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• W2320327256 abstract "Figure: Jacque Rogers-SchollFigure: Jace WolfeMost audiologists are aware of the benefits of intervening as early as possible with infants identified with hearing loss. When a permanent bilateral hearing loss is identified, we should follow the lead of experts like Carol Flexer, PhD, and Anu Sharma, PhD, and recognize hearing loss for what it really is: “a neuro-developmental emergency.” In such cases, clinicians should ACTT! (Assess the loss, Correct with amplification immediately, and, Talk/Teach about the whole child). Some audiologists contend that parents need time to grieve the hearing loss and choose a communication option before progress can begin. But this approach flies in the face of what's done in other aspects of pediatric healthcare when a child's development is at risk. Remember that congenital hearing loss impedes the development of the body's most important treasure—the brain. As audiologists, we have a professional obligation to maximize auditory brain development for every child we serve. The first step toward doing this is to assess the loss and optimize audibility for speech and environmental sounds. INTERVENING EARLY INCREASES OPTIONS To provide amplification promptly does not violate parents' right to select a mode of communication for their child. In fact, we would argue that the quick fitting of hearing aids supports various options. Most parents of children with hearing loss have normal hearing and choose spoken language as a goal for their hard-of-hearing child. In such cases, delaying the fitting of hearing aids or cochlear implantation runs counter to the wishes of these parents. Delayed intervention holds back brain development and damages spoken language outcomes. Even when parents elect not to pursue spoken language, providing access to environmental sounds makes the world a safer place for their child. And, even in these cases, parents need to understand the consequences that delayed intervention will have on their child's spoken language and auditory development. Ear impressions should be taken at the time of diagnosis and medical clearance should be sought for an imminent fitting. The best-case scenario is to fit amplification within 2 or 3 days of diagnosis. An infant's first 6 months are a time of rapid development, both external and internal, and the importance of using hearing aids during all waking hours cannot be stressed enough. This period is especially difficult for parents since they're sleep-deprived, emotional, and often overwhelmed. So, don't expect them to understand all the implications of their child's hearing loss overnight. It's our job to teach them to recognize when earmolds don't fit and to call them the day after the fitting to check on how things are going. We need to make ourselves available for questions and to provide support. Schedule the family for a return appointment within a week of the fitting. Many problems can arise during this period, and a baby may be deprived of optimal brain development during the first month of life. Earmolds are one of the biggest challenges for families during the first 6 months of a hearing-impaired baby's life, and they need to be replaced every week or two, particularly if the child has a severe-to-profound hearing loss. In our experience, it's not uncommon to replace earmolds 10 or 15 times during the first year. It's also essential that earmolds be fitted within a few days of when the ear impressions are made. Most labs are eager to make and return earmolds as fast as possible when they know they're for an infant. Each day between the impression and the earmold fitting is time the child isn't wearing his or her hearing aids. TALK AND TEACH Once you've assessed the loss and corrected it with amplification, it's time to talk and teach. It's been shown that children with a large, active vocabulary learn to read more easily. Listening as their parents talk to them is one very important way that babies begin to learn language. So, it's essential to inform parents of their key role in developing language and literacy skills. In their article “The early catastrophe. The 30-million word gap,” Betty Hart and Todd Risley showed that children from professional families hear 45 million words by age 4, while their contemporaries from families on welfare heard only 13 million words—30 million fewer.1 The authors determined that the slower rate of vocabulary growth in the latter population of children resulted in part from their fewer experiences with words. Most importantly, they discovered that this disparate developmental trajectory had its foundations early—from birth to 3 years of age. Ensuring access to every word that children are exposed to is the responsibility of the audiologist. Exposing their children to 45 million words so their vocabulary will grow is the role of parents/caregivers. So, the next time you identify a baby with hearing loss, remember to ACTT. We have no time to waste because babies can't wait to hear. Don't let your little patient be the one with a 30-million word gap!" @default.
• W2320327256 created "2016-06-24" @default.
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• W2320327256 date "2008-06-01" @default.
• W2320327256 modified "2023-09-26" @default.
• W2320327256 title "Don't wait to ACTT" @default.
• W2320327256 doi "https://doi.org/10.1097/01.hj.0000324324.83886.5b" @default.
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