Alisha, Author at Hear and Say

Types of Lisps

There are four different types of lisps, each with distinct characteristics lisp sounds related to the tongue placement.

Interdental Lisp or Frontal Lisp - occurs when the tongue protrudes or sticks out between the teeth when making "s" or "z" sounds, resulting in a "th" sound.
Dentalised Lisp or Dental lisp - occurs when the tongue rests or pushes up against the front teeth, resulting in a muffled sound.
Lateral Lisp - occurs when extra air flows over the sides of the tongue instead of down the middle, resulting in a slushy lisp sound.
Palatal Lisp - occurs when the tongue tip touches the roof of the mouth (also called the soft palate) when making "s" or "z" sounds rather than behind the teeth.

Lisps can impact clear communication and self confidence. Untreated children's lisps can impact typical speech development, self esteem and lead to speech delay and cause other long-term speech errors.

What is an Interdental Lisp?

Interdental lisps are the most common in early language development. It is a speech sound error arising from the abnormal tongue protrusion between the front teeth that causes speech sounds to sound "muffled" or ''hissy''.

What is an Example of Interdental Lisping?

When a child produces a 'th' sound for 's', 'z', 'sh' sounds.

What Causes an Interdental Lisp?

There is no definitive answer, but there are a few factors that can result in interdental lisps such as unknown causes, anatomical issues or prolonged habits that can lead to disruptions to learning speech.

Some anatomical issues include cleft palate, tongue tie, misalignment of teeth that results in the abnormal forward tongue movement which distorts the speech sounds. Similarly, prolonged habits of thumb sucking or dummy use pushes the front teeth forward that causes a teeth misalignment and forward tongue placement as the child produces sounds like ‘s’, ‘z’, ‘sh’.

Other factors that may result in an interdental lisp could include hearing loss, cognitive difficulties which affects speech development.

When Does an Interdental Lisp in Children Start?

Interdental lisps can typically occur before four years before a typical child fully develops the ‘s’, ‘z’, ‘s’ sounds but if the lisp persists beyond seven years, further assessment by a speech pathologist is recommended as these sounds are usually developed by this age.

What are the Common Signs and Symptoms of an Interdental Lisp?

When you notice your child producing a 'th' sound for 's', 'z' sounds. For e.g. "thebra" for "zebra" etc. It might also be helpful to observe your child when he or she makes the 's' and 'z' sounds, as a common sign of interdental lisp, is when the tongue abnormally protrudes between the front teeth while making these sounds.

If your child has a prolonged habit of thumb sucking, dummy use, or has dentition problems, these might be common signs of an interdental lisp.

How is an Interdental Lisp Diagnosed?

An interdental lisp is usually diagnosed by a speech pathologist after a comprehensive assessment has been done on a child. This may include analysing their speech sounds, oromotor skills, hearing and general observations and parent interviews to gather more information to make an accurate diagnosis. A speech sounds assessment allows a speech pathologist to assess the types of speech sounds the child finds difficulty in. For e.g. an interdental lisp would suggest that the child is unable to produce 's', 'z', or 'sh' sounds.

An oromotor assessment takes place to provide more information about the child's muscle movement for speech in terms of strength and accuracy. It is also strongly recommended that their hearing is also checked, as a child requires good auditory perceptual skills to receive feedback about their speech and correct it if necessary. Through observations and case history interviews, the speech pathologist would be able to look out for any red flags that could indicate if an interdental lisp is present such as prolonged thumb sucking, poor dentition, tongue thrust etc.

How is an Interdental Lisp Treated in a Child?

These errors are usually treated in speech therapy sessions through articulation therapy that aims to provide the child with feedback and intensive practice to correct the way their mouth moves to say the sound. Speech language pathologists will often work up a hierarchy with the child from discriminating between different sounds to allowing them to practice producing the sound in syllables, words or sentences. Providing the child with auditory cues is often used throughout the therapy to raise their awareness about the sounds and placement of the structures in their mouth as they produce different sounds.

It is often recommended for a child to seek early intervention as prolonged outward movement of the tongue can reinforce the habit and distort the sound, which might be harder to treat and correct the neural pathways for the speech sound at an older age.

How Can I Help my Child who Has an Interdental Lisp?

It is often emphasized in therapy for the child to be able to hear and discriminate between the different speech sounds to raise their awareness and be able to monitor the difference in their own speech.

Hence, helpful ways to help a child with interdental lisp is to provide them with auditory and visual feedback for them to be aware and correct the sound if needed. For example, "I heard a 'th', let's try that again 'zebra'." or "Look where my tongue is, it goes behind my teeth" etc.

It is also important for your child to have regular practice at producing the speech sound with correct tongue placement for the error to be reduced permanently.

What are the Long Term Effects of an Interdental Lisp if Left Untreated?

Long term effects of a persistent interdental lisp may decrease a child's overall speech clarity, and this might not only affect their literacy and academic success but also their social interactions with others due to their decreased ability to be understood by their peers and other children.

When Should I Speak With a Speech Language Pathologist?

If you notice and hear that your child is consistently unable to produce 's', 'z', or 'sh' sounds, a further assessment by a speech language pathologist (also known as a speech pathologist or speech therapist) is recommended.

If you suspect your child has a lisp, a speech language pathologist can evaluate and recommend treatment tailored to the individual child. Most lisps can be treated successfully through early intervention and speech therapy.

If your child's lisp is identified at an older age, the habit of incorrect placement and tongue position becomes harder to break and correct sounds. It is still recommended to start therapy session and begin working on correction techniques as early as possible.

