Hearing loss in children: signs, screening, and what to do

Children do not always tell you they cannot hear. A baby who does not startle at a loud sound, a toddler who is slow to talk, a seven-year-old who keeps asking you to repeat yourself: all of these can be signs of hearing loss. The first years matter more than most parents realise, because hearing is how a child learns to speak. This guide covers what to watch for at each age, how newborn screening works in India, and what you can do about it.

Why the first years matter most

Hearing drives speech and language. In the first two to three years the brain builds its speech pathways from the sounds a child hears every day. If those sounds are missing or muffled, speech and language fall behind, and catching up later is harder. This is why early detection makes such a difference. A child whose hearing loss is found and treated in the first months often develops speech close to other children their age. The same loss found at three or four usually means slower progress and more therapy. None of this is cause for panic. Early action simply gives the brain the sound it needs while it is still wiring itself for language.

Newborn hearing screening in India

Most Indian hospitals now offer newborn hearing screening, usually before the baby goes home or at the first check-up. The first test is OAE (otoacoustic emissions). A soft probe sits in the baby's ear and measures the echo a healthy inner ear gives back. It takes a few minutes, does not hurt, and is often done while the baby sleeps. If the OAE result is not clear, the baby is called back for a second test, often BERA, also called ABR. BERA checks how the hearing nerve carries sound to the brain. A first 'refer' result does not mean deafness. Fluid in the ear or a restless baby can cause it, which is why the repeat test matters.

What the two tests involve

• OAE: a small earpiece plays soft sounds and records the inner ear's response. Quick, painless, no needles.
• BERA or ABR: soft stickers on the head record the hearing nerve's activity while sounds play through tiny earphones. The baby usually sleeps through it.
• Both are safe for newborns and can be repeated as often as needed.

Signs of hearing loss by age

Babies (birth to about 12 months)

• Does not startle or blink at a sudden loud sound.
• Does not settle or turn towards your voice, especially by around six months.
• Stops babbling, or the babbling does not grow into new sounds.
• Wakes to touch but not to noise.

Toddlers (about 1 to 3 years)

• Speech is delayed, or words are unclear for their age.
• Does not respond to their name unless you are in view.
• Wants the TV very loud, or sits very close to it.
• Watches your face and hands closely to work out what you mean.

School-age children

• Falling behind in class for no obvious reason.
• Mishears words, or often asks you to repeat yourself.
• Says 'what?' a lot, or gives answers that do not fit the question.
• Struggles much more in noisy places, like a busy classroom.

What causes hearing loss in children

The causes fall into a few groups. Some children are born with hearing loss. Others develop it later, which is why a clear newborn screen does not rule it out for good.

• Genetic: hearing loss can run in families, sometimes with no other affected relative.
• Birth complications: premature birth, low birth weight, lack of oxygen, jaundice needing treatment, or infection around the time of birth.
• Ear infections and glue ear: repeated infections or fluid trapped behind the eardrum, common in young children and often treatable.
• Childhood infections: mumps, measles and meningitis can damage hearing.
• Ototoxic medicines: a few strong antibiotics and other drugs can affect hearing, usually where there is no safer option.

What to do if you are worried

See a paediatric audiologist and get a proper hearing test. Do not wait to see if the child grows out of it, and do not rely on clapping behind them at home, which is easy to misread. A trained audiologist uses tests suited to your child's age, from BERA in babies to play-based testing in toddlers. If ear infection or glue ear is the cause, treating that may be all that is needed. If the loss is permanent, the audiologist will explain the options clearly. The point of testing is not a label. It is to know exactly what your child can and cannot hear, so the help can be matched to them.

Hearing aids and therapy for children

Children are not small adults, and their hearing aids are fitted differently. The settings come from the child's own test results, the earmoulds are remade as the ear grows, and the fit is checked as the child develops. Alongside aids, speech and auditory therapy teaches the child to use the sound they now hear and to build language. Started early, this pairing lets many children with hearing loss speak, learn, and attend a regular school. At Prudent we offer paediatric audiology and speech and auditory therapy for children across our clinics.

"Finding hearing loss early is good news, not bad. The sooner a child gets the right sound, the closer their speech and learning can stay to other children their age."

What to do next

If your baby did not pass newborn screening, or your child shows any of the signs above, book a hearing test rather than waiting. Prudent Hearing Solutions runs RCI-registered clinics in Pune (Viman Nagar), Delhi (Rohini and Green Park) and Bengaluru (Jayanagar), and the first 45-minute hearing test is free. You can call us on +91 9429690093. If your child needs aids, there is a 5 to 7 day home trial before you pay, with a return if they do not suit. Acting early is one of the most useful things you can do.