The Development of Hearing: Its Progress and Problems (Studies in Development Paediatrics)
When a sperm with 23 chromosomes fertilizes an egg with 23 chromosomes, the baby will then have a complete set of 46 chromosomes. Half are from the father and half are from the mother. But sometimes an error occurs when the 46 chromosomes are being divided in half. An egg or sperm cell may keep both copies of chromosome number 21, instead of just 1 copy. If this egg or sperm is fertilized, then the baby will have 3 copies of chromosome number This is called trisomy This may cause translocation Down syndrome.
This is when an error in cell division happens after the egg is fertilized. People with this syndrome have both normal cells and some cells with an extra chromosome number This risk increases with each year of age, especially after age But younger women are more likely to have babies than older women. So most babies with Down syndrome are born to women younger than Chromosome problems such as Down syndrome can often be diagnosed before birth.
This is done by looking at cells in the amniotic fluid or from the placenta. This is a noninvasive prenatal screening. These tests are very accurate. Fetal ultrasound during pregnancy can also show the possibility of Down syndrome. Problems from Down syndrome may not be seen with ultrasound. After birth, your baby may be diagnosed with a physical exam.
The healthcare provider may also take a blood sample. This is checked in a lab to find the extra chromosome. There is no cure for Down syndrome. But a child with Down syndrome may need treatment for problems such as:. Heart defects.
Language development in premature babies
About half of babies with Down syndrome have heart defects. Some defects are minor and can be treated with medicines. Others may need surgery. All babies with Down syndrome should be looked at by a pediatric cardiologist. This is so that any heart defects can be treated.
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Intestinal problems. Some babies with Down syndrome are born with intestinal structure problems that need surgery. Vision problems. Common problems include crossed eyes, nearsightedness or farsightedness, and cataracts. Most eyesight problems can be made better with eyeglasses, surgery, or other treatments. Your child should see an eye doctor pediatric ophthalmologist before he or she turns 1 year old.
Hearing loss. This is caused by fluid in the middle ear, a nerve defect, or both.
Premature baby development common concerns | Raising Children Network
Other children are born with normal hearing and begin to have hearing problems as they grow older. The checklist below presents the average age by which most babies accomplish a variety of early speech and language skills. Typically, a child may not accomplish all the items in an age category until he or she reaches the upper age in the age range.
Tell the doctor if you think your child has trouble hearing. If you think your child may have a hearing problem, here are some things that your doctor might ask you about:. Voice is the sound we make as air from our lungs is pushed between vocal folds in our larynx, causing them to vibrate. A Cochrane review  , originally published in and now withdrawn due to lack of revision, cited a similar conclusion. In the most recent USPSTF review  , the authors concluded that there was adequate evidence demonstrating that children with an earlier diagnosis had improved expressive and receptive language scores.
Updated evidence from multiple studies     now indicate that infants who are diagnosed and receive intervention before six months of age score 20 to 40 percentile points higher on school-related measures language, social adjustment and behaviour compared with hearing-impaired children who receive intervention later on .
Management of hearing loss is dependent on the etiology. Medical and surgical interventions focused on establishing functional access to sound have improved significantly as a result of technological advances during the past two decades. Depending on the etiology and severity of hearing loss, this may involve hearing aids, cochlear implants or bone-anchored hearing aids. Surgical options exist for many conductive disorders including ear malformations, ossicular chain abnormalities, tumours and cholesteatomas.
Hearing aids, which offer sound amplification, are now widely available using advanced digital technology, and may be worn by very young infants. Environmental sound amplification devices, including FM and wireless devices, are also available for individuals of all ages. Cochlear implants, used in children for the past 20 years, are electronic devices surgically placed in the cochlea to provide stimulation to the auditory nerve. A systematic study  showed clear effectiveness in hearing and language development. Cochlear implants, along with oral language habilitation, have transformed the hearing and language potentials of severely and profoundly deaf individuals, enabling highly functional language development.
Current recommendations for eligible children are bilateral implantation between eight and 12 months of age, coupled with auditory oral therapy .
This may take many forms including oral and gestural communication, or a combination of both. Families require clear, objective information on the interventional options and expected outcomes. Data from the Ontario newborn hearing screening program indicate that between and , Specialized auditory-verbal therapists, teachers of the deaf and speech therapists, who are trained to work with infants and young children and their families, are instrumental in the auditory habilitation process.
Therefore, child and family support is a key element of early intervention.
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For older children, liaisons with school services are important. In the position statement  , the JCIH summarized intervention strategies and provided recommendations. This question was systematically evaluated by Nelson et al  in Data were extracted from two fair-quality cohort studies and multiple survey studies.
In summary, it appears that screening is well accepted by the vast majority of parents, with rates of refusal estimated to be 0. Anxiety was found to be highest in parents whose infants had confirmed hearing loss. Integrated parental information and counselling is recommended as part of a high-quality UNHS program. While the overall benefits of UNHS are increasingly clear, limitations exist. In two-step screening, low-risk infants with auditory neuropathy may not be detected by the OAE test alone.
Health care providers, educators and parents must remain attentive to the developmental progress of children, especially in expressive and receptive language domains. A hearing re assessment is recommended for all children experiencing developmental or learning difficulties. Beyond the quality of life and psychosocial benefits of improved language, communication and learning, there are increasing data on the cost effectiveness of UNHS.
The actual costs of screening vary according to region. In general, there is agreement that the lifetime costs of deafness, particularly prelingual, are very high  . Costs of UNHS are comparable with other newborn screening programs  and, even with wide modelling parameters, the benefits of UNHS outweigh the costs .
In their role as health care advocates for children, physicians and, particularly, paediatricians should be aware of UNHS and whether it is available in their practice region. For infants with positive or equivocal test results, timely follow-up and parental compliance with the UNHS program recommendations are critical. In regions where UNHS has not been implemented, parents of newborns and young children need to be aware that clinical screening is ineffective in early diagnosis and that late diagnosis is associated with irreversible long-term language and cognitive deficits.
In a child with confirmed hearing loss, the etiology requires clarification. A detailed family history should be included. Consultation with a paediatric otolaryngologist, ophthalmologist and geneticist is indicated.