Parents often wonder how much their baby can see and hear. Newborns are amazing. They are well prepared to take on the outside world after birth, and their vision develops quickly during the first year of life. They can see large shapes, faces and bright colors. After three to four months they can focus on smaller objects, track an object and distinguish colors.
At four months of age, a baby’s eyes should be working together, with no eye crossing or drifting outward. Babies are beginning to develop depth perception, which is using both eyes to see an object. By one year, infants have attained normal adult levels (a three-year-old has 20/50 visual acuity, and by six years the visual acuity is 20/30).
Vision assessment and screening are important for children of all ages. The American Academy of Pediatrics (AAP) recommends that vision assessments begin in infancy and that vision-screening tests start at age three if your child is able and willing. Yearly vision screening is recommended after the age of three.
It’s important to know that your child’s vision is within normal limits and that there are no conditions that may result in impaired vision, which can affect school performance and increase the risk of accidents during play. An eye exam will detect any retinal abnormalities, glaucoma, cataracts, strabismus, retinoblastoma and neurological disorders.
What to Look For
The warning signs of vision problems in infants older than three months are the inability to follow or track an object or to make steady eye contact. As your baby grows, you should bring any signs of a wandering eye, crossing of the eyes or outward drifting of one or both eyes to the attention of your child’s healthcare provider.
A provider should evaluate the following: eyes that are misaligned (crossed, they turn out or cannot focus together), fluttering from side to side, a white or grayish pupil, eye pain, itchiness or discomfort, redness, a yellow eye discharge, constant watery eyes, drooping eyelids or an oversensitivity to light. Your child may be referred to a pediatric ophthalmologist for visual concerns.
Preventing Hearing Loss
Hearing loss occurs in one to two percent of all newborns. In the United States, most newborns are screened for hearing loss before they are discharged from the hospital or birthing center. It’s important to identify hearing loss in infants before six months of age in order to prevent irreversible and permanent impairments in speech, language and cognitive abilities. Early treatment and family support will enable kids to develop the necessary skills to keep on par with their peers when formal schooling begins.
Before the universal use of the newborn-hearing screening test, only infants with specific risk factors were tested, such as having a family history of hearing loss, maternal illness or exposure to specific drugs during pregnancy.
Newborn hearing loss can be due to prematurity, low birth weight, high bilirubin levels, specific syndromes, abnormalities to the head and dace, infections such as rubella (German measles), cytomegalovirus (CMV), herpes, toxoplasmosis and specific sexually transmitted diseases. A low Apgar score may be an indication of hearing loss.
The type of hearing loss needs to be determined. There are two types: conductive and sensorineural.
Conductive hearing loss is due to excessive fluid in the middle ear, usually caused by a cold or other condition blocking the normal drainage mechanism (eustachian tube). This excessive fluid can cause a temporary hearing deficit.
It’s important to check the fluid level in the middle ear by having a tympanogram examination at specific intervals. The use of antibiotics, decongestants or antihistamines does not dry up the middle ear fluid. If the fluid is persistent for more than three months, a referral to an ENT (ear, nose and throat) specialist is recommended. Myringotomy tubes may be placed to drain the excessive fluid. A hearing test is also advised before and after surgery. Note that myringotomy tubes do not prevent future ear infections.
The second type of hearing loss is sensorineural loss, an abnormality of the inner ear or auditory nerve that conducts sound waves to the brain. This is a permanent hearing loss that may be genetically inherited or caused by an infectious illness (e.g., German measles or cytomegalovirus) during a mother’s pregnancy. The use of a hearing aid or a cochlear implant may aid in helping a child attain some level of hearing, which will aid in speech development and articulation. Children with hearing deficits may learn to read lips and sign language. Families are encouraged to learn sign language to effectively communication with and teach their child.
Signs of hearing loss in kids include:
1. Not being startled by loud noises after one month of age.
2. Not turning to face someone who is talking to them.
3. Noticing only someone in their direct line of vision.
4. Not cooing by age three to four months, instead making a gargling sound, which is felt, not heard.
5. Having delayed speech, limited vocabulary, or being hard to understand.
6. Not responding to their name when called.
7. Hearing some sounds but not others, high or low frequencies.
8. Having trouble with balance or movement of the head (the middle ear is responsible for balance).
The use of earbuds and headphones also may cause a decrease in hearing if the volume is excessively high while listening to music, watching videos and attending concerts or other social events. Help your kids establish safe listening habits, such as limiting the use of earbuds and headphones to one hour a day and turning down the volume.
Kids should be able to hear conversations around them with ear devices on. Also, pain, ringing in the ears or a strange feeling after use means that the volume is too loud. If people can hear the music from the headphone or earbuds, it’s definitely too loud.
The AAP recommends hearing tests at birth, ages three to five years, and again at eight and ten years of age. Adolescents should have their hearing tested between 11 and 14 years, 15 and 17 years, and at ages 18 to 21.
Your child’s vision and hearing must be assessed at specific intervals during growth and development. It is crucial that testing be performed and the appropriate referral made for any concern you have about your child’s precious senses.
Jo Ann B. Serota, DNP, CPNP, FAANP, IBCLC, is co-owner of Ambler Pediatrics, Ambler, PA. She is president of the NAPNAP Foundation, past president of NAPNAP, corresponding editor of primary case studies for the Journal of Pediatric Health Care and a Ready, Set, Grow advisory panel member.