Health Manager Orientation Guide

Vision and Hearing Screenings

Child going through a vision screening.The purpose of vision and hearing screening is to identify children for possible sensory concerns. Screening is used to determine if a referral for further evaluation is necessary for the child.

Vision Screenings

Healthy vision supports learning, early literacy skills, social and emotional development, motor skills, physical activity, and self-image. Young children rarely complain when they can’t see well because to them, it’s normal. Families and early care and education staff cannot always tell when a child has trouble seeing. So, evidence-based vision screenings throughout early childhood are important to identify vision disorders and make sure they are treated. HSPPS 45 CFR §1302.42(b)(2-3) requires grant recipients to get the results of, or perform, vision screenings.

Three types of evidence-based vision screening tools are available:

  1. Developmental milestones checklist (for infants under 12 months of age)
  2. Instrument-based screening for refractive errors
  3. LEA Symbols® or HOTV optotype-based screening for recognition visual acuity for preschool age children

Tips and Strategies for Supporting Vision Screenings

  • Review copies of each child’s most recent physical for the date and results of a child’s vision screening.
  • Train staff or volunteers to perform evidence-based vision screening.
  • Include questions on the program’s family health history form to see which children may have a higher risk of vision problems.
  • Give resources to help families learn more about healthy eyes and the importance of early detection of vision problems.
  • Partner with local health care providers to support families. Families may need more help to understand vision concerns, diagnoses, and recommended therapies.
  • Offer families help to get to and from medical appointments and to find community resources for eyeglasses.
  • Make sure programs know they may use program funds for professional medical and oral health services when no other source of funding is available. When a program uses its funds for these services, recipient and delegate agencies must have written documentation of their efforts to use other available sources of funding.

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Hearing Screenings

Young girl raising her hand to signify she hears a sound during a hearing screening.Families and staff cannot always tell when a child is deaf or hard of hearing, so having evidence-based hearing screenings throughout early childhood is important. About two to three of every 1,000 children in the United States are born deaf or hard of hearing. A child’s hearing may also decline at any time from illness, physical trauma, the environment, or genes. The incidence of permanent hearing loss doubles by the time children enter school.

A child may have difficulty hearing in one ear or both ears. The difficulty may be temporary or permanent. It may be mild or a complete inability to hear sounds. Any inability to hear clearly can get in the way of a child’s speech, language, social and emotional development, and school readiness. Intervention may improve social and emotional and academic achievement when children who are deaf or hard of hearing are identified early. Child health status and care, 45 CFR §1302.42, says that a program must either get the results of or perform evidence-based vision and hearing screenings for every child. Conducting hearing screening in early childhood settings is simple and usually takes only a few minutes by someone who is trained.

Tips and Strategies for Supporting Hearing Screenings

  • Conduct otoacoustic emissions (OAE) screening for newborns, infants, and children from birth to age 3, as recommended by the American Academy of Audiology.
  • Conduct pure tone (PT) screening for children 3–5 years old, with OAE screening for the subset who cannot complete PT screening.
  • Help families complete all recommended follow-up steps after a hearing screening and referral.
  • Rescreen children who do not pass the first time, within two weeks.
  • Refer a child who does not pass a second screening to the child’s health care provider. The cause may be waxy buildup or fluid in the ears. Rescreen the child a third time after the child’s health care provider has removed the wax or fluid.
  • Support families to follow up if the program gets results from the child’s health care provider that says the child did not pass a hearing screening.
  • Prepare families about what to expect from a hearing screening.
  • Share information with the families about the importance of hearing for children’s language development and communication.
  • Partner with a pediatric audiologist to join your HSAC.
  • Encourage families to speak with their child’s health care provider anytime they express a concern about their child’s hearing or language development.

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