Unlocking language for babies who are deaf or hard of hearing

Time is language for a baby. Over those first crucial months, the language center in the brain develops in response to external stimuli: a mother's voice, a father's laugh, a slamming door.

Babbling and cooing are signs that a baby is starting to grasp speech. They’re making sounds to mimic the noises around them. “Baby talk” is an indication of normal development of the brain's language center, which generates the ability to communicate with others.

When a baby is born deaf or hard of hearing, the language center cannot respond to sound. Without early identification, a substantial gap can form in the child’s ability to connect words with meaning, and meaning with impact.

Once that gap becomes too great, it becomes exceedingly difficult for a child to gain language comprehension.

The Centers for Disease Control and Prevention (CDC) estimates that nearly 3 of every 1,000 babies born in the U.S. are deaf or hard of hearing. Up to half of these conditions are caused by genetic mutations, and other causes can include environment factors, complications after birth, or infections during pregnancy that may have gone undetected.

Babies who are deaf or hard of hearing need early language acquisition (ELA) and intervention – an approach that supports healthy brain development and gives deaf children vibrant pathways to interact with each other and with the hearing people around them. This is often best achieved by maximizing an infant’s access to early language, which can include both spoken and sign language.

UT Southwestern's Family-Focused Center for Deaf and Hard of Hearing Children connects families with screenings, tests, services, and resources to help children thrive.

Required infant hearing screenings

Like many states, Texas requires hearing tests for all babies born in hospitals and birthing centers. There are two types of non-invasive screenings, which usually are conducted before the baby goes home from the hospital.

Both screenings assess how the tiny hairs in the inner ear transmit vibrations within the cochlea, which transmits vibrations to sound. A functioning cochlea will make its own sound in return, which can be identified by the screening machine. The two standard types of screening are:

• Oto acoustic emissions (OAE): This standard screen plays sounds through a small earphone with a sensor on it. The machine interprets whether the cochlea is functioning as expected. This screen can be done while the baby is asleep or awake, as long as the baby is quiet.
• Automated auditory brainstem response (AABR): This screen assesses more of the auditory pathway up to and including the brainstem and is often done with babies in the neonatal intensive care unit. It introduces a sound into the ear of the sleeping baby, then records activity of a responding brainstem via electrode stickers on their scalp.

In newborns, these screenings are highly specific. However, late onset hearing loss is more common than being born deaf/hard of hearing, so it is possible for hearing loss to develop later in life.

If your baby's results suggest hearing changes, or if you are concerned about their hearing or language development, we will recommend diagnostic testing with an audiologist – a doctor who specializes in hearing.

Ask for audiology testing if your baby doesn't:

• Startle in response to loud noises
• Make noises like their peers or older siblings at that age
• Mimic your sounds when you talk or sing (by three or four months)
• Localize to your voice, or look for you when you speak
• Make single-syllable sounds (by seven months)

Babies who are found to be deaf/hard of hearing do best with immediate intervention to ensure they don't get left behind in language and learning development. My colleagues and I work with families and doctors to intervene as early as we can in care to prevent long-term complications.

Early language access and intervention is key

The purpose of the Family-Focused Center is to provide infants and children with early language access. For infants, hearing loss itself is not what creates challenges. It's the lack of access to an immediate, intact language.

By around age 4, children's brains have completed a substantial amount of a process called myelination, in which a covering slowly develops over the brain's neurons as it matures. Myelination allows for faster and more effective processing of information, but it also makes the brain less “flexible” for developing new pathways. So some activities, such as learning new languages, can become more difficult.

Children who are not granted access to language by that point – often due to delayed identification or insufficient health care access – may never fully close that window of opportunity. They can struggle with communication, which leads to long-term negative effects on their personal and professional lives.

Related reading: What causes hearing loss and how to prevent it

Complex care for children who are deaf or hard of hearing

As part of the ear, nose, and throat program, our team works directly with point-of-diagnosis providers, audiologists, and parents to quickly connect families with the technology, resources, and support they need to give their baby a chance to thrive at home, socially, and in their education.