Helping Children Who Are Deaf

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Children develop more and faster in the first 5 years of life than at any other time.They learn to communicate and understand the world as they interact with peopleand things around them. Children who cannot hear well need extra help to learn aspoken or sign language. This is important since language is the foundation forthinking, problem-solving, and interacting with other people.

The simple activities in this book were developed by families with children who aredeaf or cannot hear well, deaf adults, community-based development workers,health workers, educators, and other experts in over 17 countries. They can helpparents, caregivers, health workers, rehabilitation workers, and others teach adeaf child how to communicate to the best of his or her ability. Topics include:

the HHHHHesperian FFFFFoundation

This book will make a world of differencefor so many deaf children... It is an excellentresource for teaching families, communities,and health workers how to make languageaccessible to deaf children so that they canlearn about, understand, and interact withthe world around them.

—Amy Wilson, Gallaudet University, USA

Helping Children Who Are DeafFamily and community support for children who do not hear well

• why young children need to learn a spokenor sign language, and how to teach them

• assessing how much a child can hear

• developing communication, listening,and social skills

• supporting parents

• educating a deaf child

• preventing child sexual abuse

• preventing deafness

With support and encouragement, deaf children can grow and participate fully intheir families and communities. The Hesperian Foundation’s Early Assistance Seriesshows how help for children with disabilities is within the reach of all people andmust be part of building a more just world.

We would recommend this bookfor use in helping children whocannot hear well because it usessimple language and activitiesfrom everyday life — people canrelate to them without any problem.

—Susan Nanjobe, Uganda Societyfor Disabled Children

Helping ChildrenWho Are Deaf

Sand

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Devo

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Darlen

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the HHHHHesperian FFFFFoundationEarly Assistance Series for Children with Disabilities

Family andcommunitysupport forchildrenwho do nothear well

Sandy Niemann,Devorah Greenstein,and Darlena David

Making deafness a community issue willhelp you, your child, and your community.

Deafness is a community issueThis book was written primarily for parents and other caregivers of youngchildren who are deaf or cannot hear well. But it is not their task alone to dealwith the needs of their children — it is the whole community’s responsibility.Both deaf and hearing people can accept and welcome children who are deaf,and give them the care and attention they deserve. Communities can organizeways for deaf children to learn a language and for everyone to learn tocommunicate with deaf children. They can begin to address the causes ofdeafness, and help children who are deaf grow up to be active members of thecommunity.

Around the world, many children lose their hearing because of illnessand untreated ear infections. This means thatmost deafness is preventable. Toreduce and preventdeafness, we mustchange the conditionsof poverty that oppressso many people aroundthe world. Allcommunities need basicsanitation,good food, clean water,safe housing, andhealth care. And everyonebenefits from bettereducation and morecommunity participation.

When we reach out to ourfriends and neighbors, thebonds we create help usbuild stronger communitiesand a more just world.

When we make ourcommunities places wheredeaf children can thrive, weimprove life for everyone.

Helping Children Who Are DeafFamily and community support for childrenwho do not hear well

By Sandy Niemann,Devorah Greenstein,and Darlena David

Illustrated by Heidi Broner

The Hesperian FoundationBerkeley, California, USA

Copyright © 2004 by The Hesperian Foundation. All rights reserved.

The Hesperian Foundation encourages others to copy, reproduce, or adapt to meetlocal needs any or all parts of this book, including the illustrations, provided thatthe parts reproduced are distributed free or at cost — not for profit.

Any organization or person who wishes to copy, reproduce, or adapt any or all partsof this book for commercial purposes must obtain permission from the HesperianFoundation.

Before beginning any translation or adaptation of this book or its contents, pleasecontact the Hesperian Foundation for suggestions about adapting the informationin the book, updates on the information provided, and to avoid the duplication ofefforts. Please send the Hesperian Foundation a copy of any materials in which textor illustrations from this book have been used.

Cover art: anonymous indigenous design, Panama.

Cover photograph:by Devorah Greenstein, of a deaf boy and his father in Haiti.

The boy is using a sign he made up to describethe bright light from a camera’s flash.

The Hesperian Foundation1919 Addison Street, Suite 304

Berkeley, California 94704, United States of America

Library of Congress Cataloging-in-Publication Data

Niemann, Sandy.

Helping children who are deaf: family and community support for children who donot hear well / by Sandy Niemann, Devorah Greenstein, and Darlena David ; illustratedby Heidi Broner.-- 1st ed.

p. cm. -- (Early assistance series for children with disabilities)

Includes bibliographical references.

ISBN 0-942364-44-9 (pbk.)

1. Deaf children--means of communication. 2. Deaf children--Family relationships. 3.Deaf children--Services for. 4. Child development. I. Greenstein Devorah, 1944- II.David, Darlena. III. Title. IV. Series.

HV2391.N54 2004

362.4’25’083--dc22

First edition: March 2004.

Printed in the USA.

ISBN: 0-942364-44-9

Credits

Project coordinator:Darlena David

Art coordination:Sarah Wallis, Nicole Perez,Devorah Greenstein

Design and production:Sarah Wallis

Cover design:Sarah Wallis

Additional writing:Todd Jailer, Susan McCallister,Nicole Perez, Tawnia Queen,Sarah Shannon, Sarah Wallis

Research assistance:Amina La Cour Mini, NicolePerez, Tawnia Queen, RebeccaRatcliff, Amy Wilson

Production management:Susan McCallister, Sarah Wallis

Field-testing and networking:Amina La Cour Mini, Nicole Perez, TawniaQueen, Rebecca Ratcliff, Kathryn Young

Additional illustrations:Sara Boore, Barbara Carter, Joy Conway,Christine Eber, Regina Faul-Doyle, SandyFrank, Anna Kallis, Susan Klein, JoyceKnezevich, Gabriella Nuñez, Kate Peatman,Nicole Perez, Petra Röhr-Rouendaal, MonaSfeir, Christine Sienkiewicz, Sarah Wallis,Lihua Wang, David Werner

Copy editing:Todd Jailer, Jane Maxwell

Proofreading:Leona Benten

Editorial oversight:Sarah Shannon, Todd Jailer

And all the other staff and volunteers at Hesperianwhose efforts made this book possible.

Thanks

A special thanks to all the funders of this book and the Early Assistance Series:

This publication was made possiblethrough support provided byPlan International, Childreach —the US member of Plan International,DANIDA — Royal Danish Ministry ofForeign Affairs, The May and Stanley Smith Charitable Trust, United NationsChildren’s Fund (UNICEF), and the US Agency for International Development(under the terms of Cooperative Agreement No. 442-A-00-02-00172-00). Theopinions expressed herein are those of the authors and do not necessarily reflectthe views of the US Agency for International Development nor those of our othercommitted supporters.

Some of these supporters have also been collaborators, sharing their understandingof the needs of parents and health promoters working with children. They havereviewed and field-tested early versions of this book, improving it immeasurably.

Advisors and reviewersHow to help children who are deaf communicate is a very controversial topic. We areespecially grateful to the many committed people who gave so freely of their guidanceand opinions despite the inclusion of ideas they may not have completely agreed with.

This book could not have been written without the help of parents, teachers, deafadults, and health workers from around the world, who shared their experiences,stories of the challenges they faced, and solutions they found.

Thanks to the following groups who contributed so much of their hearts andminds in reviewing draft materials:in Bangladesh:Center for Disability inDevelopment

in Cameroon:Abundant Life Ministryfor Blind and DeafChildren

in People’s Republicof China:Tianjin Hearing DisabilityRehabilitation Center

in Ghana:Ashanti School for theDeaf

in Haiti:Pazapa

in India:Balavidyalaya

in Jamaica:Clarendon Group for theDisabled, JamaicaAssociation for the Deaf

in Mongolia:The School for Deaf andBlind Children

in Tanzania:Chama Cha ViziwiTanzania (CHAVITA)

in Uganda:Uganda Society forDisabled Children

in Vietnam:Catholic Relief Services,Pearl S. BuckInternational

in Zimbabwe:NZEVE Deaf Children’sCentre

Several stories in this book were adapted from articles written by thefollowing persons or organizations:Thanks to Judith Collins (page 103), Birgit Dyssegaard (pages 142, 161, and166), Elina Lehtomaki (page 148), Asocicao de Pais e Amigos dos Surdos doCabo (page 150), M. Miles (page 162), Paul Mumba (page 163), and EENET —Enabling Education Network and DICAG — Disabled Childrens Action Group(page 189).The hearing aid checklist (page 226) is reproduced with the kind permissionof Balavidyalaya, in India.

Thanks also to Fundación Puntos deEncuentro for facilitating review of parts ofChapter 1 in Nicaragua with members ofthe Centro Fé, Esperanza y Amor, EscuelaCristiana de Sordos in Managua;Asociación por un Mundo sin Barreras inChinandega; and the Asociación Nacionalde Sordos de Nicaragua (ANSNIC).

Carol-lee Aquiline, WorldFederation of the Deaf,FinlandJonathan Brakarsh,Family Support Trust,ZimbabweFreda Briggs, AustraliaArlene Brown, Speech,Language, and HearingSciences, University ofColorado, USAGonzalo Delgado, PlanInternacional, UKCharlie Dittmeier,Maryknoll DeafDevelopment Program,CambodiaBirgit Dyssegaard,DANIDA, DenmarkJill Ellis, Center for theEducation of the InfantDeaf, USARoxanna PastorFasquelle, MexicoTeresa Glass, USAGulbadan Habibi,UNICEFKathleen Huff, CatholicRelief Services, VietnamKhairul Islam,Plan International,Bangladesh,Namita Jacob, Chetana,IndiaPatrick Kangwa,Inclusive Education,Zambia

We also wish to express our thanks to the many advisors, reviewers, and others whoshared their knowledge and expertise:

Liisa Kauppinen, WorldFederation of the Deaf,FinlandMargaret Kennedy,Trainer on Disability &Abuse, UKElina Lehtomaki,University of Syvaskyla,FinlandSusie Miles, EENET, UKDavid Morley, TALC, UKNancy Moser, Center onDeafness, UCSF, USANatalia Popova, LosPipitos, NicaraguaShannon Reese, USACharles Reilly,Gallaudet University,USARosalinda Ricasa,Gallaudet University,USAMarilyn Sass-Lehrer,Gallaudet University,USAJudy Shepard-Kegl andJames Shepard-Kegl,Nicaraguan SignLanguage Projects, Inc.,USA

Medical reviewersBrian Linde, USA

Chris Forshaw, UgandaMike C.F. Smith,

UK and Nepal

Andrew Smith, WorldHealth OrganizationTheresa Smith, AmericanSign Language andInterpreting School ofSeattle, USAEster Tallah, PlanInternational, CameroonAbiola Tilley-Gyado, PlanInternational, UKAndrew Tomkins,Institute for Child Health,UKJoanne Travers, USAMadan Vashista, USASusan Wecht,USACindy Weill, CatholicRelief Services, VietnamAmy Wilson, GallaudetUniversity, USASheila Wirz, UKDoreen Woodford, DeafAfrica Fund, UKGabriela Woodman, JeanWeingarten PeninsulaOral School for the Deaf,USAOwen Wrigley, Burma

Contents

Chapter 8: Learning to use a sign language ........................................................ 85Help your child learn different kindsof signs ..................................................... 87Learning to sign ...................................... 89Understanding groups of signs ............... 94Using groups of signs .............................. 97

Use questions to encourage yourchild to think ........................................... 99Teaching sign language to parents ofdeaf children ......................................... 103

How children learn language ................. 68Language and thinkingdevelop together ...................................... 69Sign language and spoken language ..... 72

Using sign language ............................... 73Using spoken language ........................... 75

Chapter 7: Choosing and learning a language ................................................... 67

Chapter 6: Listening skills ...................................................................................... 59Tips for parents to becomeaware of sounds ...................................... 61

Activities to help your child noticemore about sounds .................................. 62

Chapter 5: What can your child hear? ................................................................. 47Understanding sound(loudness and pitch) ............................... 48What sounds can your child hear? ........ 50

How to check your child’s hearing ......... 51

Chapter 4: Basic communication skills ................................................................ 33How children learn to communicate ..... 34Preparing a child to use signsand to speak ............................................ 37

Communicate with home signs .............. 40Examples of signs .................................... 42Encourage your child to make sounds ... 44

Chapter 3: Guidelines for teaching language ...................................................... 21Communicate as much as you can ........ 21Fitting activities into your family’sdaily life ................................................... 22Many people can help ............................ 24

Suggestions for helping yourchild learn ............................................... 26Change activities to suit your child ........ 31

Chapter 2: Children who cannot hear well need help early .............................. 13How children develop new skills ............ 14Learning language .................................. 15How language helps the mind develop ... 17

Deaf children need help early ................ 18How to know if your child needs help .... 18

Chapter 1: Hearing difficulties and communication ........................................... 1Why communication is important ........... 2Language makes learningand community possible ........................ 10

Coming together for deaf rights ............. 11All children can learn to communicate .. 12

Chapter 9: Learning to use a spoken language ................................................. 105Help your child learn speech sounds ... 106Help your child learn his first words .... 107Encourage your child to answersimple questions .................................... 111

Pay attention to how words are said .... 112Help your child learn more words ........ 114Understanding groups of words ............ 116Learning to use groups of words ........... 118

Chapter 10: Social skills ........................................................................................ 121How children learn social skills ............ 122Deafness makes it harder to learnsocial skills ............................................. 124

How to manage your child’s behavior .. 125How to encourage a child’ssocial development ............................... 132

Chapter 11: Working together to help children who are deaf ......................... 139What is your community? .................... 139Making the community a better placefor children who are deaf ...................... 142Forming support groups........................ 146

Bring deaf children together withother deaf people .................................. 147Everyone benefits from efforts tosupport deaf children ............................ 149

Chapter 12: Education .......................................................................................... 151Schools and language ........................... 154Deaf children in classes withhearing children .................................... 155Deaf children in their own group ......... 157

Good schools meet deaf children’sneeds ...................................................... 160Good schools prepare a child tomake a living ........................................ 164

Some facts about child sexual abuse ... 168Why are deaf children at risk? ............. 169Preventing sexual abuse ....................... 171

Chapter 13: Preventing child sexual abuse ........................................................ 167How can I know if my child hasbeen abused? ......................................... 176If your child has been abused .............. 177

Appendix A: Hearing aids ..................................................................................... 219

Appendix B: Cochlear implants and hearing .................................................... 227

Appendix C: Child development charts ............................................................... 231

Where to get more information ........................................................................... 239

When you first learn your childcannot hear well ................................... 180Understanding your emotions .............. 181

Chapter 14: Support for parents and caregivers ............................................... 179

Managing the stress of caregiving ....... 182Parents’ groups ...................................... 184Planning for action ............................... 187

Chapter 15: Why children lose their hearing and what we can do ................ 191

Ear infection .......................................... 193Something blocks sound in the ear ...... 198Childhood illnesses ............................... 201Medicines that damage hearing .......... 206

Women’s health can damage orprotect children’s hearing ..................... 207Loud noises and injury ......................... 213Hearing loss passed down in families .. 215

About this bookIn this book we offer information, explanations, suggestions, examples, andideas to help you respond in a flexible and creative way to the needs of the wholechild. Every child who is deaf or cannot hear well is unique and will be helpedmost by approaches and activities that are lovingly adapted to her specificabilities and needs.

As much as we can, we try to explain basic principles and give reasons for doingthings. After understanding the basic principles behind different activities orexercises, parents can begin to make adaptations. They can make better use oflocal resources and of the opportunities that exist in their own area.

In this book, we define ‘a child who is deaf’ as a child who is unable to hearanything. We use ‘a child who cannot hear well’ to describe a child who hassome hearing loss but can hear some sounds (many people call this ‘hard ofhearing’). Sometimes, when we refer to both groups together, we use both terms— ‘children who are deaf or cannot hear well’. But sometimes, for simplicity’ssake, we use one term or the other, meaning to include all children withhearing loss.

ABOUT THE PICTURES

Since this book is written for peoplearound the world who care for childrenwith hearing problems, the drawingsshow people from many places. Wehope these drawings will remind youthat people all over the world face thesame challenges you do.

THERE ARE MANY SIGN LANGUAGES

There are probably as many signed languages in the world as there arespoken languages. Signed languages are as old as history. They are not usuallynew languages recently invented. In many countries there is a national signlanguage for official use. Many countries also have regional sign languages.

Most of the pictures in this book show signs in American Sign Languagebecause this book was written in the United States. (Some of the signs are inMexican Sign Language or other national sign languages.) If you do not live inthe United States, American Sign Language is not your sign language, and thedeaf people in your community may not use or understand American SignLanguage.

For example, although the spoken language in the United States,England, and Australia is the same, the sign language in eachcountry is different. In the United States people use American SignLanguage, in England people use British Sign Language, and inAustralia people use Australian Sign Language.

In addition, many of the signs in our pictures are made-up signs, orare real signs but not the signs that match the words in the text.They are simply shown to give the idea of using sign language.

So please do not copy the signs in this book thinking you are learningsign language. If you do, the deaf people in your area may not understandyou. Try to learn and use your own country’s national sign language. Deafpeople who sign are usually the best teachers.

HOW WE SHOW COMMUNICATION IN THIS BOOK

We show communication in 3 different ways in this book: speaking, thinking,and signing (using the hands and body to communicate in sign language).

I wonderwhere Adam

went...

Adam,comehere!

The rounded box thatcontains the words hasa ‘tail’ that points tothe speaker’s head.

The ‘cloud’ that containsthe words has circles thatpoint to the person’shead.

When people speakwe show it like this.

When people thinkwe show it like this.

The box that contains thewords has a line thatpoints to a person’shands.

Adam is inthe kitchen.

When people signwe show it like this.

ABOUT THE WAY WE USE ‘HE’ AND ‘SHE’ IN THIS BOOK

Most books about children who are deaf talk about the children as if they areall boys and use the word ‘he’ to refer to any child. This happens becausesociety holds men to be more important than women and that belief is builtinto our language.

In fact, girls are not only left out of our language,they often receive less attention and care as well.This can include getting less food and getting lesshealth care — both of which may contribute todeafness.

In a small way, we have tried to reflect a moreequal world by using both ‘he’ and ‘she’ to referto children. Because ‘he or she’ is awkward, weuse ‘he’ in some sections and ‘she’ in others. If attimes this is confusing, please pardon us.

Remember, all children need and deserve ourlove and support.

TO START USING THIS BOOK

The first chapter of this book explains the kinds of problems many children andfamilies face when a child cannot hear well. Chapter 2 explains how parentsand others can make a difference by helping children develop to the best oftheir ability. Chapter 2 also describes what you will find in the different parts ofthis book.

Within each chapter we point to other places in the book you might want tolook for additional information.

A NOTE TO TRANSLATORS

We hope this book will be translated into many writtenlanguages. From experience, we know that althoughthe words will be changed, in many cases theoriginal pictures will be used. We encouragetranslators to make an extra effort to change thepictures that include signs. That way, theirtranslation could show signs that are actuallyused in their own country or community.

1

Hearing difficulties andcommunication

Chapter 1

Like all children, children who are deaf orcannot hear well need love, attention,friendship, a sense of belonging, and aneducation. Because they do not hear, thesechildren cannot learn language without help, andwithout language they cannot communicate withothers, express themselves, or learn as easily asother children.

But with early help, children who are deaf can learn a language justlike any child. So the most important resources for children who aredeaf are parents, family members, and friends who take the time tohelp them learn to communicate.

All over the world there are many children who are either deaf or canhear very little. Parents may never know what caused their child tobe deaf. The deafness may be the result of an ear infection,an illness such as meningitis, an injury, or may beinherited. For information about causes of deafnesssee Chapter 15.

With support, families of children with differenthearing abilities can create homes andcommunities where theirchildren are acceptedand their strengthsrecognized — wherethey can makefriends, learn, andlead happy lives.

Ch01 kids hearing final-corr.p65 3/24/04, 5:44 PM1

2 HEARING DIFFICULTIES AND COMMUNICATION

Why communication is important

For a child, being deaf can belike living with a glass wallaround him. A child who isdeaf can see people talkingbut he cannot understandwhat they are saying.

People can interact with eachother because they have learneda language to communicate with. But a deaf child cannot learn alanguage that he does not hear. This means many deaf children growup not being able to learn or use a language to interact with othersaround them.

People have a strong need to communicate with each other and tobuild relationships. When a child does not have the communicationskills to relate to other people, and when other people do not knowhow to communicate or relate with him, he may be left alone most of

the time, even by the people closest tohim. After a while he becomessocially isolated.

THE LONELINESS OF A DEAF CHILD

A child learns language very quickly in the first years of life. It isimportant that a child’s hearing problem be recognized early and thathe receives effective help. If not, the best years for learning

communication skills maybe lost (birth to age 7). Theearlier a child begins tolearn a language and topractice communicating,the more he can learn.

My neighbors don’tlike to look after

Akhila when I haveto go to the

market. They sayshe doesn’tunderstand

anything they say.

Sometimes otherchildren come

running behind usand call Habib bad

names. I wish Icould protect him

from all thismeanness.

Communication happens when weunderstand what is being said tous and respond, and when weexpress our thoughts, needs, andfeelings so they can be understood.


3HEARING DIFFICULTIES AND COMMUNICATION

Children use communication to learn about the world, to relate toother people, to express themselves, and to think and develop theirideas. Without some form of communication, a deaf childcannot fully develop her mind or abilities.

The more children are able to learn alanguage, the more they can understand theirworld, think and plan, and develop closerelationships with the people around them.

For more information about language andchildren’s development, see Chapter 2.

COMMUNICATION FOR LEARNING AND THINKING

Hi. My name is Carmen and I use my hands tocommunicate because I am deaf. I went to a schoolfor deaf children in Nicaragua. There, we made upNicaragua’s first sign language. I still remember whatit was like to finally have people understand me.

It is as though I havecolors to paint thewhole world, wherebefore I had only gray.



Anita’s storyAnita was born almost completely deaf, but her parents didnot realize this until she was 4. When she was a baby, theyonly saw that she was healthy and energetic. Until her sisterLora was born, they didn’t worry that Anita wasn’t learning totalk. They thought she was just a little slow to develop.

“Are you sure she can hear?” a neighbor asked one day. “Ohyes,” said Anita’s mother, Eva. Eva called her name loudly andAnita turned her head.

But when she was 3, Anita could still only say a few words.Her 2-year-old sister Lora was saying new words every day.Lora smiled and laughed more than Anita when Evatalked or sang to her. So Eva talked and sang moreto Lora than to Anita. Lora asked forthings, sang simple songs, and playedhappily with other children. Anitaplayed by herself, since playing withother children often ended in fightingor crying.

Once in the village market, Lora asked for a hair ribbon andEva bought her one. A moment later Anita quietly picked upanother ribbon and began to put it in her hair. Embarrassedand upset, Eva took it away. Anita threw herself on the groundand began to kick and scream.

When Anita’s father heard what hadhappened in the market, he lookedangrily at Anita and said, “When willyou learn to ask for things? You’re4 years old and still don’t even try totalk. Are you stupid or just lazy?”

Anita looked at her father. She couldnot understand what her father said. But she understood theangry look on his face. Tears rolled down her cheeks. Herfather softened and took her in his arms.

I will tell you my story, but first I want to tell youthe stories of some other children who cannot hear.Not every child goes to a school like mine. Anita isdeaf like me but she was not able to learn tocommunicate. Here is Anita’s story.



When the family sat down that evening to talk, Evaremembered her neighbor’s question about Anita’s hearing.She decided to try making different sounds behind Anita’s backto see what she could hear. When the family saw that Anitadid not respond to most of the sounds, they realized she wasdeaf. It was a very sad day for them all.

Anita’s family worried that Anita would never be able todevelop like other children.

Anita is not stupid. Because no one ever taughther language and learned how to communicatewith her, Anita and those around her frequentlymisunderstood and disappointed each other.

Anita’s parents did their best to help her. They were verybusy taking care of their other children and their fields, so itwas hard for them to give Anita the attention she needed. Theyhoped that someday Anita could have a full life, but they didnot know how they could help her.

Anita and other deaf children may behave badlybecause they do not understand what they should do. Because Anitacannot hear words clearly, it is much more difficult for her to learnher family’s language. So she has trouble understanding what peoplewant and telling them what she wants.

It is no surprise that children who cannot hear well sometimes feellonely or forgotten, develop ‘behavior problems’, or are slow inlearning to relate to other people. Anita needs help to developlanguage so she can understand the world around her.

How can I explain things tosomeone who does not hear

or speak? I want her tohave a normal life like hersister. What kind of future

can a deaf girl have?



Omar’s parents will probably have to struggle to findmoney for batteries and new parts for his hearing aid ashe grows. If they are able to do this, Omar will do fine.

Omar’s father took him to a hearing clinic in the city. Thepeople there tested his hearing and thought that a hearing aidwould help him. So Omar’s father borrowed money from hiscousin and Omar was fitted with a hearing aid. The familypracticed with Omar to help him understand words and speakcorrectly. Since he is still a little boy, Omar’s hearing aid willneed many new parts as he — and his ears — grow bigger.

This is Omar’s story. Omar was not born deaf.He lost his hearing after he learned to talk.

Omar’s storyOmar was born with normal hearing and was a verytalkative boy. For a couple of years he had many earinfections. His family could not afford to buy

medicine to treat them. With each infection he lost a little morehearing. By the time he was 4 he could not understand hisparents when they talked to him. He justlooked at them in a puzzled way, andspoke less and less.

Omar’s grandfather, who had lostmuch of his hearing in his old age,suggested some things that might help.He said he usually understood peoplefairly well by using what hearing hestill had and by watching people’slips.

But, Omar’s grandfather said,it was sometimes difficult tounderstand people because somany words look alike on the lips.He wondered whether a hearing aidwould help Omar.

I think Omarcan still hearsome sounds.

Some children like Omar, who can hear a little, may be able to speak andread lips. A hearing aid can help Omar because he has some hearing. It

also helps that he understood language before he became deaf.



Julia’s storyIrene and Pedro realized their daughter Julia wasdeaf when other children her age were talking butshe had not yet learned to speak.

Irene was determined that Julia would have every chance tolearn and succeed in life. Despite her doubts, fears, and manyquestions, Irene thought, “Just because she can’t hear doesn’tmean she can’t learn how to do things.”

Irene remembered the time she met a foreign woman whospoke a different language. While they weren’t able to talk toeach other, they used gestures and acted out what they wantedto say. Even though it tookmore time and theysometimes misunderstoodeach other, they enjoyedthemselves.

So to communicate withJulia, the whole family made upgestures and ‘home signs’ and usedthem together. Even the neighborsbegan to learn how to use Julia’shome signs.

Then Irene asked a teacher at thevillage school when Julia could start.The teacher said that she did not have any way to teach deafchildren. She told Irene about a school that might be able toteach Julia, but it was a 2-hour walk there and back. Pedro andIrene wondered how old Julia would have to be before shecould go there by herself every day.

But every child has the right to an education! How canJulia continue to learn? It was only because of how thingschanged in my country that I was able to go to school.

Here is Julia’s story. When Julia’s parents realizedshe was deaf, they made up signs to use with her.

The human desire to communicate is very strong. When parentslearn how to communicate with gestures and home signs, little

girls like Julia can blossom into smart, happy children.

Julia is so smart.Look how quicklyshe learns newsigns. And now

Miguel is learningthem too.



Then in 1979 the Nicaraguan people overthrew the Somozadictatorship and brought in a new government. The newgovernment believed everyone had a right to be educated andmade education available to allchildren, including thosewho were deaf. For thefirst time inNicaragua, a schoolfor deaf children wasopened.

When everyone is committed to education, deaf children can havethe chance to learn, go to school, and develop their capabilities justlike everyone else!

Before I tell my own story, you must first know aboutNicaragua, the country in Central America where I live,and how it was when I was growing up.

Education for disabled children in NicaraguaFor many years Nicaragua was ruled by the Somoza

family. They controlled most of the country’s wealth andprovided the people with few services.

The Somozas did not consider education importantfor everyone. They felt that people who spent theirlives working in the fields did not need to go toschool. Somoza himself said, “I don’t wanteducated people, I want oxen!”

As a result, most people in Nicaragua could not read or write.Many children — the poor, the disabled, almost all children inrural areas, and especially children who were deaf — could notgo to school.

People with power find it easy to treat those whoare different from themselves as though theyhave fewer rights and are less than human.This happens to poor people, people who speak adifferent language, women, those who practicea different religion and especially to peoplewith a disability!



After the revolution in Nicaragua, a school for deaf childrenopened and my parents took me there. They realized the schoolcould help me in ways they could not. The teachers at the schooltried to teach us all to read lips and to speak. Even though manyof us could not learn to read lips and speak well, just beingtogether began to open up the world for us.

Many of us started school as older children. We communicatedusing ‘home signs’ we had used with our families, and whichwere all different. But we taught each other these signs and madeup new signs together. It was easy for us to use signs tocommunicate. As we used more and more signs, it grew into areal language. Soon we were able to communicate many thingsto each other, about our families and friends, our plans anddreams, and things that happened to us.

Carmen’s storySome months after I was born, an illness spread quicklythrough many children in my village. I got sick too, with avery high fever. My parents were thankful when I got better,but they realized that the illness had left me deaf. As I grewolder, we all felt frustrated because it was so hard tocommunicate even simple ideas or needs. My family did notknow how to communicate with me or how to teach me.

I had never known another deaf child. Mostof my new classmates had never met otherdeaf children either. When I saw the otherchildren use signs, I began to use them too.For the first time, I began to learn.

If I wanted something, I had to show my familyby pointing at it. If it was not there to point at,I could not make them understand.



Sign language lets me speak with others,learn about the world, and say what I think.I am no longer alone, feeling frustrated, orconfused. Sign language — my language —lets me be a part of a community.

LANGUAGE MAKES LEARNING AND COMMUNITY POSSIBLE

Carmen and the other deaf young people in Nicaragua proved to theworld that sign language is a natural and complete language thatdevelops in a community. As with any other language, to use signlanguage you need a group of people to use it with.

As Carmen and other children developed the Nicaraguan signlanguage and their communication skills, they also developedabilities to describe things, solve problems, and make their feelings,needs, and ideas known. Sign language not only gave the children away to communicate, it helped them develop their ability to think.

Accepting differences can bring people togetherDeaf people are different in theway they understand and uselanguage to communicate andexpress themselves. Ratherthan pretending thatdifferences do not exist, it iswiser to accept the differencesand use them to bring people together. Manyhearing people say that deaf people have helpedthem become ‘warmer’ and more expressive in howthey relate to others.

One of the reasons the Nicaraguan childrendeveloped such a complete language is therewere many children using it. They could dothis because the people of Nicaragua decidedto put more of their resources into education.They started an educational reform movementthat created a strong school system for allchildren — including children who were deafor could not hear well.

Do not turnaway — I amnot ashamed.I am proud tobe deaf!



Coming together for deaf rightsThanks to the Nicaraguan people’s struggle to makeeducation available to all, hundreds of young deaf peoplewere brought together in schools for the first time. In onegeneration, the children began to produce a new anddifferent form of communication — which developed intoNicaraguan Sign Language.

By the mid-1980s, these young deaf adults beganmeeting and working to promote their rights as deaf people.They formed the National Association of the Deaf ofNicaragua (ANSNIC). The people of ANSNIC helped todevelop and promote Nicaraguan Sign Language,publishing a dictionary as well as a book for children. Theyworked with the Ministry of Education to begin to includesigning in the deaf schools, and to improve the programsfor deaf education.

Today, ANSNIC is a powerful group in Nicaragua thatworks for the rights of deaf people and also serves as asocial center for its members.



All children can learn to communicateChildren who have different hearing abilities can communicate withgestures, home signs, a complete sign language, and lip-reading andspeaking. Some children who can hear a little will be able to speakand read lips. Other children communicate best by making signs withtheir hands. Young deaf children can learn sign language easily and

naturally — just like young hearing children learn aspoken language.

To feel good about themselvesand to have a sense ofbelonging, it is important fordeaf children to meet each otherand also to meet adults who aredeaf.

There may be a deaf person inthe community who can teachchildren sign language.

Some families are able to send their child to a special school for deafchildren. Other families teach their children at home. Some childrenmay be helped by getting a hearing aid from a clinic and learning toread lips.

Whatever type of communication you use, this book will try to helpyou communicate with your child.

Every family has its own story aboutthe difficulties they faced andwhat they did to help theirchild. Sharing these stories canhelp families find ways tohelp their childrenlearn and feelsecure.


13

Children who cannothear well need help early

Chapter 2

In their first years of life, all children, including children who aredeaf or cannot hear well, will learn more skills and learn them morequickly and easily than at any other time in theirlives. Their physical development is easy to see.First they crawl, and then they walk and run.

Children also start to develop mentally as soon asthey are born. The baby’s brain is like a spongethat has a great capacity to absorb and learn newthings. During the first years, children who canhear learn language very quickly. As theirlanguage and communication develop, theirability to think also grows. That is why it is veryimportant for parents to help children who are deaf or cannot hearwell learn a language as early as possible. With a language, childrenwho cannot hear well can also develop their mental abilities.

Now it’syourturn!

Papa, wheredoes the sungo at night?

To sleep?

What do youthink, Hari?

14 CHILDREN WHO CANNOT HEAR WELL NEED HELP EARLY

In all areas of development, each new skill a childlearns builds on the skills she already knows andmakes it possible for her to learn other, moredifficult skills.

When a child does not learn a skill, she cannotlearn other skills that depend on it. Forexample, if she has a problem holding up herhead, she will then have difficulty learningskills like sitting or crawling, in which holdingup the head is important.

Each new skill builds onalready-learned skills,like building blocks.

How children develop new skillsEvery child develops in 4 main areas: body (physical), thinking(mental), talking and listening (communication), and getting alongwith other people (social). In each area, a child learns new skills stepby step.

For example, before a child can learn to walk, she must first learnmany simple kinds of body control:

First, she learns tohold her head upand to move herarms andlegs.

1 Then she canuse her armsand legs tosit up.

2

4 Crawling helps her learnto coordinate her armsand legs, which alsohelps her braindevelop.

3 While sitting, shecan reach andturn, whichimproves herbalance.

Then she pullsherself up to astandingposition.

5

15CHILDREN WHO CANNOT HEAR WELL NEED HELP EARLY

Learning languageWhen you are surrounded by words, it is easy to learn the languagethat people in a community speak. Children learn language as theylisten to people talk to each other and watch what happens, and asthey talk to other people. Language becomes a way for them tounderstand their experiences and how the world around them works.

Babies begin to express their thoughts,needs, and feelings by making sounds orusing facial expressions and pointing.

Do youwant some

more?

CHILDREN’S COMMUNICATION SKILLS AND LANGUAGE

ALSO DEVELOP STEP BY STEP

Children’s language develops in the same way as their physical skills.They learn simple skills first.

Later they start to talkand express themselvesmore completely.

They hear and understandother people’s words.

They begin to use words. They knowand use names of the people closest tothem.

Where ismama?

Nana?Yes,

sweetheart?

1 2

3 4

Allclean!

That’sright,Mari.

Words help them thinkand learn new things.

5

Can I havesome?


Learning a spoken language is difficult for children who cannot hearWhen children cannot hear well, they willhave difficulty understanding simplespoken words. And children need tounderstand many simple words to learna language.

When they know many words, they canlearn more advanced communicationskills, such as speaking in sentences orengaging in conversation. Children who aredeaf or cannot hear well need help to learnskills like saying simple words or doing things thatdepend on simple communication, like taking turns.

Can yousay helloto Papa?

?

But without the first steps ofhearing or understanding...

Children learn alanguage in steps

he hears words

learns in words

thinks in words

then he can use a completelanguage with the community

uses words

understands and responds to words

...he cannot learn a language,so he cannot develop histhinking or communicate.

He has no way to becomepart of the community, andgets left out.


HOW LANGUAGE HELPS THE MIND DEVELOP

Language enables children to think, to plan, to understand the worldaround them, and to be a part of a community. Without language,children cannot develop their minds.

When children cannot hear, and do not get help learning a languageto communicate, they will face problems in their mentaldevelopment. Many parents with young deaf children or childrenwith hearing loss are glad if the children learn a few simple words orgestures. But children need more than this. They need to learn alanguage.

A deaf child needs to learn language early, so that she can use it totalk to herself, that is, to think. Expressing ideas in words makes itpossible to think about those ideas.

Because she knows the words forbigger and smaller, Amina can learnhow to compare sizes. Withoutlanguage she cannot learn this.

Because she has words for doingthings in order, Rosa can plan.

First I add theegg. Then I mix

in flour untilthe dough is

sticky.

She also needs language to express her ideas to others, to tell peoplewhat she wants or needs. She needs language to understandexplanations. Through communicating with others, she learns aboutthe world around her. This helps her mind to develop and lets herrelate to people.

?

Without a way for her mother toexplain, Evi does not understandhow her mother knows thatsomeone is at the door.

Without language a child may notknow why he must stay away fromdangers. Dan cannot understand whythey must keep the well covered.

The biggershirt mustbe Papa’s.


The important thing is that a child continue to learn new skills. Butwhen a child is not learning a skill even long after other children herage have learned it, this is usually a sign that she may have aproblem or need extra help.

How to know if your child needs helpBabies develop at their own pace. Some develop more quickly thanothers. But most children grow and develop new skills at about thesame age. By age 2, most children can speak or sign about 50 to 200words. A child usually knows about 900 words at age 3, and 1500words by age 4.

