Did you know newborn hearing screens are routine tests done in the hospital before your baby goes home? Sometimes, parents don’t realize it happens because they’re sleep-deprived but it does and it’s so important. I welcome Kelsey Kerkhove, a pediatric audiologist, to discuss:

• What happens during a newborn hearing screen and why it’s important
• What happens if a baby doesn’t pass the screen
• Risk factors for congenital hearing loss
• Signs of childhood hearing loss later in childhood

 

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Kelsey Kerkhove
Find out more about Kelsey at kelseykerkhoveaud.com or connect on Instagram @kelseykerkhove_aud

00;00;01;01 – 00;00;31;18

Kelsey Kerkhove

So there are two test methods that are basically allowed. One is called O2 acoustic emissions, and that tests response from the inner ear directly, and one is called an automatic auditory brainstem response that ABR testing or auditory brainstem response testing is a little bit more sensitive and can test measure higher up the hearing pathway. So what the recommendation is in the well baby nursery, a baby can have either that O2 acoustic emission test or the ABR testing.

 

00;00;31;18 – 00;00;39;20

Kelsey Kerkhove

But if your baby has spent any time in the Nic, what’s required is that they receive the auditory brainstem response testing.

 

00;00;39;23 – 00;01;02;01

Dr. Mona

Welcome to the PedsDocTalk Podcast. This show’s success is largely due to you and the way you share the podcast. Show up each and every week and how you leave reviews. So thank you so much for tuning in today. I am so grateful to have the most amazing array of guests to guide you in your parenting journey. Topics about all things parenting, infant and child health and development, and parental mental health.

 

00;01;02;08 – 00;01;18;07

Dr. Mona

Today’s guest is Kelsey Kerkhove, who is a pediatric audiologist. And we’re talking about why early detection and intervention of pediatric hearing loss is important for both. Thank you so much for joining me today, Kelsey.

 

00;01;18;09 – 00;01;19;27

Kelsey Kerkhove

Thank you so much for having me.

 

00;01;20;01 – 00;01;38;01

Dr. Mona

Well, this is an important conversation. We’re going to be diving deeper into that newborn period with hearing screens. Obviously we can also talk about other hearing evaluations that happen later. But we’re really focusing on that newborn period. And a lot of parents will come in and say, you know, my child had a hearing test. They may have not passed it.

 

00;01;38;02 – 00;01;47;29

Dr. Mona

What does this all mean? We’ll get into all of that juicy information, which I think is so important for parents to understand. But before we do that, if you can introduce yourself to everyone listening today.

 

00;01;48;02 – 00;02;12;14

Kelsey Kerkhove

Yeah. Hi. I’m Kelsey Kerkhove. I’m a pediatric audiologist. I grew up in the Midwest and have been out in Southern California for the last five years. I worked at a large medical center in Los Angeles, and largely focused on the early identification and intervention of sharing loss in children. And I also helped oversee the newborn hearing screening program.

 

00;02;12;14 – 00;02;26;13

Kelsey Kerkhove

So I am very passionate about early identification of hearing loss and making sure that parents get the right information and the right support in their hands at the right time to be able to help guide their child down the best path possible.

 

00;02;26;16 – 00;02;46;14

Dr. Mona

I love it, and like I already mentioned, I think it’s so important that were chatting about this one because this is important for their development. And also a lot of parents don’t realize unless they read a material or, you know, went on a tour of the hospital or got information that this is a routine part of an assessment in the hospital for them to get a hearing evaluation before they leave.

 

00;02;46;18 – 00;03;00;10

Dr. Mona

So I want to talk about that hearing screen that’s done called the newborn hearing screen. What happens during this and what type of tests are usually done? Is there a preferred type of test that’s done in the hospital? If you can kind of run down the differences?

 

00;03;00;13 – 00;03;20;20

Kelsey Kerkhove

Yeah, absolutely. And I think you’re absolutely right. It’s a routine screening that happens. But I think so many parents aren’t aware that that may happen. Or b if the baby doesn’t end up passing the hearing screening are totally thrown off because they weren’t even expecting for their baby to have their hearing screened. And there’s so many questions like you would just ask, how do we screen a baby’s hearing?

