Tag Archives: AZAAP

Hearing loss in newborns and toddlers: when to worry

According to the Arizona Department of Health Services, approximately 300 newborns each year in the state have an inherited disorder that could be identified through screening.

Hearing loss is the most common of these disorders.

Babies born in hospitals are screened for hearing loss within the first few hours after birth.

Watch a newborn hearing screening at Cardon Children’s Medical Center/Banner Desert Medical Center

If a baby doesn’t pass the initial test, parents need to make sure they return for a repeat screening two to four weeks later, says Patty Shappell, AuD., CCC-A, an audiologist with Neonatology Associates, Ltd.

“Parents may get home and think the baby is responding normally, says Shappell, “but they still need to have a follow-up evaluation to assess hearing and rule out even mild or unilateral hearing loss.”

What happens if screening results are not within the normal range? Read about Brooke Gammie’s journey after her daughter, Payton, did not pass her newborn hearing screening.

For babies born outside of a hospital, screenings are available at outpatient clinics such as Neonatal Associates. Most insurance companies, including AHCCCS, cover the costs of the screenings.

What do babies miss if they are born with even a mild hearing loss? Hearing acuity directly affects the development of speech and verbal language skills. A baby with hearing loss, even during the first year, can be short-changed in his or her social, emotional, cognitive and academic development.

Diagnosis and early intervention are critical during the first year for the child with any degree of loss.

 How do you know if your baby is at risk for hearing loss?

Risk factors for hearing loss, according to the Arizona Department of Health Services include:

  • Babies who stay in the NICU for more than 5 days
  • Babies who have had an infection before or after birth such as CMV, herpes, rubella or meningitis
  • Babies who have a family member with hearing loss from birth or childhood

Follow-up with a physician is critical for babies at risk as it is possible that they may pass a hearing screening at birth but will still need more testing later.

New parents, says Shappell, should be sure to talk to their baby’s doctor and make an appointment with a pediatric audiologist or hearing specialist for further testing.

Normal milestones for the first year:

By 2 months of age a baby with normal hearing should be able to:

  • Quiet when hearing a familiar voice
  • Make sounds like ahh and ohh

By 4 months of age a baby with normal hearing should be able to:

  • Look for sounds with his eyes
  • Make sounds like squeals, whimpers or chuckles

By 6 months of age a baby with normal hearing should be able to:

  • Turn his head toward a sound
  • Make sounds like ba-ba, ma-ma, da-da

By 9 months of age a baby with normal hearing should be able to:

  • Imitate speech sounds made by others
  • Understand no-no or bye-bye
  • Turn his head toward a soft sound

By 12 months of age a baby with normal hearing should be able to:

  • Correctly use ma-ma or da-da
  • Respond to singing or music

Still, it is important to remember that babies with mild hearing loss may also be able to do these things.

During the second year, parents should continue to monitor any changes in a child’s development.

Candice L. Grotsky, Au.D., a Cigna audiologist who practices at the Stapley Hearing Center in Mesa, says that by twelve months to two years, children should still be turning to sounds from either side and “look up or down” for a sound if it comes above or below them.

They get better at  “localizing” or turning directly to a sound the older they get assuming hearing is normal and there are no developmental delays,  she adds.

Grotsky says that in toddlers, hearing loss is often caused by ear infections.  She says that most parents seem to know “when something is wrong” and bring their child in for testing.

“Maybe speech is delayed or mushy sounding, maybe speech was progressing well and all of a sudden stopped or regressed,” she says. ” Sometimes the child doesn’t respond if you are behind them and make a sound or noise.  These are all clues that hearing loss could be present.”

Grotsky says that most of those children in the age range of 2-4 years that she sees are coming in for the first time  — and it is usually a speech delay that prompts parents to seek testing.

If you suspect for any reason that your child — at any age — is having difficulty hearing or seems to be delayed in speech or in any other area, talk to your child’s physician.


