hazards in Your Home"). Noises of 85 dB and up can damage the tiny sensory cells in the inner ear, according to the NIDCD, and damaged cells don't grow back. Elmo held against the ear registers at 98 dB (but a safer 82 dB at 10 inches), well above a passing motorcycle (90 dB). Pop star-inspired dolls may belt tunes at 105 dB, and transformer toys are even louder.
Preschoolers may not be into MP3 players quite yet, but lots of them use handheld video games with headphones, and experts believe today's literally plugged-in kids are particularly prone to hearing loss. About 12.5 percent of kids ages 6 to 19 have some level of noise-induced hearing loss, a number considered epidemic. "That suggests hearing loss is starting in toddlers and preschoolers," Dr. Djalilian says. "These kids will have significant hearing problems when they reach their 40s and 50s."
"Noise-induced hearing loss is completely preventable," Peterson says. "If something's too loud, turn it down, walk away from it, or block it out." Apply these strategies to a blaring television, a jackhammer on the path of your usual stroll, or an earsplitting concert. "Earmuffs marketed for NASCAR fans work well," she says. These come in both adult and baby sizes.
Do a sound check on toys: hold them against your ear, then about a foot away. If it's too loud for you, it's too loud for your child. Teach children to keep noisy toys away from their ears, and turn off the sound frequently to let ears recuperate.
Only an audiologist or otolaryngologist can truly assess your baby's hearing. But there's one at-home check parents can try for babies 6 months and up, says Hunter. Have one parent capture the baby's eye with a toy while the other stands about a foot away from behind and whispers the child's name.
"If your baby turns toward the source of the whisper, that's a good sign," Hunter says.
Earwax isn't pretty, but it serves a purpose. It's a natural lubricant that gathers up dust and foreign bodies, protecting the ear from the injury and infection. Never push anything into the ear -- not even a cotton swab. "I've had several patients who went deaf because of cotton swabs," says pediatric audiologist Lisa Hunter, PhD. "They're like ramrods if the baby jerks." If your child produces an excess of earwax, a pediatrician or an ear, nose, and throat specialist should clear it out.
Toys can be louder than your noisiest appliances. Here's how toys (when held close to the ear) and common household items rate.
Vacuum cleaner, hair dryer: 70 Decibels
Dishwasher: 75 Decibels
Washing machine: 78 Decibels
Lawn mower, blender: 85-90 Decibels
LeapFrog Learning Lily: 90 Decibels
Little People Dump Truck: 92 Decibels
High School Musical Hip Pop Dance Jammer: 96 Decibels
Bob the Builder Deluxe Talking Tool Belt: 96 Decibels
Tonka Lights and Sounds Hummer: 97 Decibels
Tickle Me Elmo: 100 Decibels
Hannah Montana Holiday Pop Star: 105 Decibels
Transformers Optimus Prime Voice Changer: 110 Decibels
Sources: NIDCD (appliances); University of California, Irvine (toys)
Rachelle Vander Schaaf, a mother of two, lives in eastern Pennsylvania.
Originally published in the June issue of American Baby magazine.