Deaf children need help earlyWith help, children who cannot hear cancommunicate and learn language. Sincebabies start learning as soon as theyare born, it is important that familiesbegin giving extra attention tocommunication to help their deafchildren as soon as possible. If childrenwho cannot hear well have help to learna language — and that language maybe a sign language — they can understandand communicate with people around them.Then they can learn what other children usuallylearn by hearing.

Do you wantanother kissfrom mama?

If the child’s hearingproblem is noticed earlyand effective help isprovided, the best years forlearning language andcommunication skills(birth to age 7) will not belost. See Chapters 7, 8,and 9 for more informationabout helping a child learnlanguage.

What didGrandmaask us to

buy?

Tea.


This chart describes some of the communication skills children learnand when most children learn them. Parents can usethe chart to decide which skills their childrenalready know, and which skills they need tolearn. To decide what activities to do first,start by asking yourself, “Is my child doingeverything that other children his age aredoing?” For more information on the agesand order in which children usually learnnew skills, see the Child DevelopmentCharts on pages 231 to 238.

6 months

5 years

3 months• responds to familiar

voices or faces

• reacts to suddensounds ormovements

1 year 2 years

• understands mostsimple language

• knows and uses500 to 1000words or signs

My cup.

• makes simple soundsor gestures

• turns headtowardmovementsor sounds

• talks or signsabout whathe has done

• asks manyquestions

• joins sounds together orrepeats hand shapes

• begins to name things

• understands and respondsto simple words or signs

• imitates single signs

• uses simple wordsor signs

• uses sentences with2 and 3 words or signs

• knows 50 to 200 wordsor signs

3 years

NOTE: Some children who cannot hear well may have other problems. Theirminds and bodies could be slow to develop for other reasons. See the bookDisabled Village Children for more information on how to help a child whosemind and/or body are slow to develop.

ba-baga-ga

Where is thebiscuit?

I ate it.What are

those peopledoing?


If you think your child’s communication is not developing as itshould, you can help him learn. Parents often think that onlysomeone with professional training can help their child. But as aparent, you know your child better than anyone else, so you canmake a big difference in hisdevelopment.

• guidelines for teaching language (Chapter 3)

• basic communication skills (Chapter 4)

• finding out what your child can hear (Chapter 5)

• listening skills(Chapter 6)

• choosing andlearning a language(Chapter 7)

• learning asign language(Chapter 8)

• learning aspokenlanguage(Chapter 9)

In Chapters 3 to 9 you can find information about:

What’sthat sign?

‘Fix’. Can yousign ‘fix’?

YOU CAN HELP YOUR CHILD LEARN

Other children Ali’s ageknow how to behave

with each other. I thinkit’s important for himto learn how to get

along with otherchildren.

21

Guidelines forteaching language

Chapter 3

Communicate as much as you canHelping deaf children learn a language is the most important thingthat parents and others can do. Even if people generally do not talkto children as they do their work, your child needs everyone to makeextra efforts to speak to her. Communication is the only way she willlearn.

Sometimes parents may feel ashamedof a child who cannot hear well.Or the child may be protected toomuch. But a child needs to takepart in her family’s activities.Being left alone will stop her fromlearning many things.

Throughout the day, look foropportunities to communicate withyour child. Include her in activitieswith other people, so she gets usedto seeing and hearing differentpeople communicate. Encouragethe whole family — brothers, sisters,grandparents, and other relatives —to do this too.

A child who is deaf or cannot hear well learns to communicate by seeing.He will not learn words like others do, just by listening to people talk. Heneeds a longer time and more help to learn a language — whether bywatching and listening to people talk, or by seeing them sign. He maystart earlier than other children to pay attention to written words. Whenhe sees written words, such as his own name, he can make the connectionbetween a word and its meaning.

The guidelines in this chapter can make it easier for parents andothers to teach children how to use a language. Try using theseguidelines while working on the activities in this book.

Are you comingto the market

today?

Yes. Ashaki andI will bring some

cassava andmangoes.

A child needs to take partin her family’s activities.

22 GUIDELINES FOR TEACHING LANGUAGE

Fitting activities into your family’s daily lifeIt is important to think about how to support your child’sdevelopment in ways that make sense for your family. Some of theactivities in this book will take extra time to do or may change theway you usually do things.

Your child will learn better whenteaching becomes a part ofeveryday activities.

• Talk or sign to your childwhile you do activitiestogether, like eating,bathing, changing clothes,and so on. These are goodtimes to talk and signbecause you are close toyour child and he is usually payingattention to you.

• As much as possible, keepyour child nearby whileyou work. Make manyshort comments aboutwhat you are doing.

If we take good care ofthe bean plants, they will

grow big and strong.

Big!

Lihua’s mother is usinghome signs to communicate.

Shirt.To describe what you do, use thesame signs or words for the samethings, each time. This will helpyour child learn the meaning ofsigns and words, and help him touse signs and words (see Chapter 4,pages 37 to 46).

Cesar’s mother is using signlanguage to communicate.

Are you hungry?Can you smellthe rice? Mmm!

23GUIDELINES FOR TEACHING LANGUAGE

• Talk and sign about whatyou think your child isseeing, doing, and feeling,as if you were him.

Jawad’s cousin is usingwords and expressions onthe face to communicate.

Yuck!Don’t likespinach...

• Follow the child’sinterests. Makeactivities usingthings your childis interested in.

BE REALISTIC

• Try to be realistic about how much time you and others can spendworking with your child.

• Try to adapt activities sothey fit more easily intoyour daily life and takeless time.

When I weave, I can talkabout colors, and Teresawill learn the names ofcolors when she gives

me the yarn.

• Try breaking large tasks into smaller, easier steps. This way youwill see progress and not get discouraged.

Why not start witheach separate

sound first — like‘RaRaRaRaRa’ and ‘vivivivivi’?

I want Ravi to learnto say his name.

A pineapple!What else

do we need?


Though children need the care and love of both their parents, parentsdo not have to be a child’s only teachers. Let friends, neighbors, andother family members help. Get to know deaf people who use thelocal sign language. It is especially important for the child who isdeaf or cannot hear well to have many people doing activities withhim because:

• it will help him learn to communicate with many peopleincluding other deaf people.

• he will learn to get along with different people.

• other people will learn how to interact with deaf people.

Many people can help do these activities

I don’t have much time tohelp Mira since my husbandhad to go away to work. Ihave to take care of our

fields, as well as the houseand the children.

Some people, sometimes even close family members, may not want tospend time with deaf children. Other people, even if they want tohelp, do not know how. You can help them learn about deafness andhow being deaf makes it more difficult for someone to learn alanguage. They may become more comfortable if they know what todo.

Share what you have learned about hearing problems, the activitiesyou and your child are working on, and the reasons for doing theseactivities.

My neighbor’s eldestdaughter is helping ourson learn to speak every

afternoon. Maybe shecould teach Mira at the

same time.That’s a good

idea! We are alsovery busy, but we

showed mymother-in-law

ways to help ourdaughter.

Parents who have children that are deafor do not hear well can work togetherto solve problems (see page 184).


TALK WITH YOUR FAMILY

Everyone in a family plays a role in a child’s life. Each person caringfor a child, especially one with special needs, may have differentideas about the best way to raise and help that child. It is importantfor all those who care for the child to find time to talk together and

understand each others’ideas. And if one of youis feeling tired ordiscouraged, the othersmay be able to help.

ASK OTHERS FOR HELP

Parents can ask othercommunity membersand neighbors to helpcare for the deaf child.

Meet the deaf people inyour community. Deafadults remember what it feltlike to be deaf children. Theywill probably be happy tohelp your family and yourchild.

Hearing people who use signlanguage can help youcommunicate with deaf adults ifyou do not know sign language.

Talk to a health worker or school teacher, or someone that teacheschildren who are deaf. This is especially helpful if your child does notseem to be learning new skills after several months.

Mariama isexplaining how herparents would bringher to the market...

When I was little,my parents usedto take me to themarket with them.

I will writeto Mrs. Patel.She is a deaf

teacher inthe city.

Let me watchThuy for theweekend soyou can getsome rest.


Children can help with these activitiesChildren can be very helpful. Usually brothers,sisters, and other friends of a deaf child learnsign language very quickly. As much aspossible, let children take part in theseactivities.

Younger children can join the activitiesand older children can be teachers if youshow them what to do. They can alsoteach a deaf child other skills andinclude him in their play. This will helphim make friends and learn how tobehave with others. This will also helpthe children who can hear learn aboutdeafness and how to communicate withdeaf children.

LET YOUR CHILD TAKE THE LEAD

Children are most eager to learn when they are doing something theylike. If your child seems interested in something, or likes to play with

a special toy, make that anopportunity to help hercommunicate or learn.

Let your child take the lead. Itwill keep her interested and helpher learn that her decisions areimportant. She will know thatshe has some control over whathappens. This is especiallyimportant for girls. In manyplaces, girls are expected to bequiet and to follow instructions.

Helping a girl make decisions and follow her own ideas canstrengthen her confidence and abilities.

But just because you let your child take the lead does not mean youallow her to act badly or get into dangerous situations. Your guidanceis important. And the knowledge you have about her language needsand abilities can help you guide her play so that she will learn.

Suggestions for helping your child learn

Did youfind a new

game?

Older children are oftennatural teachers, andenjoy doing activitieswith younger children.


MAKE COMMUNICATING FUN AND USEFUL

Children enjoy communicating when theyhave real things to sign or talk about, andpeople to sign or talk with. Try to giveyour child many opportunitiesto learn about the worldand encourage her to signand talk about what sheis learning. Makingconversation withyour child will helpher learn faster thanif you ask her only tomemorize and repeatsigns and words.

LET YOUR CHILD HELP YOU DO WORK

As your child helps you do your work, communicate with him aboutwhat you are doing. Use words or signs to ask him to help you dosomething, to get you tools, or to help in other ways. Your child willbe more interested in paying attention and communicating when heis helping you do something you both value.

GET YOUR CHILD’S ATTENTION BEFORE YOU COMMUNICATE

A child who cannot hear well needs to watch your lips move or seeyou gesture or sign to understand you. He also gets a lot of

information from seeing the lookon your face. So it is important towait until he is looking at youbefore you begin to talk or sign.

To get a child’s attention, move orwave your hand where he can seeyou, call his name, touch him, orhit a nearby object to make a loudnoise so the child can feel thevibrations.

What areyou making,Najuma?

Suren’s brothertouches hisarm to get hisattention.


At first, it can be hard to remember to get your child’s full attentionbefore you begin to communicate. But it gets much easier withpractice.

If your child is more interested in an object than in what you arecommunicating, you can get his attention by stopping all action,bringing the object close to your face, or gesturing or signing near theobject.

• Stop all action. If you completely stop moving, especially with anobject in your hand, your child willprobably look at you to see why you havestopped.

• Bring the object close to your face,so he can see your face andthe object at the same time (ifyou want him to see yourmouth).

• Point to or sign near theobject (if you want him tolearn a sign for the object).

Other ways to get your child’s attention

SIGN OR TALK FACE TO FACE, AT EYE LEVEL

Your child will be able to understand more of what you say or sign ifyou squat down close to her (within about 1 meter, or 3 feet), andlook her in the eye as you speak or sign.

If possible, try to have light from the sun or a lamp shining on yourface, not from behind you. When the light comes from behind you,your face and hands will be in a shadow and harder to see.

Toy.

To call his attention to the sign,Obasi’s sister is signing near his toy.

Sweet orange,half a lime,

give me a hugso you’ll...

...be mine!

Mariana’s mother isplaying a clappinggame with her.


What do youhave there?

It will be easier for your child tounderstand spoken words if you talknaturally and in a clear voice. Donot shout. Shouting makes thewords harder to understand. Speakin short, simple sentences so youdo not confuse her. It will be easierfor your child to see your lipsmove if you do not have anythingin or in front of your mouth whileyou are speaking.

If your child can hear a littleThese suggestions may help her hear sounds a little better.

• Cupping a hand behind the ear canhelp more sound reach the ear.

• Speaking close to a child’s earcan help her hear better. Thismakes sounds louder andlessens the amount of noisefrom the environment.Remember she also needs tosee your face while you aretalking to her. Let’s go give

Mrs. Chifeveher gift.


REDUCE BACKGROUND DISTRACTIONS

AS MUCH AS POSSIBLE

Background distractions, such as otherchildren playing near your child, can makeactivities more difficult or even impossibleto do. You can help by finding a place withfew distractions. Try to get rid of any noisesthat are not necessary. When a room isnoisy, a child who cannot hear well finds itmore difficult to understand what is beingsaid.

This father is shuttingoff the radio beforeplaying with his son.

USE GESTURES, TOUCH, AND

EXPRESSIONS ON THE FACE

All people use body movements,touch, and expressions on the face tohelp people understand what theywant to say. Children often use touchto communicate with each other.Children who cannot hear well findtouch extremely useful. A touch willhelp communicate your care andconcern in a way that nothing elsecan. Sometimes movements and lookscan take the place of a word or sign. At other times they addinformation to words and signs.

Help your child by using your body and face tocommunicate as much as possible. First, try tonotice how you already do this. Then lookfor ways to add to what you do.

Try to make sure that the messages you sendwith your body and face are the same asthose you send with words and signs. If themessages of your face do not match yourwords, your child will be confused.

Goodgirl!

Maria’s angry expressionsends a different messagethan her kind words. Thisis confusing.


CHANGE ACTIVITIES TO SUIT YOUR CHILD

The activities in this book can help your child learn to communicate.But they are just examples of activities that can help a child learn.Watch your child carefully to see what interests him and makes himwant to communicate — and also watch for what upsets him andmakes him want to stop. Then you can think of ways to adapt theactivities in this book so they will work better for your child and fitmore easily into your family’s daily activities.

• If a child cannot hear speech sounds well,teach everyone somesigns to use with him.See Chapter 8 forinformation aboutteaching signlanguage.

You can also adapt these activities so they fit with your child’sabilities. For example:

• If a child can hear somespeech sounds, help himlearn simple words bygiving them emphasisand repeating them. Thenuse the words oftenthroughout the day.

• If your child can hearsome of the soundsaround her, everyonecan help her payattention to sounds bypointing them out.

Did you hear?Someone is at

the door.

If you use thissign for ‘ball’,

Paulo canunderstand you.

It is hot. Do youwant some waterwaterwaterwaterwater? I

want water water water water water too.


As you do the activities in this book, try to:

• be patient. Very young children can onlypay attention for a few minutes at a time.

• be light-hearted. Learning activities willwork only if they are fun for both of you.

Do not get discouraged. Do not expectimmediate changes in a child’s behavior. Your child willgain something from every activity, even if you do notnotice it right away.

If you make these activities part of your family’s everyday life,your child will have a childhood that is full of fun andlearning. As he grows up he can:

join in family conversations develop friendships withother children

go to school and learn a trade

and years from now, marryand have a family of his own.

Helping your child grow

meet other childrenand adults who aredeaf or cannothear well

MMMMMAKEAKEAKEAKEAKE LEARNINGLEARNINGLEARNINGLEARNINGLEARNING FUNFUNFUNFUNFUN

~ Be patient

~ Be positive

~ Keep activities short

He will be able to supporthis family and be involvedin the community.

33

Basic communication skillsChapter 4

People usually communicate by using words or signs. But childrenbegin to communicate long before they learn these skills.

Communication happens when:

• one person sends a message, and

• another person receives the message and responds.

A young child sends a message by moving her body, making sounds,or changing the look on her face. When parents understand hermovement and respond to her, they are already communicating.

She is excited. She wants her toy.

This child is sending messages that:

She is happy to see her mother.

Basic communication skills develop when achild is a baby, before she learns to talk orsign. During this time you can help your childlearn that communication makes thingshappen. Basic communication prepares your childto learn to speak and use sign language.

Yes,Laila!

Mama’sback.

Aahh!

This chapter will help you understand how your baby can:

• take turns.

• pay attention to you.

• understand you.

• use gestures.

• make sounds.

Mmm!

34 BASIC COMMUNICATION SKILLS

How children learn to communicateAlthough a child communicates from birth, at first he does notrealize he is doing so. He moves his body, makes sounds, or changesthe look on his face because of the way he feels. For example, hemight cry because he feels hungry or wet. Slowly, he sees that hismessages make things happen. When he cries, someone comes to findout what is wrong. When he smiles, people smile back. So he beginsto send messages to make things happen.

Communication is a powerful tool for getting what we want or needand understanding what other people want or need. You can help achild begin to communicate by responding to his movements,sounds, and looks on the face. This helps him learn that his actionshave an effect on others.

Let your child take turnsTaking turns helps your childdevelop two-way communicationskills. When he is older, this willhelp him learn how to makeconversation with other people.

Here, Kwame’s mother Holahelps them get started.

Hola’s face shows sheis asking a question.

That’s aball.

Can I havethe ball?

Thank you,Kwame.Good job!

Your child will learn even more if you can keep a give-and-takegoing between you.

35BASIC COMMUNICATION SKILLS

Kwame rolls the ballback to Hola. She smilesand claps her hands...

...and rolls the ballback to him.

Now Kwame knows what to do. He and his mother are taking turns.

Then Hola changes the game to keep Kwame’sattention. She hides the ball inside a box.Notice Hola’s face. How would yourface look if you wereasking, “Where is theball?” without usingwords?

Hola waitswhile Kwamecrawls to thebox.

Hola smiles andclaps her handsagain when hefinds the ball.

For example: Hola waits untilKwame is looking at her. Shegets him interested andengaged by raising hereyebrows, smiling, andshaking the ball.

When Kwame isready, Hola rollsthe ball to him.

As you see in these pictures, basic communication begins when achild is very young. Communication does not have to include words.


To encourage your child to take turnsEvery time you take turns with your child it will be different. Here aresome general guidelines to make taking turns successful.

To begin:

• Get your child’s attention and let herknow you are ready to play.

Wait until you have yourchild’s attention before youtake your next turn. Thentry to take about the sameamount of time for your turnas your child took for hers.

If your child does not respond inany way, try giving her a prompt,like a touch on her arm, toremind her it is her turn.

• Let your child take her turn first. You can then respond to whatinterests her. But if you have to wait a long time, go ahead andbegin yourself.

Aysha?

Allow your child to stopwhenever she wants. At first,taking turns may last only aminute or two. But soon yourchild will want to take turns for alonger time.

When you respond to your child, try to:

• copy her sounds and actions (if she says “ga...ga,” thenyou say “ga...ga”).

• continue things that she likes (rolling the ball to her again).

• add to what she does (like making her look forthe ball), to keep her attention and tohelp her learn new ways of playing.

• Your child will know that you noticed her action and liked it. Shewill now try to use it again to get a response. When your childmakes a sound or a sign and gets a positive response, she willwant to make more sounds or signs.

Here itcomes!

All done?

As children grow, they will take turns more.


Here are some examples of people using gestures:

Using gestures and signs does not prevent a child from learning to talk.Gestures help prepare a child to sign and speak. By using them helearns that he can send specific messages. For example, he learns thatby shaking his head, he makes it clear he does not want to dosomething.

ENCOURAGE YOUR CHILD TO USE HAND MOVEMENTS

It is natural for a child to use gestures. Both deaf and hearing peoplealready use their hands, bodies, and make expressions with theirfaces to communicate many things — both with words and withoutwords. These movements are called gestures. We wave‘good-bye’, shake our heads when we mean ‘no’, and we point.

Older children who cannot hear also need tolearn to keep a give-and-take going throughwhatever activities that interest them. For achild who is 5 years old, playing a game maybe more interesting than rollinga ball.

This child istelling hismother thathe wantssomething.

This man isansweringthat he doesnot know.

Do youthink it

will rain?

Rene’s older sisteris teaching her aclapping game.

Preparing a child to use signs and to speakWhile a child is learning that communication can make thingshappen, you can help her learn to understand words and signs. Thiswill prepare her to use signs and to speak. To understand words andsigns, she must first learn to pay attention to them and learn thatwords and signs have meanings. See Chapter 8 and Chapter 9 forsuggestions to help your child learn the meaning of signs and words,and learn how to use signs and words herself.


• Use gestures often to send messages to your child.

Sunil’s aunt isusing a gesture.

Titus’ grandmotheris using a gestureand wordtogether.

No!

• Use the hand movements your child already uses to communicate.Many children begin to make up hand movements that nameobjects, people, or activities. If you watch for these movements,you and your family can begin to develop ‘home signs’.

For example:

Tae Woo points at a bird. Tae Woo makes a ‘flying’movement to name the bird.

A bird!

Tae Woo’s motheruses his movementtogether with words.

When you are with your child, expect him to use gestures, signs, orsounds. Your child needs to learn that his words or signs areimportant and that people react to his communication.

These signs are very useful for family members to communicate witheach other but they may not be understood by other people. See page40 for more information on home signs.


Where’smama?

• Play games that help a child learn to point.

• Draw pictures of different family members, and of the foods yourchild usually eats, the objects he likes to play with, and theclothes he wears. Encourage him to point to what he needs.

• Help your child show what he feelsby using gestures. He willremember the gestures you makeand he will copy them.

Yes! Here’smama!


COMMUNICATE WITH HOME SIGNS

When a family has a deaf child, gestures help them begin tocommunicate with each other. But people need more complete waysto communicate than simple gestures. Families often make up anduse ‘home signs’, hand and body movements that they develop toexpress themselves and communicate with their deaf child.Here is an example:

A Mexican man wentto a village with his6-year-old deaf son.When the boywanted to go home,he pulled on his father’sclothes. Then he used homesigns that he and his family hadmade up.

This boy is pulling on his father’sclothes, pointing and also using homesigns (‘riding the mule’ and ‘please’).

Making up and using home signs is natural for families withchildren who are deaf or cannot hear well. Other deaf and hearingpeople will probably not understand the signs you have made up,but you can share them with friends just as you have done with thefamily.

Your child and your family are probably using gestures and homesigns right now. It makes sense to continue doing this. Even thoughhome signs do not make up a complete language, they can be veryhelpful for expressing simple ideas and are a good start tocommunicating. To learn more about teaching your child the signlanguage that is used where you live, see Chapter 8.

Making up home signsMaking up signs can be fun. Remember, it will take time andpatience. But there will be big rewards as you and your child begin tounderstand each other. The next few pages give ideas for making upsigns. You can change them to fit the gestures, customs, andlanguage of your area. You and your family will have many ideas forcreating your own home signs.

riding the mule

please!

Let’s go (home)

This helps him communicate morethan he could by simply usinggestures.


5. Combine signs for objects,actions, and ideas to createsentences. A child who learns toput ideas together will developmore complete communicationskills. cup on table

“Put the cup on the table.”

Here are some suggestions to help you get started:

1. Try to make signs looklike the things or actionsyou want tocommunicate:

This sign for ‘baby’looks likesomeoneholdinga baby.

baby

4. Try to create similar signs for actions or things that go together.For example:

lie downstand jump

You can also create similar signs for opposites, like ‘push’ and ‘pull’.

Shape your hand like a cup.Then move your hand as if youwere drinking from the cup.

3. Use hand shape, position, and movement to make different signs. Forexample, when making the sign for drinking from a cup you could...

Or, if you wanted to sign aboutdrinking from your hands, you couldchange your hand shape like this:

drink (from a cup) drink (from hands)

2. Watch for signs your child makesup and use them. Many children,for example, make up signs toname people in the family.

One childmade this signfor her sister,Maria, whowears glasses.

Maria

cup


Examples of signsThese signs are from American Sign Language. You may find usefulideas for creating your own home signs from these signs, together withsigns from your local sign language. These examples also show themany types of signs a child needs to know in order to communicate.

Describing signs

thirstydirtyclean, nicehappy angry

bluehot cold deaf red

Signs for things

water bread

chicken

money sign

house village,community

school toilet shoe, sandal

Signs for people

his, her, their, your

direct signtowardsperson

ourbrotherfatherman

sistermotherwoman


These examples also show how each sign can be changed andcombined with other signs to give it new meaning.

Question signs

where why who no yeswhat

Signs about direction

under inside outside

ball throw to her

Direct thesign towardthe personor object.

“Throw the ball to her.”to

Signs about time

future “It is going to rain.”

future-sign rain

past “It rained.”

past-sign rain

now “It israining.”

rain now

day night

Action signsabout doing something

start stop

use walk

about relating to others

like love

help play

about thinking

understand forget

want don’twant


ENCOURAGE YOUR CHILD TO MAKE SOUNDS

Children start using hand movements and gestures at an early age,and these can become the basis for developing communication andsign language. Children also start making sounds and noises at anearly age, and these too can become the basis of communication andthe development of spoken language.

Your child needs to learn that a person makes sounds with the lips,the tongue, the breath, and vibrations in the throat and nose.

Teach a child how sounds feel in his body, how to control his breath,and how to shape his mouth and tongue to make different sounds.

As you do the activities below, encourage your child to imitate you. Itcan be difficult for a deaf child to learn to make sounds. So when hedoes, let him know he has done something important.

• Lay your child on your chest. At first, let him feel your chest riseand fall as you breathe normally, without talking.

Then talk or sing, letting your child feelthe different ways your chest moves.

• In a natural voice, speak very closely (about 8 centimeters or3 inches) to your child’s ear. Speaking this close makes soundseasier to hear. Your child will also feel your breath as youspeak.

Manuel,what are

you makingwith yourblocks?

La la la...

Encourage him to feel thebreath coming out ofyour mouth, too.


• Make up sounds that are easy tosee on your lips and repeat themoften during the day.

• Try matching a sound with an object.

• Try matching the length ofa sign to a movement... ...or the length of a word

to a movement.

Rooooll.

Bounce... bounce...bounce... bounce.

That’sright,bang!Baan!

Praise your child when he makesa sound or says a word.

Bang!

Ba baba ba.


Encourage your child to make sounds by praising her as soon as shemakes a sound or says a word. Small praise is enough — you can usea smile as praise. Or point to your ear and say, “I heard you.” Or nodor say, “Yes.” Remember, it is very difficultfor her to learn how tospeak clearly and tocommunicate usingspoken words.

Here are 3 ways to show your child you are paying attention to hissounds:

• You can imitate him, showing that you enjoy imitating him. Forexample, if your child says “ooo” then you do that too, and waitto see if he does it again.

• You can respond to his sound like it is the beginning of aconversation. Try to understand what your child iscommunicating and answer it.

• You can ask him questions about what he is communicating. Itwill encourage him to start a conversation. Besides, askingquestions is a good way to encourage him to ask you questions.

Bird. That’s abirdbirdbirdbirdbird in the tree.

Aaaa?

Wa?

Yes, Emilia!You want

some water?

When your child has developed basic communication skills, heis ready to learn a language. For more information on learninga language, see Chapter 7. See Chapter 8 for information onlearning sign language, and see Chapter 9 for informationon learning a spoken language.

47

What can yourchild hear?

Chapter 5

Some children are completely deaf and cannothear at all or can hear only very loud sounds.When babies are very young, parents noticetheir babies cannot hear, because they do notturn their head or respond, even to loud sounds.

Many more children with some hearingloss can still hear a few sounds. This sortof hearing loss can be harder for parentsto notice. A child may show surprise orturn her head to a loud noise, but not tosofter noises. She may respond only tocertain kinds of sounds. Some children

can still hear a little when people speak to them. They may slowlylearn to recognize and respond to some words. But they do not hearall words clearly enough to understand. Children with this sort ofhearing loss are slow to learn to speak.

Many children develop hearing loss because of repeated and long-lasting ear infections, or as a side effect of certain medicines (forcauses of deafness see Chapter 18). Parents may not notice a child isslowly losing his hearing until he is maybe 4 or 5 years old and hasnot yet started talking, or is not talking clearly.

If you can find out early how much your child can hear, it will helpyou know what kind of extra help to give him so he cancommunicate. Sometimes parents, other children, or teachers think achild with hearing loss is mentally slow. If children who are deaf getextra help to learn to communicate, most of them can learn and beeducated like other children. That is why it is important to find outwhat, if anything, a child can hear.

48 WHAT CAN YOUR CHILD HEAR?

Some sounds can be made louderor quieter. For example, you canincrease the loudness of a radioor you can make your voicequieter by changing from ashout to a whisper.

PITCH

Pitch is how high or low the tone of a sound is. Like in music, soundscan go up and down from high to low pitch.

Understanding sound

LOUDNESS

Some sounds are louder thanothers. Noises that are closerare louder than the samenoises farther away.

A motorcycle is much louderthan a person walking. Whena motorcycle is close by, it willsound much louder than amotorcycle farther away.

If parents know about the different types of sounds, it will help themunderstand how much and what kind of sounds their children canhear.

Lower-pitchsounds have afull, heavysound that youcan feel in yourbones.

a cow a drum thunder a man’s voice

Lower-pitch sounds

a bird a flute water pouring a baby’s cry

Higher-pitch sounds

WAH

Higher-pitchsounds have asharp, thin soundthat can feel like itgoes right throughyour ears.

quietsound

loudsound

49WHAT CAN YOUR CHILD HEAR?

There are many kinds of hearing lossA child who has problems hearing usually has difficulty with bothloudness and pitch. For example:

This baby does not hearwell. She cannot hearhigh-pitch sounds.

He cannot hear his father playing thedrum, though he may feel its vibration(shaking). But he can hear high-pitchsounds like a baby crying.

She can hear high-pitch sounds, so she canhear the baby crying. She can also hearlow-pitch sounds like her father’s voice. Butshe cannot hear her mother’s voice.

Different speech sounds also have higher or lower pitches. Forexample, the sounds ‘o-o-o’ and ‘m-m-m’ have a low pitch. Thesound ‘e-e-e’ has a medium pitch. The sounds ‘s-s-s’ and ‘f-f-f’ have ahigh pitch.

She cannot hear her fatherplaying the flute. But she canhear low-pitch, loud soundslike drums.

This boy cannot hearwell. He cannot hearlow-pitch sounds.

This girl cannot hear well. She cannot hearmiddle-pitch sounds.

He cannot hear hismother, the chickens inthe yard, or the truck onthe road, no matter howloud they are.

This boy is completely deaf.He cannot hear any sounds.


What sounds can your child hear?If your child can hear a little, finding out which sounds she can hearwill help you. The more you know about your child's hearing, thebetter you can communicate in a way she can understand.

NOTICE HOW YOUR CHILD RESPONDS TO SOUND

It can be difficult to know if and when a child hears a sound,especially with very young children. You will know if your childhears a sound because she may:

• move her arms and legs.

• change the look on her face.

• become very still.

• make a sound herself.

• smile or laugh.

• turn toward the sound, or tilt her head to listen.

• be startled, open her eyes wider, or blink.

When the room is quiet, Kofican hear the blocks fall down.

Does your child seem to hear some sounds?To find out more about what a child can hear, watch him closelythroughout the day and ask yourself:

• Does he seem to hear mostly high-pitch sounds? Or mostlylow-pitch sounds? Or a mixture of both?

• Does he hear a sound some of the time but not all the time?

• Can he only hear sounds when the room is quiet?

• Does the sound have to be very loud for him to hear it?

Kofi may not hear the blocks fall downwhen there is other noise in the room.

Ba!


CHECKING A CHILD’S HEARING AT HOME

It is hard to check a small child’s hearing. But even if you plan to haveyour child’s hearing tested by a professional, it is helpful if you can firstcheck your child’s hearing yourself. Then you can give information to

the professional and you can better understandwhat the professional is doing.

Also, checking hearing at home is free and usesmaterials that are easy to find. And doing thechecking yourself will give you more confidenceto decide about your child’s care anddevelopment. It is also a good way for friendsand family members to get more involved asyour child learns to communicate.

Keep in mind that your child may respond to:

• what she sees, not to the sound.

• the vibration (shaking) that a loud sound makes.

• the expression on your face, or to your gesture.

And your child may not respond if:

• she is busy doing something.

• she is sick or has an ear infection.

• she is tired, bored, or in a bad mood.

How to check your child’s hearing

First try to check the hearing of a child who is the same age as yourchild and whose hearing is normal. Practice until you see how ayoung child responds to hearing a sound.

To do this, you need:

• a quiet place without other sounds or noise.

• some simple equipment.

• 2 people to help you.

Try to notice the sounds your child responds to in everydaysettings. This is a good, general way to learn about yourchild’s hearing. Next, you can check to see what kinds ofsounds your child may or may not hear. You can firstcheck to see what sounds she hears that different objectsmake, and then what ‘speech’ sounds she hears whenpeople talk.


One helper sits in front of aparent and child. He will getthe child’s attention byshowing her a small toy.

helper

tester

The other person stays1 meter (3 feet) behind theparent, out of sight of thechild. This person is thetester. He will make thesounds to each side of thechild, for the child tohear. If the child turns tolook at the tester, thetester should not interactwith the child by smilingor looking at her.

Check for loudness and pitch of sounds

Shake the can gently for a quiet sound. Shake it harder for a mediumsound. Shake it very hard for a loud sound. The tester should practiceshaking each of the cans until he can control the loudness.

• Keep the checking relaxed and enjoyable.

• Use a variety of small toys to keep the child from getting bored.

• Keep the sessions short. You can check hearing in more thanone session.

What you will need to check hearingIn this test you will use simple sound makers made from3 identical empty tin cans.

1. Put a piece ofwood in thefirst tin can(low-pitch sound)

2. Put a handful of largeuncooked dry beans inthe second tin can(middle-pitch sound)

3. Put a handful ofuncooked rice inthe third tin can(high-pitch sound)


Here is one way to make a chart to recordwhat sounds the child can hear. Thechart has one section for each ear.Each section has boxes for low,middle, and high pitches.

You will mark each box to record ifthe child heard each sound when itwas quiet (1 circle), medium (2 circles),or loud (3 circles). If the child couldnot hear the sound at all, no matterhow hard you shook the can, therewill be no circle.

How to record sounds the child hears

= soft sound = medium sound = loud sound

Testing the childHelper: Calmly get the child’s attention with thetoy. When the child is paying attention to the toy,gently cover the toy with your other hand.

Tester: Use the can tomake the low-pitchsound. Cover the top ofthe tin can and shakeit for about 3 to 4seconds behind each ofthe child’s ears. Firstmake a quiet sound.

Helper and parent: Notice if the child responds to the sound.

Helper: If the child responds, nod your head slightly to show thetester that the child responded.


Tester: If the child responds to the quietsound, mark the chart with 1 circleand stop testing that ear with the low-pitch sound.

If the child does not respond to thequiet sound, shake the can a littleharder to make a medium sound, alsofor about 3 to 4 seconds. Wait to see ifthe child responds.

If the child does respond, mark the chart with 2 circles andstop testing that ear with that sound. If the child does notrespond to the medium sound, shake the can hard to make a loudsound for 3 to 4 seconds. If the child responds to the loud sound, put3 circles in the correct box on the chart.

There will be no circle if the child did not hear the sound.

When you have finishedLook at the pattern of hearing. It may be very different for each child.

The high pitch sounds have tobe louder for her to hear them.She also hears better on herright side than on her left.

This childhears lowpitch soundsbetter thanhigh pitchones.

This childis almostcompletelydeaf.

He can hear no sounds in hisleft ear. He can hear a littlein his right ear, but only lowpitch sounds that are loud.

= soft sound = medium sound = loud sound

Be sure to check both ears with all three sounds —

• the low-pitch sound (the can with wood)

• the middle-pitch sound (the can with beans)

• the high-pitch sound (the can with rice)


The helper should

• keep the child’s attentionon the toy.

• be calm and quiet.

• not look at the tester.

• not react to any of thesounds made by the tester.

The tester should

• stay behind the child.

• make the sounds at the sameheight as the child’s ears.

• make the sounds 1 meter(3 feet) from the child.

• not let the child see him, orhis shadow or reflection.

• make the sounds on the leftand right side of the child.

To get the best results

The parent should

• hold the child steady on her lap,but freely enough that the childcan turn around.

• not react to any of the soundsmade by the tester.


CAN THE CHILD HEAR SPEECH SOUNDS?Speech sounds also have differences in pitch. The speech sounds ‘t’,‘d’, ‘s’, and ‘sh’, for example, have a higher pitch than sounds like‘oo’, ‘ee’, and ‘m’. This means your child may be able to hear somespeech sounds but not others.

It will help to know if your child can hear high, middle, or low-pitchspeech sounds, and how loud the sounds have to be for him to hearthem. Try to notice the sounds he seems to hear when familymembers speak.

Children may seem to understand words when it is really thesituation that makes the meaning clear. If someone says “Get theball,” while pointing or looking at it, the child may go to get the ball.He may not have heard the word but may have seen the personpointing at the ball.

To find out if he is hearing words or not, use 3 or 4 familiar objects ina game or as part of a daily task he already knows. Do this severaltimes to find out if your child hears the names for the objects.

Your child may also seem to hearsounds some times but not always.This does not mean your child isbeing stubborn. He just does nothear you. Many things can affecthow he responds to sounds — likethe time of day, hunger, or howyour child is feeling that day. Coldsand ear infections can also affectchildren’s hearing temporarily.

Then, if your child did notunderstand the words alone, saythe words, then look at theobject.

Get yourball.

If your child still does notunderstand, say the words, then lookand point to the object.

Get yourball.

First, say thewords withoutgiving anyclues.

Let me see if Kwamecan hear what I say.

Getyourball.


Check for speech sounds a baby or child can hearIn a speech test, instead of shaking a can to make a sound, the testermakes the sounds using his voice.

In this test you will use simple sounds.

