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Hesperian Health Guides

Women’s health can damage or protect children’s hearing

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HealthWiki > Helping Children Who Are Deaf > Chapter 15: Why children lose their hearing and what we can do > Women’s health can damage or protect children’s hearing


It is important that girls and women, especially pregnant women, have enough good food and access to health care. A baby can be born with hearing loss because:

A woman touching her pregnant belly.
  • his mother was sick or did not eat well as a young girl, or during her pregnancy. For example, a baby born to a mother who did not get enough to eat can often be born early or have low birth weight and his hearing can be damaged.
  • sickness or poor nutrition caused problems during birth. For example, if a woman has a small pelvis from poor nutrition, her baby may get stuck during birth. This could cause hearing loss from brain damage.
  • some infections can pass from the mother to the baby during pregnancy and damage the baby's hearing. These infections include rubella (German measles), tuberculosis, cytomegalovirus (CMV), and syphilis.

Contents

Lack of iodine in the diet during pregnancy

A woman with a swelling in the front of her neck.
goiter

Iodine is a mineral found in the soil and water — and in foods like liver, onions, egg yolks, seafood, and plants from the ocean. When a pregnant woman does not get enough iodine, her baby may be born mentally slow, or have serious problems including deafness. In some places in the world, the soil contains very little natural iodine so vegetables and crops that grow in the soil also contain little iodine. In these places, swelling of the thyroid gland in the neck is common. This is called goiter. If many people in your community have this swelling, then everyone needs more iodine.

A boy with iodine deficiency.

A child with iodine deficiency may be mentally slow, deaf, unable to speak, and have weak neck and leg muscles. Many children only suffer hearing loss, some weakness in the legs, and are slow to learn. But others may have noses with a flat wide base, squinting eyes, hair low on the forehead, puffy eyelids and face, and have physical problems such as growing slowly and being short.

Treatment:

Get medical advice as soon as you can. A medicine called thyroxine, if started in the first months of life, may help a child with iodine deficiency grow better, though it will not help a child hear better.

The whole community, including the affected child, needs iodine supplements, but this will not help any nerve or brain damage that has already occurred.

Prevention:
Image of the foods described below.
Foods from the ocean, as well as liver, egg yolks, and onions, can be good sources of iodine.

Goiter and iodine deficiency are easy and cheap to prevent. Women must get iodine before becoming pregnant. Taking iodine after the first few weeks of pregnancy is too late.

  • The easiest way to get enough iodine is to use iodized salt instead of natural or rock salt. You can find packaged iodized salt in most places.
  • Iodized oil taken by mouth is available in some countries. You need to take only 1 dose every 1 to 5 years.
  • If iodized salt or iodine-rich foods are hard to get, you can make an iodine solution at home with Lugol's iodine. This is an antiseptic that is often available where medicines are sold.


To make an iodine solution to drink:

Add 1 drop of Lugol's iodine to 1 glass of clean drinking water or milk. Drink this once a week. Store iodine at room temperature and in dark containers to protect it from light.

Rubella (German measles)

Rubella usually causes only a slight rash and gives the person no other problems. But if a woman who is pregnant gets rubella during the first 3 months of pregnancy, her child may be born deaf or with other serious problems.

A woman giving an injection to a girl.
Prevention:
  • Give rubella vaccination to girls before they are old enough to have babies. If vaccination is not available, let young girls build a resistance to rubella before they are old enough to have children. They can visit people in the community who have rubella. They may catch the infection and develop resistance.
  • If girls and women have not been vaccinated or have not had rubella by the time they are old enough to have children, they should prevent deafness in their babies, if they are or might be pregnant, by staying away from people with rubella.

Tuberculosis(TB)

Children of mothers who have tuberculosis during pregnancy sometimes get a type of meningitis called 'tubercular meningitis' in the first few months of life. This can cause deafness.

Prevention:
  • Immunize children against tuberculosis with the BCG vaccine.
  • Everyone, especially children, should eat plenty of nutritious foods.

Syphilis

Syphilis is a sexually transmitted infection that can be passed from mother to baby during pregnancy and cause loss of hearing. Without treatment, syphilis can invade any part of the body. It can damage the inner ear and the nerves that affect hearing and cause deafness.

Signs:

The signs for syphilis in an infant or a child may be: rashes, blisters on the palms or toes, sores, or anal warts; swollen spleen, liver, or retina, or generalized swelling; jaundice, ringing in the ears, dizziness, deafness that comes and goes, loss of eyesight, and headaches. (Some of these signs are different from those in an adult.)

