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Medical Screenings for Newborns

“We just adopted a newborn—what should we watch for, in terms of his vision and hearing?”AF's adoption medicine expert gives you the answer.

Vision develops rapidly during the first year of life, so you’ll want to screen as early as possible for any problems that may lead to long-term impairment. Likewise, failure to diagnose hearing loss by six months of age may lead to serious delays in language development. Poor prenatal care or illness during pregnancy, premature birth, extended use of oxygen after birth, infection, jaundice, and genetic conditions are the most common causes of vision and hearing problems. The sooner any problems are identified, the better the long-term prognosis for your child.

Checking on vision
Your child’s primary care physician should check your son’s vision as a newborn (to look for infections, cataracts, and eye defects), at six months (to check for alignment of the eyes), at three to four years old (to check vision and alignment), and annually from age five. He should refer you to an appropriate specialist if any of the exams show abnormalities.

There are many signs to watch for that indicate healthy vision development. By two to three months, your infant should be watching faces and objects as they move. By three to four months, he should be able to focus his eyes on small objects. By six to nine months, his eyes should be aligned.

What to Watch For
Take your child to your physician if you notice any of the following:

• Squinting
• Closing one eye to see better
• Eyes that flutter from side to side or up and down
• Bulging eyes
• Infection (pus) or persistent redness
• Trouble reading, or holding work close to face

• Not reacting to a loud sound as an infant
• Not turning to find the source of a sound by six months of age
• Not responding to a voice that’s coming from another room
• Greatly increasing the volume on TVs and music players

Parents can also detect signs of several vision problems, including strabismus, or crossed eyes, where one or both eyes turn inward. This occurs in four percent of children, and may be caused by tight eye muscles or excessive farsightedness. Early detection of this condition is important to prevent double vision. Amblyopia, or lazy eye, happens in two percent of children. Lazy eye causes the vision in the weaker, turned-in eye to “switch off,” and can lead to permanent vision loss in that eye.

Parents may have a harder time detecting pseudostrabismus, a condition that affects children whose eyes appear to be crossed, but aren’t, and who have a flat nasal bridge (common in children of African and Asian descent). If you notice any of these signs, have a pediatrician or ophthalmologist examine your child.

Checking on hearing
More than 65 percent of children born in the U.S. are screened for hearing loss as a routine matter of best practice before they leave the hospital. If you don’t receive a record of this screening, or if your child was born outside the country, schedule a hearing examination as soon as possible. Early detection of hearing loss is crucial to language development. (If your child is older and has language or socialization delays, make sure he’s tested.)

By three to four months, your baby should stop what he’s doing when he hears your voice or loud sounds. Even if a child passes the newborn screen, your pediatrician should continue to monitor hearing in cases of premature birth, jaundice, abnormalities in the ears, face, or skull, or if there’s a family history of hearing loss. Children should be screened by a pediatrician annually from age five.

Untreated ear infections can lead to fluid build-up in the middle ear, causing conductive hearing loss, which muffles sounds. Most pediatricians recommend a hearing exam if a child has had repeated ear infections or middle ear fluid for more than three months. Conductive hearing loss is usually reversible, and is treated by surgically inserting tubes into the eardrum to permit ventilation. Ear infections should taper off as a child’s Eustachian tube matures.

Nerve damage or inner ear problems may cause permanent hearing loss, but even this can be remedied with hearing aids or cochlear implants—surgically implanted devices that stimulate the auditory nerve. Children who have these implants done at an early age and who receive speech therapy have an excellent chance of normal speech.

Deborah Borchers, M.D., is a founding member of the American Academy of Pediatrics Section on Adoption and Foster Care, and the mother of three adopted children.

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