Hearing is necessary for a child’s speech and language development. Children learn to communicate by replicating the sounds they hear, so unrecognized hearing problems in toddlers or preschoolers can cause significant learning problems that can lead to social withdrawal, academic difficulties, and other psychosocial problems.

The earlier hearing problems begin, the more serious the problem becomes as time passes; therefore, the earlier a hearing problem is identified, the less serious the problems become as the child matures.

Unfortunately, there are an estimated 1.5 million children and young adults who have untreated hearing loss. Prevention, early detection, and treatment could significantly reduce this number. Childcare programs can help with both detection and prevention.

Issues That Can Cause Hearing Loss

There are two primary causes of hearing loss in children: congenital hearing loss (present at birth), and acquired hearing loss, which occurs after the child is born. There are two types of acquired hearing loss: conductive hearing loss and sensorineural hearing loss.

Conductive hearing loss is caused by interference of the transmission of the sound waves to the inner ear. This interference may be caused by blockage from foreign body in the ear canal or buildup of ear wax. Interference also can be caused by infection.

For example, otitis media (an infection in the middle ear) is a frequent childhood disease and a common cause of conductive hearing loss. Conductive hearing loss is generally temporary and usually resolves after medical treatment.

If hearing loss is caused by problems with the inner ear, it is called a sensorineural hearing loss. Causes can include damage to the cochlea due to chronic exposure to noise. For example, if a child listens to loud music over a long enough period of time, the damage that occurs within the cochlea is permanent.

Damage to the inner ear also can occur from a single exposure to a very loud noise, such as a sounds produced by fireworks, loud whistles, or gunshots near the ear. This type of hearing loss is generally permanent.

Anatomy of the ear

Each part of the ear is important to hearing. An understanding of the anatomy of the ear will help childcare providers understand what the child is experiencing and can help make one aware of potential problems. The ear has three parts; a problem with any of these parts can cause hearing loss.

• The outer ear consists of the pinna (the part you see on the side of the head), the ear canal, and the eardrum (also called the tympanic membrane).
• The middle ear consists of the inner part of the eardrum plus three little bones that transmit vibrations (sound) to the inner ear.
• The inner ear consists of a small, snail-shaped organ called the cochlea. From the cochlea extends the auditory nerve, which transmits the sounds to the brain for interpretation. The cochlea also contains the balance organs; often, a children with hearing issues will also have balance problems.

How Does Hearing Loss Affect Children?

There are four major ways hearing loss affects children. You may see many of these in the childcare setting.

• It causes delay in the development of receptive and expressive communication skills (speech and language).
• The language deficit causes learning problems that result in reduced academic achievement.
• Communication difficulties often lead to social isolation and poor self-esteem.
• It may have an impact on activity choices (e.g., sports, music).

Signs of Hearing Loss in Young Children

The signs of hearing loss or decreased hearing in a toddler or preschooler can include:

• Difficulty in understanding what people are saying (especially if there is background noise). A child might be able to follow direction easily in a quiet room but not a noisy one.
• Turning the television or radio to a level higher than in the past such as if a child asks you to turn up music when he has been able to hear it on other occasions.
• Avoiding social interaction where a child may choose to play alone.
• Complaining of not being able to hear well.
• Complaining of itching or pain in the ears.
• Drainage from the ears.
• Noticeable dizziness.

Preventing Hearing Loss in Young Children

Fortunately, acquired hearing loss is often preventable. There are several precautions in childcare to help prevent acquired hearing loss.

When playing music, keep the volume low. You should be able to talk and hear a normal voice, even with the music playing. If you have to yell for children to be hear you, the volume is too loud.

If you provide headphones for music or activities in your childcare setting for children old enough to use them, encourage him or her to keep the volume at a low level. If you are sitting next to the child and can hear the music playing, the child has the volume set too high.

Model and teach children to use their “inside” voice, a quieter voice. Help children learn to effectively communicate and actively listen. Demonstrate inside voices when reading. One children’s book that looks at listening is Howard B. Wigglebottom Learns to Listen.

Avoid toys that produce loud, shrill noises, such as whistles, “poppers,” air horns, and megaphones. If power tools are being used nearby, keep children away from the area. For example, if a lawn mower is being used outside the childcare setting, move children to the other side of the room for activities and close the window or door.

Never use cotton swabs or other items to clean the ear canal, and advise parents of the same. First, cleaning is ineffective. The diameter of the cotton end is generally greater than the diameter of the ear canal in an infant or young child; so the swab simply pushes the ear wax deeper, impacting it against the eardrum.

If you or the family suspects any hearing issue, advise parents to take their child to a health care provider for diagnosis and treatment as soon as possible.

Joe Knight
Medical Writer and Physician Assistant, Chowchilla, California

Resources

Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care Programs, 2nd Edition, National Resource Center for Health and Safety in Child Care and Early Education, www.nrckids.org

American Speech & Language Association, 2200 Research Blvd., Rockville, MD 20850; 301-296-5700; www.asha.org

Children’s Hearing Institute, www.childrenshearing.org

Detecting Hearing Loss in Young Children, www.medicinenet.com/detecting_hearing_loss_in_children/article.htm

Ear Health, www.kidshealth.org/parent/general/eyes/hear.html

Hearing Loss in Children, Center for Disease Control & Prevention, www.cdc.gov/ncbddd/hearingloss/index.html

Hearing Loss Fact Sheet, www.cdc.gov/ncbddd/actearly/pdf/parents_pdfs/HearingLossFactSheet.pdf