As many as three out of every 1,000 children are born deaf or hearing-of-hearing each year according to the Ohio Department of Health. By school-age, that number more than triples. Hearing loss can occur at any age and can have devastating effects if left unmanaged.
Hearing is an essential part of how we learn to talk and listen. Babies develop the ability to hear before they are born and continue to develop communication skills rapidly during their first few years of life. Some examples of communication milestones for children with normal hearing are listed below.
Hearing and Talking Milestones
(Adapted from the American Speech-Language-Hearing Association brochure “How Does Your Child Hear and Talk?”)
- Birth-3 months – Startles to loud sounds, quiets when spoken to, makes cooing sounds, cries differently for different needs
- 4-6 months – Moves eyes in direction of sounds, responds to changes in your tone of voice, attends to music, babbles, vocalizes excitement and displeasure
- 7-12 months – Turns and looks in the direction of sounds, recognizes words for common items, imitates different speech sounds, has one-two words
- 1-2 years – Follows simple commands, points to pictures in a book when named, says more words every month, puts two words together
- 2-3 years – Follows two step commands, understands differences in meaning, has a word for almost everything, speech is understood by familiar listeners
- 3-4 years – Answers “who,” “what,” “where,” “why” questions, hears TV at same loudness level as rest of family, uses sentences with four or more words, usually talks easily without repeating syllables or words
- 4-5 years – Pays attention to short stories and can answer simple questions, voice is clear like other children’s, uses sentences with a lot of detail, says most sounds correctly
Hearing Evaluation at Any Age
Hearing can be evaluated in children of any age. Newborns have their hearing screened before they are discharged from the hospital. In fact, the majority of infants with more than a mild degree of hearing loss are detected by their state’s newborn hearing screening program. More in-depth diagnostic testing is recommended for babies who do not pass their screenings at birth as well as for babies with risk factors for hearing loss.
A variety of techniques can be used to test children’s hearing depending upon their age, developmental level, and cooperation. Prior to 6 months of age, infants are scheduled for hearing testing that does not require active participation (i.e. Auditory Brainstem Response and/or Otoacoustic Emissions). These tests are typically performed while the child is asleep. Although these tests provide important information about hearing function, they do not provide a complete evaluation of hearing ability. Only after a child is 6 or 7 months of age can behavioral testing be done to provide a more complete picture of a child’s response to sound.
Risk Factors for Hearing Loss
Some common risk indicators for hearing loss include, but are not limited to:
- Caregiver concern for hearing, speech, language, or developmental delay
- Neonatal Intensive Care Unit (NICU) stay of more than five days
- Craniofacial anomalies
- Family history of permanent hearing loss
- Syndromes associated with hearing loss, progressive hearing loss, or late-onset hearing loss
- In utero infections
- Ototoxic medications
A complete listing of risk factors for hearing loss can be found in the 2007 Position Statement by the Joint Committee on Infant Hearing (JCIH).
For older children who may have initially passed their newborn hearing screenings, it is crucial that any concerns for hearing be investigated further. The effects of hearing loss at any age can be devastating. Effects can range from speech/language difficulties to trouble in social situations to increased risk of academic failure. Some common warning signs of hearing problems in children:
- Parent/caregiver or teacher concern for hearing
- Speech/language delay or differences
- Says “what?” or “huh?” often
- Difficulty understanding speech in background noise
- Difficulty hearing in one or both ears on the phone
- Increased TV/stereo volume compared to rest of family
- Not startling to very loud sounds
- Attention or behavioral problems
- Academic difficulties
- Unable to detect where sounds are coming from
If you have concerns for any of the above, please schedule an appointment as soon as possible to have your child’s hearing evaluated.
Hearing Loss Management
We depend on our sense of hearing in order to communicate with each other and carry out our daily routines. For infants and children, hearing is even more crucial. Imagine learning to talk without being able to hear the sounds of speech properly or learning to cross the street without being able to hear oncoming traffic. We use our sense of hearing all day, every day to listen and learn about our surroundings, so it is essential that infants and children with hearing loss are given the same opportunity. For infants, the Joint Committee on Infant Hearing (2007) recommends the following timeline:
- 1 month – Hearing screening in all newborns
- 3 months – Diagnosis of hearing loss in referred infants
Fitting of amplification, if appropriate, within one month of diagnosis
- 6 months - Enrollment in early intervention
For older children, a hearing evaluation should be scheduled as soon as possible if there are any concerns for hearing or a speech/language delay. If your child fails a hearing screening at school or at the pediatrician’s office, it is very important to follow through with further testing and have a full hearing evaluation completed.
If a permanent hearing loss is diagnosed, regardless of the child’s age, a follow-up appointment should be scheduled with an Ear, Nose, and Throat (ENT) physician. Further testing may be ordered to try and determine the cause of the hearing loss, and referrals may be made to other specialists in areas such as ophthalmology and genetics.
Once a permanent hearing loss is diagnosed and a child is medically cleared by a physician, a hearing needs assessment can be performed. The hearing loss, implications for speech/language/learning, and amplification options are reviewed. Many children with permanent hearing loss are eventually fit with hearing aids. Hearing aids provide amplification for sounds that the child is missing, giving the child access to sounds that are crucial for his/her growth and the development of speech/language.
Some children with very specific types, severities, and configurations of hearing loss may also be candidates for other types of hearing technology. These may include the Baha hearing system or the cochlear implant.
Along with the timely diagnosis of hearing loss and fitting of amplification, when appropriate, it is very important to investigate early intervention options in your area. Various services are available for children with hearing loss. Children under the age of 3 may receive early intervention services through the Ohio Department of Health’s early intervention program, Help Me Grow. You will also be referred to the Regional Infant Hearing Program (RIHP), a specialized outreach program for deaf/hearing-impaired children and their families through Help Me Grow. RIHP provides you and your child with educational resources, family support, and language/auditory stimulation that will encourage your child to learn to communicate.
Children who are 3 years of age and older may receive services through the Ohio Department of Education. Contact your local school system to find out what services are available in your area. Depending on the age of your child and the area you live in, you may have access to a hearing-impaired preschool class or special school for children with hearing loss.
FM (Frequency Modulated) or IR (InfraRed) systems may also be recommended for children with hearing loss to improve their access to auditory information. Listening at a distance, in the presence of background noise, or in places of high reverberation can be very challenging even for children who use amplification. An FM/IR system involves the use of a microphone (transmitter) worn easily by the person speaking (e.g. parent or teacher) and a small receiver worn by the child (personal) or placed in the room (sound field) and can help to overcome some of the challenging listening situations mentioned above. FM/IR systems can be used with or without other devices, such as hearing aids and cochlear implants. FM/IR systems may be purchased for private use at home or may be provided by the school district.
If a school-aged child requires special education or related services due to his/her hearing loss, the school may provide assistance through the Individuals with Disabilities Education Act (IDEA, 1997). Most often, an Individualized Education Program (IEP) is created for each child individually by school administrators, teachers, parents, and other professionals involved in the child’s care. If a child qualifies for an IEP, assistance such as speech/language therapy, audiology services, and/or a FM/IR system may be provided. It should be noted that the assistance provided can vary significantly from one school district to another, so it is important to find out what your local school district will provide and to be an advocate for your child.