Infant and Young Child Hearing Detection and Intervention

by Thomas A. Powers, PhD

In 1999, The American Academy of Pediatrics recommended universal newborn hearing screening to detect hearing loss before three months of age and to begin treatment before six months of age. Hearing is critically important for the healthy development of infants and young children. Babies learn to talk by listening to their parents and caregivers and imitating the sounds that they hear in their environment. However, about two to three children per 1,000 births have a detectable hearing loss, with more acquiring a hearing loss later in their childhood. Today, over 96% of newborns in the United States have their hearing checked during their first month of life. Since children start learning speech in the first six months of life¹, it is critical that hearing is checked and any type of hearing loss is diagnosed as early as possible. 

The testing is completed in the hospital or the birthing center and usually consists of at least one of the following tests. 

• Otoacoustic emissions (OAE) tests whether some parts of the ear respond to sound. During this test, a soft earphone is inserted into your baby’s ear canal. It plays sounds and measures an "echo" response that occurs in ears with normal hearing. If there is no echo, your baby might have hearing loss.
• The auditory brainstem response (ABR) tests how the auditory nerve and brain stem (which carry sound from the ear to the brain) respond to sound. During this test, your baby wears small earphones and has electrodes painlessly placed on his or her head. The electrodes adhere and come off like stickers and should not cause discomfort.

Parents should confirm with their doctor that a hearing screening was conducted and ask for the results. 

Some infants (about 1.5%) will not pass the initial tests in the hospital due to the fluid that may still be present in their ears immediately after birth.  The hospital may conduct a second test before the infant leaves the hospital.  A failed hearing screening may indicate the presence of hearing loss, so parents or caregivers should make an appointment with a pediatric audiologist specializing in the testing of infants or young children no more than two months after the screening at the hospital.  At this follow up, an audiologist will complete additional testing to determine if your child does have a hearing loss.  If a hearing loss is present, treatment should begin as soon as possible to minimize the delay in speech and language development.  The pediatric audiologist may recommend a visit to an ear, nose, and throat (ENT) specialist for further medical evaluation.

Treatment for hearing loss in children depends on the severity of the loss.  Treatment options can include hearing aids, cochlear implants or assistive devices for better speech understanding in classroom situations.  In addition, speech therapy may be recommended to assist with speech and language development.

For older children, you will need to work with your child’s school to develop an Individualized Education Program (IEP) or Individualized Family Service Plan (IFSP).  You should ask that an educational audiologist is included a part of the team developing these plans.

Due to the importance of hearing at every stage of a child’s life, it is important to remain aware of  communication milestones. If you have any questions or concerns regarding your child’s ability to hear or develop language, reach out to your child’s pediatrician as soon as possible to keep your growing child healthy, happy, and hearing the world!