When a small child can’t hear, he doesn’t develop speech normally, and when he can’t see, learning suffers. That’s why early detection in both areas is key to giving children a leg up on later achievement.
Nurse Pamela Breitweiser runs St. Louis Children’s Hospital Healthy Kids Express, mobile screening vans that go out to schools and other locations to conduct vision and hearing screening. She notes that the program appears to be filling a gap in services in these trying times. “We started out with one van and screened 1,000 kids. Last year, with two vans, we did 182,000 screenings,” she says.
It’s important to get children used to being screened because they can really catch things that, if left undetected could have a profound impact on school performance,” Breitweiser says. “For vision, we check near and far vision and binocularity to see if the eyes are working together. Several hearing tests are used, depending on the age of the child and whether verbal communication is a problem. Finally we look in the ears. You’d be surprised what we find.” She says the bottom line is that if learning problems are identified, vision and hearing issues could be ruled out.
Washington University School of Medicine pediatric otolaryngologist Dr. Judith Lieu stresses the need for catching hearing problems as young as possible. “The biggest development in the last 10 years is mandated hearing screening in both Missouri and Illinois for children by one month of age,” she says. “When we identify hearing loss early, we can head off speech and language difficulty.”
Lieu says the biggest public health problem with childhood hearing loss is parents not following through, noting that 40 percent don’t. She says that if one ear didn’t pass, the parent may be lulled into thinking that’s okay, but even a small loss can affect developmental progress. “My recommendation is that if screening detects any hearing loss, get the child comprehensively diagnosed, and keep following up.”
Lieu says even if the child passes newborn screening, there are many reasons he could lose hearing later. She says some causes of later hearing loss include malformations in the ear that can’t be seen from the outside, serious illness such as meningitis, head trauma, ear infections with persistent fluid build-up, and a familial hearing loss. Another cause that may result in newborn or delayed hearing loss is cytomegalovirus (CMV).
James Wachter, medical director for Clarkson Eyecare, says he has seen an increase in identified vision problems since Missouri enacted a law two years ago that all children must have an eye exam before they can enter kindergarten.”This time of year, we are really busy catching up on screenings for kids before they can start school,” he says. “Our vision exams pick up refractive errors such as near and farsightedness and astigmatism, lazy eye, depth perception, color vision, and physical problems.” He adds many vision problems don’t have symptoms so the kids don’t know they have a problem. Finding them early can really head off more serious, less treatable problems later.
Wachter cites amblyopia as one example. Caught early, it can be easily corrected with treatment regimens while the vision system is more moldable. If caught too late, the visual system is too rigid. In addition, he says kids at age four or five are not sure what they should be able to see. “They can see at distance and haven’t done much reading yet, but if farsightedness is not corrected it can cause amblyopia later,” he explains. “It’s not just a matter of getting glasses to correct an error, but also of preventing other problems down the line.”