Better Hearing Institute


HEARING SOLUTIONS - A Guide to Your Child's Hearing

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Judith Gravel, Ph.D., Children's Hospital of Philadelphia, Philadelphia, PA

Children's quality of life and development vitally depend on hearing. Children learn to speak because they hear others and themselves communicate. Hearing help your child learn to read, appreciate music, and receive warnings of approaching harm. Your child will have difficulty coping with many of life's challenges and opportunities at home and in school without good hearing.

Age Communication Behavior
5 months Turn to source of moderate & soft sounds
6 months Recognize familiar voices & engage in vocal play with parents
9 months Demonstrate understanding of simple words
10 months Babbles by stringing multiple, single-syllable speech sounds together
12 months One or more real, recognizable spoken words emerge
18 months Understands simple phrases, retrieves, places or manipulates familiar objects on spoken request; points to body parts on request. Spoken vocabulary of 20-50 words and short phrases
24 months Spoken vocabulary 200-300 words; speaks in simple sentences; most speech is understandable to adults not with the toddler on a daily basis; sits and listens to read-aloud story books
3 - 5 years Uses spoken language constantly to express wants, reflect emotions, convey information and ask questions. Understands nearly al that is said. Vocabulary grows rapidly: 1000-2000 words; produces complex and meaningful sentences. All speech sounds are clear and understandable by 5 years.
Signs of Hearing Problems

family talkingThe single most important sign of hearing loss in children is the failure to develop, or the delayed development of spoken language.

If children have severe or profound hearing loss, it is usually obvious that they do not respond to sound. Sometimes it is difficult to detect mild forms of hearing loss, including hearing loss in only one ear. Even the more common forms of mild hearing loss, however, can negatively impact communication development and school performance.

Common warning signs for hearing loss include:

  • Family member or teacher concern regarding:
    • hearing acuity
    • delays or differences in speech and language development
    • attention or behavioral difficulties
    • academic performance
  • Inappropriate, delayed, or lack of response to soft and moderate-level sounds: speech or environmental when distractions are minimal
  • Use of "what?" or "huh?" frequently
  • Intently watching the faces of speakers
  • Difficulty understanding speech in background noise
  • Sitting close to the TV set when the volume is adequate for others; increasing the TV or stereo/tape/CD player volume to unreasonably loud levels
  • Not responding to voices over the telephone or switching ears continually when the phone is utilized
  • Not startled by intense sounds
  • Unable to locate the source of a sound accurately
Newborn Hearing Screening

Today, the vast majority of newborns receive a hearing screening before discharge from the hospital. Two types of objective test technologies are used to screen for hearing loss in newborns: otoacoustic emissions and the auditory brainstem response (sometimes called ABR test or BAER test). These screening tests can detect 80-90% of infants with moderate degrees of hearing loss and greater. However, no screening test is perfect. Children with mild hearing loss may pass newborn hearing screening. Newborn hearing screening cannot identify children with late onset or progressive types of hearing loss.

Even when an infant passes a hearing screening test in the hospital, it is important to monitor developmental milestones for hearing, language and speech. If your child was born with visual, cognitive or motor disabilities, a comprehensive audiological evaluation would be important to ensure your child's hearing is completely normal.


family readingHearing assessment can be completed in children of any age using objective and subjective audiologic test technologies. Therefore, hearing testing should not be delayed. Confirmation of hearing loss is made following audiologic and medical assessment.

All newborns should be screened for hearing loss before 1 month, hearing loss should be confirmed by 3 months, and children with diagnosed hearing loss should receive intervention, which means enrollment in early intervention programs by 6 months of age. (Maternal and Child Health Bureau, Centers for Disease Control and Prevention, Joint Committee on Infant Hearing (JCIH, 2000)

It is important to remember that infants may be fit with amplification soon after the confirmation of the hearing loss. As such infants may begin to use hearinginstruments and assistive devices before 6 months of age.

Infants age 12 months with profound hearing loss, who have not made sufficient progress with conventional hearing aids are considered candidates for cochlear implants. In some cases (as when meningitis is the cause of deafness), younger infants may be candidates for a cochlear implant.

Risk Conditions for Childhood Hearing Loss
(Joint Committee on Infant Hearing, 2000)

Neonates from Birth Through 28 Days

  • An illness or condition requiring admission of 48 hours or greater to an infant care unit
  • Stigmata or other findings associated with a syndrome known to include a sensorineural and or conductive hearing loss
  • Family history of permanent hereditary childhood sensorineural hearing loss
  • Craniofacial anomalies, including those with morphological abnormalities of the pinna and ear canal
  • In-utero infection such as cytomegalovirus, herpes, toxoplasmosis, or rubella

Infants 29 Days Through 2 Years

  • Parental or caregiver concern regarding hearing, speech, language, and or developmental delay
  • Family history of permanent hereditary childhood hearing loss
  • Stigmata or other findings associated with a syndrome known to include a sensorineural and or conductive hearing loss or Eustachian tube dysfunction
  • Post-natal infections associated with sensorineural hearing loss including bacterial meningitis
  • In-utero infections such as cytomegalovirus, herpes, rubella, syphilis, and toxoplasmosis
  • Neonatal indicators, specifically hyperbilirubinemia at a serum level requiring exchange transfusion, persistent pulmonary hypertension of the newborn associated with mechanical ventilation, and conditions requiring the use of extracorporeal membrane oxygenation (ECMO).
  • Syndromes associated with progressive hearing loss such as neurofibromatosis, osteopetrosis, and Usher's syndrome
  • Neurodegenerative disorders, such as Hunter syndrome, or sensory motor neuropathies, such as Friedreich's Aataxia and Charcot-Marie-Tooth syndrome
  • Head trauma
  • Recurrent or persistent otitis media with effusion for at least three 3 months

If speech must be raised (shouted) to communicate, it is very likely that the noise is excessive and possibly damaging. Ringing in the ears (tinnitus) after noise exposure also indicates excessive sound levels. Children should be told about the dangers of noise exposure and the use of ear protection (ear plugs, ear muffs, etc.). When ear protection is unavailable, simply block the ear canal opening with yours fingers. This serves as to reduce the level of sound going to the eardrum. Obviously children should be protected from excessive noise exposure whenever possible.


Through the Individuals with Disabilities Education Act (IDEA, 1997), the federal Department of Education provides funds to States for children birth to 21 years who have disabilities. A child with a hearing loss is covered by the provisions of IDEA if, by reason of the child's hearing loss the child is deemed to require special education and related services. Related services includes transportation, speech-language pathology, audiology and other such services as may be required to assist the child in benefiting from special education. Services provided can however, vary by State and even School District.

Preparing Your Child for Better Hearing

You are your child's role model for attitudes on hearing loss and hearing conservation. If hearing and the use of hearing protection are important to you, it will be important to your child as well. With your understanding, encouragement, and support, your child will enjoy a world of better hearing.


  • Your child's hearing is the means through which communication will develop and flourish.
  • Guard your child's hearing carefully and seek professional help if you are concerned at any time.