Download Sensori- Neural Hearing Loss

Combined Child Health Service
Sensori- Neural Hearing Loss
Diagnostic and Patient Care Pathways
Diagnosis to School Leaver
November 2008
Combined Child Health Service
Table of Contents
Pathway 1 ............................................................................................................ 1
Well Baby .................................................................................................. 1
Pathway 2 ............................................................................................................ 2
High Risk Baby ......................................................................................... 2
Pathway 3 ............................................................................................................ 3
Late Onset Hearing Loss ......................................................................... 3
Pathway 4 ............................................................................................................ 4
Patient Care Pathway ............................................................................... 4
Guidance on the use of Sensori-neural Hearing Loss Patient Care
Pathway..................................................................................................... 5
Sensori-neural Hearing Loss ........................................................... 5
Universal Newborn Hearing Screening (UNHS) .............................. 5
Late onset hearing loss ................................................................... 8
Audiology Service ............................................................................ 9
Speech and Language Service ..................................................... 10
Information for Parents .................................................................. 11
Refer to Community Child Health .................................................. 12
Universal Child Health Screening .................................................. 13
Social Work Department ................................................................ 13
Education ...................................................................................... 14
Joint Assessment of Needs / Integrated Assessment.................... 16
Individual Educational Plan/ Co-ordinated Support Plan ............... 16
Key worker .................................................................................... 17
Regular Review ............................................................................. 17
Transfer to Adult Services ............................................................. 17
Annex 1 ................................................................................................... 18
Checklist for Reaction to Sounds................................................... 18
Checklist for Making Sounds ......................................................... 19
Documents used in the development of pathways ............................. 21
References .............................................................................................. 21
Working Group Members ...................................................................... 22
November 2008
Combined Child Health Service
Pathway 1
Well Baby
Birth of Baby
Universal Newborn Hearing Screening (UNHS)
Otoacoustic Emissions Test (OAE)
Offered to all well newborn babies
Clear response in
both ears
No Clear Response in
one ear (unilateral)
or
both ears (bilateral)
Automated Auditory Brainstem Response (AABR)
carried out by hearing screener
No Clear Response in
one ear (unilateral)
or
both ears (bilateral)
Thresholds within
Normal Range
Auditory Brainstem Response (ABR)
Diagnostic test carried out by Audiologist
Normal Hearing
Discharged from
Audiological
Services
November 2008
Mild/Moderate
Hearing Loss
Severe/Profound
Hearing Loss
Retest at 9 months of age
Unilateral: Retest at 9 months
Bilateral: Hearing aids fitted
before child is 6 months old
Regular Follow up with Audiological Services
1
Combined Child Health Service
Pathway 2
High Risk Baby
Birth of Baby
Clear response in
both ears
Repeat Hearing Test
Required
If child identified as having
high risk of progressive
hearing loss
NO
Universal Newborn Hearing Screening (UNHS)
Automated Auditory Brainstem Response







Offered to all newborn babies with high risk factor
family history,
in Neonatal Unit,
repeated courses of aminoglycoside,
high bilirubin level requiring transfusion,
proven or possible congenital infection,
craniofacial abnormalities including chromosomal or
syndromic conditions, (e.g. Down’s Syndrome, cleft palate)
Neurodegenerative or neurodevelopmental disorder
YES
Repeat Hearing Test
Carried out at 9 months
(corrected age)
Thresholds
within Normal
Range
No Clear Response in
one ear (unilateral)
or
both ears (bilateral)
Auditory Brainstem Response (ABR)
Diagnostic test carried out by Audiologist
Normal Hearing