1. The sound ‘m-m-m-m-m’ (humming) (low-pitch sound).

2. The sound ‘oo-oo-oo-oo’ (‘oo’ as in ‘boot’) (middle-pitch sound).

3. The sound ‘s-s-s-s-s’ (hissing) (high-pitch sound).

The soft sound should be as quiet as possible. Ask a person withnormal hearing to listen to you and tell you if she can hear thesound when you say it softly.

The test is done in the same way as theloudness and pitch test. You start with thelowest pitch ‘m-m-m-m’, making the soundsoftly for 3 to 4 seconds behind the child’s leftear. Continue in the same way — softer tolouder, left ear then right ear, lower pitch tohigher pitch. Be careful not to increase pitchas you increase the loudness.

Sssssss.

CHILDREN CAN HELP TOO

Children can also play an important role in helping to check thehearing of brothers, sisters, and other children in the community.

How to check babies 4 months and older

• Call the baby’s name fromdifferent places in the room.See if she responds in anyway.

• Make a rattle from a can or gourd with smallstones inside. A child can creep up quietlybehind the baby. Make sure the baby doesnot see you first. Shake the rattle behindher head, first on one side and then theother. See if she is surprised.

Salima!


What to do with this informationIf your child can hear some sounds, you can help her learn to use herhearing better. See the next chapter on developing listening skills.After working on your child’s listening skills for about 6 months,check her hearing again to see if you get the same results.

Ways to check young children’s hearing

First, the speaker uses a veryloud voice to say the name of acommon animal.

The young children whisper thename they heard to their olderpartners. The older children writethat down on a piece of paper.

Then the speaker names other animals, each one morequietly, until he is whispering. The older children write downevery name that the young children tell them.

After the speaker has named about 10 animals, and the youngerchildren’s words have been written down, compare the lists. Any childwho has not heard as many words as the others, or has not heardthem correctly, may have a hearing problem.

Game: What’s that animal?Make one child the speaker and have him stand 4 meters (12 feet)from a line of younger children. Behind each young child stands anolder child with a pencil and paper.

speaker

cat

Tests that can be done at a health centerA clinic or health center may also be able to test yourchild's hearing. This kind of testing can be useful ifyou think your child has difficulty hearing but youcannot tell what kinds of sounds he can hear, if any.

Unfortunately, a clinic that can test hearing may bevery far away or be very expensive. But professionaltesting will be necessary if your child is going to use a hearing aid.

If you have already checked your child’s hearing yourself in afamiliar place, he may feel less afraid when he is tested by a strangeperson in a strange place. He may be more cooperative and he mayunderstand more about what he is supposed to do.

Information from the hearing test is used to set a hearing aid tomatch the child's hearing. For more information about hearing aidssee pages 217 to 224.

59

Listening skills

Chapter 6

With help, children who cannot hear well can learn to listen morecarefully to the sounds they are able to hear. Understanding moreabout sounds will help them learn more about their world and willhelp them use their hearing better, protect themselves, be safer, andbecome more able to take care of their own needs.

Some children can hear a little when people speak to them. Manychildren who cannot hear well may be able to hear loud noises, evenif they cannot hear softer ones. Or they may hear a low-pitch soundlike thunder, even if they cannot hear a high-pitch sound like awhistle. But because the sounds do not make sense to them, they donot pay attention to them.

If children practice listening, it will help them develop and usewhatever hearing they may have.

To use his hearing better, a child must:

• notice sounds or voices.

• figure out the direction thesound or voice comes from.

• recognize what the sound is.

• tell the difference betweensounds.

This chapter has activities thatwill encourage a child to look,to listen, and to feel thevibrations of sound. The activitieswill help children who cannot hear well learn more about sounds.The activities will also help you find out whether a child has somehearing, and what kind of sounds and words the child can hear. Thisinformation will help you know if it would be better for your child tolearn a spoken language or a sign language.

Manuel,listen to the

chickens!

60 LISTENING SKILLS

As you do the activities in this chapter, look for signs that show thechild is listening to a sound. She might show she is listening byturning her head, changing the look on herface, moving her body, getting verystill, blinking hereyes, or making asound herself.

As you practice listening, try to notice background noise. Evenpleasant background sounds might keep a child from hearing yourvoice or picking out the one sound you want her to hear. If the childuses a hearing aid, remember that hearing aids make your voicelouder but make other sounds louder too, including backgroundnoise.

Praise her if she responds to sounds and words. If she does notrespond, repeat the sound if you can. Try moving the sound closer toher rather than making it louder. Be patient. It takes time for a childto develop listening skills.

Azlina heard some of her father’s words. But because of the noisethe other children are making, she is not sure exactly what he said.

Can youhear me,Azlina?

Ca...mm..??

I wonder if Deepaturned her head

because she heardthat can?

61LISTENING SKILLS

Tips for parentsTry to become more aware yourself of the sounds around you. Peoplewho can hear often ignore sounds because they have become sofamiliar. They also know when to take more care, because they canrecognize sounds that can mean danger.

Listening skills are importantfor all children who cannothear well. Children will besafer if they learn to usewhatever hearing they have.

Try to adapt the activities in this chapter sothat your child is working with soundsshe can hear. For example, if you knowshe can hear low-pitch sounds but nothigh ones, use sounds with lowpitches when doing the activities.(See Chapter 5 for ways to learnwhat sounds your child can hear.)If you are not sure what soundsyour child can hear, try differentsounds.

I wonder if Ashawill hear thedrum or flute

better.

Paulo would besafer if he

could hear thecar horns.

62 LISTENING SKILLS

ACTIVITIES

Ways to help your child notice sounds• When you hear a sound

nearby, show your child thatsomething is happening.Encourage her to looktoward the sound.

That’s a loudnoise, Radha!

• Find sounds you can start andstop. Let your child know thatsomething is about to happen and then make the sound. Repeatthe sound several times. Try pointing to your ear when a sound ismade. This will help your child know when a sound is made.

• Make up games in which your child needs to listen to sounds inorder to play.

While they hear thedrum, the childrendance.

When the musicstops, everyonefalls down.

Some adults are not used to playing and may feel uncomfortablejoining in activities with children. But music can help your childlearn to use her hearing, and is a good way to involve otheradults and children. Think of the songs you sang as a child, orlearn songs that other children know. Choose songs that arehappy, that have a nice rhythm, and that everybody can singtogether. Adults and children can all be included. Make singingan everyday family activity.

Look, Sayaka, upin the sky! It’san airplane.

• Let your child play with toys thatmake noise. From time to time, callher attention to the sound. If thetoys do not make a lot of noise, tiesomething that makes noise, like abell, onto the toy.

63LISTENING SKILLS

Ways to help your child notice people’s voices• Talk to your child as you hold her

close. When she is touching yourchest, neck, or cheek she will feelsome vibration from the sound ofyour voice.

You’regetting to be

such a biggirl, Efra.

• As you do things withyour child, make upsounds that go alongwith the activities.

Rub-a-dub-dub.

• Say her name often.

Juana! Come tome, Juana.

• When your child knows hername, use her name in songsand stories you make up. Thiswill help catch her interest.

• Talk with your child as often as you can. Use your voice indifferent ways. Try stretching words, and add high and lowpitches. Use words that have opposite meanings.

A word that stretches a sound (‘dowwwn’)in contrast with an opposite short word (‘up’) givessound clues that help young children understand.

Up... up...up...

...anddowwwwn.

Once therewas a littlegirl named

Seema...

64 LISTENING SKILLS

• Change the expression onyour face, or call attentionto the sound with agesture — like pointing toyour ear and then to whatis making the sound.

• Try hiding a noisytoy in your pocket.See if the child canfind it while youmake noise with it.

What’s thatsound, Lupe?Where is it?

How to learn the direction a sound comes fromChildren first learn to locate sounds that happen near their ears.Then they learn to look for the source of sounds that are above orbelow their ears. Then they look for the source of sounds that arefarther and farther away. Finally, children learn tolook for the source of sound that is behind them.

• If your child is interested in a noisy toy that youare sure she can hear, try moving it out of sight.Then make the noise again above her ears andsee if she will turn her head to search for it.When she has learned to do this, make noisebelow the level of her ears. Finally, make anoise behind her.

Try to be patient, because it can take severalmonths for a child to turn toward sounds.When she responds some of the time (even ifnot all the time), you can move on to thenext step.

65LISTENING SKILLS

Ways to help your child recognize what a sound is

Hear theknocking?

Someone wantsto come in.

Here’s howyou blow the

whistle...

• Take your child to differentplaces and when you hearsounds show her what is makingthem.

• Show her how tomake differentsounds herself.

• Notice common soundsthat she hears and helpher name them.

• When your child showsinterest in a sound,explain what it is.

66 LISTENING SKILLS

Ways to help your child notice when2 sounds are different

• Find 2 things that make different sounds.Remember, they must have a pitch andloudness your child can hear. Put themin front of your child. Show her thenoise each thing makes. Then ask her toclose her eyes while you make a noisewith one of the things. When she opens her eyes, ask her to showyou which thing she thinks made the noise.

• Together, make up movements for 2 or 3 similar sounds. Thenask your child to make the movement whenever you makethe sound. Here isan example withspeech sounds:

Pa..pa..pa..pa. La..la..la..la.

• Have your child guess who in thefamily is speaking by the sound oftheir voice. This will also helpher learn to tell whether aman or woman is talking.

Who’stalking

now,Nami?

Is my child learning to listen?You will need to do all these activitiesmany times, over and over. After about 6 months, check your child’shearing again (see Chapter 5). You may find your child can hearmore sounds than before. This does not mean her hearing haschanged. It simply means she has learned to use her hearing better.Praise your child when she notices sounds and words.

As you practice together, try to build on what she has learned byusing all the sounds she can hear. As a child learns more words andunderstands them better, she will be able to express herself better andbe able to communicate more.

67

Choosing and learninga language

Chapter 7

When a child is comfortable using the basic communication skillsdescribed in Chapter 4, she is ready to learn a language. A childwho is deaf or cannot hear well can first learn a sign language (seeChapter 8) or a spoken language (see Chapter 9). Whicheverlanguage a child learns, it must meet her needs.

The language she learns first will depend on many things such ashow much she can hear, which language she prefers, her naturalabilities and the resources available in her community. It can alsodepend on how her parents react to her deafness. Knowing deafpeople in the community may help parents be able to accept theirchild’s deafness and also find ways to help her learn a language.

In places where there are few resources for deaf children, parentsmight feel that they have no choice about which kind of languagetheir child can learn. But if you put your child’s needs and abilitiesfirst, you will make the best decisions you can.

It is not always easy to knowwhat is best for a child...but you must try.

68 CHOOSING AND LEARNING A LANGUAGE

Children first learn single words. Thenthey learn the rules for using wordstogether. As they use language withother people, over time they learn therules of language.

Children learn language by listeningand seeing the language around themand practicing what they hear and see.Children develop their mental abilitieswhen they learn more words and usethem according to the language’s rules.They make mistakes, and then begin tocommunicate successfully.

Learning language early is importantThe best years for learning language are from birth to age 7. Usually achild learns most language between 2 and 4 years old. If a child doesnot learn language by the time he is about 7 or 8 years old, it will bemore difficult for the child to learn it later. If a deaf child does notlearn a spoken or a signed language, it will also be difficult for him tofully develop thinking skills. That is why learning language is soimportant.

HOW CHILDREN LEARN LANGUAGE

Languages use symbols such as sounds, writing, or signs that allowpeople to communicate with each other. Reading, writing, speaking,and signing are all ways of using language.

The first step a child takes to learn language will be to learn thenames for people and the words for things he sees every day — wordslike ‘mama’, ‘cat’, or ‘baby’. But often, the first wordshe will say are to make something happen —words like ‘milk’, ‘no’, or ‘up’.

Kofi,up.

Up, up, up,Adom!

A child learns that wordshave power to make thingshappen. It is very rewardingfor a child to communicateand get what he wants.

Grandmago-ed to the

market?

Yes, Grandmawent to the

market.

Children learn language bypracticing it with others.

69CHOOSING AND LEARNING A LANGUAGE

LANGUAGE AND THINKING DEVELOP TOGETHER

Language allows us to communicate with others. It also allows us tocommunicate with ourselves. The language a child learns when heis young gives him the tools to develop his thinking — the languagehe uses to talk to himself. So even how we think depends on howmuch language we know and can use.

The more children are able to learn a language — whether they speakor sign — the more they can understand their world, expressthemselves, think, hope, plan, and communicate with the peoplearound them.

But if Daniel and his family shared a language, theycould communicate much more. And Daniel’s abilityto think and plan would be stronger.

Today I went fishing, but I only caught little ones,about this long. I had to throw them back. Maybetomorrow I will go fishing near the bridge.

Fishing bad...little fish.

Daniel is deaf. He cancommunicate a littlethrough gestures,expressions on his face,and through signs hisfamily made up.This is what Danielcan tell his motherabout his day:


Children develop their thinking when:

• they see or hear peopleusing words or signs toexchange information.

• they use language todescribe what they see,hear, and touch.

• they use language toexpress what theyexperience.

• they use language to makeconnections between things.

Mayra develops herthinking skills byhearing people uselanguage to expressthoughts and ideas.

The work will go quicklyif we do it together.

Please give methe big ball.

small ball,big ball

A young child first learnssimple thinking skills byplaying. For example, shelearns the words ‘small’ and‘big’. Then she uses thosewords to understand thatthere is a ‘small’ ball, and a‘big’ ball.

Then, when a child understandshow to compare ‘small’ and‘big’, she can begin to thinkabout other things that aresmall or big. She learns theidea of ‘size’.

We got milkfrom thatcow today!

The biggershirt must be

Papa’s.

Children develop thinking skills step-by-step


BASIC THINKING SKILLS AND LANGUAGE

As they learn language, children organize their thoughts and makeconnections between different ideas:

• how an object, person, orevent causes somethingelse to happen.

If I find woodfor the fire,

then Mama cancook dinner.

• how to solve problems.

• how to order thingsone after the another.

• how to count.

• how to identify categories ofobjects — to learn that oneword can mean differentthings, and several words canmean the same thing.

• how to describe what aperson is feeling and whyshe is feeling that way.

It is important that learning language becomes a part of the life of achild who is deaf or cannot hear well. Parents, community workers,and teachers must encourage children to learn and to use a languageto express themselves, to communicate with others, and to developtheir mental abilities.

Papa isworking

tonight, sowe need only

4 plates.

Mama isworriedbecauseMagda isso sick.

First I add theegg. Then I mixin flour to makethe dough sticky.

This is apineapple, that

is a mango.Both are kinds

of fruit.

I can reachthe ball if Iuse a stick.


Sign language and spoken languageThe 2 kinds of language a child who is deaf or cannot hear well canlearn are:

• sign language, when she uses her hands to communicate withthe signs used by the deaf community in the region or countrywhere she lives.

• spoken language, when she uses her voice and lip reading tocommunicate in the spoken language in that region or country.

Some children who can hear a little will be able to speak and readlips. Other children communicate best by making signs with theirhands. You may want to begin with one language and teach yourchild other ways to communicate as he gets older.

The language your child uses may depend on:

• how much or how little he can hear.

• which language he prefers.

• how you react to his deafness.

• when he began to have difficulty hearing.

• the resources available in your familyor community.

Other people start with speaking and lipreading if they know their child can hearsome sounds, or if he became deaf after helearned to talk. When a child is notlearning a spoken language after a periodof time, it may mean that a sign languageis better suited for this child.

Vaw.Ball!

That’sright!

Many people start with gestures and signswith a young child, especially if they are notsure if the child can hear speech sounds.Then, as the child gets older andunderstands some signs, they may tryteaching her to read lips and to talk.

It’s timeto sleep.

For example:


Using sign languageSign language is used by deaf peoplethroughout a community. It is a languagethat uses hand shapes, body movements,gestures, and expressions on the face tocommunicate experiences, thoughts, needs,and feelings. A sign language includescommon gestures as well as thousands of signsthat deaf people have developed over time.

Sign languages are real languages which havean organized grammar and structure just likespoken languages do. People use them to askcomplicated questions, describe things around them, and discussrelationships, ideas, and beliefs. People use sign language to discusshow things affect each other, or refer to the past or the future.People who use a complete sign language can communicateeverything that a hearing person can communicate using spokenwords.

One way a sign language may be different from the local spokenlanguage is that the order of signs in a sentence is often differentfrom the order of spoken words.

Deaf people in nearly all countries, all over the world, have created theirown complete sign languages. Like spoken languages, complete signlanguages differ from region to region and country to country.

Here, for example, arethe signs for ‘mother’in 3 different countries:

Even though they are different, each sign language is a full andnatural way for deaf people to communicate.

For example, thequestion “What isyour name?”would look likethis in AmericanSign Language:

your name what?

Australia Spain Thailand

I want to be ateacher like youwhen I grow up!

You would makea great teacher,Teresa.


DIFFICULTIES WITH USING SIGN LANGUAGE

• A child who uses sign language cannot communicate withpeople who do not know sign language. To be able tocommunicate with your child, familymembers, friends, and others in thecommunity must also learn signlanguage.

• While children learn to signeasily, adults have to study a lotto learn a complete signlanguage.

• If a family lives in a communitywhere there are no people whouse sign language, it may be verydifficult to find a sign languageteacher, or other people to use a sign language with.

BENEFITS OF USING SIGN LANGUAGE

• Young children learn sign languagevery easily when they are exposed toit. With practice, older children andteenagers are able to learn and usesign language without too muchtrouble.

• A child who uses sign language cancommunicate with anyone who knows the same sign language— just as fully as a hearing child who uses a spoken language.He will get to know other people who are deaf, and learn thatdeaf people are an important part of the community.

• It may be easier for a child who knows sign language to learn toread and write the language of her community. The morelanguage a person has, the easier it is to learn anotherlanguage.

• Unlike spoken languages, different sign languages are moreeasily understood by people around the world. It is easier for asigning child from China to communicate with a signing childfrom Nicaragua than it is for hearing people from thosecountries to communicate.


Using spoken languagePeople who can hear communicate by talking, and hearing others talk,in their local language. It is natural for families to want their deafchild to understand their words and to talk to them using a spoken(oral) language.

To learn a spoken language, a child who cannot hear well will need to:

• listen with his remaining hearing so that he can learn tounderstand spoken words. It may be helpful for him to use ahearing aid.

• watch a person’s lips when she is talking and guess the words she issaying (lip-reading).

• practice speaking words so that others will understand him better.

Remember, if you use spoken language with yourchild, you and your family will have to talk to yourchild as much as you can.

Different communities have different ideasabout how deaf children should learn tocommunicate. A pre-school in southern Indiatries to teach young children who cannot hearwell to speak, read, write, and listen.

They try to prepare deaf children to attendregular schools at the age of 5. Because theschool wants children not to be ashamed ofbeing deaf, they insist that children wearbody-harness hearing aids (see page 219).Besides making sounds louder, this sort ofhearing aid helps everyone see and accept thatthese children are different.

Be patient. Your child will learnlanguage much more slowly thanchildren who can hear well. You willneed to make your child use words evenwhen it is easier to do things for him orgive him things without waiting for himto ask you.

Your child will speak differently. Most deafchildren talk differently than a child who canhear. It is natural to feel embarrassed at first by the way your childspeaks. Once you get used to it, you can explain this to other people.

Yes,Raimon,a spoon.Boon.

This child is wearinghearing aids in abody harness.


BENEFITS OF USING SPOKEN LANGUAGE

• A child who communicates like other people in the community willhave many more people who understand him.

• A child who uses a spoken language will be more ready for a schoolif that school does not use sign language.

• A child using spoken language may find it easier to read, becausethe language he speaks and the written language are similar.

Yes, and I hope itwill prepare him toattend the regularschool later. I wanthim to study so hecan get a good jobwhen he grows up!

I am glad Haipengis going to a

nursery schoolwhere he can talk

with otherchildren who

cannothear well.

The words ‘baby’,‘maybe’, and ‘payme’ all look thesame on the lips.

DIFFICULTIES WITH USING SPOKEN LANGUAGE

• Spoken communication usually works wellonly for a child who has some hearing(enough to hear the differences betweenmany words) or for a child who became deafafter he had learned to speak.

• A child may find it difficult to read lips,because many sounds look the same on thelips or cannot be seen on the lips. Forexample, the words ‘baby’, ‘maybe’, and‘pay me’ all look the same. You can see thisyourself in a mirror.

• A child who has difficulty hearing speech sounds will find it verydifficult to speak clearly, because he cannot hear himself talk.His speech may not be understood by anyone but his family.

• Young children may not sit still for long lessons to teachlanguage.

• Because so much effort goes into learning to talk and learning tounderstand what other people are saying, a child may misslearning more about the world.


• your family is able andwilling to learn and usesign language.

• there are people or booksthat can teach signlanguage to your childand your family.

• there is a deaf school inyour area that teachessign language tostudents.

may succeed if: is more likely to succeed if:

• your family is patient andeveryone works hard tolearn and use signlanguage.

SIGN LANGUAGE

• your child can hear somespeech sounds (see Chapter4, ‘Finding out what yourchild can hear’).

• your child learned to speakand understand wordsbefore he lost his hearing.

• your child finds it easy toread lips (some children arebetter at it than others).

may succeed if: is more likely to succeed if:

• your child has a hearing aidthat he uses almost all thetime.

• your child getsprofessional help at a

clinic or pre-schoolprogram for

deaf children.

SPOKEN LANGUAGE

Things to think aboutBecause each family — and each child — has different needs andabilities, there is no single method that is always right for everyone.The important thing is to work well with the resources you have. Thenext few pages give some information and ask some questions thatcan help you get the best results with your child.

• there are peoplewho can teach acomplete local signlanguage to yourchild and yourfamily.


What if your child’s first language is not your language?Using the same language helps communication. But often the signlanguage used by deaf children to develop their minds and learnabout the world is not the language used by their families. Manyparents and deaf children who use different languages find itdifficult to communicate with each other. They may not feel close toeach other and become frustrated because it is so hard tounderstand each other. Deaf children may feel left out in the familyhome.

Sign language may be best for the child but less convenient for thefamily. Or it may draw attention to a child who communicates in adifferent way. But with the support of their communities, parents ofdeaf children can help their children learn the language that isright for them.

How many people will your child be able to communicate with?It is important for children who cannot hear well to communicatewith many other people. A child who uses homesigns can communicate with only the people inhis home. A child who uses a more completesign or spoken language will be able tocommunicate with more people. A child whocan also read and write the local spokenlanguage will be able to communicate withmany more people.

Whether you use a spoken or signlanguage, it is very important that thewhole family use it together. This way yourchild can communicate with everyone inthe family. He will also feel included in thefamily and can learn about the world from their conversations.

People without hearing problems can learn sign language if theywant to. The story on page 150 tells how people in a town in Brazillearned to communicate with deaf children.

Make sure everyone signswhenever a child who usessign language is present.

And we can helphis cousins learnto sign, too.

I feel so happynow that I can usesign languagewith Amadou.


When did your child begin to have difficulty hearing?If your child became deaf after he learned to speak, he may still beable to read people’s lips and improve his speech. He can continueto develop his language even after he loses his hearing. But if yourchild is born completely deaf or cannot hear speech sounds, it willbe very difficult or impossible for him to learn to read lips or tospeak.

What’s that,Safiya?

This child can hear speech sounds.She might learn to read lips andto speak.

This child cannot hear any sounds atall. It will be very difficult or impossiblefor her to read lips or to speak.

How much can your child hear?The more speech sounds (talking) a child can hear, the more hecan use his hearing to understand words or parts of words, to readlips, and perhaps to learn to speak. Children who cannot hearspeech sounds will have difficulty learning these skills or maynever learn them.

This girl became deafwhen she was 6. She canspeak and read lips.

These childrenwere born deaf.They cannot speakor read lips.

Children who learned to talk before they lost their hearingcan speak better than children who were born deaf.

This boy lost some hearingat age 3. He can hear somespeech sounds. He maylearn to speak and read lips.

What do youhave, Abena?


How will I know if my child is learning?It will take time to know if a child is learning a language. After youhave worked with a language for several months or more, evaluatehow your child is doing. Ask yourself these questions:

• Does my child understand more than she did before?

• Is my child using speech or sign more often than before?

• Does she seem interested in learning to communicate? Or is shegetting more and more frustrated?

• Does my child have any behavior problems that may be causedby frustration with not knowing a language, or with not knowingit enough to understand and express herself?

• Do I enjoy communicating with my child, or is it always afrustrating experience?

• Can we communicate easily enough so that I am able to talkwith my child about what is happening?

• Does my child communicate well with other people?

• Can my child understand the information that her brothers andsisters understand?

Will your child use a hearing aid?A hearing aid may help your child understand words. But hearingaids do not help all children. Sometimes health professionals maysuggest that your child use a hearing aid. Try to get opinions fromother parents with children who wear hearing aids, and rememberthat each child’s hearing is different. Ifyou think you want to buy hearing aidsfor your child, read pages 217 to 224 tohelp you decide.

The people who sell hearing aids maygive you some information about them.But they are not always the best peopleto ask for advice. They may be moreinterested in selling their products thanabout finding out what is right for yourchild. Sometimes the clinic or thehearing aid store may allow the childto use the hearing aid for a few days orweeks before deciding to buy it.

This is the bestbrand of hearingaid. Of course it

will help your child.

A hearing aid may help yourchild. But it may not. Do notlet anyone pressure you intobuying something or makeyou feel guilty if you do not.


Parents are often told they must choose one language tocommunicate with their child and keep using it, no matterhow much or how little their child is learning. Sometimeshealth workers encourage this, because they think one methodis right and the others are wrong. But no method is perfect.

I just want Leila tolearn to talk. But Iget so mad at hersometimes when I

don’t know what shewants. And she gets

mad at me too.

Let’s not getdiscouraged. We

can work togetherto find some newways to help her.

If your child is not learning and is getting very frustrated, thentry another approach. Each family must make their owndecision based on their child’s hearing and their situation.

Who knows what is best for your child?Many people have strong opinions about what language to use withdeaf children. In many countries, using spoken language (oralcommunication) with deaf children has been the rule for manyyears. Sometimes, medical and education professionals tell you thatall deaf children can learn to speak. This is not true, even thoughthey may introduce you to achild who is deaf and whospeaks perfectly.

Sometimes professionals tell youwhat they themselves weretaught many years ago.They may tell you thatyou must use spokenlanguage with yourchild or you are notbeing responsible. Thisis not true. You knowyour child and familysituation better thanthey do.

All children can learn totalk if you spend enough

time practicing with them.

Maybe signlanguage wouldwork better...

But I already spend allthe time I can with Marta— and she still does notrespond when I speak to

her. And my other childrenand my sick mother needme too.


Use the language that works for your childYour child needs to express himself and understand others. A childneeds to know more than to say ‘mama’ or ‘papa’. He needs todevelop the ability to listen, to understand what is said, and to

respond and communicate with others aseasily and as fully as possible.

Parents and caregivers can help a childlearn language in a way that makes itpossible for him to absorb it. If you find

that sign language does not work for yourchild, think about helping him learn a spoken

language. Or if he does not seem to understand spoken language,try to help him learn sign language. Once children know and useone language well, it will be easier for them to learn anotherlanguage.

Talking to parents whose children have learned a language — asign language or a spoken language, or both — will help otherparents who are trying to teach their children a language.

Mygrandsonuses over500 words

now!

My son who doesnot hear at all

finds it easier tocommunicate insign language.

But some deafchildren can can can can can learn

to understandwords and talk. My

child did.

Even if they cannot hear words, deaf children can still learn to usewritten language. A child who is deaf learns how words look, ratherthan how they might sound. They see the relationshipsbetween symbols. (This is also how the writtenChinese language works.) Deaf children wholearn to use a language early — a spoken ora signed language — can learn to read andwrite well. It will help if they also meetdeaf adults who can read.

Sometimes deaf people do not learn to communicate when they arechildren. Although it is much better for young children to learncommunication, older children and even adults can learn tocommunicate. Chapters 8 and 9 describe methods you can use toteach a language to children who are deaf or cannot hear well.

• To help a child learn a sign language, see Chapter 8.

• To help a child learn a spoken language, see Chapter 9.


Resources that can helpHow children who are deaf or cannot hear well learn a language willdepend on the child, the resources available, the families andcaregivers, and their communities. But it will be easier for parentsand caregivers to help children learn a language if they get supportfrom each other, from community organizations, from schools forthe deaf, or from other organizations.

We wish Lili could talklike the rest of the

family and go to schoolwith her cousins.

The clinicoffered us afree hearingaid, but we

don’t know ifit will help

her.

Yan lost his hearing before helearned to talk. So my deafneighbor taught him sign

language. He learned easily,but it took a lot of practicefor the rest of the family.

It can be hard to decide whatwill work best for Lili.

I sign and and and and and speak with my son. Wedon’t always understand eachother, but we have fun trying!

Resources in the community can include:

• a deaf community in your area, deaf clubs, or someone who canteach your child and your family sign language.

• community-based rehabilitation programs, parents’ groups, andother community-based groups.

• teachers in local schools, older deaf children, or others who arewilling to try to teach your deaf child.

• a school in your community that can teach deaf children.

• books and videos about issues and themes of importance to deafpeople, experience of life as a deaf person, and stories aboutsuccessful deaf people.


Learning to sign will also help yourchild get to know other peoplewho are deaf. She will learnthat deaf people are animportant part of thecommunity.

If there are no deaf people in your area, try to contact your country’sAssociation of the Deaf, or a school for deaf children. Try to getbooks to help you learn to sign. If this is not possible, continue touse local signs and gestures, and create more signs of your own.

Your child should knowthat your love and approvaldo not depend on his abilityto speak or sign.

The important thing is thatyou communicate as muchas possible with your child.Most of all, children needpeople to love them,encourage them, and givethem direction. This willhelp language become apart of children’s lives.

Good! Now both ofyou repeat after me...

Mama, now youcan sign just likeme and Alfredo!

My nameis Esme.

If there are deaf adultsin your community,ask them to spendtime with yourfamily and to teachyou all to sign.

85

Learning to usea sign language

Chapter 8

It is easy for a young child to learn a complete sign language. A childwill first begin to understand the signs that others use, especially forpeople and things that she sees every day. After she begins to use signsthat are important to her, she will learn and use many others.

Each sign will help your child learn more about the world around her.As her language skills develop, she will begin to put signstogether. After a while she will be able to sign in fullsentences. This will also help her develop her mind. Ifyou and your child enjoy learning sign languagetogether, you will get better results.

The best way for you and your family to learn thesign language used in your area is to have a deafperson who uses it teach you. See Chapter 3 for guidelineson how to teach your child language. See pages 103 and 150 for moreinformation on how deaf adults can help the community learn signlanguage.

If there is no one who can teach sign language, there may be a book tolearn some signs to use with your child. But learning sign languagefrom a book is harder and less effective than learning from a person.

Drink?

In this chapter, we show people using signs, and we also showhow signs can be put together to make sign sentences, like this:

One picture byitself does notshow all of thesigns in asentence. hello

Papa

Say helloto Papa.

Wesometimesshow thesigns thatmake up asentence inboxes thatyou readfrom top tobottom.

86 LEARNING TO USE A SIGN LANGUAGE

How to help your child understand new signsA child first learns the signs for things and people that are importantto her. So notice who or what your child is interested in. To help achild learn her first signs:

1. It helps to make the sign near the objector point to the person, so your childconnects thetwo. Show bythe look onyour face thatsomething importantis happening.

2. Sign the name of the object or personand use it several times. Be sureyour child can see your hands andface when you sign with her.

hello

Papa

3. Watch for your child’s response.Does she respond in any waythat shows she understood? If so,praise her. If she does notrespond, repeat the sign a fewmore times.

4. Use these signs as muchas you can throughoutthe day. Encourage thewhole family to usethem, too.

Try to be patient. It maytake your child sometime to learn her firstsigns.

Say helloto Papa.

This is Papa’schair. For Papa.Papa.

Hello,Papa.

Hello,Norma!

87LEARNING TO USE A SIGN LANGUAGE

Help your child learn different kinds of signsIn addition to learning the names of objects and people, your childneeds to learn many different kinds of signs. This will help her learnmore about the world around her. it will also prepare her to be ableto think and sign in sentences later on.

You can use the same steps as on the previous page to teach yourchild ‘action signs’, ‘feeling signs’, and ‘describing signs’.

Eat Eat Eat Eat Eat yoursoup, Thuy.

soup

eat

Signs for ‘eat’, ‘sleep’,and ‘drink’ are oftenthe first action signsa child learns.

• action signs

• feeling signsYou look sadsadsadsadsad,Ramona.Signs for ‘happy’,

‘sad’, and ‘angry’are often the firstfeeling signs achild learns.

• describing signs

Signs for ‘wet’,‘dry’, ‘hot’, or ‘cold’are often the firstdescribing signsa child learns.

Stay back, Seema.The pan is hothothothothot.

Hot?

hot

pan


• name signs (the name given to each person)

Look, your cousins Yenaand Konti are coming.

Another kind of sign that is important to know is:

You can make up name signs for each member of the family.A sign will be easier to remember if it looks like the person insome way. This brother and sister made up signs for eachother based on how they look:

Where isIsabel?

Carlos ishungry.

Carlos has amole on hischeek.

Isabel has acurl on herforehead.

coming

Yena

Konti


Ways to encourage your child to begin using signs1. Watch for the messages she is already

sending through gestures, sounds,and expressions on the face.

2. Give her the signfor the messageshe is sending.

3. Emphasize the sign, and repeat it severaltimes. Encourage her to imitate you.

If she tries to imitate you,praise her. If she does notmake the sign in the rightway, do not correct her.Instead, simply repeat thecorrect sign.

4. When your child has learned a sign,encourage her to use it often. Findways to include it in your everydayactivities.

Learning to signWhen your child sees people around her using sign language tocommunicate she will begin to use signs herself. Remember that somesigns are easier to use than others.

When a child learns to sign, she first learnswhere to put her hands. Then she learns tomove her hands in the right way and, finally,to shape her hand and fingers correctly.

Your child is not going to make every sign exactly right. At first, youmay not even be able to understand the sign. But praise her fortrying, and do not be too anxious about her signing clearly.

Drink?

That’s right,Fatima, drink!

Drink.

This shape ismore difficult.

This shapeis easier.

Dollydrinks!


Ask questions that can beanswered with a single sign.

If your child answers, praise her. Ifyour child does not answer:

• she may not understand the sign.

• she may not understand the ideaof a question — that it needs ananswer.

One way to teach your child about questions is to answer them forher at first. After a while she will get the idea.

We need2 squash.

How many squashdo we need?

Squash?

doll

blanket

Doll.

want

Do you wantyour doll orblanket?


How to encourage your child to communicatesimple needs

When your child wants something, she is more eager to learn a signthat will help her get what she wants. Here are some ideas forencouraging your child to usesign language to communicatesimple needs:

• Whenever your child seemsto want something,encourage her to sign forwhat she wants.

• Create situations that need yourchild to ask for something.

What do you want,Rani? Tell me insign language.

Playmore?

Oscar’s fatherstopped their gameuntil Oscar askedhim to continue.

When your child uses a gesture that can mean different things, actconfused. Encourage her to send a more specific message by givingyou the sign.

Cup.

Do you wantyour cup or ball? Can you sign ‘cup’?


How to help your child make and follow simple requestsAs your child learns to recognize the names of objects, people, andactivities, she can begin to understand simple requests you make.Begin with short requests. Emphasize the signs she already knowsand use gestures to make the message more clear. Be sure to giveyour child enough time to respond and repeat the request ifnecessary.

Ai, bring meyour shirt.

At first, make requests about objects or peopleshe can see around her.

Then make requests aboutobjects or people she cannotsee, using signs you havetaught her.

Ai, bring me somewater, please.

bring

your

shirt


Your child will soon learn tomake requests herself.Everyone should encourageher when she tries to makerequests.

Play?Yes, come playwith us, Jama.

• Everyday activities are a good time to learn new signs. This givesa child achance to usethe same signsover and over.

Ways to encourage your child to learn more signsThe best way to help your child learn more signs is to communicatewith her as much as you can — and to encourage her to sendmessages back to you. Here are a few ideas for communicatingthroughout the day.

• Make a mistake to encourageyour child to correct you.Here, this child’s mothercalled her by her brother’sname.

Who’s this for?Is it for Raj?

No!Neela!

pants

your

What goes on next,Mei Mei? Your pants?

Pants.

Always makesure your childis looking atyou when yousign with her.


Try making up games that include some new signs. For example,these children are playing a game to find hidden objects they canname by sign. At the same time they are learning some new signs.

See if you can findthe cup, bottle,spoon, and can.

After using single signs, a child begins to put signs together toexpress complete thoughts. By learning to combine signs to expresscomplete thoughts, a child is on the way to using a full language.

Putting groups of signs together is a big step for a child. It allows himto communicate more about the objects and people around him thanjust their names. At first he puts 2 signs together. Then he begins touse 3 signs — and, finally, longer groups of signs. He must firstunderstand how other people do this before he can do it himself.

Understanding groups of signs


How to help your child understand groups of signs1. When your child names

an object or person,expand on what he says.

Stress the group of signs youwant your child to learn andrepeat it several times.

2. Watch for your child’sresponse. Does he respond inany way that shows heunderstood? If so, praise him.If he does not respond, repeatthe sign several times.

3. Use these signs as muchas you can throughoutthe day. Encouragethe whole familyto use them too.

big

tree

In this example, the parents puttogether the name of an object ('tree')with a word that describes it ('big').

