What parents need to know about vision and hearing health

Hearing and vision examinations are an important part of a child’s overall health for a variety of reasons. ParentingNH 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:


Why is vision and hearing screening so important?

Dionne: “Hearing screenings are very important because young children are learning language and if their access to language is restricted it can lead to a delay in speech and language development as well as lead to poorer academic outcomes. Restricted hearing can also affect self-esteem and ability to make friends. We want all children screened and treated for hearing loss of any type so we can maximize their access to our hearing world thereby providing them with the greatest opportunity to develop speech and language skills at a rate on par with their typical hearing peers. We also want them to perform well in school, make friends and develop a healthy sense of self.  By addressing any hearing loss with appropriate intervention we can give children the foundation for all of these important developmental milestones.”

Wong: “Vision screening is vital because infants or children may have impaired vision in one or both eyes that is not visible or detectable by even the most vigilant parents or primary care physicians. Even children that are very bright and excelling in other ways may be compensating for impaired vision in one or both eyes. Children will rarely complain of poor vision because they assume that the world is meant to be blurred and accept it as the norm. Vision screening is meant to detect amblyopia or amblyopia risk factors. Vision screening is either done at the primary care physician's office starting in infancy, or is done in school, or may be done in community-based screening programs.”

What are some of the consequences of leaving problematic eye/ear conditions untreated?

Dionne: “As noted above, untreated hearing loss can lead to a delay in speech development, academic underperformance, low self-esteem, poor social interactions and fatigue. The effect on speech and language may seem obvious. If children aren’t hearing speech sounds correctly they are not going to be able to process and mimic those sounds correctly, causing a delay in the ability to develop along the typical timeline for language acquisition. The type and degree of hearing loss can affect the degree to which a child may suffer the consequences of untreated hearing loss. Children with hearing loss can be accused of daydreaming or not paying attention which can lead to low self-regard. Relatedly, hearing loss can also lead to difficulties socializing. In a typically developing friendship, children learn to respond to social cues, make eye contact, smile and greet peers, take turns, respond appropriately to questions and learn to be sensitive to others’ feelings. They support each other by giving attention to friends and help solve the problems of another. Untreated hearing loss can create a communication barrier which can lead to difficulty engaging in typical friendship behavior as described above. Also, untreated hearing loss causes fatigue from the effort of listening. A study performed in 2014 on school aged children demonstrated that fatigue caused by hearing loss was greater than fatigue caused by other chronic diseases affecting children such as rheumatoid arthritis, diabetes, cancer and obesity. The classroom itself in a typical public school can exceed the recommended noise standard even when not occupied by students and staff. The introduction of teachers and students brings the noise level up even higher, creating additional challenges for all children – namely stress and fatigue.  Children suffering from recurrent fatigue tend to miss more school, leading to academic underperformance , putting them at risk for advancing in their curriculum and at risk for failure of or repeating a grade level.”

Wong: “Amblyopia refers to vision that is poor in one or both eyes secondary to impaired development of the visual system in the brain in infancy or childhood. Amblyopia is the number one cause of preventable vision loss in childhood. If visual development in the brain is not well developed in each eye by the time a child is eight or nine years old, it is not necessarily something that can be ‘fixed’ with glasses, contacts, LASIK or other eye surgery in the future as a teenager or as an adult. There is a critical period of vision development in childhood. Earlier detection of amblyopia results in more effective treatment.”

What hearing or vision development milestones should I be aware of?

Dionne: “The following is a list of hearing related milestones and an average age range. Some children may not exhibit this behavior until it reaches the upper age in the range.

  • From birth to 3 months a child should react to loud sounds, smile or be calmed when spoken to. An infant at this age should recognize a parents’ voice and coo. A child this age will probably have a different cry for different needs – such as pain, hunger, fear or tiredness.  
  • At 4-6 months a child will follow sound with his or her eyes (if vision is typical) and notice toys that make sounds. A child this age may pay attention to music and begin babbling with the “p” “b” or “m” sound. A child this age may laugh or make gurgling sounds.
  • At age 7-12 months, a child may turn and look in the direction of a sound, or listen when spoken to. A child this age may understand a few common words. A child this age may babble with more sounds or respond to a short command. A 7-12 month old child will communicate with gestures and try to imitate sounds. Usually by age 1 a child will say their first word.
  •  A child between the ages of 1 to 2 will know a few body parts and can follow more complex directions and will enjoy stories or songs. A 1-2 year old can point to pictures in books and is always learning new words. By age 2 a child should be speaking in 2 word sentences.
  • At age 2-3 a child will have a word for almost everything. This aged child will speak in 2-3 word phrases and talk and ask for things. A 2-3 year old will use the k, g, f,t,d and n sounds. A child of this age will be understood by family and friends.
  • A 3 to 4 year old child will hear him or herself being called from another room. A child this age will answer “w” questions (who, what, where, when, why) and talk about activities and interests. A 3-4 year old will speak in sentences of 4 or more words and have fluid speech.  
  • A 4-5 year old can pay attention to a short story, hear and understand speech at home and school, can give many details and tell stories that stay on topic. A child this age can speak easily with other children and adults. A 4-5 year old child has all sounds with the possible exception of l, s, r, v, z, ch, sh, and th. A child this age can use rhyming words and knows some letters and numbers. It is important to note that failure to reach a particular milestone can mean any number of things, but is something to be discussed with a child’s pediatrician for possible referral to the appropriate professional.”

