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Who is in day care?

The 2000 census reported that of among the nation’s 19.6 million preschoolers, grandparents took care of 21 percent, 17 percent were were cared for by their father (while their mother was employed or in school); 12 percent were in day care centers; nine percent were cared for by other relatives; seven percent were cared for by a family day care provider in their home; and six percent received care in nursery schools or preschools. More than one-third of preschoolers (7.2 million) had no regular child-care arrangement and presumably were under maternal care.

Day care establishments are defined as those primarily engaged in care of infants or children, or in providing pre-kindergarten education, where medical care and/or behavioral correction are not a primary function or major element. Some may or may not have substantial educational programs, and some may care for older children when they are not in school.

What are your child’s risks of being exposed to a contagious illness at a day care center?

Medline, a service of the National Library of Medicine and the National Institutes of Health, reports that day care centers do pose some degree of an increased health risk for children, because of the exposure to other children who may be sick.

When your child is in a day care center, the risk is greatest for viral upper respiratory infection (affecting the nose, throat, mouth, voice box) and the common cold, ear infections and diarrhea. Some studies have tried to link asthma to day care. Other studies suggest that being exposed to all the germs in day care actually IMPROVES your child’s immune system.

Studies suggest that the average child will get eight to ten colds per year, lasting ten – 14 days each, and occurring primarily in the winter months. This means that if a child gets two colds from March to September, and eight colds from September to March, each lasting two weeks, the child will be sick more than over half of the winter.

At the same time, children in a day care environment, exposed to the exchange of upper respiratory tract viruses every day, are expected to have three to ten episodes of otitis media annually. This is four times the incidence of children staying at home.

When should your child remain at home instead of day care or school?

Simply put, children become sick after being exposed to other sick children. Some guidelines to follow are:

  • When your child has a temperature higher than 100 degrees, keep him/her at home. A fever is a sign of potentially contagious infection, even if the child feels fine. Schools often advise keeping the child at home until a fever-free period has existed for 24 hours.
  • When other children in the day care facility have a known contagious infection, such as chicken pox, strep throat or conjunctivitis, keep your child at home.
  • Children taking antibiotics should be kept at home until they have taken the medicine for one or two days.
  • If your child is vomiting or has diarrhea, the young patient should not be around other children. Other signs of illness are an inability to take fluids, weakness or lethargy, sunken eyes, a depressed soft spot on top of infant’s head, crying without tears and dry mouth.

Can you prevent your child from becoming sick at a day care center?

The short answer is no. Exposure to other sick children will increase the likelihood that your child may catch the same illness, particularly with the common cold. The primary rule is to keep your own children at home if they are sick. However, you can:

  • Teach your child to wash his or her hands before eating and after using the toilet. Infection is spread the most by children putting dirty toys and hands in their mouths, so check your day care’s hygiene cleaning practices.
  • Have your child examined by a physician before enrollment in a day care center or school. During the examination, the physician will:
    • Look for otitis (inflammation) in the ear. This is an indicator of future ear infections.
    • Review with you any allergies your child may have. This will assist in determining if the diet offered at the day care center may be harmful to your child.
    • Examine the child’s tonsils for infection and size. Enlarged tonsils could indicate that your child may not be getting a healthy sleep at night, resulting in a tired condition during the day.
    • Alert the day care center manager when your child is ill, and include the nature of the illness.

Day care has become a necessity for millions of families. Monitoring the health of your own child is key to preventing unneccessary sickness. If a serious illness occurs, do not hesitate to have your child examined by a physician.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

El humo de segunda mano es una combinación del que brota de un cigarrillo ardiendo y el humo que exhala un fumador. También llamado Humo de Tabaco Ambiental (HTA), es fácilmente reconocido por su olor distintivo, el HTA contamina el aire y es retenido en la ropa, cortinas y muebles. Mucha gente encuentra que el HTA es desagradable, molesto e irritante para los ojos y la nariz.

¿Es común la exposición al humo de tabaco ambiental?

Aproximadamente un 26 por ciento de los adultos en los Estados Unidos fuman cigarrillos, y entre 50 por ciento a 67 por ciento de los niños viven en hogares con al menos un adulto fumador.

Efectos del humo del tabaco ambiental

El feto y el recién nacido

La sangre maternal, fetal, y placental cambian cuando una mujer embarazada fuma, aunque los efectos a largo plazo todavía no son bien conocidos. Algunos estudios sugieren que fumar durante el embarazo produce defectos tales como labio leporino y fisura de paladar.

Las mujeres que fuman producen menos leche, y sus bebés tienen menos peso al nacer. El fumar materno también está asociado con el Síndrome de Muerte Súbita Neonatal, la mayor causa de muerte en infantes entre un mes y un año de vida.

