Approximately 1 to 3 per 1000 children are born with atypical hearing thresholds, and similar numbers of children become deaf or hard of hearing later in childhood. All benefit from receiving medical support as early as possible, especially between birth and 5 years of age, a critical time of brain development and language acquisition.
In a clinical report, "Hearing Assessment in Infants, Children, and Adolescents: Recommendations Beyond Neonatal Screening," the American Academy of Pediatrics (AAP) for the first time since 2009 updates its recommendations on risk assessment, terminology and other considerations for children who are deaf or hard of hearing. The clinical report will be published in the September 2023 Pediatrics.
Policy statements created by AAP are written by medical experts, reflect the latest evidence in the field, and go through several rounds of peer review before being approved by the AAP Board of Directors and published in Pediatrics.
Some signs & reasons a child may be deaf or hard of hearing
"Parents and caregivers are often the first to realize their child is experiencing a change in hearing level," said Charles Bower, MD, FAAP, lead author of the report, produced by the AAP Committee on Practice and Ambulatory Medicine and Section on Otolaryngology – Head and Neck Surgery. "Sometimes this may appear as a child's inattention or erratic responses to sound. It's important to bring this up with the pediatrician, even if the child passed a newborn hearing screen after birth."
Genetic causes that impact hearing may show up beyond the newborn period, according to the report. Congenital cytomegalovirus (cCMV) infection is the most common infectious cause of childhood sensorineural hearing change and accounts for 25% of deaf and hard of hearing children ages 4 years old. Other infectious diseases, especially meningitis and otitis media, are leading causes of a change in hearing.
Why early identification & intervention is key
Delayed identification of changes in hearing status during early childhood and lack of timely or adequate support for language access often result in delayed development and permanent deficits. The report also notes potential impacts on sequential memory, abstract thinking, and executive function, poor academic performance, personal-social maladjustments and emotional difficulties.
AAP policy recommendations for newborn and childhood hearing screening
All children should have an objective, evidence-based risk assessment for changes in hearing thresholds at key points in their growth and development, starting at birth.
Concerns about a child's hearing may come from parents, caregivers, family members, pediatricians and other medical providers. Whenever signs of hearing changes appear, the child's hearing should be promptly tested.
Children whose hearing screening tests show results outside the typical range—whether in one or both ears—should be referred to an audiologist for diagnostic testing.
Certain hearing tests may be difficult for kids with developmental or behavioral health conditions. For them, the best solution may be to visit an audiologist who uses an auditory brainstem response (ABR) test, paired with sedation.
Hearing test results for newborns and older children should be reviewed carefully with families. Documentation of screening results is also essential for tracking and follow-up.
To prevent false negative results, and to avoid delays in identification, access to language, and support, screening tests should not be repeated more than once before referral to audiology for consultation and further testing.
If tests show that a child is deaf or hard of hearing, the child's medical team should work closely with the family, emphasizing support for the child's communication, language development, social and emotional needs, both at home and school.
Avoiding deficit-framing terminology around deafness
The AAP also observes the clinical report no longer contains deficit-framing terminology, such as "loss," "failed" or "impairment," to reflect that children who are deaf or hard of hearing are equal, healthy, and whole. The report is informed by published materials and engagement with Deaf and Hard of Hearing professionals and partner organizations, such as the National Association of the Deaf, working with the AAP Early Hearing Detection and Intervention program.
In the report, the capitalized term "deaf" refers to the community of individuals who identify with the culture of deaf people that has been historically created and actively transmitted across generations. The terms "deaf" and "hard of hearing" are audiological designations. Culture and personal experiences will likely influence the degree of medical intervention that family members desire.
"Most important is developing a rapport of trust and respect for our families' lived experiences, expertise and cultural perspectives," Dr. Bower said. "We share a common goal of making sure every child lives their healthiest life possible."
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