Recent statistics indicate that approximately 1-3 of every 1,000 babies born in the U.S. will experience bilateral (in both ears) hearing loss. According to the American Academy of Pediatrics (AAP), this averages out to 33 newborns a day who are born with some degree of hearing loss.

Some hearing problems are caused by defects present at birth. However, some hearing loss stems from easily correctable issues such as infection or fluid in the ear. Other conditions, such as abnormalities within the ear canal, may require extensive therapy or surgery, while some may not be repairable at all.

Regardless, early detection is a crucial part of preventing permanent hearing loss and other difficulties, such as speech impediments and delayed language development. Further, screening of newborns and routine preventive checkups may lessen the possibility of long term hearing problems.

Behavioral observation is not enough to detect hearing loss in newborns and young children. Some parents and caregivers do report signs of inattentiveness or concern about hearing loss before it is confirmed by a health professional. But screening tests, typically provided at birth, are more reliable and an essential part of promoting and maintaining auditory health.

But why is early screening so important to a child’s development? According to the AAP, failure to detect hearing loss at an early age “may result in lifelong deficits in speech and language acquisition, poor academic performance, personal-social maladjustments, and emotional difficulties.”

The American Speech-Language-Hearing Association (ASHA) agrees, stating that late detection of hearing problems typically means a delay in language development. Fortunately, children whose hearing problems are detected early and receive proper intervention are more likely to rebound and function at the same level as other peers by the time they start school. Given this, it is clear that early detection is not just important, it is critical to all aspects of development.

Screening of newborns for hearing detects problems by measuring both auditory output and brainstem response. For infants who do not pass the screening measures, follow-up exams and monitoring are recommended to confirm findings and track progress. Even if a child passes the tests, future hearing loss is still possible, as some of the conditions that cause hearing loss may not surface until the child is older.

Children ages 7-36 months are screened using a more behavioral-based approach. Visual reinforcement audiometry is typically used for children 6-24 months of age and involves a child looking in the direction of a sound source.

Conditioned play audiometry, typically used for children 2-3 years of age, involves a child performing a specified activity whenever he or she hears a sound. If such tasks are beyond the child’s ability, the methods used on infants may be administered in their place.

If a child fails these tests, then a referral to an audiologist will most likely be made. ASHA recommends that the hearing status of such children be confirmed within 1-3 months of the first screening.

A number of risk factors increase the likelihood that a child will have hearing problems, including head trauma, a family history of childhood hearing loss, recurrent or persistent ear infections, the use of certain medications, and illnesses such as bacterial meningitis or mumps.

In addition, children who are born prematurely or have a low birth weight may be at risk for hearing problems. Children with any of these risk factors should be screened every six months until at least three years of age, with follow-up evaluations regularly performed thereafter.

For babies and young children, failure to do age-appropriate tasks such as respond to a noise, turn in the direction of a caregiver’s voice, squeal, or babble may indicate a potential hearing problem. For toddlers and older children, the signs may be more obvious.

For example, if a child consistently ignores your requests, or does not respond to inquiries by name, this could be due to a hearing problem. However, it could also be the result of a behavioral issue, so additional evaluation may be needed.

Of course, with older children you have the additional advantage of verbal communication. Simply asking if a child can detect certain sounds or hear her name being called may help identify that a problem exists.

Along with providing information to families who might not have had access to screening for hearing at birth, childcare providers can encourage parents to have hearing tests performed regularly, particularly if any problems or early warning signs are detected. Regardless of a child’s age, if a caregiver detects any signs of hearing loss, the parents or guardian should be notified immediately and advised to seek prompt medical treatment.

Caring for Our Children: National Health and Safety Performance Standards: Guidelines for Out-of-Home Child Care suggests that caregivers should note all hearing screening performed prior to enrollment in a child’s health report. If no screening has been done, the early childcare and education program should advise the parents or guardian to have the child screened no later than six weeks after admission. The health report also should list any acute or chronic problems detected and be signed by the child’s health care provider.

By being aware of potential symptoms of hearing loss and observing children closely, childcare providers can make parents aware of any problems or concerns and encourage prompt evaluation by a health professional. A quick response may prevent long-term damage to a child’s hearing, as well as other aspects of his or her development, academic performance, and emotional health.

Diona L. Reeves
Freelance writer and former employee of the American Academy of Pediatrics’ Healthy Child Care America program

American Academy of Pediatrics, 141 Northwest Point Blvd., Elk Grove Village, IL 60007-1098; 847-434-4000; www.aap.org

American Speech-Language-Hearing Association, 10801 Rockville Pike, Rockville, MD 20852; 800-638-8255; www.asha.org

National Center for Hearing Assessment & Management (NCHAM), Utah State University, 2880 Old Main Hill, Logan, Utah 84322; 435-797-3584; www.infanthearing.org

Centers for Disease Control and Prevention, Hearing Loss Fact Sheet, 800-CDC-INFO (800-232-4636); www.cdc.gov/actearly