TOW #25: Media screening

Happy holiday season to everyone. This topic will serve for the next two weeks given the holiday block. As most kids are now out of school for the holidays, and all of those media devices are being purchased for young ones this Christmas, now is a great time to revisit media screening and counseling! A big thank you to one of our local experts Dr. Pooja Tandon for lending her expertise in reviewing and updating this topic for us.

Materials to review for the holiday weeks:

Take-home points to review on media for youth:

  1. Media exposure for youth is significant with quantity and quality important for us to address.
  2. The 2 most important questions to ask our families in clinic are: 1) How much screen media is your child exposed to every day? 2) Does your child have a TV or internet-connected device in the bedroom?
  3. Parents should be encouraged to set limits on screen time – this is less often done among low income families. Children whose parents make an effort to limit media use (through the home media environment and rules about screen time) spend less time with media than their peers.
  4. Based on guidance from the AAP, we recommend no screen time for children under 2 (even apps!) and a limit of 2 hours per day for older children. If parents do allow more (a reality!), at least help them select more educational/prosocial media (like PBS shows such as Sesame Street).
  5. TVs in the bedroom (and other media that are connected to the internet) are associated with some of the most concerning negative effects on health. Counsel early about media to help prevent the placement of TV’s in the bedroom (which is over 50% by age 2-4 among low-income families).

Good luck providing some balanced counter messages about healthy media use this holiday season!

TOW #24: Hearing screening

We had the darkest day in 9 years this week, and I love the quote included in this week's case and discussion from Helen Keller: "Everything has its wonders, even darkness and silence, and I learn whatever state I am in, there in to be content." What a great reminder to be mindful of what we do have and to find contentment with whatever that is. Dr. Stuart Slavin gave a wonderful grand rounds today and shared his version of that message, including the power of using metacognition to  "think big" and recognize the good we have in our lives and our professions.

This week's topic is on hearing screening, common hearing disorders and interpreting the audiogram. Materials:

Take-away points about hearing screening:

  1. Epidemiology of hearing disorders: 1 to 6 per 1,000 newborns are affected by hearing loss to a significant degree. Prior to mandated hearing screening (now in all 50 states), the average time of diagnosis of hearing loss was as late as 14 months.
  2. Early recognition is key: early identification of children who are deaf and hearing-impaired allows them to approach their hearing peers in language skills and academic performance. We now want to diagnose by 3 months and intervene by 6 months for the best outcomes. Play close attention to any family history of hearing loss as there are strong genetic factors.
  3. Types of hearing loss: conductive, sensorineural, mixed, and central types. Conductive hearing loss (CHL) is far more common in kids and results from interference in the mechanical transmission of sound through the external and middle ear-this is caused most often by congenital malformation of the ear structures or infections such as otitis media. Sensorineural hearing loss (SNHL) results from a failure to transduce vibrations to neural impulses within the cochlea or transmit these impulses down the vestibulo-cochlear nerve. Causes include in utero infections (CMV, MMR-V, and syphilis are biggies), family history, severe hyperbilirubinemia, respiratory distress, and prolonged mechanical ventilation, as well as childhood infections or trauma.
  4. Types of newborn hearing screening: Otoacoustic emissions (OAE) and auditory brainstem response (ABR) [also known as brainstem auditory evoked response (BAER)] are the most common newborn hearing tests. OAE tests the reflex response of the hair cell in the cochlea to sound and detects hearing loss up to and including cochlear function. ABR tests the auditory CNS response to sound and detects hearing loss through the entire conductive, sensory, and neural pathway. OAE is faster and is not affected by motion artifact; but is affected by debris in the canal and has a higher rate of referral than ABR. ABR/BAER is sensitive to motion artifact and requires the child be asleep when tested. False positives are far more common – only 2 to 7% of those who fail screening ultimately are found to have sensorineural hearing loss. After newborn age, we have a gap until age 4 when it can be difficult to detect hearing problems. Always refer for any language development.
  5. Interpreting hearing tests: remember that hearing 0-15 dB is normal, 15-25 is minimal hearing loss and 25-40 is mild. When in doubt, refer to audiology!

While you enjoy the sounds of the season, appreciate the opportunity to hear them in whatever form.

TOW #23: Fatherhood

This week's topic is meant as a reminder to us to expand beyond our typically mother-centric perspective of child-raising and be intentional about engaging fathers (or in some cases, other support parents) in the care of children. Many more children are being raised in families where parents are not married, where mothers may be working, or where the father is the primary parent, so supporting fathers to be actively involved as parents is increasingly important.

Materials for this week:

Take-home points on fathers' role in parenting:

  1. Definition of father has expanded: a father can be any male adult who is most committed to, caring for, and supportive of the child including a stepfather, grandfather, adolescent father, father figure, or a co-parent in a gay relationship.
  2. Barriers to fathers' involvement in child's health care: 4 major barriers include employment (lack of flexibility, etc), interpersonal (cultural barriers, mother not wanting father to be involved, or not living in home), personal (lack of knowledge, comfort), and health care system (lack of access to records, appt times, etc).
  3. Fathers' involvement matters: The presence of fathers positively impacts health, mental health, and educational achievement of children. We can encourage single mothers to increase the involvement of dedicated male role models in a child's life. Additionally, we should discuss the importance of an involved father figure and parenting tips directly with fathers whenever possible. Remind dads what a difference they can make.
  4. Dads may need coaching and encouragement: They are less likely to have babysat or helped care for siblings when growing up compared to females. We need to address dad, learn his name, make eye contact with him, and include him when providing information about parenting. We also need to ask him direct questions and remind mom of the importance of involving dad. Help foster the mentality of teamwork as the best way to support the child. Doing this at the nursery and newborn visits is especially helpful to set the tone from the start-like handing the baby to the dad or asking dad to help change the diaper.

Enjoy supporting those dads and helping them know they matter!