Baby hearing milestones

Apart from passing hearing screening, there are also signs that you can watch out for that indicate your baby’s hearing is intact. Expected milestones within the first year of life include:

Birth to 3 months

  • Is startled by loud sounds
  • Makes soft sounds (vowel sounds aah, eeh)
  • When spoken to, they calm down or smile (ssh)
  • Recognizes your voice and calms down if they were crying

4 to 6 months

  • Turns the eyes towards the sound
  • Makes bubbling sounds
  • Responds to tones of voice
  • Responds to music and pay attention
  • Seems to enjoy toys that make sounds

7 to 12 months

  • Looks and turns toward the direction of the sound
  • Responds when their name is called without the voice being loud
  • Listen when spoken to
  • Responds to simple requests or commands like no, come, go, bye.
  • Looks at things you refer to e.g., a picture, toy they are familiar with.
  • Begin to imitate sounds and say names like ma-ma

Babies at a high risk of hearing loss

A baby may be at high risk of having a hearing loss if:

  • They were born prematurely
  • They stayed in the NICU (neonatal intensive care unit)
  • They were treated with medicines that could cause hearing loss
  • They had complications at birth
  • They had frequent ear infections
  • They had infections that could damage their hearing such as meningitis or cytomegalovirus

Why do newborns need hearing screening?

The sole purpose of hearing screening is to help to determine if a baby may be deaf or hard of hearing. If the hearing screening is not done, it will be difficult to tell when changes in the baby’s hearing are occurring within the first months and years of life.

Babies normally get startled by sudden noises and turn their heads towards the sound, for example, but this doesn’t mean they can hear all the sounds happening around them. Even babies that are deaf may hear some sounds, but not enough to understand what has been spoken.

Babies that are hard of hearing or deaf need early interventions, support, and care to promote healthy development. If hearing status is not identified, the necessary support will not be given, and this will lead to the baby’s communication skills being negatively affected.

In the long term, if hearing loss was missed, it would impact the child’s academic ability and social-emotional development.

How hearing screening is done

Data from CDC (Center for Disease Control and Prevention) shows that over 98% of newborns in the United States receive newborn hearing screening.

There are two screening methods that are normally used: Automated Auditory Brainstem Response (AABR) and Otoacoustic Emissions (OAE).

  1. Automated Auditory Brainstem Response (AABR)

This screening involves measuring how the hearing nerve and brain responds to sound. Soft tones or clicks are played through earphones into the baby’s ears. Three electrodes placed on the baby’s head then measures the hearing nerve and brain’s response

  1. Otoacoustic Emission (OAE)

The screening measures sound waves produced in the inner ear. A tiny probe is placed just inside the ear canal to measure the response (echo) when clicks or tones are played into the baby’s ears.

Both screens are painless and can be done while the baby is sleeping or lying still and usually take about 5 to 10 minutes. Either screen may be used or both.

What to do next if your baby didn’t pass the hearing screening

Step 1. Follow up with an Audiologist.

If your baby fails the initial newborn test, rescreening is done, then diagnostic testing. The diagnostic testing is most accurate. Your pediatrician will refer you to an Audiologist if a hearing impairment is detected, and more follow-up testing will be done before the baby is 5 months old. Interventions are then provided before the baby is 6 months old for treatment to be most effective.

Step 2. Early childhood hearing interventions

If the diagnostic test shows your baby has a hearing loss, you will need a team of early interventional professionals to guide and support your baby. They include:

  • Pediatric audiologist
  • Otolaryngologist (ear, nose, and throat/ ENT physician)
  • Service coordinator
  • Family- infant teacher
  • Speech-language pathologist
  • Family practitioner

The main goal of this team is to help your baby achieve their individual fullest development potential as possible.

Interventions

  • Hearing aids

Your child can be given a hearing aid if he has sensorineural hearing loss. This hearing loss is usually the most common. Hearing aids have three basic parts: the receiver, microphone, and amplifier. The settings of these components are normally customized to make certain sounds louder. Some hearing aids can be worn on the body, and others are fitted behind the ear or inside the ear. The doctors will guide you on which hearing aid suits your child’s needs.

