I almost didn’t take my son, Gus, for his infant hearing screening. The hospital nurse who was trained to use the screening equipment was off the day we took him home, and the pamphlet for the infant hearing program was just one of many pieces of paper we shoved in an envelope as we packed up our hospital room after he was born.
A couple of weeks later, when my mother arrived and freed up enough of my time to sort through the paperwork, I made the appointment. At this point, there was no indication Gus had hearing loss, so I was surprised at the appointment when the public health nurse told me she had to refer him to an audiologist. I asked, perhaps naively, how many kids she referred. Eight percent, she said, but a much smaller percentage actually had hearing loss. The odds were in our favour, as we had no family history, but we spent the next few weeks subtly testing his hearing and were relieved he noticed when the dog barked or something fell to the floor, and he smiled when we talked to him. It wasn’t until the audiologist walked us through Gus’s audiogram and explained that he struggles to hear high-frequency sounds, including many that are a part of speech, that we realized something was wrong.
According to the Canadian Paediatric Society, approximately two in every 1,000 babies in Canada are born with some degree of hearing loss, making it one of the most common congenital disorders. The good news is that hearing loss can be easily diagnosed, and there are well-developed resources and treatments. Because my family lives in Ontario, one of the provinces that screens infants for hearing loss at birth, by four months, Gus was wearing hearing aids whenever he was awake. Unfortunately, many Canadian kids don’t have access to this level of care. An April 2019 report card from the Canadian Infant Hearing Task Force (CIHTF) gave the country a failing grade on early hearing detection and intervention. “Every child in Canada deserves access to timely and high-quality hearing health services,” said Marlene Bagatto, an audiologist from Western University and chair of the CIHTF, in a press release. “Your postal code should not determine whether your child can access early and appropriate hearing healthcare.”
Hearing loss can have lifelong repercussions on speech and language development if not caught early. That’s because you have to hear what speech sounds like in order to develop the ability to speak and communicate in a typical way—kids whose hearing loss is not caught between birth and age five might never catch up.
In an ideal world, the Canadian Paediatric Society says, all babies should be tested by one month old and, if needed, be referred for further testing, so that treatment can be in place by six months. This could include traditional hearing aids, cochlear implants (which bypass the ear, convert sound to electronic signals and send them directly to the brain), a plan for the child to learn sign language or a combination of the three.
But kids in provinces and territories that lack access to infant screening and the proper follow-up care—Manitoba, New Brunswick, Newfoundland and Labrador, Nunavut, Prince Edward Island, Quebec and Saskatchewan all got ‘insufficient’ grades from the CIHFT in this regard—may not be diagnosed until their language skills fall seriously behind. This would most likely be when the kid is around 18 months, and a parent or healthcare provider flags a language or developmental delay—like lacking eye contact or having poor engagement with caregivers—says Maxine Armstrong, an audiologist based in Belleville, Ont.
If not diagnosed at 18 months or at an annual doctor’s checkup, a problem will likely be picked up when kids start school, and a teacher notices their language skills lag behind their peers or that the child’s speech is “slushy,” meaning it is unclear and garbled, says Jana Girdauskas, a hearing resource teacher in Toronto. Kids who aren’t diagnosed early often have lower receptive language skills (meaning the words kids can understand, often long before they can articulate them). This impacts vocabulary development and expressive language (what they can say), so they often struggle with basic communication, says speech-language pathologist Sarah Cassel, who is based in Toronto. “Missing opportunities to participate in communication because of hearing loss can become a physical and emotional barrier for young children,” she says. “Children can become frustrated and stop trying to communicate because it is hard for them to interact with their peers and make friends.”
If your kid wasn’t screened at birth, Armstrong recommends asking your family doctor for the test. It’s a fast and easy screen, done with an audiologist, that is covered under most provincial health plans (check with your doctor to confirm). Keep in mind that hearing loss is on a continuum—mild hearing loss may or may not require intervention, while a loss deemed mild-to-moderate usually requires the child to wear a hearing aid for speech and language development, although they can still hear many things (this is what Gus has). People with severe or profound hearing loss are more likely to be candidates for cochlear implants.
Many of the signs of hearing loss and developmental disorders overlap, so it’s also worth asking your doctor for a test to rule out hearing difficulty at the first sign of developmental concerns and before pursuing a diagnosis of autism or ADHD.
Even though Masha Hutner’s son Eric had passed his infant screen at birth, by the time he was 18 months old, he could only say one word: “bye.” His doctor suggested his delay might have been caused by his parents’ speaking two languages at home. He was referred to speech therapy and scheduled for a hearing test, which kept getting delayed by the public clinic. When Hutner took him to a private clinic, he passed the screen, but she later found out that that clinic didn’t do testing specific to kids. Meanwhile, Eric didn’t make progress in speech therapy, and he began to develop behavioural issues—he wasn’t listening to his parents and frequently lashed out at everyone around him in frustration. He was eventually diagnosed with moderate-to-severe hearing loss in both ears. By age four and a half, he had cochlear implants and his language skills and behaviour had improved dramatically.
