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Tuesday 17 th February Chapter 2 Hearing disorders in children/ Hala AlOmari1
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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
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All children, normal and abnormal, progress from the helplessness of infancy to the independence of maturity Hearing disorders in children/ Hala AlOmari3
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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
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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
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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
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Motor Vision and fine movements Hearing and speech Social behaviour and spontaneous play Hearing disorders in children/ Hala AlOmari7
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Little head control Jerky movements of limbs “Moro” reflex (https://www.youtube.com/watch?v=s_lAFst43T) Forward reflex – “walking movement” Hands closed at rest Hearing disorders in children/ Hala AlOmari8
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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
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Sits alone for 10-15 minutes Progresses on floor by rolling or squirming Attempts to crawl – sometimes succeeds Pulls to stand Hearing disorders in children/ Hala AlOmari10
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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
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Walks well Runs carefully Pushes and pulls large toys Walks upstairs with helping hand (and often downstairs) Hearing disorders in children/ Hala AlOmari12
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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
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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
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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
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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
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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
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Hand preference Holds pencil mid-shaft Builds tower of 3 cubes Enjoys picture books Hearing disorders in children/ Hala AlOmari18
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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
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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
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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
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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
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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
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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
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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
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Sucks well Sleeps most of the time Expression vague Hearing disorders in children/ Hala AlOmari26
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Fixes unblinkingly of mother’s face Reacts to familiar situations – smiles and coos Enjoys bath and caring routines Hearing disorders in children/ Hala AlOmari27
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Everything to mouth Holds and chews a biscuit Puts hands round bottle when feeding Becomes aware of strangers Hearing disorders in children/ Hala AlOmari28
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Look at the whole child Hearing disorders in children/ Hala AlOmari38
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