Smoker in the family? Pediatricians can help

There’s good news on second-hand smoke exposure among middle schoolers and teens, according to a new study issued this week by the American Academy of Pediatricians (AAP).

Data reviewed by the National Youth Tobacco Survey found that second hand smoke exposure decreased among both nonsmoking and smoking kids in grades six through twelve.

Send a "Love your heart- quit smoking" valentine e-card courtesy of the CDC

But there’s also not-so-good news. In 2009, 22.8 percent of non-smoking students and 75.3 percent of smoking students still reported second hand smoke exposure in a car within the past week.

Second hand smoke exposure has deleterious health effects.

According to the Centers for Disease Control, second hand smoke contains around 7,000 chemicals. Around 70 of those chemicals are known carcinogens.

Acute respiratory infections, middle ear disease, delayed lung growth, and more severe cases of asthma increase when the air kids breathe contains smoke from tobacco products.

Voluntary smoke-free policies, or expanding existing comprehensive smoke-free policies that prohibit smoking in worksites and public areas, could reduce second hand exposure in cars, says the AAP.

It can be tough for parents who smoke to limit their children’s exposure to tobacco smoke.

How to become an anti-smoking role model—even if you smoke

And discussing the issue during an office visit can sometimes be tricky, says Dr. Theresa LoCoco, a member of the Arizona Chapter of the American Academy of Pediatrics.

LoCoco, who practices with Pediatric Associates in Phoenix, says she finds it best to remember that both parents and their pediatricians have a common goal-optimum health for their children.

“This opens the door to discuss the risks of second-hand smoke: increased rates of ear infections, allergies, asthma and asthma exacerbations, pneumonia and other upper respiratory tract infections.”

There’s also an association between parental smoking and Sudden Infant Death Syndrome (SIDS) as well as behavioral issues such as ADHD/ADD, says LoCoco.

Kids whose parents smoke are more likely to smoke themselves, increasing the risk for cancer later on in life. 

But quitting smoking is tough.  And while many parents would like to for the health of their child, some are not currently ready or able to so. Sometimes it’s not the parent who smokes, says LoCoco, but instead a close family member or friend who has close contact with the child.

LoCoco advises those parents to try to limit tobacco smoke exposure to their children as much as possible.  This includes never having the child in the car or house with someone who is smoking.

Still, she emphasizes that no amount of exposure to tobacco smoke is considered safe.

Recent research warns of the dangers of “third-hand smoke,” which is exposure to nicotine and other harmful substances in the residue left by tobacco smoke.  This residue can be found on drapes, upholstery, clothing, hair and skin and has many of the same health consequences for children as second-hand smoke.

Limiting this exposure can often times be difficult. LoCoco suggests that a smoker  change clothes and shower or bathe before contact with a child to keep exposure to a minimum.

Kids who are bullied less likely to be physically active

Children who are bullied by their peers endure great emotional pain and suffering.

Staying active has emotional benefits, too. Courtesy YMCA of the East Bay, Oakland, CA

But a new study, to be published in the March 2012 issue of Pediatrics, found that children who are ostracized, even for brief periods, are significantly more likely to choose sedentary over physical activities.

Researchers asked children between the ages of 8 and 12 to play a virtual ball-toss game. They were told that they were playing the game online with other kids. In some of the sessions, the game was pre-programmed to exclude the child from receiving the ball for most of the game.

In the other sessions, the child received the ball one-third of the time. After the game, the kids were given a choice of any activity they liked. They were then monitored by a device that measured physical activity.

The researchers found the kids who were excluded were far more likely to choose an activity that did not require physical effort.  They concluded that being ostracized may reinforce behaviors that lead to obesity in children.

Even though this study seems small, it is important, says Dr. Farah Lokey, a member of the Arizona Chapter of the American Academy of Pediatrics.

Children who are prone to being bullied and then ostracized in school every day tend to spend more time at home and less time participating in activities with other children.