Los pulmones y el tracto respiratorio de los niños

La exposición al HTA disminuye la eficiencia de los pulmones y altera la función en los menores, al igual que aumenta tanto la frecuencia como la severidad del asma infantil. El fumar pasivamente agrava la sinusitis, la rinitis, la fibrosis quística, y los problemas respiratorios crónicos tales como la tos y el goteo nasal posterior. También aumenta el número de episodios de resfríos y de dolores de garganta.

En los niños de menos de dos años de edad, la exposición al HTA aumenta la posibilidad de desarrollar bronquitis y neumonía. En efecto, un estudio realizado en 1992 por la Agencia de Protección Ambiental de Estados Unidos dice que el HTA causa un promedio de 150-300 mil infecciones respiratorias cada año en infantes y niños de menos de 18 meses de vida. Estas enfermedades resultan en 15,000 hospitalizaciones. Los niños cuyos padres fuman medio paquete de cigarrillos o más por día tienen el doble de riesgo de hospitalización por una enfermedad respiratoria.

Los oídos

La exposición al HTA aumenta tanto el número de las infecciones de oído que el niño va a experimentar, como el término de la enfermedad. El humo inhalado irrita la trompa de Eustaquio, que es la que conecta la parte posterior de la nariz con el oído. Esto causa inflamación y obstrucción, la que interfiere con la ecualización de presión en el oído medio, llevando dolor, derrame e infección. Las infecciones del oído son la causa más frecuente de pérdida auditiva en los niños. Cuando ellos no responden al tratamiento medicamentoso, a menudo se requiere la inserción quirúrgica de tubos de ventilación.

El cerebro

Los hijos de madres que fuman durante o después del embarazo están más expuestos que otros niños a sufrir problemas de comportamiento, tales como hiperactividad. También se ha demostrado una ligera disminución de su rendimiento en la escuela y en los logros intelectuales.

¿Quién esta en riesgo?

A pesar de que el HTA es peligroso para todo el mundo, los fetos, los infantes, y los niños, sufren un riesgo mayor. Esto es así porque el HTA puede dañar órganos en desarrollo, como los pulmones y el cerebro. Más de 4000 productos químicos han sido identificados en el HTA, y al menos 43 de estos causan cáncer.

Fumar pasivamente produce cáncer

Usted ha leído como el HTA daña el desarrollo de su hijo; ¿Pero sabía que el riesgo de que usted desarrolle cáncer por HTA es alrededor de100 veces mayor que el que producen los otros agentes de contaminación externos? Sabía usted que el HTA causa en no fumadores más de 3000 muertes por cáncer de pulmón en Norteamérica cada año? En razón de que estos datos son bastante alarmantes para cualquiera, deberíamos dejar de exponer a nuestros niños al Humo de Tabaco Ambiental.

Consejos para proteger a sus niños del HTA

  • Deje de fumar, si lo hace. Consulte a su médico por ayuda, si lo necesita. Hay muchos productos farmacéuticos disponibles que pueden ayudar a dejarlo.
  • Si usted convive con fumadores, ayúdelos a dejar el hábito.
  • Pídale a los fumadores que viven en casa y también a sus visitas que fumen fuera de su hogar.
  • No permita que fumen en su automóvil.
  • Asegúrese que no se fume en la escuela o guardería de sus hijos.
  • Háblele a los niños de los daños que causa el tabaco y anímelos a nunca adoptar el hábito de fumar cigarrillos o masticar tabaco.

Consejos para el romper el hábito de fumar

  • Elija una fecha fija en la cual dejará de fumar y deságase de todos los cigarrillos en su casa, carro, o trabajo.
  • Pídale a sus amigos o familiares que fumen fuera de su casa o automóvil.
  • Piense en todos los beneficios que le brindará a su salud el dejar de fumar.
  • Una vez que ya ha dejado de fumar, no vuelva a probar ni un cigarrillo más.
  • Cambie su rutina diaria para evitar los momentos en los que solía fumar.
  • Tome mucha agua o fluidos.
  • Evite el estrés.
  • Este listo para no caer en un relapso. La mayoría de relapsos ocurren en los primeros tres meses. No se desanime si vuelve a fumar e intente nuevamente.

Se le agradece a la Academia Americana de Pediatría por su contribución de información para este panfleto.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Secondhand smoke is a combination of the smoke from a burning cigarette and the smoke exhaled by a smoker. Also known as environmental tobacco smoke (ETS), it can be recognized easily by its distinctive odor. ETS contaminates the air and is retained in clothing, hair, curtains and furniture. Many people find ETS unpleasant, annoying and irritating to the eyes and nose. More importantly, it represents a dangerous health hazard. Over 4,000 different chemicals have been identified in ETS, and at least 43 of these chemicals cause cancer.

Is exposure to ETS common?

