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Assess history of chronic otitis media, brain infection, use of ototoxic drugs, rubella or other intrauterine infections (viral), congenital defects of ear or nose, presence of deafness in family members, hypoxemia and increased bilirubin levels in low-birth weight infants.

Assess for auditory acuity: Infant: failure to waken to sounds; no response to loud noise; no response to sound made out of visual field; lack of startle and blink reflexes; failure to turn head to localize sound by 6 months; absence of babble by 7 months; lack of response to spoken words/failure to follow simple commands (older infant). Child: failure to respond to name or to locate sound; failure to respond to being read to or to sound of music; failure to respond to verbal speech; requesting repeat of message; gesturing instead of speech; shy, timid, inattentive; poor performance in school; failure to develop understandable language by 24 months; vocal play, head banging for increased vibratory


Provides information about possible risks for conductive or sensorineural hearing loss.

Provides information of infant/ child ability to hear using techniques that are age dependent.

sensation; stubborn attitude related to decreased comprehension; appear to be "in their own world."

Perform audiometry or other tests depending on age and preparation of technician.

Face infant/child when speaking, speak distinctly and slowly without shouting to gain child's attention.

Assist with use of hearing aid.

Encourage use of sign language, lip reading, cued speech, speech therapy and as much verbal communication as possible.

Provide for play and social interactions, self-care in all activities for age group, continued attendance at school.

Anticipate grief reaction after the diagnosis; facilitate expression of feelings and concerns.

Help child focus on sounds in the environment.

Recommend closed-captioned TV.

Encourage child to read books and practice responding to cues with language development or use of aids or methods.

Encourage child to take responsibility for the care and use of the aid as soon as possible.

Teach parents and child about type of tests to be performed and procedure to be followed by child.

Alert parents to behavioral cues indicating hearing impairment.

Teach parents about hearing aid resources, types available and instruct in cleaning and care of aid and the proper adjustment for optimal benefit.

Instruct child in methods to conceal hearing aid (specify).

Refer parents and child of resources to learn lip reading or signing or

Evaluates degree of hearing acuity and/or loss and type of hearing loss.

Provides opportunity to develop lip reading.

Promotes maximum benefit from aid hearing.

Promotes communication with others.

Promotes independence for age group and security in interacting with peers.

Grief reaction is normal part of early adjustment phase; promotes adjustment to diagnosis.

Maximizes child's hearing potential.

Provides enjoyment for the child; facilitates feelings of normalcy.

Promotes effective communication and corrects or prevents impairments.

Promotes independence and self esteem.

Prevents anxiety caused by test and possible results if not done as part of normal child assessment and screening.

Promotes identification of hearing loss for correction before development is affected.

Assists with hearing aid selection if loss is conductive type.

Prevents negative effect of self-concept and image.

Promotes a method of communication with others and speaking (specify).

Encourage parents and family to provide stimulation through language.

Refer to appropriate community resources and support groups, as needed (specify).

Encourage parents to promote socialization with peers.

Assist parents to arrange for vision testing.

Discuss with the family to maintain normalcy, including discipline and limit setting.

Assist parents and child to adjust environment and select toys that promote social interactions and increase hearing potential.

Encourage parents to notify school nurse and teacher of degree of hearing loss and methods of communications used by child.

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