And that can damage self-esteem. “The key to getting these children active, and feeling good about themselves, says Lokey, who practices at Southwestern Pediatrics Gilbert, “is putting them into activities where they can shine on their own and meet like-minded individuals.”

Individual sports such as golf, swimming, and tennis can provide these opportunities, Lokey adds. “These sports not only allow them to become experts in the sports by learning these skills but definitely help their self- esteem and pride.”

Sports like Karate and other self-defense activities encourage treating others with respect. That keeps the concept top-of-mind for children.

When to worry

Younger school-age children typically begin their school years with a sense of excitant about learning and making new friends. But if a child seems suddenly less enthused and more fearful around school, or develops separation anxiety, that could be a red flag that bullying is going on, says Lokey.

Some children will show physical problems with no diagnosable cause, such as a tummy aches – but maybe only on the weekdays, not on weekends. Sleep problems or anxiety in social situations can also be indicators.

With older children, behavior can become more aggressive and defiant, says Lokey. Grades may suffer, and parents may notice a change in appearance as well as a tendancy to seclude themselves from others.

 What to do

If parents do see sudden changes, they should speak to school officials and enlist the help of school counselors. Lokey says that pediatricians can be a great resource when parents have questions about these behaviors.

A child’s physician can talk to their patient in confidence and offer to speak with school counselors if needed. “Bolstering confidence and self-esteem in the children we pediatricians treat,” says Lokey, “is one of our main goals.”

How to talk to your pre-teen about the HPV vaccine

The American Academy of Pediatrics now recommends that boys ages 11 or 12 receive the HPV vaccine in a three-dose series, which can be started as early as 9 years old.

Courtesy MCN Healthcare

How do you explain what the HPV vaccine is to a nine-year-old boy?

Well, that’s up to parents to decide.

So you will have your facts straight, however, we asked  Michelle Huddleston, M.D.  a member of the Arizona Chapter of the American Academy of Pediatrics, to explain why the HPV vaccine is on the schedule for pre-teen girls, and now boys, too.

Vaccines are designed to prevent diseases, says Dr. Huddleston, who practices at Phoenix Children’s Hospital. This vaccine is no different.

The HPV vaccine provides protection from certain subtypes of the HPV virus long before boys and young men (and young women) become engaged in any type of sexual activity. 

HPV transmission can happen with any kind of genital contact and intercourse isn’t necessary, adds Dr. Huddleston, who says that many people who have HPV infection are without signs or symptoms and unknowingly pass the virus to their partner.

The HPV vaccine is most effective in the pre-teen age group producing higher antibody levels than in older patients. So, that’s why the vaccine is on the schedule for pre-teen boys and girls.

Talking about the purpose of the vaccine might be a conversation starter for a talk about sex. Dr. Huddleston says that although feeling nervous about broaching the subject with kids is fairly common, she suggests  that as parents,  we should try to consider sexuality a normal topic of conversation.

“Certainly by the time your child starts to exhibit the physical changes of puberty, questions will start to arise,” says Dr. Huddleston. “Be certain to listen, answer honestly and by approachable. You may start the conversation by asking, ‘What do you know about sexuality?’ and see where the conversation leads.

Dr. Huddleston recommends  www.youngwomenshealth.org as a good resource for parents as they prepare to talk to kids about sex.

Another update on the vaccine schedule is the age at which the meningococcal vaccine can be given.

Children as young as 9 months can get the vaccine if they are residents or travelers to countries with epidemic disease or at increased risk of developing meningococcal disease, says the AAP.

Routine immunization with the meningococcal vaccine should begin at 11 through 12 years with a booster dose administered at 16 years of age.

So who is at greatest risk for developing meningococcal disease? And what is it, exactly?

Children who do not have a spleen, have an abnormally functioning spleen or certain immune disorders are at increased risk of developing meningococcal disease, says Dr. Huddleston.