This is a big tree big tree big tree big tree big tree.It is a very big trebig trebig trebig trebig treeeeee!

Tree.

remember

That’s right,a big treebig treebig treebig treebig tree.

Remember the big treebig treebig treebig treebig tree,Manop? Tell Mamaabout the big treebig treebig treebig treebig tree.


To teach your child other groups of signs, try puttingthe name of an object or person together with:

• a word or signthat showswhat a personor thing does.

Look how you madeAuntie Vijaya laughlaughlaughlaughlaugh.

• a word or sign thatshows wanting more,or for something tohappen again.

• a word or sign thatshows where anobject or person is.

Now you can staywarm under under under under under theblanket, Adwin.

• a word or sign thatshows not wantingsomething, thatsomething is allgone, or thatsomething cannotbe done.

Do you wantmore more more more more rice?

No, Salim, thesweets are all goneall goneall goneall goneall gone.

Knowing words and using a language helps a child develop his mind.When he knows words like ‘big’ and ‘small’, he can use those wordsto think and to express difficult ideas — like comparing one thing toanother. See Chapter 7 for information about how language helps achild’s mind to develop.

want

more

Auntie Vijaya

laugh


Using groups of signsYou have been using groups of signs to communicate with your child.For a child to begin using groups of signs by himself, he needs toknow several signs so he can put them together in different ways.

Ways to encourage your child to put signs togetherWhen your child signs a single sign, encourage him to expand onwhat he says. You could:

• expand on the signyourself andencourage him tocopy you.

• ask a questionand encourageher to answer.

• ask your child about what he is doing.

What are youmaking, Minh?

House.

What areyou makingit with?

Sticksandleaves.

That is a prettynecklace,Maryam! Whogave it to you?

Can you sign‘big tree’?

Big tree!

what

making


• Ask your child todeliver a simplemessage.

Tell Papa,‘come eat’.

• Try telling stories together.When your child has seenyou tell a story manytimes, he may be able tosign part of it himself.

Three goats werewalking down the road...Who did the goats meet?

Brotherfox.

• Encourage yourchild to take ondifferent roles.

Now you beMama for a

while.

What doesMama do? Mama

cooks.

Here are some more ways to encourage your child to use groups of signs:


Use questions to encourage your child to thinkAsking questions is a good way to keep communication going.Questions also encourage your child to think.

• Give your child tasks that ask her to think in new ways. Thenencourage her to communicate about what she is doing.

Please take out the stonesand throw them away. Howcan you tell which are stonesand which are beans?

Beans are bigger.

take out

stones

• When your childhas a problem, askher to tell you howto solve it.

The wagon istoo heavy topull. Whatshould we do?

what

do?

please

we


• When you notice your child is expressing an emotion, ask her toexplain how she feels.

Li Ming, why areyou crying?

I wantto play.

If she has trouble answering you, first think about whether she knowsthe signs she needs to answer the question. If she does not, help herlearn these signs.

Li Ming, you look upset.Are you feeling sad?Or angry?

Sad.

‘Why’ questions can be complicated and difficult for a child toanswer. Because the answers to ‘why’ questions must often includethings, actions and emotions, they are important for developingchildren’s thinking skills. A child needs a lot of practice to answerthese questions, so keep working on ‘why’ questions. If your child stillhas trouble answering the question, give her several choices.


Help your child notice that how a sign is madeis part of its meaning

A person adds meaning to hersigns by making them larger orsmaller, by making some signsslower or faster than others, andby changing the way her facelooks.

Help your child pay attention tothese different ways of signing sohe will understand more of themessage being sent.

If you want to saysomething is bad,you can make asign like this:

If you want to sayit is very bad, youwould make thesame sign (‘bad’)larger and faster:

How to help your child follow 2-step requestsWhen your child understands more signs, he can begin to followmore difficult requests. You can start by expanding the simplerequests your child already understands, by turning them intorequests with 2 steps.

wash hands

First, make a requestabout something yourchild can see.

Then slowlymake therequests moredifficult.

eat

bad

very bad

Carlos, after you eat,please bring somefirewood from outside.

Carlos, wash your handsand then come eat.


Telling stories is one of the most enjoyable ways to teach your childsign language. Try signing in different ways as you play differentcharacters. Also try putting a lot of emotion (like joy or sadness) inyour voice and on your face to show how the characters are feeling.

The papa bear says,‘Who’s been sittingWho’s been sittingWho’s been sittingWho’s been sittingWho’s been sittingin my chair?in my chair?in my chair?in my chair?in my chair?’

my

chair

‘papa bear’ sign

‘baby bear’ sign

Signing for different characters helps a child pay attention to thestory. It also helps a child see the expression, the size, and thedifferent ways signs are made.

and the baby bearsays, ‘Who’s beensitting in my chair?’

my

chair


Teaching sign language to parents of deaf childrenPeople who use sign language as their first language can teach parentshow to communicate with babies and children who are deaf.

Here is a story about a group of Indian mothers with deaf children,living in England, who learned British sign language from a deafteacher. Before they learned sign language, the children and theirparents had trouble communicating because it was so hard tounderstand each other. Learning sign language changed this.

Signing across language barriersLisa is a British woman who was born deaf. After she finishedteacher training school, she got a job teaching deaf children.Part of her job was to help the mothers of the deaf childrenlearn sign language. Among the groups that Lisa taught wasa group of Indian women who did not speak English. At first,it was difficult for Lisa and the mothers to communicate witheach other. Lisa used British sign language and anotherteacher translated for her into spoken English. Then anotherwoman translated the spoken English intoPunjabi, the language that all the mothersspoke.

The mothers’ group first learned signsabout the home. They also learned signs forwhat the children were studying in class.This helped parents understand andcommunicate with their child at home.

Later, a man joined Lisa’s group ofmothers learning to sign. He then taughtfathers and older brothers in a group formen. In both groups, parents with olderdeaf children shared their experiencewith parents of very young deaf children.This let them use their new sign language skills to talk aboutthings that were very important to them.

Watching Lisa work and teach, the parents saw that deafchildren could be teachers, make a living, and be respectedby other people. Many families in the community learnedsomething about deaf people at the same time that theylearned how to communicate with their deaf children.

I am so gladAshis and I canshare ideas witheach other now...


TIPS FOR ADULTS LEARNING SIGN LANGUAGE

Sign language depends a lot on the way you express things throughthe whole body. The way you stand, and expressions on your face allcommunicate as much as your hands.

• Act out what you want to say. Do not worry about makingmistakes or looking foolish.

• Use anything and everything thathelps to communicate: gestures,expressions on the face, bodymovements, pointing, signing, andfinger spelling (spelling out words byusing signs for each letter). Trycommunicating an idea or simple sentencewith no formal signs at all. Just usegestures, facial expression, andpointing. Even when you do not knowor forget a formal sign, you can stillcommunicate with deaf people this way.

• Each person learns language in a differentway and at a different pace. Learn as much as you can. Do notworry about what others have or have not learned. The goal is tohelp your child, not to compete with others.

• To really learn sign language, use it often with deaf peoplewho sign.

Learning sign language will not be easy. But remember, it isimportant to your child to have a common language that all of youcan share. Keep practicing sign language. If you do not use it, youlose it — just like any other language you learn.

Deaf people watch the face of the person they are communicatingwith — not only that person’s hands — just as hearing people look ateach other’s faces as they listen.

what we do

See how Nimi’s expression changes as she asks the question,“What should we do?” in sign language.

Minh and I sometimesmake each other laughtrying to act out a sign wedo not know. But the morewe sign, the more we learn!

105

Learning to usea spoken language

Chapter 9

Children who can hear the differences between many words or whobecame deaf after they learned to speak may be able to use a spokenlanguage.

Most deaf children talk differently from children who can hear.People who do not know a particular deaf child well often havedifficulty understanding her speech. If you use a spoken languagewith your child, she will need extra help as she learns to read lipsand speak clearly. You will get better results if you and your childenjoy learning words and language together. Remember, everyone inthe home will have to talk to your child as much as possible.

First, a child will begin to understand words that other people use.Then your child will begin to use words for people and things she seesevery day that are important to her. Later she will learn manydifferent kinds of words. This will help your child learn to speak insentences. See Chapter 3 for guidelines on how to teach your childlanguage.

If your child responds to her name, use it to get her attention. If shedoes not respond, try tapping the floor with your foot, so she feels thevibration.

Your child needs to see your lips move to be able to understand yourwords. Be sure she is looking at you when you talk to her.

How to get your child’s attention

Nadia?

TAP TAP

Nadia, are youhaving tea? CanI have some tea?

106 LEARNING TO USE A SPOKEN LANGUAGE

How to help your child learn speech soundsSimply speaking to a child who can hear is enough for him to be ableto learn to speak. But to help a child who cannot hear well learn tospeak, he needs to listen to and remember the distinct speech soundsthat make up words. So in addition to talking naturally to your child,you should have your child listen to and use specific speechsounds.

Every language has soundsthat are easier and harder forchildren to learn. Teach thesimpler sounds first (like ‘ma’before ‘ra’).

Every 2 weeks, choose a differentdistinct speech sound and and useit as often as you can — inconversation, by itself, or as agame. Ask other people to use thesame speech sound too.

Repeat the chosen sound asoften as you can. Use thespeech sound alone too, forexample, by saying 'c-c-c cold'.

It’s cold. C-c-c-cold.You need a coat.

• Talk about things sheknows and can see: herfood, her clothing, her toys.

• Talk about things thatinterest her. If she likestrucks, talk about them. Ifshe likes to play with dolls,talk about what she isdoing.

• Talk often, not just atteaching times. Your childmay not yet understand thewords, but it will help herbecome more aware of language.

• Try to reduce the noise around you. Remember to speak closeto the child. If her hearing in one ear is better, remember tospeak near that ear.

Ways to keep your child’s interest

Face your child when you aretalking, and be in good lightso she can see your face.

107LEARNING TO USE A SPOKEN LANGUAGE

Watch your own lips in a mirror, or watchother people’s lips when they talk, to seewhat kinds of sounds can be seen on yourlips. Sometimes different sounds look thesame on the lips. You will soon see how hardit can be to read lips.

2. Choose words that areeasy to hear. Somesounds are louderthan others. Someof the loudestsounds are ‘ah’ like in‘mama’ or ‘papa’, ‘oo’ like in ‘book’ and ‘ee’ like in ‘street’. Theseare good words to begin with.

3. It is easiest to hear a word if it is at the beginning or end of asentence.

1. Choose a few words that are easy to see on the lips. Somesounds are easier to see than others. Sounds like ‘b’ where thelips start to close andthen open are theeasiest to see.

To help a child learn a word:

Let’s playballballballballball. Give me

the ballballballballball.

The words ‘baby’,‘maybe’, and ‘pay me’ alllook the same on the lips.

4. To teach words, youwill have to use themhundreds of times. Sochoose words that canbe used in conversationmany times every day.

Now I’ll rollthe ball.

Ba.

How to help your child learn his first wordsYour child will have to learn to watch your lipsand listen very carefully. So it is best to teachonly a few words at a time.


YOUR CHILD NEEDS TO KNOW DIFFERENT KINDS OF WORDS

In addition to learning the names of objects and people, your childneeds to learn many other kinds of words. This will help your childlearn more about the world around her and help prepare her tospeak in sentences later on. Be sure to practice all of the following:

• proper names(the name givento each person)

When you are sure yourchild understands the wordsyou have been using, teachmore words that look andsound very different from the firstfew words. As you teach your child thenew words, continue to practice the old words.

5. Use the same words over and over in the same situations.Repeating them is necessary, and young children like it.

6. Speak clearly. Use careful, but not exaggerated, lip movements.

Put onyour coat. Put on your

coat now.Everybody should use thesame word for anything thatcan have different names —like ‘coat’ or ‘jacket’.

7. Make a short list of useful words you want your child to learn,and ask everyone in the family to use them often. Choose wordsthat are easy to see on the lips.

Nisa Nisa Nisa Nisa Nisa andMoshe Moshe Moshe Moshe Moshe are

here. Let’s sayhello to them.


• action wordsRrrrr...

Yes, you can riderideriderideridethe scooter just

like Papa!

• describing words

• feeling words

Knowing ‘name words’, ‘action words’, ‘describing words’, and‘feeling words’ helps a child to use those words to think about theworld around her.

When children know the meanings of words, they can learn tocompare, sort and order things, solve problems, and describe feelings.See Chapter 7 for more information on how children develop theirlanguage and thinking.

You look happyhappyhappyhappyhappy!Are you happy to

see your littlebrother?

You were right.The baby washungryhungryhungryhungryhungry. She

cries when sheis hungry.


How to encourage your child to begin using wordsIf your child has difficulty hearing speech sounds, he can learn towatch your lips to give him clues about how to say these wordshimself. It is important to remember, though, that many sounds lookthe same on the lips.

1. Encourage children to use words when playing. Sit in front of thechild in good light and show him something that interests him,like a favorite toy. Encourage him to watch your lips move as yousay the name of the toy. Repeat the same word several times.

Be sure to speak clearly and in anatural way. This will help your childread the lips of other people sayingthe same thing.

A ball! Is thatmy ball? It is avery nice ball.

2. Have the child try to copy you.

Ball.

Can yousay

‘ball’?

3. Sit with the child in front of a mirror,so she can see both of your faces.Show her an object. Say the nameof the object, and then have hercopy you.

4. Repeat these steps with different words,especially ones that name things yourchild is interested in at the moment.

Your child is not going to say words exactlyright. Remember, she cannot hear exactly howthe words are supposed to sound. At first, you may not even be ableto understand what word she is saying. But praise her for trying, anddo not be too anxious about having your child say words clearly.

Shoe.

Soo!


Encourage your child tocommunicate simple needs

When your child wants something, sheis more eager to learn a word that willhelp her get what she wants.

• Whenever your child seems to wantsomething, encourage her to ask forwhat she wants using words.

Ramona, doyou want

some? Whatis it called?

Milk.

How to encourage your child to answersimple questions

Asking your child questions is a good way to encourageher to talk. Remember to use looks on the face (like raising youreyebrows and looking puzzled) and body movements (like tilting yourhead) to help your child know you are asking a question.

• To begin, try asking questions that require a ‘yes’ or ‘no’ answer.When your child shakes her head ‘yes’ or ‘no’, remind her to usethe word that sends the same message.

Are youwet?

You are notwet? Say ‘no’,

Nina. ‘No’.

• Ask questionsthat can beanswered with asingle word.

Frog.Did you findsomething?What is it?


Where isyour other

sock?

You can teach your child about questions by answering them for herat first. After a while she will get the idea.

• Create situations that need yourchild to ask for something. Here,Ana’s sister gave her an emptybowl and waited for her to askfor beans.

Beans?

Help your child pay attention to how words are saidWhenever people speak, they tend to stress some words more thanothers (loudness), to speak some words morequickly than others (rhythm), and to changehow high or deep their voices are (pitch).People also show what they are feelingby their tone of voice. These differentways of speaking all add meaning tothe message being sent.

Listening to the tone inhis mother’s voice andher stress on the word‘no’ helps Manuel knowwhat she means.

NoNoNoNoNo,Manuel!

If your child answers, praise him. If your child does not answer:

• he may not understand the words you are using.

• he may not understand that a question needs an answer.

On the bed.The sock is on

the bed.


How to help your child say things in different waysJust as your child learns to listen and watch for the different waysthings are said, he needs to learn to speak in different ways.

• Play games that encourage your child to speakwith feeling.

Boom!Fall down!

Boom! Allfall down!

...the little chicks saycheep, cheep, cheep...

• Encourage your child to sing. This will help his voice go up anddown, and help change the rhythm of his speech.


Chin, put yourshirt on.

How to help your child follow simple requestsAs your child learns to recognize the names of objects, people, andactivities, he can begin to understand simple requests you make.Begin with short requests. Emphasize the words he already knows,and use gestures to make the message more clear. Be sure to giveyour child enough time to respond. Repeat the request if necessary.

At first, make requests aboutobjects or people he can seearound him.

Then make requests aboutobjects or people he cannot see.

Get your sandals,Haseeb. You needto wear sandals

when you gooutside.

• Everyday activities area good time to learnnew words. This givesa child a chance topractice the samewords over and over.

Ways to encourage your child to learn more wordsThe best way to help your child learn more words is to communicatewith her as much as you can — and to encourage her to speak toyou. Here are a few ideas for communicating often throughout theday:

Is that yourknee, Manu?Your knee?


After using single words, a child begins to put words together toexpress complete thoughts. At first he puts 2 words together. Then hebegins to use 3 words — and finally, bigger groups of words.

Putting groups of words together is a big step for a child. It allowshim to say more about the objects and people around him. He mustfirst learn to understand how other people do this before he begins todo it himself.

• Make amistake toencourage herto correct you.

• Leave out a word in a song ornursery rhyme your child hasheard often. Encourage him tosay the missing word.

My donkey eats,my donkey — ?

— sleeps!

What areyou buying

at themarket? Anelephant?

No!


Understanding groups of words used by othersHow to help your child understand groups of words

1. When your child names anobject or person, expand onwhat he says.

Stress the group of words youwant your child to learn andrepeat the group severaltimes.

2. Praise your child if heresponds in any waythat shows heunderstood. If hedoes not respond,repeat the wordsseveral times.

3. Use these words as much as you can throughout the day.Encourage the whole family to use them, too.

In this example, the parents puttogether the name of an object(eggs) with a word that describesit (chicken). Using a group ofwords in a full sentence can helpfocus a child’s attention on thewords.

Chicken!

Leave thechicken, Manop.Today we needchicken eggschicken eggschicken eggschicken eggschicken eggs.

Can you find morechicken eggschicken eggschicken eggschicken eggschicken eggs? Wewill cook chickeneggs for dinner.

Mama saysyou found 3chicken eggschicken eggschicken eggschicken eggschicken eggs

today!

Eggs.


To teach your child other groups of words, tryputting the name of an object or persontogether with:

• a word that shows what aperson or thing does.

• a word that shows who orwhat an objectbelongs to.

Fishswimswimswimswimswim.

• a word that showswhere an object orperson is.

• a word that showssomeone wantssomething tohappen again.

Do you wantmore more more more more beans?

• a word that shows somethingis over, or that somethingcannot be done.

Rice isfinishedfinishedfinishedfinishedfinished.

Maria ison on on on on theswing.

Papa’sPapa’sPapa’sPapa’sPapa’sshirt.


How to help your childfollow 2-step requests

When your child understandsmore words, he can begin tofollow more difficult requests.You can begin by expanding thesimple requests your child alreadyunderstands by turning them intorequests that have 2 steps.

Then slowly make therequests moredifficult.

Learning to use groups of wordsFor a child to begin using groups of words by himself, he needs toknow several words so he can put them together in different ways.

Ways to encourage your child to put words togetherWhen your child says a single word, encourage him to expand onwhat he says. You could:

• ask a question andencourage him to answer.

• expand on the words yourselfand encourage him to copy you.

Pick the beansand put themin the basket.

Push!

Say ‘pushmore’.

Do you wantto push high?Can you say‘push high’?

Chin, can youempty thebasket and

bring it back?


Here are some more ideas for encouraging your childto use groups of words:

• Ask your child about whatshe is doing.

That smells goodsmells goodsmells goodsmells goodsmells good!What is in the pot?

• Ask your child to deliver asimple message.

Tell Papa,‘come eat’.

• When your child has a problem,ask him to tell you how to solve it.

Heavy.The basket is tootootootootoo

heavyheavyheavyheavyheavy? Whatshould we do?

• Try telling stories together. Whenyour child has heard and seena story many times, shemay be able to tell partof it herself.

...and thenthe farmer —

— fell inthe river!


• Encourage your child to act out different roles.

Now you beMama for awhile. What

does Mama do?

Mamacooks.

• Praise him when he puts words together. By using completesentences, expand on what he says. Talk to him in completesentences. But do not expect him to use complete sentences yet.

Don’t stop singing?Okay, let’s sing one

more song.No stop.

Sometimes I getangry at something

you do, Li Ming...

...but Ilove you

very much.

• Share the ideas or feelings you are thinking about as you playtogether.

Keep practicing the spoken language. Remember, it is important foryour child to have a language that all of you can share.

121

Social skills

Chapter 10

When people get along well with others, itmeans they have good ‘social skills’. Peopledevelop social skills as they relate to eachother, learn about themselves, and considerother people’s feelings.

Having good social skills is important foreveryone. To be part of any group —whether a family, a group of friends, oreven a class at school — it is necessary tohave social skills.

Good social skills will helpchildren make friends and relateto others in the community.

It is important for children who aredeaf or cannot hear well todevelop good social skills. Theirability to get along with otherpeople will help them be lessisolated.

Like hearing children, deafchildren must develop social skillsby watching and interacting withthe people around them. Thishelps them learn to do things liketreating older people with respect,asking permission to use thingsthat belong to someone else, orwaiting for their turn to participatein an activity.

Social skills are more than just good manners. Good social skillslet people:

• give and receive attention, affection, or help.

• express their needs, feelings, and rights in an acceptable way.

• communicate effectively.

122 SOCIAL SKILLS

How children learn social skillsWe are not born with social skills. We begin to learnthem as babies, as soon as we become aware of otherpeople. As children and adults, we continue to learnand use these skills throughout our lives.

At first these social skills are very simple. A babylearns to return his mother’s smile or a child learnsto take turns while playing a game. But as a childgrows older, he needs more developed social skillsto get along with other people.

2 years old• asks others when

she needs help

• plays alongsideother children

• imitates caregiver

5 years old• understands rules, and

ideas like fairness andright and wrong

• expresses many feelings

• plays with otherchildren

3 years old• enjoys helping

around the house

• likes to be praised fordoing simple tasks

• is aware of otherpeople’s feelings

The ‘right’ behavior for your child depends on his age. If you expectmore than your child can do, you and he will both be unhappy. Butif you expect too little from your child, he will not learn new skills.For more information on when children learn new social skills, seethe child development charts that start on page 229.

Try to become aware of yourattitude toward your deafchild’s ability. Do you expecthim to do less than he isactually capable of?

123SOCIAL SKILLS

AT HOME

Children first learn socialskills by watching howparents and familymembers behave witheach other. Children copywhat others do and whatthey say as they interactwith each other.

PLAYING WITH OTHER CHILDREN

As they play, children learn to followdirections, cooperate, take turns, andshare. Play helps young childrenunderstand their own emotions, feel proudof what they can do, and develop a senseof who they are.

Please havea little soup,

Haseeb. Can I havesome too,

please!

Menext?

CHILDREN LEARN SOCIAL SKILLS IN STEPS

Like all kinds of development, children learn social skills in steps. Todevelop social skills, a child needs to become aware of other people’sfeelings. And she needs to learn how to share and cooperate withother people.

At first a child plays alongsideother children. This meansshe enjoys being nearthem as she plays, butshe does not actuallyplay with them.

Then she learns to playwith others. She learns to share toys andplay games where everyone mustcooperate.

As children get older, they need tounderstand rules and be able to controltheir behavior.

Even though Callam wants asweet, he has learned not to grabit out of another child’s hand.

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Deafness makes it harder to learn social skillsChildren who can hear learn a lotabout the world by listening to whatgoes on around them. Many of thesocial skills they learn are nevertaught to them directly, but developas they listen to other peopletalking with each other.Children who cannot hearmiss a lot of this information.

A child who cannot hear welloften finds it harder thanother children to learn howto behave with other people.She does not understand thebehavior she sees and thereasons why people behave acertain way.

This is true especially when a deafchild and her parents are not able tocommunicate well with each other.When she misbehaves it may be difficult to explain how she shouldact. She may become frustrated and misbehave even more. A childwho misbehaves a lot may get left alone by other people.

A deaf child needs extra help learning how to communicate, how tocooperate with others, and how to control her behavior.

IN THE COMMUNITY

Outside their own homes andimmediate families, childrensee how older children andadults talk, play, and workwith each other. This is howchildren learn ways to relateto people outside their families.And in the wider world that opensto them, children learn to practicedifferent responses to situations anddifferent ways of doing things. Theydevelop social skills as they discover theirown strengths and weaknesses.

Mr. Lopes,which bugsare thebad ones?

I am glad to have yourhelp keeping bugs offthe bean plants.

Ramani wants a banana, butshe doesn’t understand that hermother must pay for it first.

Ramani! Put thatback — it’s not yours!

Oh, that’s fine,she can have it.

No, sheshould know

better!

125SOCIAL SKILLS

How to manage your child’s behaviorDeafness does not cause bad behavior, though it may seem like it does.A child who cannot hear well communicates mainly through hisbehavior — just like a hearing child whose communication skills havenot yet developed.

Parents need to pay close attention to how a child who is deaf orcannot hear well is behaving. It takes patience to understand whatyour child is communicating to you with his behavior and learn howto communicate your expectations.

Children who can hear learn good behavior more easily, and at ayounger age, than children who cannot hear. Children may gothrough times when they say ‘no’ to everything a parent wants themto do. These behaviors can be very frustrating to a child’s family, butthey are normal and usually go away when a child learns better self-control.

It is much more difficult for a childwho cannot hear well to learnself-control. When people cannotcommunicate with deaf children,the children become frustrated,upset, or angry. They cannotunderstand why they must docertain things or what ishappening around them.

Aaaah!

Since Paulo cannot hear well, he is surprised when hisgrandmother tells him they have to go home. Like Paulo, deafchildren experience surprises all the time.

Learn to recognize the signals that tell you problem behavioris about to begin.

If Paulo could hear, hewould have heard hismother and grandmothertalking and known theywere leaving soon.

He would have beenbetter prepared forwhat would happennext.

We have to gohome rightnow, Paulo.

Paulo lookssurprised andunhappy. Hemay start toyell and cry

soon.

126 SOCIAL SKILLS

You may be able to avoid certain behavior problems ifyou understand what causes them. Your child may:

• need attention. She may have learned thatshe gets more attention if she behaves badly.

• feel tired, hungry, or afraid of something.

• not understand what you want. Or she may want something butbe unable to communicate it so you understand.

• have been teased or treated badly by another child or adult.

• be copying another child’s behavior.

• not be able to meet your expectations. Or she may be resistinglimits that you have set, or showing you she does not want to dowhat you want.

Even though you may understand why your child becomes upset,there will be times when she gets upset no matter what you do. But ifyou can see a child’s behavior as her way of communicating withyou, you may be able to take care of the child’s need before itbecomes a problem.

HOW TO SET LIMITS

Even when your child behaves well, there are times when you haveto tell your child ‘no’, and set limits on the child’s behavior. Thismay be to keep your child safe, or because he is misbehaving, orbecause he wants to do something you cannot allow him to do.Children of different ages need to have differentlimits. The limits you set will change as your childgets older and learns more about the world.

Because your child cannot hear well, sometimesshe will not understand what you want. Whenyou say ‘no’, or you tell your child what you wanther to do, you may not have enoughcommunication skills to make her understand.You may think your child is ignoring you ormisbehaving, when in fact she does not understandwhat you want or do not want her to do.

???

Anita does notunderstandwhat her fatheris telling her.

TRY TO PREVENT PROBLEMS FROM STARTING

When your child behaves badly, ask yourself, ‘What is my childtrying to tell me?’, ‘What does she need?’. Remember that your child’sbehavior is one of the ways she communicates with you. Because shecannot communicate in words or signs, she is often telling yousomething with her behavior.

127SOCIAL SKILLS

When you want to limit the child’s behavior or change what thechild is doing:

1. Tell him. Before you say ‘no’, think about it carefully. When yousay ‘no’ you should be firm about it.If you let your child change yourmind by his bad behavior, then hewill learn to misbehave in order toget what he wants.

2. Show him what you mean.

Once you tell your child that he cannot dosomething or have something, you should notchange your mind just to stop his crying.

3. Use pictures tomake the requestclearer.

4. Help him do as you request.

If the deaf child has trouble understanding what you requested, showhim by doing what you mean.

Pictures are especiallyhelpful for things thatare hard to communicate— like how a child´sactions affect others.

These are Papa’s eyeglasses,Sunil. They are not forplaying with!

You must cover thewell or someone

could fall in!

No, you muststay here.

128 SOCIAL SKILLS

WAYS TO MANAGE BEHAVIOR THAT DO NOT WORK WELL

Families with deaf children may be faced with behavior problems theydo not know how to handle. They sometimes use solutions that workfor them at the moment — even if those ways do not help the childlearn good behavior. Here are some examples of things thatdo not work well:

• Using commands without explaining the reasons forthem or what they mean. This prevents the child frommaking good decisions by himself.

• Punishing a child who is deaf more than otherchildren. Physical abuse can make a child depressed and violent.

• Allowing the misbehavior of a child whocannot hear well to continue withoutcorrecting it. This makes the child moresocially isolated.

• Keeping a child who cannot hear well at homemore than other children. This holds back thechild’s social development.

While these methods may seem to work for themoment, they will not help a child learn how tobehave well or interact with other people.

All parents want their children to behave well and grow up to beaccepted members of the community. For your child to developself-control, your own self-control can be a model. Show your childthe kind of behavior that makes anyone a good person to live with.

How to help your child calm down when he behaves badlyWhen your child is behaving badly, take him to a different spot andmake him sit for about 5 minutes (less timefor a very young child). If he tries to leavebefore the time is up, start the time overagain. Do not leave him alone. You canuse a ‘time out’ like this to giveyour child a chance to thinkabout his behavior and howhe can do better. ‘Time outs’also give you time to calmdown when you arefrustrated and upset.

129SOCIAL SKILLS

Before giving him a ‘time out’, hold him firmly and explain to himhow you want him to behave.When he is calmer,communicate with him aboutwhy he needed a ‘time out’ andabout how his behavior affectsothers. Always remind him thatyou like him, but that you do not likethe way he acted. Encourage him to talkor sign about what happened and whyand how he could react differently. Helphim understand why he needed the‘time out’.

What to do if your child has a tantrumAs with many other young children, your child’s anger may becomea ‘temper tantrum’. A tantrum is when a child completely losescontrol and screams, kicks, hits, or cries. Children who cannotcommunicate easily usually have more tantrums than other children,and it may be harder to calm them down.

It is important for you stay as calm as you can. Take a minute todecide what to do. Here are some useful ways to deal with tantrums:

• Do not try to explain things to him once he has lost control. Thisis not the time for a discussion.

Omar, kicking your brother is wrong.Let’s think of another way you canlet him know when you are angry.

Take a child who is havinga tantrum away from thesituation if you can.

• Do not respond to your child’s screaming and kicking, but do notleave him completely alone. His behavior may frighten him andhe needs you nearby for security.

• Do not spank, pinch, shake, or scream at your child. This willonly make the tantrum worse. But do not let him hit you.You can hold him, but only to prevent him from hurtinghimself, hurting you, orbreaking things.

• Try to distract a child during atantrum. For example, if yourchild yells because you havetaken something away fromhim, you can try to offersomething else that he wantsor show him somethingunusual. This works betterwith very young children.

130 SOCIAL SKILLS

When your child misbehaves or has a tantrum in publicIf a child behaves badly in public, pick the child up if youcan and remove her from the situation. Try to actcalmly and without anger. Take her out of the store,away from the market, or wherever the problemhappens. If you can, find a private place for her tocalm down. If neccessary, have someone else stay withher while you finish what you need to do.

It may seem easier to keep a child at home than toworry about behavior problems in public. But it isimportant for all children to learn how to behave inpublic and to be part of the community.

If the tantrum is in response to a limit you have set, do not allowyour child’s behavior to change the limit. If you give in to yourchild’s behavior, he will learn that he can get what he wants fromyou by having a tantrum.

OUR ACTIONS ARE POWERFUL TEACHERS

As with any family, it is very important for a family with a deaf childto set a good example. The family must act the way they want theirdeaf child to act, and encourage their child by explaining what kindof behavior they like. But it is not easy to set a good example andencourage children to behave well.

Raising small children can often be frustrating. And whencommunication is difficult, it is even harder to teach a child how tobehave. Because communication with deaf children is more difficult,

parents and other caregivers may becomefrustrated with them and hit or shake themmore than hearing children. See Chapter 17 formore information to help parents andcaregivers.

It can be hard for people to change the waysthey discipline children. Most people disciplinechildren the same way they themselves weredisciplined as children. But when we handleour own frustration without becoming violent,we are sending our children a powerfulmessage that they too can handle frustration

without violence. Here is a story about how one group of parentsworked to change the way they disciplined their children.

No, Oscar!

131SOCIAL SKILLS

Parents in Mexico find another way to disciplineIn Oaxaca, Mexico, a preschool program for deaf childrenwas started by a social worker and a teacher. Every dayparents came to the program with their children. Theparents participated in the activities with their children andthey supported each other.

After a while, the parents began to notice how often theyhit or shook their deaf children. They talked it over with thesocial worker and decided they wanted to find another wayto discipline their children. The social worker explained theidea of a ‘time out’: taking the child away from the problemsituation and having the child sit quietly for a few minutes.

The parents decided it would help them to stop hittingtheir children if they fined themselves a few pesos every timethey hit or shook their child. They put an empty tin can on ashelf to hold the money. At first, almost every parent wasputting money in the tin can every day. But the fines helpedthem to stop and think before they hit or shook theirchildren.

As they tried new methods and improved their communicationskills, they noticed that their children were behaving better. At thebeginning, it did not seem easy to change how they disciplinedtheir children, but now they almost never hit or shake them.

Hugo used to do that. I foundmyself hitting him a lot, but I

couldn’t explain why it waswrong. I used to feel angryand sad at the same time.

Maria always grabsthings from her sisters.

They let her do itbecause she is little. Butshe is getting bigger andshe should know better.

It is gettingbetter as we

learn tocommunicate.But it takes solong to learn!I try hard notto get angry.

132 SOCIAL SKILLS

How to encourage a child’s social developmentHelp your child get to know adults who are deaf or cannot hear well.This helps her learn thatadults who cannot hear canstill be successful, and willhelp her build confidenceand self-esteem. If she seesthem cooperating, askingquestions, responding andexpressing feelings, she willlearn social rules anddevelop her social skills.

Encourage your child tobecome responsible andindependent.

Help him be aware of skills healready has that are valued or usefulin the community. Encourage him todevelop these skills even more.

HELP A CHILD COMMUNICATE ABOUT HIS FEELINGS

A child who cannot talk about his feelings may have no choice but toact them out instead. He may hit, scream, or kick when he isfrustrated or angry because he has no other way to express thosefeelings. If your child is often frustrated, rude, or angry, you need tohelp him learn to express his feelings in other ways.

I always wantedto be just likemy big sister.

Me too!

How many brothers andsisters do you have?

Fatuma saysI am a big help toMama. I can get

wood for Grandmatoo.

Good job,Kofi. You

did ityourself!

133SOCIAL SKILLS

Look for opportunities to teach your child signs and words for strongemotions. This will help him know and understand his emotions.When he does, he will find it easier to talk or sign about his emotionsrather than acting them out.

REWARD GOOD BEHAVIOR

When a child behaves well, he is treated well by the people aroundhim. When your child is behaving well, praise him. A child wants thelove and approval of his parents and others, and he will repeat thebehavior that brings praise and attention. A few comments duringthe day, or giving him a hug or a treat, will go a long way toencourage good behavior.

Teaching a deaf child good behavior takes patience and hard work.But once he begins to develop social skills and behaves well, it will beeasier for him to make friends, join the community, and eventuallygo to school.

• Praise her when she doessomething well.

• Reward good behaviorrather than problembehavior. Give yourchild a smile or aloving pat when youlike the way he isbehaving.

Those men arevery angry, Moshe.

Sometimes youfeel angry too.

Like when Aminatabroke your toy.

Mother encouragesSisi when she triesto wash her clothes.

Good job, Sisi!

134 SOCIAL SKILLS

Often a child continues a problem behavior because he has learnedthat it will get him what he wants. For example:

But if you give your child attention when he behaves well andrefuse it when he behaves badly, you can teach him that actingbadly does not get him what he wants. For example, Kwame’smother learned that:

Kwame has been leftto play by himself. Hetries to get his motherto come play with him.

When she does not, Kwamestarts yelling. His mothercomes to see what’s wrong.

Now Kwame hasher full attention.

encouragesbad behavior.

Refusing attention whenKwame is being nice...

and giving it only whenhe begins to yell...

Ma!

Waaa!Aaah!

Kwame!Stopthat!

What is it, Kwame?Shhh. Mama is

here now.

but refusing itwhen he yells...

Giving attention whenKwame is being nice...

encouragesgood behavior.

Are youhelpingMamacook? Waaa!

Aaah!

What agoodboy.

135SOCIAL SKILLS

MAKE CHANGE EASIER

Transitions (changing from one activity to another) can be difficultfor many young children. They may get upset at going from onehouse to another, or at having to stop playing in order to take abath. They still have to get used to daily routines. Until they learn toexpect a chain of daily activities and become comfortable with this,children may struggle with the ordinary routines of the day. Andwhen they get used to a routine, even small changes can makechildren feel insecure.

It is easier for children toaccept changes when theyknow what to expect. Picturescan sometimes help youcommunicate abouttransitions. For example, ifyour child is playing and it istime for his bath, you canshow a picture of him takinga bath. Discussing what thepicture communicates can give him a chance to prepare for thechange and may make the transition easier for both of you.

To make going out in public easier, it may help if you explain to yourchild where you are going before you go. For example, show himyour basket to help him understand you are going to the market.

Remember — change will be easier as children get older.