What is Stuttering?

Everyone has probably experienced a time when they did not speak as smoothly or clearly as they would have liked. They might fumble on their sentences or add filler words such as 'uh' or 'like'. These are called disfluencies.

People who stutter experience more disfluencies and have different types of dysfluencies that disrupt the normal rhythm and flow of their speech. Often times, people who stutter know exactly what they want to say but have a difficult time expressing themselves. This can lead to the association of stuttering with negative emotions and feelings, which could continue to impact their confidence and self-esteem.

Everyone stutters differently and how much they stutter can change depending on the environment that they are in or their emotions at the time. How much someone stutters can also change from day to day or even during different times of the day. Stuttering may also be known by other names including stammering, disfluent speech and childhood-onset-fluency disorder.

What Causes a Child to Stutter?

There is no known cause of stuttering, but research has shown that it is likely due to a combination of multiple different factors which include:

Family history of stuttering - many people who stutter are likely to have other family members who also stutter
Differences in brain structure - people who stutter may have differences in the way their brain works during speech production (specifically the regions that coordinate and control the muscles responsible for speaking)
Gender - boys are more likely to stutter than girls are

Additional factors that do not cause stuttering but can affect it include:

The child's speech and language development - if the child's speech and language abilities are still developing, it is normal for them to not be able to produce smooth speech
Environment - a child's stuttering may worsen if they are competing with someone else, being interrupted or in a noisy environment
Heightened emotional stress - a child's stuttering may worsen if they are in a heightened emotional state such as feeling stressed or excited

When Does Stuttering in Children Start?

For most children, stuttering emerges in childhood around the ages of two to four years, which is consistent with the age at which they are starting to acquire more speech and language skills. As the characteristics of each child’s stutter are different, so is the way that a child may start stuttering. Some children may suddenly develop a stutter overnight, whereas other children’s stuttering may have a slower and more gradual development of a stutter.

What are the Signs and Symptoms of Stuttering?

The signs and symptoms of stuttering can change significantly throughout the day, but it is generally worse during a stressful situation such as speaking to a group. It is also normal for a person's stuttering to temporarily reduce while they are singing, reading, or speaking in unison. Some signs of a stutter include:

Finding it difficult to start talking
Repeating a sound, syllable, or whole word - e.g. I w-w-want to eat
Stretching and drawing out a word or sounds in words - e.g. Ssssally is kind
Pausing between words or within the word, where airflow is physically stopped at some point - e.g. I want a (pause) cookie
Adding extra words such as 'um' and 'like' if they are expecting themselves to have difficulty with producing the next word
Avoiding the use of certain words that they know they will have difficulty with or specific speech sounds
Feeling emotions such as anxiety towards talking

Sometimes people who stutter may have associated actions which include:

Unusual facial movements (sometimes called facial tics)
Rapid eye blinks or loss of eye contact
Head nodding
Trembling of the lips or jaw
Associated body movements - e.g. tightening of fists

How is Stuttering Diagnosed?

Stuttering is usually diagnosed by a speech pathologist (also known as a speech language pathologist or speech therapist), who is trained to assess and treat individuals with voice, speech and language disorders.

A speech pathologist will analyse your child’s stuttering by asking questions about your child’s history such as how long they have had a stutter or when it started. They may also collect a sample of their language to determine what types of stuttering your child presents with the most.

Sometimes they may also assess your child’s speech and language abilities, to see whether these may have a role to play in your child’s stuttering. This is because many children stutter during a period of time when they are still acquiring speech and language skills. Depending on how your child presents, they may also consider the impact that your child’s stuttering may have on their life.

How do you Treat a Child for Stuttering?

There is currently no cure for stuttering but there are a variety of treatments available that help people to reduce stuttering in their speech and to speak more smoothly. Many of the current therapies focus on teaching new ways of speaking that minimize stuttering through strategies such as speaking slowly and coordinating their breathing with their speech.

Many of these therapies also include a component that considers and helps to address possible anxiety that a person who stutters may feel in certain speaking situations. Children may benefit from attending speech therapy to address how stuttering affects their own speech. It is helpful to seek professional help and early treatment to avoid the child becoming aware or self-conscious of their stuttering. Sometimes children will begin to try different aways to avoid stuttering or change how they form sentences.

The treatment focuses will differ based on a child's age, communication goals and other factors. If you or your child stutters, it is important to work with a speech pathologist to determine the best treatment options.

How can I Help my Child who has Stuttering?

Some things that you can do to help your child in their stuttering journey include:

Keeping a relaxed and calm home environment that allows many opportunities for the child to speak – e.g. setting aside time to talk to one another, especially if the child is excited and has a lot to say
Listening attentively by focusing on the content of the message, rather than responding to how it was said or interrupting the child
Speaking in a slightly slowed and relaxed manner to help reduce any time pressure
Waiting for the child to finish their own sentences when they are stuttering instead of finishing their sentences or giving them advice when they are speaking – this is important as it helps the child to learn that they can still successfully communicate when stuttering occurs
Not punishing them for stuttering – this can have the opposite effect and lead to more feelings of anxiety towards talking

When Should I Speak With a Speech Pathologist?

For the majority of children between the ages of two and five, stuttering is a normal part of their process of learning how to speak and will naturally resolve on its own. However, stuttering that continues in older children (past five years of age) may require help from a speech pathologist to improve the rhythm and flow of their speech.

