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June is the month South Africa celebrates its youth. Actually, we should celebrate our children every month. We should protect them and encourage them, but most of all, we should watch them while they are in our care, and allow them their best chance at a great future.
Stepping into our world
When that little baby comes tight-fisted and squalling into the world, caring hands lift its little form and examines the child for the first time. A health professional immediately performs a battery of tests on the baby, examining breathing, skin colour, reflexes, muscle tone, and heart rate. Among this list, it is notable, there is no reference to anything related to auditory functioning. Believe it or not, it is not yet standard practice for a baby’s hearing to be checked at birth!
At present, a hearing check is voluntary, and a parent might not even be aware that such a screening is available. We want to emphasis to you the importance of examining a newborn’s auditory functions; the optimal time for this examination is while mom is still in the hospital or at least before baby’s six-week check-up with the paediatrician. Screening is available at most private hospitals from as early as 12 hours after birth. At Tami Mehl Audiology, we feel that a hearing check should be performed on every newborn and should not be an optional extra.
Why the rush? I’ll have him checked before I send him to school.
Babies begin to hear sound even while in their mother’s womb. There is much to read about the importance of speaking to a child during pregnancy. Many a parent may remember playing “Majors for Minors” and other classical music to a moving belly with the hope that this would encourage their future child’s intellectual abilities (and music taste).
From birth, a child is exposed to a rainbow of sounds at a volume quite different to the level inside it’s 9-month stay on a cocoon. Whether it’s the soft cooi-ng of the person who baths the baby or the lilting sounds of a parent singing a lullaby; music from a favourite toy or the sounds from the garden, a baby needs to have auditory stimuli to establish the root of speech recognition. When a child hears the sibilant voices of their parents and siblings, they learn to recognise a feeling of security. The cadences of the sounds also begin to trigger future responses in recognition of praise; of questioning or of reproval.
Parents think that they will know if their child is unable to hear. But this is mostly not the case. A child may have sufficient hearing ability to respond to loud sounds but may not be able to hear the softer sounds that they need in order to develop language and speech. Often hearing tests are only done when parents notice a delay in baby’s speech development. By then a lot of harm may have already been done.
The first hearing screening is an important step in helping to understand if your baby might have difficulty hearing. Without this baseline, it is hard to know when there are hearing changes in the first months and years of your baby's life.
She’s so small. How will you test my baby’s hearing?
Tami Mehl Audiology uses Oto-Acoustic Emissions (OAE) to screen a baby’s hearing. The words seem foreign, but simply mean that a miniature earphone and microphone are placed lightly in the child’s ear; sounds are played and the baby’s response is measured. The test is non-invasive and does not rely on a baby’s behavioural response.
Normal hearing is marked by an echo reflected into the ear canal and is measured by the microphone. If a baby has fluid in the ear from after birth, an ear infection or a possible hearing loss, no echo can be measured, and further testing may be required.
The screening is quick (about 5 to 10 minutes), painless, and may be done while your baby is sleeping or lying still. During the first day or two after birth it is possible that some amniotic fluid remains in baby’s ears, which can affect the test. For this reason, a positive test will be repeated before any further referral is done. Sometimes a baby may fail a screening due to other factors such as vernix or fluid in the ear, and it doesn’t necessarily mean that your baby has hearing problems.
What are signs that my newborn can’t hear me?
There are a few things a new parent can look out for (but be careful not to let too much information make you paranoid). As with any health-related issues, remember, signs and symptoms of hearing loss may be different for each child. You also need to consider the noise environment your child is regularly exposed to. The more sounds a child must distinguish, the longer it may take to differentiate between them.
According to the textbooks there are some signs you should be aware of, but they are not a definitive mark of hearing loss:
If you’re concerned about any of these signs, then contact Dr Tami Mehl so that she can reassure you, conduct further auditory tests if necessary and advise you on the best next steps.
What if my baby does not pass the initial hearing screening?
If your baby does not pass the hearing screening at birth, it does not necessarily mean that he/she is deaf or hard of hearing. There could be something in the baby's ear left over from the birth process or even excessive noise in the room of the screening which can affect results.
If my baby passes the newborn hearing screening, does it mean he or she will not have hearing loss later?
Unfortunately, no. Some children may develop hearing loss at a later age. Causes of late onset hearing loss in children might be, but are not exclusively, as a result of genetics, frequent ear infections, a head injury, exposure to damaging levels of noise, or even second-hand smoke.
What could have caused my son to be born deaf?
As a parent you should not blame yourself for your child’s hearing loss. There are many things that increase the chance that a child will have hearing loss and none of them is controllable by you. Here are just a few:
Or the cause may simply be unknown.
Breaking news here at home:
In June 2020, one of South Africa’s largest groups of hospitals launched a hearing screening programme for newborn babies at its hospital maternity units countrywide. This new initiative aims at identifying hearing loss in infants, to address it as soon as possible, and prevent it from impacting a baby’s development.
The hospital group in conjunction with the South African Association of Audiologists (SAAA), are trying to ensure that all neonates born at their facilities will have their hearing screened by professionally qualified audiologists. The cost of the specialised screening is covered as part of their maternity offering.
The specialised screening may diagnose hearing loss in the first weeks of life. The South African Government has emphasised the importance of the early detection and intervention in infant hearing.
International guidelines propose that screening for hearing loss occurs by no later than one month of age, and early intervention should be in place by no later than six months of age. Interventions will depend on the cause of the hearing impairment and the specific circumstances of the child.
There has never been a formal system for capturing the number of children with hearing loss in South Africa, but from now on, at least in this hospital group, such a process will begin. While the data will only cover this specific hospital group, it might still reveal some important trends regarding hearing impairment in children locally. This is good news for parents.
