Hearing Tests for Young Children
When parents have concerns about their child’s communication skills, one of the very first recommendations we make is to get a hearing test. But a common rebuttal is, “We know they can hear, why do we need this?” So we asked our friend and pediatric audiologist, Dr. Kelsey Kerkhove to help us explain why your child might benefit from a hearing test, the difference between hearing screenings and comprehensive hearing evaluations, as well as what to expect during a hearing evaluation depending on your child’s age.
We hope this post clears up a few things!
A few key things you should know about your child’s hearing
Did you know that hearing loss can have a direct impact on your child’s ability to learn how to talk and communicate? So much so that your child’s hearing journey begins before ever going home from the hospital (and continues throughout their childhood).
When a child has difficulty hearing, the brain will have trouble accessing sounds and words needed to develop listening and spoken language. This can result in delays in learning speech and language, academic, and social skills. However, when hearing loss is identified early and managed appropriately these delays can be prevented.
Hearing loss can occur at any time. And because hearing at all the different frequencies of speech sounds is necessary for correct speech production, speech therapists will always recommend that your child have a hearing test if you have concerns about your child’s speech and language development.
The newborn hearing screening
The Universal Newborn Hearing Screening Program was first established in 1999 and ensures that every baby throughout the country receives a hearing screening before leaving the hospital. This is because early identification and management of hearing loss is key to children learning and developing spoken language.
The newborn hearing screening is a quick, painless, and non-invasive way to detect if your child might have difficulty hearing and can be completed as early as 6 hours of life.
Types of newborn hearing screenings
OAEs
One way to screen your baby’s hearing is using otoacoustic emissions, commonly referred to as OAEs.
A tiny headphone will be placed in the baby’s ears and different sounds will be played. If your baby has a healthy functioning inner ear, an echo response will be measured across the different sounds which would indicate a ‘pass’ result. If that echo response is not able to be measured, this would result in a ‘not pass’ or a ‘refer.’
AABR
Another way to screen hearing is using an automatic auditory brainstem response test, commonly referred to as an AABR.
This test is similar but instead of measuring responses to sound from the inner ear, this automatically measures responses from the brain. Stickers are placed on your baby’s head and headphones are placed over the ears. A relatively soft sound is played in both ears and the machine automatically measures if the brain is responding. If the sound is able to properly travel through the hearing pathway this will indicate a ‘pass’ result. If your baby does not pass, this could mean there is something preventing the sound from getting through and we will need to do a little more investigating to determine why.
Monitoring hearing throughout childhood
Even if your child “passed” their newborn hearing screening, their hearing journey does not stop there! Children will continue to have their hearing monitored throughout their life whether it be at the doctor's office or even at school. This is because any level of hearing loss can potentially have an impact on your child’s development and young children are not always able to report when there has been a change in hearing.
What’s the difference between a hearing screening and a comprehensive hearing evaluation?
Now you may be asking yourself, why would my child need to see an audiologist if I know they can hear or if they’ve had their hearing screened?
A hearing screening is just that, a screening. This is usually completed by a nurse or technician and provides only a ‘pass’ or ‘refer/not pass’ result. It does not provide any diagnostic information such as type and degree of hearing loss or rule out slight to mild hearing loss.
A comprehensive hearing evaluation is different from a hearing screening and can help gather additional insights on how to help your child.
Because hearing loss can occur at any age AND because any degree of hearing loss can have an affect on your child’s speech and language development, it’s important to follow through with the testing if it’s recommended. Hearing loss may not be as obvious as you think!
A comprehensive hearing evaluation is completed by an audiologist and will provide specific information about your child’s hearing. The audiologist will assess several different functions of the ear and measure their hearing across many different pitches or frequencies (things that are important for your child’s speech and language development).