Hearing aids make sounds louder for the deaf child.

Because of the technology used to develop them, hearing aids are expensive. You might find some health insurance companies cover part of their cost.

  • FM system (auditory trainers)

It is a unique amplification device that is designed to help school-going kids. The system has a microphone that the teacher speaks into and a receiver help for the child. They send the sound either to the ears or to a hearing aid. FM devices improve hearing in a group or noisy environment. They can also be used at home and also work well for older kids.

  • Hearing rehabilitation

Hearing rehabilitation works on developing and improving the child’s ability to communicate. They include auditory therapy, listening therapy, and speech (lip) reading. Technology is coming up with new inventions by the day; your specialist team will guide you on the best tools that will further aid in your child’s communication.

  • Surgical treatment

A cochlear implant is surgically placed into the inner ear to send sounds directly to the hearing nerve. This treatment does not cure hearing loss, but it is very effective for children with profound hearing loss who cannot be helped by hearing aids.

Is my child deaf or ignoring me?

If your child doesn’t seem to pay attention when you are talking to them and sometimes are forced to keep repeating what you are saying to them, it is possible they are ignoring you, or it is a hearing impairment.

You can tell they are ignoring you if they seem responsive to other sounds, like music or TV. However, if they don’t seem to respond to sounds or they ask you to repeat what you said to them, or you have to be loud for them to listen, it might signal hearing impairment, and you need to have a pediatrician check them. If they are school going children, their teacher will also notice and raise this concern.

Baby passed hearing test but doesn’t respond to sound/signs of baby hearing problems

Sometimes babies who pass the newborn hearing screening go on to develop hearing loss a few months or years down the lane. Progressive hearing loss or late onset can happen from a lot of factors such as infections, e.g. Measles or meningitis, head injuries, exposure to loud noises, secondhand smoke and more

So, even if your baby has passed the newborn hearing screening, you still need to watch out for possible signs of hearing loss as they grow and discuss them with your pediatrician. Some of the signs to watch out for include:

  • The baby doesn’t startle at loud noises by the time they are 1 month old or turn toward sounds by 3-4 months.
  • The baby doesn’t notice you until they see you
  • The only sound the baby concentrates on is vibrating noises
  • When you read to them, they don’t seem interested or to be enjoying
  • If the baby has delayed in beginning talking, has difficulties understanding, or hasn’t said single words like ma-ma or pa-pa by the time they are 12 to 15 months old.
  • Doesn’t respond when called out to from another room
  • The child wants the TV volume turned up than others
  • The child appears to hear some sounds but not others. (There are variations, some children only one ear affected by hearing loss other times the hearing loss affects only the high pitched sounds).
  • The child sits slowly or cannot walk unsupported properly or has trouble keeping and holding their head steady. (It happens in children with sensorineural hearing loss if the inner ear part which affects balance and movement of the head is also damaged)

Do deaf babies cry differently?

Crying is the first way babies are able to communicate, and all babies cry for the same reasons, either they need something or they are having discomforts. All babies’ cries are usually inborn or instinctive. They are therefore not affected by external factors except those that affect brain development like prematurity or injury, the larynx or if the mouth is affected like having a cleft palate.

So, deaf babies and hearing babies cry the same the only difference being the deaf babies cannot hear themselves.

How to Test Baby’s Hearing At Home

As earlier discussed, earlier detection is key in treating babies with hearing impairment so that they can develop normally. However, we know that not all mothers around the world are able to access hearing screening services for their babies. Even in America, where almost all babies receive the newborn hearing screening, 45 % of parents with babies who need repeat screening after failing the first do not return.

The good news is, every parent with an iOS smartphone or tablet can download a free app created by Eric Kraus, MD, surgeon in otology and neurology, and screen their baby’s hearing at the comfort of their own home.