Possible Hearing
Loss
Discharged from
Audiological Services
November 2008
Mild/Moderate
Hearing Loss
Severe/Profound Hearing
Loss
Retest at 9 months of age
unilateral or bilateral
Unilateral: Retest at 9 months
Bilateral: Hearing aids fitted
before child is 6 months old
Regular Follow up with Audiological Services
2
Combined Child Health Service
Pathway 3
Late Onset Hearing Loss
Hearing Concerns
Possible acquired Hearing Loss
Parental or professional concerns about,
development of auditory behaviour, vocal
behaviour, social communication skills
confirmed or suspected bacterial meningitis,
middle ear disease
Head Injury
Hearing within
normal range
Refer to Audiology Services
for age appropriate testing
Conductive hearing loss
(persistent)
Refer to ENT Services
Under 4years of age
Combined Hearing
Assessment Clinic
(CHAC)
4 years and over
ENT Clinic
Sensori-neural hearing loss in
one ear (Unilateral)
or
both ears (Bilateral)
Requiring hearing aid
Paediatric hearing aid
clinic (3rd Tier)
Hearing aids not
required or refused
Regular monitoring at
Paediatric Audiology
clinic (PAC)
Discharge from
Audiology services
Ongoing Audiology
Assessment
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Combined Child Health Service
Pathway 4
Patient Care Pathway
Ongoing Audiology Assessment
Paediatric Hearing Aid Clinic (3rd Tier) – hearing aid prescription,
fitting, verification, and regular maintenance of hearing aids
Liaise with multidisciplinary services
ENT Services – middle ear effusion (glue ear), wax,
Cochlear implant referral if appropriate
Education
Community Child Health Services
Social Work
Liaise with Hearing
Support Service from
time of diagnosis
Identify any additional
support for learning
needs
Educational Psychology
Aetiological investigation, developmental
progress, management of medical
conditions, genetic referral, assessment of
communication by speech and language
therapist
Liaise with Audiology, ENT Services,
General Practitioner, Allied Health
Professional Services, Educational
Psychology, Hearing Support Service,
Nursery, School, Social Work
Identify any
Social Care and
Support Needs of
the child/young
person and the
family
Mainstream Nursery
Developmental
Nursery
Mainstream School
Specialist Unit
Special school
Joint Assessment of Need
Integrated Assessment Framework Action Plan
Key Worker Appointed
(Not yet implemented)
+/- Individual Education Plan/
Co-ordinated Support Plan
Regular review and reassessment of needs by
various professionals, involving parents and
child as appropriate
Transfer to appropriate adult specialities.
Taking into account existing services for the
young person
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Combined Child Health Service
Guidance on the use of Sensori-neural Hearing Loss Patient
Care Pathway
Sensori-neural Hearing Loss
Sensori-neural hearing loss results from damage to the neural receptors in the
inner ear (the hair cell, organ of Corti), the nerve pathway to the brain (notably
the auditory nerve), or the area of the brain that receives sound information.
This type of hearing loss is usually permanent.
Level of hearing loss may worsen as the child grows older, depending on the
cause of the hearing loss.
Levels of Hearing Loss: If a sound has to be greater than 20dB for a person
to hear it, then they are said to have a hearing loss. There are 4 different
levels of hearing loss:
Mild: quietest sound heard is between 21-40dB. Person will have difficulty
following a conversation if the speaker is more than six feet away or if there is
background noise.
Moderate: quietest sound heard is between 41-70dB. Person can hear if
speaker spoke loudly about three-five feet away.
Severe: quietest sound heard is between 71-95dB. Person can hear if
speaker shouts from about a foot away.
Profound: quietest sound heard louder than 95dB. Person can only hear very
loud sounds.
Universal Newborn Hearing Screening (UNHS)
The objective of the UNHS screening programme is to identify, as soon after
birth as possible ‘Significant’ (more than 40dB of loss, i.e. infants with
moderate, severe or profound losses) Permanent Congenital Hearing
Impairment (PCHI), which can then be treated to give the baby the best
chance of compensating for their hearing loss. It is well documented that
infants whose hearing loss is identified early and dealt with appropriately
develop better speech and language skills than those diagnosed after six
months of age.
Using the distraction test, (which was carried out when the babies were
between 7-8 months old) some children with hearing impairment were not
detected until the children were at least 18 months and some not until they
were 3-4 years old.
Universal Newborn Hearing Screening is offered to parents of all newborn
babies in Scotland within the first four weeks after birth, thus reducing the age
in which hearing impairment is confirmed and therefore improving the child
educational and social needs.
