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Ear Infections and Language Development
How ear infections and
middle ear fluid might affect your childs language development
What you can do to help
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What is
Otitis Media?
Otitis media, an inflammation of the middle ear (behind the
eardrum), is one of the most common illnesses of childhood. There are two
different types of otitis media. Either can occur in one or both ears.
- Acute otitis media, which
is also called an ear infection, is an
infection of the middle ear. Fluid in the middle ear may remain even after an
infection is gone.
- Otitis media with effusion,
also called middle ear fluid, is fluid that
is not infected. When a child has a cold, a small tube between the ear and the
throat can become blocked, causing fluid to build up in the middle ear.
Most children will have at least one episode of otitis media by
one year of age. And 10 20 percent of children will have otitis media
three or more times, with fluid lasting an average of one month each time.
Persistent ear fluid is more common in children under two years, but it can be
seen in children older than two.
The middle ear space behind the eardrum usually contains air. When
there is fluid in this space, it can cause the bones in the middle ear not to
vibrate properly. This may cause a mild, temporary hearing loss. The mild
hearing loss lasts until the fluid is gone. Because this can happen when your
child is learning to speak, families and health care providers may have
concerns. If there are concerns, a hearing evaluation and/ or speech and
language evaluation may be appropriate.
- Child pulls on ear
- Child says ear hurts
- Drainage from ear
- Fever (acute otitis media)
- Irritability
- Poor sleep
A child may have all, some, or none of these symptoms and still
have otitis media. Otitis media frequently occurs when a child has a cold. When
a child has otitis media with effusion, most of the time there are no symptoms.
Ear infections are best detected by your childs health care provider.
Contact your health care provider if you think your child may be sick.
How is Otitis
Media treated?
Acute otitis media (ear
infections) can be treated by:
- Antibiotics prescribed by
your health care provider. Medicine should be given until it is gone. Fever and
pain should decrease within two days.
- Surgery to put a tube in a
childs ear if your child has a lot of ear infections. This surgery is
done by an ear, nose, and throat doctor. This tube allows air to enter the
middle ear space. This, in turn, helps the lining of the middle ear return to
normal and helps prevent new infections. The tube generally stays in place for
six to twelve months and falls out by itself.
Otitis media with effusion (fluid) can be treated by:
- Waiting for the fluid to go
away. For 60 80 percent of children, middle ear fluid will go
away by itself in three months. For 85 percent of children, fluid will go away
by itself in six months. A health care provider should check a childs
ears regularly during this period.
- Antibiotics may help reduce
middle ear fluid in a small number of cases.
- Surgery to put a tube in
the childs ear if fluid continues for four to six months in both
ears.
Talk with your childs health care provider about these
treatments. It is important to keep follow- up appointments.
How can
Otitis Media affect hearing?
When a child has fluid in the middle ear, the fluid reduces sound
traveling through the middle ear. Sound may be muffled or not heard. Children
with middle ear fluid will generally have a mild or
moderate temporary hearing loss. (Its as if you plugged your
ears with your fingers.) However, some children have no change in their hearing.
- Mild Hearing Loss A
child may not hear or may hear very faintly the soft sounds at the beginnings
and ends of words, such as the s in sun and the
t in cat, and words spoken quickly such as
and.
- Moderate Hearing Loss
A child may have trouble hearing most speech sounds, and may have trouble with
short, softly spoken words and word endings. Its important to know that
some children with otitis media have no loss of hearing. A hearing loss due to
middle ear fluid should go away once the fluid is gone.
How can I
recognize if my child has a hearing loss?
- Having difficulty paying attention
- Showing a delayed response or no response when spoken to
- Saying huh? often
- Not following directions well
- Turning up sound on radios, TV, CDs
- Withdrawing from other children
- Being over- active or uncooperative
Children with temporary hearing loss may show all, some, or none
of these behaviors. These behaviors may be different at each age. It is often
hard to tell whether a child has a hearing problem or whether the child is just
acting a certain way because of age or temperament. If you are not sure, ask
your health care provider for help. The milestone chart on the following pages
may also be helpful.