It is encouraged for your child to see a trusted health professional if their stuttering:

Lasts six - 12 months or longer
Started later than three and a half years
Occurs along with other speech or language difficulties
You notice your child starts to tense up or seems to physically struggle when talking
Affects their ability to communicate at school or in social situations
Causes them to start to feel anxiety or embarrassment about their talking - e.g. fear of participating in class activities

What are the Long-Term Effects of Stuttering if Left Untreated?

The long-term effects of untreated stuttering can be influenced by factors including how often the child stutters, what type of stutter they present with as well as whether their attitudes and feelings towards their stutter are positive or negative.

For many children who stutter, increased self-awareness and consciousness about their speech could lead to more instances of feeling fear, embarrassment and anxiety towards situations that require them to speak. Stuttering may also impact and limit their participation in social interactions at school, and their ability to make requests or complete tasks such as speaking on the phone.

Can Dummies Impact Speech Development

For years there has been a 'dummy debate' over whether parents should provide their child with a dummy for soothing purposes, with strong arguments for both sides, resulting in confusing advice over the benefits and risks of dummy use in the early years.

What is the Purpose of Dummy use?

Dummies can be incredibly useful for settling young babies, particularly when they are distressed or trying to go to sleep.

However, despite common use for encouraging strong sucking patterns, dummies can act as a barrier to breast feeding with the different shapes and firmer feel of a dummy confusing babies over how to effectively suck for feeding versus comfort.

After six to 12 months of age, a dummy’s specific usefulness declines when weighed against its risks of contributing to developmental challenges.

What are the Average Speech Development Milestones?

There is a typical pathway of speech development milestones that occur across a young child's journey towards using correct speech sounds when talking. At one year of age, babies start saying their first words. By two years, many children start combining words and can be understood around 50 per cent of the time by strangers. By four years, children are using full sentences, and their speech clarity has significantly improved such that, although they still often have some slight sound errors, strangers can understand their overall speech 100 per cent of the time.

In their speech, children use predictable patterns of errors (known as phonological processes) that make sounds easier to say while they are learning to say them correctly. For example, many parents will have heard their young child say "wing" instead of "ring" or "nana" for "banana". These speech sound error patterns gradually decrease over time, with most eliminated around five years, up until around seven years when a child should have no errors left.

Delays in reaching these milestones might indicate a speech sound disorder or phonological impairment in which a child needs intervention from a speech pathologist to help them learn how to say certain sounds correctly.

What are Common Signs Your Child's Speech Development Could be Falling Behind?

Signs of speech problems, common speech disorders or delayed speech development include difficulty producing speech sounds correctly, learning new sounds, being understood by others, needing a familiar person to translate for them, and anxiety about or unwillingness to talk.

Is There a Legitimate Concern About the Potential Impact of Dummies on Speech Development?

Like thumb sucking, prolonged use of dummies has consistently been shown to increase the risk of a child developing a speech sound disorder or phonological impairment.

Babies and young children are less likely to try to babble or talk when they have a dummy in their mouth, which decreases their practice in learning to use words to communicate and say words correctly.

Dummy and pacifier use can also present an increased risk of a child experiencing middle ear infections (known as otitis media) which can negatively impact their hearing. If a child cannot hear sounds correctly when listening to other people speak, they are unable to learn and imitate them in their speech.

How can Prolonged Dummy use Impact Speech Clarity?

Prolonged dummy use, beyond the developmental age when children naturally outgrow sucking behaviours, can often impact the clarity of children's speech articulation.

Not only can using a dummy delay a child from using sounds to communicate, but its physical presence in the mouth can also restrict the child's tongue from exploring the full range of movements required to make all the different speech sounds.

Over time, dummy use can lead to oral health problems as the constant pressure of the dummy in the mouth pushes the child's front teeth forward leading to an open bite where the front top and bottom teeth do not align properly.

This then affects the child's development of speech as they cannot coordinate the placement of their tongue and teeth to produce certain sounds. This is particularly noticeable for 's' sounds and 'th' sounds, where a gap in the front teeth causes the child's tongue to protrude between them, resulting in a 'th' sound, known as an interdental lisp.

What do Speech Experts Recommend?

Speech pathologists often advise balancing dummy use for comfort and soothing with the need for speech and language outcomes in the child’s early years. They encourage parents to be mindful of the duration and frequency of dummy sucking particularly after 12 months of age when children are starting to use words.

Parents should be careful of abruptly stopping dummy use as children may then develop a similar dependency on similar oral sucking behaviours such as thumb sucking or finger sucking. Instead, a gradual transition away from the child’s dummy habit is typically more effective where a dummy is provided only at specific limited periods, such as bedtime.

How to Take a Balanced Approach to Providing Comfort and Supporting Speech Development?

Adopting a balanced approach to dummy use involves ongoing consideration of how your child's speech and language development is progressing compared to the average milestones.

Encouraging other forms of comfort, such as a soft toy or blanket, can also help reduce dependency on dummies whilst still providing your child with an effective method of self-soothing. If you are finding your child wants to suck their dummy most of the time throughout the day, encouraging crunchy or chewy snacks can help provide alternative enjoyable sensory stimulation to their mouth.

Get Advice From a Qualified Speech Pathologist

If you are concerned about your child's speech or language skills, consulting with a speech pathologist is always an important first step. They can provide an assessment of any speech impairment and discuss potential contributing factors in your child's history, including dummy use. A speech pathologist can then work with you and your child to develop individualised therapy goals and strategies to address any speech disorder concerns.