(NHS Quality Improvement Scotland 2005)
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Combined Child Health Service
Newborn Hearing Screening allows the identification of two groups of babies:
 Babies who have passed their hearing screening and therefore need
only be investigated further if they are at risk of late-onset or
progressive hearing loss.
 Babies who have failed their hearing screen and need to have further
testing to establish their hearing status.
Prior to hearing screening being carried out parents will receive information
leaflets explaining the Newborn Hearing Screening Programme.
1. Your Baby’s Hearing Screen
2. Your Baby’s Visit to the Audiology Clinic
The information leaflets may be give out at the Antenatal Clinic (at 34 weeks
gestation), in maternity hospital prior to testing or sent out to parents with
hearing screening appointment.
UNHS is carried out using, Otoacoustic Emission Test (OAE), Automated
Auditory Brainstem Response (AABR) testing or a combination of both may
be required. Further assessment may also be required using threshold
Auditory Brainstem Response (ABR).
Parents of all newborn babies in Grampian are offered the OAE or AABR test.
Otoacoustic Emissions Test (OAE): is a non invasive test which tests the
hearing receptor organ, or cochlea. The OAE tests the auditory pathway up to
but not beyond the cochlea. It does not test the connections between the
cochlea and the hearing centres of the brain stem.
OAE is an automated system with the hearing screener only having to
position the probes in the baby’s ears and help settle baby if required.
A soft tipped probe is placed in baby’s ear canal. This sends clicking sounds
down the ear and records the ear’s response using a microphone which is
incorporated in the probe. When the ear receives sounds, the cochlea usually
produces an echo. Using computer software the hearing screener can see
how both ears respond to sound, whether the response is a clear response
or no clear response.
Automated Auditory Brainstem Response (AABR): is a non invasive test
which tests the pathway up to the brainstem, with results being affected by
any problem in the outer or middle ear.
This involves three small sensors being placed on the baby’s head. Soft
earphones are placed over the baby’s ears and a series of clicking sounds are
played while the electrodes record the brain’s electrical activity. The computer
software assesses the electrical activity for the presence of an auditory
component and gives a decision of clear response or no clear response.
Clear Response
If a clear response is obtained in both ears the baby may be discharged from
Audiology care. Parents will receive checklists to refer to if they have
concerns about their child hearing, these are, Reaction to Sounds and Making
Sound. (See annex1)
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Combined Child Health Service
A clear response from a baby with any of the following high risk factors may
require a repeat hearing test at 9 months old (corrected age if premature).
 Family history of sensori-neural hearing loss
 Admitted to Neonatal Unit
 Repeated courses of aminoglycoside or aminoglycoside levels in toxic
range at any time.
 Jaundice where bilirubin level indicated a need for exchange
transfusion
 Proven or possible congenital infection
 craniofacial abnormalities including chromosomal or syndromic
conditions, (e.g. Down’s Syndrome, cleft palate)
 Neurodegenerative or neurodevelopmental disorder
(NHS Scotland Screening Programmes, 2004)
All professionals involved in the care of children e.g. General Practitioners
Health Visitors, Child Development Services, ENT Services, Speech and
Language Therapists, Nursery and school staff should remain aware of the
possibility of hearing loss at any age despite a clear response on newborn
hearing screening. Refer back to Audiology can be made at any time if
parents and/or professionals have any concerns.
No Clear Response
If there is no clear response in one or both ears ABR testing will be carried out
by the audiologist.
Auditory Brainstem Response (ABR): reflects activity of the cochlea nerve
and the auditory brainstem pathways, therefore assessing hearing beyond the
cochlea.
Threshold ABR is carried out by an audiologist to establish accurate levels of
hearing
Unilateral
Threshold within normal range with ABR testing (In Grampian accepted
normal response of 40dB), discharged from Audiology. Checklists given to
parents.
No clear response (raised level greater than 40dB), retest at 9 months old
(corrected age if premature). If clear response, child discharged from
Audiology service.