Approximately 26 percent of adults in the United States currently smoke cigarettes, and 50 to 67 percent of children under five live in homes with at least one adult smoker.

Smoke’s effect on…

The fetus and newborn

Maternal, fetal and placental blood flow change when pregnant women smoke, although the long-term health effects of these changes are not known. Some studies suggest that smoking during pregnancy causes birth defects such as cleft lip or palate. Smoking mothers produce less milk, and their babies have a lower birth weight. Maternal smoking also is associated with neonatal death from Sudden Infant Death Syndrome, the major cause of death in infants between one month and one year old.

Children’s lungs and respiratory tracts

Exposure to ETS decreases lung efficiency and impairs lung function in children of all ages. It increases both the frequency and severity of childhood asthma. Secondhand smoke can aggravate sinusitis, rhinitis, cystic fibrosis and chronic respiratory problems such as cough and postnasal drip. It also increases the number of children’s colds and sore throats. In children under two, ETS exposure increases the likelihood of bronchitis and pneumonia. In fact, a 1992 study by the Environmental Protection Agency says ETS causes 150,000 – 300,000 lower respiratory tract infections each year in infants and children under 18 months old. These illnesses result in as many as 15,000 hospitalizations. Children of parents who smoke half a pack a day or more are at nearly double the risk of hospitalization for a respiratory illness.

The ears

Exposure to ETS increases both the number of ear infections a child will experience and the duration of the illness. Inhaled smoke irritates the eustachian tube, which connects the back of the nose with the middle ear. This causes swelling and obstruction which interferes with pressure equalization in the middle ear, leading to pain, fluid and infection. Ear infections and middle ear fluid are the most common cause of children’s hearing loss. When they do not respond to medical treatment, the surgical insertion of tubes into the ears is often required.

The brain

Children of mothers who smoked during pregnancy are more likely to suffer behavioral problems such as hyperactivity than children of non-smoking mothers. Modest impairment in school performance and intellectual achievement has also been demonstrated.

Who is at risk?

Although ETS is dangerous to everyone, fetuses, infants and children are at most risk because it can damage developing organs, such as the lungs and brain.

Secondhand smoke causes cancer

You have read how ETS harms the development of your child, but did you know that your risk of developing cancer from ETS is about 100 times greater than from outdoor cancer-causing pollutants? Did you know that ETS causes more than 3,000 non-smokers to die of lung cancer each year? While these facts are alarming for everyone, you can stop your child’s exposure to secondhand smoke right now.

What can you do?

  • If you smoke, stop now. Consult your physician for help, if needed. There are many new pharmaceutical products available to help you quit.
  • If you have household members who smoke, help them stop. If it is not possible to stop their smoking, do not allow them to smoke in your home or near your children.
  • Do not smoke or allow smoking in your car.
  • Be certain that your children’s schools and day-care facilities are smoke-free.

Acknowledgment to the American Society of Pediatric Otolaryngology for contributions to this content.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Choking is a very common cause of unintentional injury or death in children under age one, and the danger remains significant until the age of five. Objects such as safety pins, small parts from toys, and coins cause choking, but food is responsible for most incidents. You must be particularly watchful when children around the age of one are sampling new foods. Here are some additional suggestions for preventing choking:

  • Don’t give young children hard, smooth foods (i.e., peanuts, raw vegetables) that must be chewed with a grinding motion. Children don’t master that kind of chewing until age four, so they may attempt to swallow the food whole. Do not give peanuts to children until age seven or older.
  • Don’t give your child round, firm foods (like hot dogs and carrot sticks) unless they are chopped completely. Cut or break food into bite-size pieces (no larger than ½ inch [1.27 cm]) and encourage your child to chew thoroughly.
  • Supervise mealtime for your infant or young child. Don’t let her eat while playing or running. Teach her to chew and swallow her food before talking or laughing. Chewing gum is inappropriate for young children.

Because young children put everything into their mouths, small non-food objects are also responsible for many choking incidents. Look for age guidelines in selecting toys, but use your own judgment concerning your child. Also be aware that certain objects have been associated with choking, including uninflated or broken balloons, baby powder, items from the trash (e.g., eggshells, pop-tops from beverage cans), safety pins, coins, marbles, small balls, pen or marker caps, small, button-type batteries, hard, gooey, or sticky candy or vitamins, grapes and popcorn. If you’re unsure whether an object or food item could be harmful, you can purchase a standard small-parts cylinder at juvenile products stores or test toys using a toilet paper roll, which has a diameter of approximately 1¾ inches.

Source: American Academy of Pediatrics; Caring for Your Baby and Young Child: Birth to Age 5 (Copyright © 2009 American Academy of Pediatrics).

