How to identify hearing impairments in children and why early diagnosis is important

Key Points

• If children have difficulty talking, don’t respond to noise or aren’t starting to talk, their hearing may be impaired.
• A handheld device or a test measures the brain’s responses to sounds and is used to test hearing in newborns.
• Not recognising and treating impairment can seriously impact a child’s ability to speak and understand language and can cause social and emotional difficulties.

​What is a hearing impairment?

In Australia, three to six children in every thousand have some degree of hearing impairment. Approximately 250 to 400 children are born each year with significant permanent hearing impairment in both ears. However, hearing impairments can occur during and after birth.

Hearing impairment, hearing loss, or deafness refers to the partial or total inability to hear sounds and speech. Impairments can range from mild to severe and can be temporary or permanent.

Some people with mild deafness may have problems understanding speech, particularly if there’s a lot of noise around, while those with moderate hearing impairments may need a hearing aid.

Those who have severe hearing impairments may hear little to no sounds and rely on lip-reading and sign language to communicate.

​Types of hearing loss

Deafness or hearing impairment can occur:

• At birth – this is known as congenital hearing impairment or deafness
• After birth – this is known as acquired or progressive deafness or hearing loss

There are three main types of hearing loss, these include:

Conductive hearing loss

With this type of hearing loss, outside sounds have trouble getting to or through the inside of the child’s ear. This can be caused by middle ear infections, ear wax, punctured eardrum, fluid in the ear, or abnormal bone growth. The condition is usually treatable and is temporary.

Sensorineural hearing loss

Sensorineural hearing loss occurs when the hearing organ (cochlea) and/or nerves in charge of receiving and interpreting sound don’t work properly. Essentially, the child’s ears are unable to send sound signals and messages to the brain. This condition is usually permanent.

Mixed hearing loss

This is a combination of conductive and sensorineural, will include symptoms of both and may lead to temporary or permanent hearing issues in children.

​Diagnosing a hearing impairment

In Australia, a Universal Newborn Hearing Screening is an important step in diagnosing deafness or hearing impairment in children.

All newborn hearing screening programs aim to:

• Screen the hearing of babies
• Refer babies with possible hearing impairment for testing with an audiologist
• Start early intervention for babies with hearing loss

During the screening, special equipment plays sounds into your child’s ears and records the responses from your baby. In most cases, babies are screened in hospital before they’re taken home.

Each State and Territory has its own method for following up on babies who don’t have a hearing screen in hospital and also has its own way of referring babies to audiologists. A hearing screening isn’t compulsory though and you have to provide permission for your baby to be screened.

How to spot hearing impairments in children

Babies and young children have developmental milestones. While it’s normal for babies to develop at different times, milestones should be reached in the same order.

Common things you should expect in a developing baby are:

• 0-4 months – the baby should be startled by loud noises, turn their head or move their eyes to find the source of sound. If they’re upset, they should calm down when they hear a soothing voice

• 4-8 months – the baby should notice sounds around them, smile when spoken to, and understand simple words like ‘hi’, ‘yes’, ‘no’, and ‘bye-bye’

• 8-12 months – the baby should respond to their name and speak simple words like ‘mama’ ‘dada’, as well as being able to copy simple sounds and use their voice to get attention

• 12-24 months – The baby should start developing vocabulary, understand and follow simple instructions, and be able to put two words together

If your baby isn’t doing these things, it might be a good idea to talk to your General Practitioner (GP), or child and family health nurse.

Misinterpreting behaviours in older children

If your child has a hearing impairment, they might not be able to hear people speaking and may not respond to your voice and other noises in the way you’d expect. As they get older you might also notice that their speech and language aren’t developing like other children’s.

Less severe hearing impairment can be more subtle though and lead to behaviours that are misinterpreted such as:

• Ignoring people who are talking to them some, but not all, of the time
• Talking and hearing well at home but not in school because mild or moderate hearing impairment may cause problems with background noise, such as that in a classroom or schoolyard setting

​Early intervention services

The earlier you find out your child has a hearing impairment, the sooner they can begin early intervention. It also gives your family the opportunity to get advice and support as soon as possible, giving your child the best start in life.

The team of professionals involved in supporting your child and your family might include audiologists, speech pathologists and teachers. When you’re working with these professionals, it’s normal to have lots of questions on the best way to support your child.

Don’t be afraid to ask lots of questions. Forming a relationship with these professionals means they can continue to work with you and your child.

Learning to communicate

Being able to communicate is an important part of your child’s development. Many families choose to teach their child to sign and speak, regardless of whether the child can use spoken language. If this is your family’s choice, you and the rest of your family should learn sign language too.

You can ask your health care professional for more information and support learning sign language.

​What treatments are available?

Hearing impairments may not be able to be reversed, however, there are treatments and devices available for children that can help them hear spoken language.

The right type of device will depend on what type of hearing impairment your child has and how severe it is.

These devices, called amplification devices or assistive listening devices, include:

• Hearing aids
• Bone conduction implants
• Cochlear implants
• Personal frequency modulation systems (FM)

Some phone apps and other technologies have also been found to help. Your child might use one or multiple devices. Using a combination gives your child more opportunities to hear sounds because each device does a slightly different job.

You might also use these devices in combination with spoken and sign language. Your child’s audiologist will be able to help you determine what device is best for your child.

Hearing support and the NDIS

If your child has a confirmed diagnosis of hearing impairment, they might be able to get support under the National Disability Insurance Scheme (NDIS).

The NDIS helps you get services and support in your community and gives you funding for therapies and one-off items like hearing aids.

The Hearing Services Program (HSP) and the NDIS fund public hearing services in Australia. The HSP provides eligible people with subsidised hearing products and services through an accredited hearing services provider.

This can include fully subsidised hearing aids, batteries and repairs, as well as further support and hearing services with no additional contribution or annual fee required.

To be eligible for the HSP you need to be an Australian citizen or permanent resident and satisfy the eligibility requirements. To find out if your child meets their eligibility criteria visit the HSP’s eligibility checker available on their website.

The NDIS may also be able to provide additional hearing supports for participants if they are not available through the HSP.

Your Local Area Coordinator, Early Childhood Partner or planner can help you consider what support might be reasonable and necessary for your child.

What would you like to know about hearing impairments in children? Let us know in the comments below.

Related Content:
What is a hearing impairment and how can it be treated?
What is the NDIS
What support can I get?