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Speech and Language Therapy Advice
HELPING A CHILD WITH FLUCTUATING HEARING LOSS
Some children suffer from hearing loss that comes and goes. This type of hearing
loss is called fluctuating hearing loss and is often related to colds and middle ear
infections. It can be relatively small and inconsistent (a problem one week, but not
the next). Whilst the odd bout is unlikely to have an impact on speech and language
development, persistent hearing problems can lead to delays in key communication
skills and unfortunately it can be very difficult to detect fluctuating hearing loss. The
following are a few warning signs that might indicate that a child needs their hearing
checked. Whilst one of these signs on its own is not of particular concern, if you feel
that a child is showing several signs then it would be good to discuss your concerns
with a Health Visitor, School Nurse or GP:
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A lot of colds, sore throats, coughs or ear infections.
The child seems to pull their ears a lot, complains about sore or popping ears
or has visible discharge from their ears.
The child seems to spend most of the time breathing through their mouth.
The child seems to daydream a lot or only does things when they want to.
(Remember that young children will find it hard to hear instructions when they
are focused on something. This is part of normal development and does not
necessarily relate to hearing difficulties.)
The child seems very restless and inattentive and isn’t interested in being told
stories.
The child either sits close to the television or turns the volume up.
The child is slow to follow instructions in a group.
The child has times when they are irritable, aggressive or loses their temper
easily.
The child is better at practical skills than those involving language.
The child has immature speech.
There are several things that you can do to help:
Try to make sure that the child is looking at you when you are speaking to them and
that you have their full attention before you begin talking. You might need to call their
name to help with this.
Make sure that you are not too far away from the child; 1 - 2 metres is a good
distance.
Make sure that you are at the child’s level when you are talking to them. Crouch
down so that they can see your face. Do not expect a child to hear conversation that
is going on above their head.
Try to make sure that your face is well lit when you are talking. This will help the
child to see what your mouth is doing. Try to stand with the light falling on your face
rather than in front of a light or window (this tends to put your face in the shade).
Try to limit the amount of noise that is going on in the background. Turn off the
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television or music and avoid lots of people talking at once.
Try to speak slowly and clearly. This does not mean that you over exaggerate your
words. Do not shout as this can distort what the child hears and tends to be very off
putting.
Give the child enough time to take in what you are saying. Do not rush to the next
idea and try to give the child extra clues if you change the topic. If necessary repeat
what you have just said.
Try to reward good behaviour as much as possible. It is easy for a child with hearing
difficulties to get bored and develop a negative self image. Praise helps a child to
feel valued and can encourage them to join in. It might help to give the child a clear
role in listening situations, eg. lifting a flap at story-time.
Try to talk about what is happening during the day. Focus on what the child is
looking at and interested in. Use short simple sentences with the right grammar, eg.
“Let’s put your coat on. Where is the sleeve? Push your arm through. Hello fingers.
Let’s do the buttons up. One, two, three, four.”
If it is hard to listen and a child has low levels of discomfort then they are likely to
become tired and disgruntled more quickly then other children. They may also tend
to appear shy and unsociable. It often helps if you can spend time quietly together
without talking. This helps them to feel supported and enables them to relax and
enjoy your company.
Remember to tell other people (such as grandparents or supply teachers) about
these suggestions so that the child is supported by as many people as possible.
Active Listening:
One of the biggest problems with children with fluctuating hearing loss is that their
hearing is so inconsistent that they learn to “tune out” and develop the habit of not
listening or participating. It is very important for them to learn that it is not silly to
mishear, but it is very silly not to let someone know or ask for a repeat. The following
ideas are ways in which you can encourage active listening skills:
- Let them see other people asking for a repeat when someone speaks softly or
mumbles. They might need help to learn to say “I didn’t hear.”
- Play listening games together to remind them that listening is worthwhile. This
might involve waiting for a signal before doing something, eg. putting a the next brick
on a tower, making different movements according to the sound you hear (clap when
you hear a bell and jump when you hear a whistle). There are lots of sound lotto
games available which can be fun to play, or you might make up your own. Once the
child understands how to play then try turning the sound down to low occasionally
and praise them for telling you that they cannot hear it.
- Say something silly every so often. You might throw a silly option in when asking
children a question, eg. “Would you like socks with your chips?” Another adult can
then model how to deal with this by asking you to repeat it.
- Give impossible directions for finding something either in a game or real life and
then praise them when they ask you for help.
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