Hearing is critically important for a baby and is closely linked to language development in the first few years of life. Because of this, it is important to identify potential hearing loss as soon as possible so that early intervention can be arranged. Maura Cosetti, MD, Director, Otology/Neurotology, Mount Sinai Downtown, Associate Director, Ear Institute, New York Eye and Ear Infirmary of Mount Sinai (NYEE), and  Aldo Londino, MD,  Assistant Professor of Pediatric Otolaryngology at the Mount Sinai Health System and Chief of the Division of Pediatric Otolaryngology at the Mount Sinai Kravis Children’s Hospital, detail what parents need to know about spotting—and addressing—hearing loss in babies.

How common is pediatric hearing loss and what are the causes?

Approximately two to three infants per 1,000 are born deaf or with severe to profound hearing loss. Causes range from hereditary hearing loss to improper development of the inner ear. Hearing loss can also occur after birth and may be related to infections or other medical problems that occurred around the time of delivery.

How and when are babies tested for hearing loss?

All newborns are given a mandatory hearing test before leaving the hospital. This non-invasive screening helps identify babies who are deaf or hard of hearing by monitoring for either an ear or a brain response to a sound.

What does it mean if my baby “fails” the newborn hearing screening? 

There are many reasons that your baby may have failed the newborn screening test.  Because it is a screening, failing does not always mean your child has permanent or severe hearing loss. It is important to have a trained audiologist perform additional testing to assess your baby’s condition.

If hearing loss—whether permanent or temporary—is suspected, follow up testing with a pediatric audiologist is necessary to determine the amount of hearing loss and the appropriate interventions.  Interventions may range from observation, to hearing aids, and even cochlear implant evaluations.

My baby did not fail the newborn hearing screening. What are the signs of potential hearing loss as my child develops?

Signs and symptoms of hearing loss in babies vary, as children may reach milestones at different ages. However, the earlier hearing loss is diagnosed, the earlier it can be treated and the better the outcome for your child’s future development. Be aware of the following age-related guidelines to help gauge your child’s progress:

What steps should I take if my baby begins exhibiting signs of hearing loss?

If you feel that your baby is not meeting their developmental milestones to speak, play, or communicate, you should ask your pediatrician for a referral to a pediatric ear, nose, and throat specialist. Since hearing loss can affect your child’s ability to develop speech, language, and communication skills, it is of the utmost importance that your child receive appropriate services and treatment, which may include hearing aids, as soon as possible.

Pediatric otolaryngologists (ear, nose, and throat doctors) play a vital role in the evaluation and management of children with speech delay, a communication disorder characterized by late speech and language development. These specialists, working with audiologists, speech therapists, and teachers, are an important part of the team that many children with speech delay rely on to reach their potential. Aldo Londino, MD, a pediatric otolaryngologist at The Mount Sinai Hospital, explains speech delay, what parents should expect during a physician visit, and how the condition is treated.

How do I know if my child has a speech delay?

While common causes of the condition include oral-motor problems (difficulty controlling speech muscles), significant ear wax buildup, chronic ear infections, or fluid behind the ear drums, signs of speech delay are varied.

Contact your child’s physician if your child:

• By four months is not babbling with expression and copying sounds he or she hears
• By six months is not responding to his or her name and/or cannot string vowels together (“ah,” “eh,” “oh”)
• By 12 months is not able to say “Mama” and “Dada” and/or is not expressing gestures, such as pointing or shaking head “no”
• By 18 months has difficulties imitating sounds
• By two years cannot follow simple directions or use verbal language to communicate more than immediate needs

Early detection can be critical. There are various steps both parents and doctors can take to help at-risk children.  If you need additional help deciding when to ask your pediatrician or ear, nose, and throat specialist about possible speech delay, consult the well-organized and thorough reference of milestones during childhood compiled by the U.S. Centers for Disease Control and Prevention.

Keep in mind that many children are late bloomers. Not every child with a late start will go on to have a speech delay.  Albert Einstein, for instance, was initially considered delayed because he developed speech late in childhood.

What tests are important for evaluating speech delay in children?

All children with a suspected speech delay receive a formal hearing test in the office.  Though sometimes difficult to perform in a young child, this test is a complete evaluation of how your child hears and provides valuable information about the health and function of their ears.  We always review hearing test results with the parent in the office.  Additionally, as part of the evaluation for delayed speech, we always perform a thorough physical examination of your child, focused particularly on the ears and the oral cavity.  We also evaluate the tongue for a tongue-tie and ensure that the tongue has good mobility.

What should I expect during a visit for speech delay?

Your pediatric ear, nose, and throat doctor will ask several questions about you and your child. Records from birth and from your child’s pediatrician can inform the best diagnosis and treatment.  Be prepared to answer the following questions, among many others:

• Were there any hurdles or challenges during the pregnancy or delivery of your child?
• A hearing test is generally done while your baby is in the nursery soon after birth. Did your child pass this screening?
• Has your child suffered from recurrent ear infections? If so, how frequent and how severe?
• Has your child ever had ear surgery?
• Is there a history of hearing loss in your family? Please note younger family members with hearing aids or any possible hereditary hearing loss.
• Does your child respond to sounds/noises/conversation in his or her environment?
• When was the last time your child had a hearing test?
• How is your child doing in school or day care?