When syphilis affects the nervous system it can cause severe hearing loss. This can happen when syphilis is left untreated, but babies can also be born with it. Fortunately this form of nerve deafness can be treated, which will prevent further hearing loss. Testing for neurosyphilis may include blood tests or a lumbar puncture (test of fluid from the spine). If you cannot get the child tested, but strongly suspect syphilis, give the treatment.

If there is any chance that someone, especially a pregnant woman or a child, may have syphilis, she should immediately see a health worker. Special blood tests and other tests may be needed. If the person cannot go to a health center or hospital, give the treatment for syphilis.

To treat syphilis in a child
Age 2 years or less
  • benzylpenicillin, inject slowly into the muscle
25,000 units (15 mg) for every kilogram of body weight (per kg), 2 times a day for 10 days. Do not give more than 1,500,000 units in each dose.
Age more than 2 years
  • benzylpenicillin, inject slowly into the muscle
100,000 to 150,000 units (60 to 90 mg) per kg in each buttock, once a week for 14 days. Do not give more than 2,400,000 units (1.44 g) in both buttocks each time.
or
  • procaine benzylpenicillin
50,000 units per kg 1 time per day for 10 days. Do not give more than 1,500,000 units each time.
If the child is allergic to penicillin and is age 8 years or more:
  • doxycycline
2 mg per kg by mouth, 2 times a day for 30 days. Do not give more than 100 mg each time.
or
  • erythromycin
7.5 to 12.5 mg per kg by mouth, 4 times a day for 15 days. Do not give more than 250 mg each time.

WARNING! Pregnant women must not use doxycycline.




To treat syphilis in an adult
Early syphilis
(less than 2 years duration):
  • benzathine benzylpenicillin by injection in the muscle
2,400,000 units, one time only
or
  • procaine benzylpenicillin by injection in the muscle
1,000,000 units, 1 time per day for 10 days
Late syphilis (not neurosyphilis)
(more than 2 years duration):
  • benzathine benzylpenicillin by injection in the muscle
2,400,000 units, once a week for 3 weeks.
or
  • procaine benzylpenicillin by injection in the muscle
1,000,000 units, 1 time per day for 21 days.
Neurosyphilis
  • benzylpenicillin by injection in the muscle
4,000,000 units, 6 times a day (every 4 hours) for 14 days.
or
  • procaine benzylpenicillin by injection in the muscle
1,000,000 units one time per day for 14 days
AND
  • probenecid
500 mg by mouth, 4 times a day for 14 days.


A woman giving an injection to another woman.

To cure syphilis completely, the full treatment is essential.
Hearing loss caused by syphilis may develop when the child is an infant, or later as a teenager. Treating syphilis will not fix any hearing loss that has already occurred, but it will prevent any hearing loss that could still be caused.

See the books Where There Is No Doctor or Where Women Have No Doctor, published by the Hesperian Health Guides, for more information about syphilis.

Note: If a child is born with syphilis, the child's mother and father will also need treatment.

Cytomegalovirus

Most people with cytomegalovirus (CMV) are not sick. But babies of mothers who become infected during pregnancy can have severe deafness, blindness, or physical and mental disability. The germs that spread CMV can be found in body fluids — like saliva, urine, stool, semen, vaginal fluids, and breast milk. To prevent the spread of CMV, wash hands with soap and water, especially after contact with stool, urine, or saliva.

Brain damage during birth can cause hearing loss

If a baby suffers brain damage during labor or birth, he may be born deaf. The baby's brain can be damaged if there is not enough oxygen reaching it. This is more likely to happen if labor is very long, if the baby is in a difficult position for birth, or if there are twins.

To prevent brain damage during birth

Midwives and others caring for pregnant women can learn about the danger signs during pregnancy and labor when a woman must get medical help at a hospital. Community members can organize to make sure there are ways to get women to the hospital if there is an emergency.

A man carries a pregnant woman in distress to a truck while 2 other women help. Another man waits to drive the truck.
  • Some methods to make labor go faster can damage the baby's brain, which can cause deafness. To protect the baby, avoid these ways to make labor go faster:
Do not push forcefully against the womb.
NO!
Do not give injections that make labor go faster.
NO!


  • Get medical help right away if the labor is taking too long, if the baby is in a difficult position, or if the cord is around the baby's neck. For more information about safe birth, see A Book for Midwives published by the Hesperian Health Guides.


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