Hearing and Vision
Screening
Who, When, and Why
Hearing & Vision
• For the newborn, hearing his/her parents
voices started as a fetus in the uterus. After
birth, the newborn now gets to put a face on
those familiar voices.
• This is where the communication initiates.
• It all starts at the top.
Hearing & Vision
• Who receives Hearing & Vision Screening?
• When do children receive Hearing & Vision
Screenings?
• Why do children receive Hearing & Vision
Screenings?
WHO
• NEWBORNS
• On January 1, 2003 the universal newborn
screening for hearing loss program began in
Illinois. The goals of the program include
detection of hearing loss in infants before 3
months of age and the initiation of
appropriate intervention no later than 6
months of age.
State Programs
• States have taken a variety of approaches to
address this issue: some mandate that all
hospitals or birthing centers screen infants for
hearing loss before they are discharged; some
mandate that insurance policies cover the cost
of the screening; others use state dollars to
fund screening programs.
THE ILLINOIS NEWBORN HEARING
PROGRAM
• IDPH is charged with maintaining a registry of
infants in need of follow-up. In addition, IDPH is
required to refer children with confirmed hearing
losses for services to minimize problems caused
by the impairment.
• For further information about the Illinois
Newborn Hearing Program, contact the IDPH
Newborn Hearing Program team at (voice) 217782-4733 or (TTY) 800-547-0466.
THE ILLINOIS NEWBORN HEARING
PROGRAM
• The Illinois Newborn Hearing Screening
Program maintains the registry of infants in
need of follow-up testing through three
stages:
Screening;
Audiologic evaluation of those with an
abnormal result (confirmation); and
Early intervention for those with confirmed
hearing impairment
Who
• In addition to newborn screenings routine
screenings are also required.
Who
• According to the IDPH Vision and Hearing
Screening Codes (77 Ill. Adm. Code 675 and
685), vision and hearing screening services
"shall be provided annually for all preschool
children three years of age or older in any
public or private educational program or
licensed child care facility."
WHO
• Department of Children Services also require routine
hearing and vision screenings.
• Part 407.310, Health Requirements for Children: "D). The
center shall ensure that hearing and vision screening
services are provided annually in accordance with Illinois
Department of Public Health’s Hearing and Vision Screening
Codes (77 Ill. Adm. Code 675 and 685) and the Illinois Child
Vision and Hearing Test Act (410 ILCS 205)."
Who
• Can perform hearing and vision screenings:
• Certification by the State of Illinois as a
licensed Vision Screening Technician and
Hearing Screening Technician is required for
individuals performing hearing and vision
screenings.
When
• According to both DCFS and Illinois
Department of Public health, screenings are to
be obtained annually.
Hearing & Vision
• As the infant grows his/her body systems grow
and develop.
• Hearing and vision interventions are required
for the infants and children to reach
developmental milestones.
• It is of utmost importance that with hearing
and vision screenings infants and children can
successfully grow and develop.
WHY
• The first three years of life are the most
important for language and speech development.
• Consequently, for many infants and young
children with unidentified hearing impairment,
much of the crucial period for language and
speech development may be lost.
• This in turn leads to lower reading abilities,
poorer academic achievement and fewer career
opportunities (Task Force on Newborn and Infant
Hearing).
State Programs
With early intervention in mind, states have taken
action to ensure children are screened and treated
early for hearing loss.
Screening programs are typically cost-effective.
WHY
• According to the American Academy of
Pediatrics, hearing loss is one of the most
frequently occurring birth defects;
approximately 3 infants per 1,000 are born
with moderate, profound or severe hearing
loss. Hearing loss is even more common in
infants admitted to intensive care units at
birth.
Why
• According to the Centers for Disease Control and
Prevention, of the nearly 4 million infants born in the
United States in 2005, 91.5 percent were screened for
hearing loss. States have taken a variety of approaches to
this issue: some mandate that all hospitals or birthing
centers screen infants for hearing loss before they are
discharged; some mandate that insurance policies cover
the cost of the screening; others use state dollars to fund
screening programs. Still other states require that
information on hearing screening be available to parents
before they leave the hospital. Fourteen states allow
newborns to be exempt from universal hearing screening
programs if a parent objects to the testing.
