Answers to questions families often have about caring for their child with hearing loss and deafness

Since the brain’s ability to learn about sound and spoken language depends on normal hearing, helping infants and children with hearing loss develop language is very important to their development.

Hearing loss can have many causes, including genetic (inherited) problems, birth defects, illnesses, medication side effects, or injury. It can involve problems with the outer ear, ear canal, middle ear, inner ear, hearing nerve, or how the brain sorts and manages sound. Hearing loss can happen in 1 ear or both ears and be temporary or permanent. Some children born with typical or mild hearing loss can gradually lose their hearing. The child will need to see an ENT to diagnose the cause of hearing loss (genetic vs anatomical vs environmental).

Hearing loss may also occur later or can be progressive. You may wonder about hearing loss when a child does not respond to sounds such as their name being called, a squeaky toy, or a plane overhead. Because it is difficult to tell what may be causing a lack of response to sounds, a professional hearing evaluation is the best way to learn how well a child can or cannot hear.

Most children born with hearing loss are identified at birth through newborn screening. Newborns are required to have their hearing tested before leaving the hospital at birth. If a child is born at home, the birth attendant must ensure the hearing screening is completed. The method for testing children is dependent on their age. Young infants will need a test called an Auditory Brainstem Response (ABR) test. Older babies and children can be tested by an audiologist by obtaining an audiogram.

Early Intervention Part C Programs can provide hearing screens for infants and children. Your primary care doctor can provide a referral to both Early Intervention and audiologists. See Hearing Screening.

An audiogram is a graph that shows the results of a test. The graph displays the level of hearing at different frequencies of sound (low, medium, and high). This helps the audiologist understand the degree and type of hearing loss and advise on treatment options. Regular testing allows the hearing levels to be monitored over time. See What is an Audiogram? (babyhearing.org) for examples.

The long-term outcome depends on the cause of the hearing loss, other medical issues a child may have, treatments, and support received. For young children, early exposure to language improves language development. Language exposure can be provided through hearing aids, frequency modulation (FM) systems, cochlear implants or other assistive listening devices, and American Sign Language or other visual languages.

Research shows that infants enrolled in Early Intervnetion by 6 months old demonstrate higher expressive and receptive language (either verbal or visual), higher expressive vocabulary, and better personal social and speech skills than children identified and receiving services later in life.

The possibility depends on the type and cause of the hearing loss. If the hearing loss is caused by illness, medication side effects, or injury, other family members are unlikely to be affected.

If the cause is genetic, some families may have others with hearing loss. A doctor or audiologist can help decide whether family members should be tested. A geneticist or genetic counselor can provide more information about genetic conditions and likelihood for family members.

First and foremost, interact with your child. Learn about the options (use of hearing aids or other technology and/or using visual language) and focus on language exposure. Like any hearing child, a child who is deaf or hard of hearing needs access to language to achieve their developmental milestones.

Options to amplify sound for your child may include:

• Hearing Aids
• Frequency modulation (FM) systems
• Cochlear implants
  • Cochlear implants may help some children who are deaf or hard of hearing and who are not helped by hearing aids or FM systems alone. A wire is surgically placed into the cochlea (the organ of hearing in the inner ear) and connected to a receiver placed in the bone behind the ear. A microphone and transmitter, worn behind the ear, sends signals to the receiver, creating sound signals sent to the brain. Cochlear implants are now water-resistant. FM systems are also used with cochlear implants to help facilitate direct amplification in large group settings such as classrooms.
• Bone Anchored Hearing Aids (BAHA)
  • Bone Anchored Hearing Aids (BAHA) are another technology available to children with birth defects of the outer and inner ear (microtia or atresia) or conductive hearing losses caused by other issues such as chronic middle ear disorders.

Your child's age, level of hearing, type of hearing loss, and the needs of the child and family will help decide which is best. Hearing aids or cochlear implants may not be tolerated by some children, and some families may not want to use these options. Contact your Early Intervention for Children with Disabilities/Delays (see NW providers [3]) or speak to your child’s audiologist (Audiology (see NW providers [3])) for available options.

American Sign Language (ASL) and other visual languages are often used for communication and developing language skills. In addition to ASL, other visual languages include:

• Signed Exact English (SEE)
• Conceptually Accurate Signed English (CASE)
• CUED Speech

Every child and family reacts differently to hearing loss. Family members may feel many different emotions along the way, including denial, anger, and guilt, as well as frustration from not understanding the process or the specialists involved in the child’s care. It is vital for families to connect with other families living the same experience to find a nurturing, supportive community. To connect with other families, contact your local Early Hearing Detection & Intervention (EHDI) office, Hands & Voices (H&V), Alexander Graham Bell Association, your local School for the Deaf, parent groups on Facebook, or the support links listed in the Resources section below.

It also is important to work closely with an audiologist, the Early Intervention Part C Program, and the school system to help provide appropriate supports for the child. If your child or another family member is struggling to understand and accept a diagnosis, ask your primary care doctor for suggestions or speak to a counselor to ask about developmentally appropriate insights.

Your baby may not have passed their newborn hearing screening for various reasons, including fluid in the ear canals or middle ears. Hearing screening tests do not diagnose hearing loss but find all infants who may have hearing loss. In the U.S., between 10 and 100 babies per 1,000 (1 to 10 percent) do not pass the screening test. Only 1 to 3 babies per 1,000 (less than 1%) have hearing loss. This means most babies referred for further testing will have normal hearing. Because a hearing screening does not determine why a baby failed a hearing screening (fluid vs hearing loss), all children with a failed hearing screening need prompt follow-up. Acting early is vital for infants with hearing loss. It is very important for all infants who fail the hearing screen to have a full hearing evaluation.

The most important things you can do for your child are to love, support, and encourage them - and provide access to language so they can communicate with you. Many tools and resources are available for children with all levels of hearing loss. Research options and follow your child's lead in making decisions that work for your family. There is no "right" or "wrong." You may even find that the choice you began with may not be the one you stay with. This is okay and normal. Find other families who have already been on this path for help and support. Your audiologist and early intervention team can help you find support and answers. Many resources are listed in the Support section below.