Detecting Hearing Loss in Infants and Toddlers

CME WebsitesChild Development, Infants 3 - 12 Months, Toddlers 12 - 36 Months

In 1993, the National Institute of Health made a recommendation that all babies have their hearing tested between birth and three months of age. By 1999, 20 states had implemented laws encouraging newborn hearing screenings and 12 states passed laws requiring them. Today, 10 years later, 30 states plus Guam, Puerto Rico and Washington, DC provide for the establishment of mandatory early hearing screening programs. Seventeen states require specified or all health insurers to cover the screening and three states (Ohio, Massachusetts and West Virginia) have laws that specify who will pay for the screening if the facility is not reimbursed by a third-party payer and parents are unable to pay.

A number of states have created task forces or advisory committees on newborn hearing screening. The only states with no current laws pertaining to newborn hearing screening are: Alabama, Idaho, North and South Dakota and Washington. Also, fourteen states allow newborns to be exempt from universal hearing screening programs if a parent objects to the testing. Most states have found newborn hearing screening programs to be cost effective at a rate of about $8-$50 per baby screened.

According to the American Academy of Pediatrics, hearing loss is one of the most frequently occurring birth defects with approximately 1-3 infants per 1,000 being born with significant hearing loss. Hearing loss is even more common in premature infants and those admitted to the NICU.  If hearing loss is not detected and treated early, it can impede speech, language and cognitive development.  Over time, such a delay can lead to significant educational costs and learning difficulties. The National Center for Hearing Assessment and Management (NCHAM) reports that detecting and treating hearing loss at birth for one child saves $400,000 in special education costs by the time that child graduates from high school. NCHAM data shows that, of the more than 4 million infants born in the United States in 2005, 93 percent were screened for hearing loss.  (Source: National Conference of States Legislatures).

Even though a child was screened as a newborn, there are still babies who exhibit hearing impairments later on in infancy or the toddler years.

What are some ways to determine if your child is hearing properly?

  • Birth to three months: Reacts to loud sounds (may startle), is soothed by the sound of your voice, looks toward you when you speak, wakes upon hearing loud voices and/or sounds; smiles in response to someone speaking, seems to recognize your voice and quiets down if crying.
  • Three to six months: Looks around for a new sound that is made, begins to coo and babble some consonant-vowel sounds (dadada), shows enjoyment of rattles and other toys that make noises, may be scared of loud sounds or voices.
  • Six to ten months: Responds to name and familiar environmental sounds such as the ringing of the phone or the noise of the vacuum cleaner, babbles a greater variety of consonant-vowel combinations and begins to repeat sounds others make.
  • Ten to fifteen months: Turns to locate familiar people when named (where is Mommy?), points to a familiar toy (where is your ball?) or in a picture book when asked, says first true words.
  • Fifteen months to 2 years: Uses at least 10-15 consistent words and attempt to repeat new words, follows simple 1-2 step directions (Get your ball or get your cup and put it on the table), identifies sounds with the source (ie. Who is barking? And points to or says dog).

Some of the things that can affect a child’s hearing include:

  • Premature birth
  • Family history of hearing problems
  • Prenatal exposure to rubella
  • Certain types of birth defects
  • Problems during birth that may have resulted in a lack of oxygen to the brain
  • Exposure to prolonged, high-decibel noise (airport runways, loud concerts/music)
  • Chronic middle-ear inflammation (otitis media), which may cause scarring in the Eustachian tubes if your child has frequent ear infections. Children may also have temporary hearing loss during an ear infection.

However, be aware that 50% of babies with hearing loss had no known risk factors.

Babies learn to speak by listening and the child who does not have normal hearing will have delayed speech and language. The most critical years for the development of language are from birth to three years of age and the earlier a hearing loss is discovered the better. If you suspect that your child is not hearing properly have your baby screened by a trained and qualified Audiologist.