Dummy use is common among many young children and has its benefits, particularly in the early months of life. Being mindful of how dummies can affect speech development is important. Parents can make more informed decisions, by understanding the significant associations between prolonged dummy use and speech problems.

Tongue Thrust Affect on Speech

What is a Tongue Thrust?

Tongue thrust is a condition where the tongue pushes forward against the back of the teeth or between the top and bottom front teeth during breathing, swallowing, and speaking. Often times, the tongue will push forward but sometimes it can also press into the back of the teeth. A tongue thrust can also be known as a "reverse swallow" or "immature swallow".

When Should I be Concerned About a Tongue Thrust?

The tongue thrust is an important protective reflex seen in young babies that allows them to push food out of their mouth to prevent choking when breastfeeding or bottle feeding. For most children, this reflex typically matures at around six months and develops into a more effective swallowing pattern for eating solid foods.

For some children, the transition from tongue thrusting to a more mature swallow does not occur seamlessly, which can lead to the persistence of a tongue thrust swallow pattern well into older childhood and even adulthood. Targeted intervention from a health professional would be required to correct a tongue thrust.

What Causes a Tongue Thrust?

There is no single underlying cause, but rather there are a range of factors in a child's development that may be contributing to persistent tongue thrusting. Some possible reasons include, but are not limited to:

Prolonged thumb sucking or dummy use beyond 12 months of age (this can narrow the shape of the mouth and cause the tongue to push forward)
A tongue tie (where the band of skin beneath the tongue is shorter than usual) can restrict the tongue's movements, so children tend to use a forward tongue position
Mouth breathing often stemming from nasal congestion, chronic allergies, tonsillitis or enlarged adenoids also encourages the tongue to rest in a forward position
Certain conditions such as cerebral palsy and Down syndrome have an increased likelihood of a tongue forward resting position
Genetic factors such as the angle of the jaw line

What are the Common Signs and Symptoms of a Tongue Thrust?

One of the most common indicators of a tongue thrust is seeing the child's tongue tip poking through their front teeth when resting, speaking and eating. This can also result in messy, fast and slow eating habits.

Another indicator of a tongue thrust is an open bite, where the front teeth don't meet, and the mouth remains slightly open even at rest. Some children may also find it difficult to close their lips completely. In some children, this can be particularly noticeable during periods of concentration, relaxation or sleep.

An overbite, also known as protruding upper front teeth, are another common sign of a tongue thrust caused by the constant pressure of the tongue pushing against the front teeth. A dentist or orthodontist will often notice these signs of malformed teeth in young children and attribute them to tongue thrusting.

How Does a Tongue Thrust Impact Swallowing?

Clear speech is created through the precise coordinated movements of the articulators – lips, tongue, teeth, and roof of mouth. The forward movement of a tongue thrust interferes with the correct tongue placements required for certain speech sounds.

The most common presentation that children with a tongue thrust will present with is an interdental lisp, where the ‘s’ and ‘z’ sounds become distorted. Most people will usually touch the tongue to the roof of the mouth to create the ‘s’ and ‘z’ sounds, but a child with a tongue thrust will stick their tongue out between their front teeth which distorts their ‘s’ and ‘z’ sound, to create a ‘th’ sound instead. A lisp is a concerning speech problem that not only impacts speech clarity but also a child’s self-esteem and confidence when talking to others.

What are the Long-Term Effects of a Tongue Thrust if Left Untreated?

Looking ahead, the significant problems of an untreated tongue thrust extend far beyond childhood. The constant pressure of the tongue thrusting against or between the teeth when swallowing could result in misaligned teeth such as an overbite, underbite, protruding front teeth or an open bite (where the top and bottom teeth don't meet). Improper alignment of the teeth can further increase difficulties with biting and chewing food.

Other anatomical changes associated with a persistent tongue thrust include an elongated facial structure, changes in the development of the roof of the mouth and a narrowed upper jaw. As permanent teeth settle into their positions, this can require extensive orthodontic treatment to correct.

Difficulties with the production of specific speech sounds or lisping may also become ingrained. This may present a challenge to correct later on as speech muscular patterns are increasingly difficult to address with speech therapy as a child ages.

How is a Tongue Thrust Diagnosed?

Tongue thrusting can be corrected through specific evidence-based speech therapy strategies, to improve tongue muscle strength, coordination and range of movement beyond a forward position.

Depending on the presentation of the child, they may also receive speech therapy to correct their production of specific sounds that have been affected by the tongue thrust.

Creative play-based methods are often employed to make the treatment enjoyable and motivating for children. For successful treatment, speech therapy activities should be integrated into daily routines, to ensure the child has multiple opportunities to practice consistency to break their tongue thrust habit.

In more severe tongue thrusting cases, orthodontic appliances may be required to act as physical guides to retrain the tongue’s resting position in the mouth. This may also be done to correct any teeth or jaw misalignment.

If the tongue thrust was caused by an underlying condition, allergies, nasal or breathing issues, it may be recommended by health professionals to treat or resolve them first to improve the chances of successful therapy.

When Should I Speak with a Speech Pathologist?

If you notice any concerns regarding your child’s tongue placement during speech, at rest, or feeding, it may be time to consult a professional. Speech pathologists are responsible for the identification and treatment of tongue thrust concerns relating to speech and feeding.

If tongue thrust is identified, early intervention can prevent the condition from causing long-term speech, swallowing, and dental issues. It’s particularly crucial for older children, whose academic and social development could be impacted by speech difficulties.

