As a follow up to our blog post titled White Noise Machines and Auditory Development, we’ve been in contact with some experts in our own community to ask a few more questions to help parents with understanding their child’s needs related to auditory, speech and language development. Below is a Q&A session with Carla Monteleone, Speech-Language Pathologist and Fred Matta, Audiologist. Both clinicians specialize in pediatric services.
Question 1: From the article in Pediatrics published on March 3rd, we learned that white noise should not be played continuously (24/7) as it can affect speech and language development. If parents are using white noise at night as a means to improve their child’s sleep, what can they do during the day to help with speech and language development when the white noise is off?
The auditory system is constantly active, even during sleep, and although speech and language development is a process that takes place during waking hours, the fine tuning of the cochlea (organ of hearing) and the laying down of the auditory pathways occurs in response to sound stimulation. An infant’s auditory system requires exposure to a variety of complex sounds such as speech and music in order to develop the proper auditory pathways needed to be able to discriminate and recognize meaningful sounds. White noise may be a helpful way to lull or sustain an infant’s sleep state, but should be used sparingly because it does not vary in pitch and loudness across pitches.
Question 2: During the day, parents can help with their child’s speech and language development in many different ways including:
Talk to your child as you change, dress, feed and bathe your him/her. You can talk about what you are doing, what you are seeing.
Add gestures with words when you communicate (e.g. waving bye while saying bye, throwing kisses and making a kissing noise)
Respond to your child by imitating your child’s smiles, laughter, vocalizations, babbling sounds and/or word attempts
Sing songs especially action songs (e.g. itsy bitsy spider, pat-a-cake, the wheels on the bus)
Play people games (e.g. peek-a-boo, row row row your boat)
Read to your child. Children seem to enjoy lift the flap books and books with different texture. These add the opportunity for my language input.
The more your child sees non-verbal language (facial expressions, gestures) and hears verbal language (sounds and words), the more his/her language skills will develop.
Question 3: Can you give us a brief description of auditory development in a baby? For example are all the auditory pathways laid down before birth or do they continue to develop in the first year(s)?
The human cochlea (organ responsible for hearing) is fully formed and functional by the end of the second trimester (weeks 24 – 26 gestation). The period of time from the end of the second trimester to about 6 months of age is critical. This is when the fine-tuning of the cochlea or in other words, its ability to discriminate between different pitches of sound develops. This is why the recommendation for babies born with hearing loss is to provide them with suitable amplification before or by 6 months to maximize communication development and learning. The auditory pathway continues to develop over the next several years as the child begins to acquire speech and language. Chronic hearing loss in the early years can negatively affect normal auditory development and delay speech and language acquisition and learning.
Question 4: We talked about what to do to support speech and language development during the day, do you have any recommendations about protecting hearing?
Four ways to protect hearing include:
ONE: Learn to recognize sources that generate harmful noise and avoid or limit exposure when possible. Hearing damage caused by noise is primarily due to two things: A) Loudness of noise source and B) Exposure time. The louder the sound, the shorter the time before permanent hearing damage may occur. Some examples of potential sources of loud noises a child may be exposed to include: IPODs, car stereos, vacuum cleaners, power tools, lawn mower, TV, blender. Events such as weddings, concerts, movie theatres and sporting events are other examples.
TWO: Avoid competing noise sources in the same area (e.g. don’t try watching TV while vacuuming). You will simply end up turning the volume of the TV higher to overcome the noise of the vacuum cleaner and inevitably risk overexposure to loud noise.
THREE: Avoid purchasing very noisy toys. In Canada, The Hazardous Products Act prohibits the sale of toys that emit sound exceeding 100 decibels. However, even this level of sound can cause hearing damage in a child. Read the label on the toy to check its noise rating. If there is no noise rating, listen to the toy and if you have to raise your voice to be heard over the toy or if it sounds uncomfortably loud, don’t buy it.
FOUR: Wear hearing protection. When it’s not possible to avoid the potentially harmful noise source, hearing protection may be the next best alternative.
Question 5: From a sound and noise perspective, what are the ranges in loudness that a baby experiences in a day? For example, how loud are the sounds around the house and the community?
For a baby, the primary place in which he or she spends the majority of time is in the home. The sound environment will differ depending on the location, for example, a noisy main street versus a quiet cul de sac. Generally, sounds around the house can range from the hum of a refrigerator (around 50 decibel) to a food processor (80 – 90 decibel). Average conversational speech is at around 60 – 65 decibel). A vacuum cleaner, traffic noise and a dog barking are about 70 decibel. A hair dryer is around 90dB and inside a concert space can be as lout as 110dB.
