Families and early childhood staff cannot always tell when a child is deaf or hard of hearing. That’s why it’s important to conduct evidence-based hearing screenings throughout early childhood.
Hearing helps us communicate with others and understand the world around us, but about two out of every 1,000 children in the United States are born deaf or hard of hearing. A child may also have hearing loss that develops later because of illness, physical trauma, environmental causes, or genetics. A child may have difficulty hearing in one or both ears. The hearing loss may be temporary or permanent. It may be mild, or it may be a complete inability to hear spoken language and other important sounds.
Any problem with hearing can get in the way of a child’s speech, language, social and emotional development, and school readiness. Learning about a child’s hearing problem early can improve social and emotional development and academic success.
Evidence-based Hearing Screening
Evidence-based refers to the use of the best research evidence (found in health sciences literature) and clinical expertise (what highly experienced health care providers know).
An evidence-based hearing screening is a way to identify children who need a follow-up evaluation that will confirm or rule out hearing loss. Head Start programs must get results from an evidence-based hearing screening or do one themselves. A hearing screening in an early childhood setting is simple, usually taking a trained screener only a few minutes.
Hospitals screen almost every newborn before discharge. Any newborn who does not pass the screening should receive a follow-up evaluation. Newborn hearing screening results are an important part of each child’s health history.
For newborns, infants, and toddlers, early childhood hearing experts recommend otoacoustic emissions (OAE) evidence-based hearing screening. The OAE screening does not require the child to follow instructions to respond to sounds. A screener places a small probe into the ear canal. The probe makes a quiet sound. The OAE screening equipment captures the inner ear’s response, called the otoacoustic emission. The equipment lets the screener know the child either passed the hearing screen or needs further evaluation
Another evidence-based practice is pure tone (PT) hearing screening. Trained screeners can use PT to screen children 3 years and older. Children must be able to follow instructions to complete the PT screening. A screener places headphones over the child’s ears. When the screener plays a tone, the child responds by raising a hand or dropping a block in a bucket. First, the screener decides if the child can listen for the tones and respond accordingly. The next step is completing the screening by presenting a sequence of soft tones to each ear and documenting the child’s response or lack of response. Finally, the screener decides whether the child passes or needs a referral.
The American Academy of Audiology (AAA) recommends OAE screening for newborns, infants, and children from birth to age 3. The AAA recommends PT screening for children 3 to 5 years old. It also recommends OAE screening for preschool-age children who are unable or unwilling to do the steps of PT screening.
If a child in your program does not pass a hearing screening, it’s important to support the child’s family as they complete these follow-up steps:
- The child is typically screened a second time within about two weeks.
- If the child does not pass the second screening, refer the child to a health care provider for a middle ear evaluation. A health care provider can diagnose and treat common problems such as earwax buildup or middle ear infections. A third screening is necessary after this medical examination.
- If a child still does not pass, ask for a referral to a pediatric audiologist for a complete diagnostic evaluation. Help families follow up with the next steps.
Engaging Families and Promoting Health Literacy
It’s easier for families to partner with you and health care providers when they understand how hearing influences their child’s speech and language development, socialization, and learning. Preparing families on what to expect from a hearing screening helps them prepare their child. It’s also important to talk about who will have access to their child’s screening results.
When staff collaborate with the audiologist and other early intervention providers, it’s helpful for families of a child who is deaf or hard of hearing. Share information with the family about the importance of hearing for children’s language development and communication. This supports a family’s health literacy, and it may help them complete the follow-up steps.
Share these family-friendly materials in several languages to help families learn more about developmental milestones, hearing screening, and hearing loss:
- Hearing Screening for Newborns, Children, and Adolescents: AAP Policy Explained (English and Spanish)
- How Does Your Child Hear and Talk? (English and Spanish)
- Communicate With Your Child (English, Spanish, Chinese, Vietnamese, Korean, and Tagalog)
- PBS Kids for Parents: Literacy
- Can your baby hear you say “I love you?”
- A Parent’s Guide to Hearing Loss
Preparing Staff and Building Community Partnerships
Early childhood programs can begin developing evidence-based screening practices by inviting an audiologist, preferably a pediatric audiologist, to join your Health Services Advisory Committee. The audiologist can help with choosing equipment and training screeners.
Screening results are just a glimpse of a child’s hearing at one moment in time. Screening is not the only way to notice issues with a child’s hearing. Families, teachers, home visitors, and other staff may have concerns about a child’s hearing or speech. Encourage families to speak with their child’s health care provider anytime they express concern about their child’s hearing or language development.
These resources can help staff learn more about hearing screening and hearing loss in young children:
- The ECHO Initiative has resources for training, planning, finding audiologists, choosing equipment, protocols and forms for screening, letters to families and providers, tracking and follow-up, and what to do for children with hearing loss. Send questions to email@example.com.
- Probes and Tips is a monthly electronic newsletter from the ECHO Initiative. Complete this subscription form to receive announcements about the latest hearing resources.
- This checklist for supporting families can help staff support a family when their child has hearing loss.
- Hearing Loss in Children includes information about types of hearing loss, screening and diagnosis, and treatments.
- The American Speech-Language-Hearing Association (ASHA) (ASHA) is the national credentialing association for speech, language, and hearing professionals. The ASHA Action Center answers questions and requests for information from members and nonmembers.
- The American Academy of Audiology has a tool to find a local audiologist.
- Advancing Periodic Hearing Screening in Early Childhood Education Settings includes information about potential collaborations with audiologists.
Resource Type: Publication
National Centers: Health, Behavioral Health, and Safety
Last Updated: January 29, 2024