LET A CHILD KNOW ‘WHY’It is easier for children to do something you ask if they know whythey should do it. But because youngchildren who cannot hear well maynot know enough words or signs tounderstand ‘why’, parents oftenfind it easier just to tell themwhat to do. If children donot understand why theyhave to do something,they can becomefrustrated.

Julio, it is bathtime. I am

heating thewater now.

Hoa might walkmore quickly if hisfather couldexplain to him thatdinner is waitingfor them at home!

Hoa, I said stopplaying and

hurry up!

136 SOCIAL SKILLS

Everyone can help deaf children developsocial skillsChildren who are deaf can learn and practice their social skills bestwhen they are part of a caring community, and when they go toschool. When children interact and spend time in a social groupoutside the family, they make a big leap in developing their socialskills. Some communities have child care centers or preschools, wheregroups of children can play and learn together. The childrenunderstand that expectations are different in a group setting. Theylearn to share, take turns, and think about the feelings of others.

HELP A DEAF CHILD LEARN ABOUT THE WORLD

It is important for children who are deaf or cannot hear well toexperience community events, take part in daily activities anddiscuss these with their families and friends. Parents, sisters, andbrothers can help by taking a deaf child out as much as possible topublic places and to visit relatives and friends. You can use everychance to teach the child how things work in the community.

HELP YOUR CHILD LEARN TO MAKE DECISIONS

One of the most important things children need to learn is how tomake good decisions. If you or others tell a child what to do all thetime, she will not learn to make good decisions.

Being able to make good decisionshelps children become confident.Being confident will help themparticipate fully in the activities oftheir communities and help themhave better lives. Whenever you can,encourage your child to make simplechoices about things that affect her.For example, sometimes she can decidewhat to eat or drink, what to wear,when to sleep, or choose what to do.

If a deaf child wants to make a decisionbut cannot tell you what she wants orlikes, try asking her questions to helpher communicate what she would liketo do.

Let’s see if Pu Yi understandsthat she can choose either a

round bun or a long bun.

137SOCIAL SKILLS

Take her with you when you collect water, gather wood, or when yougo to the market, to school, to places of worship, to festivals, or tocommunity meetings and events. Alongthe way, try to notice what hearingchildren can learn just by listening.Try to explain these things to yourchild by using signs or words thatyou both understand.

By watching others, childrencan learn about the worldaround them. They can learnthings like who grows the foodthey eat, and how people buyand sell at the market.

For this moneyyou can have 2.

HELP YOUR CHILD DEVELOP FRIENDSHIPS

As children begin playing more with each other, communication andthe ability to get along with others become more important. Manydeaf children are lonely and isolated. This is partly because they

have not learned enoughsocial skills to developfriendships. It is alsobecause hearing children donot know how to includethem.

You can help children in thecommunity who are not deafunderstand how to communicatewith deaf children. When otherchildren know how tocommunicate with a deaf child,they may be more willing toinclude her in their games.

Simon’s brother and sister areplaying ‘store’ to help himunderstand how people act in storesand how things are purchased.

Since Rina can’thear well, let’splay a game

where hearingdoesn’t matter!

We could usehand signals

instead of sayingwords for ‘ready’,

and ‘out’.

Children often make up games of‘pretend’. If they include a deafchild, it can help him learn aboutwhat to expect in new situationsand how to behave.

138 SOCIAL SKILLS

To help your child make friends and play with other children, helpher become aware of other people’s feelings, learn to share andcooperate, and understand rules. She may also need helpcommunicating with other children.

Other children may become frustrated trying to play with a childwho does not understand the rules oftheir game. They may start to leave thedeaf child out of their games. You canhelp by showing hearing children waysto play that do not need words. Youcan explain the rules to your child andshow her how to play the game.

Rina is so strong! I want heron my team next time.

The ‘social skills’ of the communityWhile teaching social skills to children is very important, that aloneis not enough. Children learn social skills not only from how weteach them and treat them, but also from how they see peopletreating each other in their community.

But we must take our own advice, and set an example by our ownactions! If our children see us ignoring or rejecting those who havedifferent abilities from ourselves, or those who look different, or whoare poor, they will learn a very different lesson from what we mean toteach them.

If we want our children to learnto respect themselves and others,they must see us putting thesevalues into practice. We ourselvesmust show respect for people whoare different. All of us must also

work to create a community that welcomes and supports allpeople, and acts on the values that are important to us.

When we are kind andrespectful to others,children learn that thisis how people shouldtreat each other.

When we teach children to befriends with children who are deaf,and to respect those who aredifferent, we are helping themunderstand that we valuecompassion. We are teachingthem that helping others iseveryone’s responsibility.

When we teach children to play together ina group, we are helping them understandthat we value solidarity and cooperation.

139

Chapter 11

Working together to helpchildren who are deaf

There are many ways that communities can work together to make adifference for their deaf children. They can make the community abetter place for children who are deaf by raising awareness about theneeds and capabilities of people who are deaf or cannot hear well.Communities can support families with children who cannot hearwell and they can make it possible for deaf children to get aneducation.

What is your community?The main community that most people consider their own is theirneighborhood, or the area where they live. But there are many otherkinds of community. Many groups can provide support for deafchildren and their families since families with deaf children oftenbelong to many different communities at the same time.

the school

the village

deaf people inyour country

families withdeaf children

deaf peopleeverywhere

140 WORKING TOGETHER TO HELP CHILDREN WHO ARE DEAF

CHILDREN WHO LEARN AND PLAY TOGETHER FORM A COMMUNITY

Children are a natural community for each other. But children needencouragement to include others who are different fromthem — whether they are deaf or have some otherdifference. Adults and older children can helpchildren learn to respect others and todevelop qualities like patience, fairness,and caring. For more information abouthow to encourage children with differenthearing abilities to relate to each other, seeChapter 10 on developing social skills.

DEAF PEOPLE FORM A COMMUNITY

Sometimes, people who are deaf may feel there is no community thatcares about their welfare. In many communities, people who are deafor cannot hear well are made to feel unwelcome by their families,relatives, neighbors and others who do not know how tocommunicate with them. Sometimes other people laugh at them andtease them. And it can be especially hard for parents of a deaf childto see their child getting teased by other people. Wherever they are,people who are deaf or cannot hear well often face similar problems.Many deaf people still have few opportunities to take their placewithin society.

Deaf people often feel a close bond with each other because they facesimilar problems and share a similar way of communicating, likesign language. Whether they live nearby or must travel to visit each

other, deaf people play a veryimportant part in each other’s lives.

People who are deaf can be a sourceof comfort and guidance to eachother. When they can meet togetherthey usually form very strongcommunities. Communities may formaround deaf schools, as deaf childrenlearn and grow up together. Or deafpeople may gather in deaf clubs, workcooperatives or religiousorganizations.

Deaf adults can also be a great helpto families that are raising deaf children, because they understandthe needs and challenges these families often face.

Anywhere there are 2 or moredeaf people together, there is acommunity — created by thecommon experience of being deaf.

Oh, I know. Me too!

141WORKING TOGETHER TO HELP CHILDREN WHO ARE DEAF

HEARING PEOPLE WHO WELCOME DEAF PEOPLE

CAN HELP BRING COMMUNITIES TOGETHER

Many hearing people realize the value of friendship with deaf people.They may have deaf friends, work with a deaf person, or they mayhave family members who cannot hear well. Hearing people who arecomfortable communicating with deaf people can build bridgesbetween the hearing and deaf communities. When hearing peoplelearn sign language, they can help deaf and hearing peopleunderstand each other and help deaf children thrive.

Joseph and the deaf choirJoseph, a young man from Haiti who can hear, learned signlanguage at a class in his neighborhood. Joseph made friendswith some of the deaf people in his city. They encouraged himto volunteer at a church that held prayer services for deafpeople. Joseph learned to translate the prayers from spokenlanguage to sign language.

As he got more involved, hebegan teaching youngdeaf people at thechurch to sign (andsing out loud) some ofthe songs that wereused in the prayerservice. Soon a wholechoir of young deafpeople was singingand signing with him.

Now Joseph and the deaf choir drive far into the ruralmountains of Haiti where they sing at other churches. Manypeople approach Joseph to ask him about the choir, and tellhim about the deaf children in their own families.

Joseph uses the opportunity to tell people about a programfor young deaf children in one of the towns, and about theresidential school for older deaf children in his city.

By bringing young deaf people to rural churches, Josephhas been able to bring the hearing community and the deafcommunity closer together.


Making the community a better placefor children who are deaf

A school learns to welcome deaf childrenIn one town in Mongolia, a few families worked hard toorganize classes for deaf children in their local school. Aftersome cases of teasing and making fun of the deaf children,the school principal called all the students to a meeting andexplained to them that this behavior was not acceptable,and that all children at the school should feel welcome.

Everyone’s behavior changed when the school principalinsisted on better treatment of the children who could nothear. As time passed, the teachers,parents, and students began to feelproud of their deaf classes and feelresponsible for the students. Now,when the other children meet theirdeaf schoolmates outside the school,they are friendly to them. Children fromother classes often visit the deaf class, andsome of the older girls have taught the youngdeaf children the complicated steps oftraditional Mongolian dances.

RAISING AWARENESS

The way that adults and older children act towards deaf children canhave a strong effect on others. For example, if people include deafchildren in their activities, or if they oppose poor treatment of deafchildren, it is more likely that others will follow their example. Hereis a story about a school principal in Mongolia who used his positionto influence how deaf children were treated in his school.

Help people communicate with your childAdults and children in the community can help deaf children byinteracting with them. They must treat deaf children with the samerespect and kindness they show to others. When community memberscommunicate with deaf children, they will learn that children whoare deaf are just like other children.

Comeplay ballwith us.

Okay!


Encourage people to communicate with your child whenever they seeher. Introduce her to people you meet. Show them how to greet her,and teach her how to greet them. Just as you teach a hearing childthe name or term of respect for each person you know in thecommunity, teach your child a sign orspoken name for each person, andteach people your child’s sign orspoken name.

People in the community may feelmore comfortable with your childif you explain how to act, andshow them a few signs or gestures.Explain to people that it is best tobe at the same eye level as yourchild when they talk or sign to her.People can use gestures andexpressions on their faces as if theyare communicating with a childwho can hear.

Goodmorning,

Alicia.

How to help hearing people understand what it is liketo be deaf or not hear well

Game: What did you say?One person covers his ears while another tells a funnystory to the group. Or people can take turns sitting faraway, so they cannot hear the story. Another person askseveryone questions about the story, including the personwhose ears were covered or who sat far away.

Ask this person what it felt like not being able to hear the story well.

Families of deaf children can organize programs for people in theneighborhood to help them understand about ‘differences’, respect,and awareness of deafness and hearing. They can help their friendsand community-based groups to welcome children who are deaf or‘different’ in other ways.

People will better understand a child who does not hear well if theycan get an idea of what that might feel like. Here are some fun waysto learn. These games can be used in public places such as churches,temples or other religious places, clinics, schools, and communitygroups. You can use them during awareness-raising sessions orduring a parents’ meeting.


How to help children communicate without speechChildren who have difficulty hearing usually have difficulty speaking.Their speech sounds strange to people who can hear. This is becausepeople who cannot hear have no way to know how speech is supposedto sound. It is very hard for them to speak like hearing people do. As aresult, many deaf people choose not to speak, and communicate onlywith gestures, or signs or sign language. People with different hearingabilities may feel shy and only talk to the people they know well.

Ask a group of children if they know other children in the communitywho are deaf or cannot hear well. You can all discuss ways tocommunicate with children who have different hearing abilities.

Game: Talking without wordsThis game will help childrenunderstand how difficult it can be fora child who cannot speak, or whocannot speak well, to communicate.Everyone takes turns trying to saysomething to the group withoutusing words. Begin with easy ideas,like ‘I am sleepy’, or ‘give me theball’. Then try harder ones, like‘I’m lost and can’t find my house’,or ‘I had a bad dream’.

No, he’s tired.He’s sayinghe’s sad.

No, hehurthis

arm!

What could I doto help Mosheunderstand the

story?Speak

clearly.

Draw pictures thathelp tell the story. Make sure he can

see your face whenyou talk.

Ask him tosit near you.

Act outthe story.

Then everyone can talk about what they can do to communicatebetter with children who really do have difficulty hearing.


Afterwards, you can talk about:

• Was it difficult to explain something without talking?

• How did you feel when someone did not understand?

• What did other children do that helped you communicate withthem? What else could they have done to help?

• How might you communicate with children who cannot speak?

Then you could make up some signs for the ideas you tried. Seehow much easier it is to communicate with signs.

This is a good time to tell children about their local sign languageor about how families can make up signs to help each othercommunicate (see Chapter 4). To help children learn some homesigns, see pages 40 to 43 in Chapter 4.

SERVICES FOR DEAF CHILDREN AND THEIR FAMILIES

All people need basic services such as water, electricity,transportation, education, and health care. It usually takes theresources of a whole community to provide services like these. Thesame is true of services needed by deaf children and their families.People in the community have knowledge, resources, and skills theycan share. By working together, a group of families or an entirecommunity can organize efforts toward things like:

• learning how to checkthe hearing of youngchildren.

• helping local healthworkers learn torecognize and treat earinfections, which canhelp prevent deafness.

• finding a place wherefamilies with deaf childrencan meet.

• organizing speech or sign language classes.

• helping hearing people learn to talk so thatchildren who can hear a little can understand them.

• translating between sign and speech at schools or play groups.

A safety sign likethis can make astreet safer foreveryone!


OTHER COMMUNITY ORGANIZATIONS CAN GIVE SUPPORT

Many local community-based groups such as women’s groups, parents’groups, farmers’ groups, or credit or income generation groups canprovide support to parents of children who have difficulty hearing.

For example, families may need extra time to teach and look after achild who cannot hear well. This might make it difficult to find paidwork outside the home. A community-based group could help parentsfind ways to earn an income. Community-based groups such as amother’s group can also help deaf children get hearing aids, findresources to pay sign language teachers, arrange opportunities forearly childhood education, subsidize payment of school fees, or help inother ways.

One group of parents in India worked to bring hearing aid services totheir town, so that children would have trained health workersnearby to fit, repair, and maintain their hearing aids.

A parents’ group or village health association can inviteorganizations or people from outside the community to visit thevillage to start new services, give training, or lead discussions. Or thecommunity can collect money to send one person for training. Thisperson can then train others when she returns.

Form support groupsFamilies of deaf children areimportant resources for each other.By organizing regular meetings,they can help each other withproblems they face, and sharesuggestions of new ideas andopportunities for their children.This can be a great help, not only inorganizing for their children’s needs, butalso in giving each other support as they overcome challenges.

The community can help this happen by providing space for meetings(for example, at a local temple, church, or mosque) and by lettingpeople know about the meetings, so that other families can join.

Families with deaf children face many similar challenges andexperience similar joys. See Chapter 14 for examples of how parentscan start a group where they share feelings, information, and ideas tomake a community more supportive for their children.


BRING DEAF CHILDREN TOGETHER WITH OTHER DEAF PEOPLE

A community’s efforts to support deaf children can also bring themtogether. When children who are deaf or cannot hear well have anopportunity to meet together they can begin to form a naturalcommunity and develop their language and communication skills.

One town in China took a survey to find out how many deaf childrenthere were who might attend a deaf school. Because of this survey,two families living next to each other were surprised to find that theyboth had deaf family members who had never met!

Many larger communities have socialclubs, associations, or large informalgroups made up of people who aredeaf. Sometimes these associationshave programs for deaf children andtheir families. You and your child willbe welcome there.

Every year the Delhi Foundationof Deaf Women, in India, has atalent contest for deaf children.After the contest, families meetand learn about deafness. Thisis part of the foundation’s‘Catch Them Young’ programto involve families with youngdeaf children in deafcommunity activities.

Deaf people whocommunicate well are oftenthe best teachers and advisorsfor a family with a deaf child.

Are you coming to eatat our house tonight?Ravi and Mita will bethere too!

If you live in a large town or city, you canprobably find ways to meet other deafpeople. Even if you live in a small villagethere may be some deaf and hearingpeople who communicate using signsand gestures. They will often be happyto help families with deaf children.


HELP DEAF CHILDREN GET EDUCATION AND TRAINING

Many families struggle to give their children who cannot hear wellthe chance to go to school. It takes time, energy, and resources toorganize opportunities for deaf children to learn. But when a wholecommunity works for educational rights for deaf children, it canmake a big difference.

Chapter 12 describes in more detail the benefits that different kindsof schools or classes may have for deaf children and their families.

Communities interested in organizing better education and trainingfor deaf children should contact their local or national association forthe deaf, and the Ministry of Education. This will help them learnmore about the opportunities and laws about deaf education in thearea. The laws of most countries support the rights of all children —including deaf children — to a public education.

Here are some ways a community can help schools meet deafchildren’s needs better:

• Offer extra training to teachers so they can learn how tocommunicate with deaf children.

• Invite deaf adults to help teachers, families, or students learn signlanguage. Or they can work in the classroom and give extraattention to the deaf students. Chapter 12 includes more activitiesthat help deaf children learn in local schools.

• Offer extra training in skills that will help students earn an income.

Bringing deaf children together in their own school or classroom cancreate a community of children who might otherwise have beenisolated from each other. Some communities get money from local ornational associations, donor organizations, or their government tohelp pay for training and facilities.

Awareness is the first step towards changeDeaf adults, parents, andcommunity membersmust work withgovernment officials sothat the officials know theneeds of deaf children andwhat deaf children can becapable of. Together they can dispel theignorance and the myths that surround deafness.

If the president or theprime minister had a

child who could not hearwell, then then then then then there would beschools and teachers for

our children!


EVERYONE BENEFITS FROM EFFORTS TO SUPPORT DEAF CHILDREN

The entire community becomes stronger when people take care ofeach other, are responsible for each other, and when they accept

people’s differences as well as thethings they have in common. Sowhen attention is given to the specialneeds of deaf children, it oftenimproves conditions for the entirecommunity.

All children in the community canbenefit from improved social services like hearing tests and betteraccess to education and training.

When people learn to work together toward a common goal theylearn that they can achieve much more together than alone. Acommunity that organizes around one issue will be able to use thatexperience to address otherneeds and do otherprojects.

When teachers findways to communicatewith children whocannot hear, it canhelp all children tounderstand theirlessons better.

If children who cannot hear well do not get education and support,they may never learn to communicate with other people or learnuseful skills to get work, take care of themselves, or live peacefullywith others. Their unhappiness and poverty may become a burden ontheir families, neighborhoods, and communities.

Aren’t you afraid thathaving those deaf childrenin your class will slow the

class down?

No, I think theother childrenneed to learn

some patience!And all of their

reading isgetting stronger.

They are alsolearning sign

language.


A town learns a new languageIn a northeastern town in Brazil, a church started a smallschool for deaf children. Soon the families that attended begana parents group, the Association of Parents and Friends of theDeaf in Cabo (APASC). As a group, APASC decided to offer signlanguage classes to hearing people so that they couldcommunicate with their deaf children. They contacted the deafassociation in theneighboring bigcity and hired adeaf man to teachthe parents andtheir familymembers signlanguage.

APASC also gotthe local governmentto open the local schoolto their deaf children.The school hired trainedteachers and started classesfor deaf children. The deaf children joined the hearing childrenin many of the school’s activities. Soon, the town was seeingsign language in the schools, in the shops, and in the streets.

Before, many people had thought that deaf people werementally slow. Now, they have new ideas about deafness. Theysee sign language interpreters at church services, deafteenagers getting jobs in the community, and deaf childrenstudying and playing with hearing children.

APASC helped raise the level of awareness about deafness intheir community. They have workshops and monthly meetingswhere parents can find support from other parents, and learnabout deafness and how to communicate with their deafchildren. APASC also printed a simple sign language dictionarywith 500 signs that many people in the community use.

By working together, they are building a society that helpsall children develop to their full potential.

More and more people took signlanguage classes and learned how tocommunicate with the deaf childrenand deaf adults who lived in the town.

Here is a story about how a group in Brazil is working in theircommunity to change the lives of deaf children.

151

Education

Chapter 12

Learning begins at homeLearning begins at home, in a child’s infancy, andcontinues throughout her life. The familyplays a very important role in helpingchildren learn. Parents and familymembers are the earliest and mostimportant teachers. At home, achild will learn to communicate,start thinking, and begin relating toother people.

Some communities have teachersand deaf adults who come topeoples’ homes to help parents learn how to communicate with theirdeaf child. They show family members activities they can do togetherto learn language. (For ideas and activities to help families teachtheir children a language, see Chapters 7, 8, and 9.)

All children — deaf and hearing — have a right to education.Children who get an education have more opportunities to learnabout the world, develop skills, and find jobs. Education is especiallyimportant for deaf children because it allows them to develop theirthinking, to communicate with other deaf and hearing people, and tomake friends. And with the skills they gain, children who cannot hearwell will be able to live productive, independent lives and take part inthe life of the community.

Though this book is mostly for children from birth to age 5, thischapter includes some important issues about educating older deafchildren, to help parents plan for their child’s education.

152 EDUCATION

Going to school is important for deaf childrenEducation in school will improve the ability of children who are deafor cannot hear well to communicate, and can give them skills to leadproductive lives and to support theirfamilies.

At school, deaf children can learn toread and write — often the only waysthat deaf people can communicate withpeople who do not know sign language orcannot understand their speech. Readinghelps people who cannot hear wellunderstand the ideas, emotions, andexperiences of other people. Writinghelps them communicate and sharetheir thoughts and emotions.

Learning continues in the communityChildren learn from their families and friends theskills they need to live in their community. Bywatching how children and otherpeople talk, play, andwork with each other,children learn how to getalong with others. Theylearn to get places theyneed to go — walking,riding, or driving. They learn tobuy and sell, to pay bills, and to getthings done. They learn to gather wood, plantcrops, fish, weave or sew, make handcrafts, and many other skills.

When children participate in the community, they also learn abouttheir emotions and build self-esteem. Games they play with eachother are informal ways of learning to be part of communities.(Chapter 10 and Chapter 11 describe ways to include children in thecommunity and to build strong social skills.)

As children grow older they become ready to go to school. Educationin school will build on the skills children learn at home and in thecommunity. What they learn at school also gives children skills thatprepare them for life as adults.

With thismoney we willbuy some fishat the market.

Education takesplace in manysituations: at home,in the community,and at school.

I’m going to write aletter to my brotherwho went away towork in the city.

153EDUCATION

Deaf girls especially need education!It is often even more difficult for adeaf girl to get an education. A girlwho cannot hear well is often keptat home doing housework — evenafter her sisters and brothers leaveto go to school or get married.

Why does a deaf girl need to knowabout the world? She needs skills to keep herselfsafe and take part in her community. Sheneeds to know her rights, and get the skillsto have a job and live an independent life.

Without communication and education, adeaf girl cannot learn about social rules orunderstand changes in her body. Too manydeaf girls become pregnant without knowinghow or why. In some parts of the world, more deaf women haveHIV/AIDS than other women because they do not have a way toget the information they need to stay safe.

You don’t have to worryabout Chung-Yi. You did

the right thing bysending her to school.

One day she will be ableto look after you!

Different kinds of schools for deaf childrenChildren who are deaf or cannot hear well can go to school and learna lot, including skills they will need to earn a living. They can learnin regular classes together with hearing children, or separately withother deaf children.

Pama will beold enoughfor school

next year, butI don’t knowwhat schoolwill be best

for her.

My sister’s son goes to aresidential school for deaf

children. The next timeshe visits, you must come

and ask her about it.

Or maybe Pama can goto our neighborhood

school. She has a rightto go there like any

other child!

We would have tohelp make sure

that the teacherknows how to

teach a deaf child.

154 EDUCATION

Schools and languageSchools that teach deaf children usually focus either on thespoken language of the community or on sign language.Some schools teach deaf children to speak and use signlanguage at the same time, or to speak and use fingerspelling. They use sign language, gestures, pictures,lip reading, speech, and reading and writing.

Often the teachers who use spoken language and teacherswho use sign language do not agree with each other’smethods. This can make it very difficult for parents to getinformation about what is good in each method.

Even though you may not have many choices about the kind ofschool to send your child to, knowing about schools is importantbecause:

• it can help you think about what would be best for your child.

• it can help you work with your school to make the school betterfor deaf children.

• it can help you work with the community to get the kind of schoolthat families with deaf children need.

See Chapters 7 to 9 for information about spoken and signlanguages and how to start using them. It is important toremember that each child has his or her own needs andabilities.

Our school believes thatdeaf children have a rightto learn sign language, asit is the ‘natural language’for deaf people.

We also teachabout the historyand importanceof deaf peopleand the deafcommunity.

Our school believes thatonly deaf children who canunderstand and respond to

spoken language cansucceed in the world.

155EDUCATION

DEAF CHILDREN CAN LEARN IN THE SAME CLASSES AS

HEARING CHILDREN

Teaching deaf children and hearing children in the same class isoften the only way a community is able to educate deaf children.Children who hear may tease or ignore deaf children because of theway they speak or because they may not understand what people say.But if people make an effort to stop that kind of hurtful behavior,deaf children can have the opportunity to make friends with hearingchildren and to become part of the local community.

As the childrenbecome part of eachother’s lives, theylearn to appreciateeach other’sstrengths andsupport each other.

We deaf and hearingchildren would notwant to be separated— we would be losingour good friends!

We helpthose whocan’t hearsee see see see see what

they need toknow.

We push those intheir wheelchairsif they need help.

We lend eachother things

we haveforgotten.

Benefits of learning with hearing children

• Deaf children can continue living at home with their families.

• It is often less expensive.

Difficulties of learning with hearing children

• Children who can hear may tease or ignore deaf children.

• Teachers may not be able to learn much about deafness or how toteach children with different hearing abilities.

• There may not be enough people fluent in sign language to learna complete language. The child’s mental development may suffer.

Some local schools teach everyone sign language so deaf children arenot left out. Or they spend extra time to teach children who cannothear well to speak.

156 EDUCATION

Ways to support deaf children in hearing classroomsIt is not enough just to open the school doors to deaf children. A deafchild who learns in a regular classroom needs a teacher andclassmates who can communicate with her. Lessons must be taughtin a way deaf children can understand. If a deaf child cannotunderstand, she will not learn.

When schools do not provide enough support for deaf children, theywill not learn as well as hearing children. If schools expect deafchildren to learn less, then all children will learn the same thing —deaf children are less capable. This idea is not true and harmseveryone.

Ping-guo enjoys lookingat posters, drawings,and models. He learnsmost by seeing, but hecan hear a little, too.

We will do ourbest to help

Ping-guoparticipate in

class activities.

Offer extra training to teachers so they can learn how tocommunicate with deaf childrenA teacher who has not worked with children who are deaf orwho can hear only a little may be unsure about how to teacha child who does not hear well. Talk to the teacher about thechild’s needs and abilities, and see if there are simple ways tomake learning easier for the child.

If a child can hear a little or read lips, the teacher should face thechild when she speaks and check often to make sure the child can seeher mouth.

Let the child sit close to the teacher. She will be better able to see theteacher’s lips move. She will also be less distracted by the movementsof other children.

157EDUCATION

DEAF CHILDREN CAN LEARN IN THEIR OWN GROUP

Children who are deaf or cannot hear well can learn in separateclassrooms for deaf children in a local school, or in separate dayschools or residential schools.

Many local or national associations, or government, religious,community, or aid organizations have started separate schools orclassrooms to educate children who are deaf or cannot hear well.These organizations may even offer scholarships for children who aredeaf or do not hear well to study in such schools or classrooms.Bringing deaf children together in their own schools or classroomscreates a community of children who otherwise might have beenisolated from each other.

When children attend schools likethese, they often learn signlanguage. Family memberswill be able tocommunicate better withtheir children if theylearn sign language too.

Parents can meet with a child’s teachers to getinformation about what and how she is learning.This will help parents strengthen and build on what

their child is learning at school. They can also tell theteacher about what the child does at home. That way the teachercan include things from the child’s experience in her lessons.

Help schools meet a deaf child’s needs:• Teachers can prepare the rest of the school — the other teachers

and children — about deafness and about how deaf childrenlearn best by seeing. This way everyone in the school can getready to welcome deaf children.

• Deaf adults can help the teacher or the students learn signlanguage. They can help the teacher in the classroom by givingextra attention to the deaf students.

• Because children who are deaf or cannot hearwell learn by seeing, schools can help them havetheir eyes checked and get glasses, if needed.

158 EDUCATION

Residential schoolsDeaf children live at these schools and return home only forweekends or holidays. Children at residential schools often learnskills for work, like computers, mechanics, art, and farming, as wellas reading, writing, and math.

Day schools for the deafThese day schools teachonly deaf students. Thechildren live at homewith their families andcontinue to interactwith hearing children andadults in their community.

Families sometimes worry about their children when they are farfrom home. Communicating with families of other students, visitingtheir children at school, and meeting the children’s friends andteachers can help parents feel more comfortable when their childrenare away at residential schools.

Like anywhere else where children live, there are chances for abuse ata residential school (see Chapter 13 for information on abuse).Parents must encourage their children in residential schools tocommunicate their problems to teachers, house parents, and others.

Most deaf people who have studied in residential schools found theexperience good. Even though they missed their families, the schoolgave them more opportunities to communicate with a larger group ofpeople, and the deaf students created close communities withother students and the staff.

...and who cantell me what12x12 is?

I’ll neverrememberall this!

Come sit withus at lunchand we’ll helpyou with it.

159EDUCATION

Difficulties of learning only with other deaf children

• Deaf children who study in separateschools may not learn how to live andinteract comfortably with people inthe ‘hearing world’.

• The schools may be far awayand costly.

• Classes may include children ofdifferent ages. It may bedifficult for teachers to meettheir different needs.

Benefits of learning only with other deaf children

• Most deaf schools and classrooms have teachers with specialtraining to teach deaf children. These teachers can usually meetthe deaf children’s needs and attend to each child.

• Deaf children feel less isolated when they can communicate withall the people around them.

• Deaf children have opportunities to play, learn, develop socialskills, and create friendships.

• Children can meet andinteract with deaf adultswho work at the school.

• Some deaf schoolsor classrooms alsohelp deaf childrenget hearing tests andhearing aids.

Separate deaf classes in local schoolsIn some schools, deaf children spend the entire day in a separate

classroom and see hearing children only duringbreaks. In other schools, deaf children spend

part of the day in classrooms with hearingchildren, learning art or doing exercise. Theages and abilities of children in the specialclass may vary.

160 EDUCATION

Good schools meet deaf children’s needsAll communities can have good schools for deaf and hearingchildren. It is not money, new buildings, or ‘expert’ teachers thatmake a good school. A good school pays attention to all the needs ofits students and has committed teachers who help children ofdifferent hearing abilities learn and use language.

When schools first include children who are deaf, they often makemistakes, despite their good intentions. Schools have to learn aboutdeafness, just like deaf children have to learn about schools. Here is astory of one family that persisted in getting their daughter aneducation and about the change that made in her life.

I enjoy teaching morethan working in themine, even though I

get paid less.

And the town ismore aware ofour children’s

needs than everbefore!

The children likelearning from eachother. They have

made good friendsand learned more

about socialresponsibility.

Schools that respond to the many different needs of deaf children canmake a great difference in their lives.

Schools can cooperate with health care services and hospitals toprovide hearing and eye tests, and hearing aids and eyeglasses. Theycan make the school available for vaccination campaigns to make iteasy for parents to get the children vaccinated. And they can includenutrition and sanitation in the subjects they teach.

Schools can make time for deaf children to learn and play withhearing children, and not allow children to tease each other. Whenschools teach about the history and importance of deaf people andthe deaf community they can help deaf children feel important andbuild self-esteem.

161EDUCATION

Oyuna’s storyWhen Oyuna was 7 years old she started going to herneighborhood school, in a small town in Mongolia, with otherchildren her age. Her parents had to work hard to convincethe school to allow their deaf daughter to attend. Thetraditional belief in Mongolia is that deaf children are‘abnormal’ and should not be with ‘normal’ children. Herparents felt very lucky that the director of the school agreed toadmit her.

But even though Oyuna was going to school, she still hadno means of communication except some gestures, pointing,and a few sounds. Her teacher at the neighborhood schoolcould not communicate with her. It was soon obvious thatOyuna was not learning. Oyuna’s parents began to lose hopebecause the only school for deaf children was in the capitalcity, very far from Oyuna’s home.

Then a neighbor told them about a new program atanother nearby school. A teacher at that school, whose ownson was deaf, was helping to train the other teachers in basicsign language. The deaf children and the hearing childrenwere all being taught in sign and in spoken words, in thesame classroom.

Oyuna now goes to her new school happily everymorning. The children in her class won a prize in amath competition among all schools in thetown. And Oyuna got a prize for her goodhandwriting. Oyuna has changed from thesad, unsmiling girl who started school intoa happy, playful child who often helpsother children in her class.

How can Oyuna be expectedto learn so far away from

the support and love of herfamily? Especially when wehave no way to explain thesituation to her, or to be in

contact with her.

162 EDUCATION

Many people think that a teacher with special training is the bestteacher for deaf children. This is not always true. Training aboutdeafness does not automatically make a better teacher. Manyteachers of the deaf do not have the opportunity to train in their owncountry, so they go away to learn in places that are very differentfrom their own communities. The ideas they learn in another countrymay be difficult to use or may notwork at all in the schools andcommunities back home.

Experience makes the best teacherA day school for the deaf in Tanzania had a teacher who wasdeaf herself. Even though she had no formal training as a

teacher, her patience and creativity helpedto bring out the abilities of each child.Because the teacher could not hear theirvoices, she rested her hand on theirshoulders to feel the vibration of the soundas they learned to speak. She also used signlanguage with them, helped them withtheir handwriting, and taught the childrenmath by counting bottle caps.

The class was small, so the teacher wasable to spend time with each child. Shelearned to identify and make use of theirstrongest abilities to help them learn.

GOOD SCHOOLS HAVE TEACHERS COMMITTED TO LEARNING

The most important qualities in a teacher are that she expects deafchildren can do well in school and life, and that she takes the time tolearn about each child’s needs and abilities.

A teacher who is trained to teach deafchildren can be a resource for otherteachers. Teachers of the deaf andteachers with experience teachinghearing children can learn from eachother and build on what they know.This sharing of experience benefits allchildren.

That’sa greatidea!

I have arranged for the localhospital’s eye clinic to do eyetests for all our children.

Ba!

Say‘ba’.

163EDUCATION

DEAF ADULTS HELP DEAF CHILDREN LEARN

Deaf adults are probably the best teachers for deaf children. Goodschools involve deaf adults in the classroom as teachers, translators,and assistants. Deaf adults understand the challenges deaf childrenface. Deaf adults can become role models for deaf children, and helpcreate positive attitudes about deafness and deaf people.

CHILDREN CAN HELP EACH OTHER LEARN

Many children need help to learn difficultideas. Deaf children often need extra helpand attention to learn skills like readingand writing. Children — deaf and hearing,older and younger — can help each otherlearn skills and feel comfortable at school(pages 26, 137, and 138 include examples ofhow children can help each other).

Older children can helpyounger children learnto read and write.

Children can take part in their own educationA teacher in a school in Zambia encouraged the children toexpress themselves freely about what they wanted to learn. Theteacher introduced ideas like voting in the classroom.

One week the children chose to learn aboutthe reason why people fight and have wars.Another week they chose to learn about theweather and the reasons it rained during thewet season. As the weeks went by, manychildren became more interestedin what they learned. Theybehaved better and attendedschool more regularly.

By the end of the school year,the children even went aroundthe village to find other childrenwho weren’t attending schooland encouraged them to come.

When children are involved in their education and work together tosolve problems, they get an education better fitted to their needs.They feel confident about themselves, about what they learn, andabout their ability to make a difference in the world!

164 EDUCATION

As parents becomemore aware of their child’sright to education and abilityto learn, they will themselvesbegin to make demands onlocal schools.

FAMILY SUPPORT AT SCHOOL IS IMPORTANT

Parents and families have a major role in the education of their deafchild. Parents have experience they can share with the school to helpteach deaf children. Parents can also work with the community tomake schools better for deaf children. Schools with active parents’groups can talk about the educational and emotional needs offamilies with deafchildren. Suchschools are oftenbetter schools.

Good schools prepare a child to make a livingMany parents worry about the future for their children who are deaf orcannot hear well. How will they be able to earn a living and supportthemselves and their families?

Some schools for the deaf train their students in vocational skills theycan use later to find a job or start a business. Both sewing andcarpentry are common trades taught in vocational programs. Thereare also training courses that deaf children can go to after completingschool, in computer skills, motor repair, printing technology,accounting, cooking, agriculture, and art. In fact, it is almostimpossible to find a career in which a deaf person has not excelled!

At a residential school for the deaf in Romania, the childrencome from all over the country — sometimes from small villagesmore than 200 kilometers away. The childrenspend 9 months of the year at school, so itbecomes a second home for them.

At school everyone uses hearing aids, learnsspeech and lip reading, and is taught to workwith clay to make pottery. Many of the childrenleave the school when they are 14 years old andlater earn their living as skilled potters.

I am a little worriedbecause I have never

had a deaf child in myclass, Mrs. Gomez.

Angela is a smartgirl. I know she’lldo well here. AndI can teach yousome signs untilyou find a deafperson to teach

you and the classhow to sign.

165EDUCATION

Working together to help deaf children succeedDeaf children can succeed when parents, schools, and communities worktogether to create a positive environment for them. Good education forthese children depends on many things, including:

• whether children learn and use a language.

• whether there is good teaching, communication, andfamily participation.

• whether the communitycreates opportunities fordeaf people to succeed.

