Screening and Testing Infants and Children

Speech and language skills start to develop early in a child’s life. Within months of birth, babies begin to hear and recognize the rhythm and melody of speech and often respond with cooing sounds when someone talks to them. An untreated hearing problem can slow the development of speech, language, thinking, and learning skills. Early screening, diagnosis, and treatment can help children who have hearing loss develop in ways that equal hearing children.

Most hospitals screen all newborns with one of two tests that are quick, painless, and often done while the baby is sleeping.

• Otoacoustic Emissions Test (OAE) - A small device connected to a machine is placed in the baby’s ear. The machine sends sounds to the inner ear. The “echo” of the sound coming from the inner ear is recorded. The machine analyzes the “echo” and compares it with normal inner ear function.
• Automated auditory brainstem response (AABR) - A small device that makes special sounds is placed in the baby’s ear. A machine measures the hearing nerve's response to the sounds. It analyzes the response to see if it matches that of infants with normal hearing.

If a baby fails either of these tests, it is usually repeated. Keep in mind that an abnormal screening test results does not confirm a hearing problem. A full hearing evaluation is needed with a specialist—an audiologist or an ENT (ear, nose and throat specialist)—who deals with babies.

Parents can watch for development milestones to monitor for signs of any hearing problem in their child.

The following responses are generally found in children with normal hearing:

• Newborns – usually respond (“startle” or jump) in response to sudden loud noise. Will sometimes turn head in direction of sound.
• By 2 months – baby's hearing has improved. The baby should now able to hear sounds in different pitches, intensities and intonations.
• By 3-4 months – baby usually recognizes parent's voice, can vocalize consonant sounds (m, k, g, p, and b), and sometimes couples these sounds with vowel sounds.
• By 5-6 months – Baby may start laughing, and babbling sounds start sounding more like speech sounds.
• By 8-9 months – Baby starts to understand the relationship between words and gestures.
• By 11 -12 months – understands many words and is starting to learn names of body parts. Should be making simple words (like “Mama" or "bye-bye")

If a child needs a full hearing evaluation by a specialist (an audiologist, or an ENT -- ear, nose and throat specialist), some or all of the following tests may be performed.

If you suspect any type of hearing problem in your child, talk with your pediatrician about getting your child a complete hearing evaluation.

An infant or child may need a full hearing evaluation if:

1. the infant or child does not seem to respond to sounds the same as other children, or is not developing skills similar to children the same age (based on reports by parents, teachers, or health professionals)
2. newborn screening tests suggest a potential problem
3. the baby does not get newborn screening tests in a hospital
4. the child has many ear infections
5. the child has certain diseases (meningitis or other diseases that can cause hearing loss)
6. the child is diagnosed with another condition that sometimes includes hearing loss

A full hearing evaluation may include some or all of the following tests.

Test	Age of infant/child	What happens
Diagnostic Auditory Brainstem Response	under 6 months	Like screening tests, but shows more detailed results
Visual Reinforcement Audiometry (VRA)	6 months to 2 years	Sounds presented through earphones or speakers Child is trained to turn toward a sound using a reward system (shown an appealing visual image)
Conditioned Play Audiometry (CPA)	2 years to 4 years	Child is asked to do something when they hear a sound (like put a ring on a peg) Similar to test for adults, who press a button or raise their hand when they hear a sound
Tympanometry	any age	Tests how eardrum moves using soft sounds and air "Sees" middle ear problems (like fluid behind eardrum)