hearing loss in children
Health and safety

Spotting the signs of hearing loss in children

Hearing loss in children can interfere with the quality of their life, restricting their ability to interact with others – which is why early diagnosis is vital. Speech and language therapist Dr Mary-Pat O’Malley-Keighran explains how to spot the signs of a hearing disorder in your little one.

Hearing loss in children

Hearing is vital for the development of speech, language, and communication. In the womb, babies pick up information about intonation patterns in the language(s) of their environment. I will always remember my daughter’s reaction when she heard my voice for the first time on the outside, just after birth: when I said ‘hello’, her eyes widened immediately and she turned her head towards me, looking directly at me. For me, that was a clear illustration of the importance of hearing in communication.

Hearing is a complex process involving the brain and the ears. The ear consists of three parts: outer, middle, and inner ear. Sound travels from the outer ear, through the ear canal to the ear drum, causing it to vibrate. The vibrations are then transmitted to the middle ear. In the middle ear are the three smallest bones in the body: the hammer, the anvil, and the stirrup.

hearing loss in children

The bones vibrate and pass the sound to the inner ear. The inner ear contains the cochlea and semi-circular canals. The semicircular canals contain fluid and small hairs, which move as the sound waves pass through the fluid. The cochlea also contains fluid which vibrates as sound passes through it and converts sound into nerve impulses. The nerve impulses are then sent to the auditory nerve, which passes the information to the brain, which processes the sound and allows us to hear.

Types of hearing problems

Hearing loss can be temporary or permanent. It can be caused by damage or conditions in the outer, middle, or inner ear.

1. Glue ear – One of the most common problems of the middle ear is glue ear or otitis media with effusion (OME). This condition refers to infection of the mucous membrane lining the middle ear. When there is fluid in the middle ear, hearing is impaired as sound cannot vibrate properly in the presence of excess fluid.

Three percent of two to four year olds have a hearing loss due to glue ear for more than 50% of the time. It is a very common reason for GP visits in childhood (HSE 2011).

2. Symptoms of glue ear may include sleep disturbance, speech and language delay, behaviour problems, ear ache when lying down, and requesting a high TV volume. It is associated with frequent colds.

Well-timed diagnosis and intervention is important in order to deal with the potential impact of hearing loss on children’s speech, language, communication, and learning.

There is a high incidence of OME in children who have cleft palate or Down syndrome and these children require on-going review by an audiologist and/or ear, nose, and throat surgeon (ENT).

Audiologists assess, identify, and manage hearing loss, while the ENT surgeon would be responsible for inserting grommets (aeration tubes) and/or removing adenoids. OME is considered a self-limiting condition with 90% of cases resolving within 12 months. Any child who appears not to be hearing well should be evaluated by a GP and have a hearing test.

Hearing impairments, and speech and language development

Hearing problems in children can affect speech and language development in a variety of ways and the effects depend on the type of hearing loss, its severity, and when it was identified. Early identification and intervention are important for minimising the impact on speech and language development. The same level of hearing loss may have very different effects on communication skills in different children.

Hearing loss may cause a delay in the understanding of language and in putting words together to make sentences. Vocabulary tends to develop more slowly in children with hearing loss and these children tend to learn concrete words such as cat, jump, red more easily than abstract words like before, after, first, friendly, the, are, etc.

hearing loss in children

Children with hearing loss understand and make simpler sentences than children who have normal hearing. Often they have trouble hearing the ends of words, particularly – ‘s’ or – ‘ed,’ e.g. cats, waited. This means their communication can be affected as they have trouble indicating plurals (dogs, cats), possessives (Mary’s, Sam’s) and verb tenses (eats, sleeps). These difficulties can combine to have a negative effect on reading and writing and how children perform in school.

In relation to speech development, children with hearing loss often cannot hear sounds like ‘s’ (see), ‘z’ (zebra), ‘sh’ (shoes), ‘f’ (feet) ‘v’ (vet). They also tend to leave out these sounds in their speech so they may be hard to understand. They may not be able to hear their own voices when they are talking so they might talk too loudly or not loudly enough.

Children with hearing loss need to be seen by a team consisting of the family, the audiologist, the ENT surgeon, the speech and language therapist, and other healthcare professionals (e.g. visiting teacher service provided by the Department of Education and Science) depending on the child’s needs.

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Ask Sarah

Q I’ve heard a lot about the Paleo diet and as I am very interested in reducing the amount of processed foods and grain based meals my family eats, we are considering following this diet. From what I read it seems to be a back-to-basics type of eating. Is a Paleo diet safe for children? My kids are aged seven and nine.