Why
• If hearing loss is not detected and treated
early, it can impede speech, language and
cognitive development. Over time, such a
delay can lead to significant educational costs
and learning difficulties.
Why
• With early intervention in mind, states have
taken action to ensure children are screened
and treated early for hearing loss.
• Screening programs are typically cost-effective
and amount to about $10-$50 per baby,
according to NCHAM. National Center for
Hearing Assessment and Management
Why
• The National Center for Hearing Assessment
and Management (NCHAM) reports that
detecting and treating hearing loss at birth
for one child saves $400,000 in special
education costs by the time that child
graduates from high school.
State Programs
• The hospital are required to maintain written
documentation in the infant’s clinical record.
• Such documentation shall include:
 Procedures used for hearing screening
 Time and location for the screening
 Individual administering the screening test
 Screening results per ear, for each and every
screening or screening attempt and
recommendations for further testing.
State Programs
• Vision and hearing screening services shall be
administered to all children as early as
possible, but no later than their first year in
any public or private education program,
licensed day care center or residential facility
for handicapped children; and periodically
thereafter, to identify those children with
vision or hearing impairments or both so that
such conditions can be managed or treated.
410 ILCS 205/3)
How the Ear Works
• A baby's hearing, is fully mature by the end of
his first month outside the womb.
• Hearing system is based solely on physical
movement.
• Your ears are one of the most incredible parts
of your body!
Hearing
• To hear sound, your ear has to do three basic
things:
• Direct the sound waves into the hearing part
of the ear
• Sense the fluctuations in air pressure
• Translate these fluctuations into an electrical
signal that your brain can understand
The Ear
The Ear
Pinna/Outer Ear
• The outer structure of the
ear.
• Funnel and focus sound
waves on their way to the
middle ear and auditory
canal.
Sound Waves
The Ear
Middle Ear
• The middle ear contains the
auditory canal / ear drum
The Ear
Inner Ear
• The inner ear functions for
purposes of equilibrium
Infections of The Ear
• An ear infection, or otitis media, is the most
common cause of earaches.
• Can affect children and adults.
Infections of The Ear
• It very often accompanies a common cold, the
flu, or other types of respiratory infections.
This is because the middle ear is connected to
the upper respiratory tract by a tiny channel
known as the eustachian tube.
• Germs that are growing in the nose or sinus
cavities can climb up the eustachian tube and
enter the middle ear to start growing.
Infections of The Ear
• In children and infants, the eustachian tube is
often too soft or immature and has a harder
time staying open.
• Allergies, post nasal drainage, sinus
infections, and adenoid problems can all
interfere with the eustachian tube’s ability to
let air pass into the middle ear.
Infections of The Ear
• When the doctor looks at the ear drum, he or
she will see that it is red, often bulging, and be
able to make the diagnosis of an ear infection.
Infections of The Ear
• Ear infections occur in various patterns. A
single, isolated case is called an acute ear
infection (acute otitis media).
• If the condition clears up but comes back as
many as three times in a six-month period (or
four times in a single year), the person is said
to have recurrent ear infections (recurrent
acute otitis media).
Infections of The Ear
• Recurrent acute otitis media usually indicates
the eustachian tube isn't working well.
• A fluid buildup in the middle ear without
infection is a condition where fluid stays in the
ear because it is not well ventilated, but germs
have not started to grow.
Infections of The Ear
In recent years, scientists have identified the characteristics of
people most likely to suffer recurrent middle ear infections:
• Males
• Individuals with a family history of ear infections
• Babies who are bottle-fed (breastfed babies get fewer ear
infections)
• Children in day care centers
• People living in households with tobacco smokers
• People with abnormalities of the palate, such as a cleft palate
• People with poor or damaged immune systems or chronic
respiratory diseases such as cystic fibrosis and asthma
Complications of Ear infections
• Chronic or recurrent middle ear infections can
have long-term complications. These include
scarring of the eardrum with hearing loss,
speech and language developmental
problems, and meningitis.