Parents, schools, and communities can work together to make surevocational training is available to deaf youths, jobs are offered todeaf people, and loans or grants are available for small businesses.

Some communities even givelower taxes or financialassistance to businesses thatemploy workers who are deaf ordo not hear well. Communityorganizations have establishedrevolving loan plans thatprovide deaf craftspeople with

funds to buy the basic equipment and materials to start their ownsmall businesses. The loans are paid back little by little, so that thesame money can be used to help another deaf person get started.

A young deaf person may be able todecide what skills she wants to learn,depending on her abilities andinterests, as well as on the localresources, market, trainingopportunities, and other factors.

Our group of deaf adultsmanage the railway

station’s restaurant. Ithink it is good for thehearing people we meetto learn to communicatewith us. And if they don’t

learn, they don’t eat!

House painters find successA network of deaf men in the south of India ran ahouse-painting business. People preferred to ask themto paint their houses as they did it faster than otherpainters. Babu, the leader, was skilled at negotiating and activelylooked for new business. With many houses being built orremodeled, more and more people discovered the group of deafmen were skilled at their work, and they were in great demand.

Several of my deaffriends who studiedreligion now serveas priests, and usesign language tocommunicate.

The primary school where Iteach has a popular carpentry

class taught by a deaf man.

166 EDUCATION

NEVER TOO LATE TO LEARN

Tsogu lost his hearing after a serious illness when he was3 years old. As he grew older, he stayed at home while hissisters and brothers went off to school. Tsogu’s family used afew home signs to communicate withhim, but hespent most ofhis time alone,taking care ofthe family’shorses, sheep,and goats.

One day his parents learnedabout a new class, started by acommunity group, for deafadults who had never gone toschool. After studying hard therefor 2 years, Tsogu was finally ableto communicate easily with hisclassmates, and to read, write, and do math.

Tsogu decided he wanted to learn a skilled trade like someof his friends from the same program. He was accepted at avocational training school to learn how to be a carpenter.

We wanted him to be ableto make friends, to readand write, and maybe

learn a trade so he couldhave a better life.

Tsogu was a goodherdsman, but he

was so isolated. Wedidn’t want hisworld to be so

limited.

With a good job, Iwas able to thinkabout marrying andstarting a family.

While this book is about the importance of helping a deaf child asearly as possible, it is also important to try to help deaf adults. Ourcommunities are strongest when they look after all of us.

And our little girlhas her father’scuriosity anddetermination!

My name is Tsogu, and I live inMongolia. Here is my story.

167

Preventingchild sexual abuse

Chapter 13

It might seem strange to find information about sexual abuse in a bookon helping children who cannot hear well. But, sadly, children who aredeaf are even more at risk for sexual abuse than children who are notdeaf. So it is very important for families with deaf children, and thosewho care for or teach deaf children, to know about it.

Keep our children safeNo one has the right to use achild for sex.

• Not a family member (child or adult)

• Not a family friend

• Not a neighbor

• Not a stranger

• Not a teacher

• Not a caregiver

Yet it is hard to talk about sexual abuse. In many places:

• people do not know what sexual abuse is, how it happens, andthe harm it causes.

• people are uncomfortable talking about sex.

• people do not want to believe that sexual abuse happens to veryyoung children, so they do not think or talk about it.

• rules or customs limit who can talk to children about sex, whatcan be said, and when such conversations can happen.

Every child should be safe from sexual abuse.Keeping children safe from abuse is every adult’s responsibility.

Not anyone!

We parents need totalk about sexualabuse — with eachother and with our

children.

Talkingabout it is

the first stepin stoppingit. Silence

only protectsabusers.

168 PREVENTING CHILD SEXUAL ABUSE

Some facts about child sexual abuseChild sexual abuse means using a child for some kind of sexualactivity. Sexual abuse can happen to any child. It happens in allcommunities, and in rich and poor families. It happens to both girlsand boys. Most sexual abuse happens to children older than 5 years,but it happens to younger children too.

We do not know exactly how common sexual abuse is, since manychildren do not tell what happens to them. But it is possible that asmany as 1 out of every 4 children in the world is sexually abused.

Most sexual abusers are men. And most abused children areabused by someone they know, like a relative, a familyfriend, or a neighbor. Abuse is rarely done by a stranger.Sometimes the abuse goes on for a long time, even foryears.

Not all people who abuse children sexually usephysical force. Sometimes a person uses a positionof trust or influence to make a child have sex. Hemight use persuasion and ‘kindness’, threats andbullying, or give gifts or treats. (An abuser mayeven be a deaf person who befriends the child.)Whether someone uses physical force, threats, or‘kindness’ to make a child have sex, the result ofthe abuse is still very damaging to the child.

There are many ways children can be abused. Some are:

• using sexual talk or picturesto shock a child, make hersexually excited, or make herfamiliar with sex

• making a child hear or watchsex between other people

• oral sex (when a man puts hispenis in a child’s mouth)

• kissing or hugging a child in asexual way

• sexual intercourse or anal sex(when a man puts his penis in achild’s vagina or anus)

• making a child pose for sexpictures (pornography)

• making a child look atpornography

Abuse when a child is touched

Abuse when a child is not touched

• touching a child’s genitals(sexual parts) or making achild touch an adult’s or anolder child’s genitals

• forcing a child to become aprostitute (take money fordoing sex)

169PREVENTING CHILD SEXUAL ABUSE

`

Why are deaf children at risk for sexual abuse?All children are at some risk for sexual abuse because they must trustadults and older children, and depend on them for care. Children aretaught that ‘good children’ do as they are told. This makes it difficultto say no to adults. Very young children also have no way to knowhow adults normally behave, or what is acceptable adult behavior.

Deaf children are especially at risk for sexual abuse because:

• Society, in general, values people with disabilities less than others.So an abuser may think it is okay to use a deaf child for sex. Andbecause girls are usually valued less than boys, deaf girls arevalued even less than deaf boys. So deaf girls are most at risk.

• Deaf people use touch to communicate — for example, to getsomeone’s attention. A deaf child may think someone’s touch isokay even if it is not.

• Deaf children have less informationthan hearing children, but arejust as curious. They mayalso be isolated or feellonely, which makesthem easy targets forabusers.

• Deaf children whohave limitedcommunication mayhave learned to dowhat others wantwithout asking why.

• Deaf children whohave limitedcommunication skillsmay not fullyunderstand what you tellthem about their safety.

• Limited communication also makes it harder for deaf children totell anyone about abuse. Someone may abuse a deaf childbecause he knows she will not be able to speak about theexperience. Deaf children may only be able to communicate withfamily members or others who look after them. If the abuser isalso a family member, caregiver, or teacher, the child may notfeel safe telling anyone.

I want Radha to besafe. But how can Iteach her to protectherself? My mothernever talked to me

about this.

I know what youmean. My daughterMishiri also can’thear well. And I’mnever sure if she

understands me. Canwe think of ways to

explain this to them?


Sexual abuse causes lasting harmSexual abuse harms a child at the moment when the abuse happensand can continue to harm a victim throughout his or her life. This isespecially true if a child is unable to talk about the abuse or receivehelp, support, and treatment.

Lasting physical harmLasting physical harm can be caused by sexually transmittedinfections (STIs). An abuser can infect a child with HIV/AIDS andhepatitis, which cannot be cured. Other STIs, if left untreated, cancause future problems with pregnancy, cancer, and death from severeinfection. Children who get STIs from sexual abuse often do not showany signs and so they do not get treatment.

Damage to a child’s developmentChildren who have been abused sexually are likelyto feel a great deal of guilt, shame, and anger.Many victims of sexual abuse are unable to trust otherpeople. Victims are also likely to have poorself-esteem — they feel they are not valuable and notworthy of being treated with respect.

Cycles of abuseChildren who have been abused sexually may continue to be abusedby others throughout their lives. Because of their experience of abuseas children, they may grow up to believe that sex is the only way toget affection or security. Being treated badly and being abusedsexually can become a pattern in their lives.

Also, without support and help to healfrom the abuse, boys who have beenabused may become abusersthemselves when they grow older.This cycle of abuse createsanother generation of victimsand future offenders.

The harm caused by child sexualabuse is not just to children andtheir families, but to entirecommunities. For example, peoplewho are unfairly shamed and isolatedbecause of sexual abuse can sometimesbecome destructive or violent, or turn to alcohol or drug abuse.


Preventing sexual abuseHow we are treated by others affects ourself-esteem. When children are treated ashelpless, and hopeless, they seethemselves as helpless, and hopeless.So we must teach children to feel goodabout themselves so they will beconfident and better able to protectthemselves.

To keep children safe, we must givethem the knowledge, skills, andconfidence to reject sexualmisbehavior — even from bigger,stronger, and more powerful people.

HELP YOUR CHILD UNDERSTAND AND COMMUNICATE ABOUT

SEXUAL ABUSE

Deaf children learn most easily when they see things. Signs, bodymovements, and expressions on the face, along with picture cards,puppet shows, and role plays, can all help you teach a deaf childhow to be safe from sexual abuse. Help her understand that:

• some kinds of touches are not okay (a handshake is okay, a hugmay be okay, but touching genitals is not okay, and putting apenis in a child’s mouth is not okay).

• she should tell you if something she does not like happens to her.

• she can refuse if someone tries to touch her sexually.

Ideas like ‘private’, ‘secret’, ‘trust’, ‘safe’, and signs for them, arehard to explain to young children, especiallyif they are deaf. Remember that you willhave to explain these ideas over and over.

Use different signs, gestures, pictures,and words until you feelsure your childunderstands. Act outsituations with yourchild, or use dolls orpictures to try asmany ways ofshowing these ideasas you can.

Leave mealone!

This man is touchingthe little girl in a

bad waybad waybad waybad waybad way. If this everhappens to you, you

come tell mamatell mamatell mamatell mamatell mama!

Tellmama.


Some examples of signs that may help you explain sexual abuseThese signs are in American Sign Language. Remember, the signs inyour own country’s sign language may be different.

body private

help

secret

badgoodhurt / violate

touch

HELP CHILDREN NAME AND DESCRIBE ABUSERS

Give your children sign names for people in their lives. Practicenoticing details about people and places and communicate aboutthem with your child. Teach your child describing words, like tall,short, hairy, fat, thin, and others. When a child can describe aperson, she can describe an abuser.

Give everyone a sign nameOne of our little girls, a 6-year-old deaf girl, was raped.The police asked us to question her about who had donethis to her. She was not able to give an answer. Onereason is that she does not have sign names for everyonearound her. We are now encouraging parents to give everyonewho comes into their lives a sign name. In this way, anyonewho hurt the child could be named and brought to justice.

— Nzeve Deaf Children’s Center, Zimbabwe, Africa

rapesexvagina penis


Ways to help your child understand thatsome parts of the body should be private

Explain to your child that her body belongs to her alone, and thatsome parts of her body are more private than others. Explain thatadults and older children should not touch her genitals or private

parts, and that she should not touchan adult’s private parts, even if askedto. Use dolls, puppets, or pictures, andshow approval or disapproval by yourbody movement and facialexpression.

Also, explain that if someone asks yourchild to watch private things or look at

pictures of private things, that is not okayeither.

When your child is between 3 and 5 years old, teach about genitalsand other private parts of the body, and about the differencesbetween boys’ and girls’ bodies.

These are difficult ideas to teach, so use different methods to try tomake sure your child understands. Teaching can happen naturally,for example while your child is getting dressed. You can also use ormake a doll to teach about body parts.

Here are more activities to help your child be safer from sexual abuse.

ACTIVITIES

How to help your child learn to make noise or yell for helpMany deaf children do not like to usetheir voices. This is because they arelaughed at or told they sound funny whenthey do. Explain to your child that it isokay to shout if someone is bothering himand he needs help.

Teach your child that he should shout ‘No,no!’, or ‘Help!’, or stamp his feet if an adultor older child tries to hurt him. He can alsoscream, bite, and struggle. Use dolls orplay-acting to show him what you mean.

Your bottomis a privateprivateprivateprivateprivatepart of the

body.

If someone hurts you, yellor say ‘no’. Let’s practiceyelling out loud.


How to help your child learn to say noDeaf children often do not understand why they should do or not docertain things, or why things happen to them. They want to pleasepeople, and so they learn to obey without question. This can be aproblem if someone tells them to do something that is wrong.

Ask your child to tellyou or another adultright away if someoneasks him to do anythinghe feels uncomfortabledoing.

Have you ever wanted to stay awayfrom some children because youwere afraid of them?

If you feel thatway, come tellme about it.

Yes.

Help your child practice saying ‘no’. First, try making up situations inwhich a child may want to say ‘no’.

Norma was going toschool. A boy came

and pushed her. Howdid Norma feel?

Mad.

What couldshe do?

Later, talk about saying ‘no’ andwhere your child can get help.

You can say ‘no’ tosomeone who wants to

touch your body. Yell ‘no’over and over and fight

back until they stop.


How to help your child know where to go for helpWho can your child turn to? Allchildren should have at least 3 peoplewhom they can go to with problems.This could be their mother or father,older sister or brother, aunt, neighbor,or any other person both you and thechild trust outside the family, likeanother child’s mother.

Children should know that if oneperson is not available or will notpay attention, they should go tothe next person. Tell thosepeople that you are teaching thechild to go to them for help ifnecessary. Practice with the childhow to go to people for differentkinds of help.

How to help your child understand that he or she doesnot always have to obey bigger people

Where could you go for helpif I am at work? How aboutyour Aunt Rose? Or Lisa’smother? Who else?

To Nana.

Once a child has learned to say ‘no’, you can make up situations inwhich the child does not have to obey adults.

No.Suppose an adult

tells you to gooutside and runafter cars and

buses in the road.Must you do it?

Whynot?


How can I know if my child has been abused?When young children are abused, they may be afraid to tell you.Often the abuser warns the child not to say anything. Sometimes thechild fears he did something wrong. Or he may not know how tocommunicate what happened.

Since children do not always communicate about abuse, you need towatch for possible signs. The following signs are not always theresult of abuse, but they should always cause concern, especially if achild shows several of the signs.

Some physical signs include:

• unexplained pain, swelling, redness or bleeding of the mouth, thegenitals or around the anus area.

• torn or bloody underwear.

• difficulty passing urine or stool, or blood in the urine or stool.

• unusual discharge from the vagina, penis or anus,or a sexually transmitted infection (STI).

• bruises, headaches, or belly aches.

Sexually abused children may:

• stop bathing, or wash themselves more than usual, or refuse toget undressed.

• play sexually with other children or with toys, in a more knowingway or more often than you would expect for their age.

• know more about sex than other children their age.

Child victims of violence, including sexual abuse, may:

• seem very fearful, sensitive and watchful, or suddenly becomeafraid of certain people or places, or want to be onlywith their parents.

• be secretive or want to be alone most of the time.

• start acting in a younger, more baby-like way.

• become more violent and aggressive.

• try to run away from home.

• feel sad most of the time, or show no feelings at all.

• have difficulty sleeping because of bad dreams, fears of the dark,and bed-wetting.

• be afraid of touch or physical activities.


If you suspect abuseTry to stay calm. Encourage your child to show you what hashappened or what she knows.

To get more information, set up play situations with your child. Paycareful attention to what he shows you because he may not haveenough words or signs to explain himself clearly. With your voiceand your expressions, make sure your child knows you believe himand will not punish him.

If your child has been sexually abusedIf your child has been sexually abused, you can help if you:

• believe what she shows or communicates with you. It may bedifficult to believe that someone you know and trust has done thisto your child, but children rarely make up stories about sexualabuse. Some abusers are very friendly to parents. That way theygain better access to the children and it keeps theparents from reporting the abuse.

• praise her for telling you. Children need toknow that they have done the right thingby communicating about the abuse.

• reassure her that the abuse is not her faultand that you are not angry with her. Use asmany different ways of communicating thisas possible.

• protect your child’s safety. Try to prevent futurecontact between the child and the abuser. If thisis not possible, make sure you or someone who knows whathappened is always with your child when the abuser is present.

• treat physical health problems from the abuse. Try to get yourchild tested for sexually transmitted infections, even if she doesnot have any signs. Some sexually transmitted infections do nothave any signs, or the signs do not show until a child is older.

As a parent, you also need help. Parents feel many emotionsincluding disbelief, anger, and sadness when they learn their childhas been abused. Parents may blame themselves or each other forwhat happened to their child. It can help to talk about these feelingswith someone you trust. Be patient with yourself. It may take a longtime for these feelings to change.

There is no shame to the family if a child has been abused. Abuse isa crime — like theft — and was not caused by the family.


To make all children in the community saferMost people are not comfortable talking about sexual abuse,accepting that children are not safe, or discussing the harmful effectsof sexual abuse. Yet sexual abuse can only be prevented if everyonecan talk about it.

Programs in schools and communitymeetings can educate the entirecommunity about sexual abuse.Acting out short plays or skits aboutthe effects of sexual abuse sometimesmakes it easier for people to discussabuse as a group.

Here are some community-wide waysto work on preventing sexual abuse:

• Workshops for parents and teachers to help them learn ways tocommunicate with young children about how to prevent sexualabuse. Read written materials aloud with parents if discussion isnot possible.

• Training for teachers, staff working in schools, doctors andhealth workers so they can notice signs a child may have beenabused, and learn how to talk with a child who may be a victimof abuse. Hold workshops with school staff to discuss the ethics ofworking with children.

• Education for school children to prevent sexual abuse. Thiseducation can also include age-appropriate education on healthysexuality.

• Reporting abuse when it happens can help prevent it in thefuture. Find out what procedures exist for reportingchild sexual abuse and make sure this informationis available to parents, teachers, health workers,and others who may learn about the sexualabuse of a child. Work to create a procedure ifnone exists.

The more people know about the problemof sexual abuse, the more we can prevent itfrom happening to our children.

179

Support for parentsand caregivers

Chapter 14

Because we share our lives with our children, everything thathappens to them affects us deeply. Many families with deaf childrenfeel helpless or fear the future. If parents join together to supporteach other, they can improve the lives of their deaf children. Theycan also work as a group to get their community to better supportall children who have hearing problems.

All over the world, parents and other family members work very hardcaring for their young children. And when a family has a child whocannot hear, there is the extra responsibility of making sure he getseverything he needs to grow well. The extra work will make a bigdifference to the child, but it can be very stressful and tiring for theparents. This chapter has information to help families and caregiversof deaf children find ways to cope with their situation and care forthemselves as well as for their children.

180 SUPPORT FOR PARENTS AND CAREGIVERS

When you first learn your child cannot hear wellLearning that a child cannot hear well or is deaf can be veryupsetting, even for families who have relatives who are deaf orcannot hear well. This is natural. You may have feelings of:

• worry about what to do

• denial

• fears of what it means to bedeaf and fears about the future

• sadness, helplessness, orno feelings at all (depression)

• anger at what has happened

• shame becauseyour child is deaf

• accepting it as fateor punishment We can’t do anything

to change a curse. Itis just our fate.

I feel sohopeless...

What will ourneighbors

think?

My child will hearwell if I just find

the righttreatment.

How will my childget married or earn

a living?

I don’t knowanything aboutdeafness. How

could I possiblyhelp my child?

It’s not fairthat this happened

to my family.

• guilt about what you mighthave done to cause the deafness

If I had eatenbetter during mypregnancy, this

would never havehappened.

• loneliness

No one elseknows what

this is like. Noone can help.

181SUPPORT FOR PARENTS AND CAREGIVERS

Understanding your emotionsParents, other family members,and caregivers will react to theemotions they feel in differentways. It is best to let eachperson feel the emotions in hisor her own way, withoutjudgment.

When you accept that your child cannot hear well, you can begin tolove your child as she is. And, like all children, she will give youmuch support, pleasure, and joy!

Emotions such as worry,loneliness, or fear will become lessstrong as time passes. You will come to realize that a child whocannot hear well has the same needs for love, affection, discipline,and learning as other children.

These emotions will return toyou at important times inyour child’s life, like when shestarts school. This does notmean something is wrong. Itjust means you are goingthrough another period ofadapting to her deafness.

These strong emotions canhelp you take action to makeyour child’s life better. Forexample, loneliness may

encourage you to reach out to deaf adults in your community or toother families with deaf children. Anger may give you energy to helporganize other parents to persuade the government to provideeducation for deaf children.

Look at how much fun theyare having! How did I everthink Delphine would be a

burden to our family?

What if she can’tlearn like the other

children?

Touli feelsangry that thebaby is deaf,

but I feel sad allthe time.


Managing the stress of caregivingBeing a parent of any child is hard work.And if your child cannothear well or is deaf, thenthere is even more work.For example, familiesmust teach deaf childrenthings that other childrenlearn on their own, fromhearing people talk.

CARING FOR CAREGIVERS

Parents and other caregivers will beable to look after children better ifthey also have some time to relax.Simple things — like going to the market,visiting friends or relatives, talking withfriends, having a massage, or beingpart of a community group —can all be helpful. Remember,

you can help yourchildren more

when you feel well.

It can be difficult to findtime and energy for thisextra work. This page and thenext one have some suggestionsfrom families about different waysthat have helped them manage this stress.

too littlemoney

caring fordeaf child

teachingdeaf child

meetinghusband’sneeds

gettingwater, fuel,and food

caring forthe sick

Sometimes it is helpful for a group of parents toget together to talk with each other about anydifficulties they may be having. If some havedifficulty saying things to others in a group,perhaps they can make up songs, poems, orstories about their situation. Drawing andpainting pictures can also help some peopleexpress their thoughts and feelings withoutusing words. They do not have to be ‘real’artists to do this.

Remember to care foreach other. Being aparent is hard work.


exercise ormartial arts

Many communities have beliefs and traditions that help calm thebody and mind, as well as build inner strength. Practicing thesetraditions may help you take better care of yourself.

prayer meditation

Since the newbaby was born,it is so hard for

me to maketime for Carla!

I know just how youfeel. I hardly foundtime even to sleepuntil Mario was a

year old!

You can sendthe older kidsto play at my

house anyafternoon, Eva.


With the help of Los Pipitos and alot of effort at home, we havecome a long way in 3 years. To

other parents I would say, ‘I coulddo it, and you can too! Try!’

A parents’ group changes Irlandita’s lifeA mother in Nicaragua, named Rosa, began to suspectsomething was not right with her daughter Irlandita. Irlanditadid not respond when her name was called, and only reactedto very loud noises.

Worried for her daughter, Rosa took Irlandita to a doctorwhen she was 16 months old. The doctor was very cold to her,and said only, “Your child can’t hear anything. Bring her backwhen she’s 5 years old and we will see if anything can be donefor her.” Rosa left feeling more frightened and lost than shehad been before the visit.

On the way home she met a friend whosuggested that she make an appointmentwith Los Pipitos, a communityorganization. Los Pipitos was started bya group of parents who wanted theirchildren with disabilities to have theopportunity to develop fully.

Although the doctor and staff at Los Pipitos gave Rosa thesame diagnosis — that her daughter was deaf — they alsogave her hope for the future. They explained how with specialhelp and extra support from her family, Irlandita coulddevelop just like a child who hears normally. With the supportof other parents at Los Pipitos, Rosa began to feel confidentthat she could make a difference in Irlandita’s life.

Now Rosa is an active member of Los Pipitos and she worksto give other parents the same help and friendship that sheherself found when she needed it.

Thanks to the support of her family, and the care given atLos Pipitos, Irlandita is an expressive, caring, happy,intelligent, and confident girl. She can communicate and isable to attend a regular school.

Parents’ groups


STARTING A GROUP

If you know there are other parentswith deaf children in your community,but there is no parents’ group in yourarea, it may be up to you to start one.Some of the strongest, most activeparents’ groups began because of oneperson’s idea. As a group, parents can worktogether to solve problems. Parents working togethercan do more than if they each work alone.

• Find 2 or more parents or caregivers who want tostart a group. If you do not know other familieswith deaf children, you may be able to findparents of children with other disabilities. Or a health worker mayknow of parents in nearby communities.

• Plan when and where to meet. It helps to choose a place whereeveryone will be comfortable talking, perhaps a room in a school,health center, cooperative, or place of worship. At the firstmeeting, discuss why you are meeting and what you hope to do.

• Probably one person will be the leader of the first few meetings.But it is important that no one person makes decisions for thegroup. Everyone should have a chance to talk. Try to keep thediscussion focused on the main reasons for the meeting. After thefirst few meetings, take turns leading the group. Having differentpeople lead each meeting will help shy members participate.

Our group sent someone totalk with the National

Association of the Deaf inthe city. Now a field workerwho is deaf regularly visits

our village.

LEARNING TO SUPPORT EACH OTHER

Even when people know each other well, it may take time to feelcomfortable talking about feelings, experiences, and the challengesof raising a child who is deaf or cannot hear well. These things takepractice.

Why should weshare our troubles

with the wholeneighborhood?

Omar, who can helpus better than ourfriends? At least weall can face these

problems together.


Listen carefully to what others say, without judging them. Thinkabout how you want others to listen to you, and then try to listen tothem in the same way.

Try not to tell other people what to do. You can help othersunderstand how they are feeling, and share your own experiences.But everyone must make their own decisions about the best way tocare for their children.

Pearl, I’m not sureI understand what

you are saying.

Can you try toexplain it again?

Vladir gets very angryif we try to change

our daily routine. Doyou have any ideasthat will help us?

Paulo would get soangry at little things

when he was that age.It is easier now.

How did you helpPaulo learn to

control histemper? That issomething we

are facing withour daughter.

Here are some suggestions to help group members feel comfortableand to trust in each other:


Planning for actionParents working together can take action to solve many problems.Here are some useful steps for taking action:

1. Choose a problem that most people in the group feel is important.Although many changes are probably needed, your group may bemore effective if it works on one problem at a time. At first, pick aproblem that your group has a good chance of solving quickly.Then, as the group learns how to work together, you can work onmore complicated problems.

My mothercares for myson now, buther health is

getting worse.

I have a new job in thecity. I can’t find anyonewho wants to take care

of a deaf child.

I need someoneto look aftermy child on

market days.

Respect each person’s privacy. Never tell others what the grouptalks about unless each person says that is okay.

I know that.It’s a relief to

be able totalk freely.

Don’t worry,Eduardo. I would

never repeat whatyou say here.


4. When you meet together, talk about how the work is going. Adjustyour plan as needed if difficulties arise.

Have we foundanyone who knows

sign language?

No, not yet. Notmany people know

sign language.

But Arti is eager tolearn sign and to

care for ourchildren.

2. Decide how you want to solve the problem. List many ways theproblem could be solved and then pick the one that best uses yourgroup’s strengths and resources.

3. Make a plan. Members of the group will need to do differentthings to get the job done. Try to set a date when each task shouldbe finished.

Guddi, you are part ofthe deaf community.

Can you see if there issomeone who is

looking for work whoknows sign language?

I’ll find out howmuch we would need

to pay someone.

I’ll ask Arti ifshe would wantto learn somesigns from me.

We could hiresomeone to take

care of ourchildren. Maybewe can find a

person who knowssign language.

We could take turns. Eachfamily could care for all the

children one day a week.

Arti is lookingfor work.


Building resources — the power of determinationIn a city in South Africa, children with learning disabilities rarelyplayed with other children or attended school. Many parents couldnot work outside the home because the local day care centers didnot want to include their children. The centers told the parentswho approached them, “You cannot tell us what to do!” and “Wehave no facilities for teaching these children.”

A group of parents — all unemployed mothers, many with littleor no formal education — got together and decided they must dosomething for these children and their families. They decided that1 or 2 of them would look after all the children so that the otherswould be free to look for work.

The mothers organized a schedule for caring for the children.One of them volunteered to cook. One became a teacher. Otherslooked for work that they could do at home. Parents whomanaged to find work began to contribute a little to those whocared for the children and to the growing day care center. Oneparent who worked began to buy books for the children.

A social worker heard about the group and came to see whatthey were doing. She was able to get the local government to givesome money to pay the mothers who took care of the children.

With the only resource the mothers had — determination —they were able to establish a day care center for their children,and they were also able to earn a living!

A GROUP WITH FEW RESOURCES CAN STILL MAKE A DIFFERENCE!We believe the whole community — neighborhood, village, city, ornation — is responsible for supporting families with children who havedisabilities. But sometimes it takes parents working together to makethe larger community take that responsibility. As the following storyabout a group of determined parents in South Africa shows, whenpeople cooperate and put their resources together, they can overcomeobstacles and make something where there was nothing!

With these ingredients,those of us who were

caring for the childrenwould cook soup.

We had no funding, nospecial resources. We

agreed that parents wouldsend something with theirchildren — half a cabbage,

a carrot, or a potato —whatever we could

manage.


Some parents’ groups work to improve government programs andlaws for children who are deaf. They contact people in thegovernment, like the ministers of health and education. They tellthem about services theircommunity needs, or aboutlaws needed to protectchildren who are deaf orhave hearing problems.They write letters, passaround petitions, ororganize protests ifgovernment officials do notimprove conditions for theirchildren.

These mothers learned howto sew clothing so theycould earn more money, workcloser to home, and spendmore time with their children.

Working together for changeParents’ groups work on many kinds of projects. They may try toimprove the economic conditions of families, the attitudes ofcommunities, or the government’s laws and services for deaf children— all as a way to help their children. To get more resources for theirchildren, a parents group can:

• find ways to get funding for new projects to help deaf children.

• help parents develop new job skills.

• offer workshops on ways to teach and help their children.

• share information about hearing aids.

• organize sign languageclasses.

• bring hearing and deafpeople together.

Many parents’ groups work to educate the rest of the communityabout deafness. They often work together with people who are deaf.The groups use workshops, radio programs, newsletters, billboards,street theater, and posters to help others understand more aboutdeafness.

191

Why children lose theirhearing and what we can do

Chapter 15

There are millions of children all over the world who are deaf or havehearing problems. Most of them are poor. Out of every 3 childrenwith hearing problems, 2 live in poor countries. Their deafness isoften caused by infection and poor nutrition. For most of thesechildren, deafness could have been prevented by taking care of basicneeds — like good food, clean drinking water, a safe, clean place tolive, and access to health care.

This chapter can help you learn about the causes and medicaltreatments for some hearing problems. To prevent deafness,communities must work together to solve the social causes thatmedicine cannot fix.

Children’s health and hearing benefit when communities have cleanair (free of smoke and dust) and good sanitation, and are free ofviolence. Good health care, including health education,immunizations, and early treatment of illness, is key to protectingchildren’s hearing.

Wrong beliefsSome people believe a child is deaf because the parentsdid something wrong. Other people believe a child is deafbecause someone has done evil to the child’s mother, and thechild is ‘witched’. Neither of these things causes deafness.

He had manyuntreated earinfections.

Her mother didnot have enoughfood when shewas pregnant.

She did nothave enoughiodine in herfood and water.

He hadmeasles.

192 WHY CHILDREN LOSE THEIR HEARING AND WHAT WE CAN DO

Problems in any part of the ear can cause deafness

Problems in the outer ear and middle ear:• ear infections (page 193)

• something blockssound fromtraveling throughthe ear (page 198)

• injury (page 214)

Problems in the innerear and the nerveleading to the brain:• infection during

pregnancy (page 208)

• baby’s brain damagedduring labor or birth (page 212)

• childhood illness such as meningitis (page 201)

• lack of iodine in mother’s food during pregnancy (page 207)

• medicines that damage hearing (page 206)

• deafness passed down in families (page 214)

• damage from loud noises (page 213)

ear canal

ear drum

this tubeconnects tothe noseand throat

nerves tothe brain

INNER EAR

OUTER EAR MIDDLE EAR

How the ear works

The brain then helps a childunderstand what the sound means.

The outer ear picks up a sound.

It travels through the ear canaland ear drum to the middle ear.

Then the inner ear sends the soundto the brain so he can hear it.

The ear is made up of 3 main parts: the outer ear, the middle ear,and the inner ear. The outer ear is the part you can see. The middleand inner ear are inside the head and cannot be seen. All 3 parts ofthe ear are needed for a child to hear.

193WHY CHILDREN LOSE THEIR HEARING AND WHAT WE CAN DO

Ear infectionEar infections are one of the most common childhood illnesses andwithout treatment, they can cause permanent hearing loss. Earinfections often start with an infection of the nose and throat. Theinfection travels from the throat along the tube into the middle ear.

Children get these infections easily because the tube fromthe throat to the ear is shorter than in adults. When theear is infected, the fluid and infection cannot drain out ofthe middle ear. And if a child has a cold, the tube from thethroat that leads to the middle ear often gets blocked. Aschildren grow older and stronger, they develop moreresistance and get fewer colds and throat infections.

SUDDEN EAR INFECTIONS (ACUTE)Sudden middle-ear infection can occur at any age, and is commoneven in babies and infants. The child may cry, be irritable, and have afever. Often the infection gets better in 1 or 2 days without anytreatment. A painkiller will help the child feel better but will not curethe infection. Sometimes an antibiotic is needed to cure the infection(see page 195). The ear drum may burst and pus leaks out through asmall hole. This hole usually heals quickly.

LONG-LASTING EAR INFECTIONS (CHRONIC)When children do not get treatment for repeated sudden ear infections,the infection can become long-lasting. An ear infection is long-lastingif pus drains from the ear and there is discharge for 14 days or more.This can damage the ear drum. The ear drum may become pulledinward or have a hole that does not heal. Both of these problems leadto more infection with discharge.

Without proper and early medical care, children may lose theirhearing, suffer from dizziness, weakness on one side of the face, or anabscess draining behind or below the ear. Rarely, an ear infection mayalso cause a serious complication like a brain abscess or meningitis(see page 204).

More poor children lose their hearing because of earinfections than any other cause. Hearing loss due toear infections can be prevented by improving generalhealth and living conditions, and by access tomedical care. Every community needs people trainedto identify ear infections early, or clinics or hospitalsthat are affordable and easy to get to.


Signs of ear infection:• Pain — a young child may cry, rub the side of

his head, or pull on his ear

• Fever between 37.7° and 40°C (100° and 104°F)

• Runny nose, sore throat, cough

mastoiditisDifferent signs may be present at different times— for example, the pain may stop when fluidstarts flowing out of the ear.

Check the ear in 3 to 4 months after any ear infection, even if there isno pain and check the child’s hearing (see pages 50 to 58).

• Hearing loss — temporary or permanent —in one or both ears

• Sometimes nausea and vomiting

• Sometimes infection spreads to the bonebehind the ear (mastoiditis). This is verypainful and antibiotics must be given.Go to a hospital!

• Fluid may drain from the ear. It may be yellow,white, watery or sticky. The fluid may have someblood in it. A heavy flow of sticky, clear fluid isprobably from a hole in the ear drum. This fluidmay stop with medicines, but it can happen everytime the child has a cold, or puts his ears underwater or swims.

A slight fluid discharge that smells and may beyellow or green is probably from damage to the eardrum. An operation may be needed to repair theear drum.

Glue earSometimes after sudden ear infections, thick and sticky fluid collectsin the middle ear (this is called glue ear). Glue ear does not usuallyhurt and drains away down the tube to the nose after a few weeks,but sometimes it lasts for years. Glue ear often affects both ears and itmakes the child partially deaf as long as it lasts. Most cases of glueear will heal without treatment. But if there is anypain, give an antibiotic by mouth as for acuteinfection (see pages 195 to 196).

fluid


To treat sudden (acute) ear infections

For pain and fever:• give paracetamol (acetaminophen) by mouth

3 to 4 times a day as needed.

age 3 months to 1 year ................. 60 to 120 mg

age 1 to 5 years .............................. 120 to 250 mg

age 6 to 12 years ............................ 250 to 500 mg

• give ibuprofen by mouth.

age 1 to 2 years .............................. 50 mg, 3 to 4 times a day

age 3 to 7 years .............................. 100 mg, 3 to 4 times a day

age 8 to 12 years ............................ 200 mg, 3 to 4 times a day

Note: Do not give ibuprofen to children younger than 1 year oldor who weigh less than 7 kg.

For the infection:• give amoxicillin by mouth, for 3 to 10 days.

age 2 years or less .......................... 125 mg, 3 times a day

age 3 years or more ....................... 250 mg, 3 times a day

• give amoxicillin with clavulanic acid as syrup (preferably sugar-free)by mouth, for 5 days.

age less than 6 years ..................... amoxicillin 125 mg withclavulanic acid 31 mg, 3 times a day.

age 6 to 12 years ............................ amoxicillin 250 mg withclavulanic acid 62 mg, 3 times a day.

or

or

When willhe feelbetter?

Make sure yougive all the

antibiotic or theinfection may

come back.

The ibuprofen willhelp his pain right

away while theantibiotic treatshis infection over

the next week.

(If syrup is not available give half a tablet of amoxicillin250 mg with clavulanic acid 125 mg, 3 times a day.)

(If syrup is not available give 1 tablet of amoxicillin250 mg with clavulanic acid 125 mg, 3 times a day.)

TREATING EAR INFECTIONS


If there is fluid draining from the ear, wipe it away, but do not stickanything in the ear to clean it. Encourage the child to rest anddrink a lot of liquids. The child can bathe, but should not put his earsunder water or swim for at least 2 weeks after he is well.

If you think the child may have a complication, take him to a hospital.If you suspect meningitis, give medicine immediately (see page 204).