What can I do
if I am concerned about my child s hearing?
If your childs response to sound seems different or
inconsistent, you should request a hearing evaluation to check your
childs hearing. Children as young as newborns can have their hearing
tested. Health care providers can screen hearing. When a child fails a hearing
screening, you should take the child to an audiologist for a hearing
evaluation. The audiologist specializes in diagnosis and treatment of hearing
loss.
How may
language learning be affected by Otitis Media?
During the first three years when children have the most problems
with otitis media, they are learning to speak and understand words. Children
learn to do this by interacting with people around them. It may be harder to
hear and understand speech if sound is muffled by fluid in the middle ear. Some
researchers report that frequent hearing loss in children with middle ear fluid
may lead to speech and language difficulties. However, other researchers have
not found this to be true. Researchers are still studying this. In the
meantime, its best to pay special attention to the language development
of children who have middle ear fluid.
What can I do if I m concerned about my child s
speech and or language development?
When you have concerns about your childs language
development, talk to your childs health care provider. A speech- language
pathologist specializes in diagnosis and treatment of speech and language
problems.
The next section describes milestones in language development.
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Is my child
achieving milestones of language development?
INSTRUCTIONS Read each question
through your childs age group and check yes or no. Add the total
and see below.
All Yes: Your child is developing hearing,
speech, & language in the typical way. 1 2 No: Your child
may have delayed hearing, speech & language development. Seek professional
advice if you are unsure. 3 or more No: Ask for a referral to an
audiologist or speech- language pathologist. |
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Circle One |
Hearing &
Understanding |
Childs Age
|
Talking |
Circle One |
YES NO YES NO YES NO
YES NO |
- Startles to loud sounds.
- Smiles when spoken to.
- Seems to recognize your voice and quiets if
crying.
- Increases or decreases sucking behavior in
response to sound.
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Birth to
3 Months |
- Makes pleasure sounds (cooing, gooing).
- Cries differently for different
needs.
- Smiles when she sees you.
|
YES NO
YES NO
YES NO |
YES NO
YES NO
YES NO
YES NO |
- Moves eyes in direction of sounds.
- Responds to changes in tone of your
voice.
- Notices toys that make sounds.
- Pays attention to music.
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4 - 6 Months
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- Babbling sounds more speech- like with many
different sounds, including p, b, and m.
- Vocalizes excitement and displeasure.
- Makes gurgling sounds when left alone and when
playing with you.
|
YES
NO
YES NO
YES NO |
YES NO
YES NO
YES NO YES NO
YES NO |
- Enjoys games like peek- a- boo and pat- a-
cake.
- Turns and looks in direction of sounds.
- Listens when spoken to.
- Recognizes words for common items like
cup, shoe, juice.
- Begins to respond to requests.
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7 Months to 1 Year
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- Babbling has both long and short groups of
sounds such as tata upup bibibibi.
- Uses speech or non- crying sounds to get and
keep attention.
- Imitates different speech sounds.
- Has 1 or 2 words ( bye- bye,
dada, mama, no) although they may not be
clear.
|
YES
NO
YES NO
YES NO YES NO
YES NO |
YES NO
YES NO
YES
NO
YES NO |
- Points to pictures in a book when named.
- Points to a few body parts when asked.
- Follows simple commands and understands simple
questions ( Roll the ball, Kiss the baby,
Wheres your shoe?).
- Listens to simple stories, songs, and rhymes.
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1 - 2 Years
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- Says more words every month.
- Uses some 1 2- word questions (
Where kitty? Go bye- bye? Whats that?).
- Puts 2 words together (more cookie,
no juice, mommy book).
