All children learn to babble and talk at different times. Before you know it, they can read their favorite book or tell you what they want for their birthday. But, when they can't tell you what they want to eat for breakfast or the daycare teacher can't understand what they say, parents need somewhere to turn.

At Cook Children's Rehabilitation Services, our speech language pathologists (SLPs) are highly skilled and experienced in children's communication development. They work with parents to help empower their children to achieve their goals.

We have about 40 SLPs who serve our patients in our medical center and outpatient clinics. They have expertise in:

• Feeding/dysphagia
• Speech/language skills
• Augmentative and alternative communication
• Hearing loss
• Autism
• Traumatic brain injury and so much more!

As we celebrate Better Speech and Hearing Month this May, Jonathan Suarez, Rehabilitation Services clinic lead, and Suzanne Bonifert, Rehabilitation Services manager, provide answers to commonly asked questions about speech and hearing.

What can I do to get my child to speak more?

Model words for your child, even if he/she doesn’t repeat them. For example, if he/she vocalizes and points to juice, you can say, “juice” or “you want juice.” That way the child is hearing the words even though he/she cannot say them yet.

It’s also good to use comments (i.e. “You want juice.”), rather than questions (i.e. “What do you want?”). Doing so can be less stressful for kids, especially those having some challenges learning to talk.

We also recommend talking to your pediatrician about a referral to see a SLP for an evaluation. The SLP can help you identify your child’s strengths and challenges and may recommend therapy to help give your child a boost!

Is it OK to speak more than one language to my child throughout the day?

Yes, yes and yes! Every child is different and the amount of time they spend using each language can vary, depending on exposure in school, at home or during extracurricular activities.

Sometimes a child may understand multiple languages but will only use one. Keep practicing each language!

Some children may “code switch,” or use both languages when they speak. This is not a disorder. The child is learning how to use the rules of both languages.

How do I know when to be concerned about my child’s communication or when to see a speech therapist?

By the time your child is 12 months old, he/she should be able to speak two to three words. By the time he/she is 2 years old, he/she should be able to speak at least 200 words. By age 3, he/she should be able to speak 900 words.

Trust your gut. If you feel there is a concern, you can ask your pediatrician for a speech therapy referral and have your child evaluated.

Once the evaluation is complete, an SLP can provide information to help with your child’s communication.

Here are links to two helpful speech and language milestone charts:

• Speech and Language Milestone Chart, LD Online
• Speech and Language Developmental Milestones, National Institute on Deafness and Other Communication Disorders

Is there something I could have done as a parent to prevent my child’s speech delay?

No. We often hear parents say, “We never had to worry about my older children talking.” But there is nothing you could have done to prevent your child’s speech delay. In most cases, there are steps you can take now to help your child’s language skills grow.

Since your child has a language delay, we need to be intentional in the language we are using with them.

How long will my child need to be in speech therapy to gain the skills they need to communicate?

Progress can vary from child to child. Our goal is to improve the child’s language while also teaching the parent or caregiver some interaction and language strategies to elicit communication.

What can a speech therapist do with a toddler who cannot sit still?

We can teach language in a variety of ways! Activities involving movement are great for keeping children interested. Sometimes, children are having so much fun that they do not realize they are actually doing a language activity!

Instead of sitting at a table for activities, you could:

• Stand up and sing songs using motions and actions
• Play hide-and-seek
• Play chase while running, jumping or skipping
• Read a book while acting each part out

To learn more about the Cook Children’s speech therapy program, please visit our website. 

She gives tips to parents about the importance of checking the volume of their child’s headphones and earbuds. The question for the column: My child wears headphones for school and on long car rides. Can this hurt their hearing? The answer, yes.

We live in a world where children love to watch movies or play games on their electronic devices, but Vaughan warns that prolonged headphone use can be risky.

“What is ‘too loud’ can vary based on a child’s ear size, type of headphones, and length of listening time,” Vaughan said.

With children having control of how loud or soft the volume is in their ear, she says listening at too high a volume can cause permanent hearing damage.

Vaughan explains if you can hear what your child is listening to, the volume is too loud and urges parents to use headphones with volume limits.

