What is hearing loss in children?

Hearing loss is when any part of the ear is not working the way it should. This includes the outer, middle and inner as well as the hearing nerve and portion of the brain dedicated to hearing.

Significant hearing loss is uncommon in newborns and young children. However, nearly all children develop transient hearing loss related to middle ear infections or glue ear during early childhood. Hearing loss in the first years of life can cause delays in speech, language, and brain development.

For newborns, detection and intervention for hearing loss prior to six months of age results in significantly better outcomes than intervention after six months of age.

How do I know if my child has hearing loss?

If you think that your child might have hearing loss, ask the child’s doctor for a hearing screening as soon as possible. Don’t wait!

Even if a child has passed a hearing screening before, it is important to look out for the following signs.

Signs in Babies

• Does not startle at loud noises.
• Does not turn to the source of a sound after 6 months of age.
• Does not say single words, such as “dada” or “mama” by 1 year of age.
• Turns head when he or she sees you but not if you only call out his or her name. This sometimes is mistaken for not paying attention or just ignoring, but could be the result of a partial or complete hearing loss.
• Seems to hear some sounds but not others.

Signs in Children

• Speech is delayed.
• Speech is not clear.
• Does not follow directions. This sometimes is mistaken for not paying attention or just ignoring, but could be the result of a partial or complete hearing loss.
• Often says, “Huh?”
• Turns the TV volume up too high.

What are the speech and language milestones of children?

Monitoring of speech and hearing milestones is one way of determining if your child is developing appropriately.

Birth to 1 year

Hearing and Understanding	Talking
Birth–3 Months Startles to loud sounds Quiets or smiles when spoken to Seems to recognize your voice and quiets if crying Increases or decreases sucking behavior in response to sound	Birth–3 Months Makes pleasure sounds (cooing, gooing) Cries differently for different needs Smiles when sees you
4–6 Months Moves eyes in direction of sounds Responds to changes in tone of your voice Notices toys that make sounds Pays attention to music	4–6 Months Babbling sounds more speech-like with many different sounds, including p, b and m Chuckles and laughs Vocalizes excitement and displeasure Makes gurgling sounds when left alone and when playing with you
7 Months–1 Year Enjoys games like peek-a-boo and pat-a-cake Turns and looks in direction of sounds Listens when spoken to Recognizes words for common items like “cup”, “shoe”, “book”, or “juice” Begins to respond to requests (e.g. “Come here” or “Want more?”)	7 Months–1 Year Babbling has both long and short groups of sounds such as “tata upup bibibibi” Uses speech or noncrying sounds to get and keep attention Uses gestures to communicate (waving, holding arms to be picked up) Imitates different speech sounds Has one or two words (hi, dog, dada, mama) around first birthday, although sounds may not be clear

 

One to two years

Hearing and Understanding	Talking
Points to a few body parts when asked. Follows simple commands and understands simple questions (“Roll the ball,” “Kiss the baby,” “Where’s your shoe?”). Listens to simple stories, songs, and rhymes. Points to pictures in a book when named.	Says more words every month. Uses some one- or two- word questions (“Where kitty?” “Go bye-bye?” “What’s that?”). Puts two words together (“more cookie,” “no juice,” “mommy book”). Uses many different consonant sounds at the beginning of words.

 

 

Two to three years

Hearing and Understanding	Talking
Understands differences in meaning (“go-stop,” “in-on,” “big-little,” “up-down”). Follows two requests (“Get the book and put it on the table”). Listens to and enjoys hearing stories for longer periods of time	Has a word for almost everything. Uses two- or three- words to talk about and ask for things. Uses k, g, f, t, d, and n sounds. Speech is understood by familiar listeners most of the time. Often asks for or directs attention to objects by naming them. Asks why? May stutter on words or sounds

 

Three to four years

Hearing and Understanding

Talking

Hears you when you call from another room. Hears television or radio at the same loudness level as other family members. Understands words for some colors, like red, blue, and green Understands words for some shapes, like circle and square Understands words for family, like brother, grandmother, and aunt

Talks about activities at school or at friends’ homes. Talks about what happened during the day. Uses about 4 sentences at a time. People outside of the family usually understand child’s speech. Answers simple “who?”, “what?”, and “where?” questions. Asks when and how questions. Says rhyming words, like hat-cat Uses pronouns, like I, you, me, we, and they Uses some plural words, like toys, birds, and buses Uses a lot of sentences that have 4 or more words. Usually talks easily without repeating syllables or words.

 

Four to five years

Hearing and Understanding

Talking

Understands words for order, like first, next, and last. Understands words for time, like yesterday, today, and tomorrow. Follows longer directions, like “Put your pajamas on, brush your teeth, and then pick out a book.” Follows classroom directions, like “Draw a circle on your paper around something you eat.” Hears and understands most of what is said at home and in school.

Says all speech sounds in words. May make mistakes on sounds that are harder to say, like l, s, r, v, z, ch, sh, th. Responds to “What did you say?” Talks without repeating sounds or words most of the time. Names letters and numbers. Uses sentences that have more than 1 action word, like jump, play, and get. May make some mistakes, like “Zach got 2 video games, but I got one.” Tells a short story. Keeps a conversation going. Talks in different ways depending on the listener and place. May use short sentences with younger children or talk louder outside than inside.

 

This information represents, on average, the age by which most monolingual speaking children will accomplish the listed milestones. Children typically do not master all items in a category until they reach the upper age in each age range. Just because your child has not accomplished one skill within an age range does not mean the child has a disorder. However, if you have answered no to the majority of items in an age range, seek the advice of a doctor.

Should my child go for screening?

Hearing screening can tell if a child might have hearing loss. Hearing screening is easy and is not painful. In fact, babies are often asleep while being screened. It takes a very short time — usually only a few minutes.

Babies-All babies should have a hearing screening no later than 1 month of age. Most babies have their hearing screened while still in the hospital. If a baby does not pass a hearing screening, it’s very important to get a full hearing test as soon as possible, but no later than 3 months of age.

Children-Children should have their hearing tested before they enter school or any time there is a concern about the child’s hearing. Children who do not pass the hearing screening need to get a full hearing test as soon as possible.

What are the causes or risk factors of hearing loss in children?

• Caregiver concerns regarding hearing, speech, language, or developmental delay.
• Family history of permanent childhood hearing loss.
• Neonatal intensive care of more than 5 days
• Infections within the womb
• Genetics
• Abnormalities of the face and skull
• Syndromes or neuro-degenerative disorder associated with hearing loss or progressive or late-onset hearing loss.
• Head injury that requires hospitalization.
• Chemotherapy
• Recurrent or persistent otitis media for at least 3 months.

 

What are the treatment options?

No single treatment or intervention is the answer for every person or family. Good treatment plans will include close monitoring, follow-ups and any changes needed along the way. There are many different types of communication options for children with hearing loss and for their families. Some of these options include:

• Learning other ways to communicate, such as sign language
• Technology to help with communication, such as hearing aids and cochlear implants
• Medicine and surgery to correct some types of hearing loss
• Family support services

 

Disclaimer

The content on the Nairobi ENT website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions.

References

1. Harlor, Allen D. Buz, and Charles Bower. “Hearing assessment in infants and children: recommendations beyond neonatal screening.” Pediatrics4 (2009): 1252-1263.
2. American speech, language and hearing association.

Further information

1. babyhearing.org
2. handsandvoices.org