 

00;03;20;23 – 00;03;51;11

Kelsey Kerkhove

So there are two test methods that are basically allowed. One is called Odo Acoustic emissions, and that tests response from the inner ear directly, and one is called an automatic auditory brainstem response that ABR testing or auditory brainstem response testing is a little bit more sensitive and can test, measure higher up the hearing pathway. So what the recommendation is in the well baby nursery, a baby can have either that auto acoustic emission test or the ABR testing.

 

00;03;51;11 – 00;04;13;07

Kelsey Kerkhove

But if your baby has spent any time in the ICU, what’s required is that they receive the auditory brainstem response testing. So a lot of hospitals are going more towards that. ABR or auditory brainstem response testing because it is a little bit more sensitive. But in many well baby nurseries, babies will receive the OTA acoustic emissions testing.

 

00;04;13;10 – 00;04;21;05

Dr. Mona

Is there a difference in price or cost, between why a facility won’t always just go to the ABR if it’s more sensitive.

 

00;04;21;08 – 00;04;40;27

Kelsey Kerkhove

So there’s not a difference in price or cost from the patient standpoint, but from the hospital standpoint, the auditory brainstem response equipment is a little bit more expensive. So I would imagine that is, you know, what kind of gears decisions to use, the auto acoustic emissions testing. But I do know in our hospital for all babies they receive the ABR testing.

 

00;04;40;27 – 00;04;46;23

Kelsey Kerkhove

So okay, I’m optimistic that it’s most places are moving more towards the more sensitive tests.

 

00;04;46;26 – 00;05;05;24

Dr. Mona

And you know, sometimes parents will ask, well, if it’s loud in the nursery or, you know, there’s reasons why maybe they may not have passed it. Is there anything external that can cause a child or a newborn not to pass it, like ambient noise, things like that? Or is that more common with the OAC test versus the ABR test?

 

00;05;05;27 – 00;05;34;09

Kelsey Kerkhove

There are definitely external factors that can affect the test. However, I think it’s really important that the person doing the test make sure that they’re able to rule out all external factors that could potentially interfere with the results. So if your technician or the audiologist doing the test is very well trained, they’ll make sure to give you some tips and recommendations to basically control the environment to the best of their ability to produce the most reliable test results.

 

00;05;34;12 – 00;06;04;07

Kelsey Kerkhove

So unfortunately, when babies don’t pass the hearing screening, it’s very common to hear, oh, you know, they may have had fluid in their ears or the vent was very loud or they weren’t sleeping enough. You know, there are external factors that can impact the results. However, I train our team to say the goal is to eliminate any and all external factors so you have confidence that this produced a reliable result because unfortunately, the narrative really is to parents.

 

00;06;04;09 – 00;06;23;04

Kelsey Kerkhove

Oh, it’s probably just flu and don’t worry about it. And it is a fine line. It’s just a screening. It’s not a diagnostic test. So if your baby doesn’t pass the screening, it doesn’t mean that they’ve been diagnosed with hearing loss. But it does mean that you should receive education and proper steps to take in order to get the information you need about your baby’s hearing.

 

00;06;23;04 – 00;06;41;27

Kelsey Kerkhove

And the reality is, the reason we screen every single baby’s hearing at birth is because hearing loss is one of the most common congenital birth defects, so we want to identify as soon as possible. So I think it’s important to give parents realistic information and say, you know, this isn’t a diagnostic test. However, it does mean they’ve been referred for more testing.

 

00;06;41;27 – 00;07;00;19

Kelsey Kerkhove

So it’s really important you follow up because hearing loss is a possibility and help prepare parents. Because as an audiologist, I see the other side of things. I diagnose babies with hearing loss. And so many parents have said to me, I wish someone would have just told me that hearing loss was a possibility. Instead, everyone told me not to worry about it.

 

00;07;00;22 – 00;07;15;27

Dr. Mona

No, I completely agree. I mean, that’s what a screening test should be. You know, we do so many screening tests in the hospital and it’s all benign, right? When we talk about this, all the things that you’re mentioning, the both types of tests noninvasive, what that means is that it’s on the surface of the skin or outside the ear.

 

00;07;15;27 – 00;07;19;20

Dr. Mona

Nothing’s getting in. Put it inside the child. Correct?

 

00;07;19;23 – 00;07;24;00

Kelsey Kerkhove

Yes. I mean, the most invasive. It’s a headphone in the ear. So exactly.

 

00;07;24;02 – 00;07;38;17

Dr. Mona

Yeah. And that’s really important. And you know all of these things like we talk about this, the newborn screening, jaundice screening, all of it like you mentioned is to provide the best benefit of the child in terms of making sure that there is not a concern. Now, thank you so much for talking about why the test is important.