A The Paleo diet is one of the most fashionable diets around at the moment. It is also known as the ‘caveman diet’ and is based on cutting out processed foods, starchy foods like bread and potatoes and eating more meat, vegetables and fruit.
As fad diets go, it is not the worst but there are some good and bad sides to it. Reducing the amount of processed foods we eat is always a good idea and by doing that you will usually reduce the amount of fat, salt and sugar you eat, which is a good thing! The problem with the Paleo diet is that it also cuts out dairy (on the basis that cavemen didn’t drink milk) and this means that the diet is very low in calcium. For this reason it is really not suitable for children who do need a lot of calcium for growing bones. How did cavemen manage without dairy? They ate a lot more food than we do (up to 10,000 calories per day compared to the 2,000 most of us eat). By eating that amount of food they were able to pick up just enough calcium from green vegetables and seeds. To put it in perspective, you would need to eat 16 servings of broccoli a day to get all the calcium you need. This is easier to do if you eat 10,000 calories per day rather than 2,000.
The other problem with the paleo diet is that it is not entirely based in science. Many of the Paleo diets out there say you should not eat wheat, even though we know that cavemen did in fact eat wheat and other grains. These diets also don’t recommend that you eat blubber and the big lumps of fat that were also a large part of the caveman diet!
A final problem is that many Paleo diets encourage people to cut out beans and lentils and to get their protein from meat and fish instead. Many studies over the last few years are clear that eating too much animal protein is linked with more cancer and heart disease. Eating some vegetarian meals based on beans and lentils is a great way to get your protein without always going for meat.
Is this a diet we should follow? I think there is a lot we can learn from the Paleo diets. We could all do with eating less salt, sugar and processed foods and adding in more nuts and seeds as well as more vegetables. However, I think following a strict Paleo diet could lead to low levels of calcium and vitamin D and so it is not suitable for children or teens and adults would need to think about a calcium supplement.

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Ask Allison

Q My sister-in-law and I both work three-day weeks and we help each
other out with child minding on our working days, which up until recently has worked out really well. Between us, our kids are aged between five and nine years – the problem is that it’s now become quite apparent that we have very different parenting styles. I prefer my two daughters (seven and nine) to have a structured day. For example, in my house, we have allocated times for television and iPads, etc. My sister-in-law, however, lets the kids run loose after school – homework is ignored and my kids end up wired after eating sugary treats all afternoon. I am considering looking at after-school childcare for the kids, but I’m worried that this is going to cause a family argument. Is there a diplomatic way that I can ask my sister-in-law to introduce some discipline into her child-minding days? It certainly doesn’t do her two kids any harm when I am minding them in my own house!

A
In a word, no, there is no diplomatic way to do this as it may very likely seem like your saying that your parenting style is better than
hers. As L’Óreal says, ‘now here comes the science bit.’ Dr. Kaylene
Henderson, a child psychiatrist, wrote a very interesting blog about ‘the
science behind the Mummy Wars’. She explains that before she had
children of her own she hadn’t been aware of how parents have a
very specific sense of the right parenting style. She also found that parents could be very definite in defending their chosen parenting style. Dr. Henderson, who describes herself as a curious, scientific, open-minded person, was surprised at how defensive parents could be and, at times, of their judgemental attitude towards each other. She explained the neurology of the Mummy Wars; okay, I’ll need you to bear with me for a second. Warning; I’m about to use some neuro-techie language.

Why do we judge each other?
As we have all had different experiences, this means that we all have very different memories stored in our brains. Most of our memories are ‘explicit’ memories – these are ones that we can recall easily such as important dates that mean something to us; important birthdays, special events or stories of and about our lives.
There is another type of memory called ‘implicit’ memory that plays a
key role in our parenting. This type of memory is the stuff that you do on autopilot. Psychologists call these heuristics or rules of thumb –
such as tying your shoelace, or driving your car (once you have learnt
to do both first!). Otherwise we’d really waste a huge amount of time
pondering over tasks that we have readily available to us. This seems to be where the science bit of our parenting style kicks in. This implicit memory goes all the way back to when you were an infant being parented by your parents. This is when you started the process of storing up how they did it into your memories.
Unless you make a conscious choice and effort to parent differently, what you saw and unconsciously learnt will be your automatic go-to parenting style.

We learn habits
This can really kick into gear when we feel our parenting style is
being mirrored or highlighted by disapproval from another parent. I know the cold sweat you feel when your child decides to make their outstanding bad behaviour performance at, of course, the most public and worst time. The implicit autopilot of how your parents dealt with these outbursts will flow unconsciously from you if you haven’t worked super hard to be aware and consciously change the old habits.
What’s happening for the on-looking parent is that they see you doing something they are used to doing, but you are doing it all wrong. Simply, because that is not how they know how to do it.

Find a way that works
You both have different parenting styles – who is to say which type is correct? You just need to know what works best for your family and that’s the bottom line. The irksome feelings won’t go away. You can talk to your sister-in-law, but I’m adding a caveat that it would be hard not to hurt her feelings. What we’re possibly looking at is that you prefer a more structured form of parenting, whereas your sister-in-law has a more permissive style. I’m not sure the two styles can mix, the mixture is a bit like oil and water.
If a collaborative shared form of parenting style can be agreed upon, then that is great, but our learnt hardwiring may prove difficult to change despite the intent to do so.
Perhaps, your own instinct of changing childcare might work best for you. In terms of making childcare work; the fit is ultimately the most
important aspect as you want a cohesive congruent feeling of the other caregiver to just ‘getting it’, like in any good partnership. Best of luck
with this and I wish you both well.