- Uses many different consonant sounds at the
beginning of words.
|
YES NO
YES NO
YES
NO
YES NO |
YES
NO
YES NO |
- Understands differences in meaning ( go-
stop, in -on, big- little, up- down).
- Follows two requests (Get the book and
put it on the table).
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2 - 3 Years
|
- Has a word for almost everything.
- Uses 2 3- word sentences to
talk about and ask for things.
- Speech is understood by familiar listeners most
of the time.
- Often asks for or directs attention to objects
by naming them.
|
YES NO
YES NO YES NO
YES NO |
YES NO
YES
NO
YES NO |
- Hears you when you call from another room.
- Hears television or radio at the same loudness
level as other family members.
- Understands simple who?,
what?, where? questions.
|
3 - 4 Years
|
- Talks about activities at school or at
friends homes.
- Usually talks easily without repeating
syllables or words.
- People outside family usually understand
childs speech.
- Uses a lot of sentences that have 4 or more
words.
|
YES NO
YES NO
YES NO
YES NO |
YES
NO
YES NO |
- Pays attention to a short story and answers
simple questions about it.
- Hears and understands most of what is said at
home and in school.
|
4 - 5 Years
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- Voice sounds clear like other childrens.
- Uses sentences that give lots of details (e.
g., I like to read my books).
- Tells stories that stick to topic.
- Communicates easily with other children and
adults.
- Says most sounds correctly except a few, like
l, s, r, v, z, j, ch, sh, th.
- Uses adult- like grammer.
|
YES NO
YES NO
YES NO YES NO
YES
NO
YES NO |
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(Adapted with permission from the brochure How
Does Your Child Hear and Talk? © American Speech- Language- Hearing
Association.)
How can I
help my child who has persistent middle ear fluid?
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Promote a Healthy
Setting |
These suggestions will help all children stay healthy. They may be
especially important for children who tend to get ear infections and ear fluid.
- Wash child and adult hands after blowing noses or going to the
bathroom. This will fight the spread of germs.
- Clean toys that have been in a childs mouth before
another child plays with them.
- Follow directions for giving medicine so that it is given on
time and for the entire time that is recommended.
- If possible, breastfeed for at least the first four to six
months of life to reduce the chance of otitis media.
- Bottle- feed in an upright or slightly leaning position.
Cuddle the child in your lap with his head raised up. A child should not be put
to bed with a bottle. A bottle should not be propped in bed. Those practices
may cause the liquid from the bottle to go up a small tube leading to the
middle ear, causing middle ear fluid.
- Keep children away from smoke. Cigarette smoke increases a
childs chance of middle ear disease.
- If possible, put children in small rather than large groups of
children. Colds pass more easily in large groups, and colds in young children
can lead to middle ear fluid.
It can be difficult to hear and concentrate in a noisy area such
as a classroom (with lots of children talking) or home (with TV on), even with
only a small amount of hearing loss. These suggestions will help all children
listen better.
Help children hear and understand your speech
- Get within three feet of a child before speaking.
- Get your childs attention before speaking.
- Face your child and speak clearly with a normal tone and normal
loudness.
- Use visual cues such as moving your hands and showing pictures
in addition to using speech.
- Seat your child near adults and children who are speaking.
- Speak clearly and repeat important words, but use natural
speaking tones and pattern.
- Check often to make sure your child understands what is said.
- Stand still when talking to your child to decrease
distractions.
Decrease background noise, especially for children with hearing
loss
- Turn off unnecessary music and TV in the background.
- Fix noisy appliances such as heaters or air conditioners.
- Limit play with noisy toys.
- Encourage teachers to create quiet areas. For example, use
dividers for small group play and reading.
- Close windows and doors when it is noisy outside.
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Promote Language
Learning |
Take advantage of opportunities every day to help children develop
their language. All children can benefit from responsive language interactions,
especially children with hearing loss due to otitis media.
- Get down on your childs eye level when talking.
- Listen to your child when your child is talking.
