Congenital hearing loss is surprisingly common, effecting 1-6 newborns per 1000 in the US. This rate obviously climbs as children get older with hearing loss caused by things like infections, head injuries, noise exposure, ototoxic (toxic to the ear) medications, and simply late identification of congenital loss.
So often when we think of hearing loss, we only think of hearing loss caused by aging or noise exposure from the military or working in an industrial setting. We don’t tend to think about small children who are hard of hearing.
On top of this reduced awareness of the issue, hearing loss can masquerade as other problems (like a learning disability, behavior problems, or lack of attention) making it difficult for parents and healthcare providers to identify.
But before I get too far in to this post, I want to point out a few things about how I/we talk about children who are hard of hearing or deaf:
- I used the term birth defect* as in ‘defection from the norm’, NOT defective. No child is defective. I’m making no statements about “good” or “bad.”
- Some parents are devastated by the news their child has a hearing impairment. They fear their child will have a harder life relying on hearing aids or other devices, potentially having trouble learning to speak and understand speech, and be overall limited in their options compared to their peers. But some parents celebrate bringing their deaf child in to Deaf culture, using American Sign Language (ASL), and being woven in to a community with a language, art, culture, and history based in the use of an entirely visual language that is not reliant on hearing devices. They do not feel their child has to hear or use speech to live a fulfilled life by any means. Do not assume what a diagnosis of a hearing loss in a child means to their family. (These are of course only two possible parent reactions out of a wide range of possibilities.)
- Hearing loss is not black and white. There are mild, moderate, severe, and profound losses that can occur in only one or both ears. There are also different types of hearing loss. Degree and type of hearing loss dramatically impact treatment options and outcomes. So, just because a child is born with a hearing loss, doesn’t mean they are candidates for a cochlear implant, traditional hearing aids, or surgery – it all depends on the degree and type (i.e. location in the auditory pathway) of the hearing loss.
That being said, when we talk about children with a hearing impairment raised in a hearing and speaking environment, the negative impact of leaving it untreated is very well documented. Because speech and language development have critical windows in early life, hearing loss can significantly impact this development. This is true even when it is mild or only in one ear! Even common (though not at birth) and seemingly benign things like ear infections can cause mild (or greater) conductive hearing loss and impact development.
If we think about it for a minute this makes a lot of sense…
Babies with hearing loss can’t hear all of the sounds of speech (some hear more than others). This clearly impacts their ability to develop speech, but also means they miss out on language learning opportunities. In a classroom setting, hearing loss can look like the child simply isn’t paying attention. They may also appear to have difficulty grasping concepts or following instructions, or even outright defiant if they do something they are told not to do. If these children are labeled as disobedient or intellectually disabled, without addressing the main cause, you can see how this could create more problems!
This high prevalence, coupled with overall lack of awareness, and significant impact on learning, make hearing loss in kids a very important issue to routinely screen for at birth, as well as throughout childhood.
To be clear, speech and language development includes speaking and understanding spoken language, as well as manual language, like ASL. If a child’s family decides they want their child to use ASL for example, but the rest of the family does not know ASL, this requires a fair bit of outside intervention to teach the family and the child a new language. If the family wants their child to use speech and hearing to communicate, this also relies upon early intervention with hearing aids and/or other devices to get sound to the brain. In both cases, intervention should be implemented quickly and thoroughly.
We know from years of identifying children with hearing loss after there are signs of speech and language delays that delayed intervention can be extremely costly. Turns out it is much cheaper for the government to identify and intervene with children with hearing loss as early as possible, rather than wait.
This is why we have newborn hearing screening.
Hearing losses in children can be congenital (present at birth) or acquired close to birth or in early childhood. It can be caused by genetics, malformations of the structures in the auditory pathway, infections, birth trauma, and even life-saving medical interventions such as certain antibiotics after birth, to name a few. The screening test does not identify the cause of hearing loss or even how much hearing loss the child may have.
A hearing screening only tells us whether or not there is a strong likelihood the child has hearing loss.
Once they do not pass a screening they are referred either for an additional screening or a complete diagnostic hearing test. From there, the appropriate interventions and follow-ups are discussed with parents.
Want to learn more about options for children and their families?
Watch out for our next post where I’ll talk to a pediatric audiologist on what’s out there for children with hearing loss today.
For more information about hearing loss in children look for resources from your state early intervention programs or a pediatric audiologist near you. If you need help finding a good audiologist or need assistance navigating hearing healthcare, use our contact form to get in touch.
Here is a link to the WA state early intervention program for more information: