Early detection of hearing status in children is critical to prevent the significant detrimental effect on cognitive development it can have if not appropriately addressed. Current guidelines by the Joint Committee on Infant Hearing (JCIH) recommend what is commonly referred to as the 1-3-6 time line: All infants should receive a hearing screen before age 1 month; those who do not pass should receive a full pediatric audiology diagnostic evaluation before age 3 months; and those identified as deaf or hard of hearing should receive special services (such as early childhood intervention, access to visual and spoken language, and amplification) no later than age 6 months.
In a session titled “Listen up! Early detection of hearing loss” at the American Academy of Pediatrics (AAP) National Conference and Exhibition on September 19, Rachel St. John, MD, director of the Family-Focused Center for Deaf and Hard of Hearing Children at Children’s Health in Dallas, Texas, and associate professor, Department of Otolaryngology, at the University of Texas (UT) Southwestern Medical Center, Dallas, discussed some of the practical applications of the recommendations by the JCIH.
Updates to these recommendations are forthcoming and support an even tighter time line for hearing screening and evaluation. “The new recommendation is that if the 1-3-6 time line is being met, practitioners should aim for a 1-2-3 time line in order to maximize early intervention for optimal language development,” said St. John.
She emphasized that the overarching goal of these recommendations is to ensure that infants and children who are deaf or hard of hearing have access to the earliest and most complete language learning as possible, which encompasses presenting multiple opportunities for language learning including both spoken and sign language.
“We know from a growing body of research that early identification of hearing status and provision of support for language learning has a statistically significant effect on overall cognitive development, and lack of early language access can have detrimental and permanent developmental effects,” St. John said.
St. John also spoke about new recommendations for the evaluation of hearing in children who pass their newborn screen but have risk factors for late onset hearing loss. The new recommendations state that, in general, children with risk factors have a full audiologic evaluation by age 9 months. However, this time line varies according to the etiology of the hearing loss, with earlier and more frequent audiologic evaluation recommended for children with known etiologies that cause rapid and/or progressive changes, such as congenital cytomegalovirus.
St. John emphasized the benefit primary care practitioners can give to families by being aware of the time lines for newborn hearing screening, as well as by paying attention to expressive language milestone development and, importantly, concerns a parent or guardian may express about their child’s hearing. “Parental concern is an extremely sensitive indicator of possible hearing changes,” she said, “and children whose parents express such concerns should be referred immediately for a full audiology evaluation.”