07/10/2022

Hearing Milestones and Informal Methods of Testing A Child’s Hearing

Hearing ie perceiving and understanding sounds is a basic life function. Hence, it is essential to be aware of the ways through which you could judge your child’s hearing. A child who cannot hear sounds will not know how to talk, as auditory input is mandatory for speech development. Hence, in order to speak, the child requires to hear!

HEARING ➔ SPEECH

A child displays different behaviors for different activities happening in the surroundings. Similarly, a child’s ability to hear can be tested by parents or teachers informally by observing his/her behavior. It is important to understand that if there is an indication of hearing loss by any of the child’s behaviors, the child should be referred for further detailed testing

Hearing development in Children

Babies begin to hear at a very early stage. Your little one could hear sounds from the 18^th week of pregnancy itself. After this stage the baby’s sensitivity towards sounds continues to increase. Around 25^thto 28^th week ie nearing to 7 months (In Vitro) the hearing of the child is fully developed. Babies display various responses to sounds. For instance, a newborn baby will close the eyes, startle, awaken from sleep or show increased heart rate to unexpected sounds. The responses could be easily observed when there are sound like slamming the door, whistle sound of the pressure cooker, bursting of crackers, playing loud music.

Children having normal hearing will continue to show different responses to different sounds thereby achieving hearing milestones as they grow. As the ability to hear, discriminate and comprehend (understand) sounds develops your child would eventually begin to perceive speech and language. Along with achieving hearing milestones, at the same time your child will show development in speech as well which can be observed by the beginning of vocalization, babbling and eventually saying their first word.

Through this we can understand how hearing and speech is co-related. Without hearing development there is no means through which speech can develop.

The following table shows the hearing and language development in children from birth till two years of age.

Age	Hearing development	Language development
Birth to 3 months of age	Babies turn towards mother’s voice, smile when they hear a new voice and calms to familiar voices. Responses to loud sounds- Startle responses, crying response, surprise eye blinks Responses to soft sounds- eye blink, change in sucking behavior, change in breathing pattern.	The baby makes sounds like ‘oo’ and aah’. Displays different cry for their requirement. Eg- Special cry for hunger.
4 – 6 months of age	The baby turns his/her eyes and head toward the sound. They like sound making toys.	The baby makes a combination of sounds like ‘ba-ba’ and ‘ga-ba’ and enjoys it. Repeats series of same sound especially when alone or talked to. (Babbles) eg /p/, /b/, /m/. They try to change voice i.e. pitch of their voice readily. They listen and respond with marked behaviors such as vocalization when spoken to, eye gazing, smiling etc.
7 – 9 months of age	When sound is presented the baby turns sideways in search from where the sound is coming (sound source). They respond to their own name and listen attentively to music and singing. They look at familiar objects and people when it is named.	They understand ‘no’ and ‘bye-bye’ and say ‘da-da’ or ‘ma-ma’ in a meaningless way. Frequently respond with some vocalization when called by name
10 – 12 months of age	The baby can turn its head quickly and accurately to the side, and below in search of the sound source for loud or soft sounds. Stops an activity in response to ‘no ‘and give their toys when asked. Follows simple directions. Eg- Come here, Give it to me, Where is mumma? etc Tries to repeat some words and sound they hear and perceive.	They can speak two or three words correctly. Example- says mumma meaningfully. Just as humans speak long sentences, children make strings of meaningless utterances to a human voice.
13 – 18 months of age	The child turns head correctly in direction of sound source. Jump in rhythm with music Repeats some words that you say or overheard in conversations.	As they listen they can understand and recognize approximately 50 words. Example- people, body parts, and toys. They can tell what they want and try to talk in sentences and use correct gesture with speech. They can say at least one meaningful word at a time along with increased usage in gestures.
19 – 24 months of age	Follows simple two-step commands. Eg- Open the cupboard and take out your doll/car, take the cup and keep it on the table, go to your room and get your books, etc.	Even though they speak couple of phrases (2-3 meaningful word together example- Mumma give water) their speech is not adult-like. They learn new words at a fast pace at this stage. Hence, there’s an increase in their vocabulary

How to know your child’s hearing function?

The following questions will help and guide you to know your child’s hearing function according to the age of your child and seek appropriate referral. Answer ‘yes’ if your child does the activity and answer ‘no’ if he//she does not do the activity.

Questions	Age range
1. Have you had any concern about your baby’s hearing? 2. When your baby is sleeping, does he/ she move or awaken to a noisy sound? 3. Does your baby show startle or crying response to loud/sudden sounds? 4. Does your baby turn his/her head in the direction of any sound? 5. Does your child make playful sounds while playing with him/her? Eg- cooing sounds.	UPTO 6 MONTHS
6. Does your baby turn the neck in the direction of any sound/ name call? 7. Does your baby enjoy listening to rhymes and poems? 8. Does your baby try and copy you while you make sounds? 9. Is your baby starting to repeat a number of the sounds you make? 10. Has your baby uttered his first word?	UPTO 12 MONTHS

The answers to the questions from Q1 to Q5 should be yes if your child is below 6 months of age and the answers to the questions from Q1 to Q10 should be yes if your child has reached 12months/ 1year of age.

Incase majority of the questions are negative then the development of the child might not be age-appropriate. We recommend you to schedule an appointment with an Audiologist- Speech Language pathologist right away. You could also contact us at Montfort Early Intervention Centre, Dadar- West. We help to identify the reason for any speech or language delay and can assist you in beginning a seamless rehabilitation process at the earliest.

Ling six sound test

The ling six sounds are ‘a, i, u, m, s and sh’. The sounds range from low to high pitch (frequency). You can use these sounds to make certain in case your baby’s listening to the variety of speech sounds needed to learn language. Though this test is usually used for children with hearing loss, it can also be used as a tool to check hearing status in normal hearing children in an informal way.

How to test?

Before beginning the test, position yourself behind the child,
Say one sound at a time and observe their responses.
Vary the distance and loudness: Initially you could say the sound near the child’s ear or at a distance of three feet. The loudness can be varied and tested i.e. you can test by saying the ling sounds softly, at normal level and then louder.
Reinforce: When your baby responds correctly, encourage him/her.
Detection Activity: In the initial months your baby may not have the ability to show or inform you which sound they heard however they’ll display that they’ve heard it by turning, smiling or going still.
Identification activity: Another activity that you could use to judge your child’s hearing using ling six sounds could be using 6 different cards or toys and assigning one sound to each card. You could initially say the sound and pick the card or toy a couple of times in a sequence, then you could randomly say a sound and pick the card or toy assigned with that sound. Encourage your child to pick up the card or toy along with you during the practice. Once you think your child has understood the activity, you could just make the sound and wait for the child to pick the card or toy. Perform the activity by varying your distance from the child and varying the loudness levels as well.
If your baby does not reply the second time, move on to any other sound. Make a note and speak to your Audiologist.