Bilateral
Mild/Moderate hearing loss, child retested at 9 months old (corrected age if
premature). If hearing remains at same level after retesting discuss with
parents use of hearing aid. Hearing checked yearly
Severe/Profound hearing loss, use of hearing aids discussed with parents.
Ideally hearing aids should be prescribed and fitted before the child is 6
months old.
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Combined Child Health Service
Late onset hearing loss
Late onset hearing loss may be progressive or acquired and cannot be
detected at Newborn hearing screening.
As Health Visitor distraction tests and primary one (school entry) tests are no
longer carried out it is important that professionals are vigilant in detecting
these types of hearing losses.
Any suspicion of persistent hearing loss of any degree requires prompt
referral for hearing assessment.
Age appropriate hearing tests will be carried out by Audiology services e.g.
Visual Reinforced Audiometry (VRA): This is a test which establishes the
child’s behavioural response to sound.
Using an audiometer sounds of different volumes and frequencies are played
through speakers. When the child hears the sound they turn their head
towards the source and are rewarded by a visual display such as a toy lighting
up.
Performance Testing: In this test a child is conditioned to wait for an auditory
stimulus and then respond in a play activity such as placing the man in a boat.
The test is started with a demonstration by the tester. The tester holds the
man ready to respond then promptly places the man in the boat when the
sound stimulus is heard. After a few demonstrations the child should be
offered the toy and the response guided by the tester. Once the child is
prepared they should hold the item ready to respond for up to 10 seconds.
The tester should vary the time between sound stimuli from 1-10 seconds to
reduce the possibility of anticipatory responses.
Nottingham Toy Test (McCormick): The test is administered by setting out a
display of toys containing only paired items known to the child. The child is
conditioned to point to the toys on request. Children with normal hearing can
identify the items at a minimal listening level of 40dB the aim of the test is to
determine the quietest level at which the child can identify the items with 80%
success.
Pure Tone Audiometry: an audiometer generates sounds at accurate
volumes and frequencies. Sounds are played through headphones and the
child is asked to respond when they hear them e.g. moving a toy, placing a
peg into a board, pressing a button or saying yes.
Tympanometry: Shows how mobile the eardrum is. An eardrum needs to be
flexible to allow sound to pass through it. A small earpiece is placed gently
into the ear canal allowing gentle air pressure changes to be applied. The
eardrum should move freely in and out with the change in pressure. The
earpiece measures this by checking the sounds reflected by the eardrum. If
the eardrum is too ridged (there is fluid (glue) behind it) the sounds bounce
back off the eardrum instead of going through it. The amount of sound
bounced back determines if the child has glue ear.
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Combined Child Health Service
Audiology Service
The Audiology service provides age appropriate hearing tests to evaluate the
degree, extent and nature of any hearing loss.
When hearing loss is identified in a child appropriate Audiology support is
provided, this may involve monitoring the situation or the fitting of hearing
aids.
Audiology support will continue even although a child/young person declines
the option of having a hearing aid fitted.
If significant permanent hearing loss is identified, attendance at Audiology
clinic will be required for hearing aid fitting/ trial.
Review will take place approximately 4-6 weeks after the initial fitting then as
required to test hearing, verify and evaluate hearing aid function. Once
satisfactory fit of hearing aid established the child/ young person will have an
annul review. The child/young persons hearing levels, use and effectiveness
of the hearing aid and ear-mould impressions are usually taken at this time.
A written report of the child’s Audiology results and findings will be sent to,
Hearing Support Service, Speech and Language Therapy and Community
Child Health Department. A copy of the report may also be sent to Social
Work Department if they are involved with the child/ young person and
parental/patient consent is obtained.
Hearing aids and ear moulds are maintained on a regular basis and
repaired/replaced as required by the Audiology Department at the Royal
Aberdeen Children’s Hospital.
Pre-School followed up monthly - yearly at Audiology clinic.
School aged children followed up yearly at Audiology clinic.
If the child has any underlying ENT problem they will be reviewed at the
combined ENT/Audiology clinic.
If evidence of little or no benefit from use of conventional hearing aids the
child may be referred through the ENT Services for cochlear implant
assessment.
