Proper hearing is essential to a child’s ability to develop speech and language skills, as well as his or her cognitive, social and emotional development. The first few years of a child’s life are particularly important. During this time, children learn to make sense of sounds via their ears, working in conjunction with their brains. The importance of these early years is what prompted many states to initiate hearing tests for all newborns. Early detection and appropriate intervention are key factors in eliminating or minimizing the negative impact of hearing loss.

Despite the importance of early intervention, on rare occasions parents still are told their child is too young for a hearing test. Very young children can be tested. Here are some of the more common tests:
 
Visual reinforcement audiology
This is a behavioral testing technique typically used with children between 6 months and 3 years old. In a special booth, the child is seated on a parent's lap with speakers situated on either side. An audiologist transmits speech and different pitches of sounds through the speakers. When the child hears the voice or sounds and looks in the direction of the sound, an animated, lighted toy appears. Using this type of visual reinforcement, the child eventually learns to look toward the source of the sound when he or she hears it, allowing the audiologist to evaluate the child’s hearing.

Conditioned play audiometry
This test typically is used for children between 3 and 5 years old. While wearing headphones, the child is encouraged to play a listening game. Different sound pitches are introduced through the headphones, and the child is taught to perform a task, such as putting a block in a bucket every time a sound is heard. If the child is willing and able, his or her ability to hear and understand speech also can be assessed by using a picture-pointing task or repeating words. By having the child wear headphones, the audiologist is able to determine the level of hearing in each ear.

Conventional audiometric testing
Most people are familiar with this test. It typically can be used with children age 5 and older. With headphones on, the child is asked to raise his or her hand every time different sounds or pitches are heard. In addition, the child’s ability to detect and understand speech is evaluated by having him or her repeat words.

Newborns, very young infants and some children with special needs, such as visual difficulties, cognitive or physical impairments, and/or behavioral issues, may not be able or willing to perform some of these tests. In these situations, audiologists rely on electrophysiological tests that do not require any responses from the child. These tests include auditory brain stem response evaluations and auditory steady state response testing. During these noninvasive and painless tests the child typically is sedated. Headphones generate a series of clicking sounds, and electrodes attached to the child’s head record neural responses. Using these tests, audiologists are able to obtain very good, objective estimates of a child’s hearing status.

If you have concerns about your child’s hearing, discuss them with your pediatrician. Masters Family Speech and Hearing Center at Children’s Hospital of Wisconsin offers comprehensive hearing tests by audiologists who specialize in working with kids.

FAST FACT: If you have concerns with your child’s hearing, don’t dismiss them just because he or she passed a newborn hearing screening. It is not uncommon for children to develop temporary hearing problems, such as fluid behind their eardrums, which require medical attention. On rare occasions, a progressive, possibly permanent hearing loss may develop that was not present at birth.

Catherine Holland, MS, CCC-A, is a pediatric audiologist with Masters Family Speech and Hearing Center at Children’s Hospital of Wisconsin.

 

Parents who are concerned with their child’s speech and language development may not know what to do or where to go for help. With the help of a speech-language pathologist, it is possible to evaluate both receptive and expressive speech and language skills.

Receptive skills include a child’s ability to listen and understand, and expressive skills include a child’s ability to speak and use language, such as sounds, gestures and/or words.

Keep in mind that children learn at different rates. Watch for language skills that develop steadily, not whether they are fast or slow. Below is a list of basic speech and language milestones to look for, as well as some red flags, and the next steps to take if you are concerned.

A child’s common speech and language milestones include:

Six months
•    Babbles, laughs, coos.
•    Turns to look at new sounds.
•    Recognizes familiar people.

12 months
•    Uses simple gestures, such as waving, pointing and clapping.
•    Begins to understand the meaning of simple words and daily routines, such as eating and bedtime.
•    Follows some basic instructions.
•    Begins to imitate sounds and may say two or three words.

18 months
•    Uses 10 to 20 words.
•    Recognizes pictures of familiar people and objects.
•    Points out several body parts on self or a doll.

Two years
•    Has a vocabulary of at least 100 words.
•    Combines several words.
•    Understands simple questions and instructions.
•    Can be understood 50 to 75 percent of the time.

Three years
•    Sings simple songs and nursery rhymes.
•    Asks and answers simple questions.
•    Follows two- and three-step directions.

Four to five years
•    Identifies colors and shapes.
•    Can be understood 90 percent of the time.
•    Asks “who” and “why” questions.
•    Can retell a story.

When to seek help
Children who have one or more of the following issues may need to be evaluated by a speech-language pathologist.
•    No babbling, pointing or gesturing by 12 months.
•    Frequent ear infections with middle ear fluid.
•    No single words by 16 months.
•    Difficulty with or reluctance to imitate new sounds or words by age 2.
•    No two-word spontaneous phrases by 24 months.
•    Difficulty sucking, chewing or swallowing.
•    Poor voice quality.
•    Failure to answer simple questions and follow two-step directives by age 2½.
•    Stuttering that causes a child embarrassment, frustration or difficulty with peers.
•    Regression in language or social skills at any age.

Referral process
If you are concerned about your child’s speech-language development, discuss your concerns with your pediatrician. The Masters Family Speech and Hearing Center at Children’s Hospital of Wisconsin offers speech, language and hearing assessments for children from infancy through adolescence.

Susan W. Haessler, MS/CCC-SLP, is a pediatric speech-language pathologist at Children's Hospital of Wisconsin Clinics-North Shore.

FAST FACT: Parents don’t have to rely on the predictions of others or guess whether their child will be just like a friend’s and eventually catch up in language development. (“My son was slow, too. Now he won’t stop talking.”) If you are concerned about you child’s speech and language development, talk to your pediatrician or a speech-language pathologist.