Speech Pathologists can work with you and your child to develop a treatment plan that combines the necessary goals and therapy exercises to help correct the tongue's placement and movement.

How Else can I Help my Child With a Tongue Thrust?

A parent's role in identifying and correcting a tongue thrust is critical. There are many things you can do to help your child in their tongue thrusting journey such as:

Consider transitioning your child away from prolonged habits such as dummy sucking or thumb sucking
Encourage your child to eat a range of food textures to promote tongue strength and range of tongue movement in the mouth
Incorporate activities from your speech pathology therapy sessions into your child's daily routine to support learning of correct tongue placement and tongue movement
Don't make a big deal about the child's tongue thrust in front of them as it may impact their confidence when eating or swallowing. Instead, praise when you see them move their tongue in the correct positions for speech and swallowing
Keep a record of your child's individual tongue thrusting signs and symptoms to track their progress
Most importantly, tongue thrust is much easier to correct if caught early so seek advice as soon as you can from a health professional

Why Reading is Important for Young Children

The building blocks of speech and language are set very early in a child's life, so it is important to take advantage of the periods of early child development to support their growing communication skills.

Reading aloud to children is one of the greatest opportunities to expose little ones to lots of different sounds, language, and vocabulary, which is particularly important for increasing their background knowledge across a range of topics.

Each book read together nurtures the development of a child’s brain. By reading with your child from a young age, you are encouraging language growth, early literacy skills, cognitive development, and family bonding.

Ideally, parents and carers should aim to read at least five books or short stories each day to their child.

Reading aloud also exposes children to repetitive language, slows the rate of speech for easier listening, and exaggerates features such as rhythm and intonation – which is key for children who are deaf or hard of hearing.

The Million Word Gap

When books are not read with children at home, there can be significant impacts on a child’s language skills.

Research shows that there is a million word gap between families who expose children to regular reading at home compared to those who do not.

This means that children who do not read books from an early age are potentially missing out on key language development opportunities by being exposed to significantly fewer words.

Reading is incredibly valuable for a child’s development.

Songs for Language Development

Singing songs and rhymes is very important for a child's development, especially their language and speech development. As a bonus, your child will probably have fun too! Parents are encouraged to sing songs with their child and other children who may also be present, as this may encourage other parents to join in as well. Singing songs with children is also helpful in working on their attention span and developing various emotions that may be conveyed through the song.

The rising and falling intonation of singing also slows the rate of speech - which is beneficial for children who are deaf or hard of hearing. Singing highlights different rhythms and phrasing which supports listening skills.

Often, young children learn the words to their favourite songs and rhymes, and this supports children in learning more words.

Storytime at Home

Your child might also enjoy hearing made-up stories or stories that involve your family. Hearing parents tell stories will help children in telling their own stories later down the line.

Listening to new words and the structure of how stories are told is really beneficial for a child to start telling stories about their own lives.

What are the Main Benefits of Reading with Children?

There are many benefits to reading with children. Reading supports:

Early literacy skills
Independent reading skills
Critical thinking skills and problem-solving
Listening skills
Vocabulary skills
Language acquisition
Cognitive development
A child’s imagination
Child-parent bonding and social development

Importantly, reading aloud with babies and young children promotes brain development including helping to create numerous brain connections.

Reading in the early years also helps to cultivate a child’s life-long love of reading. This is important as reading is the key to life-long learning, especially in the later years of school, assisting in a child’s education.

Which Types of Books Should You Read With Babies and Early-Age Children?

When picking books to read with babies and young children, look for books that are age-appropriate, visually appealing, and entertaining. Books with bright pictures, large print, and rhyming words are excellent choices when picking a children's book.

For babies and young children, simple picture books featuring objects and animals your child can identify are best.

It’s helpful to have a varied supply of books on hand, whether that’s your collection or by joining a local library to borrow books. Keep an eye out for hard-paged books which will survive the rough-and-tumble of small children, and can be read together many times over.

You might find that young children gravitate towards their favourite book to read again and again. This shows that they are enjoying the story. It is important to note that often children learn best through repetition. The familiarity that reading the same story brings supports children's language acquisition. Parents can further develop their child's development by focusing on a different feature during each reading.

What books should older children read?

For older children, books that feature characters who also have hearing loss can encourage inclusivity and normalise wearing hearing technology.

Books featuring hearing loss or hearing devices include:

Freddie and the Fairy, Julia Donaldson
The Cochlear Kids: Liam the Superhero, Heidi Dredge
Bill and Hug: A Dragon’s Tale, Julianne Schmid
Goat Goes to Playgroup, Julia Donaldson
Dachy’s Deaf, Jack Hughes
Our Sister Lotte and her Special Ears, Kelsey Browning
Chelsea’s New Ear, Simone Cheadle
Chelsea and her Little Ear Make a New Friend, Simone Cheadle
Now Hear this: Harper Soars with her Magic Ears, Valli and Harper Gideons

Older children can be encouraged to read aloud to support them in reading aloud fluently, including all of the individual sounds of each word.

Tips on how to read with your child

Although a very young child may not be able to understand or concentrate on the full story, you can try talking about what’s happening in the pictures, which is relevant to the child’s developmental stage and interests. At this stage, you can expose children to new vocabulary by describing and pointing out the exciting things within the pictures, rather than the story itself. This also creates opportunities to reinforce the child’s learning elsewhere which supports language development – such as seeing a flower in a book, then when playing in the backyard, pointing out the flowers. This assists with creating connections and linking words to real-world objects.