In the column, she also teaches parents that headphones are always a better route to go than earbuds, and often the volume has to be louder in earbuds to compensate for the way they fit in a child’s ear.

Lastly, she gives guidance that best practice may be for your child to go without headphones, but to also remember that external speakers can also be a hazard if your child is too close or the volume is too loud.

Braden Baker is one of those superheroes. Except Braden is not only in the pages of a comic book, he's also a compassionate kid raising money for people from all over the world who can’t afford hearing aids.

Because of his heroic deeds, 13-year-old Braden will appear on the latest episode of Marvel’s Hero Project, which debuts today on Disney+.

Marvel’s website describes the documentary as a show which “reveals the remarkable, positive changes several young, real-life heroes are making in their communities. These inspiring, driven, and engaging kids have dedicated their lives to selfless acts of bravery and kindness. These young heroes are finding creative solutions to tackle big issues such as protecting our environment, ending hunger, championing inclusivity, and many more. Now, Marvel celebrates them as true Super Heroes. They are welcoming them into Marvel’s Hero Project.”

In superhero form, he is known as "Battlin' Braden!" "Braden considers his hearing aids his superpower: when he puts them in, he feels his world comes alive. But when he learned that not everyone who is hearing impaired can afford hearing aids, he knew he had to help. Made possible through his tireless fundraising efforts, he travels, across the world delivering hearing devices, witnessing how lives are transformed when the sound finally comes on." You can read Battlin' Braden #1 for free here.

So how did Braden land a spot on this program? Well, like any good superhero, let’s look at his origin story.

During his newborn hearing screen, doctors found that Braden was born 65% deaf. He was sent to Cook Children’s shortly after to begin treatment for his hearing loss. It was there that Braden’s mom, Ashley Baker, discovered her own set of heroes.

“I get emotional talking about Cook Children’s. From the moment I walked in there, I knew everything was going to be OK,” Ashley said. “I knew because of the people there, who were taking care of Braden. To have somebody tell you who knows, ‘Everything is going to be fine’ meant the world to me. They told me it was best they found it at the newborn hearing screening. Because we are catching it now, we can help Braden.’”

Most babies are born with normal hearing but every year three out of every 1,000 babies are born with hearing loss. Hearing loss is most often discovered during a newborn hearing screening in the hospital shortly after birth.

Pediatric audiologists focus on diagnosing specific types of hearing loss in children. At Cook Children's, the audiologists work closely with the child, as well as family, speech pathologists, school personnel and physicians to enhance functional hearing to help your child learn and develop.

That suppoort allows Ashley to even laugh now looking back, thinking about the first pair of hearing aids placed on Braden at Cook Children’s. He simply “freaked out” the first time he was able to hear. But because of the staff taking care of her, Ashley says she remained calm.

“It never felt huge or overwhelming because of the staff,” Ashley said. “Cook Children’s held my hand from the beginning. I did everything they told me to do. That is the whole reason, Braden has done so well. Early intervention. They changed the entire trajectory of my kid’s life. They even had someone from Cook Children’s go to Country Day when he began kindergarten. They told the teachers how he hears, what he hears, and the importance of wearing an FM (a wireless assistive hearing device that enhances the use of a hearing aid). And we still go to Cook Children’s to this day.”

Braden’s trajectory changed again in June 2017 when his dog, Chewy, ate one of his hearing aids. Braden’s parents lectured their son on the importance of taking better care of his hearing aids and explained they could be quite expensive.

Braden took the message to heart and decided he wanted to help others who couldn’t be careless with their hearing aids or couldn’t afford them.

He asked himself a question based on his fandom of his favorite talk show host, “What would Ellen do?”

Braden decided to launch a GoFundMe campaign to raise money for people who can’t afford hearing aids. He advertised the campaign on his mom’s Facebook page.

He began to work with his local community, including Cook Children’s and the Fort Worth ISD. He also established a relationship with the Oticon Hearing Foundation, the company that makes his hearing aids.

Braden eventually connected with the Entheos Audiology group, “Hearing the Call,” which led to mission trips to Guatemala, Ecuador and Zambia, Africa. Ultimately, Braden helped reach more than 200 people who have received new hearing devices. Today, he has raised more than $107,000.