How is speech delay treated?

The effective treatment of speech delay very much relies on the underlying cause. Treating recurrent ear infections, for example, can help a child hear normally, and thereby enhance their ability to interact and learn from the words and sounds in their environment. Repairing a tongue-tie can help increase the mobility of the tongue and, with practice and help, have a big impact on pronunciation.

Regardless of the underlying cause, it is important that your child has a team dedicated to helping them reach their full potential.  Pediatricians, pediatric otolaryngologists, audiologists, speech therapists, and teachers all play a critical role in helping you and your child reach your goals. As a parent, always communicate with your child.  Your positive reinforcement of their expressive habits is a valuable tool. And, most importantly, if you have concerns about your child, ask your pediatrician about consultation with a pediatric ear, nose, and throat specialist.

Screens are everywhere, even in the waiting areas of pediatric practices. This makes it harder for parents to control the amount of time children spend engaging with digital media. While there are legitimate educational applications that involve handing your child, or putting your child in front of, a screen, limits are important. Micah Resnick, MD, a board certified pediatrician at Mount Sinai Queens, explains how, and why, parents should limit usage.

How much is too much screen time?

Parenting is not easy. Sometimes a screen is the most efficient solution for occupying your child while you attend to the needs of other family members, or even your own needs. Despite the ease and importance of using digital media, the American Academy of Pediatrics (AAP) recommends the following:

• No screen time before 18 months old except for video chatting
• Strictly limited screen time for toddlers 18 to 24 months old
• One hour a day of “co-viewing” for children two to five years old
• Consistent limits on screen time for children six years and older

Those are pretty serious restrictions, and with good reason.  Too much screen time can result in lack of sleep, aggression, obesity, and loss of social skills.  No one wants that, especially during your child’s crucial development stage.

So, what are parents to do?

An excellent starting point to help limit screen time is the creation of a family media plan.  HealthyChildren.org, a parenting advice website from the AAP, provides helpful tools like a media plan template and a media plan calculator here. Using the media plan calculator, you are given an age-appropriate checklist advising how to help create screen-free zones, screen-free times, and device curfews, and how to balance online and offline time for your child.   There are also important sections on how your child can be a good “digital citizen.”  Speak with your child about cyberbullying, the dangers of sending or receiving explicit images via text, and the importance of following online guidelines.

Encourage tactile activities. 

While digital media is ubiquitous, it is not essential. An early childhood filled with books and educational toys will pay off well into adolescence.  Play with your children, read to them, and teach them about colors and numbers and how to play musical instruments.  These tactile interactions will promote the most intellectual and emotional development.

No one likes injections. In just the first year of a healthy baby’s life, 12 shots will be administered. More injections will follow through adolescence, making needles an uncomfortable but necessary fact of life. Micah Resnick, MD, a board certified pediatrician at Mount Sinai Doctors Queens, explains how to minimize the stress and pain surrounding these injections, which help you and your child stay healthy.

Only a handful of my friends get their annual flu vaccines, the rest skip out because of their needle phobia, so it is no surprise that infants and children are fearful of injections and blood draws. How can we, as parents and as physicians, help alleviate the fear? I never lie to parents when they ask me if infants can feel pain. Yes, they can. However, for babies and children of all ages, it is important that parents stay calm, smile, and use encouraging words. Your child, especially toddlers and older children, will take cues from you.

For babies, physical contact is very important. Hold your baby close in an upright position. You may want to breastfeed before, during, and after the immunization to calm your baby down. There are over-the-counter topical anesthetic creams that may minimize the pain, but these can take 30 to 60 minutes from application to start working.

Toddlers require more active intervention. Tell your toddler about the injection ahead of time. You know your child best—some young children respond well to being told just before, while other children may do better with several short discussions in the days leading up to the doctor visit. In either case, try to distract your child at the time of the injection by blowing on a pinwheel or even blowing something imaginary out of your hand. Don’t tell them it will only hurt a little, or it will be over soon. This will only remind them of the discomfort.

School-aged children are typically more reasonable. Honesty is the best policy here. The goal is to set a realistic expectation. Explain to your child that injections are necessary. Let them know that the little pinch from the needle keeps them from getting sick.  For the injection, your best bet is to distract your child: you can play music or talk about a book you both like. In my office, I have colorful posters of animals and trees on the wall. I often point to those animals or ask a child to list the different ones on the wall he or she recognizes.

Talk with your child about the experience afterward. Acknowledge the pain. Give praise for doing a good job, or even just for a “best effort.” Ice cream or another enjoyable treat may also be in order.

What do you do with an absolutely inconsolable toddler or child?  Number one, don’t drag it out. Take a short time to reason with your child, and if it is a no go, hold your child while the injection is given. It is only very rare cases, when the fear turns into a phobia, that the services of a psychologist may be necessary. Remember, we are hoping that your child sees injections as an unpleasant fact of life. Stay positive, stay supportive.