You can also read aloud and point out interesting or new words in the books to help your child learn new vocabulary.

Asking questions about the pictures on the page can be another way to expand on the language learning opportunities during story times. Just remember, for every question you ask, offer five comments to optimise the amount of new words kids hear during book reading aloud.

The key is to start young as children learn to enjoy the sounds of different words as you read aloud, even before they can read the printed text.

Building book reading into your routine

It can be tricky to stay consistent with story time but building books into your daily routine can help children enjoy the benefits of reading. This can also be a lovely way to spend time together in the early years. Reading aloud with your child at a regularly scheduled time signals to young readers that reading is valuable and fun.

You can take books out with you when you leave the house to enjoy anywhere. School pickup, time at the park, bedtime, and bath time could all be opportunities to read a book together.

How can teachers encourage reading in young children

Teachers can also encourage reading stories with young readers to support children's development of language skills both in the education environment and at home. Teachers can do this by:

Provide access to a broad range of books
Keeping school libraries organised and inviting
Allowing students to choose the books they read
Allocate regular reading time to promote independent reading
Read aloud to students in the classroom, even to older students
Create opportunities for students to share their reading skills

From being a qualified children’s librarian to sharing literature with families and professionals, a love of words has shaped both Bernadette’s personal and professional life.

Bernadette was born deaf before the Newborn Hearing Screening was introduced, and diagnosed with hearing loss at the age of four years old.

“Born hard of hearing, I got by with my limited hearing and, over the years, I taught myself to lip read,” she said.

However, after noticing a slow but gradual decrease in her hearing as she got older, Bernadette started to look into hearing aids as an option.

“I was struggling to hear in noisy situations and hear people speak in low/quiet tones. I wanted to preserve what hearing I did have, with the assistance of hearing aids,” she said.

After searching for a provider for hearing aids and trying a couple of places, Bernadette was excited to find out that Hear and Say was now offering hearing tests and hearing aids for adults.

“My first appointment, I was very nervous. I was not sure what to expect. The audiologist was very understanding, explaining every step of the way what she was doing. I was in awe to see the setup at Hear and Say,” said Bernadette.

Bernadette was initially hesitant about wearing hearing aids due to the stigma of wearing them but a chance encounter with one of Hear and Say’s young clients changed her outlook.

“My problem was my ‘hang up’ about wearing aids. I thought people would treat me differently,” she said.

“When I visited Hear and Say, I sat waiting for my appointment in the reception area. Suddenly, a door opened and out walked a young boy. As he walked past me, I saw he had a hearing aid behind his ear.

“He looked at me and smiled a brilliant smile. I smiled back and said to myself, if this little boy is brave enough to wear a hearing aid, then so am I.”

Now fitted with hearing aids, Bernadette credits them with significantly enhancing her quality of life.

“I wish I had done it years ago! It has changed my life and now I do not leave the house without them,” said Bernadette.

“I enjoy social settings so much more now. With volume adjustments, I can moderate the aids to suit the occasion.”

An audiogram is a graph that displays the results of a hearing test. It shows the softest sounds someone can hear at different pitches (low, mid, and high frequency sounds), including those required to hear and understand speech (the major speech frequencies). Where the results fall on the audiogram reflects how loud a sound must be for someone to hear it and which speech and environmental sounds can be heard and not heard at their normal volume.

If you or someone you know has had their hearing tested, you might have seen a chart like this:

How is an audiogram done?

The type of hearing test depends on the person's age and abilities. Sounds are played through the speaker, headphones, ear plugs, or headband in a quiet listening environment. The person must indicate that they have heard it in some way - options includes pushing a button, raising a hand, playing a piece in a game, or turning their head to a puppet. The volume of the sound is changed until the softest sound is determined. This is called a hearing threshold. Then different pitches are tested. Adults and older children are tested on six to eight pitches while young children complete four pitches.

Typically, the right ear and left ear is tested separately. When working with young children, sometimes the ears are tested together as they are unable to wear headphones or ear plugs

Air Conduction Testing – Testing starts by measuring the whole ear system working together, via the speakers, headphones, or ear plugs. This is called an air conduction test, because the sound travels through the air, via the ear canal, ear drum, and middle ear bones.

Bone Conduction Testing – If a hearing loss is found, then testing aims to identify what part of the ear is not working. A vibrating box on a headband is used. This is called a bone conduction test because the sound travels through the bones of the skull, directly to the hearing organ or cochlea.

When the sound is played loud enough, both cochleae will hear it, regardless which ear is being tested, as they are close together in the skull. Therefore, whooshing or rain sounds will be play into one ear to distract it while the other ear is tested. This is called masking.

The ability to hear speech is then assessed. The person is asked to point to pictures or repeat words or sentences. This tell us how well a person can hear and understand speech to see how much a hearing loss is impacting a person’s communication.

What are the different types of hearing loss an audiogram will measure?

An audiogram will help identify not only if someone has a hearing loss, but the type of hearing loss they have. Knowing the degrees of hearing loss, which ear or ears the hearing loss affects, and if the hearing loss is conductive, sensorineural or mixed helps inform what treatment options are best.

Conductive hearing loss

Conductive hearing loss occurs when sound is unable to travel through the outer or middle ear. This could be due to earwax or a foreign object blocking the ear canal, a ruptured ear drum, fluid or infection in the middle ear space, or damage to the middle ear bones. Often conductive losses are temporary and will resolve when the obstruction is removed, the ear drum heals, or the middle ear fluid clears. This can require medical treatment. Some conductive hearing losses are permanent, so it is important to recheck hearing after any medical treatment.