Complications of Ear infections
• A hearing test may be needed if you child
suffers from chronic or frequent ear
infections.
Ear Tubes
• If your child has recurrent ear infections or
fluid that just won’t go away, hearing loss and
a delay in speech may be a real concern. One
solution is for your doctor to insert small
tubes through the eardrum.
Ear Tubes
• Ear tubes let fluid drain out of the middle ear
and prevent fluid from building back up. This
can decrease pressure and pain, while
restoring hearing. The tubes are usually left in
for 8 to 18 months and most often fall out on
their own.
Preventing Ear Infections
• The biggest cause of ear infections is the
common cold, so one strategy for prevention
is to keep cold viruses at bay. The most
effective way to do this is frequent and
meticulous hand washing.
Preventing Ear Infections
• Other lines of defense against ear infections
include avoiding secondhand smoke,
vaccinating your children, and breastfeeding
your baby for at least six months.
Allergies and Ear Infections
• Like colds, allergies can irritate the Eustachian
tubes and contribute to middle ear infections.
Getting allergies under control can help
reduce the risk of ear infections.
Eyes
• Communication Starts at The Top
Eyes
• As any mom will tell you, a newborn baby
always looks at the face of the person holding
them.
• The baby will stare and not make a sound as if
he or she is studying the object in front of
them.
Eyes
• Newborns have all the eye structures
necessary to see when they are born, still a
newborn has to learn how to utilize his/her
eyes.
• Development of vision begin at birth.
Eyes
• While your newborn's eyes are physically
capable of seeing just fine at birth, his brain
isn't ready to process all that visual
information, so things are not clear, they are
fuzzy for a while.
Eyes
• As the newborn’s brain develops, so does
his/her ability to see clearly, giving him/her
the tools he/she needs to understand and
manage his/her environment.
Eyes
• Babies spend much of their early weeks and
months of life developing skills such as
focusing, teaming their eye movements,
recognizing depth, developing eye-hand
coordination, and making spatial judgments.
Eyes
• As the child grows, more complex skills are
developed, such as visual perception and
visual motor integration.
• These skills are needed to meet the child’s
growing need to understand and interpret
their world.
Eye Anatomy
Eye Anatomy
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Pupil
Sclera
Iris
Retina
Lens
Optic Nerve
Eye Lid
Eye Anatomy
• The white outer part of the eye is called the
sclera.
• The sclera is a tough, fibrous tissue that
extends from the cornea (the clear front
section of the eye).
• The cornea helps the eye focus as light makes
its way through. It is a very important part of
the eye, but you can hardly see it because it's
made of clear tissue.
Eye Anatomy
• The iris (say: eye-riss) is the colorful part of
the eye. When we say a person has blue eyes,
we really mean the person has blue irises! The
iris has muscles attached to it that change the
size of the pupil.
Eye Anatomy
• The pupil is the black circle in the center of
the iris, which is really an opening in the iris,
and it lets light enter the eye.
Eye Anatomy
• Your retina is in the very back of the eye. It
holds millions of cells that are sensitive to
light.
• Think of the retina or optic nerve as the great
messenger in the back of your eye.
Eye Anatomy
• The optic nerve serves as a high-speed
telephone line connecting the eye to the
brain. When you see an image, your eye
"telephones" your brain to trigger images.
Eye Anatomy
• The many parts of the eye work together to
transform light rays passing through your pupil
into information that your brain can interpret.
The final result is an awareness of the objects
around you based on the information sent to
the brain.
Eye Anatomy
How Eyes Work
• The human eye is like a camera. Light comes in
through the cornea, a clear cover that is like
the glass of a camera's aperture.
• The amount of light coming in is controlled by
the pupil, an opening that opens and closes a
little like a camera shutter.
How Eyes Work
• The light focuses on the retina, a series of
light-sensitive cells lining the back of the eye.
• The retina acts like camera film, reacting to
the incoming light and sending a record of it
via the optic nerve to the brain.
