Hearing loss in children

Parents may not notice any problems with their baby's hearing in the first few months of life. This is because babies are often put in quiet areas at home and are held close when spoken to.

Signs that a baby might have hearing loss include:

• Not turning towards noise or being startled by loud noises by 4 months of age
• Not noticing you are there when you are not directly in front of them
• Not making sounds other than gargles and other vibrating noises that they can feel.

As your child starts to walk and explore surroundings, they might start to have difficulty with:

• hearing you if they are further away or in a noisy room
• hearing you talk when they cannot see your face
• hearing well while they are sick with a cold or have blocked ears
• knowing which direction from which sounds are coming from.

Older children with hearing loss might:

• have trouble listening or paying attention
• need the TV volume up louder than usual
• have difficulty hearing if there is background noise such as the TV or a noisy game
• hear quite well when they are in a quiet area
• have unclear speech
• have difficulty communicating at the same level as other children their age
• have difficulty learning to read or spell
• become disinterested or disruptive in class
• find it hard to hear you talk when they cannot see your face.

At school, teachers might notice that your child:

• seems to ignore the teacher when there is background noise
• seems unable to concentrate
• copies what another child is doing, rather than say they did not hear the instructions
• misses important instructions during times when noise is louder and there is more movement, like going home time or before lunch time
• have trouble hearing soft sounds in the classroom such as ’s’, ’f' and ’th', which affect the ability to break words up into sounds for reading and spelling
• have trouble with subjects that involve following processes or sequences, like math
• find it hard to understand and talk to other children when there is a lot of noise.

Many babies who are born with hearing loss are diagnosed in their first month of life by NSW Statewide Infant Screening - Hearing (SWISH) test.

The SWISH test will happen in hospital after your baby is born. If your baby was not born in hospital, you will be contacted by your local child and family health centre or hospital to do the test.

The SWISH test involves playing a soft sound into your baby's ears and recording their response to the sound. Passing the test means your baby can hear quiet noises in both ears.

If your baby does not pass the SWISH test, it will be repeated in a few days or a week's time. If your baby does not pass the second time, they will be referred for further checks at the hospital closest to you.

Your local doctor can refer your child to a specialist who will check your child for hearing loss. Specialists include:

• paediatric audiologist – a health professional who tests hearing
• ear, nose, and throat (ENT) specialist
• paediatrician – child specialist.

It is important to continue to check your child's hearing and speech as they grow, as hearing loss can happen at different ages.

If you think your child is having issues, or has had sudden changes in hearing and listening, see your local doctor as soon as possible.

Temporary hearing loss is also called conductive hearing loss. It can be common in children who have problems with their ears that make it difficult for sound to travel from outside, to the outer or middle ear.

These problems can include:

• glue ear - buildup of fluid in the middle ear
• buildup of earwax
• otitis media - middle ear infection
• otitis externa or swimmers’ ear - outer ear infection.

If your child has hearing loss for longer than a month, see your local doctor as soon as possible.

Some children can be born with hearing loss, called otitis externa or swimmer’s ear. Other children can develop hearing loss as they grow, called acquired hearing loss.

Your child may be at risk of hearing loss if:

• they were born prematurely - before 37 weeks of pregnancy
• they weighed less than 1500g at birth
• you have a family history of hearing loss
• you had a viral infection during pregnancy, like rubella and cytomegalovirus
• they have meningitis or encephalitis – an infection of the brain and/or its coverings
• they have a syndrome that is linked to hearing loss, like Down syndrome or Usher syndrome
• they were born with a birth defect of the ear, nose, face, or neck, for example a cleft palate
• they have had trauma or damage to their head or ears
• they have had long and/or repeated exposure to loud noises.

Hearing loss can affect your child's development of speech and language skills, especially if it is not found or managed well.

Early intervention services will help your child to learn how to:

• communicate in different ways
• use any hearing they do have more effectively
• interact with family and the community as they grow.

There are many different options for managing hearing loss and communication in children. These can include:

• learning and using Australian sign language (Auslan)
• hearing aids
• cochlear implant
• communication devices like mobile phones/tablets, interactive whiteboards, hearing loop, the national relay service and closed captioning services.

It is important to remember that every child is different. There is no right way to manage communication, other than the way that works best for your child.

Tools and strategies can work differently and change for your child as they grow and learn more about how they want to communicate.

Parents, carers, and other people interacting with your child can support communication by:

• choosing a quiet environment when talking and listening so they can hear you better
• remembering to stand closer to make your speech louder, not shouting
• making sure the face, lips and hand gestures are visible to your child when communicating
• being aware of lighting in different environments
• repeating and emphasising key words.

To support your child’s development of communication and language at school, you should:

• tell your child's school and teacher about any learning support they need
• check in with your child's teacher about their hearing loss in the classroom
• ask that your child be seated with their better ear close to the teacher
• check homework at home in a quiet area
• check with your child's school and medical team about extra support for language and learning.

It is important to protect your child’s ears and any hearing they have, to prevent any further damage.

You can protect your child's ears by:

• treating ear infections and glue ear as soon as they occur
• using noise protection for both ears when around loud noises, like concerts
• reducing exposure to loud noises
• setting noise or volume limits on your child’s phone or headphones.

You should also talk to your child’s treatment team about:

• regular hearing checks to monitor changes in hearing levels for both ears
• equipment options for reducing background noise, like Field FM or personal FM units
• Any future treatment or surgery of your child’s “hearing” ear, if relevant.