Wong: “Full term infants should be making good eye contact around 3-4 months of age, and their eye alignment should have drastically improved in that time as well. It is not uncommon for children to have eye crossing or eye drifting when younger than 3-4 months of age. An infant or child should not have eye shaking, or nystagmus, and if that is detected it should warrant a full exam by a pediatric ophthalmologist. A child should be able to read the 20/30 line on an eye chart by the time they are 5 years old in each eye.”

How common are hearing impairments in children, and what are some indications that my child may have hearing issues?

Dionne: “Hearing loss is very common in young children. The vast majority of these cases are a result of an ear infection. According to the American Academy of Pediatrics, acute otitis media (AOM) or ear infections, affects about 25 percent of children in the first year of life and at least 60 percent of children by 5 years of age. Ear infections can cause temporary hearing loss that resolve when the infection goes away. If the infections recur, the hearing loss can be fluctuating. Even fluctuating or temporary hearing loss caused by these infections can negatively affect speech development and educational outcomes depending on when and how often they occur. Hearing loss requiring treatment with hearing aids, cochlear implants or hearing assistive technology occurs in 1-3/1000 births and that number increases to 3-6/1000 children by school age. Things to look for in children, adolescents and teens are behavior changes, difficulty making friends, speech delay or delay in the above mentioned milestones, fatigue – particularly after the school day has ended, and engagement in unsafe listening behaviors (loud music – personal or concerts, arena type sports events, rifle shooting, attending car races, motorcycle riding, etc).”

How common are vision impairments in children, and what are some indications that my child may have issues?

Wong: “Vision impairment in the form of amblyopia affects 4 percent of children. Amblyopia can be caused by structural problems in the front or back of the eye, or by unrecognized refractive error (myopia, hyperopia, astigmatism), or by eye misalignment (strabismus). There are many risk factors for amblyopia that are only detectable in screening, and fully able to be diagnosed and treated with a full dilated eye exam by a pediatric ophthalmologist. There are other indicators that a child may have issues, such as squinting or holding objects up close, however these indicators are nonspecific and may have variable significance. Any child who fails a vision screening, at any age, should have a full dilated eye exam. Additionally, children should have a full eye exam if there is a strong family history of childhood eye problems, developmental delays, or complex medical issues that could affect vision.”

Why is it important to detect hearing impairment early, and what are the benefits of early intervention?

Dionne: “The importance of early detection of hearing impairment cannot be overstated. Treating a permanent hearing loss with hearing aids, hearing assistive technology or a cochlear implant can improve a child’s chances of developing socially, cognitively, psychosocially and educationally on par with their typical hearing peers, maximizing his or her chance of academic success, healthy friendships and healthy self-esteem. Ear infections should be discussed with a child’s pediatrician and managed medically to allow a child to develop speech/language and other skills at the same rate as typical hearing, non-ear infected peers.”

What hearing and vision services are available for my family at Core Physicians and Exeter Hospital?

Dionne: “Core Otolaryngology & Audiology has a team of 9 providers who are expertly trained in diagnosing and treating all types and degrees of hearing loss. The practice has offices in Exeter and Portsmouth.”

What type of vision services are available for my family at NH Eye Associates?

Wong: “There are ways that vision can be assessed in pre-verbal and nonverbal children; age or ability should not deter a family from getting a full dilated eye exam with a pediatric ophthalmologist if a screening is failed. There is no age minimum. Objective findings combined with subjective observations can help detect and treat preventable vision impairment. NH Eye Associates has the region's only pediatric ophthalmologist, an eye physician, trained in detecting and treating amblyopia, strabismus, glaucoma, along with other complex medical eye issues. NH Eye Associates also has wonderful optometrists to co-manage and maintain excellent vision in children with healthy eyes.”