A child’s ability to hear and distinguish sounds is a critical component in his or her early language development.

Unlike other deficits in the speech-language-learning realm that have a birth to 3 years old early intervention window, the critical window is much smaller for infants born with hearing loss.

"If a child can’t hear, that child can’t communicate," emphasizes Jennifer Phelan, AuD, CCC-A, specialist in the evaluation, diagnosis and treatment of hearing loss in children at the Center for Audiology, Speech, Language and Learning at Northwestern University.

Language ability tied to early intervention

A body of research has shown that having access to sound by six months greatly improves the outcomes for speech and language development in children with hearing loss.

"Early intervention is really, really critical because of that language development piece. Research shows the longer that it’s pushed off, the more impact hearing loss has on language," said Phelan, previously an inpatient audiologist at a nationally recognized children’s hospital.

This is the case more so than speech, which a child can develop later is that underlying language component, explains Phelan. "It means having a language base that is robust — being able to have a communication interaction with one’s communicative partner who for a young child is their caregiver."

For this reason, there exists a 1:3:6 rule for hearing — every baby born should be screened by one month of age,those who refer on screening for further testing should get diagnostic evaluation with an audiologist by three months so that if there is hearing loss they are getting early intervention with a hearing aid by six months.

Limitations to newborn hearing loss screening

With universal newborn hearing screening instated in all hospitals across the United States, children with hearing loss are being identified and treated at much younger ages, writes Mandy Mroz, AuD, in an article where she provides a detailed overview of pediatric hearing loss.

While this has significantly increased the detection of infants with congenital hearing loss, mandated screenings don’t catch every child who needs intervention. Being aware of gaps in the system can aid pediatricians and family doctors in identifying children at risk for hearing loss.

Statistically, 1.7 children test positive for hearing loss for every 1,000 screened, according to 2016 Centers for Disease Control (CDC) numbers. This figure reflects only the cases reported to the state or territorial Early Hearing Detection and Intervention (EHDI) program, so cases of congenital hearing loss are likely to be higher.

Screenings are not always mandated for babies born outside the hospital. Phelan, who previously resided in another state, was taken aback to learn that homebirths in Illinois are exempt from the state’s newborn screening mandate. Awareness of the laws for nonhospital births the state where one practices will let doctors know whether they need to pay extra attention when attending this population.

Additionally, newborns in NICU won’t be screened when it is not appropriate medically, notes Phelan. Generally, they will undergo screening later, but not always.

She also cautions against taking the screening lightly for infants referred. This includes messages along the lines of, "It’s not a big deal that he/she didn’t pass, there was probably fluid in the ear." Instead, she urges physicians to order a rescreening for such cases so that hearing loss is definitively ruled out. The stakes are far too high to risk having a child go without proper evaluation and treatment if necessary.

Serious ramifications for children with mild and acquired hearing loss

Due to their timing, newborn screenings can’t detect acquired hearing loss. Unfortunately, the prevalence of progressive hearing loss is even higher than congenital, shown by CDC as five in every 1,000 children by school age.

Nonetheless, both mild and acquired hearing loss affect a child’s ability to communicate and interact with their caregivers and peers to some degree.

Any toddler or school-age child that shows signs of delayed language development or difficulty hearing should be referred to an audiologist for an evaluation.

Behavior problems and difficulty socializing with other children has been shown by recent research as a key indicator of language delay that may point to hearing loss.

"We see the effects of hearing loss even when it’s temporary in kids who have chronic ear infections," says Phelan. "So often manifesting in isolation or in behavior."

Interestingly, newborn screenings were never intended to detect moderate or mild hearing loss, so infants without severe loss will pass.

Yet, just being able to hear isn’t enough. Although it may be clear that a child can hear something, it’s important that each child is evaluated to make sure that the child can hear all the pitches.

"Hearing loss is not black and white," emphasizes Phelan. "Yes, a child may hear, but the question is ‘can they hear what they need to hear in order to communicate effectively?'"