Reasons your child should see an audiologist
You may be wondering, “When should my child receive a comprehensive hearing evaluation?” There are a few instances where seeing an audiologist would be helpful:
If your child does not pass their hearing screening
If your child is showing signs or symptoms of hearing loss such as a delay in speech and language development
If your child has risk factors for late onset hearing loss
If you as their parents have concerns about their hearing. Always follow your gut!
What to expect at your child’s hearing test, broken down by age group
Hearing can be tested at any age however, the test strategy may vary based on how old your child is and their development.
Birth-6 months
If your child did not pass their newborn hearing you were likely referred to an audiologist for additional testing. You may have also received pre-test instructions that sounded like cruel and unusual punishment such as “keep your baby awake in the car,” or “do not feed your baby until you arrive at the appointment” or even “have your baby skip their nap to make sure they arrive at the appointment sleepy.”
These instructions might sound strange, but are actually critical to the success of the appointment. This is because the test performed is an Auditory Brainstem Response (ABR) evaluation and requires your baby to be completely asleep in order to obtain accurate and reliable results. Any movement such as crying or sucking on a pacifier could potentially interfere with the test.
For this comprehensive hearing evaluation, the audiologist will place stickers, also known as electrodes or sensors, on your baby’s head and headphones in their ears. A variety of sounds will be played through the headphones and the audiologist will measure the brain's response to sound.
6 months-2.5 years
Once your baby turns 6 months it’s not as easy for them to fall asleep in strange places as they are much more alert, aware, and observant. Therefore, the strategy to test your baby’s hearing will change significantly.
The test approach for children around age 6 months to 2.5 years is known as Visual Reinforcement Audiometry (VRA). For this test, your child will sit on your lap in a sound booth. The audiologist will play a variety of sounds through speakers or headphones followed by a positive reinforcement such as a light up toy or image on a television screen and observe how your child reacts to the sound.
Do not be discouraged if your child’s attention fades quickly and the audiologist does not get all the information needed at the first appointment. Depending on your child’s age and attention, sometimes it can take more than one appointment to gather all the information needed to put together all of the pieces of the puzzle about your child’s hearing.
2.5 years-5 years
For children approximately 2.5 to 5 years old the technique is known as Conditioned Play Audiometry (CPA) which is a fancy term for turning the hearing test into a game. The audiologist (and often an assistant) will work together to teach your child the ‘game.’ The goal is to teach them that whenever they hear the sound (usually a beep) to drop a toy in the bucket. This is then followed by lots of positive praise. This keeps the task fun, exciting, and engaging and provides reliable test results to determine your child’s hearing levels.
5 years and older
For children 5 years and older the test strategy is known as standard audiometry and this is what you would typically expect from a hearing test. Headphones are placed on your child’s ears and they are asked to respond either by raising their hand or pressing a button when they hear a beep. The audiologist will then determine their hearing levels based on their responses.
What the hearing evaluation can tell you
No matter which test your child participates in, each testing strategy will allow the audiologist to not only determine if there is hearing loss present but also to determine the type and degree of hearing loss in order to come up with the best treatment plan for your child.
Any level of hearing loss can put your child at risk for speech and language, academic, and social delays, so it’s really important that you understand how their hearing might impact them. Remember, if you have concerns about your child’s speech and language development, their hearing should be assessed before beginning speech therapy to make sure their brain has access to all of the sounds!
I think my child might have hearing loss…
Each child’s hearing journey is unique to them and Dr. Kelsey’s goal as a pediatric audiologist is to support families every step of the way through community, connection, and kindness. If you have any questions about your child’s hearing journey, connect with Kelsey. And make sure to grab her free guide for your child’s first hearing assessment before you go! We highly recommend her resources and services!
Curious where your child is at with their communication development?
We recommend downloading our toddler talking milestones checklist to find out which skills they’ve mastered, which ones they’re working on, and which ones they may be behind on.
And of course, if you have concerns, of any kind, we always recommend talking to your pediatrician or seeing a speech-language pathologist. You won’t regret getting a head start!