Infants Vision Development
• Healthy eyes and good vision play a critical
role in how infants and children learn to see.
• Their eyes are providing information and
stimulation important for their development.
• It is important to detect any problems early to
ensure babies have the opportunity to
develop the visual abilities they need to grow
and learn.
Vision Birth to Four Months
• When babies are born, they see in black and white and
shades of gray. Newborns can only focus eight to
twelve inches away, thus most of their vision is blurred.
• Babies first start to learn to focus their eyes by looking
at faces and then gradually moving out to bright
objects of interest brought near them.
• Newborns should be able to momentarily hold their
gaze on an object for a few seconds, but by 8-12 weeks
they should start to follow people or moving objects
with their eyes.
Vision Birth to Four Months
•
At first, infants have to move their entire head to
follow objects, but by two to four months they should
start to follow with their eyes more independently with
much less head movement.
•
When infants start to follow moving objects with
their eyes they begin to develop tracking and eye
teaming skills. Young infants haven't learned to use
their eyes together; they haven't developed enough
neuromuscular control yet to keep their eyes from
crossing.
Vision Birth to Four Months
This will alarm most parents, but by four or
five months, babies usually will have learned
to coordinate their eye movements as a team,
and the crossed-eyes should stop. (If you're
seeing your infant's eyes cross after this time,
this could indicate a problem, and you should
seek the advice of your family optometrist.)
Vision Birth to Four Months
By four months, babies start to reach for
objects, the beginning of eye-hand
coordination. Also by four months of age,
babies' visual systems will have developed the
ability to see in full color, and they're exposed
to an exciting new world!
Vision Four to Six Months
• As babies learn to push themselves up, roll
over, sit, and scoot, eye-body coordination
develops as they learn to control their own
movements and space.
• Likewise, four- to six-month-old babies
become quite skillful with their eye-hand
coordination, able to direct a bottle into the
mouth or grasp at objects freely.
Vision Four to Six Months
• Their hands become their most important
tool--they reach for almost everything they
see! This is also the time they start to work
on remembering things they see.
Vision Four to Six Months
• By the fourth or fifth month, babies' brains
have finished learning how to fuse the
pictures coming in from both their right and
left eyes into a single image for full
binocularity, or "two-eyed" vision with strong
depth perception. Spatial and dimensional
awareness continue to improve as the baby
learns to aim accurately when reaching for
objects of interest.
Vision Four to Six Months
• Likewise, they refine their eye teaming and
focusing skills as they learn to look quickly and
accurately between near and far distances.
Normal visual acuities, or a child's sharpness
of vision, has usually developed to 20/20 by
the time the child reaches six months
Vision Six to Eight Months
• By the sixth month, babies acquire fairly
accurate eye movement control. Some experts
caution that early walkers may not learn to
use their eyes together as well as babies who
have crawled a great deal and teamed their
eyes more when looking at close-up objects.
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Vision Six to Eight Months
• The sense of sight develops gradually over 6 to
8 months, While your newborn's eyes are
physically capable of seeing just fine at birth,
his brain isn't ready to process all that visual
information, so things stay pretty fuzzy for a
while.
Vision Six to Eight Months
• As his brain develops, so does his ability to see
clearly, giving him the tools he needs to
understand and manage his environment.
Though a baby starts out life being able to see
only as far as your face when you hold him, his
range of clarity grows steadily, month by
month.
Vision Eight to Twelve Months
• Babies can now judge distances well.
Eye/hand/body coordination allows them to
grasp and throw objects fairly accurately.
• Perception skills such as visual memory and
visual discrimination help babies make sense
of their exciting new world.
Vision Eight to Twelve Months
• The integration of their vision and fine motor
coordination allows babies to manipulate
smaller objects, and many begin feeding
themselves with finger foods.
• Most babies start crawling during this time,
further developing eye-body coordination.
Vision Eight to Twelve Months
• They learn to judge distances and set visual goals,
seeing something and moving to get it. Their sudden
freedom allows for many new experiences and the
rapid development of visual perception skills as babies
experience their own bodies in relation to other
objects and notice differences in size, shape, and
position.