Thank you to Fred and Carla for sharing some great insights and tips on speech, language and hearing development and ways to protect our little one’s ears.
Fred Matta, MClinAud, R.AUD., R.HIP is a Vancouver-based Audiologist involved in the diagnosis and management of childhood and adult hearing disorders as well as having a keen interest in hearing conservation and auditory processing disorders.
Carla Monteleone. MSLP RSLP SLP(C) is a Speech-Language Pathologist primarily working in the Lower Mainland. Carla primiarily works with preschool and school-aged children. Her interests are in the areas of children with apraxia of speech and fluency disorders.
White Noise Machines and Auditory Development are in the News Today
Many news outlets are sharing their take on an article released today (March 3, 2014) from Pediatrics which studied the upper limits of 14 commercially available white noise machines. White noise machines are a common choice on the list of “baby gear” that new parents obtain to help their baby obtain better sleep. Based on the news stories today, we’ve had a lot of concerned parents contacting us to ask us our opinions based on our professional health care training in Occupational Therapy.
What are the news articles and the research paper really telling us?
- 1.We know that noise levels and certain lengths of exposure for adults can produce damage to the ear.
- 2.Animal studies were cited to demonstrate that completely replacing the varied natural sounds of an animal’s environment with white noise can be detrimental to their auditory pathway development and it’s postulated that this could also occur with infants affecting their development of speech and language.
- 3.Hospital nurseries (Neonatal Intensive Care Units – NICUs) that serve critically ill and premature infants have recommended policies to decrease ambient noise to 50 decibels to both decrease the stress of environmental stimuli for these sensitive babies, to protect their sleep by decreasing disruptive noises and to protect their sensory development (the brain of infants born at 24 weeks gestation – 4 months early – will increase in volume 4x by term). This ambient noise is constant day and night in NICUs.
- 4.Many commercially available white noise machines can exceed the upper limits of noise safety for adults when turned to full volume. The loudness is amplified when the machine is closer to the baby/person.
- 5.Babies require many auditory inputs like singing and conversation with their caregivers to optimize their development. It is best to not use white noise all day long.
What we know as Occupational Therapists:
- 1.Infants, children and adults that have sensory processing differences, particularly those that are hyper sensitive to stimuli can have difficulty filtering out extraneous noises at any time of the day, and specifically while in light sleep or REM sleep phases. An infant or child that is sensory sensitive will respond to noises more frequently and with greater intensity to their peers making sound masking more critical as when roused, they may have a difficult time re-settling.
- 2.White noise has a sound masking effect due to its broad range of sounds. This effect decreases the risk of unpredictable environmental sounds rousing an infant or child from sleep.
- 3.Decreased overall sleep or disrupted night and day sleep can have significant implications on development and general health of infants and babies. Increasing an infant or child’s ability to fall asleep and stay asleep is important to an infant and child’s overall health.
What you need to know as a parent:
- 1.If you have a baby that has difficulty settling to sleep and is sensitive to sounds, the noise dampening effects of white noise may assist your baby to get the sleep that he/she needs to maintain good health and promote optimal development
- 2.Because there are no definitive studies available at present that document long term outcomes of white noise and development in infants and children (particularly auditory), the most conservative approach that is presented in robust literature is what we can form our parenting practices around. This is the research that is being applied in the hospital NICUs to aim for a noise level no higher than 50 decibels.
- 3.There are decibel readers available to parents, easily accessed by downloading an app on a smart phone. This meter can be used to calibrate the level of noise.
- 4.Based on the recommendations from this study, you can also place the white noise machine a minimum of 2m away from your baby and then use your meter to calibrate the noise level.
- 5.If you want to further decrease exposure, you can use the white noise machine in the later part of the night when your baby has a greater amount of REM sleep and is more vulnerable to environmental stimulus and to waking.
If you are interested in learning more about sensory sensitivity and your baby’s unique profile as it relates to promoting healthy sleep, our Registered Occupational Therapists can work with you to assess your child and provide a unique sleep plan which includes strategies to address sensory differences and sleep.
SleepdreamsTM Inc. offers sleep seminar courses on sleep for infants and children by Jennifer Garden. Jennifer is the founder of Sleepdreams, is part of the sleep research team at Children's SunnyHill UBC. She is university faculty and practicing Occupational Therapist registered in BC & Alberta. Get the right information on sleep help for your baby or child by a true professional with trusted qualifications. Jennifer presents at international conferences to health care professionals including paediatricians, physicians, therapists, nurses, respiratory therapist, researchers and other health care professionals. Jennifer is interviewed as a trusted expert on sleep across Canada as interviewed by the CBC, Global News, CityTV, and newspapers from coast to coast. Jennifer's clinical practice in paediatric sleep, experience as a mother of twins and abilities as university instructor provide for an informative, interactive and personal sleep seminar.
