SPEAKER: Welcome to the American Speech-Language-Hearing Association’s podcast series highlighting issues in the field of human communication.
FRANCINE PIERSON: Newborn hearing screening is now considered standard care in the United States, with the vast majority of babies screened for congenital hearing issues within days of birth. But many parents still don’t know much, or anything, about the hearing screening that will occur before an audiologist knocks on their hospital room door. As such, news that a baby has failed a hearing screening often comes at a great shock. This can result in some parents not taking appropriate follow-up steps, which is a serious problem.
Today we’re joined by Dr. Patti Martin, Director of Audiology and Speech Pathology at Arkansas Children’s Hospital and an ASHA-certified audiologist, who is going to discuss what parents need to know about the screening, next steps if a child fails the hearing screening, and the importance of continued vigilance about the signs of hearing loss throughout a child’s first year of life. Dr. Martin, thank you for being here.
DR. PATTI MARTIN: Well, thank you for inviting me. It’s great to be here this morning.
FRANCINE PIERSON: Well, it seems that the U.S. has made great strides to make newborn hearing screening near universal today. What are the issues that audiologists are looking for in a newborn baby, and what sort of testing occurs to detect these issues?
DR. PATTI MARTIN: So the whole premise behind newborn hearing screening is that it’s critical to figure out how a baby hears early and that time is of the essence. So for audiologists and other healthcare providers, we really advocate for newborn hearing screening so we can identify children as early as possible who do have a hearing loss.
And so, we’re looking for any type of hearing issue that might impact a child’s ability to develop speech and language, because we know there’s this critical period of time for that to happen and that babies have the best chance for typical speech and language development if they’re identified with hearing loss early.
FRANCINE PIERSON: So you talk about time being of the essence here. Are there babies who may slip through the cracks and not get screened? For instance, babies whose mothers chose home birth or those who were discharged early, before 24 hours? And if that’s the case and time is of the essence, what are the recommendations for parents in these cases?
DR. PATTI MARTIN: Well, the good news is that hearing screening is not a difficult or a time-consuming task, and so I would encourage a parent in that situation to contact their pediatrician or their primary care physician to see about a recommendation of where they might have a hearing screening done. Certainly, we don’t want babies who aren’t born in typical hospital settings or babies who discharge early to not be screened.
Another option is to look at the PALS list, which is a list of providers of pediatric audiology services that the Centers for Disease Control, the CDC, houses on their website. And ASHA has been a member of PALS, as well as other government agencies and other agencies like ASHA, and it provides a list of pediatric audiologists that parents can search by where they live, and it talks about what kind of equipment they have available, et cetera. So I think primary care physicians, looking at the PALS list online to find a provider close to you, are both good options.
FRANCINE PIERSON: Wonderful. Well, once this screening occurs, if a parent does receive a diagnosis of a failed screening in their child, what does this mean exactly, and what are their next steps?
DR. PATTI MARTIN: So for parents who find out that their child didn’t pass the newborn hearing screening, they might be told their child didn’t pass it. The language might be that their child failed the test, or the language might be that their child referred on the test. Either way, what it tells us is that this is a baby, of all the babies that have been born and screened, that needs to have a little bit more testing done. So it doesn’t definitely mean that the child has hearing loss because they didn’t pass the hearing screening, it just is an indicator that this is a child who deserves additional testing so that we can determine truly what their hearing levels are like.
So for a family that doesn’t pass—or for a baby who doesn’t pass the newborn hearing screening—the recommendations that are put out by most of the national organizations, that we want to have that baby re-screened in the next few weeks of their life. And there’s a couple of reasons for that. One is that babies spend a lot of time sleeping in the first few weeks. And even though the hearing screening is quick and painless, it’s easiest to get on a sleeping baby.
And so there’s a recommendation that, by the time a child is one month of age, that they be re-screened if they didn’t pass the initial screen. The good news is also that a lot of those babies who return for re-screening will pass at that point in time and then they’re through with the process, the initial screening process. Those babies who don’t pass at a re-screen, they should be referred at that point in time for full evaluation by an audiologist.
FRANCINE PIERSON: So if a parent doesn’t follow up with that full evaluation by an audiologist, what are the consequences if this doesn’t occur? How does untreated hearing loss affect the child developmentally and their overall health?
DR. PATTI MARTIN: Well, babies are designed to listen for the first nine to 12 months of their lives, and then we look for them to have first words around 12 months of age. So the baby’s task really is to do lots of good listening and soak up sounds in their environment when they are little bitty. And so, if a child has an undiagnosed hearing loss during the first few months of life, they miss this window of opportunity to naturally be hearing and learning the sounds of speech, even though they’re not saying any of those sounds back.
So for a child who doesn’t get appropriate follow-up services, parents are going to notice different things about them. They may not babble or make some of the sounds that typical hearing, babies with typical hearing might make, and they might be inconsistent in how they appear to be listening. It could impact how they respond to different sounds in their environment and that kind of thing. But the most critical thing is the long-term consequence of unidentified or untreated hearing loss, and that is its impact on communication development.
