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

Hearing loss and deafness can be caused by problems with the outer ear and the ear canal, with the middle or inner ear (where sound is converted to signals to the brain), or with the way the brain sorts out and manages sound. It can happen in either or both ears, can be present at birth or develop later in life, and may be temporary or permanent.

In young children, the brain’s ability to learn about sound and spoken language depends on normal hearing. Helping infants and children who have hearing loss develop language is very important to their overall development.

Is all hearing loss the same?

The amount of hearing loss is defined as the threshold (lowest level) of sound that can be heard, measured in decibels (dB). The normal hearing threshold for children is 15 dB or less; mild hearing loss starts at 20 dB. The degrees of hearing loss are defined as:

• Mild, 20 to 40 dB
• Moderate, 41-70 dB
• Severe, 71-90 dB
• Profound, >90 dB

Human Hearing Chart ( 1.0 MB) shows the dB levels of several common sounds.

Hearing loss can have many causes, including genetic (inherited) problems, birth defects, illnesses, medication side effects, or injury. Some children born with typical hearing or mild hearing loss can gradually lose their hearing.

Most children who are born with hearing loss are identified at birth through newborn screening. 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.

Newborns are required to have their hearing tested before leaving the hospital at birth. The best way to be tested for hearing loss that occurs later (acquired) or is progressive is with an audiogram performed by an Early Intervention Part C Program or a licensed pediatric audiologist. Your primary care doctor can provide a referral to both. See Hearing Screening.

What is an audiogram?

An audiogram is a test that displays the level of hearing at different frequencies of sound (low, medium, and high). This helps the clinician or audiologist understand the degree and type of hearing loss, diagnose the cause 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 prognosis, or expected long-term outcome, depends on the cause of the hearing loss and the treatments and help provided to the child. For young children, early exposure to language improves language development. Language exposure can be provided though hearing aids, frequency modulation (FM) systems, cochlear implants or other assistive listening devices, as well as through American Sign Language and other visual languages.

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, it is unlikely that other family members would be affected.
• If the cause is genetic, some families may have multiple members with hearing loss. A doctor or audiologist can help decide whether others 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. Just like any hearing child, a child who is deaf or hard of hearing needs access to language to achieve their developmental milestones.

How will we decide what type of support to choose for our child?

Many technology options are available to amplify (or augment) sound for the child. These include:

• Hearing aids
• Frequency modulation (FM) systems
• Cochlear implants
• Bone Anchored Hearing Aids (BAHA)

Selecting among them is based on factors such as age, level of hearing, and the needs of the child and family. An audiologist who works with children can help you with the decision-making process. See Hearing Aids.

American Sign Language and other visual languages can be used for communication and developing language skills. Visual languages include:

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

What is a cochlear implant?

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 that is placed in the bone behind the ear. A microphone and transmitter, worn behind the ear, sends signals to the receiver creating sound signals that are then sent to the brain. Cochlear implants are now water resistant. FM systems are also used in conjunction with cochlear implants to help facilitate direct amplification in large group settings such as classrooms.

Bone Anchored Hearing Aids (BAHA) are another technology available to children who have birth defects of the outer and inner ear (microtia or atresia).

Hearing aids or cochlear implants may not be tolerated by some children, and some families may not want to use these options. For more information on all of the options available, contact your Early Intervention Part C Program.

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.

There are a variety of reasons your baby may not have passed their newborn hearing screening, including fluid in the ear canals or in the middle ears. Hearing screening tests do not diagnose hearing loss – they are designed to 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 one to three babies per 1,000 (less than 1 percent) actually have hearing loss. This means that most of the babies referred for further testing will have normal hearing. Because 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.

If you have a child who has been diagnosed with hearing loss or is suspected of having hearing loss, you may experience a variety of feelings. While the early stages of diagnosis can be confusing and emotion-filled, the opportunities available to you and your child are no different than those available to a child with typical hearing. Take the time to research options available for your child and follow your child’s lead in making a decision that will work for your family. There are a variety of tools and resources available for children with all levels of hearing loss, and one or more may be a good fit for your child. The most important things you can do for your child are to love, support, and encourage her/him, and provide access to language so he/she can communicate with you. There is no “right” or “wrong” answer for your child. You may find that the choice you begin 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. Many resources are listed in the Support section below.