Signs of hearing loss in children

Pediatric hearing differences are more common than people may think. Knowing if your child does not hear some or all sounds is very important for language development. Identifying hearing differences early can make a big difference in how your child learns and communicates.

Leslie Katz Lestz, M.D., Pediatrician at Children’s Health℠ and Associate Professor at UT Southwestern, and Rachel St. John, M.D., Pediatrician and Director of the Family-Focused Center for Deaf and Hard of Hearing Children at Children’s Health and Professor at UT Southwestern, share the signs of hearing changes in children and what to do if you think your child is having trouble hearing.

“I always remind families that children with hearing differences can do everything other kids can do,” Dr. Lestz says. “It’s not necessarily going to limit them. We just have to make accommodations for their hearing.”

What is pediatric hearing loss?

Some kids are born with hearing differences. Other kids develop hearing loss later on.

Hearing changes may be temporary or permanent.

Temporary hearing changes

Temporary hearing changes happen when a child has reduced hearing for a period of time, but their hearing typically comes back. Temporary hearing changes might be related to:

• Middle ear problems like ear infections or fluid in the ear

• Exposure to loud noises

• Having a virus

Permanent hearing change

This type of hearing difference is long-term and hearing may not come back without treatment. Children with permanent hearing differences may communicate using visual language (such as sign language), spoken language or both. Some children may use technology like hearing aids or cochlear implants to help them hear.

Words to describe children with hearing loss include:

• Hard of hearing: A child can hear some sounds but not all.

• Deaf: A child has little to no hearing. Some children use sign language as their primary language and may identify with the Deaf community, which has its own shared language, culture and traditions.

“It’s common for parents to hear terms like ‘hearing loss’ or ‘hard-of-hearing’ and think their child doesn’t hear at all,” Dr. St. John says. “But it's not binary – hearing or not hearing – it's more of a spectrum. Some kids don’t hear anything, some hear most but not all frequencies and sometimes it only affects one ear.”

Permanent hearing differences may be related to:

• Genetics. Hearing differences in both ears (bilateral) are caused by genetics 50-60% of the time.

• Structural changes. Hearing changes in one ear (unilateral) are often related to differences in the structure of the ear or differences in how the hearing nerves developed.

• Noise-induced hearing loss. This can be temporary or permanent and happens when a child can’t hear as well after being around loud noises for too long.

• Other medical conditions. Occasionally, hearing loss can be related to a virus, an immune system condition or a more complex medical condition.

Why is detecting hearing change early so important for kids?

In babies and toddlers, identifying hearing changes early is very important for language development. After a hearing difference has been identified, a child can:

• Start learning visual language (sign language)

• Get hearing aids or cochlear implants to help them hear and develop spoken language

“Kids develop language starting at birth,” Dr. St. John says. “After the first few years, the flexibility in their brains starts to go down and it becomes harder to develop language. So we try to do everything we can to support language as early as possible, whether that’s sign language, spoken language with technology or both.”

In older kids and teenagers, hearing loss can make it difficult to connect with friends and family, to learn at school and to hold conversations.

“Even children with very small hearing changes can start to develop cognitive fatigue in the classroom – meaning they're using so much energy just focusing on hearing that they miss the content of what's being taught,” Dr. Lestz says.

Hearing and language support can help kids do better in school, feel less exhausted and make it easier to connect with friends and family.

Signs of hearing loss by age

Signs of hearing differences in infants and babies

• Not turning their head towards sounds

• Not noticing or being startled by a loud sound

• Not babbling or seeming to know their name by age 1

Signs of hearing differences in toddlers and preschoolers

• Speech delays or unclear speech

• Not responding when you talk to them or call their name

• Making the volume on the TV or other devices very loud

Signs of hearing differences in school-aged children and teens

• Saying “what?” or “huh?” frequently in conversation

• Seeming not to pay attention or respond when you talk to them

• Turning up the volume on the TV or other devices very loudly

• Having trouble holding conversations in loud places

“We sometimes see older children with hearing changes that may have gone unnoticed because it’s all they've ever known,” Dr. Lestz says. “Often, we only see kids after they don’t pass a hearing test at school or at the pediatrician’s office.”

What to do if you think your child has hearing loss

If you think your child can’t hear as well as other kids, talk to your pediatrician. They will likely do a routine hearing screening your child.

You can also ask for a referral to an audiologist if you’re concerned about your child’s hearing, even if they pass the hearing screening at the pediatrician's office.

“The hearing screening at a pediatrician's office only checks four frequencies, so it's possible for a child to pass that hearing screening but still have a hearing difference,” Dr. Lestz says. “An audiologist can offer a more comprehensive test that checks the full range of hearing.”

Care and support for kids with hearing differences

If your pediatrician or audiologist finds a difference on your child’s hearing test, they will typically:

• Recommend one or more additional hearing tests to confirm results.

• Refer your child to another type of specialist, an otolaryngologist (ENT), if they think structural changes may be causing hearing loss.

• Connect you to places your child can select and get fitted for hearing aids or receive other appropriate care.

As a pediatrician with a special interest in caring for kids who are deaf and hard of hearing– and as parent of a child with a hearing difference – Dr. Lestz shares two pieces of advice:

1. Know that your child can do anything their peers can do, with the right school accommodations, support and tools.

2. Talk to your child about how hearing differences are nothing to be ashamed of – they‘re part of what makes them who they are.

Resources for kids with hearing differences and their families

The following organizations and resources offer expertise and support for kids with hearing differences and their families.

“It can be overwhelming to learn your child has hearing differences because you receive so much information all at once,” Dr. St. John says. “Connecting with local organizations and meeting other families who have kids with hearing differences can be very helpful.”

• Texas Hands and Voices, a local, parent-run organization with many resources, meetups and community events for kids with hearing differences.

• Texas Parent-to-Parent, dedicated to improving the life of kids in Texas with specific health care needs, chronic illnesses and disabilities.

• Texas Deaf Action Center, providing advocacy, interpreting services and other resources for people who are Deaf and hard of hearing in Texas.

• American Sign Language (ASL) resources, including Gallaudet Children’s Dictionary of ASL, StartASL.com, ASLNook.com, ASL Storytelling Library and Family Signs Online Sign Language Course.

Learn more

The Family-Focused Center for Deaf and Hard of Hearing Children at Children’s Health is home to an expert team who offers comprehensive care for children with hearing differences. This includes not only expertise in hearing-related care but insight about parenting, accommodations for school and connecting to community resources. Learn more.