 

00;07;38;17 – 00;08;03;04

Dr. Mona

You mentioned that, you know, congenital hearing loss is a reality in some cases. So what happens if the child doesn’t pass one of these tests, like let’s say they do an OAC test. The first one that you mentioned, do they get a repeat ABR in the hospital or do they get discharge? What’s usually what you’ve seen? I know the protocol can depend on facility to facility, but what’s going to happen for that family and that baby.

 

00;08;03;06 – 00;08;24;01

Kelsey Kerkhove

Yeah. So every baby will receive at least two hearing screens prior to going home. The reason is because, you know it is just a screening. It is not the most sensitive test. So we give the baby two times to pass or two or so if they don’t pass the first test. And if it isn’t screening, usually that’s the equipment that the facility has.

 

00;08;24;01 – 00;08;47;00

Kelsey Kerkhove

So they’ll repeat the test with another East. Then what’s recommended is that they follow up with an audiologist within one month. So most states have kind of policies in place on what’s recommended to make sure that babies receive proper follow up in a timely manner. So typically, before leaving the hospital, the family will have an appointment scheduled with an audiologist within one month.

 

00;08;47;00 – 00;09;25;07

Kelsey Kerkhove

Ideally last, you can test a baby’s hearing like we saw it at any age. So if they’re two days old and you’re able to get in, that’s fantastic. Because really the goal is early identification. If your baby fails the hearing screening, we want to make sure that they’re getting the proper diagnosis as early as possible. And that is because research shows if we’re able to identify hearing loss very, very early and we’re able to intervene with the proper treatment, then their outcomes to develop speech and language can very, very much be on par with other kids their age, and it’s less likely that they may fall behind in some of those developmental milestones.

 

00;09;25;09 – 00;09;56;22

Dr. Mona

Well, I love that we’re again chatting about this because you said it already that sometimes it’s kind of said as like, hey, it’s okay that you didn’t pass it, that’s fine. But the biggest take home on my side as well, being a pediatrician, is even if they did not pass it and there’s no family history of hearing loss, there’s no reason it’s so important for us to get the repeat like, you know, when they come out of the hospital if it wasn’t passed, making sure that we get another evaluation as an outpatient, usually what we do is if they didn’t pass it in the hospital, they come to us.

 

00;09;56;24 – 00;10;18;24

Dr. Mona

We look at that, you know, we look at, okay, did they pass the hearing screen if they needed a car seat test for premature babies, that sometimes happens. So hearing screening for all babies, car seats. What was the jaundice level congenital heart screening. Like all of these little things that happened that are so important. And if it wasn’t passed, then we usually do refer to an audiologist as an outpatient just to make sure that it is passed.

 

00;10;18;24 – 00;10;38;05

Dr. Mona

And if it’s not, like you said, getting tied in with an audiologist and I will say sometimes patients fall through the cracks because they think, well, how can something be wrong? You know, like there’s nothing my baby’s a newborn, like there’s something wrong. But I can’t stress the importance of if there is something that was not passed. It’s so important to get the follow up just because we want to be completely sure.

 

00;10;38;09 – 00;10;51;23

Dr. Mona

If it turns out to be nothing, great. But if it turns out to be that the child’s not passing the test, we want to make sure that your child gets the the best evaluation and treatment possible. And I think that’s such an important conversation that we’re having.

 

00;10;51;25 – 00;11;14;23

Kelsey Kerkhove

Yeah, I completely agree. And I think you made a good point earlier about how if someone has if their baby doesn’t pass, you know the question. So there’s no family history. You know, it’s probably nothing. And the reality is 90% of babies are born to normal hearing parents. So just because there isn’t that very obvious family history doesn’t mean that there might be something worth looking into.

 

00;11;14;26 – 00;11;21;00

Kelsey Kerkhove

Usually, if there is a diagnosis of hearing loss, most of the time it does come as a complete shock to parents.

 

00;11;21;03 – 00;11;44;21

Dr. Mona

Yeah, and we know that of course this is done at the newborn period. Usually, like we said before, they leave the hospital now just because a child passes their hearing test at birth. We also know that hearing loss in children can develop later. What are some signs and symptoms of hearing loss later in childhood that a parent should be kind of aware of so that they can bring it up to their child’s pediatrician?

