Toronto mom Amy de Domenico wears hearing aids, so she knew her children would be at risk of hearing loss, too. When her fourth child, Lauren, was born in 2004, she underwent the newborn screening at the hospital and passed. But because Amy and her husband Markus were aware of the risk, they had Lauren undergo a more sophisticated test. The result? Moderate to moderately severe bilateral hearing loss. She was fitted with hearing aids at three months.

In 2008, Amy and Markus had their second child, Ava. The newborn screening equipment at the hospital wasn’t working, so again, they took Ava for further screening. “She didn’t act any differently than any of my other children at that age,” says Amy. “She wasn’t showing any signs of hearing loss. She was such a happy baby!” So they were shocked to learn that not only did Ava have hearing loss, she was profoundly deaf. “It’s difficult to tell if infants can’t hear,” says Amy. “They act like hearing babies. But the only thing was that she didn’t have a startle reflex.” Hearing aids would not help, and Ava was a candidate for cochlear implants.

Ava was lucky that her parents were aware of potential hearing issues and persisted with follow-up tests. But most deaf children — more than 90 percent — are born to hearing parents who have not experienced hearing loss and so they have no reason to suspect problems with their child. This leads to delayed diagnoses, or no diagnosis at all. Or, sadly, children may be misdiagnosed as having learning disabilities or behavioural problems. According to a 2001 StatsCan study of children with disabilities, hearing loss can hinder a child’s learning and development. The advocacy group Voice for Hearing Impaired Children notes an estimated three of every 1,000 babies are born with hearing loss. Others will develop it through their school years.

Most provinces have early birth detection called the Universal Newborn Hearing Screening (UNHS), although Manitoba, Alberta and a few Quebec hospitals only offer screening for babies who are at high risk for hearing loss. If screening is not offered, parents are urged to arrange for their new baby to be tested.

A child who is at risk for hearing loss or who did not pass a birth screening (if it was administered) will be monitored every six to nine months until the age of three. If problems are shown, the child will be advised to see an audiologist for a comprehensive assessment. Visual response audiometry and play audiometry tests can better measure a child's range of hearing.

Hearing help

There is good news. Deaf children who receive a cochlear implant and appropriate rehabilitation before age two can achieve a high level of listening and spoken language and literacy skills. Cochlear implants were first developed in the ‘60s and by 1990, they were being used in children. A small device is surgically implanted behind the ear beneath the skull. The procedure takes two to three hours under general anesthetic. Then the child is fitted with an externally worn audio processor that is worn behind the ear much like a hearing aid.

Ava received hers at nine months. “The sooner children are fitted with a cochlear implant and begin auditory verbal therapy, the quicker they will catch up to their hearing peers in terms of speech and language,” says de Domenico. Then it takes a lot of hard work to catch up and they are significantly delayed in speech and language development. “When Ava's implants were activated, she had a hearing age of a newborn baby. By the time she was two and a half, her language development had caught up and in some instances surpassed that of her hearing peers.”

Ava’s cochlear implants have ensured her development is on track. Now six and in Grade 1, she has excelled in school. She sings, reads at level and is an active child. “She does need to use an FM system,” says de Domenico, referring to a microphone device the teacher wears around his or her neck. “It helps filter out the other noises so Ava can hear the instructions.” The couple have worked with the school to make sure Ava’s getting what she needs, but they're grateful the cochlear implants have helped her communicate.

Signs of hearing loss

Signs of hearing loss in infants vary by age. Speech-Language & Audiology Canada notes:

  • A newborn baby with hearing loss may not startle when there is a loud noise nearby.
  • A six-month-old with hearing loss might not turn his/her head or move eyes to find a familiar voice.
  • A nine-month-old with hearing loss might not respond to his/her name.
  • A 12-month-old might not look at your face when talking to you.
  • Toddlers might not react when spoken to; their language and speech may be delayed: a child usually uses single words by 15 months and simple two-word sentences by age two.
  • A child with hearing loss may demonstrate inattention.

Resources

MED-EL

The MED-EL online hearing test helps parents identify potential hearing issues in their children.Take it free at medel.com/ca/hearing-test.

Voice for Hearing Impaired Children

“Early screening and detection of childhood hearing loss is crucial to a child’s speech and listening skills and their overall development,” says Norah-Lynn McIntyre, Executive Director of VOICE for Hearing Impaired Children. Parents can find support at voicefordeafkids.com.

The Hearing Foundation of Canada’s Baby’s Communication Checklist

This is a colourful keepsake guide to childhood language milestones, packed with practical tips to help you nurture good communication. Download it at hearingfoundation.ca.

Originally published in ParentsCanada magazine, November 2014.