What to know about your child’s hearing

When young children have trouble hearing, it can affect their speech, social connections, and development. Early diagnosis, treatment, and support help kids have the best outcomes possible.

There are several types of hearing loss and many different causes. Hearing difficulties can be caused by genetics, infections, obstruction, trauma, or noise exposure. Hearing loss in children can be partial (meaning children hear some sounds but not others) or full (meaning children cannot hear at all) and can happen in one or both ears. Just because a child reacts to some sounds doesn’t mean their hearing is perfect. It’s important for children’s speech and development to hear sounds in a variety of pitches and volumes.

By understanding hearing screening, warning signs, risk factors, and prevention, parents can be strong advocates for their children’s hearing health.

Newborn Hearing and the 1-3-6 Rule

Some types of childhood hearing loss are present at birth. This is called congenital hearing loss. Parents of infants should know the 1-3-6 guidelines for newborn hearing. All children should have a hearing screen by 1 month old. Babies who didn’t pass their hearing screen should be seen by an audiologist by 3 months old. Infants with hearing loss should get Early Intervention services by 6 months old.

Every newborn should have a hearing screen before they leave the hospital. This is a safe, painless test that takes about 10 minutes. It’s usually done when newborns are sleeping. There are several reasons a baby may not pass their first hearing test. These include hearing loss, fluid in the ears, baby moving around a lot, or background noise. If a baby doesn’t pass the hearing screen, it may be noted as “not pass” or “refer.”

If a newborn doesn’t pass their hearing screen in the hospital, it must be repeated. Before discharge, the hospital should give you a prescription or referral for a follow-up test and information about how to make the appointment. It will either be done at the hospital where the baby was born or by an outpatient audiologist (hearing specialist). It’s common for newborns to not pass their first hearing test, usually due to fluid in their ears. However, since a small percentage of newborns will have true hearing loss, it’s very important to get them re-tested.

If your baby doesn’t pass the newborn hearing screen by 1 month, they will need a full evaluation by an audiologist. Your pediatrician can help with a referral and scheduling the appointment. The audiologist can diagnose the type of hearing loss and how severe it is. After this evaluation, you may be sent to an otologist or otolaryngologist. These are doctors who specialize in ears and can also be called an Ear, Nose, and Throat Doctors or ENTs.

Any infant with hearing loss should be referred to Early Intervention. This is a free service for infants and toddlers with disabilities or delays. Early Intervention supports children’s development by evaluating their needs and providing services like speech therapy or assistive technology. Families or providers can make a referral by reaching out to the Early Intervention contact in their county.

Hearing loss in infants and toddlers

If your newborn passes their newborn hearing screen, that’s great news. However, hearing loss can also happen after babies are born. This is called acquired hearing loss.

Many types of hearing loss are treatable if they are diagnosed and treated early. Most pediatricians don’t regularly check children’s hearing until they are around 5 years old. So, it’s important to talk to your doctor if you have any concerns about your child’s hearing. Also, if your child was exposed to specific infections during pregnancy or has a family history of hearing loss, they may need regular hearing testing even if they don’t have symptoms.

If you are worried about your child’s hearing or if they have a risk factor for hearing loss, there are a few things your pediatrician can do. They may perform a hearing test in the office, refer to an ear, nose and throat specialist (also called otolaryngologist or ENT), or refer to audiology (hearing specialist). Here is a list of audiologists that see children in NY State: Pediatric Audiology Directory. Let your pediatrician’s office know if you have trouble making an appointment or finding an audiologist.

If your child has hearing loss or speech delays and your child is under 3 years old, you may also be referred to Early Intervention. If your child is over 3 years old, they may qualify for services through their local school district.

You should have your child’s hearing checked if they have the following:

• Family history of hearing problems
• Certain infections in pregnancy including toxoplasmosis, syphilis, cytomegalovirus (CMV), or rubella
• Frequent or severe ear infections
• Serious head injury
• Not meeting speech and hearing milestones: Hearing and Talking Checklist by Age
• Trouble hearing, even if it’s only in certain situations (for example, difficulty with background noise, turns head to one side when listening, trouble with quiet sounds, turns TV or music louder than other people)
• Ringing in the ear or ears “feel clogged”
• Taking medications that can affect hearing

How to protect your child’s hearing

Loud noises are everywhere, including video games, music players, blenders, power tools, lawnmowers, motorcycles, fireworks, concerts, and sports events. These loud sounds can damage parts of the inner ear and cause “noise-induced hearing loss.” This can happen from one loud event or by hearing many loud sounds over time. This kind of hearing loss affects up to 1 in 10 children and is hard to treat. But it is preventable.

Here are few ways you can help protect your child’s hearing:

• Avoid loud sounds when possible
• Use age-appropriate hearing protection like ear muffs or ear plugs when loud sounds are unavoidable
• Turn TV, video games, and music down to lowest comfortable volume
• Use “output-limiting” or “children-safe” earphones when listening to music or videos
• Take listening breaks when using earphones
• Don’t let children put q-tips or other items in their ears
• Make sure children wear helmets when riding bikes

Resources for Families

Hearing Loss in Children (HealthyChildren.org)

New York State Early Hearing Detection and Intervention Program

Your Baby’s Hearing Screening and Next Steps (NIH)

What is Noise-Induced Hearing Loss (CHOP)