NORTH VANCOUVER: February 23, 2014 at Modern Family Expo Jennifer Garden is giving a free 15 minute seminar on sleep with admission. Modern Family Expo is at the Pinnacle Hotel from 10 am to 3 pm. Info here.
VANCOUVER: February 27, 2014 at Vinci's Cafe & Gallery from 10 am. to 12 noon Sleep Seminar with Jennifer Garden. Please visit Modern Mama's Page for location details and to register.
KAMLOOPS: THOMPSON RIVERS UNIVERSITY SLEEP CONFERENCE March 6 - 8th. Two lectures on March 8th by Jennifer Garden: 1. Sensory Processing and Sleep Disorders 08:30 - 09:15. 2. Children, Sleep and Occupational Therapy 15:20 - 16:00 hours. Information here.
NORTH VANCOUVER: March 24th at 10am Sleep for Infants hosted by Modern Mama at Gymboree North Vancouver. Information and Registration here.
NORTH VANCOUVER: March 24th from 7 to 9 pm Toddler Sleep. Location TBA. Contact Modern Mama North Shore for info.
April 2nd Capilano Universe Talk at Gibsons Public Library Jennifer will be presenting on sleep and the role of occupational therapy in paediatrics. This is a free lecture series put on by Capilano University.
April 11th – FASD Conference presentation with Children’s Sleep Network research group. Medications for Chronic Sleep Problems in Adolescents and Adults with FASD. UBC Interprofessional Continuing Education.
Go to our Seminars Page for more info!
Can developmental milestones in the first year interrupt sleep?
Yes! Let’s take a look at what’s happening with your child’s development and a perspective on how to manage when their progressions in one area seem like set-backs in other areas.
We often hear parents ask about sleep regressions related to different developmental periods. While it can definitely feel like a regression, it’s really just an interruption as your child moves into a new stage and all their developmental paths settle out.
Here are some developmental progressions your child will make in the first year, some common ways in which these progressions affect sleep and what you can do if your family is in this stage.
1. Motor milestones – When your baby reaches the point of mobilizing on their own, they will be endlessly fascinated with their new skill and often want to practice it while they are in bed or if they wake in the night. Sometimes they are in the middle of their skill development and get “stuck” literally in a position and it’s frustrating for them. Examples include rolling front to back, back to front, crawling and standing. These are the skills we hear a lot about from parents. What you can do is help you baby along to practice these skills and get lots of exposure to them during the day. For example, if your baby is rolling back to front and then gets stuck, work with him to roll front to back so he can become independent in this skill and sort out his own position at night. Babies that are developing motor skills also need more movement during their day than they did when they were newborns. Give younger babies lots of floor time to practice their skills and older babies lots of opportunity to move, crawl, climb, explore. The balance of getting good sleep is getting a good quantity and quality of movement time during the day.
2. Cognitive milestones – Around 4 months of age, babies ‘wake up’ to the world and are very interested in what’s around them. They are keen to explore and know what is going on around them. This is a fun age but can lead to over stimulation for sensitive babies. Watch your child’s reactions to stimulation at this point and take care to not over stimulate them, especially close to a sleep time. This can make it difficult for them to settle to sleep and stay asleep. Around 6-9 months of age, your child will develop object permanence. This means they will understand that you still exist though they cannot see you. Babies that are in their crib room awake may be upset because they cannot see you. Give your baby lots of reassurance during the day by playing games like peek-a-boo and leaving them to play independently in a safe space for a few minutes at a time, returning cheerfully.
3. Teeth! Teething can be a huge issue for some kids and a non-issue for others. It is typically the phase in which the gums are swollen before a tooth erupts that are the most difficult. Comfort your baby during these times using pain management (discuss with your doctor/pharmacist) and lots of love and support. A baby in lots of discomfort needs you to help them be comfortable and get sleep. This is not a teachable time for babies. It too will pass with the eruption of the tooth and then you can get back on track with sleep.
As Registered Occupational Therapists specializing in sleep for infants and children, many extended health care plans recognize and cover the cost of our services. Sleep is an activity of daily living and falls within the scope of practice of Registered OT's. Ask your extended health care provider if they cover Occupational Therapy services. If your health care coverage includes an expense account then OT services should be covered within that umbrella of registered health care providers. Our OT's are registered health care providers and specialists in sleep.