- Talk about familiar things snacks, pets, rain
anything your child knows about and is interested in.
- Talk with your child during mealtimes, baths, and throughout
the day.
- Play interactive games with your child to encourage talking,
such as pat- a- cake.
- Ask simple questions and pause for your child to respond.
- When your child says something, respond to what the child is
talking about immediately and with interest.
- Add to what your child has said by using more words.
- Praise your child for talking, even if the speech is unclear.
- Take your child lots of places (library, supermarket, the park)
and talk about what you see there.
- Say the names of things your child sees or plays with and
describe things that happen.
- Talk with preschoolers about what they did, what they will do,
why things happen, and their feelings.
- Encourage children to talk to one another.
- Repeat language activities so children learn what to expect.
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Promote Early
Literacy Learning |
Activities such as reading to your child help develop early
literacy skills.
- Read often to children, describing and explaining pictures and
referring to childs own experiences ( Spot is like your
dog.).
- Read slowly to children, pausing at times to ask questions
( What do you think will happen next?).
- Give children books and magazines to look at.
- Read out loud traffic and store signs, labels of packages, and
words on a menu.
- Let children draw and write using crayons, markers, and
pencils.
- Sing simple songs with repeated words and phrases.
- Talk about sounds and names of letters.
- Play sound, alphabet and word games that focus on beginning and
ending sounds of words.
- Play word and listening games to encourage children to listen
to familiar patterns and fill in words.
- For older preschoolers, play rhyming games such as hat, cat,
bat.
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Ear Infections and Language Development by
Joanne E. Roberts, Ph. D. & Susan A. Zeisel, Ed. D.
This booklet will help you understand ear
infections and middle ear fluid, how hearing and language learning may be
affected, and how you can support childrens language learning.
Additional information & resources
Agency for Health Care Policy and Research.
(1994). Middle Ear Fluid in Young Children, Consumer Version, Clinical Practice
Guideline Number 12. (English and Spanish versions are available). The booklet
is available online at www.kidsource.com/kidsource/content/mef.html
Green, A. R. (1997). The parents complete
guide to ear infections. Allentown, PA: Peoples Medical Society. Roberts,
J. E., Wallace, I. F., & Henderson, F. W. (Eds). (1997). Otiitis Media in
Young Children. Baltimore, MD: Brookes Publishing
Co. Stool & the Otitis Media Panel. Otitis Media with Effusion in Young
Children.
Clinical Practice Guideline Number 12. AHCPR
Publication No. 94- 0622. Rockville, MD: Agency for Health Care Policy and
Research, Public Health Service, U. S. Department of Health and Human Services.
July, 1994. (Medical Version, Professional Guidelines). This booklet is
available online at www.aap.org/policy/otitis.htm
Watt, M. R., Roberts, J. E., & Zeisel, S.
(1993). Ear infections in young children: The role of the early childhood
educator. Young Children, 49( 1), 65 71. Questions & Answers about
Otitis Media, Hearing and Language Development http://www.asha.org/hearing/disorders/causes.cfm
Infections & Immunizations, Ear
Infections www.ama-assn.org/.
For more information about speech, language, and/
or hearing, call American Speech- Language- Hearing Association (ASHA) at 1-
800- 638- TALK.
Published in collaboration with ASHA and the
National Center for Early Development & Learning. This project was
supported in part under the Educational Research and Development Centers
Program, as administered by the National Institute on Early Childhood
Development and Education, Office of Educational Research and Improvement, US
Department of Education, and the Maternal and Child Health Bureau, US
Department of Health and Human Services (MCJ- 370599 & MCJ- 370649).
This publication was funded by the
U. S. Department of Education. The content
does not necessarily reflect the views of the Department or any other agency of
the US Government. This publication is in the public domain. Authorization to
reproduce it in whole or in part for educational purposes is granted.
American Speech -
Language - Hearing Association U. S. Department of Education |
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