Sensorineural hearing loss

Sensorineural hearing loss occurs when the cochlea cannot detect sound and/or send it via the hearing nerve to the brain. It is often due to the hair cells in the cochlea being absent or damaged. This can be due to an inherited genetic condition, excessive noise exposure, aging, injury, or disease. Sensorineural hearing losses are often permanent.

Mixed hearing loss

Mixed hearing loss is a combination of both conductive and sensorineural hearing loss. In these cases, there is damage to both the outer/middle and inner ear/cochlea.

How long does an audiogram take?

This depends on the person's age and hearing ability. A full hearing test can take between 40 to 90 minutes. This will likely be longer if a hearing loss is found. This includes about questions about your hearing concerns, hearing history, and general health or lifestyle. It is important to mention any previous ear infections/surgeries, if you experience any dizziness/balance issues, if you have seen an Ear, Nose, and Throat Specialist (ENT), or if you have a family history of hearing loss (particularly if it is permanent or acquired from a young age). Parents will also be asked if their child passed their newborn hearing screening and about their speech and language development.

How do you read an audiogram?

The horizontal axis of the audiogram represents the sound’s pitch or frequency range, ranging from 250 to 12,000 hertz (Hz). Most speech is within 250 to 6,000Hz. Vowels are typically low pitch while consonant are typically mid or high pitch. Soft high pitch sounds such as ‘s’, ‘f’, ‘th’ and ‘t’ are often the most difficult to hear because high frequency hearing losses are most common.

The vertical axis shows the sound’s loudness or volume, ranging from -10 to 120 decibels (dB). The closer to the top your results are, the better you can hear sounds.

Each ear is recorded as a separate line on a chart called your audiogram. A blue cross symbol is your left ear and the red circle symbol is your right ear. A black box or ‘s’ symbol shows how a child hears when listening with both ears together. Air conduction results and bone conduction results are also marked separately.

Any sounds below the line can be heard while any sounds above the line cannot be heard.

What does normal hearing look like on an audiogram?

Normal hearing for children and adults is between -10 and 20dB.

A hearing loss occurs when hearing is at 25dB or greater. The severity of a hearing loss is determined by how loud sounds must be for them to be heard. The severity of hearing loss may change between different pitches and between each ear.

Mild hearing loss = 25-40dB
Moderate hearing loss = 45-65dB
Severe hearing loss = 70-85dB
Profound hearing loss = 90dB or greater

Who should get an audiogram?

If you are worried about your hearing or suspect you have a hearing loss, a hearing test is recommended. Here are some common symptoms of hearing loss:

Missing what people say.
Asking people to repeat themselves.
Asking people to speak clearer or stop mumbling.
A ringing or buzzing in your ears (tinnitus).
Difficulties following conversations.
Difficulties talking on the phone.
Turning up the volume on the TV or radio.
Difficulties hearing people when it is noisy, for example in a restaurant or at the shops.
Using lots of effort when listening or finding listening tiring.

Children may also show delays in their speech and language development.

What’s next?

Following a hearing test, the audiologist will talk through the hearing test results, including if there is a hearing loss.

If there is a hearing loss, a treatment plan will be discussed. This may include watchful waiting, further/repeat testing, seeing an Ear, Nose, and Throat Specialist (ENT), using communication strategies, trialing hearing aids, or considering a cochlear implant.

For people who require hearing aids, the audiologist will use the audiogram results to determine how to program the hearing aids so that the person can hear clearly.

Hear and Say provides an array of audiology services for people of all ages, including comprehensive hearing tests, hearing aid fitting and management, tinnitus assessments, and hearing/cochlear implant services.

Find out more or book your hearing test today.

Whether it's to listen to music or the TV, for a call at work, or to study, headphones are a regular part of everyday life for many of us. However, for people who also use hearing devices such as hearing aids or cochlear implants, using headphones to tailor your listening experience comes with some careful considerations.

If you have hearing aids or a cochlear implant, the first step is to check with your audiologist if the device has Bluetooth technology. If they do, you can stream sound and play audio directly from your smartphone or another wireless device, cutting out the need for headphones altogether.

"You will get the best sound directly via your hearing aids or cochlear implants, depending on the hearing technology you have for your specific hearing loss“, said Hear and Say Audiologist, Anna Whittington.

Things to consider when buying headphones with hearing aids

For some people with a hearing device, tracking down suitable and compatible headphones can be challenging.

Over-ear headphones, on-ear headphones, bone-conduction headphones, earbuds, in-ear headphones, stereo headphones, and noise-cancelling; there are a lot of options, and it can be a trial-and-error process.

When it comes to wearing headphones and finding the best headphones for you and your individual needs, the main factor to consider is fit.

For hearing aid users, it is important to find headphones that fit comfortably around your hearing aid microphones. If your headphones do not sit up and over the microphones, then you may not pick up any sound, so over-the-ear models can be a great option.

Ensure you also check for audio feedback – that is, listening for a whistling noise coming from the hearing aid – when using this style of headphones. If there is feedback, try repositioning the headphones, or test out a few models to determine what suits you best. Your Hear and Say Audiologist can assist you if hearing aid adjustment is required.

If the hearing loss is mild or in one ear only, some people may also prefer the sound without their hearing aids. Standard headphones can be used in this case, but a number of modern headphones can be customised to exactly match your hearing level. Speak to your Hear and Say Audiologist for more information.