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

High risk foods and food characteristics:

  • Hard candy
  • Peanuts/nuts
  • Seeds
  • Whole grapes
  • Raw carrots
  • Apples
  • Popcorn
  • Hot dogs
  • Chunks of peanut butter
  • Marshmallows
  • Chewing gum
  • Sausages
  • Foods that are round and could conform to a child’s airway

Since 60% of non-fatal choking incidents result from food, let’s examine some ways to reduce the risk of choking while children are eating.

Reducing Food Choking Risks

  1. Children should be seated when eating – Caregivers/Teachers should ensure that children do not eat when standing, walking, running, playing, lying down or riding in vehicles.
  2. Children should not be allowed to continue to feed themselves or continue to be assisted with feeding themselves if they begin to fall asleep.
  3. Active supervision is a must! Watch children for “squirreling” of several pieces of food in their mouth. This increases the risk of choking. Remember a choking child may not make any noise, so adults must keep their eyes on children who are eating.
  4. Children at this age require increased supervision when eating because they are easily distracted and may not pay full attention to the task of eating.
  5. Food should not be used for children’s games that involve catching the food item in the mouth or stuffing large numbers or amounts of food in the mouth.
  6. Cut foods such as grapes and other fruits, meat, cheese and raw vegetables into small pieces and shapes that will not block the airways. Cut hot dogs lengthwise as well as widthwise.
  7. Cook vegetables so they become softer and easier to swallow.
  8. Give only small amounts of peanut butter or other similar foods to prevent them for blocking the child’s airway.
  9. Offer plenty of liquids to children when eating, but make sure liquids and solids are not swallowed at the same time.
  10. Remember, foods do not contain warning labels about possible choking hazards.

Reprinted with the permission of AAP News (January, 2011)

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

¿Por que la detección temprana de la hipoacusia es importante para su hijo?

Aproximadamente dos a cuatro de cada 1000 niños en los Estados Unidos nacen sordos o hipoacúsicos, haciendo de la pérdida auditiva la alteración más común al nacimiento. Muchos estudios han mostrado que el diagnóstico temprano de la hipoacusia es crucial para el desarrollo del lenguaje, habilidades cognitivas y psicosociales.
El tratamiento es más exitoso si la pérdida auditiva es identificada tempranamente, preferentemente durante el primer mes de vida. Todavía una cada cuatro niños nacidos con severa pérdida auditiva no recibe un diagnóstico hasta la edad de tres años o más.

¿Cuando se debe evaluar la audición de un niño?

La primera oportunidad para evaluar la audición de un niño es en el hospital apenas nacido. Si la audición del niño no es evaluada antes de irse del hospital se recomienda su evaluación durante el primer mes de vida. Si los exámenes indican una posible pérdida en la audición se deberá buscar una evaluación más profunda lo más pronto posible, preferentemente entre el primero y los seis meses de vida.

¿Es obligatoria la evaluación de pérdida auditiva?

En los últimos años las organizaciones de salud, incluyendo la Academia Americana de Otorrinolaringología han trabajado para remarcar la importancia de un screening o tamizaje precoz en todos los recién nacidos para buscar pérdida de la audición. Estos esfuerzos han dado sus resultados. En 2003 más del 85 por ciento de todos los recién nacidos en Estados Unidos fueron evaluados buscando pérdida auditiva. De hecho casi todos los estados han realizado leyes que obligan a alguna forma de evaluación de los recién nacidos antes de dejar el hospital. Esto todavía deja a más de un millón de bebes que no son evaluados para pérdida auditiva antes de abandonar el hospital.

¿Como se realiza la evaluación?

Dos exámenes son usados para evaluar la pérdida auditiva en niños y recién nacidos. Ellos son:

  • Otoemisiones acústicas (OAE) que consiste en colocar un audífono de esponja en el canal auditivo para medir si el oído responde correctamente al sonido. En los chicos con una audición normal, un eco medible se producirá cuando el sonido es emitido a través del audífono. Si no se mide ningún eco puede indicar pérdida de la audición.
  • Potenciales evocados de tronco (BERA) es un examen más complejo. Audífonos son colocados en los oídos y electrodos se colocan en la cabeza y oídos. El sonido es emitido a través de los audífonos mientras los electrodos miden como el cerebro del niño responde al sonido.

Si alguno de los exámenes indica una potencial pérdida auditiva, el médico sugerirá un seguimiento y evaluación a cargo de un otorrinolaringólogo.

Signos de pérdida de audición en el niño

La hipoacusia puede ocurrir en la infancia tardía, luego que el recién nacido abandonó el hospital. En estos casos, los padres, abuelos y demás personas de que cuidan al niño son frecuentemente los primeros en advertir que algo ocurre con la audición de ese chico. Incluso si su audición fue evaluada en el momento de nacer se debe continuar estando alerta a señales de pérdida auditiva tales como:

  • No reacciona de ninguna forma frente a sonidos intensos e inesperados.
  • No se despierta frente a sonidos de gran intensidad
  • No gira su cabeza en la dirección de la voz que le habla.
  • No es capaz de seguir o entender instrucciones
  • Pobre desarrollo del lenguaje
  • Habla muy fuerte o no usa las habilidades de lenguaje apropiadas para su edad.