The cochlear implant team based at Crosshouse Hospital Kilmarnock will
guide parents and professionals to the child’s suitability for a cochlear implant.
(suitability of anatomical structure of cochlea, medical cause of hearing loss,
age of child in relation to hearing loss) Many factors have to be taken into
account which will be discussed with parents at time of assessment, to decide
whether proceeding to surgical implant is in the child’s best interest.
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Combined Child Health Service
Speech and Language Service
Communication assessment and progress of language skills is carried out by
Speech and Language therapy.
The Speech and Language Service is available throughout Grampian and can
be accessed by referral to:North Aberdeenshire
c/o Manager / Lead Therapist
SLT Department
Chalmers Hospital
Clunie Street
Banff
AB45 1JA
Tel: 01261 879149
Aberdeen City
c/o Manager / Lead Therapist
SLT Department
Airyhall Clinic
Springfield Road
Aberdeen
AB15 7RF
Tel: 01224 310582
Central Aberdeenshire
c/o Manager / Lead Therapist
9 Watson Avenue
Huntly
AB54 8BF
Tel: 01466 765013
Moray
c/o Manager / Lead Therapist
SLT Department
Spynie Hospital
Elgin
IV30 5PW
Tel: 01343 567162
South Aberdeenshire
c/o Manager / Lead Therapist
Arduthie Lodge
Community Hospital
Kirkton road
Stonehaven
AB39 2NJ
Tel: 01569 792067
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Combined Child Health Service
Information for Parents
Parents of children diagnosed with Sensori-neural hearing loss will require
clear verbal and written information about the condition and of any associated
health issues.
NHS Scotland, Newborn Hearing Screening Programme has produced a
booklet “Your Baby has Hearing Loss”, available from the Audiology clinic.
Providing information on local support groups and other national and local
resources will empower parents in the care of their child.
Further sources of information include:
Grampian Deaf Children’s Society
Website: www.grampiandcs.org
Contact chairperson or vice chairperson for details
Chairperson
Vice Chairperson
Jim Neish
Carrie Heddle
60 Highfield Walk
63 Alder Drive
Turriff
Portlethen
Aberdeenshire
Aberdeen
AB53 4LG
AB12 4WA
Tel: 01888 562089
Tel: 07866 856356
Email: [email protected]
Email:[email protected]
National Deaf Children’s Society Scotland
187-189 Central Chambers
93 Hope Street
Glasgow
G2 6LD
Tel: 0141 248 4457
Website: www.ndcs.org.uk
NDCS Family Support Workers
Alan MacQueen
Tel: 01382 500580
Email;[email protected]
Debbie Taylor
National Deaf Children’s Society
16 Kenneth Street
Inverness
IV3 5NR
Tel: 01463 226509
Mobile: 07800658286
Email: [email protected]
Aberdeen & North East Deaf Society
13 Smithfield Road
Aberdeen
AB24 4NR
Tel: 01224 494566
Email: [email protected]
Website: www.aberdeennedeaf.org.uk
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Combined Child Health Service
Refer to Community Child Health
Community Child Health is available at local clinics throughout Grampian and
can be accessed by referral to:Community Child Health Department
Royal Aberdeen Children’s Hospital
Westburn Road
Aberdeen
AB25 2ZG
Raeden Centre
Midstocket Road
Aberdeen
AB15 5PD
or
Dr A Liebenberg
Ward 2
Dr Gray’s Hospital
Pluscarden Road
Elgin
IV30 1SN
The Audiology department liaises regularly with Community Child Health.
Further to receiving this information a medical appointment for Community
Child Heath may be offered to manage health and development needs. This
may include aetiological investigation and management of any medical
condition if parents wish. Referral to Genetic services is offered to assess risk
to any further planned children.
Community Child Health will liaise with parents and relevant professionals
involved with the child’s care to help plan and provide appropriate support for
the child and their family as required.
Referral to Ear, Nose and Throat (ENT) Services may be required for wax and
middle ear effusion (glue ear) as this may compromise efficiency of hearing
aids.