If the child is allergic to penicillin or the treatment is not working:• give co-trimoxazole (trimethoprim + sulfamethoxazole)

by mouth, for 3 to 10 days.

age 6 weeks to 5 months ............... 120 mg, 2 times a day

age 6 months to 5 years ................ 240 mg, 2 times a day

age 6 to 12 years ............................ 480 mg, 2 times a day

• give cefuroxime by mouth, for 5 days.

age 2 years or less .......................... 125 mg, 2 times a day

age more than 2 years .................. 250 mg, 2 times a day

• give cefaclor by mouth, for 3 to 10 days.

age 1 month to 1 year ................... 62.5 mg, 3 times a day

age 1 to 5 years .............................. 125 mg, 3 times a day

age more than 5 years .................. 250 mg, 3 times a day

• give erythromycin by mouth, for 3 to 10 days.

age 1 year or less ........................... 125 mg, 4 times a day

age 2 to 8 years .............................. 250 mg, 4 times a day

age more than 8 years .................. 250 to 500 mg, 4 times a day

or

or

or

To treat long-lasting or repeated (chronic) ear infections(discharge for 2 weeks or more)• Give antibiotic ear drops for 1 week (2 to 3 drops, 3 times a

day) such as ciprofloxacin, framycetin, gentamicin,gramicidin, neomycin, polymyxin B, or ofloxacin.

Sometimes it helps to give an antibiotic by mouth at the same time as theear drop. Use the same antibiotic as for sudden ear infection (see page 195).

Antibiotic drops should not be used for longer than 10 days, or repeatedfrequently, as they can cause hearing loss themselves. But chronic earinfections are more likely to cause hearing loss than antibiotic drops.

Other treatments for sudden (acute) ear infections


If the discharge continues or returns, or ifantibiotic ear drops are not available:• give antiseptic ear drops such as vinegar (see page 201) or

povidone iodine (betadine).

for all ages ...................................... 2 drops in the ear, 2 times a dayfor 2 weeks

then give ......................................... 2 drops in the ear, 1 time a day(before going to sleep), for severalweeks or months

PREVENTING EAR INFECTIONS

To prevent ear infections, breastfeed babies —for up to 2 years if possible. Breast milk helps ababy fight infection. Breastfeeding also helpsstrengthen the muscles that keep the tubesbetween the throat and middle ear open.

Repeat the same treatment if infection and discharge occurs again. Ahealth worker or doctor can teach parents to clean out the dischargewith cotton wool before each dose of ear drops.

Keep all water out of the ear. Carefully dry the ear two times dailywith cotton wool or gauze for several weeks (until it remains dry).

Sometimes an operation is needed to repair the ear drum. This is doneby a specially-trained health worker in a hospital, usually when thechild is at least 10 years old.

HIV/AIDS and breastfeeding

If a woman has HIV/AIDS, sometimes this disease can pass to ababy through her breast milk. But if she does not have access toclean water, her baby is more likely to die from diarrhea,dehydration, and malnutrition than from AIDS. Only a mothercan evaluate the conditions in her home and community anddecide what to do.

Babies older than 6 months have less danger ofdying from diarrhea because they are bigger andstronger. A woman with HIV/AIDS who hasbreastfed her baby should stop at 6 months andfeed him with other milks and foods. This way thebaby will have less risk of getting HIV/AIDS.


Something blocks sound from traveling throughthe earChildren can lose their hearing temporarily when something like hardear wax or another object blocks sound from traveling through the ear.

EAR WAX PLUGS

Ear wax helps to prevent infection. It forms a protective layer on thedelicate skin in the ear, helps keep the ear clean, and makes the skinwaterproof. Usually, the wax gradually moves out of the ear, carryingwith it trapped dirt and dust, but sometimes the wax builds up,

hardens, and becomes stuck. This can happen because ofcleaning ears with cotton buds (small sticks with cotton onthe ends) or other objects that push the wax deep into theear canals. This hard plug of ear wax keeps sounds fromtraveling easily through the ear and can cause aninfection. Ear wax can also be a problem for childrenwho use hearing aids, so these children’s ears shouldbe checked regularly and their hearing aids shouldbe cleaned if necessary.

Signs:• A child seems to hear less well than usual.

• Sometimes you can see the plug of hard wax in the ear.

• Sometimes the wax plug or infection around it may cause thechild to have an earache with pus draining out.

A small amount of wax is normal and should not be touched.

• Teach a child to wipe his nose instead of blowing it.If he does blow his nose, he should do it gently.

• As much as possible, keep children away from smoke, includingsmoke from stoves and cooking fires. Smoke can make the tubebetween the throat and middle ear swell and close. Then fluidbuilds up in the middle ear and it can get infected.

• When your child has a cold, find out if he also has ear pain. Asmuch as possible, keep your child away from people with colds.

Other ways to prevent ear infections• If a baby has to be fed from a bottle or a cup, be

sure to keep his head higher than his stomach asyou feed him. If he lies down while feeding, themilk can flow from his throat into the tubes andinto his middle ears, helping to cause infection.


INSECT IN THE EAR

Signs:• The child may say he can feel or hear

scratching, crawling, or bumping in the ear.

• Fluid or pus may drain from the ear.

• A child may hear less well than usual in the affected ear.

For an insect in the earFill the ear with clean mineral or vegetable oil. The insect may drown andthen float out. If this does not work, try to wash the ear in the same wayas for removing wax.

For ear waxIf there is no pain, fever, or discharge from the ear, too much wax or awax plug can be removed by washing out the ear with warm water.

1. First, soften the wax by putting several drops of warm, mild vegetableoil into the ear. Keep the child lying down on her side with her ear upfor 15 minutes.

2. Next, wash the ear well by pouring several cups ofclean, warm (not hot) water into the ear with a spout.If this does not work, use a syringe with no needle(preferably 20 ml size) or a rubber bulb syringe tosquirt the warm water into the ear.WARNING: Do not squirt water in the ear ifthere is fluid draining from the ear!

• Remove the needle from the syringeand fill the syringe with warm waterfrom a cup.

• Gently pull the ear away from the head. Carefully squirt the waterinto the ear canal. Do not point the syringe directly down the eartoward the ear drum. Point it sideways toward the back wall ofthe ear canal. Stop if your child starts to feel dizzy.

With a bulb syringe, do not put the tip far or tightly into the earcanal. Try to keep the tip steady in the ear while squeezing the bulb.

Repeat this 3 times a week for 2 weeks and then once again after1 or 2 weeks. Doing it more often can damage the ear.

Get medical advice for a hard plug of wax that does not dissolve easily.


Prevention:Older children can help care for their brothers’ and sisters’ ears bychecking regularly to see if there is a lot of wax (or pus, or any objects)inside. Ask them to tell you right away if they see anything wrong.

Teach them never to put their fingers or anything else in the ear to tryand remove objects or wax. This can push the material in farther anddamage the ear drum. Prevent children from scratching inside the earwith anything, as it can cause infection.

Keep children’s ears dry. After swimming or bathing, teach children toshake their heads gently to clear the water out. If possible, childrenshould not swim or bathe in dirty or polluted water. If a child has hadinfections before, try putting a few drops of rubbing alcohol or vinegarinto his ears after swimming or bathing.

INFECTION OF THE EAR CANAL CAUSED BY

OBJECTS OR WATER IN THE EAR

Infection in the outer ear can be caused by insects, wax, water, orother material getting into the ear, or if a child scratches inside theear with something (like a small stick). This infection of the ear canalis more common in adults than in children.

Signs:• Pain — if wiggling the outer ear causes pain,

there is probably infection in the outer ear.

• Itching in the ear

• A blocked or full feeling in the ear

• The ear canal may be swollen.

• A child may hear less well in the affected ear.

For objects in the earChildren sometimes put small objects into their ears. If the object is soft, andif a health worker or you can easily reach behind the object with a smallwire hook, try carefully removing it.

Do not use tweezers or anything that may push the object farther into the ear.

If the object is hard, like plastic or metal, then try to wash it out with warmwater, just as for wax. Do not do this for vegetable objects like seeds, becausethey swell when they get wet and become more difficult to remove.

Stop if the object starts to move further into the ear or if your childcannot keep still. You could damage the ear canal or the ear drum.


Childhood illnessesInfection during childhood by diseases such as malaria, measles,mumps, or meningitis can damage the hearing nerve. Sometimes onlyone ear is affected, but meningitis usually affects both ears. For moreabout these illnesses, see Hesperian’s book Where There Is No Doctor.

Prevent childhood illnesses with immunizationsImmunize children against all the childhood diseases —especially those that can cause deafness, such as measles,mumps, and rubella (German measles). Vaccinations are usuallygiven free. It is better to take your children to be immunizedthan to take them for treatment when they are sick or dying.

If health workers do not immunize in your village, take yourchildren to the nearest health center to be immunized. Or worktogether with other people in your area to bring health workersto your community. Immunizations save lives and hearing —they should be made easily available.

For infection of the ear canal caused byobjects or water in the earMix 1 spoon of vinegar with 1 spoon of boiled water (cooled untilwarm). Put drops of this solution into the ear 3 or 4 times a day.

If there is fever or swelling around the ear:give ampicillin, amoxicillin, or penicillin (same dosage as forsudden ear infection, see pages 195 to 196).

It is best to take the child to a hospital immediately. But if you cannotand if there is no improvement in 2 days then change to amoxicillin withcloxacillin (same dose as amoxicillin on page 195, but 4 times a dayinstead of 3), or erythromycin (see page 196 for dose). Use for 5 to 7 days.

If there is a lot of wax or anything else in the ear:Wax can be removed by washing with warm water (see page 199). The earmust be kept as dry as possible afterward.

If infection or itching continues after the bad pain goes away:put 2 or 3 drops of gentian violet (2% in 70% alcohol) in the earonce a week for 2 or 3 weeks.

Note: A child can bathe, but should not put his ears under water or swimfor 2 weeks after the infection is gone.


MEASLES

Measles causes ear infections in many children. Measles may damagethe inner ear and also may cause a middle ear infection with an ear

discharge and hole in the ear drum. A few children also getencephalitis, an inflammation of the brain that can lead tofits, and can leave children deaf.

Sometimes there are black spots caused by bleeding into theskin. This means the infection is very severe. Get medical help.

Prevention:Children from other families should not go to a house where someonehas measles. They should stay away from children with measles andtheir brothers and sisters. To prevent the illnessfrom spreading, children in a family wheresomeone has measles should not go to school,stores, markets, or other public places for10 days, even if they are not sick themselves.

Children who are weak, poorly nourished, orwho have tuberculosis or HIV/AIDS need tobe carefully protected from measles. It isespecially dangerous for them.

Treatment for childhood illnessesChildren should stay in bed, drink lots of liquids, and eat nutritious food.If a baby cannot breastfeed, give breast milk in a spoon.

For feverGive paracetamol (acetaminophen — see page 195).

If fluid starts draining from the earGive an antibiotic by mouth as for sudden infections (page 195).

If signs of chronic ear infection developSee pages 196 to 197.

If the child has diarrheaGive rehydration drink in small sips, 1 glass for each watery stool.

In 1 liter of clean water mix half a teaspoon of salt with 8 teaspoons ofsugar. Or make a watery porridge with 1 liter of clean water, half ateaspoon of salt and 8 heaped teaspoons of powdered cereal (rice flour,maize flour, wheat flour, sorghum, or cooked and mashed potatoes).

If signs of pneumonia, meningitis, or severe pain in the ear orstomach develop, get medical help.

No school foryou, Lan, until

Thuy is allbetter.


MALARIA

Children who are seriously ill with malaria can become deaf. Malariais an infection of the blood, spread by mosquitoes, that causes chillsand high fever (40°C or 104°F or more). Sometimes this deafness maygo away within 2 to 3 days. But children who have been sick withmalaria are weaker and get ear infections more easily, which can alsocause deafness.

Prevention:• Cover sleeping children, or use mosquito nets or a thin cloth over

beds and cradles. Nets treated with insecticide work best.

• Reduce standing water, which is the breeding ground for themosquitos that pass malaria. Clear away cans, pots, or old tiresthat collect water. Drain, fill, or release fish into pools of water, ormarshes. Fill the tops of bamboo posts with sand.

• Prevent or reduce the effects by taking anti-malaria medicines.

If malaria is suspected, get treatment quickly. This will keep malariafrom being passed to others.

To treat malaria• In areas where malaria is common, treat any unexplained fever as malaria.

• When children have repeated fevers or if you suspect malaria, seea health worker, and if possible go to a health center for a bloodtest. In areas where an especially dangerous type of malariacalled falciparum occurs, seek treatment immediately.

• If a child who may have malaria begins to have convulsions(fits) or other signs of meningitis (see the next page) he mayhave cerebral malaria. Get medical help immediately.

Note: The treatment for malaria is different in different places. Medicinesthat work well in one place may not be effective in another place. Find outfrom a health worker which malaria medicine works best in your area. Somemedicines used to treat malaria can also cause deafness (see page 206).

MUMPS

Mumps infection begins with fever, and pain when openingthe mouth or eating. In 2 days, swelling develops on the side ofthe neck. Sometimes mumps can cause severe hearing loss, usuallyin only one ear. The swelling goes away after about 10 days, withoutneed for medicine. For pain or fever give paracetamol (acetaminophen).Feed the child soft, nutritious foods and keep his mouth clean.Get medical help if signs for meningitis appear (see page 204).


To treat meningitis while taking the child to a hospitalInject one of the following 3 medicines in the muscle or in thevein. Injections in the vein should be done only by a well-trainedhealth worker. If a health worker is not available, it is best toinject the child in a muscle.

• ceftriaxone

give 50 mg to 100 mg for every kilo of body weight, 1 time only

• benzylpenicillin

age less than 1 year .................300 mg (500,000 units), 1 time only

age 1 to 9 years ........................600 mg (1,000,000 units), 1 time only

age 10 years or more ...............1.2 g (2,000,000 units), 1 time only

• cefotaxime

age less than 1 year .................12.5 mg to 50 mg (for severe infection) perkilo of body weight, 4 times a day.(A 10 kg child needs at least 125 mg andup to 500 mg per dose.)

age 1 to 9 years ........................25 to 50 mg per kilo of body weight,4 times a day. (A 20 kg child needs at least500 mg and up to 1000 mg per dose.)

Lower a high fever with wet cloths and/or paracetamol (see page 195).

Signs of meningitis:The signs of meningitis are severeheadache and fever. The child maybe sleepy and have fits or jerks.Sometimes there is vomiting and arash. A child with meningitis mayfaint (quickly go unconscious).

Get medical help fast —every minute counts.Take the child to the hospital!

soft spot bulges up(babies under 1 year)

stiff neck

back arched,knees forward

or

or

MENINGITIS

Meningitis (brain fever) is a serious infection of the brain that canspread to the ear nerves and cause deafness. Or ear infections canspread towards the brain and cause meningitis. Meningitis may beginafter another childhood illness, such as measles, mumps, whoopingcough, or an ear infection. It may also be caused by a virus.


HIV/AIDS

Children with HIV/AIDS have low resistance to infections. Theirlower immunity leads to increased risk of infections such ascytomegalovirus (CMV), syphilis, tuberculosis (TB), and some typesof meningitis. All these illnesses can damage the ear. See the bookHIV, Health, and Your Community, published by the HesperianFoundation, for ways to prevent HIV/AIDS.

Note: Chloramphenicol should be used only for severe, life-threateninginfections such as meningitis. In very severe cases chloramphenicolmay be given as well as benzylpenicillin.

JAUNDICE

Sometimes a baby becomes yellow soon afterbirth. This is a sign of jaundice. If the baby isenergetic and breastfeeding well, a littleyellow color is normal between 2 and 5 daysold — the mother should keep breastfeedingoften and let the baby get plenty of sun.The jaundice may be more severe if theyellow color starts from the first day afterbirth, if it extends to the hands and feet, orif the baby is unusually sleepy and suckspoorly. Get medical help. Severe jaundice canbe dangerous, and may also cause hearing loss.

If other medicines are not available• give chloramphenicol by mouth, if possible. If not, by injection in

the muscle or the vein, changing to by mouth as soon as possible.

age less than 2 weeks .................... 6.25 mg per kilo of body weight,4 times a day. (A 4 kg baby shouldget 25 mg per dose.)

age 2 weeks to 1 year of age ......... 12.5 mg per kilo of body weight,4 times a day. (A 10 kg child shouldget 125 mg per dose.)

age 2 years or more ....................... 12.5 to 25 mg per kilo of bodyweight, 4 times a day. (A 10 kgchild should get between 125 mgand 250 mg per dose.)


Medicines that damage hearingSome medicines can damage the hearing of children whotake them. Several medicines can cause hearing loss inunborn babies when the medicine is taken by thepregnant mother. The risks with these medicines areincreased if the child or the mother also has kidneydisease. Some common medicines that damage hearing are:

• Some powerful antibiotics that contain aminoglycoside cancause deafness in children (such as amikacin, garamycin,gentamicin, kanamycin, neomycin, netilmicin, streptomycin, ortobramycin). This can happen when the child himself is giventhe antibiotic, or when his mother was given the medicineduring pregnancy. These antibiotics usually have to be injected.They should be used only for serious infections that could causedeath.

• Children under 12 should not take aspirin. For pain and feverchildren can take paracetamol (acetominophen). Aspirin candamage the hearing when taken at higher than normal doses. Itcan also cause temporary deafness and buzzing in the ear(tinnitus) but these usually stop soon after stopping the aspirin.

• Quinine and chloroquine (which are used to treat malaria) canboth sometimes damage hearing in the person taking them.

• If a mother uses thalidomide in pregnancy (to treat cancer,leprosy, or conditions associated with HIV/AIDS), it can causemany severe defects in a baby, including hearing problems.

Traditional ear medicinesTraditional medicines and treatments are sometimes used totreat ear problems. Some traditional treatments can beharmful. Here are some general things to rememberabout traditional cures for health problems:

• Never use human or animal excrement as acure. It can give the person an infection.

• The more the cure looks like or resembles the sickness, themore likely its effect comes only from people’s belief in it.

• Ears are very fragile. Do not put anything very hot in or nearthe ear. It can also be dangerous to pour liquids or put thingsin the ear.


Let’s see if we can find anantibiotic that is safe for

you and and and and and your baby.

Women’s health can damage or protectchildren’s hearingIt is important that girls and women, especially pregnant women,have enough good food and access to health care. A baby can beborn with hearing loss because:

• his mother was sick or did not eat well as a young girl,or during her pregnancy. For example, a baby born to a motherwho did not get enough to eat can often be born earlyor have low birth weight and his hearing can bedamaged.

• sickness or poor nutrition caused problemsduring birth. For example, if a woman has asmall pelvis from poor nutrition, her baby mayget stuck during birth. This could causehearing loss from brain damage.

• some infections can pass from the mother tothe baby during pregnancy and damage thebaby’s hearing. These infections includerubella (German measles), tuberculosis,cytomegalovirus (CMV), and syphilis.

Prevention:• Help mothers avoid using medicines

during pregnancy that can causedeafness in children. Pregnantwomen should always consult adoctor or health worker beforetaking medicine duringpregnancy.

• Tell a health worker immediatelyif you think a medicine isaffecting hearing.

• Do not allow untrained peopleto inject antibiotics.

• Do not inject powerfulantibiotics like gentamicin unlessit is necessary to save a life andthere are no other medicines available.


A child with iodine deficiency may be mentally slow, deaf, unable tospeak, and have weak neck and leg muscles. Many children only

suffer hearing loss, some weakness in the legs, and areslow to learn. But others may have noses with a flat widebase, squinting eyes, hair low on the forehead, puffyeyelids and face, and have physical problems such asgrowing 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 iodinedeficiency grow better, though it will not help a child hear better.

The whole community, including the affected child, needs iodinesupplements, but this will not help any nerve or brain damage thathas already occurred.

goiter

LACK OF IODINE IN THE DIET DURING PREGNANCY

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

Prevention:Goiter and iodine deficiency are easy and cheapto prevent. Women must get iodine beforebecoming pregnant. Taking iodine after thefirst few weeks of pregnancy is too late.

• The easiest way to get enough iodine is touse iodized salt instead of natural or rocksalt. You can find packaged iodized salt inmost places.

• Iodized oil taken by mouth is available insome countries. You need to take only1 dose every 1 to 5 years.

• If iodized salt or iodine-rich foods are hard to get, you can makean iodine solution at home with Lugol’s iodine. This is anantiseptic that is often available where medicines are sold.

Foods from the ocean, aswell as liver, egg yolks,and onions, can be goodsources of iodine.


TUBERCULOSIS (TB)Children of mothers who have tuberculosis during pregnancysometimes get a type of meningitis called ‘tubercular meningitis’ inthe first few months of life. This can cause deafness.

To treat tuberculosisIf anyone in the family might have tuberculosis, seek medical help andsee that the whole family is tested for TB. Begin treatment at once. Manygovernments give the medicines for free. Early and full treatment is thekey to prevent the spread of TB. For more information on treatingtuberculosis see Where There Is No Doctor or another general health book.

Prevention:• Immunize children against tuberculosis with the BCG vaccine.

• Everyone, especially children, should eat plenty of nutritious foods.

To make an iodine solution to drink:Add 1 drop of Lugol’s iodine to 1 glass of clean drinking wateror milk. Drink this once a week. Store iodine at roomtemperature and in dark containers to protect it from light.

Prevention:• Give rubella vaccination to girls before

they are old enough to have babies. Ifvaccination is not available, let young girlsbuild a resistance to rubella before they are old enough to havechildren. They can visit people in the community who haverubella. They may catch the infection and develop resistance.

• If girls and women have not been vaccinated or have not hadrubella by the time they are old enough to have children, theyshould prevent deafness in their babies, if they are or might bepregnant, by staying away from people with rubella.

RUBELLA (GERMAN MEASLES)Rubella usually causes only a slight rash and gives the person noother problems. But if a woman who is pregnant gets rubelladuring the first 3 months of pregnancy, her child maybe born deaf or with other serious problems.


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

If there is any chance that someone, especially a pregnant woman or achild, may have syphilis, she should immediately see a health worker.Special blood tests and other tests may be needed. If the person cannotgo to a health center or hospital, give the treatment for syphilis.

If allergic to penicillin and over 8 years old (and not pregnant)

For children and adults who have had syphilis for less than 2 years:• give doxycycline, 2 mg for every kilo of body weight (to a maximum of

100 mg) by mouth, 2 times a day for 14 days.

For children and adults who have had syphilis for more than 2 years:• give doxycycline, 4 mg for every kilo of body weight (to a maximum of

200 mg), by mouth, 2 times a day for 28 days.

WARNING: Pregnant women must not use doxycycline.

SYPHILIS

Syphilis is a sexually transmitted infection that can be passed frommother to baby during pregnancy and cause loss of hearing. Withouttreatment, syphilis can invade any part of the body. It can damagethe inner ear and the nerves that affect hearing and cause deafness.

For children and adults who have had syphilis for less than 2 years:• inject benzylpenicillin (also called penicillin G or crystalline

penicillin) in the muscle. Give 1.2 million units (720 mg) ineach buttock, 1 time only (a total dose of 2.4 million units or 1.44 g).

• inject procaine benzylpenicillin in the muscle. Give 1.2 million units(1.2 g) every day, for 10 days.

For children and adults who have had syphilis for more than 2 years:• inject benzylpenicillin in the muscle. Give 1.2 million units (720 mg)

in each buttock, once a week for 3 weeks (2.4 million units per dose).

• inject procaine benzylpenicillin in the muscle. Give 1.2 million units(1.2 g) every day for 3 weeks.

To treat syphilis (not neurosyphilis)

or

or


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

For children younger than 2 years:• inject benzylpenicillin slowly into the muscle or into the vein.

Give 25,000 units (15 mg) for every kilo of body weight2 times a day for 10 days.

• inject procaine benzylpenicillin slowly into the muscle.

Give 50,000 units (50 mg) for every kilo of body weight1 time a day for 10 days.

For children 2 years and older:• inject benzylpenicillin slowly into the muscle or into the vein.

Give 200,000 to 300,000 units (120 to 180 mg) for every kilo ofbody weight (up to a maximum of 2.4 million units or 1.44 g)1 time a day for 14 days.

or

See the books Where There Is NoDoctor or Where Women Have No Doctor,published by the Hesperian Foundation, for more information aboutsyphilis.

Note: If a child has syphilis, the child’s mother and her partner will alsoneed treatment.

To cure syphilis completely, thefull treatment is essential.

Hearing loss caused by syphilis maydevelop when the child is an infant,or later as a teenager. Treatingsyphilis will not fix any hearing lossthat has already occurred, but itwill prevent any hearing loss thatcould still be caused.


CYTOMEGALOVIRUS

Most people with cytomegalovirus (CMV) are not sick. But babies ofmothers who become infected during pregnancy can have severedeafness, blindness, or physical and mental disability. The germs thatspread 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 borndeaf. The baby’s brain can be damaged if there is not enough oxygenreaching it. This is more likely to happen if labor is very long, if thebaby is in a difficult position for birth, or if there are twins.

To prevent brain damage during birthMidwives and others caring for pregnant women can learn about thedanger signs during pregnancy and labor when a woman must getmedical help at a hospital. Community members can organize tomake sure there are ways to get women to the hospital if there is anemergency.


Loud noises and injury can damage hearingSome children lose their hearing because of very loud sounds orbecause of injury to their ears.

LOUD NOISES

Very loud noises — like bombs, gunfire, firecrackers, loud machinery,and loud music — can damage the inner ear and cause hearing loss.The amount of hearing loss depends on how loud the sound is, howlong it lasts, and how often a child hears it. In countries affected bywar, many children lose their hearing because of bombs, landmines,and gunfire. Noise damages the nerves in the inner ear. Explosionscan damage the ear drum.

Prevention:Try to keep your child away from loudnoises as much as possible. If youcannot, try to protect his ears.Use something thick to coverhis ears, like a thick blanketwrapped around his head, orthick ear muffs. You alsoneed to protect your own earsfrom noise!

• Get medical help right away if the labor is taking too long, if thebaby is in a difficult position, or if the cord is around the baby’sneck. For more information about safe birth, see A Book forMidwives published by the Hesperian Foundation.

Do not give injections thatmake labor go faster.

NO!

Do not push forcefullyagainst the womb.

NO!

• Some methods to make labor go faster can damage the baby’sbrain, which can cause deafness. To protect the baby, avoid theseways to make labor go faster:


INJURY

A child can cause infection or poke ahole in the eardrum if she puts asharp object (like a matchstick,feather, or pencil) in the ear. If thehole is very small, the ear drumusually heals and a child’s hearingwill return to normal. But if the ear drum isbadly damaged, it may not heal, and thechild’s hearing may be lost or reduced inthat ear.

Slapping or punching a child on theside of her head across her ear canburst her ear drum and causedeafness.

Head injuries with skull fractures cancause severe hearing loss. Bombexplosions and other very loud noisescan burst the ear drums.

Prevention:• Teach children not to put things in their ears.

• Never hit a child on the head, and work to reduce family violence.

No, Nina!Give me

that!

War causes more and morechildhood disabilityWe must all work toreduce the use ofviolence and war tosolve political problems,and ban weapons thatkill, disable, orphan,and make homelessthousands of childreneach year.


Hearing loss that is passed downin familiesSome children’s ears do not develop fully.This genetic problem is passed down infamilies — inherited from other familymembers and from earlier generations —although no one else in the family may showsigns of deafness.

Prevention:Avoid marriage between blood relatives suchas cousins. Genetic counselors (people whoknow about the risk of certain diseases beingpassed from parents to their children) areavailable in some cities. Try to talk toa health worker if you areconcerned about hearing loss inyour family.

This is my sonPratap. He is deaf,and so is my uncle.

Will ourother

babies beborn deaf,

too?

Hearing loss because of intermarriageSome kinds of hearing loss can happen becauseof intermarriage between blood relatives, suchas first cousins. In many village communities,intermarriage is common. Parents who arerelated to each other very closely can havechildren with hearing problems. If you, yourchildren, or your family members have problemshearing, other children born later may also havehearing problems.

Sometimes a child who has an inherited hearing lossmay also have other problems, such as problems seeing;different-colored eyes or white streaks in the hair; goiter or hearttrouble; or abnormally-shaped bones of the head, hands, feet, arms,legs, or neck. But sometimes the only inherited problem is thehearing loss. Deafness may be partial or full, and may be from thetime of birth, or may develop later.

Grandfather wasdeaf, just like

Lihua. I wonderhow much deafnessthere has been in

our family...


Ruk’s storyWhen Ruk was born in a village in Nepal, his mother struggleda long time to give birth. At first she thought her baby wouldnot breathe. As a baby, Ruk would cry at night and he alwaysseemed to have a cold or fever.

Ruk played on the mud floor and outside the house where hisfamily spread the millet and corn to dry and separated the ricegrain from the chaff and dust. Chickens, goats, and their doglived in the same small area. Ruk loved to sit and watch hismother cook at the open stove, even though the wood smokestung his eyes and made his nose run.

As Ruk grew older, he always seemed to have a runny nose.Sometimes he had very painful earaches in both ears, which

often drained pus. He loved to swim in the small riverbelow the village, but this made thepus drain even more.

When Ruk started going to school, he was slow to learn andnot very good at reading. The teacher got angry because hethought Ruk was ignoring what he said. But it was hard for Rukto hear the teacher. So, to avoid getting into trouble, Ruk sat atthe back of the class. Children teased him. He spoke in a funnyway and was difficult to understand.

Finally Ruk’s parents decided it was not worth spendingmoney to pay for his school uniform, books, and pens if he wasnot going to learn. So Ruk stopped going to school. Instead, hecarried wood for the fire, fed the animals, and scrubbed thecooking pots for his mother.

One day, Ruk got a terrible earache that lasted for severaldays. His ear filled with pus and he developed aswelling behind the ear. Finally his father tookhim to the village herbal healer, but themedicines did not take away the swelling. Hisfather had to carry Ruk to the health postin another village. The health workerthere drained an abscess behind Ruk’sear and gave him an injection and someantibiotic syrup to take for a week.

Working for change


WHY DID RUK STOP GOING TO SCHOOL?Ruk had really wanted to go to school and learn like the otherchildren. Children who lose their hearing become disabled whenteachers, family, and friends do not know how to communicate withthem. If the school and the teacher knew that Ruk could not hearwell they might have tried to communicate differently with him.They might even have helped other children understand that earinfections can cause children to lose their hearing. If the school hadaccepted Ruk and helped him to learn, he would have made friendsand had a better future.

He had many fevers andcolds. And his familydidn’t know that ear

infections coulddamage his hearing.

I’ll bet the smokeand the dust madehis nose run and

made his ear worse!

There was nohealth workernearby to tell

them what to do.

Sandra, whydo you thinkRuk lost his

hearing?

Maybe he lostsome hearing

during hisdifficult birth.

After some time, Ruk had severe pain again. Both his earsalways smelled bad and lots of pus came out of them. His neckgot swollen and he had very high fever. The health worker toldthem to take Ruk to the hospital in the city. Ruk’s parents hadlittle money and did not know where they would stay, but theyfollowed the health worker’s advice.

Ruk almost died because the infection got into his brain andbloodstream. At the hospital, they gave him a lot of medicinesbut he was still very ill. Luckily, a visiting ear doctor drained thepus from the abscess, removed a lot of infected bone, andrepaired his ear drum. The doctor explained how to take care ofRuk’s ears and said Ruk should use a hearing aid. Ruk’s parentsjust looked at the doctor and nodded.


PEOPLE CAN CHANGE THE CONDITIONS THAT MAKE CHILDREN

LOSE THEIR HEARING

There is power in communities working for change. Here aresome examples:

• People can organize local or national immunization campaignsagainst common childhood illnesses. Health workers can usesimple health education materials with parents, children,teachers, and others.

• Health workers, teachers, and child care workers can be trained torecognize, treat, and prevent chronic ear infections and othercauses of hearing loss in children.

• People can demand that the government make affordablemedicines available to treat childhood illnesses, including earinfections, and that pharmacies and clinics in their communitieskeep them in stock.

• People can also work together to remove the communicationbarriers that make deafness a disability. They can learn signlanguage themselves, and they can work to provide educationalopportunities for children who cannot hear well.

Improving the well-being of the whole community will help preventand heal many of the problems that cause hearing loss. When acountry’s wealth is shared for the good of all its people, everyone — menand women, mothers and children — can have adequate health care,good roads and communication to receive medical attention whenneeded, and enough good food and clean water to help them growstrong and stay healthy.

Yes, but if the health workerhad come to the village andtaught everyone the causes

of deafness, they would haveknown what to do.

And if themedicines werecheaper, they

might have gottenthem sooner.

Ruk’s parents shouldhave visited the

health worker beforehe lost his hearing.

Maybe the village couldorganize a way to get sick

children to the hospitaleasily when they need it.

If we could growmore vegetables to

eat, the childrenmight not get sick

so much.

219

Hearing aids

Appendix A

A hearing aid is a small piece of equipment that makes soundslouder. Many people think that a hearing aid will cure a child’shearing problem and make him hear sounds like other people do.This is not true. Hearing aids only make sounds louder. They do notfix any other problem. For more about different kinds of hearing loss,see Chapter 5, starting on page 47.

Hearing aids can be worn in one or both ears, depending on the kindof hearing loss a child has. They can help a child who hears somesounds to hear sounds better. If a child cannot hear any sounds, ahearing aid will probably not help.

Is a hearing aid right for my child?

A hearing aid will only work well if it fits a child’s ear exactly. Theearmold (the part that fits in the ear) is made from impressions of theouter ear, and no two ears are the same. In young children, theearmold must be checked at least twice a year. It must be replaced asa child’s ear grows and changes shape.

Hearing aids may helpa child who hears alittle to understandspeech, hear soundsbetter, and speak better.

BENEFITS

Hearing aids only help childrenwith certain types of hearingloss. Hearing aids need batteriesand need to be kept clean. Theyare expensive and break easily.A child who uses a hearing aidwill need to travel regularly to aclinic for hearing tests.

DIFFICULTIES

220 APPENDIX A: HEARING AIDS

WHAT HEARING AIDS CAN DO

The benefits of a hearing aid depend on the kind of hearing loss achild has.

• If a child can hear somesounds, a hearing aid mayalert him to sounds thatwarn about danger.

WHAT HEARING AIDS CANNOT DO

• If a child cannot hear any sounds of a certainpitch (see Chapter 5), a hearing aid will nothelp him hear those kinds of sounds.

This child cannot hear high-pitch sounds,no matter how loud they are. A hearingaid will not help him hear the flute.

• Hearing aids make allsounds louder. This meansa hearing aid will not helpsomeone in a noisy placehear people more clearlythan other noises.

• If a child can hear faintspeech sounds, a hearing aidwill make speech louder, andmay help her hear whatothers say. This can also helpa child learn to speak.

• If a child can hear some sounds, a hearing aid willhelp her hear sounds that are too soft for her to hearby herself.

What didPapa say?!

We’d betterget home,

Yena.

221APPENDIX A: HEARING AIDS

Types of hearing aidsHere are 2 of the most common hearing aids that children use:

Behind-the-ear (BTE) aid

Body aid

earmold(the part thatfits in the ear)

This is how achild wearsa BTE aid.

This is how achild wears abody aid.

earmold

At one school for deaf children in India, all children wearthe hearing aids in a harness on the chest. The harness ison the chest so the microphones can help the child hear hisown voice. The harness is made of thick cotton cloth, toreduce noise from cloth. The microphones of the hearingaid are kept in pockets. These pockets are tight (to reducecloth noise) and they keep the microphone visible.


Is a hearing aid a good choice for your family?If you are trying to decide whether a hearing aid is right for yourchild, you must think about:

• where your child will get hearing tests

• how much a hearing aid will cost

Your child’s hearing must be tested by someone who istrained and has testing equipment (see Chapter 5).Information from the test is used to set thehearing aid so it will make sounds the rightloudness for your child. He will need to betested every year.

Here are some questions to consider:

Can we afford the testing?Testing can be expensive. Some places,however, offer testing free or at low cost.

Can we afford a hearing aid, and new earmolds and batteries?Hearing aids are expensive to begin with, but buying the aid is notthe only cost. A child between the ages of 2 and 6 will need a newearmold about every 6 months because his ears are growing fast.The earmold must fit well, otherwise the hearing aid will not workcorrectly.

Getting new earmolds andbatteries can be very costly.

If a child can use a hearing aid, it isbest for the child to begin wearing theaid as soon as possible. This way hecan get used to hearing sounds andstart learning what they mean. To getthe most help from his hearing aid, heshould wear it all the time, except whenhe is bathing or sleeping.

In some places, the government mayhave programs to give free or low-costhearing aids to all children who needthem. Try contacting the Ministry ofEducation, the Ministry of Health, or aschool for the deaf. But such programsare not available everywhere.

Babies can beginwearing hearingaids when theyare as young as3 months old.


You may need new batteriesevery week or every couple ofmonths. How often you need newbatteries depends on how manyhours each day your child wearshis hearing aid, the type ofhearing aid he has, and the kindof batteries he uses. Somecountries provide them free.

Can we check the hearing aid every day and take care of it?Hearing aids need to be checked everymorning to make sure the batteries and theaid are working well. The earmolds alsoneed to be washed and dried regularly sothat dirt will not block sound from gettingto the ear.

And hearing aids must be handled carefully.If the aid gets wet, or is dropped, it maybreak or need repair.

Oh no,I gotwet.

If you decide to get a hearing aidIf you decide a hearing aid is right for your child, be sure that youreceive information along with the aid so you can learn:

• how to help your child get used to wearing a hearing aid

• how to care for the hearing aid

• how to check the aid each day to be sure it is working

• what to do when the aid does not work well

Ways to help your child get used to wearing a hearing aidEvery child reacts differently to wearing hearing aids. Some childrenlike them right away, some children find themuncomfortable at first. At first, put the hearing aid onfor only 15 to 30 minutes. Gradually increase theamount of time your child wears the aid. It maytake many weeks for him to get used towearing it.