 

00;11;44;24 – 00;12;04;05

Kelsey Kerkhove

Yeah, that’s a great question. So hearing loss is not always as obvious as you may think. I think for some people it can be perceived as very black and white. Either my child can hear or if they couldn’t hear, I wouldn’t be able to know, right? In some cases, the answer is yes, but in some cases, you know, there’s very different degrees and severity adds up.

 

00;12;04;05 – 00;12;25;11

Kelsey Kerkhove

Hearing loss that affects individual pitches and sounds. So it may not be as obvious as you may think. A few things to keep an eye out for. If you feel like you may be concerned about your child’s hearing, is definitely talking to their pediatrician about their speech and language milestones. That’s something that’s conversations. I’m assuming that you know you have a chance all the time checking in.

 

00;12;25;11 – 00;12;43;03

Kelsey Kerkhove

How many words do they have? Are they babbling? If they are sort of falling behind on those milestones and you have any concerns about your baby’s speech, the very first thing you should I would recommend is, you know, receiving a hearing test because a lot of parents will begin speech therapy and they haven’t had a hearing test for their little one.

 

00;12;43;03 – 00;13;08;05

Kelsey Kerkhove

And then they find out, you know, a couple months later that their child has hearing loss. And that was time spent in speech therapy that they weren’t able to get the most from because we hadn’t identified maybe what the cause was, some other things to look out for is, you know, is simply your child asking, What if you notice that even though you’re close to them, you’re talking to them and they’re asking for you to repeat yourself more than usual?

 

00;13;08;07 – 00;13;28;21

Kelsey Kerkhove

Kiddos who have reoccurring ear infections, which so many kids do get. Infections can also affect hearing. So again, it May 1st day they may be fine. And then as that your infection of the fluid happens behind their ear, it can impact their hearing over time. So yeah you know your child best. And I think following your parental gut is super important as well.

 

00;13;28;21 – 00;13;42;28

Kelsey Kerkhove

If you think something’s going on, talk to your pediatrician. Ask for their referrals. Again, a child can have their hearing tested at any point in time and it’s noninvasive. It’s not painful. So there really is no harm in getting that information if that’s something that you’re concerned about.

 

00;13;43;00 – 00;14;00;14

Dr. Mona

Yeah. And I think sometimes parents forget that just because we may not routinely screen hearing at that age, like for example, we do the newborn screen from our end. But then in terms of routine hearing tests, this is the one where if you maybe are listening and you have an older child, this is in the pediatrician’s office. They’ll put the headphones on, they’ll ask the kid to raise the hand.

 

00;14;00;14 – 00;14;28;23

Dr. Mona

That’s usually an older child, like older than four, because they have to be able to cooperate and do that. But if your child is younger than four, not passing any test, or you’re concerned about hearing using the example that Kelsey mentioned, a lot of that is language development. I agree, or the other thing that you mentioned. But yeah, if you’re seeing that, make sure you ask your clinician, say, hey, look like I am feeling like my child can’t hear or the language is not where I expect it to be based on developmental milestones.

 

00;14;28;25 – 00;14;49;20

Dr. Mona

Let’s should we do a hearing evaluation. And that is something that we can order to be done at an audiologist office, even if we can’t do it in our offices or the child does not cooperate, because I see that happen also, where sometimes a child won’t cooperate in our office like an older child for a hearing evaluation, and the medical system will just say uncooperative.

 

00;14;49;20 – 00;15;07;10

Dr. Mona

And in my opinion, it’s like, well, are they uncooperative because they can’t hear? Or are they uncooperative because of their age? But it’s really important for us to really make sure that we cross our T’s and daughter I’s so that we’re not dealing with this later. Like Kelsey said of like who you had this issue. We never evaluated it.

 

00;15;07;13 – 00;15;21;27

Kelsey Kerkhove

Yeah, I completely agree. It’s definitely something. If you’re able to identify it sooner rather than later, we’re really going to be able to help set your child and your family up for the most success to make sure that their hearing loss doesn’t hold them back in any way in life.

 

00;15;22;00 – 00;15;30;10

Dr. Mona

And we kind of alluded to it a little bit, but are there any risk factors for congenital hearing loss or hearing loss later in childhood?

 

00;15;30;12 – 00;15;52;21

Kelsey Kerkhove

Yes, definitely. So family history is one. If you have a family history of hearing loss, even like a distant cousin or an aunt, that can be a risk factor spending a minimum of five days in the year. That itself is a risk factor. So if your baby has spent more than five days in the Navy, it’s recommended that they have a follow up test around nine months to a year just to monitor their hearing.