Liaison with ENT Services, Audiology, Health Visitor, Allied Health
Professionals, Social Work, Hearing Support Service, Educational Psychology
and Nursery School/School may be required to ensure the child’s care and
social needs are being met.
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Combined Child Health Service
Universal Child Health Screening
The early identification of a child requiring an assessment for health problems
and developmental disorders is the aim of the child health screening and
surveillance programmes.
Health for all Children (Hall 4) has led to a significant change in screening and
surveillance in Scotland.
All children receive a health check when starting primary school, with little
formal child health surveillance after that. In school aged children detection of
problems should be part of mainstream school life.
Hall 4 states:Formal screening should be confined to the evidence based programmes
agreed by the National Screening Committee.
Health professionals must respond promptly to parental concerns.
Formal universal screening for speech and language delay, global
developmental delay and autism is not recommended.
Children starting school should receive the agreed screening programmes.
Health care of school-age children should include support for children with
problems and special needs.
Scottish Executive 2005
Early identification, early therapeutic and educational intervention, and
seamless delivery of services may help a child to maximise their potential.
Social Work Department
An assessment of need may be carried out to determine what support and
services are required by the child and their family. This may include respite
care, play schemes for child or siblings and details of available financial
assistance.
The Aberdeen and North East Deaf Society (ANEDS) provide a service for
children/young people and their family in Aberdeen City, Aberdeenshire and
Moray.
This service can be accessed by contacting:Aberdeen & North East Deaf Society
13 Smithfield Road
Aberdeen
AB24 4NR
Tel: 01224 494566
Email: [email protected]
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Combined Child Health Service
Education
The Hearing Support Team can provide information on services available for
the child after the initial diagnosis, with the consent of the child’s parents. An
initial assessment can be carried out to establish the type and level of support
required by the child and their family. The teacher for the deaf will discuss
with the child’s parents (when the parents feel able) the range of
communication approaches available and enable the parents to make an
informed choice.
The Hearing Support Service is available throughout Grampian and can be
accessed by referral to:Hearing Support Services
Aberdeen school for the Deaf
c/o Sunnybank School
Sunnybank Road
Aberdeen
AB24 3NJ
Tel: 01224 261722
Sensory Education Service
Beechbrae Education Centre
Duffus Road
Elgin
IV30 4NP
Tel: 01343 557921
Aberdeenshire Sensory Support Service
Hearing Support Service
Westhill Academy
Hay’s Way
Westhill
Aberdeenshire
AB32 6XZ
Tel: 01224 744786
The Health Service may identify a child as appearing to have additional
support needs arising from a disability and bring this child to the attention of
the education authority. The educational authority will decide whether to
assess the child to find out if they have additional support needs and will
determine what support is required.
The educational authority in partnership with the parents will decide if the child
attends a mainstream nursery school, developmental nursery, mainstream
school, a specialist unit attached to a mainstream school or a special school.
All three and four year olds in Scotland are entitled to a funded part time preschool education placement.
The Education (Additional Support for Learning) (Scotland) Act 2004 (ASL
Act) introduced a new framework for providing support to children and young
people who require additional help with their learning.
The education authority may then, at its discretion, establish whether the child
has additional support needs arising from a disability under its arrangements
for identifying and providing for children with additional support needs. Once it
is established by the educational authority the child has additional support
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Combined Child Health Service
needs, the authority would then have a duty to provide suitable provision to
meet those needs.
The Additional Support for Learning Act requires an educational authority to
provide additional support to certain disabled pre-school children in their area
who are under 3 years old.
The ASL Act aims to ensure that all children and young people are provided
with the necessary support to help them work towards achieving their full
potential. The ASL Act also promotes collaborative working among all
agencies involved with supporting children.
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Combined Child Health Service
Joint Assessment of Needs / Integrated Assessment
Joint assessment of needs is a co-ordinated Multi-Agency approach to
gathering information and aims to avoid parents having to repeat information
more than once, giving a holistic view of the child within their family and
community enabling assessment of medical, social and educational needs.
Action plans are developed using the systematic assessment and analysis of
the information obtained about the child. The child and their family may
participate in the development of the action plan.
