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NC Department of Health and Human Services
N.C. DPH: Women's and Children's Health Section
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Early Hearing Detection and Intervention Program

Childhood Acquired Hearing Loss

The term Childhood Acquired Hearing Loss is defined as any hearing loss that is not present at birth, but identified at a later date. Approximately two to three children per 1,000 will be identified as having childhood acquired or late onset hearing loss. This number is equal to the amount of children identified with hearing loss through the Universal Newborn Hearing Screening process. Risk indicators help identify infants and children who should receive follow-up medical care, including additional hearing screenings and audiological evaluation.

Risk Factors for Infants, Toddlers, and Children

  • Parent or caregiver concern regarding hearing, speech, language, and/or developmental delay
  • Family history of permanent childhood hearing loss
  • Infection transmitted from mother to child during pregnancy such as syphilis, herpes, CMV, toxoplasmosis or rubella
  • Syndromes associated with sensorineural hearing loss
  • Bacterial meningitis
  • Head trauma
  • Certain medications
  • Recurrent ear infections with fluid for at least three months
  • Neonatal risk factors such as prolonged ventilator use or inherited disorders
  • Childhood infectious diseases including mumps, measles, rubella and chicken pox
  • Disorders that cause nerve degeneration

Warning Signs of Hearing Loss

Delays in language development or the failure to develop language (spoken words) are the most important signs of hearing loss in children. Even mild hearing loss in one or both ears can affect how your child communicates with others and how he performs in school.

A child with a hearing loss may have one or more of the following warning signs:

  • Does not respond when he hears soft sounds such as your voice, when there is no other background noise
  • Uses the words "what?" or "huh?" many times a day
  • Carefully watches the faces of speakers
  • Cannot understand what you are saying with other noises in the background
  • Sits close to the TV set when the volume is adequate for others or "turns up" the volume to unreasonably loud levels
  • Cannot understand voices over the telephone or switches ears often when using the phone
  • Does not startle when he hears very loud sounds
  • Cannot locate the source of a sound
  • Has problems speaking, listening, learning and paying attention in school which may be noticed by a teacher or family member

How Can Hearing Loss Affect My Child?

If your child has hearing loss, the earlier it is identified and intervention is put in place, the better the outcome. Studies indicate that children with hearing loss, even if it is mild and undetected, may have:

  • Delays in speech and language
  • Learning problems, especially in reading and math once the child starts school
  • Social, emotional and behavioral problems that often lead to low self-confidence

Where Can I Have My Child's Hearing Tested?

If you think your child may have difficulty hearing, you can contact:

If you ever have concerns about your child's hearing, speech or language, be sure to discuss them with your child's doctor as soon as possible.

How Will My Child's Hearing Be Tested?

There are several methods for testing hearing and/or middle ear function in infants, toddlers, and children. All tests are very safe and will not hurt your child. Each test checks a different part of the ear, so your child may have all of them as part of the evaluation.

  • ABR (Auditory Brainstem Response) - Measures responses from your child's hearing (auditory) nerve. Clicking sounds are presented through earphones into your child's ears. Electrodes placed on your child's head pick up the sound as it travels up the hearing pathway. This test is painless, but requires that your child be asleep for testing. Sedation is sometimes required.
  • ASSR (Auditory Steady State Response) - Also measures responses from your child's hearing nerve. This test gives more information about different pitches or frequencies. It is measured the same way as the ABR, and also requires that your child be sleeping. When available, it is usually done in conjunction with the ABR. Sedation is sometimes required.
  • OAE (Otoacoustic Emissions) - Uses soft sounds to measure an "echo" from your child's inner ear. A small probe is placed in your child's ear to measure this response. Your child may be asleep or quietly awake for this test.
  • Behavioral Audiometry - Tests your child's hearing in a sound treated booth. An audiologist observes your child's responses to sound either with or without earphones. Depending on the developmental age of your child, they may be required to turn to a sound, play a game, or raise their hand in response to a sound.
  • Tympanometry - This is not a hearing test, but a test of middle ear function. Positive and negative pressure changes in the outer ear give information about the status of your child's middle ear. The audiologist is able to monitor PE (pressure equalization) tubes, possible fluid, and some other middle ear issues with this test.

Speech, Hearing and Language Development

Good hearing is essential for your child's development. Information about your child's speech and hearing development is valuable to all parents. To see how your child is growing and learning, use the list below. Children with normal hearing and development should progress at a similar rate.

  • Birth to 3 months
    • Startles to loud sounds
    • Quiets to a familiar voice
    • Makes cooing or vowel sounds like "ooh," "ahh"
    • Cries differently for different needs
  • 4 to 6 months
    • Looks for sounds with eyes
    • Notices toys that make sound
    • Starts babbling
    • Uses a variety of voice sounds, such as squeals, whimpers, chuckles
  • 7 months to 1 year
    • Enjoys games like "peek-a-boo" and "pat-a-cake"
    • Listens when spoken to
    • Imitates speech sounds
    • Has one or two words (bye-bye, mama, dada)
  • 1 to 2 years
    • Listens to simple stories, songs, and rhymes
    • Follows simple commands and understands simple questions
    • Points to pictures in a book when named
    • Says more words every month
    • Uses some one to two word questions ("Where kitty?" "Go bye-bye?")
    • Puts two words together ("more cookie,' "mommy book")
  • 2 to 3 years
    • Understands differences in meaning ("go-stop," "big-little")
    • Follows two requests ("Get the book and put it on the table")
    • Has a word for almost everything
    • Uses two to three word "sentences" to talk about and ask for things
    • Speaks and is understood most of the time by familiar listeners
  • 3 to 5 years
    • Hears when you call from another room
    • Understands simple "who?" "what?" "where?" and "why?" questions
    • Pays attention to a short story and answers simple questions about it
    • Talks about activities at school or at friends' homes
    • Uses a lot of sentences that have 4 or more words


Help is available for children who have hearing loss. Many public and private programs provide emotional support and access to information for families and their children. These services can help a child develop to his fullest potential.

Program Resources

Support Services

  • BEGINNINGS for Parents of Children Who Are Deaf or Hard of Hearing, Inc., 1-800-541-HEAR (4327), provides emotional support and information. The attached map will help you determine which office serves your county.
  • Family Support Network of North Carolina, 1-800-852-0042, offers support to families with children who have special needs.

Additional resources and funding may be available to qualifying families for hearing aids and other communications equipment.