Most children hear and listen from birth. They learn to talk by imitating the sounds around them and the voices of their parents and caregivers. But that's not true for all children.

2 or 3 out of every 1,000 children in the United States are born deaf or hard-of-hearing.

More lose their hearing later during childhood.

Many of these children may need to learn speech and language differently, so it's important to detect deafness or hearing loss as early as possible.

Your baby should have a hearing screening within the first month of life.

If hearing loss is suspected, make sure a hearing expert, called an audiologist (aw-dee-AH-luh-jist) tests your baby's hearing by 3 months of age. If hearing loss is confirmed, it's important to consider the use of hearing devices and other communication options by 6 months of age.

Many hospitals automatically screen all newborns for hearing loss. Some screen only those newborns at high risk for hearing loss, such as babies with a family history of deafness or hearing problems, low birth weight, or certain other medical conditions. Even if your baby doesn't have risk factors, being screened is important, because many children with no risk factors have hearing loss. Even children whose parents and grandparents hear normally may be born with a hearing loss. Find out what your hospital does. If you and your baby are already home and you don't know if your baby's hearing was tested, ask the doctor or the clinic where your baby's records are.

Recently, many States have passed Early Hearing Detection and Intervention legislation. A few other States regularly screen the hearing of most newborns, but have no legislation that requires screening. To find out what your State does, visit the American Speech-Language-Hearing Association (ASHA).

Hearing tests that are used to screen babies:

Otoacoustic emissions (OAE) tests can show whether parts of the ear respond properly to sound. During this test, a sponge earphone is placed into the ear canal. The ear is stimulated with sound, and the "echo" is measured. The echo is found in everyone who hears normally. If there is no echo, it could indicate a hearing loss.

Auditory brain stem response (ABR) tests check how the brain stem (the part of the nerve that carries sound from the ear to the brain) and the brain respond to sound. During this test, your child wears earphones, and electrodes are placed on the head and ears. A mild sedative may be given to help keep your child calm and quiet during the test. The nurse or doctor sends sounds through the earphones and measures the electrical activity in your child's brain when he or she should be hearing.

In both tests, no activity is required from your child other than lying still.

If your child doesn't respond consistently to the sounds presented during either of these tests, your doctor may suggest a follow up hearing screening and a referral to an audiologist for a more comprehensive hearing evaluation.

The most important time for a child to be exposed to and learn language is in the first 3 years of life. In fact, children begin learning speech and language in the first 6 months of life. Research suggests that those who have hearing impairment and get intervention have better language skills than those who don't. The earlier you know about deafness or hearing loss, the sooner you can make sure your child benefits from strategies that will help him or her learn to communicate.

Assistive devices and strategies for children who are hard-of-hearing:

Hearing aids are instruments that make sounds louder. They are worn in or behind the ear and come in several different shapes and sizes. Hearing aids can be used for varying degrees of hearing loss, moderate or severe. An audiologist will fit a hearing aid that will work best for your child's hearing loss. Hearing aids can be expensive, so you'll want to find out whether they have a warranty or trial period. You'll also want to talk with your insurance provider to understand what is covered and what isn't.

Cochlear (COKE-lee-ur) implants have three parts: a headpiece, a speech processor, and a receiver. The headpiece is worn just behind the ear where it picks up sound and sends it to the speech processor. The speech processor, a beeper-sized device that can fit in a pocket or on a belt, converts the sound into a special signal that is sent to the receiver. The receiver, a small round disc about the size of a quarter that a surgeon has placed under the skin behind one ear, sends a sound signal to the brain.

An audiologist can help you to determine whether theseor other devices can help your child. Not all children who have hearing loss should get cochlear implants. Doctors and hearing experts think they're best for children who have a profound hearing loss and won't benefit from hearing aids.

As children get older, many other devices are available to help them hear. Some devices help children hear better in a classroom. Others make talking on the phone or watching television easier. For example, auditory training systems and loop systems can help eliminate or lower other noises and make it easier for your child to hear someone in a crowded room or group setting. Others, such as FM systems and personal amplifiers, are better for one-on-one conversations.

Ways of helping children with hearing loss express themselves and interact with others:

Oral/Auditory options combine hearing, lip-reading, and hearing devices such as hearing aids and cochlear implants. The goals of oral/auditory options are to help children develop speech and English-language skills.

American Sign Language (ASL) is a language used by some deaf children and their families. ASL consists of hand signs, body movements, facial expressions, and gestures. It's a language with its own grammar and syntax, which are different from English. ASL has no written form.

Cued speech is a system that uses handshapes in different locations along with the natural mouth movements to represent speech sounds. Watching the mouth movements and the handshapes can help some children learn to speech-read English; this is especially important in discriminating between sounds that sound different but look the same on the lips.

Signed English is a system that uses signs to represent words or phrases in the English language. Signed English is designed to enhance the use of both spoken and written English.

Combined options use portions of the various methods listed above. For example, some deaf children who use oral/auditory options also learn sign language. Children who use ASL also learn to read and write in English. Combined options can expose children who are deaf or hard of hearing to many different ways to communicate and express themselves.

The option you choose will depend on how you want your child to learn and communicate. Find out about all of the choices and talk to lots of experts.

You can do a lot to help your deaf or hard-of-hearing child to develop strong academic, social, and emotional skills and succeed in school.

Find out how your school system helps children with hearing loss. With your input, your child's school will develop an Individualized Education Program for your child.

Explore programs outside of school that may help you and your child, and talk with other parents who have already dealt with these issues.

Remember, the Individuals with Disabilities Education Act (IDEA) ensures that children with hearing loss receive free, appropriate, early intervention programs from birth throughout the school years.

Please see the listing under U.S. Department of Education, along with other resources in our Health and Safety Links section.

Reproduced in part from May 2001, NIH Publication No. 01-4968

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