The app is called the Sleeping Baby Hearing Test App and is available free from iTunes store. It features an inbuilt, self-calibrating sound level meter that measures voice volume. This allows a mom to gauge the loudness of her voice while speaking the Ling 6 Sound Test while the baby is sleeping lightly.

The 6 Ling sounds are (“ah,” “oo,” “sh,” “sss,” “mmm,” “ee”). The mom will be repeating the sounds at 60-70 decibels within the first five minutes of the baby falling asleep in a quiet room.

For this screening purpose, only the mom’s voice should be used, and not the father or any other speaker because babies are mostly in tune with their moms’ voice.

Babies aged 2 weeks to 6 months will arouse and respond when the mother speaks. This indicates the baby’s hearing is intact or is at least working properly in one ear. On the other hand, if a baby fails to rouse repeatedly, it could indicate a hearing impairment, and parents should seek additional professional hearing testing for the baby.

If a baby has been using hearing aids, the Sleeping Baby Hearing Test should be performed at home when the baby is wearing them. If the baby arouses when the mom speaks, it is a positive indication that they are providing the desired benefits.

How do deaf parents know when their baby is crying?

There has been a lot of interventions used from ages past by deaf parents to be able to tell when their baby is crying. These included sleeping in the same bed with the baby, so they can detect movement, other times using a trained hearing dog to alert them, and more. These interventions were limited compared to today, but babies still thrived.

Nowadays, the options are plenty. Deaf parents can use baby monitors, smartphones, flashing light and mirrors, and the old age, most reliable option, which is simply looking at the baby.

Baby monitors– there are various kinds of monitors in the market for deaf parents such as; audio baby monitors, vibrating baby monitors, video baby monitors, and others that can do all those functions. The most favorite among deaf parents is the vibrating monitor or a camera baby monitor or monitors that combine both functions. You will be interested to learn that there is even a baby monitor that can be connected to a vibrating alarm clock which causes the bed to vibrate, waking the deaf parents if they are sleeping.

Smartphone apps– you can use FaceTime, for example, to observe your baby when you are in different rooms by placing an iPad facing him while you use the iPhone.

Flashing light– they have always come in handy in alerting the deaf of fire alarm, a phone call, doorbell, even a crying baby.

Mirrors– these can be used perfectly while having a car ride, for example, where a deaf parent can be able to observe the baby.

Trained hearing dog– hearing dogs also assist the deaf parents by physically alerting them about alarms and sounds such as the doorbell, smoke alarm, telephone call, and the baby’s cry. Some deaf parents get hearing dogs from donating organizations such as PAWS or buying the dog, which is extremely expensive.

Baby Cry Monitors for Deaf Parents

The most common cry monitors for deaf parents use the following modes:

Vibration alerts, light alerts, extra-loud sound, and combination of vibration, light, and sound. The four modes have been proven effective in alerting deaf parents when the baby needs attention.

Baby monitors with vibrating alerts

They cause vibrations on the parent unit to notify the deaf parents and usually differ in strengths. Some of the best vibrating monitors include:

  • Summer infant babble band wearable audio monitor
  • Sonic alert sonic sitter baby cry signaler
  • VTech DM 221
  • VTech DM 223
  • Vtech BA72211GY
  • Philips Avent SCD570
  • Graco Secure Coverage
  • Audio baby monitor timeflys

Baby monitors with LED lights alert

The monitors are also ideal for parents who are totally unable to hear any sound. To use, you turn the parent unit to face upwards where you will be able to see the LED lights flash when the baby cries. Some monitors have the LED levels set in a way that also matches the sound level. For instance, from a scale of 1 to 10, a LED level of 10 would mean the baby is crying very loudly and screaming while 1 or 2 the cries are just soft or wimps. Because of these variations, deaf parents are able to respond to the baby accordingly.

One major disadvantage is that the LED lights are ineffective in situations where you are not able to see the light coming from the parent unit or asleep. To solve this problem manufacturers have developed monitors that combine light function and vibration.

Baby monitors with lights, vibration, and sound.

These are the most ideal for deaf parents because it gives them two options, so they don’t miss any cry.

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