If your child wears the hearingaid while he is enjoying himself,it is less likely to bother him.

Hearing aids andbatteries should be

available to allchildren who can

benefit from them, notjust to families who

can afford them!


Start using the hearing aid ina quiet environment to helpyour child become aware ofthe new sounds she can hear.Help her notice sounds bybringing your child closer tothe sound or point the soundout to her.

Even if a hearing aid helps yourchild hear sounds, she may notunderstand the sounds she ishearing right away. Your childwill need practice listening tosounds with the hearing aid. SeeChapter 6 for activities to helpyour child listen.

You didn’t knowthat washingdishes makes

sounds, did you?

Sonal, I knowthere is a lot ofnoise, but try tohear Mr. Murthytalking to you.

Help your child understand the new sounds she is hearing

It may be weeks or months beforeyou see your child react to sound.

How to know if your child is hearing new soundsDo not expect your child to react to sounds immediately. Your childwill have to learn to be aware of sounds after his hearing aid is puton. Children’s reaction to sound depends on theirage and how much they can hear.

You may have to watch carefully to see yourchild’s reactions. She may:

• blink her eyes or stop what she is doing.

• enjoy playing with toys that make noise.

• cry when she hears a sound.

• look up or turn around when shehears a sound.

Tuan Jai doesn’t seemto be hearing

anything. She doesn’tlook at the spoon when

I tap it on the bowl.

At first, she may find it uncomfortableto hear sounds, because she is used toliving in a quieter world.


How to take care of hearing aidsWith regular care, hearing aids will last longer, and give good sound.

Here are some tips to get better service from a hearing aid• Keep the hearing aid far away from electrical equipment such as

refrigerators and televisions.

• Do not let it get very hot or very cold.

• Keep it dry — sweat or water will damage it. During the day,remove it and wipe off any sweat or moisture. Remove the hearingaid before bathing, swimming, or when out in the rain. At night,put the hearing aid in a container with silica gel (a material thatabsorbs moisture). Do not use perfumes or any sort of spray on thehearing aid.

Cleaning

• Use a soft dry cloth to clean it.Never use any cleaning fluid.

Earmold

• Check for wax in the earmold regularly.

• Clean the ear mold with warm water.

Battery

• To make the battery last longer, turn thehearing aid off when it is not being used.

• Keep the battery clean, and remove it when the hearing aid is notbeing used for a length of time — for example, when a child sleepsat night.

• Change the battery regularly. To check if it is time to change thebattery, turn the sound to the highest setting. If whistling is heard,the battery is okay. If not, it is time to get a new battery. If thebattery loses power faster than usual, it may be a sign of a problemwith the hearing aid.

• Store batteries in a cool, dry place. Bring a battery that has beenkept in the refrigerator to room temperature before using.

Try to have the hearing aid checked at a hearing aid clinic or storeperiodically.

Hearing aids may need repair. Usually hearing aid repair can be doneonly in big cities. But deaf organizations have started training deafpeople to take ear impressions, to make earmolds, and to repairhearing aids.

Now let’srub it

with thecloth.


Common problems and solutions for hearing aidsUse this list to help you to check and fix some commonproblems with hearing aids. If the hearing aid still doesnot work, it may need to be repaired.

If the hearing aid is ‘dead’

Is it turned on? ........................................... Switch on.

Is the battery dead or weak? ..................... Replace battery.

Is the battery inserted properly? .............. Check that + and – signson battery match thoseon hearing aid.

Is the cord broken? ..................................... Replace cord.

Is the ear mold blocked? ............................ Clean blockage in ear mold.

Did water get into the hearing aid? ......... Remove battery, wipe clean,and put in case withsilica gel.

If the sound is not loud enough

Is the battery low?...................................... Replace battery.

Is the sound set too low? ........................... Turn sound louder.

Are the ear molds loose? ........................... Insert carefully.

Is the ear mold blocked? ............................ Clean blockage in ear mold.

Is there lots of ear wax in the ear? ........... Clean ear wax (see page 199).

Did the child’s hearing change? ............... Check hearing.

If bothersome noises come and go

Is the battery low? ...................................... Replace battery.


If there is a ‘frying’ noise


If the sound is not clear, or is distorted



Is the microphone covered by clothes? .... Expose microphone.

Is the microphone covered with dust? ..... Clean with soft clothor brush.

227

Cochlear implantsand hearing

Appendix B

The cochlea is a small part ofthe ear inside the head. It isshaped like a snail’s shell.

cochlea

the inside of the earPeople are able to hear sounds because apart of the ear called the ‘cochlea’ sendssignals about sound to the brain. If aperson’s cochlea is damaged, he willnot be able to hear well.

A cochlear implant operation is a newway to help deaf children hear sound.Though it is very expensive, thisoperation is now available in manycountries.

To give someone an ‘artificial cochlea’,the bones of his head must be cut open inan operation. A small piece of equipmentcalled a ‘cochlear implant’ is insertedinside the innermost part of the ear.

parts of thecochlear implantoutside the head parts inside

the head

parts of a cochlear implant

Part of the cochlearimplant is inside the head.Other parts are wornoutside the head like ahearing aid.

228 APPENDIX B: COCHLEAR IMPLANTS AND HEARING

Effect of cochlear implant on hearingCochlear implants do not cure deafness. The implant’s outsidemicrophone and processor send signals to the implant which passesthem to the brain. The outside parts are tuned over a period of timeto meet each child’s needs.

If your child does not use the cochlear implant correctly, he will nothear any sounds. Even when cochlear implants work well, hearingthrough an implant sounds different from normal hearing. Somepeople say that sounds seem flat or ‘tinny’ — they compare it tolistening to a radio station that does not come in clearly. It will takesome time and practice for children with cochlear implants to learnto understand the sounds they hear. Children must go to classes to betrained in how to ‘hear’ with the cochlear implant.

This child can hear thevoices of her familymembers. She has tolearn the differencebetween eachperson’s voice.

The results of the operation, equipment, and training classes are verydifferent for each child. Most children who have a cochlear implant,and who work very hard during training, will hear and understandsounds. Some children who get cochlear implants will also learn tospeak. Other children may learn how to hear sounds and speak, butnot well.

Who can be helped by a cochlear implant?The cochlear implant is only given to children who are completelydeaf or have very little hearing even with a hearing aid. In somecountries, babies as young as 6 months can get cochlear implants. Inother places they must be 1 to 2 years old. Cochlear implants do nothelp people who already have some hearing.

Who’stalking

now,Nami?

229APPENDIX B: COCHLEAR IMPLANTS AND HEARING

COST OF THE OPERATION AND COCHLEAR IMPLANT

The operation, equipment, and years of training with professionalsare very expensive. In India, cochlear implants can cost about$10,000. (Hearing aids cost about $75.) As with hearing aids,children can lose or break parts that are worn outside the head.These parts can be very expensive to replace.

ARE COCHLEAR IMPLANTS AND PROFESSIONAL SUPPORT AVAILABLE

IN YOUR AREA?Many communities do not have doctors or professionals who aretrained to work with cochlear implants. Most countries have somedoctors who can perform the operation, but they are usually in bigcity hospitals where there may also be a cochlear implant center.

Having a cochlear implant center near you is important. You andyour child will visit the center many times for several years. YourMinistry of Health or a school for the deaf might be able to tell you ifthere is a cochlear implant center close to you.

Is a cochlear implant a good choice for your family?If you are trying to decide whether a cochlear implant is a reasonablechoice for your child, here are some things to consider.

Older and cheaper cochlear implants do not work as well as thenewer, more expensive equipment. In a few countries, programs offerthe cochlear implant for free or at low cost.

In Mexico, the cost of acochlear implant equals 4 yearsof a medical doctor’s salary.

In China, the operation, equipment,and training equals 20 years of anaverage worker’s salary.

Cochlear implants, like other kinds of health care, shouldnot only be given to those who are rich enough to affordthem. If a cochlear implant is the best thing for a child,the operation and support should be made available.

230 APPENDIX B: COCHLEAR IMPLANTS AND HEARING

Cochlear implants and illnessSometimes the cochlear implant can cause ear infectionsthat can make hearing worse. It is important to treat earinfections quickly in children who have cochlear implants.It is also important to vaccinate them against childhoodillness.

The cochlear implant equipment and operation canalso cause a serious illness calledmeningitis, even years later.Meningitis is a very seriousinfection of the brainand can happen morein children who:

• are younger than5 years old.

• became deaf because of meningitis.

• have ear infections.

• get sick often.

CARE AND SUPPORT AFTER THE OPERATION

Young children with a cochlear implantneed extra care and help from theirfamilies and professionals. Afterchildren heal from the operation,they must spend years training withprofessionals to learn to hear andto understand the sounds theyhear. The family will also needtraining in how to communicatewith the child.

For more information about meningitis, see page 201, aswell as the book Where There Is No Doctor, published bythe Hesperian Foundation.

Say ‘apple’.

Abba.

231

If your child’s development is behind others his ageIt is important to work on the skills your child needs to learnnext, even if they are skills that other children usually learnmuch earlier. When your child has mastered more basic skills,he will be able to learn skills that others his age are learning.Trying to teach a child skills before he is ready will lead tofrustration for both you and your child.

How to use these child development chartsChildren develop in several main areas: physical (the body),mental (the mind), communication (signing or talking), and social(relating to other people). Any one action a child does often includes askill from each area. For example, when a child reaches hisarms up to be held, he is using a:

• physical skill — he holds up his arms

• mental skill — he recognizes you

• communication skill — he tells you what he wants

• social skill — he enjoys being held by you

The charts in this chapter show some of the skills children learn andthe age at which most children learn them. You can use the charts toget general information about how children develop and to help youdecide what skills your child needs to learn.

Find the chart for the age group closest to your child’s age. On thechart, circle the skills your child has. You may find your child does nothave some skills that other children his age have. Knowing this canhelp you decide which activities you want to work on with your child.

How to know what skills your child needs to learn

The charts show how children’s physical skills change as children grow.

6months

12months

2years

Child development chartsAppendix C

232 APPENDIX C: CHILD DEVELOPMENT CHARTS

Physical

Mental

Social

Communication

2yearsold

walks

squats

stacks largeobjects

matchesobjects

usesobjectsrelated toeach other

plays alongsideother children

asks otherswhen sheneeds help

pays attention toactivities forlonger times

imitates caregiver

Physical

Mental

Social

Communication

In the chart above, a mother has circled the skills her 20-month-old daughter cando. Her child needs help to gain skills in each area, but most of all she needs help inthe communication area and in the mental area. For a child this young, the familyshould be working on basic communication (Chapter 4) and beginning to introducelanguage.

For an older child, you can start by looking at the chart that is nearest his age. Butyou may have to look at the charts for younger children to see the skills the childcan do. Other charts will give you an idea of the kinds of skills your child will needto learn before he can work on learning skills like the ones on the chart nearest hisage.

If your child cannot hear well, it is likely that he needs extra help to develop hiscommunication, mental, and social skills. Chapters 2 and 3 will be helpful becausethey explain how children learn language and give some general tips for how towork with young children. Because children’s mental skills grow together with theircommunication skills, the activities in Chapters 4, 7, 8, and 9 will help a childincrease both his communication and mental development. Chapter 12, on socialskills, suggests many ways you can help a child develop his social interactions.

usessimplewordsor signs

uses sentenceswith 2 and 3words or signs

Cup.

Playball.

knows 50 to200 wordsor signs

233

Physical

Mental

Social

Communication

APPENDIX C: CHILD DEVELOPMENT CHARTS

Each part of this circle shows a different area of development. The pictures and words areexamples of skills that many babies have when they are 3 months old.

3months

old

sucks on breast

is aware of hands

lifts head up when on belly

cries whenhungry oruncomfortable

responds tofamiliar voicesor faces

recognizesmaincaregivers

can becomforted byvoice or touch

smiles whenplayed with

reacts tosuddensounds ormovements

Babies who are deaf or cannot hear well will benefit from activities that help them develop inall of the skills in each area. The pictures are only examples of skills. In this example, look atthe ‘Communication’ part of the circle: You do not have to play the flute! The question to askyourself is if your baby reacts to a sudden sound or movement.

Keep in mind that the goal is for your baby to do the activities that other babiesthe same age do in your community.


Physical

Mental

Social

Communication

6months

old

wiggles and kicksarms and legs

sits with somesupport

rolls from stomach to backand from back to stomach

picks upthings andputs themin mouth

recognizesseveralpeople

plays withtoys indifferentways

is interestedin objects

makesrequests forattention

shows fearwithstrangers

makes simplesounds or gestures

turns head toward soundsor movements


Babies who are deaf or cannot hear well will benefit from activities that help them develop inall of the skills in each area. The pictures are only examples of skills. In this example, look atthe ‘Physical’ part of the circle: Your baby does not have to play with a rattle. The question toask yourself is if your baby wiggles and kicks.


235

Physical

Mental

Social

Communication


works tosolve simpleproblems

begins tounderstand causeand effect

learns that anobject existseven if it isout of sight

uses gestures

begins to enjoysocial gameslike peek-a-boo

cries whencaregiverleaves

begins to babbleby joining soundstogether, orrepeats handshapes

understands simplewords or signs

Give itto me.

12months

old


Babies who are deaf or cannot hear well will benefit from activities that help them develop inall of the skills in each area. The pictures are only examples of skills. In this example, look atthe ‘Social’ part of the circle: You do not have to play peek-a-boo with your baby. The questionto ask yourself is if your baby enjoys social games.


ba-baga-ga

sits without helpcrawls

pulls tostandingposition

imitates singlewords or signs

Papa.

Papa.


Physical

Mental

Social

Communication

2yearsold

matchesobjects

uses objectsrelated toeach other

plays alongsideother children

asks otherswhen sheneeds help

usessimplewordsor signs

uses sentenceswith 2 and 3words or signsCup. pays attention to

activities forlonger times

imitatescaregiver

Each part of this circle shows a different area of development. The pictures and words areexamples of skills that many children have when they are 2 years old.

Children who are deaf or cannot hear well will benefit from activities that help them develop inall of the skills in each area. The pictures are only examples of skills. In this example, look atthe ‘Mental’ part of the circle: Your child does not have to be able to play a drum. The questionto ask yourself is if your child uses 2 objects together.

Keep in mind that the goal is for your child to do the activities that other childrenthe same age do in your community.

Playball.

walks

squats

stacks largeobjects

knows 50 to200 wordsor signs

237

Physical

Mental

Social

Communication


3yearsold

takes thingsapart and putsthem together

sortsobjects

fits shapes intomatching holesor spaces

enjoys helpingaround the house

likes to be praised afterdoing simple tasks

is aware of people’sfeelings

communicatesclearly

understands mostsimple language

I want to gowith Papa.


Children who are deaf or cannot hear well will benefit from activities that help them develop inall of the skills in each area. The pictures are only examples of skills. In this example, look atthe ‘Social’ part of the circle: Your child does not have to sweep the floor. The question to askyourself is if your child enjoys helping work with the family.


Where’s yourbiscuit?

Thank youfor helping. runs,

jumps,climbs

uses hands formore complex tasks

throwsa ball

knows and uses500 to 1000words or signs


Physical

Mental

Social

Communication


Children who are deaf or cannot hear well will benefit from activities that help them develop inall of the skills in each area. The pictures are only examples of skills. In this example, look atthe ‘Social’ part of the circle: Your child does not have to be paying attention to a teacher. Thequestion to ask yourself is if your child understands rules like other children do.

5yearsold

easily walksbackward

hops onone foot

copies simpleshapes

follows simpledirections

understandscounting

doessimplepuzzles

plays with otherchildren

understands rules

expressesmanyfeelings

talks or signsabout whathe has done

asks manyquestions

Who is overthere?

What arethey doing?

I’m sad.I’m sorry.


I fell inthe water.

uses about2000 wordsor signs

239

Where to get more informationHere is a small selection of organizations and printed materials thatcan provide useful information about deafness and young children.We have tried to list organizations and materials covering as many ofthe topics in this book as possible, and to include groups working inall areas of the world. Many of the printed materials are easy toadapt and often include other helpful resource lists.

ORGANIZATIONS

Alexander Graham Bell Associationfor the Deaf and Hard of Hearing(AG Bell)3417 Volta Place, NWWashington, DC 20007USAphone: (1-202) 337-5220tty: (1-202) 337-5221fax: (1-202) 337-8314website: www.agbell.orgAG Bell offers its members a wide range ofprograms and services about hearing loss,resources, and support and encouragementfrom people who know and understand deafissues and needs. AG Bell publishes anddistributes books, brochures, instructionalmaterials, videos, CDs, and audiocassettesrelated to hearing loss.

Ali Yavar Jung National Institute forthe Hearing HandicappedK.C. MargBandra Reclamation, Bandra (W)Mumbai 400 050Indiaphone: (91-22) 2640-0215, 2645-5937fax: (91-22) 2642-2638email: [email protected]: www.ayjnihh.orgCollects and shares information aboutdeafness, offers training, and developsstrategies for early identification,intervention, and rehabilitation services.Source for teaching aids, films, and audiovisuals on vocational training, jobplacement, and other issues.

Christian Blind Mission International(CBMI)Nibelungenstrasse 124D-64625 BensheimGermanyphone: (49-6251) 131-215fax: (49-6251) 131-165email: [email protected]: www.cbmi.orgThe Christoffel Blindenmission International(CBMI) works to prevent blindness andsupports medical, educational, andcommunity-based rehabilitation activities fordisabled persons. They also offer support todeaf and hard-of-hearing people.

Deaf Africa Fund (DAF)Chapel Cottage, 7 King StreetMuch, WenlockShropshire TF13 6BLUnited Kingdomphone: (44-1952) 727- 093fax: (44-1952) 728- 473email: [email protected] educational opportunities fordeaf children inpoor countries.

240 WHERE TO GET MORE INFORMATION

Delhi Foundation of Deaf WomenFirst Floor, DDA Community HallGali Chandiwali, Pahar GanjNew Delhi 110 055Indiaphone: (91-11) 2353-3276fax: (91-11) 2353-3276email: [email protected]: www.dfdw.orgThis organization helps deaf womenhelp themselves.

Disabled Children’s Action Group(DICAG) South Africa3rd Floor, Norlen House17 Buitenkant StreetCape Town 8001South Africaemail: [email protected] is a campaigning organization thathelps to raise the level of awareness ofdisability and challenges stereotypes andperceptions of disabled people in South Africa.DICAG aims to ensure equal opportunities fordisabled children, especially in education.

Enabling Education Network (EENET)c/o Educational Support and Inclusion,School of EducationUniversity of Manchester, Oxford RoadManchester M13 9PLUnited Kingdomphone: (44-161) 275-3711fax: (44-161) 275-3548email: [email protected]: www.eenet.org.ukThis information-sharing network promotesinclusion of marginalized groups ineducation. They produce a regular newsletterwhich publishes case studies of excitingprograms worldwide and includescontributions of parents’ groups. They offermany useful Englishlanguage publications.The website has asection dedicated todeaf issues.

Gallaudet University800 Florida Avenue, NEWashington, DC 20002-3695USAphone/tty: (1-202) 651-5000email: [email protected]: www.gallaudet.eduGallaudet University is the only liberal artsuniversity in the world designed exclusivelyfor deaf and hard-of-hearing students. It isalso an excellent source for finding deafbooks, journals, and current research.

International Deaf Children’s Society(IDCS)15 Dufferin StreetLondon EC1Y 8URUnited Kingdomphone: (44-020) 7490-8656fax: (44-020) 7251-5020email: [email protected]: www.idcs.infoAn organization of families and caregiversof deaf children, as well as the organizationsand professionals who work with them.Established to share information and

experiences, IDCS provides a forum forideas, discussion, research and

information on all aspects ofchildhood deafness on a global scale.

The Forest BookshopUnit 2, New BuildingEllwood RoadMilkwall, ColefordGlos. GL16 7LEUnited Kingdomphone: (44-1594) 833-858fax: (44-1594) 833-446website: www.forestbooks.comA comprehensive resource for books, videos,and CD-ROMs on deafness and deaf issues.Also distributes books published byGallaudet University.

241WHERE TO GET MORE INFORMATION

Royal National Institute for the Deaf(RNID)19-23 Featherstone StreetLondon EC1Y 8SLUnited Kingdomphone: (44-171) 296-8000fax: (44-171) 296-8199website: www.rnid.org.ukThe RNID has many online publications anduseful links, as well as a large librarydatabase with detailed information aboutresources for people who are deaf. They alsohave a training and information resourcecalled Deaf at Birth (website:www.deafnessatbirth.org.uk).

World Federation of the Deaf (WFD)PO Box 6500401 HelsinkiFinlandtty: (358-9) 580- 3573fax: (358-9) 580-3572email: [email protected]: www.wfdnews.orgOne of the oldest international organizationsof deaf people, WFD includes nationalorganizations of deaf people in 120countries. WFD works for human rights andequal opportunity for deaf people, and theright of deaf people to use sign language toget education and information. WFDinitiated the annual Deaf Awareness Week tocelebrate the culture, heritage, and languageunique to deaf people of the world.

PRINTED MATERIALS

Choices in Deafness: A parent’s guide tocommunication options (1996, 275 pages)Sue Schwartz

Woodbine House6510 Bells Mill RdBethesda, MD 20817, USAphone inside the US: (1-800) 843-7323phone outside the US: (1-301) 897-3570fax: (1-301) 897-5838website: www.woodbinehouse.comExplanations of hearing loss followed byparents discussing why and how they madetheir choices among different approaches tocommunication.

The Deaf Child in the Family and atSchool: Essays in honor of Kathryn P.Meadows-Orlans (2000, 336 pages)P.E. Spencer, C.J. Erting, and M. Marschark

Lawrence Erlbaum Associates10 Industrial AvenueMahwah, NJ 07430-2262, USAphone: (1-201) 258-2200fax: (1-201) 236-0072email: [email protected]:www.erlbaum.comThis book explains the development of deafand hard-of-hearing children in the contextof family and school. It shows the role andeffects of school environments ondevelopment. Each chapter deals with issuesof culture and expectations.

Deaf Friendly Pre-Schools and Nurseries(2003, 37 pages)Anne-Marie Hall and Hilary Sutherland

National Deaf Children’s Society (NDCS)15 Dufferin StreetLondon EC1Y 8UR, UKphone: (44-020) 7490-8656fax: (44-020) 7251-5020email: [email protected]: www.ndcs.infoPractical guidebook for those working withvery young deaf children on how to includedeaf children and understand theirparticular needs. Information for staff inpre-school settings who have a deaf childattending. Covers activitiesincluding readingbooks, group andmusic time,playing games,and behavioranddiscipline.Free.


Deaf Friendly Schools: A guide forteachers and governors, with asupplement toolkit on inclusion:Deaf children in mainstream schools(2002, 32 pages)Clara Ratcliffe

National Deaf Children’s Society (NDCS),UK (see page 241 for address.)A guide for staff in mainstream secondaryor primary schools who have deaf pupils.Information on teaching strategies,inclusion, communication, deafness, andtechnical support.

Deaf Like Me (1985, 292 pages)Thomas S. Spradley and James P. Spradley

Gallaudet University PressChicago Distribution Center11030 South Langley AveChicago, IL 60628, USAphone: (1-773) 568-1550phone inside the USA: (1-800) 621-2736tty inside the US: (1-888) 630-9347fax inside the US: (1-800) 621-8476email: [email protected]: gupress.gallaudet.eduDeaf Like Me is an account of parentscoming to terms with their baby girl’sprofound deafness. It expresses the love,hope, and anxieties of many hearingparents of deaf children. In the epilogue,Lynn Spradley as a teenager reflects uponbeing deaf, her education, her struggle tocommunicate, and the discovery that shewas the focus of her father’s and uncle’sbook.

Deafness: A guide for parents, teachers,and community workers (2001, 32 pages)Akach Philemon

Special Needs Education, UNESCO7 Place de Fontenoy75352 Paris 07-SP, Francefax: (33-145) 685-627email: [email protected] [email protected]: unesdoc.unesco.org/images/0012/001255/125541e.pdf

This short and simply-written UNESCOpublication explains many complex issuesrelated to deafness, sign language, and theeducation of deaf children. It is intended toraise awareness among parents, teachers,doctors, nurses, and social workers of theimportance of sign language for deafchildren, particularly in the early years. It isaccompanied by a video. Free.

Developing Personal Safety Skills inChildren with Disabilities(1995, 214 pages)F. Briggs

Paul H. Brooks Publishing CoPO Box 10624Baltimore, MD 21285-0624, USAOffers learning activities to develop self-esteem, assertiveness, and independence— skills that children with disabilitiesneed to safeguard themselves. It can beused to teach children to recognizedangerous situations, take action, handleapproaches by strangers, communicatetheir feelings, and to recognize right andwrong ways of touching.

Family Action for Inclusion inEducation (2002, 120 pages)

EENET, School of EducationUniversity of Manchester, Oxford RoadManchester M13 9PL, UKphone: (44 -161) 275-3711fax: (44 -161) 275-3548email: [email protected]: www.eenet.org.ukA practical and inspirational handbookwith stories of family-based advocacyorganizations that have helped totransform educational systems insouthern Africa, South Asia, Europe, andAustralia. Useful for family andcommunity members who want to form asupport group or challenge exclusion.Provides valuable insights into theactivities, thoughts, and feelings ofparents involved in fighting for theinclusion of their disabled children.


Hearing Aids: A guide (2003, 52 pages)National Deaf Children’s Society(NDCS), UK(see address on page 241)Information about different types ofhearing aids, care and maintenance, andsimple repairs. Provides a range ofinformation on the different types ofhearing aids available. This booklet isaimed at both parents and professionals.

Kid-Friendly Parenting with Deaf andHard-of-Hearing Children: A treasuryof fun activities toward betterbehavior. (1995, 373 pages)D. Medwid and D. Chapman-Weston

Gallaudet University Press(see address on page 242)This step-by-step guide presents hundredsof ideas and activities for use withchildren who are deaf or cannot hear well,ages 3 to 12. In addition to short, cleardescriptions of parenting techniques, eachchapter includes a commentary from deafand hearing experts. Information isprovided about special resources andsupport services.

Let’s Communicate: A handbook forpeople working with children withcommunication difficulties(1997, Ref: WHO/RHB 971)

Co-published by WHO, UNICEF, andMinistry of Health, ZimbabweAvailable free from:Ms. Sonia Florisses, Disability andRehabilitation TeamWHO, CH-1211,Geneva 27, Switzerlandemail: [email protected] consists of a series of booklets, one ofwhich is about working with children withhearing impairments.

Not Deaf Enough: Raising a child whois hard-of-hearing with hugs andhumor (1996, 242 pages)Morgan Candlish and Patricia Ann

A.G. Bell Association for the Deaf(see address on page 239)This book demonstrates a family’s supportfor their youngest child who has a mild-to-moderate hearing loss. His motherexplains the challenges that the familyfaced and conquered together.

Omni-Directory (2003)National Deaf Children’s Society(NDCS), UK(see address on page 241)A guide to products and services forfamilies of deaf children, young people,and those professionals working withthem.

The Parents’ Guide to CochlearImplants (2002, 168 pages)Patricia M. Chute and Mary Ellen Nevins

Gallaudet University Press(see address on page 242)Make informed decisions about cochlearimplants with this easy-to-follow guide.

The New Language of Toys: Teachingcommunication skills to children withspecial needs (1996, 289 pages)S. Schwartz and J.E. Heller

Woodbine House(see address on page 241)This book provides ideas to parents andprofessionals about how to use everydaytoys to stimulate and promote languagedevelopment in children with additionalneeds.


Preparing Teachers for Inclusion(1996, video)

EENETSchool of Education(see address on page 242)This video package from Lesotho featuresfootage of deaf children included in theirlocal schools.

The Psychology of Deafness:Understanding deaf and hard-of-hearing people (1990, 292 pages)M. Vernon and J.F. Andrews

Longman. White Plains, NY.UMI: Books On Demand300 North Zeeb RoadAnn Arbor, MI 48106-1346, USAphone inside the US: (800) 521-3042fax: (1-734) 973-1464email: [email protected]: www.umi.comThis book helps explain how the lives ofpeople who are deaf or cannot hear wellare different from the lives of people whocan hear. It helps explain the level of stressinvolved in coping with the world.

Quality Standards in the Early Years:Guidelines on working with deafchildren under two years old and theirfamilies (2002, 32 pages)

National Deaf Children’s Society(NDCS), UK(see address on page 241)

Gives guidelines for good practices in theeducation of deaf children, covering theearly years, working in partnership, andinclusion.

Raising Your Hearing Impaired Child: Aguideline for parents (1982, 238 pages)S.H. McArthur

A.G. Bell Association for the Deaf(see address on page 239)Written by a teacher, who is also themother of two deaf daughters, this bookoffers ideas and suggestions for parentsraising their deaf child using oral methods.

Sign Language (2003, 6 pages)National Deaf Children’s Society(NDCS), UK(see address on page 241)A practical guide on learning signlanguage and how to find out moreinformation.

The Silent Garden: Raising your deafchild (Revised edition, 2002, 304 pages)P.W. Ogden

Gallaudet University Press(see address on page 242)Ogden, who is himself profoundly deaf frombirth, provides a foundation for parents tomake the difficult decisions necessary tohelp their deaf child reach full potential.

Raising and Educating a Deaf Child: Acomprehensive guide to the choices,controversies, and decisions faced byparents and educators (1999, 256 pages)Marc Marschark

Oxford University PressSaxon Way WestCorby, Northants NN18 9ES, UKemail: [email protected]: www.oup.co.uk/bookshop/Discusses the implications of raising andteaching a child who is deaf or cannot hearwell, trying to educate parents so they canmake knowledgeable decisions. Covers suchtopics as medical causes of early hearingloss, language acquisition, social andintellectual development, education, andenvironment. Includes a phone number andaddress section on information sources andorganizations serving deaf children.


Speak to Me! (1995, 154 pages)Marcia Calhoun Forecki

Gallaudet University Press(see address on page 242)A down-to-earth account of how a singlemother copes with accepting her18-month-old son’s deafness.

Teaching Children to ProtectThemselves (2000, 154 pages)F. Briggs and M. McVeity

Allen & Unwin83 Alexander StreetCrows Nest NSW 2065, Australiaphone: (61-2) 8425-0100fax: (61-2) 9906-2218email: [email protected] site: www.allenandunwin.comA handbook that offers guidance toteachers and counselors on how to protectyoung children from sexual abuse. It hasmany useful activities to help childrenlearn about staying safe.

Understanding Deafness(2003, 28 pages)

National Deaf Children’s Society(NDCS), UK(see address on page 241)An introductory guide to different types ofdeafness, hearing tests, audiograms,communication, and language.

When Your Child is Deaf: A guide forparents (2002, 191 pages)David Luterman and Mark Ross

York Press, Inc.PO Box 594Timonium, MD 21094, USAphone inside the US: (800) 962-2763fax: (1-410) 560-6758email: [email protected]: www.yorkpress.comInformation, advice, and encouragementfor parents about the emotional andeducational processes of coming to termswith a hearing impairment in their child.

The Young Deaf Child (1999, 214 pages)David M. Luterman and others

York Press, Inc.(see address at left)

This book provides information to guidecaregivers in raising a deaf child whenhearing loss is discovered. It presentshistorical information plus the choices thatare available so that parents can decidewhat is right for their family. The authorsrecognize that each family is different andhas their own needs, so no one method isadvocated over another.

You and Your Deaf Child: A self-helpguide for parents of deaf and hard-of-hearing children (1998, 240 pages)John Adams

Gallaudet University Press(see address on page 242)This down-to-earth book focuses onfeelings about hearing loss, theimportance of communication in thefamily, and effective behaviormanagement. Many chapters containpractical activities and questions to helpparents learn new skills. Appendicesinclude references, general resources,checklists, and guidelines for evaluatingeducational programs.

Helping Children Who Are Blind, by Sandy Niemann and NamitaJacob, aids parents and other caregivers in helping blind childrendevelop all their capabilities. Topics include: assessing what a childcan see, preventing blindness, moving around safely, teachingcommon activities, and more. 192 pages.

OTHER BOOKS FROM THE HESPERIAN FOUNDATION

Where There Is No Doctor, by David Werner with Carol Thumanand Jane Maxwell. Perhaps the most widely used health caremanual in the world, this book provides vital, easily understoodinformation on how to diagnose, treat and prevent commondiseases. Emphasis is placed on prevention, including cleanliness,diet, and vaccinations, as well as the active role people must takein their own health care. 512 pages.

Where There Is No Dentist, by Murray Dickson, shows people howto care for their own teeth and gums, and how to prevent tooth andgum problems through hygiene, nutrition, and education, in thehome, community, and school. This book gives detailed, wellillustrated information on using dental equipment, placing fillings,taking out teeth, and more. A new chapter includes material onHIV/AIDS and oral health. 237 pages.

Helping Health Workers Learn, by David Werner and Bill Bower.An indispensable resource for teaching about health, this heavilyillustrated book makes health education fun and effective. Includesactivities for mothers and children; pointers for using theater,flannel-boards, and other techniques; and many ideas forproducing low-cost teaching aids. This people-centered approachpresents strategies for effective community involvement throughparticipatory education. 640 pages.

A Book for Midwives, by Susan Klein, is for midwives, communityhealth workers and anyone concerned about pregnant women and theirbabies. An invaluable tool for training as well as a practical reference,the author covers helping pregnant women stay healthy; care andcomplications during labor, childbirth and after birth; family planning;breastfeeding; and homemade, low-cost equipment. 528 pages.

Where Women Have No Doctor, by A. August Burns, RonnieLovich, Jane Maxwell, and Katharine Shapiro, combines self-helpmedical information with an understanding of the ways poverty,discrimination, and cultural beliefs limit women’s health andaccess to care. An essential resource on the problems that affectonly women or that affect women differently from men. 584 pages.

Disabled Village Children, by David Werner, covers most commondisabilities of children. It gives suggestions for rehabilitation at thevillage level and explains how to make a variety of appropriate,low-cost aids. Emphasis is placed on how to help disabled childrenfind a role and be accepted in the community. 672 pages.

There are an estimated 150 million children with disabilities in the world. Theattention these children receive during their first years of life has a powerfuleffect on their future development. The Early Assistance Series includes severalbooks on how to assist children from birth to 5 years old who have disabilities.These books can help by giving the people closest to a child with a disability —parents, family members, friends, and health workers — an understanding ofthe disability and how to help a child learn and grow using simple andappropriate developmental activities. This material has been developed with theparticipation of communities all over the world so that it will be useful andapplicable across many cultures. These books explain how to:

The Early Assistance Series

Books currently available in the series are:

Helping Children Who Are Blind

Helping Children Who Are Deaf

Each book is written in simple language with many illustrations.

Topics the series may address include:helping children who have emotional andbehavioral problems, helping childrenaffected by HIV/AIDS, and helping childrenaffected by war and violence.

For availability in English, Spanish,and other languages, prices andordering information, or moreinformation about our work,please contact us:

The Hesperian Foundation1919 Addison St. #304

Berkeley, California, 94704 USAtel: (1-510) 845-4507 fax: (1-510) 845-0539

email: [email protected]: www.hesperian.org

• assess the extent of a child’s disability.

• stimulate a child’s development withlearning activities.

• understand what causes disability, andhow to treat and prevent it.

• cope with the challenges of raising achild with a disability.

• work with other community members toimprove care for children with disabilities,and help these children become an activepart of the community.

Help

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Wh

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Children develop more and faster in the first 5 years of life than at any other time.They learn to communicate and understand the world as they interact with peopleand things around them. Children who cannot hear well need extra help to learn aspoken or sign language. This is important since language is the foundation forthinking, problem-solving, and interacting with other people.

The simple activities in this book were developed by families with children who aredeaf or cannot hear well, deaf adults, community-based development workers,health workers, educators, and other experts in over 17 countries. They can helpparents, caregivers, health workers, rehabilitation workers, and others teach adeaf child how to communicate to the best of his or her ability. Topics include:

the HHHHHesperian FFFFFoundation

This book will make a world of differencefor so many deaf children... It is an excellentresource for teaching families, communities,and health workers how to make languageaccessible to deaf children so that they canlearn about, understand, and interact withthe world around them.

—Amy Wilson, Gallaudet University, USA

Helping Children Who Are DeafFamily and community support for children who do not hear well

• why young children need to learn a spokenor sign language, and how to teach them

• assessing how much a child can hear

• developing communication, listening,and social skills

• supporting parents

• educating a deaf child

• preventing child sexual abuse

• preventing deafness

With support and encouragement, deaf children can grow and participate fully intheir families and communities. The Hesperian Foundation’s Early Assistance Seriesshows how help for children with disabilities is within the reach of all people andmust be part of building a more just world.

We would recommend this bookfor use in helping children whocannot hear well because it usessimple language and activitiesfrom everyday life — people canrelate to them without any problem.

—Susan Nanjobe, Uganda Societyfor Disabled Children

Helping ChildrenWho Are Deaf

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Darlen

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the HHHHHesperian FFFFFoundationEarly Assistance Series for Children with Disabilities

Family andcommunitysupport forchildrenwho do nothear well

Sandy Niemann,Devorah Greenstein,and Darlena David

Documents

Helping Children Who Are Deaf