Empowering Pediatricians to Support Deaf and Hard of Hearing Children
Propelled by grief, fear, and love, I wanted my child to have every opportunity to be “normal,” which I equated to happiness. Ironically, in my focus on curing her deafness, it was I who failed to hear the data on language outcomes—and in doing so, unknowingly denied her what she needed most: accessible language from the start. -- Dr. Pesch
In a recent essay in Pediatrics, developmental pediatrician Dr. Megan Pesch tells the story of her own daughter, Odessa. When Odessa was diagnosed as deaf in infancy, Dr. Pesch did what most parents do — and, as a pediatrician herself, what the field told her to do. Cochlear implants at 10 months. Gold-standard spoken language therapies. A move across state lines for a full-time oral program. When she asked about ASL, she was encouraged to wait: wait to see how the devices worked, wait to see if her daughter would really need it. Professionals promised Odessa would catch up by kindergarten. Despite the very best spoken-language interventions, Odessa fell further behind while her critical window for language began to close. Eventually they chose to start signing, and Odessa began to thrive.
Dr. Pesch's story is one family's, but the pattern is not. Across a series of studies led by Dr. Arielle Spellun, Director of Health and Wellbeing at the Deaf Center, Spellun and her colleagues have mapped what pediatricians need to know to keep this from happening. Here's the short version.
Kids need access to language early
Children who are born deaf or hard of hearing are at risk for a secondary condition called language deprivation syndrome. The brain is built to expect language exposure during early childhood. Many aspects of learning and development, from socioemotional learning to brain development, depend on language. It can also affect physical and mental health in adulthood. It doesn't matter which language a child is exposed to; French, American Sign Language, and Farsi are all equally good at supporting a child's development. What matters isn't which language, but whether the child can fully access it.
Speech is not language
Language is a highly structured set of words and grammar that are used to express and understand meaning. Speech is the physical act of producing language using the mouth, lips, tongue, and voice. A person can have clear speech without strong language (for example, repeating words without understanding them), or strong language without speech (for example, using a signed language like ASL). A child needs a strong foundation in language for healthy development.
As Dr. Megan Pesch describes, sometimes therapy plans focus primarily on speech, rather than thinking about the best way to ensure a child has access to language. When a deaf child is making slow progress, the question to ask is not "how is her speech coming along?" but "does she have complete access to any language at all?"
Technology can't guarantee language
Hearing aids and cochlear implants give many children meaningful access to sound, and they belong in the toolkit. But sound is just the first step, not the outcome. A child's brain still has to turn that signal into language, and how well that works varies widely and unpredictably from child to child. In one study of children with cochlear implants, fewer than half reached near-normal auditory integration two years after surgery, and in noisy places — homes, classrooms, everywhere children actually live — the large majority couldn't reliably identify words. Some children do beautifully with technology. While we know some factors that improve spoken language outcomes, we can't predict with certainty whether a child will have complete access to spoken language until it is too late.
Sign language
Sign languages are naturally evolved languages, and can serve as this critical "brain food" for early development. Children who are exposed to sign language during infancy reach their language milestones on expected timelines. This is even true for the majority of families who do not know a sign language when the child is born — and the common worries don't hold up. Learning to sign does not hinder learning a spoken language. Hearing parents don't need to be fluent before starting: in our research, deaf children of hearing parents who began ASL early built age-level vocabularies and age-expected academic outcomes. Parents can learn alongside their child.
Red Flags
Families will encounter professionals and parent support organizations that focus exclusively on listening and spoken language (often abbreviated LSL) and actively discourage signing. There is no harm in trying to teach a child spoken language. However, it becomes risky when providers or organizations discourage teaching sign language and/or have no training in how to support families in learning a sign language. It is possible to become a licensed speech pathologist, audiologist, or teacher of the deaf without knowing anything about sign language acquisition. These are some things to look for:
Advice to avoid or delay sign language so it won't interfere with speech.
"Wait and see" framing — wait to see how the devices work before introducing sign language. Delaying accessible language can cause lasting harm.
Promises that a child will "catch up" by a certain age. Research shows outcomes are highly unpredictable.
Measures of success that focus only on speech, or only on improvement rather than whether a child's language is age-expected.
Programs that keep families away from deaf adults and the signing community, whether by policy or by omission.
I share our story because I thought I was doing the “right”thing—and yet my daughter still experienced language deprivation. Pediatricians are often the first professionals to guide families following a diagnosis of a hearing difference. In this role, we have extraordinary influence—not just in setting expectations but in shaping outcomes. It is vital that we present ASL not as a backup plan or a failure of technology but as an empowering, evidence-based choice. A child who is DHH from a hearing family with hearing devices and early ASL exposure is not at a disadvantage; they are on a stronger developmental path than a child who is given devices and expected to make it work. -- Dr. Pesch
Want more professional development?
Dr. Arielle Spellun, Director of Health and Wellbeing at the Deaf Center, and her team developed curriculum aimed at equipping pediatricians with the tools they need to support language development and improve outcomes for deaf and hard of hearing children.