Up to 15 percent of children between the ages of six and 19 have measurable hearing loss in at least one ear. Acquired hearing loss can take two forms: permanent or transient (also called temporary). A child’s hearing can be damaged from continued exposure to loud noises (such as city traffic or listening to blaring music in headphones) or a one-time event, like an explosion. A loss of hearing can also result from repeated or serious ear infections, or trauma to the area, like being hit in the head or sticking something in the ear.
Cassel notes that hearing loss often goes unidentified in school-aged kids, which can lead to behaviour issues, as well as social and academic problems.
Armstrong says parents should watch out for signs like their kid not responding to their name in loud situations (a crowded room, for example), articulation concerns, (slushy speech, including words running together and poor or unusual enunciation), behavioural challenges or trouble focusing, and changes in hearing after an illness or trauma.
Temporary or transient hearing loss is often caused by middle ear infections, which, in severe cases, can come and go for a person’s entire life and cause the same damage to speech and language development as permanent hearing loss. Sometimes this can be helped with having tubes inserted in the ears, but there are cases when hearing aids are required. Working with an audiologist, your doctor can explain the type of loss your child has and the best ways to treat it.
Regardless of the kind of hearing loss your kid has, you’ll want to develop a treatment plan as soon as possible. Medical interventions, which can include tubes, hearing aids or cochlear implants, combined with language learning (oral or American Sign Language, or ASL), are best started early to ensure kids have the greatest access to speech and language from as young an age as possible. Cochlear implants are controversial, as they can be implanted before children are able to consent to them, which some people in the deaf community feel is inappropriate. However, many families go ahead with them, as early implantation gives children the best opportunity to develop oral language skills. Jill Witte, a Toronto audiologist, explains: “Early access to sound using the appropriate intervention, such as hearing aids or cochlear implants, will help stimulate the auditory areas of the brain and give the baby the best opportunity to maximize their listening and learning potential.” Witte notes ASL is another viable option to create learning and communication potential.
Many provinces have resources that can support early learning, including home visits from specialized teachers. When you register your kid for kindergarten, talk to the principal about the accommodations and assistance available, which could include optimal seating placement, an FM system that transmits the teacher’s voice directly into the aid and putting tennis balls on the feet of all chairs to reduce excess classroom noise.
Gus recently turned six months old. He’s a boisterous, happy baby who is hitting all of his milestones, including his early speech and language development ones, like babbling, making “ahh” and “ooh” sounds and responding to noises in our home. Although my husband and I went through a mourning period in the beginning—it was hard to imagine our child growing up with a disability—it wasn’t until Gus got his aids and we saw that he was the same smiley, social baby he was without them that we were both able to relax and embrace this journey. We’ve attended workshops and we have become active in the hearing loss community, which hosts frequent workshops, seasonal gatherings, and camps and outings for the kids. Meeting other families dealing with hearing loss has helped us normalize our situation and feel part of a supportive community with so many amazing, thriving children.
Although parents often have a sense of whether there’s an issue with their kid’s hearing, because there are different degrees of hearing loss, it’s not always obvious. Toronto audiologist Jill Witte says parents can look out for these signs:
1. Not startling at loud noises
2. Few or no words - The expectation is three or more words by 12 months of age; at least 20 words by 18 months.
3. Failing to imitate sounds
4. Not turning to sounds (called "localizing") by 6 months of age
5. Older children with unilateral hearing loss may favour one ear or remark that one ear is a “good ear”
6. Changes in hearing after serious illness or injury- Your child doesn’t respond to sounds they once would have and perhaps misses bits of conversations.
Hearing loss can't always be avoided, but here are some ways you can protect your kid’s hearing.
* Consider the noises your child is exposed to, including television, music, sirens, a white noise machine in their bedroom, or other noises that could potentially be damaging, and intervene when you can. If it seems loud to you, it could be dangerous. Minimal exposure can be enough to cause damage to small ears.
* Discourage your child from using noisy toys close to their ears. Ensure children don’t sit too close to the television or have the volume at a level that you find irritating.
* Use protective headphones at sporting events, concerts, air shows, or even at particularly noisy, open-concept restaurants.
* Ensure ear infections are treated in a timely manner. If your child has persistent ear infections, ask your doctor if a hearing test is appropriate.
Sources: Audiologist Maxine Armstrong, Hearing Resource Teacher Jana Girdauskas, www.healthyhearing.com