By Barbara Jenkins, Au.D., BCABA

Universal hearing screening for newborns has helped to identify most children with hearing issues quickly and accurately. With simple tests, 80 to 90 percent of hearing loss can be detected, and children can begin early intervention with the best possible outcomes for language development.

However, even if your child passed the newborn screening at birth, hearing loss that is genetic or progressive may not appear until later, when a child is a toddler or older. It’s important to identify the signs that may suggest a possible hearing loss in your child as quickly as possible, so that the next steps can be taken: testing, followed by appropriate treatment and management.

The Infant and Toddler

Delayed or absent speech development is the most important clue indicating a possible hearing loss in the very young child. Identifying hearing loss in the infant and young child requires watching for critical developmental milestones. Detecting a hearing loss as early as possible and then treating it can help your child’s speech and language develop at a rate comparable with that of children without a hearing loss.

Use the following milestones as a guideline, and always discuss any concerns with your pediatrician.

By 3 months, your baby recognizes your voice, makes cooing noises, and is startled by sudden, loud noises.

By 6 months, your baby recognizes speech sounds and familiar voices, turns his head toward interesting sounds, plays with his own voice, and laughs. Your baby uses his voice to indicate pleasure and discomfort, and has speechlike conversations with caregivers.

By 9 months, your baby understands simple words like “Mommy,” “Daddy,” “no,” “bye-bye,” and his own name. By 10 months, your baby’s babbling should sound speech-like, with strings of single syllables (“da-da-da-da”).

By 12 months, one or more real, recognizable, spoken words emerge.

By 18 months, your toddler should understand simple phrases and be able to retrieve familiar objects and point to body parts on command (without gestures). Your toddler has a spoken vocabulary of 20 to 50 words and short phrases (“all done,” “go out,” “Mommy up”) and is learning new words every week.

By 24 months, your toddler’s spoken vocabulary should be 200 to 300 words, and simple sentences can be spoken. Adults who do not spend time with your child on a daily basis can understand your child’s speech. Your child should be able to sit and listen while being read to.

The Older Child

It is more difficult to identify hearing loss in children who have developed speech skills, as they may have unconsciously developed coping techniques to compensate for their loss. Watch for these signs:

1. Your child seems to hear fine some of the time and then not respond at other times.

2. Your child wants the TV volume louder than other members of the family.

3. Your child asks “what?” or says “huh?” more often than he used to.

4. Your child moves one ear forward when listening, or he complains that he can only hear out of his “good ear.”

5. Your child’s grades fall, or his teacher notes that he doesn’t seem to hear or respond in the classroom.

6. Your child says that he didn’t hear you. Many parents assume their children are not paying attention when in fact there may be an unidentified hearing loss.

7. It seems as though your child is just not paying attention.

8. Your child starts to speak more loudly than previously.

9. Your child looks at you intently when you speak to him. He may be depending on visual cues.

10. You just have a feeling. Sometimes you just can’t put your finger on what your concern is.

There are many possible causes of acquired hearing loss that appear months or years after birth. Most hearing loss in children without obvious risk factors (such as premature birth) has a genetic cause. If you have concerns, contact your pediatrician for a referral to an audiologist, the professional who is specially trained to identify hearing loss in children of all ages, for a complete hearing evaluation.

Hearing Health staff writer Barbara Jenkins, Au.D., BCABA has more than 25 years of hospital and clinical experience in treating patients with hearing loss. She was awarded the 2010 Leo Doerfler Award for Clinical Excellence by the Academy of Doctors of Audiology. This article originally appeared in the Fall 2012 issue of Hearing Health magazine; please refer also to the Center for Disease Control and Prevention’s list of developmental milestones.