Infant Hearing Screening

Childhood hearing loss data and information

Studies have shown that as many as three out of every 1,000 babies is born with some degree of permanent hearing loss. In the past, hearing loss was not discovered until a delay in speech development was noticed, which often did not occur until the child was at least 18 months old, and possibly as late as the age of three. Access to sound in the early years of a child’s life is critical for speech and language development. Because of this, babies are now screened for hearing loss before they are discharged from the hospital.

The Joint Committee on Infant Hearing put forth the following recommendations in their 2007 Position Statement in order to maximize the number of children with hearing loss who are diagnosed early and to minimize the impact of hearing loss on speech and language acquisition:

  • All children should have their hearing screened by 1 month of age, preferably before leaving the hospital
  • Diagnosis should be completed by 3 months of age
  • Intervention should begin by 6 months of age

This is commonly referred to as the 1-3-6 plan. In 2014 approximately 97% of children born in Michigan were screened by 1 month of age according to state data.

What does it mean if my child did not pass the screening?

The screening process is only effective if those children that do not pass the hospital screening return for follow-up testing. A failed screening does not mean your child has a hearing loss; however, it does mean your child requires additional testing. If your child did not pass the hospital screening, it is critical you return for further testing in order to determine if your child has any degree of permanent hearing loss.

Both the screening hospital and the state work to contact all families of babies that did not pass the initial screen in order to schedule follow-up testing. The state agency responsible for this is the Early Hearing Detection and Intervention (EHDI) program. EHDI coordinators work with families, testing facilities and pediatricians to encourage the completion of testing.

How is follow-up testing completed?

Because your baby will not be able to tell us when they hears soft sounds, we instead use a test called Auditory Brainstem Response (ABR). This test is used for children from birth to six months of age while in natural sleep.

In order to help your child sleep though the test we recommend you bring them to the appointment tired and ready to eat. We will then get the test set up and allow you time to feed your child. Often after a child eats he is able to fall asleep for the testing.

We will clean your child’s skin prior to the testing and place several small sensors around the head. We will then place a headphone in the ear and play sounds of varying loudness. The sensors are able to pick up tiny neural impulses from the hearing nerve that occur in response to the sound. Using this method, we are able to determine your child’s hearing level, along with the type of hearing loss if any is present.

In most cases, this testing can be completed in one hour. There are instances in which we will need to keep you longer, or ask you to schedule an appointment to come back another day.

What if my child has hearing loss?

Once a child is identified with hearing loss, appropriate referrals are made. First, a child will be referred to an Otolaryngologist (ENT physician) in order to determine the cause of the hearing loss and whether medical treatment is available. The ENT doctor may order additional testing, including imaging and genetic tests.

Depending on the type and degree of hearing loss, hearing aids may be recommended. Various communication strategies can also be discussed at follow-up appointments. Additionally, your child may be referred for an evaluation by Early On. Early On is the birth-to-age-three program run by the state. It has been shown that therapy early in a child’s life can greatly improve language outcomes. Regardless of the plan it is important to remember that the earlier the intervention begins, the better.

Risk factors

The following are some of the common risk factors for childhood hearing loss taken from the Joint Committee on Infant Hearing’s 2007 Position Statement

  • Craniofacial anomalies
  • Extensive NICU stay with associated treatments including, but not limited to, mechanical ventilation, ECHMO and ototoxic medications.
  • Family history of permanent childhood hearing loss
  • In utero infections
  • Syndrome associated with hearing loss

Speech and hearing milestones

The American Speech-Language-Hearing Association provides age-based milestones for how children develop hearing and speech skills. They are:

  • Birth-3 months: Startles to sounds, seems to recognize your voice and quiets when crying, makes pleasure sounds like cooing
  • 3-6 months: notices toys that make sounds, moves eyes in the direction of sounds, begins to babble
  • 7-12 months: Looks in the direction of sounds, listens when spoken to, recognizes names for common items, responds to simple requests, imitates speech sounds when babbling, knows 1-2 words by first birthday
  • 1-2 years: follows simple commands and answers simple questions, points to some body parts, increases number of words every month, can put together two- word phrases and questions closer to age 2
  • 2-3 years: has a word for almost everything, follows two-step directions, asks “why?”
  • 3-4 years: understands words for colors, shapes and family members, answers “who?”, “what?” and “why?” questions, speaks in sentences, talks about what happened during the day
  • 4-5 years: Follows multiple-step directions, tells a short story, understands words for time and order
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