Tuesday 17 th February Chapter 2 Hearing disorders in children/ Hala AlOmari1

 To know key milestones of development in early childhood  To be able to recognise important features of developmental delay  To know routes of referral if concerned about a child’s development  To be aware of constraints imposed on audiological assessment by a child’s development  To be aware of the importance of development when assessing a child with HI Hearing disorders in children/ Hala AlOmari2

All children, normal and abnormal, progress from the helplessness of infancy to the independence of maturity Hearing disorders in children/ Hala AlOmari3

 Shelter and protection  Food  Warmth and clothing  Fresh air and light  Activity and rest  Prevention of illness and injury  Training in skills necessary for life Hearing disorders in children/ Hala AlOmari4

 Affection and continuity of care  Security and sense of belonging  Sense of personal identity  Opportunity to learn from experience  Opportunity to achieve success  Opportunity to achieve independence  Opportunity to take responsibility Hearing disorders in children/ Hala AlOmari5

 Growth is an increase in size. Its progressions are mainly structural and can be measured with some degree of reliability in terms of height, weight, bone-age etc  Development is an increase in complexity. It involves both structure and function. It may manifest many individual variations Hearing disorders in children/ Hala AlOmari6

 Motor  Vision and fine movements  Hearing and speech  Social behaviour and spontaneous play Hearing disorders in children/ Hala AlOmari7

 Little head control  Jerky movements of limbs  “Moro” reflex (  Forward reflex – “walking movement”  Hands closed at rest Hearing disorders in children/ Hala AlOmari8

 Pull to sit – little or no head lag head held erect briefly  Held sitting – lumbar curve  Hands loosely open – bring together in midline  Prone – supports on forearms  Held standing – sags at knees Hearing disorders in children/ Hala AlOmari9

 Sits alone for minutes  Progresses on floor by rolling or squirming  Attempts to crawl – sometimes succeeds  Pulls to stand Hearing disorders in children/ Hala AlOmari10

 Walk alone usually –wide based gait  Move around floor rapidly (crawl/bottom shuffle)  May crawl upstairs and sometimes come backwards downstairs Hearing disorders in children/ Hala AlOmari11

 Walks well  Runs carefully  Pushes and pulls large toys  Walks upstairs with helping hand (and often downstairs) Hearing disorders in children/ Hala AlOmari12

 Runs  Walks upstairs adult fashion  Usually jumps off bottom step  Rides a trike using pedals  Throws, catches and kicks a ball Hearing disorders in children/ Hala AlOmari13

 Turns head and eyes towards light  Watches mothers face when feeding or talking  Defensive blink by 6-8 weeks Hearing disorders in children/ Hala AlOmari14

 Visually very alert  Moves head to gaze around  Follows adult’s movements  Follows dangling ball  Watches hands – clasps and unclasps  Briefly holds rattle – usually unable to regard at same time Hearing disorders in children/ Hala AlOmari15

 Visually very attentive to people, objects and events (10-12 feet)  Manipulates objects with interest  Uses both hands equally  Points at distant objects  “inferior pincer grasp”  Prods small object Hearing disorders in children/ Hala AlOmari16

 Pick up with precise pincer grasp  Watches small toy pulled along the floor  Builds tower of 2 cubes  May show hand preference  Demands objects by finger pointing Hearing disorders in children/ Hala AlOmari17

 Hand preference  Holds pencil mid-shaft  Builds tower of 3 cubes  Enjoys picture books Hearing disorders in children/ Hala AlOmari18

 Builds tower of 9 cubes  Can thread large beads  Copies circle and cross  Matches 2 or 3 primary colours  Cuts with scissors Hearing disorders in children/ Hala AlOmari19

 Startled by loud noises (aureopalpebral reflex)  Gutteral noises when content – from 5-6 weeks coos responsively to mother’s talk  (NB deaf babies also cry and vocalize in this reflex fashion) Hearing disorders in children/ Hala AlOmari20

 Do not respond to the quietest sounds they can hear  Often unable to turn to sounds – other responses can be noted  Localisation often poor  Vocalizes tunefully – vowel or single and double “syllables” – a-a, muh, goo, der, adah, er-leh, aroo  (deaf babies surprised to see mother) Hearing disorders in children/ Hala AlOmari21

 Turns head in response to minimal sounds  (possible to do distraction test or VRA)  Shouts to attract attention  Babbles loudly and tunefully – long repetitive strings of syllables – dad-dad, mam-mam, adaba, agaga  (deaf babies – meagre and monotonous vocalisaton) Hearing disorders in children/ Hala AlOmari22

 Immediate response to distraction test – but rapidly habituates  Says 2-3 words with meaning by one year increasing to several by 15 months  Understands meaning of phrases “where is your shoe” Hearing disorders in children/ Hala AlOmari23

 Performance testing possible  Joins two or three words together in short sentences  Uses I, me and you  Asks for drink, toilet and food  Talks incessantly  Echolalia almost constant Hearing disorders in children/ Hala AlOmari24

 Can do pure tone audiometry  Large vocabulary intelligible even to strangers – but still many infantile phonetic substitutions and unconventional grammatical forms  Constantly asking questions Hearing disorders in children/ Hala AlOmari25

 Sucks well  Sleeps most of the time  Expression vague Hearing disorders in children/ Hala AlOmari26

 Fixes unblinkingly of mother’s face  Reacts to familiar situations – smiles and coos  Enjoys bath and caring routines Hearing disorders in children/ Hala AlOmari27

 Everything to mouth  Holds and chews a biscuit  Puts hands round bottle when feeding  Becomes aware of strangers Hearing disorders in children/ Hala AlOmari28

 Drinks from cup and holds spoon  Objects to mouth less often  “Casts” – throws to floor  Beginning to help with dressing  Beginning to indicate when wet or soiled  Emotionally labile and dependent on  familiar adult  Need constant supervision Hearing disorders in children/ Hala AlOmari29

 Feeds with spoon  Toys no longer to mouth  Still “casts” in play or anger  Takes shoes and socks off  May be dry by day  Alternates between clingy and resistant Hearing disorders in children/ Hala AlOmari30

 Spoon feeds and drinks from cup  Dry by day  Resistive and rebellious  Tantrums  Cannot share  No understanding of deferring satisfaction of wishes Hearing disorders in children/ Hala AlOmari31

 Eats with spoon and fork  Dresses and undresses  Dry by night (variable)  Generally more amenable and affectionate  Understand sharing  Able to defer satisfaction of wishes Hearing disorders in children/ Hala AlOmari32

 To ensure prompt medical or surgical treatment  To give help and guidance to parents  To provide appropriate stimulation and education to the child Hearing disorders in children/ Hala AlOmari33

Gross motor  8 months – sit unsupported  13 months – walk without help Speech  1 year – 3 words  2 years – stringing 2-3 words Hearing disorders in children/ Hala AlOmari34

 Mother’s concern (usually right!)  Not smiling by 8-10 weeks  Visually unaware/squint  Abnormal gait  Not walking by 18 months  Abnormal social behaviour Hearing disorders in children/ Hala AlOmari35

 Use test appropriate for developmental age not chronological age – (make a brief assessment as collect child)  Get as much basic information as quickly as possible, because of child’s attention span  May be better to test first and talk later  Modify test techniques as appropriate Hearing disorders in children/ Hala AlOmari36

 Fluctuating hearing loss – so parental concern and history may be more important than hearing levels in deciding on best management Hearing disorders in children/ Hala AlOmari37

Look at the whole child Hearing disorders in children/ Hala AlOmari38