Vision and hearing health
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Hearing and vision screenings and examinations can be an important part of a child’s overall health, but quite often parents are unsure about when it’s appropriate or what’s involved. Parenting New Hampshire reached out to a pair of experts to help demystify the process, and to talk about when, how and why such testing is vital.
Our experts: Jennifer Dionne, AuD, Core Physicians’ Comprehensive Otolaryngology and Audiology, an audiologist with specialty certification in pediatric audiology at Exeter Health Resources, and Melissa Wong, M.D., of New Hampshire Eye Associates.
Why are vision and hearing screenings so important?
Dionne: “Hearing loss is the most common developmental disorder identifiable at birth and its prevalence increases throughout school age due to late-onset, late identified and acquired hearing loss. If childhood hearing loss is not managed, there are negative effects on academics, cognition and social development. Hearing loss cannot be reliably identified based on a child’s behavior in everyday situations. It is important because normal hearing, or use of amplification in the case of hearing loss, correlates highly with speech, language and learning development at the typical rate.”
Wong: “Vision screenings help to detect existing poor vision or risk factors in a child's eyes that could lead to poor vision. Children are an especially vulnerable population since they cannot always verbalize or describe an eye problem, and more likely, they do not know their vision is supposed to be any other way. They believe that blurriness or double vision or limited peripheral field are "normal." Even in preverbal children or developmentally delayed children, routine vision screenings can detect a child at risk such that a referral can be made to an appropriate specialist such as a pediatric ophthalmologist.”
Who should conduct these types of screenings and why?
Dionne: “Hearing screenings can be conducted by audiology assistants, school personnel, including audiologists or a school health professional. The best outcomes in testing consistency involve the supervision of an educational audiologist if being performed at a school. If performed in a doctor’s office, screenings can be performed by a physician or another trained health professional such as a nurse or trained medical assistant.”
Wong: “Vision screenings are conducted by a child's pediatrician, family medicine doctor, or primary care provider. Some schools in New Hampshire also perform vision screening, although that is not currently state mandated. Routine screening is recommended by the American Academy of Pediatrics and the U.S. Preventive Services Task Force because prompt and early detection and treatment of ocular disorders in early childhood can prevent lifelong visual impairment.”
When should I have my child’s vision or hearing screened?
Dionne: “The American Academy of Pediatrics (AAP) recommends hearing screening throughout infancy, early childhood, middle childhood and adolescence. All newborns are to have their hearing screened before they are discharged from the hospital. Additional screenings should be conducted during routine well child visits with the pediatrician, at 4, 5, 6, 8, and 10 years of age. The American Academy of Audiology recommends children be tested in preschool, kindergarten, and grades 1, 3, 5 and 7 or 9 at a minimum.”
Wong: “Screenings are performed routinely as part of a well-child check starting from infancy. The question is when a referral is warranted to a pediatric ophthalmologist who performs a full dilated eye exam and thorough evaluation of the child's vision and eyes. Referrals are recommended in early childhood even before the age of one if there is a strong family history of childhood eye disease, or a history of prematurity, or a history of developmental or neurological delay, or a systemic condition that is associated with eye problems. An eye exam with a pediatric ophthalmologist is recommended by the American Academy of Pediatrics for any failed vision screening (visit http://pediatrics.aappublications.org/content/pediatrics/111/4/902.full.pdf), for any child unable to be screened after two attempts secondary to cooperation, or if there is any abnormality suspected or detected by the primary care doctor's office.”
What are some common things that may damage my child’s vision or hearing?
Dionne: “Noise exposure. Hearing loss from noise exposure is 100 percent preventable but is starting to show up in upper elementary school. Walk away from the noise, turn the volume down, give your ears a break or wear hearing protection. Respect your ears – Respect your child’s ears. Model healthy listening habits by listening to music at a reasonable volume and use hearing protection for loud noises and concerts.”
Wong: “Preventable eye problems can damage a child's vision. Trauma is a concern, and that can come from projectile toys which have enough force transmitted through a focal area that it can cause serious ocular damage on the eyeball, or doing certain contact sports without polycarbonate eye protection. Many handheld laser toys are not FDA regulated and the wavelength of light can cause permanent scarring in the retina. I'm sure I sound like a broken record, but children with amblyopia risk factors that are not evaluated and followed closely can have permanent visual damage. Many parents believe that wearing glasses can make a child's eyes worse or more dependent on them. In many cases, if an ophthalmologist recommends glasses, if a young child does not wear the glasses prescribed, then normal visual development may be adversely affected.”
What warning signs would prompt me to seek additional examinations?
Wong: “Parents should seek a formal Dilated Eye Exam (not screening) if there is a problem with eye alignment, if a child preferentially closes one eye to see, if a child is constantly squinting one eye or rubbing it, or if a child has a persistent head posture such as a face turn or head tilt whenever viewing something. These could be nonverbal signs that a child needs a full exam. Of course a child should see a pediatric ophthalmologist if they are referred by their primary care team or school.”
What’s involved in vision screening?
Wong: “Vision screening done at the primary care doctor's office starts in infancy with observing motility of the eyes and checking the light reflex in a child's pupils. As a child gets older, screening involves a cover/uncover test of alignment, a check of the optic nerve using a direct ophthalmoscope (special flashlight) in the primary care doctor's office, reading an eye chart with each eye covered, and sometimes screening is performed with photoscreeners, which are machines designed to detect amblyopia risk factors. A formal dilated eye exam with a pediatric ophthalmologist can be done at any age. An initial eye exam with a pediatric ophthalmologist takes one and a half to two hours, and involves vision assessment with different tools, checking with handheld or standing lenses that magnify the eyes, dilation of the pupils with eye drops which allow examination of the structures in the back of the eye along with an objective measurement of a child's refractive error using a process called cycloplegic refraction.”