 

00;15;52;28 – 00;16;21;11

Kelsey Kerkhove

There’s certain medications that may be given in the neonatal, ICU or the NICU to treat infections that can cause hearing loss. And actually, even if you’re when your baby, when or if your baby doesn’t pass their hearing screening right away, one of the tests that they would be helpful if they are check for is cytomegalovirus. That’s a virus that can be transferred from mom to baby during pregnancy, and your baby may be born completely healthy and they may develop symptoms later on.

 

00;16;21;11 – 00;16;43;25

Kelsey Kerkhove

And hearing loss is one of the side effects from that. So being tested for cytomegalovirus or CMV at birth is really important. Yes. So there are several risk factors if your baby was on any oxygen in the hospital afterwards. So it’s really important that if they had some of those risk factors that they’re monitored. And I always say to my patients, you know, it’s unlikely that they’re hearing will change.

 

00;16;43;25 – 00;16;58;22

Kelsey Kerkhove

And usually it’s a very conservative recommendation to say, hey, let’s check in. But kind of like we talked about, there’s really not a lot of harm done. I guess it’s not a painful exam. It just is a little, you know, it’s an appointment that you have to come in, but it’s always worth it for either peace of mind.

 

00;16;58;26 – 00;17;06;23

Kelsey Kerkhove

You know, there’s no changes in their hearing or if there has been a change, we can again detect it before other challenges may have already taken place.

 

00;17;06;25 – 00;17;23;10

Dr. Mona

This is so helpful. I really enjoyed chatting with you about this one because I get so many questions in my office about the differences and details, and so whenever I do that, I’m like, hey, I have this platform called a podcast and a YouTube, and I’m like, I want to get experts in the field to chat about this stuff.

 

00;17;23;10 – 00;17;35;14

Dr. Mona

Because like we said at the beginning, this is such a routine thing that we do the hearing evaluation for newborns and obviously hearing evaluations for older children, but sometimes parents don’t know the nitty gritty. So thank you so much for this conversation today.

 

00;17;35;16 – 00;17;47;16

Kelsey Kerkhove

Oh, absolutely. I think it’s a really important topic to discuss. And like you said, we kind of peel back the layers. It does just seem like a routine screening. But once you start peeling back the layers, there’s a lot of important components to this.

 

00;17;47;19 – 00;17;53;27

Dr. Mona

And where can people find you to stay connected? I believe you do have like social channels and ways to stay connected with you.

 

00;17;53;29 – 00;18;18;10

Kelsey Kerkhove

Yeah. So, you can find me on Instagram at Kelsey Kurkov underscore a UD. And I also have a website with a blog. If you have any questions about your child’s hearing journey. Just like any unexpected diagnosis that any child may receive, it can be incredibly overwhelming, emotional. And so I also offer support to parents who are currently navigating through that process.

 

00;18;18;10 – 00;18;34;23

Kelsey Kerkhove

So you can contact me from my website as well. Kelsey Kurkov Adcom. And I’ve just recently started to dabble with TikTok. So if you want to go over there as well, Kelsey Kurkov underscore aid, you can find me there.

 

00;18;34;26 – 00;18;38;10

Dr. Mona

Well, thank you so much. This is such a great conversation.

 

00;18;38;12 – 00;18;39;29

Kelsey Kerkhove

Oh, thank you so much for having me.

 

00;18;40;01 – 00;19;00;16

Dr. Mona

And for everyone listening. I hope you really enjoyed this conversation with Kelsey. It’s so important that we have a diversity of guests on the show to talk about various things that you may find yourself in situations with your child, and this is one of those things as a pediatrician that I think is just so important. If you like this episode, please make sure to leave a review rating, share it with a friend.

 

00;19;00;16 – 00;19;22;29

Dr. Mona

Share it with a loved one. It’s so important that people get this message and learn about this show through you, and I cannot wait to chat with another guest next week. Thank you for tuning in for this week’s episode. As always, please leave a review. Share this episode with a friend. Share it on your social media. Make sure to follow me at PedsDocTalk on Instagram and subscribe to my YouTube channel, PedsDocTalk TV.

 

00;19;23;01 – 00;19;24;02

Dr. Mona

We’ll talk to you soon.