Si su niño muestra alguno de estos signos debe indicárselos al médico

¿Qué sucede si mi niño tiene hipoacusia?

La pérdida auditiva en niños puede ser transitoria o permanente. Es importante que la pérdida auditiva sea evaluada por un médico que pueda indagar acerca de los problemas que puedan causar esta hipoacusia, tales como la otitis media (infección del oído), excesiva formación de cera en el oído, malformaciones congénitas o pérdida auditiva genética.

Si se ha determinado que la hipoacusia es permanente, el uso de audífonos puede ser necesario para amplificar el sonido que llega al oído del niño. La cirugía de oído puede ser útil para restaurar o mejorar significativamente la audición en algunos casos. Para aquellos con pérdidas profundas que no se benefician suficientemente con audífonos puede ser considerado un implante coclear. A diferencia de los audífonos, el implante coclear evita las partes dañadas del sistema auditivo y estimula directamente el nervio permitiendo al niño escuchar sonidos más fuerte y en forma más clara.

Usted deberá decidir si su niño se comunicará en forma primaria con lenguaje hablado o de señas y buscar una intervención temprana para prevenir retrasos del lenguaje. Los estudios indican que la rehabilitación de la pérdida auditiva a la edad de los seis meses prevendrá consecuentes retrasos de lenguaje. Otras estrategias de comunicación como la terapia de audición verbal, lectura de labios y lenguaje de señas pueden también ser usadas en conjunto con la terapia con audífonos o el implante coclear o bien en forma independiente.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Why is Early Childhood Hearing Screening Important for Your Child?

Approximately two to four of every 1,000 children in the United States are born deaf or hard-of-hearing, making hearing loss the most common birth disorder. Many studies have shown that early diagnosis of hearing loss is crucial to the development of speech, language, cognitive and psychosocial abilities. Treatment is most successful if hearing loss is identified early, preferably within the first few months of life. Still, one in every four children born with serious hearing loss does not receive a diagnosis until 14 months old.

When Should a Child’s Hearing Be Tested?

The first opportunity to test a child’s hearing is in the hospital shortly after birth. If your child’s hearing is not screened before leaving the hospital, it is recommended that screening be done within the first month of life. If test results indicate a possible hearing loss, get a further evaluation as soon as possible, preferably within the first three to six months of life.

Is Early Hearing Screening Mandatory?

In recent years, health organizations across the country, including the American Academy of Otolaryngology – Head and Neck Surgery, have worked to highlight the importance of screening all newborns for hearing loss. These efforts are working. 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. So, check with your local authority or hospital for screening regulations.

How Is Screening Done?

Two tests are used to screen infants and newborns for hearing loss. They are otoacoustic emissions (OAE), and auditory brain stem response (ABR). Otoacoustic emissions involves placing a sponge earphone in the ear canal to measure whether the ear can respond properly to sound. In normal-hearing children, a measurable echo should be produced when sound is emitted through the earphone. If no echo is measured, it could indicate a hearing loss.

Auditory brain stem response is a more complex test. Earphones are placed on the ears and electrodes are placed on the head and ears. Sound is emitted through the earphones while the electrodes measure how your child’s brain responds to the sound.

If either test indicates a potential hearing loss, your physician may suggest a follow-up evaluation by an otolaryngologist.

Signs of Hearing Loss in Children

Hearing loss can also occur later in childhood. In these cases, parents, grandparents and other caregivers are often the first to notice that something may be wrong with a young child’s hearing. Even if your child’s hearing was tested as a newborn, you should continue to watch for signs of hearing loss, including:

  • Not reacting in any way to unexpected loud noises,
  • Not being awakened by loud noises,
  • Not turning his/her head in the direction of your voice,
  • Not being able to follow or understand directions,
  • Poor language development, or
  • Speaking loudly or not using age-appropriate language skills.

If your child exhibits any of these signs, report them to your doctor.

What Happens If My Child Has a Hearing Loss?

Hearing loss in children can be temporary or permanent. It is important to have hearing loss evaluated by a physician who can rule out medical problems that may be causing the hearing loss, such as otitis media (ear infection), excessive earwax, congenital malformations or a genetic hearing loss.

