August 2003

Test Your Baby's Hearing
Early Detection Important for Speech and Language Development

Most children hear and listen from birth. But that's not true for all children. In fact, about two or three out of every 1,000 children in the United States are born deaf or hard-of-hearing. More lose their hearing later during childhood. Many of these children may need to learn speech and language differently, so it's important to detect deafness or hearing loss as soon as possible.

If you have a new baby, in addition to counting the number of fingers and toes it's also a good time to have his or her hearing screened, according to the experts at NIH's National Institute on Deafness and Other Communication Disorders (NIDCD).

How early should I have my baby's hearing screened?
Your baby should have a hearing screening within the first month of life. If hearing loss is suspected, make sure a hearing expert (called an audiologist) tests your baby's hearing by three months of age. If hearing loss is confirmed, it's important to consider the use of hearing devices and other communication options by six months of age.

Where can my baby's hearing be screened?
Ask your doctor or hospital if they plan to do the test on your newborn. Many hospitals automatically screen all newborns for hearing loss. Some normally screen only those at high risk for hearing loss, such as babies with a family history of deafness or hearing problems, low birth weight, or certain other medical conditions. Even if your baby doesn't have risk factors, being screened is important, because many children with no risk factors have hearing loss.

How will my baby's hearing be screened?
Two hearing tests are used to screen babies. In both tests, no activity is required from your child other than lying still. Otoacoustic emissions (OAE) tests can show whether parts of the ear respond properly to sound. Auditory brain stem response (ABR) tests check how the brain stem (the part of the nerve that carries sound from the ear to the brain) and the brain respond to sound. If your child doesn't respond consistently to the sounds presented during either of these tests, your doctor may suggest a follow up hearing screening and a referral to an audiologist for a more comprehensive hearing evaluation.

How can I recognize hearing loss during early childhood?
Even though screening is designed to detect hearing loss as early as possible, some children don't develop hearing loss until later in life. Even if you've had your baby's hearing tested, you should look for signs that your baby is hearing well.

For example, during the first year, notice whether your baby reacts to loud noises, imitates sounds, and begins to respond to his or her name. At age two, ask yourself whether or not your toddler imitates simple words and enjoys games like peek-a-boo and pat-a-cake. Is he or she using two-word sentences to talk about and ask for things? At age three, notice whether or not he or she begins to understand "not now" and "no more" and follows simple directions. If for any reason you think your child is not hearing well, talk to your doctor.

If my child has a hearing loss, can hearing be improved?
A variety of devices and strategies are helpful for children who are hard-of-hearing. An audiologist can help you to decide whether these or other devices can help your child:

Hearing aids are instruments that make sounds louder. They are worn in or behind the ear and come in several different shapes and sizes. Hearing aids can be used for varying degrees of hearing loss. An audiologist will fit a hearing aid that will work best for your child's hearing loss. Hearing aids can be expensive, so you'll want to find out whether they have a warranty or trial period. You'll also want to talk with your insurance provider to understand what is covered and what isn't.

Cochlear implants have three parts: a headpiece, a speech processor, and a receiver. The headpiece is worn just behind the ear where it picks up sound and sends it to the speech processor. The speech processor, a beeper-sized device that can fit in a pocket or on a belt, converts the sound into a special signal that is sent to the receiver. The receiver, a small round disc about the size of a quarter that a surgeon has placed under the skin behind one ear, sends a sound signal to the brain.

Not all children who have hearing loss should get cochlear implants. Doctors and hearing experts think they're best for children who have a profound hearing loss and won't benefit from hearing aids.

How can I help my child communicate?
There are a variety of ways to help children with hearing loss express themselves and interact with others. The option you choose will depend on how you want your child to learn and communicate. Find out about all of the choices and talk to lots of experts:

Oral/Auditory Options combine hearing, lip-reading, and hearing devices such as hearing aids and cochlear implants. The goals of oral/auditory options are to help children develop speech and English-language skills.

American Sign Language (ASL) is a visual language used by some deaf children and their families. ASL consists of hand signs, body movements, facial expressions, and gestures. It's a language with its own grammar and syntax, which are different from English. ASL has no written form.

Signed English is similar to ASL, using the same visual vocabulary of signs, but it adheres more strictly to the sentence structures of spoken and written English.

Cued Speech is a system that uses handshapes in different locations along with the natural mouth movements to represent speech sounds. Watching the mouth movements and the handshapes can help some children learn to speech-read English; this is especially important in discriminating between sounds that sound different but look the same on the lips.

Combined Options use portions of the various methods listed above. For example, some deaf children who use oral/auditory options also learn signed English. Children who use ASL also learn to read and write in English. Combined options can expose children who are deaf or hard of hearing to many different ways to communicate and express themselves.

— a report from The NIH Word on Health, August 2003

For more information if your baby has hearing problems, see What to Do if Your Baby's Screening Reveals a Possible Hearing Problem at http://www.nidcd.nih.gov/health/hearing/baby_screening.asp.

For additional information on speech and language development, communication options, cochlear implants, hearing aids, ASL, and other topics, visit NIDCD at http://www.nidcd.nih.gov/, send e-mail to nidcdinfo@nidcd.nih.gov or contact:

NIDCD Information Clearinghouse
1 Communication Avenue
Bethesda, MD 20892
Toll-free: (800) 241-1044
Toll-free TTY: (800) 241-1055