Pediatric hearing loss is the most common congenital sensory disorder. Hearing is fundamental to the development of speech, language, and overall cognitive abilities. Without early identification and intervention, children can experience delays in communication skills, academic challenges, and difficulties forming social connections. Recognizing potential signs of hearing loss as soon as possible is paramount for ensuring a child can access language and reach their full potential.
Universal Newborn Hearing Screening
Nearly all newborns receive a hearing screening before they leave the hospital, providing initial insight into a baby’s hearing ability. This screening is important because about half of all infants born with permanent hearing loss do not have any known risk factors. The two primary, non-invasive tests used are the Otoacoustic Emissions (OAE) test and the Auditory Brainstem Response (ABR) test.
The OAE test measures sounds produced by the inner ear’s outer hair cells in response to a soft click sound presented through a probe placed in the ear canal. If the cochlea is functioning normally, a faint “echo” is recorded, indicating a healthy inner ear response. The ABR test measures how the auditory nerve and brainstem respond to sound using electrodes placed on the baby’s head.
A “pass” result suggests the baby’s hearing is within the normal range at the time of the test. A “refer” result means the test could not confirm normal hearing, often due to temporary issues like fluid or vernix in the ear canal, and requires follow-up diagnostic testing. Hearing loss can also develop later in infancy or childhood, making continued monitoring of developmental milestones necessary.
Developmental Signs of Hearing Loss by Age
The most reliable indicators of potential hearing loss shift as a child grows and their auditory-verbal skills advance. Parents should be vigilant for a consistent absence of expected sound-related behaviors. Missing a single milestone is not automatically cause for alarm, but repeatedly failing to reach several milestones warrants an immediate conversation with a healthcare provider.
Newborn to 3 Months
Infants should exhibit a strong startle reflex to sudden, loud noises. They will also quiet down or smile when they hear a familiar voice, seeming to recognize it over other sounds. During this period, babies typically begin cooing and making pleasure sounds, such as “aah” and “ooo,” and cry differently to express varying needs.
3 to 6 Months
A baby should begin moving their eyes or turning their head toward a sound source, demonstrating sound localization. They show a response to changes in the tone of a voice, such as a playful or scolding tone. Vocalizations become more speech-like, and they may babble with a variety of sounds and pitches.
6 to 12 Months
The child should consistently turn and look in the direction of a sound, even when the source is out of sight. They should respond to their own name and begin to understand simple words like “no,” “bye-bye,” or the names of common items. A notable sign of progress is the imitation of speech sounds and the use of repetitive babbling, like “mama” or “dada.”
12 to 24 Months
A child should be using single words and attempting to combine two words into phrases. They follow simple verbal commands without needing accompanying gestures, such as “get the ball.” A child with hearing loss may have very unclear speech, rely heavily on visual cues to understand communication, or fail to achieve key language milestones by the expected age.
Steps Following Suspected Hearing Loss
If a parent notices consistent delays in auditory milestones, the first action is to contact the pediatrician. The pediatrician will likely perform a basic screen and then refer the child directly to a pediatric audiologist for a comprehensive evaluation. This referral should happen quickly, as early intervention is most effective when started before six months of age.
The audiologist will perform specialized diagnostic tests beyond the initial newborn screen. For infants, this often includes Visual Reinforcement Audiometry (VRA), where the child’s head turns toward a sound are rewarded with a visual display. Older toddlers may undergo Conditioned Play Audiometry (CPA), which turns responding to sound into a game.
If hearing loss is confirmed, the audiologist and pediatrician will connect the family with Early Intervention (EI) services. EI is a coordinated system of services that provides support and resources, including speech-language therapy and family education, to minimize developmental delays. The goal is to rapidly fit appropriate amplification, such as hearing aids, typically within a month of diagnosis, to ensure the child has access to sound during the most intensive period of brain development.