If it is determined that your child’s hearing loss is permanent, hearing aids may be recommended to amplify the sound reaching your child’s ear. Ear surgery may be able to restore or significantly improve hearing in some instances. For those with certain types of very severe hearing loss who do not benefit sufficiently from hearing aids, a cochlear implant may be considered. Unlike a hearing aid, the implant bypasses damaged parts of the auditory system and directly stimulates the hearing nerve, allowing the child to hear louder and clearer sound.

Research indicates that if a child’s hearing loss is remedied by age six months, it will prevent subsequent language delays. You will need to decide whether your deaf child will communicate primarily with oral speech and/or sign language, and seek early intervention to prevent language delays. Other communication strategies such as auditory verbal therapy, lip reading and cued speech may also be used in conjunction with a hearing aid or cochlear implant, or independently.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Why Is Early Childhood Hearing Screening Important For Your Child?

Every day in the United States, approximately 1 in 1,000 newborns (or 33 babies every day) is born profoundly deaf with another two to three out of 1,000 babies born with partial hearing loss, making hearing loss the number one birth defect in America. Many studies have shown that early diagnosis of hearing loss is crucial to the development of speech, language, cognitive and psychosocial abilities. Treatment is most successful if hearing loss is identified early, preferably within the first month of life. Still, one in every four children born with serious hearing loss does not receive a diagnosis until age three or older.

Why is it Important to Have My Baby’s Hearing Screened Early?

The most important time for a child to be exposed to and learn language is in the first three years of life. In fact, children begin learning speech and language in the first six 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.

How Early Should I Have My Baby’s Hearing Screened?

The first opportunity to test a child’s hearing is in the hospital shortly after birth. If your child’s hearing is not screened before leaving the hospital, it is recommended that screening be done within the first month of life. If hearing loss is suspected, make sure an otolaryngologist orders tests for your baby’s hearing by three months of age. If hearing loss is confirmed, it’s important to consider the use of hearing devices and other communication options by six months of age.

Is Early Hearing Screening Mandatory?

In 2003, more than 85 percent of all newborns in the United States were screened for hearing loss. In fact, some 39 states have passed legislation requiring some form of hearing screening of newborns before they leave the hospital. This still leaves more than a million babies who are not screened for hearing loss before leaving the hospital.

How Is Screening Done?

Two tests are used to screen infants and newborns for hearing loss. They are:

Otoacoustic Emissions (OAE): Involves placement of a sponge earphone in the ear canal to measure whether the ear can respond properly to sound. In normal-hearing children, a measurable “echo” should be produced when sound is emitted through the earphone. If no echo is measured, it could indicate a hearing loss.

Auditory Brain Stem Response (ABR): Earphones are placed on the ears and electrodes are placed on the head and ears. Sound is emitted through the earphones while the electrodes measure how your child’s brain responds to the sound.

Signs of Hearing Loss in Children

Hearing loss can also occur later in childhood, after a newborn leaves the hospital. In these cases, parents, grandparents and other caregivers are often the first to notice that something may be wrong with a young child’s hearing. Even if your child’s hearing was tested as a newborn, you should continue to watch for signs of hearing loss. including:

  • Not reacting in any way to unexpected loud noises
  • Not being awakened by loud noises
  • Not turning his/her head in the direction of your voice
  • Not being able to follow or understand directions
  • Poor language development
  • Speaking loudly or not using age-appropriate language skills

If your child exhibits any of these signs, report them to your doctor.

What Happens If My Child Has Hearing Loss?

Hearing loss in children can be temporary or permanent. It is important to have hearing loss evaluated by a physician who can rule out medical problems that may be causing the hearing loss, such as otitis media (ear infection), excessive earwax, congenital malformations or a genetic hearing loss. If it is determined that your child’s hearing loss is permanent, hearing aids may be recommended to amplify the sound reaching your child’s ear. Ear surgery may be able to restore or significantly improve hearing in some instances.

For those with certain types of profound hearing loss who do not benefit sufficiently from hearing aids, a cochlear implant may be considered. Unlike a hearing aid, a cochlear implant bypasses damaged parts of the auditory system and directly stimulates the hearing nerve and allows the child to hear louder and clearer sound.

You will need to decide whether or not your deaf child will communicate primarily with oral speech and/or sign language, and seek early intervention to prevent language delays. Research indicates that habilitation of hearing loss by age six months will prevent subsequent language delays. Other communication strategies such as auditory verbal therapy, lip reading and cued speech may also be used in conjunction with a hearing aid or cochlear implant, or independently.

Is My Baby’s Hearing Normal?

If you think that your child has hearing loss, you might be right. The following checklist will assist in determining whether or not your child might have a hearing loss. Please read each item carefully and check only those factors that apply to you, your family or your child.

During pregnancy did…

  • Mom have German measles, a viral infection or flu?
  • Mom drink alcoholic beverages?