• Once children start walking, they learn to use their
eyes to direct and coordinate their bodies' large muscle
groups to guide their whole body movements.
Vision Toddlers and Preschoolers
A child’s vision will continue to develop
throughout their preschool years. As toddlers,
it is important for them to continue
development of eye/hand/body coordination,
eye teaming, and depth perception.
Vision Toddlers and Preschoolers
• Stacking building blocks, rolling a ball back and
forth, coloring, drawing, cutting, or
assembling lock-together toys all help improve
these important skills.
Vision Toddlers and Preschoolers
• Also, reading to young children is also
important. They develop strong visualization
skills as they "picture" the story in their minds.
Vision Toddlers and Preschoolers
• Per DCFS, Illinois Department of Public Health,
a child should have his first eye screening by
age three. In early Childcare programs,
children can receive vision screenings as
young as 6 months.
Vision School-Aged Children
• It is important for some children to have a
complete eye examination before starting school.
The optometrist needs to determine if a child’s
vision system is adequately prepared to handle
reading, writing and other close work.
• The demands of schoolwork can put too much
stress on a child’s visual system, causing problems
even if none existed before.
Vision School-Aged Children
• Whereas toddlers use their eyes mostly for
looking at distance, school requires children's
eyes to focus on very close, small work, for
hours every day. This can cause vision
problems to arise.
Vision School-Aged Children
• Children don’t often realize that their eyes are
under strain, and they rarely report vision
problems. Because their vision is "normal" to
them, they think everyone sees the way they
do.
Vision School-Aged Children
• School vision screenings provide a valuable
service, but children can pass a school eye
chart test and still have undetected vision
problems which are affecting their school
work.
• The eye chart just checks a child’s sharpness
of vision, but reading requires many other
visual skills.
Vision School-Aged Children
• The eye chart test can’t tell if a child’s eyes are
healthy, or if he can track a line of print
without losing his place, focus his eyes
comfortably, or use his two eyes together for
long periods of time.
Vision School-Aged Children
• Remember a vision screen is just a screen.
• School vision screenings are no substitute for
a complete eye examination by your family
optometrist.
Hearing & Vision Screenings
• According to the Illinois Department of
Healthcare and Family Services,” the purpose
of hearing and vision screening is to identify
children who may have a visual or a hearing
impairment”
Hearing & Vision Screenings
• Impairment in either hearing or vision may
prevent a child from obtaining full benefit
from their educational opportunities.
• Defects can be difficult to defects. Without
specific screening tests a problem may not be
found until your child develops significant
educational or medical problems.
Hearing & Vision Screenings
• Hearing and Vision screening enables
unrecognized conditions to be detected as
early as possible.
• This allows prompt treatment and resolution
to any hearing and vision problems.
Hearing & Vision Screenings
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Healthcare and Family Services covers:
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Vision:
Vision screenings for preschool age children, including screening for amblyopia, also known
as "lazy eye.“
Vision screenings for school age children
Eye exams
Eyeglasses
A second pair of eyeglasses, if glasses are lost, broken or medically necessary
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Hearing:
Hearing screenings – at newborn with follow-up as needed, for preschool age children, and
school age children
Referrals for hearing tests
Hearing aids
Hearing & Vision Screenings
• Hearing and vision deficient's have been
acknowledge as a impediment to healthy
growth and development.
• To prevent complication hearing and vision
screenings are mandatory.
Hearing & Vision Screenings
• Children who are unsuccessful at passing the
hearing and vision screenings are referred to
their pediatrician, an eye doctor or an
audiologist.
Hearing & Vision Screenings
• All referrals are followed up and must be
provided after the hearing and vision
screening has occurred.
Hearing & Vision Screenings
• All hearing and vision screenings are reported
annually to the Illinois Department of Public
health.
Hearing & Vision Screenings
• The goal with hearing and vision screening is
prevention.
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Elmwood Park, IL 60707
Telephone (708) 395.5519 Fax (708) 395.5795
Email: info@livinghealthy.com
Website: www.livinghealthyinc.com