An action plan records the needs and the professional responses and
responsibilities to the child, outlining the basis for providing support, services
and resources to meet the needs of the child.
An action plan should state:
 what action should be taken
 by whom to improve the child’s circumstances
 the reasons for the plan
 timescales
 intended outcome and future review date
The plan should be as simple as necessary and relevant to the child's needs.
It should be updated or amended as needs change.
Individual Educational Plan/ Co-ordinated Support Plan
An Individual Educational Plan (IEP) describes in detail the nature of the
child’s additional support needs, the ways in which these are to be met, the
learning outcomes to be achieved, and specifies what additional support is
required. The IEP should be reviewed and updated regularly, involving the
parents and child (where possible).
A Co-ordinated support plan is prepared for children who:
 need support due to complex or multiple factors that have a significant
adverse affect on their education
 require significant involvement from one or more additional agencies
such as health and social work
 will need support for more than a year
The aim of a co-ordinated support plan is to ensure that the various
professionals and agencies involved in providing support are working together
and that the support is co-ordinated.
A Co-ordinated support plan:
 is an action plan for children who require significant additional support
with their education
 supports partnership working to help children achieve educational
targets
 is monitored and reviewed regularly
 involves the child, their family, education, and additional agencies
(Enquire 2007)
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Combined Child Health Service
Key worker
A key worker is a named person who works in partnership with the family and
can provide a link between professionals and agencies involved in the child’s
care. Key workers can co-ordinate access to, and delivery of services
required from various agencies.
Regular Review
The child will have regular reviews carried out by the various professionals
and agencies involved in their care. Their needs will be reassessed and plans
updated as require.
Transfer to Adult Services
Transfer from Paediatric Audiology Services to Adult Services at Woolmanhill
hospital is offered to the young person on leaving school.
The adult service will initially offer the young person an annual review of their
hearing levels, use and effectiveness of the hearing aid and check ear-mould.
Self referral to the Adult Audiology Service can be made at any time by
existing hearing aid users.
A walk in hearing aid clinic is also available for repair/replacement of aids and
battery renewal.
Referral can be made to adult speech and language service if required.
Educational Psychology service is available if required until the young person
is 23 years old.
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Annex 1
Checklists for Parents
These two lists give pointers about what parents need to look and listen out
for as their baby grows to check if they can hear.
Checklist for Reaction to Sounds
Shortly after birth, a baby:
 Is startled by a sudden loud noise such as hand clapping or a door
slamming.
 Blinks or opens eyes widely to such sounds or stops sucking or starts
to cry.
At 1month, a baby:
 Starts to notice sudden prolonged sounds like the noise of the vacuum
cleaner and may turn towards the noise.
 Pauses and listens to noises when they begin.
At 4 Months, a baby:
 Quietens or smiles to the sound of familiar voice even when unable to
see speaker and turns eyes or head towards the voice.
 Shows excitement at sound e.g. voices, footsteps etc.
At 7 Months, a baby:
 Turns immediately to familiar voice across the room or to very quiet
noises made on each side ( if not too occupied with other things)
At 9 Months, a baby:
 Listens attentively to familiar everyday sounds and searches for very
quiet sounds made out of sight.
At 12 months, a baby:
 Shows some response to name. May also respond to expressions like
“no” and “bye bye” even when an accompanying gesture cannot be
seen.
If at any stage in the baby or child’s development you think he/she may have
difficulties hearing, contact your Health Visitor or General Practioner.
(Adapted from: The “can your baby hear you” B McCormack, 1982 Children’s
Hearing assessment Centre, Nottingham, UK)
Universal Newborn Hearing Screening (2003)
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Checklist for Making Sounds
At 4 months, a baby:
 Makes soft sounds when awake.
 Gurgles and coos
 At 6 months, a baby:
 Makes laughter-like sounds.
 Starts to make sing-song vowel sounds e.g. a-a, muh, goo, der, aroo,
adah.
At 9 months, a baby:
 Makes sounds to communicate in friendliness or annoyance.
 babbles (“da da da”, “ma ma ma”, “ba ba ba”).
