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Growth & Development


Permanent hearing loss affects approximately one to three children out of 1000. The hearing loss may affect one ear or both and may be of any degree from a mild hearing loss to complete deafness. It can be difficult to identify a child with hearing loss, particularly when the loss is relatively mild since the child may seem to respond to many sounds. Many children may also experience temporary hearing losses, particularly if they have a history of issues with congestion or ear infections. Any degree of hearing loss may have an impact on a child’s ability to learn speech and language or to hear clearly in a noisy situation but this is especially true as the severity of the hearing loss increases.

Healthy Child Development

There are several stages of healthy hearing development that are marked by key abilities.  

0-3 months

  • Makes cooing sounds

  • Increases or decreases sucking behaviour in response to sound

  • Startles, blinks, cries, quiets or changes breathing rate in response to a sound

  • Startles in response to sudden, loud noises

  • Stirs or awakens when sleeping quietly and someone talks or there is a sudden noise

  • Moves head, eyes, arms and legs in response to a noise or voice

  • Smiles and laughs in response to parent/caregiver’s smiles and laughs

  • Makes different cries for different needs–such as hungry, tired

  • Recognizes familiar voices and quiets when spoken to

4-6 months

  • Responds to changes in the tone of parent/caregiver voice

  • Turns head toward voices and interesting sounds

  • Enjoys musical toys or toys that make noise

  • Begins to imitate coughs and other sounds as well as make speech-like sounds e.g., ah, eh, buh, ma

  • Babbles for attention and uses vocal play

6-9 months

  • Responds to their name

  • Responds to the telephone ringing or a knock at the door

  • Responds to the word “no”

  • Gets what they want through sounds and gestures, such as reaching to be picked up

  • Babbles and repeats sounds in a series e.g. babababa, duhduhduh

9-12 months

  • Localizes correctly to sound by turning head toward the sound

  • Follows simple one-step directions, for example “sit down”

  • Looks across the room to something you point to

  • Recognizes words for common items like “mom”, “cup”, “shoe”, “book” or “juice”

  • Uses three or more words

  • Uses gestures to communicate, for example waves “bye bye”, shakes head “no”

  • Pays attention when spoken to

  • Gets parent/caregiver’s attention using sounds, gestures and pointing while looking at their eyes

  • “Performs” for attention and praise

  • Combines lots of sounds as though talking — abada baduh abee

  • Shows interest in simple picture books

12 months -18 months

  • Sometimes startles to sudden loud noises

  • Understands the concepts of “in and out”, “off and on”

  • Points to several body parts when asked

  • Uses at least 20 words

  • Starts to put words together

  • Responds with words or gestures to simple questions — “Where’s teddy?”, “What’s that?”

  • Looks at your face when talking to you

  • Makes at least four different consonant sounds — b, n, d, g, w, h

  • Enjoys being read to and looking at simple books with you

18 months -2 years

  • Follows two-step directions, for example “Go find your teddy bear and show it to Grandma”

  • Uses 100 or more words

  • Understands more words than they can say

  • Uses at least two pronouns, e.g. “you”, “me”, “mine”

  • Uses own name

  • Consistently combines two or more words in short phrases - “daddy hat”, “truck go down”

  • Asks simple questions, for example “What’s that?”

  • Enjoys being with other children

  • Begins to offer toys to peers and imitates other children’s actions and words

  • People can understand their words 50 to 60 per cent of the time

  • Takes turns in a conversation

  • Forms words and sounds easily and effortlessly

  • “Reads” to stuffed animals or toys

2-3 years

  • Is alert to environmental sounds

  • Responds to someone talking out-of-view (particularly when there are no distractions)

  • Responds to voices on the telephone

  • Understands the concepts of size (big/little) and quantity (a little, a lot, more)

  • Uses some adult grammar — “two cookies”, “bird flying”, “I jumped”

  • Uses more than 350 words

  • Uses action words, for example “run”, “spill”, “fall”

  • Uses sentences of three or more words most of the time

  • Answers simple questions, for example “Where is the car?”

  • Participates in short conversations

  • Begins taking short turns with other children, using both toys and words

  • Puts sounds at the start of most words

  • Produces words with two or more syllables or beats, for example “ba-na-na”, “com-pu-ter”, “a-pple”

  • Listens to and enjoys hearing stories for longer periods of time

  • Remembers and understands familiar stories

3-4 years

  • Tells a short story or talks about daily activities

  • Talk in sentences with adult-like grammar

  • Generally speaks clearly so people understand

  • Hears you when you call from another room

  • Listens to television at the same volume as others

  • Answers a variety of questions

  • Understands words for some colours, like red, blue and green

  • Understands words for some shapes, like circle and square

  • Understands words for family, like brother, grandmother and aunt

4-5 years

  • Pronounces most speech sounds correctly

  • Participates in and understand conversations even in the presence of background noise

  • Recognizes familiar signs, for example stop sign

  • Makes up rhymes

  • Hears and understands most of what is said at home and school

  • Listens to and retells a story and asks and answers questions about a story

  • Understands words for order like first, next and last

  • Understands words for time like yesterday, today and tomorrow

  • Follows longer directions like “Put your pajamas on, brush your teeth and then pick out  a book”

  • Follows classroom directions like “Draw a circle on your paper around something you eat”

... If a child is missing one or more of these expected age outcomes, consider this a red flag



If a child is experiencing any of the following, consider this a red flag:

► Early babbling stops

► Frequently gets colds and ear infections

► Frequently pulls at ears

► Does not understand people unless facing them

► Intently watches the face of the person speaking

► Speaks loudly or turns up the volume of the television or radio

► Does not respond when called

► Uses “what?” or “huh?” frequently

► Has difficulty understanding speech in group activities

These Practitioners and Agencies may be able to help

Services and Information related to Hearing:

Having more general concerns about a child's development?

Having difficulty coping? Need some advice?

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