FRANCINE PIERSON: Um-hmm. Well, even if the child does pass a hearing screening, hearing loss can certainly present itself weeks or even months later. What are some of the reasons that hearing loss may occur long after a child is discharged from the hospital?
DR. PATTI MARTIN: So for a child that passes his newborn hearing screening and then later is found to have hearing loss, we refer to that as progressive hearing loss, and there are several different factors that can cause that to happen. A few of those are things like having a family history of hearing loss; it puts you at a little higher risk of a child developing hearing loss, because some of the familial or family hearing losses aren’t evident right at birth. And then develop as the child grows a little bit. Sometimes children who are born premature have a little bit higher risk of developing hearing loss. And it’s not the prematurity itself, but it’s usually all the things that go along with being a premature baby that could cause that to happen. Any child that has any sort of difference or malformation in how their head or ear is shaped, it might be a little bit more risk, and would be a child I would tag as wanting to see again down the road even if they passed their newborn hearing screening. The other option is that there are some infections that a mom could get when she’s pregnant or while she’s giving birth, and those also can cause progressive hearing loss a little bit down the road.
So usually a vigilant pediatrician or family practice doc will be aware of those kinds of issues and know when a child would need additional follow-up even if they pass the screening, but certainly it’s always good for a parent to ask any time they’re concerned. I think one of the interesting things is—for children who have passed the newborn hearing screening and then acquire hearing loss in the first months or years of life—is that the mom, the parents, are usually the first ones to note that. And so I always fall back on parental concern as a huge indicator for the need for additional screening or testing even on a baby who passed the newborn screening.
FRANCINE PIERSON: Speaking of parental concern and parental awareness about these sorts of things, ASHA is currently in the midst of a public education campaign called Identify the Signs, which urges parents and others to learn the early signs of hearing, as well as speech disorders, and to seek help if they suspect an issue.
You touched on a few of these earlier, but what are the telltale signs of a hearing problem that a parent should be looking for in the child, you know, baby to one year of age?
DR. PATTI MARTIN: So probably the biggest sign that would be apparent is just lack of attention to sound and/or inconsistent response to sound. So certainly a newborn baby doesn’t pop their head up and turn to their name. But children at several months old, usually by six months, are starting to be very, very aware of their environment and respond to sounds in it. And so a lack of awareness to that or a difference in awareness between one child and another certainly would be something to look for. A little bit older children, you know, we look at whether or not they’re able to follow directions, simple directions, very easily. If they don’t turn to their name, if the child is playing and you call them and they have trouble telling where—you know, the direction that the sound came from, that could be an indicator.
Another kind of thing is kids that pull at their ears a lot. It doesn’t always mean there is hearing loss or fluid behind the eardrums or an ear infection; it can mean that. It could mean they’re just cutting teeth also.
FRANCINE PIERSON: Right, right.
DR. PATTI MARTIN: And it’s not very comfortable. Or it might mean they’ve just discovered their ears and they think they’re fun to play with. But pulling at your ears is something that, if it’s an ongoing issue, might indicate some discomfort or issue for the baby, and I would look for that.
FRANCINE PIERSON: We hear about so much fabulous technology out there, advances in hearing aids, cochlear implants. Are these sorts of interventions available to very young children? How would an audiologist treat hearing loss or another sort of hearing problem in a very young child?
DR. PATTI MARTIN: Well, in audiology, most of us have chosen to go into this profession because we’re very interested in the use of technology. And so technology offers us some great options for families and that’s continued to evolve, and there be greater options for children at younger ages, and I’ve seen huge differences in that and in my career here at Children’s Hospital.
So there are great options for families, and families have choices about what sort of technology options they might pursue. I think it’s important for parents to know that a baby is never too young for hearing aids or for other types of amplification, and that actually we try to encourage families to think about hearing actually happening at the level of the brain. And so when there’s a problem with hearing and a problem with how the ear works, the middle ear or the inner ear or the outer ear, then sometimes what the use of technology can do is just help bridge that gap so that we can get sound to the brain and really develop it so that speech and language can develop.
So takeaway point on that would be, one, a baby is never too young for hearing aids if they have a significant hearing loss and that’s appropriate. The other thing is for children with severe to profound hearing loss, there are lots of advances with cochlear implants, and those are approved for use in children down to the age of one. And so many children around the country have families who choose cochlear implantation at around 12 months of age.
FRANCINE PIERSON: Well, a lot of really great, important information. Thank you so much for being here with us today, Dr. Martin.
DR. PATTI MARTIN: Thank you for inviting me. I hope that’s been helpful.
FRANCINE PIERSON: It has. And to learn more about hearing loss in infants and the signs to look for, and also to find an audiologist in your area, visit IdentifytheSigns.org.