Advice Column, Health, Lifestyle, Parenting

Hearing in the young child

  • South African Association of Audiologists
  • Category Advice Column, Health, Lifestyle, Parenting

Hearing ability is crucial for development of speech and language in the young child. In South Africa especially, hearing loss in children often goes undetected until the child has passed the critical period of language and speech development. The hearing loss is usually only picked up when the child is about to enter school and has no little communication skills.  Even a mild hearing loss can inhibit a child’s ability to development communication and language skills severely!

Late detection has detrimental problems on the child’s mental, cognitive, developmental and social aspects of life. The key to avoid late detection is awareness of the fatal implications of undetected hearing loss and the signs and symptoms that parents and care giver should look out for in a child’s early life.

There are many factors that put a child at risk for hearing loss. These factors can be categorized into: hearing loss that is present at birth (congenital) or hearing loss that developed after birth (acquired hearing loss).  Parents and caregivers should be vigilant if the following risk factors are identified:

Indicators for a high risk of hearing loss present at birth (Congenital Hearing loss)

  • Family history of permanent hearing loss in childhood
  • Maternal infections during pregnancy or delivery these include: Toxoplasmosis, Syphilis, HIV, Hepatitis B, Rubella, CMV, Herpes simplex.
  • Physical problems of the head, face, ears, or neck (cleft lip/palate, ear pits/tags, atresia)
  • Ototoxic medications given in the neonatal period
  • Born with any Syndrome associated with hearing loss (Pendred, Usher, Waardenburg, neurofibromatosis)
  • Admission to a neonatal intensive care unit greater than 5 days
  • Prematurity (< 37 weeks)
  • Hyperbilirubinemia
  • Low Agar score (0-3)
  • Disorder of the brain or nervous system

Indicators for a high risk for acquired hearing loss after birth:

  • Childhood diseases such as mumps or measles
  • Untreated middle ear infections
  • Perforated eardrum
  • Excessive loud noise such as gunshots, fireworks or loud music
  • Severe injury to the head
  • Ototoxic medication
  • Otitis media / Ear infections (explained later in article)

With these risk factors there are also many signs and symptoms that parents and caregivers can look out for:

  • Child isn’t startled by loud sounds
  • Child is inattentive during interactions
  • Doesn’t respond to parents voice
  • Doesn’t make babble sounds
  • Doesn’t imitate sounds or words like ”bye-bye”, “mama”
  • Fails to respond to their name
  • Fails to turn his/her head to a sound source
  • Fails to follow simple instructions

With these signs and symptoms it is also important for parents and caregivers to take note of speech and development milestones from 12 – 36 months which are related to receptive language ( ability to understand words and speech) and expressive language ( ability to use speech and gestures to make meaningful communication)

Age groupsReceptive LanguageExpressive Language
12 – 24 months Recognize names of family members and familiar objects Use hand gestures to signal something such as finger pointing to toys
Understand simple phrases e.g. ‘give me’ , ‘no’, ‘ all gone’ Make one-two syllable sounds that stands for something they want e.g. ‘nana’ for a bottle
By 18months know names of body parts , objects and places By 18 months – use of made up language- mixture of made up and understandable words
Follow simples instructions like ‘ put the ball down’ or ‘come to mommy’ Between 1-2 years old has a vocabulary of at least 20-50 words which are understood by family members
24-36 Months Know and point to at least  7 body partsTend to start speaking a lot and questioning surroundings and environment 
Follow simple requests like ‘ pick up the shoes’ Use pronouns such as ‘ me, you, yours’ but often get it mixed up
Understand questions and points to pictures when asked what it is e.g. where is the rabbit or show me the balloon Make simple phrases such as ‘ want more food’ or ‘ no sleep time’


By age 3 should have 150-200 words in vocabulary and stranger should be able to comprehend their speech


Another major risk factor that parents should be on alert for is Otitis Media with Effusion (OME) or better known as ‘glue ear’. It is described as build-up of non-infected fluid in the middle ear. OME is common among children between 6 months and 3 years of age. The fluid could sometimes resolve itself however if OME is left untreated or last more than 6 days it can to fluid becoming infected and causes a temporary decrease in hearing. OME can sometimes go undetected   due to the lack of obvious or acute symptoms.

OME is usually caused by a poor functioning Eustachian tube (ET), this tube is a link between the middle ear and the throat.  The ET helps us to equalize the pressure between the air around you and the middle ear. When the ET doesn’t function correctly it stops normal drainage from the middle ear causing an accumulation of fluid behind the child’s eardrum

The following are also risk factors for your child developing OME:

  • Drinking from a bottle while lying on their back- this causes milk to seep into child’s ears
  • Developing a common cold
  • 2nd hand smoke
  • Not breastfeeding
  • Craniofacial abnormalities ( cleft palate , cleft lip )

OME can be very subtle and sometimes hard to detect however your child may show the following signs:

  • Continued tagging of ear
  • Hearing difficulties
  • Loss of balance
  • Delayed speech development

The only way to correctly diagnose an OME is to visit an Audiologist. The Audiologist will perform a Tympanometry test. This test will reveal findings of the status of the middle ear, giving information about any fluid present in the ear, mobility of the middle ear and volume of fluid in the ear. Tympanograms can be read off graphs and normative data of pressure and volume, the Audiologist can make a diagnosis from any abnormalities in the results.

If a fluid build-up in the middle ear is detected it should be monitored to determine whether it clears up by itself. Should the fluid build-up not subside or become infected, medication will need to be prescribed. If the fluid build-up is recurrent, the insertion of grommets will be considered by the ear, Nose & Throat Surgeon (ENT). Grommets are tiny tubes surgically inserted into the ear drum to drain fluid build-up.

Hearing ability is critical to speech, language, and learning and communication development.  Awareness and knowledge about hearing loss and its implications will increase chances of early detection. Research has shown that with early detection of a hearing loss comes early invention and thus develop language (spoken or sign) on par with a child’s peers, therefore not creating any social isolation or lack of confidence as a child grows.

If a hearing loss is detected in your child or family member’s child, it is vital that early family-centred intervention is implemented to encourage language and cognitive development. An Audiologist who forms part of a multi-disciplinary team will fully evaluate and monitor your child’s haring loss as well as provide appropriate invention.

If you have any concerns about your child’s hearing abilities or if you identify any of the symptoms mentioned in this article – it is highly advisable to visit your audiologist.

To find the audiologist closest to you, visit or contact Cornelle at +27 82 727 5977 or

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