 Shows pleasure in babbling loudly and tunefully.
 Starts to imitate other sounds like coughing or smacking lips.
At 12 months, a baby:
 Babbles loudly, often in a conversational-type rhythm.
 May start to use one or two recognisable words.
At 15 months, a baby:
 Makes lots of speech-like sounds.
 Uses 2-6 recognisable words meaningfully (“teddy” when seeing or
wanting the teddy bear).
At 18 months, a baby:
 Makes speech-like sounds with conversational-type rhythm when
playing.
 Uses 6-20 recognisable words.
 Tries to join in nursery rhymes and songs
At 24months, a child:
 Uses 50 or more recognisable words appropriately.
 Puts 2 or more words together to make simple sentences e.g. more
milk.
 Joins in nursery rhymes and songs.
 Talks to self during play (may be incomprehensible to others).
At 30 months, a child:
 Uses 200 or more recognisable words.
 Uses pronouns (I, me, you)
 Uses sentences but many lack adult structure.
 Talks intelligibly to self during play.
 Asks questions.
 Says a few nursery rhymes.
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At 36 months, a child:
 Has a large vocabulary intelligible to everyone.
(Adapted from: MD Sheridan (revised by Frost and Sharma), 1997 Routledge,
London. New York)
Universal Newborn Hearing Screening (2003)
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Combined Child Health Service
Documents used in the development of pathways
NHS Quality Improvement Scotland (2005), Pregnancy and Newborn
Screening – Clinical Standards
NHS Scotland, National Services Division (2003), Universal Newborn Hearing
Screening, Information for Health Professionals
NHS Scotland Screening Programmes (2004), National Service Division,
Guidelines for Surveillance and Targeted Audiological Monitoring of Infants
and Children following Newborn hearing Screening
NHS Scotland, National Services Division (2007), Universal Newborn Hearing
Screening
References
Enquire, Planning children’s and young peoples learning,
www.enquire.co.uk (accessed 2007)
NHS Quality Improvement Scotland (2005), Pregnancy and Newborn
Screening – Clinical Standards
NHS Scotland, National Services Division (2003), Universal Newborn Hearing
Screening, Information for Health Professionals
NHS Scotland, Newborn Hearing Screening Programme (2006) Your Baby’s
Hearing screening
NHS Scotland, Newborn Hearing Screening Programme (2006) Your Baby’s
Visit to the Audiology Clinic
NHS Scotland, Newborn Hearing Screening Programme (2006) Your Baby
has Hearing Loss
NHS Scotland Screening Programmes (2004), National Service Division,
Guidelines for Surveillance and Targeted Audiological Monitoring of Infants
and Children following Newborn hearing Screening
Scottish Executive, Education (Additional Support for Learning) (Scotland) Act
2004
Scottish Executive, (2005) Getting it Right for Every Child
Scottish Executive, (2005) Health for all Children
Whurr Publishers London, (1993) Paediatric Audiology 0-5 years 2nd Edition
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Working Group Members
Jackie Crum (chair)
Consultant Paediatrician
Ena Cromar
Project Co-Ordinator, Children with Disabilities
Suleman Daud
Consultant Paediatrician
Pat Dinwoodie
Head of Sensory Support Services Aberdeenshire
Deirdre Ferguson
Head of Sensory Support Services Moray
Carrie Heddle
Parent Representative
Grampian Deaf Children’s Society Representative
Audrey Henderson
Head Paediatric Audiologist
Andre Liebenberg
Consultant Paediatrician
Alison Martin
Acting Head of Sensory Support Services
Aberdeen City
Jackie McDonald
Staff Grade
Gordon McHardy
Head of Audiology Services
Dawn Proe
Social Worker Grampian Deaf Children’s Society
Ewan Rennie
Education Psychologist Aberdeen
Elma Stephen
Consultant Paediatrician
Hazel Welbon
Speech and Language Therapist Aberdeenshire
Sharon Yates
Newborn Hearing Screening Coordinator
Ruth Young
Speech and Language Therapist Aberdeen
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