Teenagers are at increased risk of developing meningococcal disease by being in crowded places, living in close quarters, sharing drinking and or eating utensils or having a run-down immune system.

Meningococcal meningitis and septicemia can present with flu-like symptoms and patients can die within 24 hours. 

And, speaking of flu, there’s one more update on the vaccine schedule. 

For children aged 6 months through 8 years, the influenza vaccine should be administered in two doses for those who did not receive at least one dose of the vaccine in 2010-11, says the AAP.

Children who received one dose last season require one dose for the 2011-12 influenza season.

Questions about vaccines or this most recent schedule revision? We list resources below, but any parent who is unsure of what a vaccine is for or when it should be given to a child should check with the child’s health care provider.

More resources on vaccines:

Centers for Disease Control and Prevention 

Center for Young Women’s Health

The Arizona Partnership for Immunizations 

American Academy of Pediatrics Healthy Children website



Rates of hospitalization for drowning decline

In the U.S., drowning accounts for nearly 1,100 deaths of children aged 1 to 19 years each year.

That makes it the second leading cause of unintentional injury death in this age group.

But not every drowning results in fatality. Some children survive a drowning…but doesn’t always mean a full recovery for the victim.

Lesia Crawford, of Phoenix, tells the story of how her younger brother, Andrew Hill, survived after falling in to a swimming pool- and what his life is like now, many years later.

For every pediatric drowning death, another two children are hospitalized after nonfatal drowning injuries.

And in Arizona, warm weather, long summers, and thousands of residential swimming pools that do not need to be drained in winter contribute to tragic water-related accidents among young children.

But there is good news.

Research results that will be released in the February 2012 issue of Pediatrics (published online Jan. 16), found rates of pediatric hospitalizations associated with drowning actually declined 49 percent during the study period, from 4.7 hospitalizations per 100,000, to 2.4 per 100,000.

The hospitalization rate for boys remained consistently higher than the rate for girls, though rates declined for all age groups and for both males and females.

Hospitalization rates decreased across all geographic regions of the U.S., with the greatest decline occurring in southern states.

The American Association of Pediatrics (check out their re-designed website) says that the study offers benchmarks that can be used to judge future efforts in drowning prevention and to target interventions to high-risk areas.

Shopping for toys? How to make sure they are safe

Put safety at the top of the list when choosing toys for young children, says the Arizona Chapter of the American Academy of Pediatrics.

Most parents are aware of the “age-appropriate” factor when they shop, says Sue Braga, AZAAP executive director.

But Braga adds that some may not realize that the high-tech toys that top the list for some kids can come with built-in risks to safety.

Look for a toy that is sturdy, made with non-toxic materials, isn’t too loud, and if it is an electric toy, that it is UL approved, says the AAP.

Ten tips from HealthyChildren.org on how to make sure toys are safe.

The Consumer Product Safety Commission highlights these five hazards that have caused injury or death in recent years:

  • Toys with small magnets, which can be swallowed and lead to serious medical problems if two or more magnets are swallowed.
  •  Toys with lithium button batteries that can be easily removed without a screwdriver and can be a hazard if swallowed.

Read more on what happens when a child swallows a button battery–and about the symptoms -in our RAK archives.

  •  Lead paint on recalled toys.
  •  Metals in children’s jewelry, which can include lead, cadmium and other toxic metals. Some manufacturers, now barred from using lead in children’s toys, began substituting cadmium, another dangerous metal.
  •  Any shooting toys or toys that have pieces that shoot or fly off. Reminder: BB guns and air guns are not actually “toys.” More on BB gun safety.

December has been designated National Safe Toys and Gifts Month. Do your homework, says the AZAAP—don’t assume that all toys on your child’s list are one hundred percent safe.

Other sites that can help parents choose safe toys:

Kids Health.org


Recalls from the U.S. Consumer Product Safety Commission