In addition to fit, sound quality, noise isolation, and noise cancellation technology can be important and allow you to enjoy your music at lower volumes. If, however, you need to be aware of ambient sound, bone-conduction headphones may be a great choice for you.

Regardless of whether you wear hearing aids that are in-the-ear or behind-the-ear, there are some great headphones to suit.

Finding suitable headphones for In-the-ear (ITE) hearing aids

Finding the right fit for headphones and hearing aids can be easier for smaller ITE types of hearing aids. These include:

Invisible in the canal (IIC hearing aids);
In the canal (ITC);
Completely in canal (CIC hearing aids); and
Low-profile hearing aids.

These types of hearing aids all fit directly discreetly in the ear canal or in the ear and are generally compatible with on-ear headphones and over-the-ear headphones. Invisible in the canal hearing aid wearers may also be able to wear earbuds.

Finding suitable headphones for Behind-the-ear (BTE) hearing aids

If your hearing aids sit behind the ear, the options for headphones are limited. These include:

Behind-the-ear;
Receiver-in-the-canal (RIC); and
Receiver-in-the-ear (RITE).

Whilst hearing aids range in size, these all have a component that sits behind the outer ear and won’t work with on-ear headphones. Headphones that can be customised to your hearing may be a suitable solution.

Look for large styles that fit comfortably over both the ear and the hearing aid, so that sound can reach the hearing aid microphone without it being covered by the headphone’s cushioning. It is important to try on different models because if they do not fit completely over, the hearing aids will pick up external sound instead.

What are bone conduction headphones?

Bone conduction headphones don't actually rest on the ear, but directly in front on the listener's cheekbones. These specialised wireless headphones are gathering attention because, unlike traditional headphones and earbuds, the eardrum doesn’t vibrate to pass the information along to the cochlea. Rather, the vibrations from the bone conduction bee-lines for the cochlea instead.

With the lack of eardrum involvement, this technology is good for people with hearing deficiencies, as the bone conduction vibration acts in lieu of the eardrum.

These headphones are ideal for in-the-ear hearing aids, in the canal, completely in the canal, or invisible in the canal hearing aid user. Plus, some bone-conduction headphones are waterproof and can even be worn swimming.

Can bone-conduction headphones damage your hearing?

Even though these headphones bypass your outer ear and middle ear entirely, they still send sound to the cochlea and they can still damage your hearing if used improperly or at too high a volume. Like all headphones if used correctly, bone-conduction headphones are safe to use.

If you work in an office space, live in a city, and want to remain aware of background noise like traffic while walking or cycling, bone-conduction headphones may be a great solution!

Audeara A-02 wireless headphones and TV bundle

Audeara A-02 over-the-ear headphones can be programmed for optimal listening for anyone with mild up to severe hearing loss and are available in your nearest Hear and Say centre. As an approved Assistive Listening Device, Audeara headphones may be purchased using Government funding through the Department of Veterans Affairs (DVA) and RAP Program of Hearing Services Program (HSP).

Still not sure which headphones are best suited? Speak with you Hear and Say Audiologist or hearing healthcare professional.

We’re here to help. Book a hearing test or speech and language assessment for your child.

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Almost one year old Archibald loves reading books, going on walks, playing at the local park, and playing chase (albeit only crawling away), and of all things – bananas!

Archibald was diagnosed with bilateral profound hearing loss at three weeks old. His mum, Cassandra, said they had mixed emotions, but they were immediately interested in finding out more information.

“We were shocked and overwhelmed as it was quite a sad realisation that he wasn’t going to hear normally however we were also interested to learn more about what this meant for Archibald’s future,” said Cassandra.

“It took us quite some time to process that he couldn’t hear. However, Romans 8:28 says, ‘And we know that in all things God works for the good of those who love him, who have been called according to his purpose.’”

“At 11 weeks old, Archibald was fitted with hearing aids, which due to his profound hearing loss, added limited benefit however gave him some access to sound,” she said.

The family found out about Hear and Say via Hearing Australia when Archibald was fitted with hearing aids.

“Hearing Australia provided options and after talking to other families, we visited Hear and Say and decided that they would be able to best cater for Archibald’s immediate and future needs,” said Cassandra.

“They were also super friendly and helpful during the journey leading up to receiving his implants.”

At nine months old, Archibald underwent cochlear implant surgery and had his implant switched on to sound for the first time two weeks later at Hear and Say’s Ashgrove centre.

“We had the switch on at Hear and Say, and are now continuing to come in regularly for audiology appointments to program the cochlear implant as well as speech therapy fortnightly to help catch Archibald up to his peers in terms of his speech and language,” said Cassandra.

“We are blessed to be in a country that has such fantastic support both financially and emotionally. We are so thankful for the amazing technology available to test and equip Archibald with the ability to hear at such a young age,” she said.

“Hear and Say have been amazing and very caring, and has given our family amazing encouragement for us as parents and helping Archibald reach his best potential.

Cassandra reflected on Archibald’s diagnosis of hearing loss now, nearly one year after finding out.

“We are excited to see him grow, and experience sounds in our world in a new way. He’s still our beautiful little boy and we love him so much. Even without his implants, this wouldn’t change,” said Cassandra.

“We know that Archibald’s hearing loss is part of God’s plan and purpose, we don’t understand at this point in time for what reason this has happened, but at some point, we will look back and understand as we see him use this as blessing to those around him and for God’s glory.”