Did your newborn baby (birth to 28 days of age)…

  • Weigh less than 3.5 pounds at birth?
  • Have an unusual appearance of the face or ears?
  • Have jaundiced (yellow skin) at birth and had an exchange blood transfusion?
  • Stay in neonatal intensive care unit (NICU) for more than five days?
  • Receive an antibiotic medication given through a needle in a vein?
  • Have meningitis?
  • Fail newborn hearing screening test?

Did your infant baby (29 days of age to two years)…

  • Received an antibiotic medication given through a needle in a vein?
  • Have meningitis?
  • Have a neurological disorder?
  • Have a severe injury with a fracture of the skull with or without bleeding from the ear?
  • Have recurring ear infection with fluid in ears for more than three months?

Does one or more individual(s) of your family…

  • Have permanent or progressive hearing loss that was present or developed early in life?

Response to the Environment (Speech and Language Development)

My Newborn (Birth to 6 months)…

  • Does not startle, move, cry or react in any way to unexpected loud noises
  • Does not awaken to loud noises
  • Does not freely imitate sound
  • Cannot be soothed by voice alone
  • Does not turn his/her head in the direction of my voice

My Young Infant (6 through 12 months)…

  • Does not point to familiar persons or objects when asked
  • Does not babble or babbling has stopped
  • By 12 months is not understanding simple phrases such as wave “bye-bye” or “clap hands” by listening alone

My Infant (13 Months through two Years)…

  • Does not accurately turn in the direction of a soft voice on the first call
  • Is not alert to environment sounds
  • Does not respond on first call
  • Does not respond to sounds or does not locate where sound is coming from
  • Does not begin to imitate and use simple words for familiar people and things around the home
  • Does not sound like or use speech like other children of similar age
  • Does not listen to TV at a normal volume
  • Does not show consistent growth in the understanding and the use of words to communicate

If your child has one of more of these indicators you should take him or her to a physician, preferably an otolaryngologist, for an ear examination and a hearing test. This can be done at any age, as early as just after birth.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Three million children under the age of 18 have some hearing loss, including four out of every thousand newborns. So, every parent and caregiver should be watchful of the signs of hearing loss in his or her child and seek a professional diagnosis. Hearing loss can increase the risk of speech and language developmental delays.

Indicators for Hearing Loss

During pregnancy

  • Mother had German measles, a viral infection or flu.
  • Mother drank alcoholic beverages.

Newborn (birth to 28 days of age)

  • Weighed less than 3.5 pounds at birth.
  • Has an unusual appearance of the face or ears.
  • Was jaundiced (yellow skin) at birth and had an exchange blood transfusion.
  • Was in neonatal intensive care unit (NICU) for more than five days.
  • Received an antibiotic medication given through a needle in a vein.
  • Had meningitis.
  • Failed newborn hearing screening test

Family

  • Has one or more individuals with permanent or progressive hearing loss that was present or developed early in life.

Infant (29 days to 2 years)

  • Received an antibiotic medication given through a needle in a vein.
  • Had meningitis.
  • Has a neurological disorder.
  • Had a severe injury with a skull fracture, with or without bleeding from the ear.
  • Has recurring ear infections with fluid in ears for more than three months.

Response to the Environment

(speech and language development)

Newborn (Birth to 6 Months)

  • Does not startle, move, cry or react in any way to unexpected loud noises.
  • Does not awaken to loud noises.
  • Does not freely imitate sound.
  • Cannot be soothed by voice alone.
  • Does not turn his/her head in the direction of your voice.
  • Does not point to familiar persons or objects when asked.
  • Does not babble, or babbling has stopped.
  • By 12 months does not understand simple phrases by listening alone, such as “wave bye-bye,” or “clap hands.”

Infant (3 months to 2 years)

  • Does not accurately turn in the direction of a soft voice on the first call.
  • Is not alert to environmental sounds.
  • Does not respond on first call.
  • Does not respond to sounds or does not locate where sound is coming from.
  • Does not begin to imitate and use simple words for familiar people and things around the home.
  • Does not sound like or use speech like other children of similar age.
  • Does not listen to TV at a normal volume.
  • Does not show consistent growth in the understanding and the use of words.

Hearing tests: How, when, and why

If you suspect that your child may have hearing loss, discuss it with your doctor. Children of any age can be professionally tested.

Tests for newborns and infants under one year

Hearing tests are painless, and they normally take less than a half hour.

Newborns are tested with either the otoacoustic emissions (OAE) test or the automated auditory brainstem response (AABR) test. During the OAE test, a microphone is placed in the baby’’s ear. It sends soft clicking sounds, and a computer then records the inner ear’’s response to the sounds. In the AABR test the child must wear earphones. Sensors are placed on his/her head to measure brain wave activity in response to the sound.