His question led to an answer and the chance to meet his inspiration. Braden appeared on the Ellen show in October of 2017. 

From there, Braden spoke at events all over, and his story has reached hundreds of thousands of people.

And that all led to a fateful phone call that invited Braden and his family to New York to meet the crew from Marvel. They talked to Braden and learned more about his incredible tale of helping others. They took his adventures and created a comic book.

When it comes to all of the exposure and amazing things he’s accomplished and been a part of, Braden is more Steve Rogers than Tony Stark.

“While being a Marvel Hero is pretty awesome, what I hope the attention does is highlight the work of audiologists,” Braden said. “A lot of doctors get attention for the great work they do, but the work of the audiologists are changing the way people hear and experience the world.”

Now, he will continue to spread his inspiring message as part of the new Marvel’s Hero project. The documentary followed Braden to stops throughout Fort Worth.

“This has been another amazing experience. It’s just cool for Fort Worth and this kid who came from Cook Children’s,” Ashley said. “But there’s no way we take all the credit. It’s all the wonderful people who have paved our journey thus far. Marvel indoctrinated him into the Marvel Hero universe. In the book, he’s in hero form. He’s in action, throwing hearing aids out to people. Braden is a kid who turned his disability into a huge ability. There’s no perfection in heroism, and that’s always kind of been Marvel’s point.”

*Credit to Disney+ for images from the episode and to Marvel for images from the comic.

Let's begin by looking at the facts:

• About one to three babies out of every 1000 will be born with a permanent hearing loss.
• Infant hearing loss is the most common health condition identified through routine newborn screens.
• Nine out of 10 cases of genetic hearing loss occur in families where both parents have normal hearing.

The earlier children with hearing loss are identified and start getting help, the more likely they will reach their full potential. Hearing loss can cause children to fall behind their peers in speech, learning, reading, and social-emotional development, which can result in lower educational and employment levels into adulthood.

1-3-6 Goal

In fact, the Centers for Disease Control recommend the following 1-3-6 Goal:

1 — All infants get a hearing screen before 1 month of age.

3 — Hearing loss is confirmed before 3 months of age.

6 — Hearing loss intervention begins before 6 months of age.

So now that we know it’s better to identify hearing loss as a baby, just how are babies tested anyway? There are two types of tests used to screen hearing in babies and both are safe and painless.

Types of Hearing Screens

Otoacoustic Emissions (OAE)

For this test, a small earphone and microphone are placed in the ear, sounds are played, and a response is measured in the ear canal. If a baby hears normally, an echo is reflected back and measured by the microphone. When a baby has a hearing loss, no echo can be measured on the OAE test.

Auditory Brainstem Response (ABR)

For this test, sticker electrodes are placed on the baby's head to detect responses while sounds are played in the baby's ears. This test measures how the hearing nerve responds to sounds and can identify babies who have a hearing loss.

The two tests can be used separately or together. Both tests require a quiet, if not sleeping baby. If a problem is found, follow-up testing should happen as soon as possible.

What if My Baby Fails a Hearing Screen?

If your baby fails a hearing screen, you will be referred to an outpatient facility where an Audiologist will complete a more in depth ABR. It will measure the softest level that the ear responds to sounds using different pitches or tones. If testing is done before a baby is 4 months old, the baby can usually sleep naturally for the testing. For older or very active babies, sedation may be needed to help them sleep during testing. It is important that babies are sleeping for ABR testing.

The newborn hearing screen is one of the most important first tests your newborn takes. Babies start learning how to use sound as soon as they are born and listening prepares them to speak. Therefore, if a baby has hearing loss it is important that services begin right away. If you have any questions or concerns about your child’s hearing, contact your Pediatrician and ask about seeing an Audiologist.

See below for additional resources on newborn hearing screening:

• Cook Children's Audiology
• CDC information on hearing loss/screening
• Babyhearing.org
• Joint Committee on Infant Hearing

About the author

Christina Graham is an audiologist at Cook Children's. Cook Children's audiologists focus on diagnosing specific types of hearing loss for kids. They work closely with the child, his/her family, speech pathologists, school personnel, specialists, and physicians to create a plan that will enhance a child's functional hearing and help them learn and develop. To learn more, click here. To make an appointment, click here.