For infants over six months of age, the diagnostic auditory brainstem response and the visual reinforcement audiometry (VRA) tests are commonly used. The diagnostic auditory brainstem response test is similar to the AABR test, but it provides more information. The VRA test presents a series of sounds through earphones. The child is asked to turn toward the sound, then he/she is rewarded with an entertaining visual image.

Tests for older children and adults

Children between two and four years old are tested through conditioned play audiometry (CPA). The children are asked to perform a simple play activity, such as placing a ring on a peg, when they hear a sound. Older children and adults may be asked to press a button or raise their hand.

All children should have their hearing tested before they start school. This could reveal mild hearing losses that the parent or child cannot detect. Loss of hearing in one ear may also be determined in this way. Such a loss, although not obvious, may affect speech and language.

Hearing loss can even result from earwax or fluid in the ears. Many children with this type of temporary hearing loss can have their hearing restored through medical treatment or minor surgery.

In contrast to temporary hearing loss, some children have nerve deafness, which is permanent. Most of these children have some usable hearing. Few are totally deaf. Early diagnosis, early fitting of hearing aids, and an early start on special educational programs can help maximize the child’’s existing hearing.

Please note that this article is not a substitute for an ear examination or a hearing test.

What you should do

If you have checked one or more of these indicators, your child might have hearing loss and you should take him or her for an ear examination and a hearing test. This can be done at any age, as early as just after birth.

If you did not check any of these factors but you suspect that your child is not hearing normally, even if your child’’s doctor is not concerned, have your child’’s hearing tested by an audiologist and when appropriate, have his or her speech evaluated by a speech and language pathologist. The test will not hurt your child.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery

Babe Ruth

The great all-American slugger George Herman “Babe” Ruth was born in Baltimore, Maryland in 1895. He entered the National Baseball League at the young age of nineteen and grew to become one of its greatest stars by hitting a long-defended 60 home runs in one season.

In 1946, just before retiring from baseball, Ruth was diagnosed with nasopharyngeal carcinoma. Nasopharyngeal carcinoma refers to a malignant growth that arises from epithelium, which tends to infiltrate and metastasize to other organs. The location of the carcinoma was in the nasophaynx, or the upper part of the throat behind the nose. Doctors tried their best to control Ruth’s cancer with surgery and radiation treatments, but were not successful and so they eventually released him from the hospital in 1947.

Even though his cancer was thought to be a result of his frivolous use of smokeless tobacco, cigars and alcohol, studies have now shown that other risk factors are associated with this particular type of cancer. Among these factors are geographic location, genetic inheritance and certain environmental carcinogens. Nasopharyngeal carcinoma is one of the most common malignancies found in Taiwan and southern China, but is rarely found in North America.

Ulysses S. Grant

Ulysses S. Grant was a man most commonly known for his victorious leadership in the Civil War, which was only comparable to his efforts to help mend a divided Union as the 18th President.

However, many do not know that Ulysses S. Grant was the only U.S. president to die of cancer. He was a popular general who enjoyed smoking cigars. He had begun this chronic habit at an early age, and once admitted to smoking as many as 12 cigars in one day.

This bad habit finally took its toll when Grant was diagnosed with a carcinoma of the right tonsillar pillar in early June 1884. The cancer was at the base of the tongue and was described as a malignant squamous epithelioma, which was a scaly, invasive, metastasizing growth. At the onset of his cancer, surgical and technological movements were not advanced enough to effectively control the carcinoma. Only meager topical applications of cocaine hydrochlorate solution or iodoform powder could be used to help suppress the pain.

Despite devoted care from his personal physician John H. Douglas, who tried desperately to keep Grant alive to finish his memoirs, he suffered a slow and painful illness until his death in 1885. Today, Grant’s carcinoma could be treated in several fashions with the inventions of the aspiration pump, radiotherapy, tracheotomy and surgery.

Sigmund Freud

Psychoanalysis, Oedipus complex and the human psyche are all concepts commonly associated with the Austrian psychologist Sigmund Freud. His theories have heavily impacted child rearing, education and sociology by introducing new approaches to these fields.

Freud’s passion for psychology was matched by his passion for cigars and smoking. His unsuccessful attempts to kick the habit led to multiple health disorders, including cancer of the jaw, which was diagnosed at the age of 67. For the last sixteen years of his life, he received constant treatment and extensive operations to attempt to control the malignant ulcer’s growth in the hard palate.

Despite treatment, the cancer metastasized to neighboring tissues including the upper part of the lower jaw, the base of Freud’s orbits, and eventually his cheek. In his second operation, after slitting the lip on the affected side, a very extensive operation transformed the nasal cavity and mouth into one. None of the operations were very successful and Freud’s sufferings were ended in 1939 by a combination of heart failure, cancer of the jaw and a morphine overdose.

© 2016 American Academy of Otolaryngology – Head and Neck Surgery