Early Childhood Intervention: Module Two – Special Needs & Conditions

Category — 2.4 Children with Sensory Losses: Hearing Losses

Children with Hearing Losses


Children with hearing losses, or hard of hearing include those with hearing loss and children who are deaf (see full Glossary). Hearing loss may be present at birth or it may occur at any stage throughout the individual’s life.

While children with hearing loss or hard of hearing may respond to different sounds, or auditory stimuli (see full Glossary), including speech, children who are deaf cannot receive sound in all or most of its forms. In British Columbia, Canada, children with hearing loss or hard of hearing and children who are deaf are eligible for early intervention and special needs educational and vocational support from birth until age 19 years (BC Ministry of Child and Family Development).


Children with hearing losses or hard of hearing can only hear sounds at a certain level of loudness or intensity, and at a certain level of frequency or pitch in one or both ears. The degree of hearing loss might vary, from slight, to mild, to moderate, to severe, and profound. These ranges depend on a child’s ability to hear speech in others, or how loud and intensely their own speech is produced.

Hearing losses can be bilateral (both ears) or unilateral (one ear). Children with a hearing loss greater than 90 decibels (dB) are considered deaf. Audiograms determine the degree of hearing loss. An audiogram is a graph on which a person’s ability to hear different pitches (frequencies) at different volumes (intensities) of sound is recorded (www.cohandsandvoices.org).

These children need specialized education support or assistance to support their optimal development and learning.

Hearing loss has also been described as conductive, sensori-neural, mixed or central.

  • Conductive hearing loss refers to hearing sounds in a limited way because the sound cannot travel within the ear channel;
  • Sensori-neural hearing loss refers to hearing sounds in a limited way because the auditory nerve cannot understand or interpret to the brain the sounds coming through the ear channel;
  • Mixed or central hearing loss indicates that the hearing is limited because both the central or inner ear and the auditory nerve are damaged.

Where does hearing loss come from (Fig. 1)?

Hearing loss

Figure 1. Hearing Loss


Many times no one can determine the cause for hearing loss (see full Glossary). Hearing loss can be the result of genetic or hereditary, pre-, peri- or post-natal factors. See the list of syndromes and conditions, and also refer to the sections on Children with Biological Risk, Children with Established Risk Conditions and Children with Genetic Disorders and Children with Nervous System Disorders.

Signs of hearing loss or hard of hearing may be present since birth. The Early Hearing Screening Program in BC provides important information on the advantages of newborn screening, as well as testimonials for parents.  PHSA – BC Hearing  provides information on what to do if your infants fails the newborn hearing screening. Step by step guidelines are provided such at: support from a Guide by Your Side (parent), introduction to all the home guidance and preschool programs for children who are deaf or hard of hearing; enrolment in the program that best fits your child’s communication needs and ongoing assessment of hearing status including amplification needs and the necessary referrals to specialized teams such as the Cochlear Implant Team of if atypical development is suspected to the Hearing Loss team at Sunny Hill Health Centre for Children (inter-professional team assessments including the developmental paediatrician/family consultant initially leading to a full inter-professional psycho-educational assessment prior to kindergarten.

Sings of Hearing Loss or Hard of Hearing

When the hearing loss has not been detected at birth, early signs of hearing loss or hard of hearing in babies (birth to 12 months) include the following:

  • By age 1 month: Not startling when hearing a noise;
  • By age 3 months:  Not  turning head in response to a sound;
  • By age 6 months: Not responding to vocalizations (cooing, gurgling sounds);
  • By age 12 months: Not vocalizing (e.g. one- to two syllable utterances, or “first words” , e.g., “ma,” “bah”, or “ma-ma”, “da-da.”);

Some of the signs of hearing loss during the toddler, preschool and school years include the following:

  • Children look as if they are less responsive and they do not hold their attention for even a few minutes;
  • Many of them may be slow to learn new words, or have difficulty with their speech (unclear or changing sounds, e.g. “w” instead of “l”).
  • Children with hearing loss or hard of hearing already in kindergarten and primary school grades find it hard to learn to read and write (see full Glossary) as they cannot blend sounds together.
  • Sounds in words or understand idioms (see full Glossary), like “catching up.”

Intervention Options

Intervention for hearing loss may start after birth, as soon as the loss has been detected. Children who are either hard of hearing or deaf generally need some form of special education services in order to receive an adequate education.

For infants and young children consultation with an early intervention consultant or deaf and hard of hearing consultant regarding ways to stimulate the child and possible medical check-ups and interventions is helpful.

Intervention options for children with hearing loss or who are hard of hearing include the following:

Amplification Systems

  • Amplification for unilateral hearing loss (one hearing aid or none)
  • Bilateral hearing loss in mild to moderately severe range usually wear two hearing aids
  • Bilateral moderately severe to profound hearing loss range are possible cochlear implant candidates, and those in the bilateral moderately severe to profound who are not cochlear implant candidates may not wear any hearing aids and rely on sign language
  • FM systems are used in tandem with hearing aids in school classrooms and some homes

For preschool and primary school age children, intervention strategies include:

  • Regular speech, language, and auditory training froma specialist;
  • Amplification systems;
  • Working with a sign language interpreter with parents and service providers who work with children who are deaf or who live with hearing loss;
  • Seating arrangements in class that help the child to do lip reading with his teachers and peers;
  • Captioned films/videos (see full Glossary);
  • Ensuring that  teacher and peers receive training in other communication methods, such as sign language (ASL) (Fig. 2);
  • Counselling.

Sign Language

Figure 2. Sign Language


People with hearing loss or hard of hearing use oral or manual communication, or a combination of the two. Oral communication includes:

  1. Speech;
  2. Lip reading;
  3. Residual hearing.

Manual communication involves:

  1. Signs
  2. Finger spelling
  • Mode of communication varies with normally developing unilateral hearing loss children using oral communication; bilateral HL children using oral communication only or assisted by some sign language in the more significant hearing loss range unless they have cochlear implants where oral communication is stressed.
  • You can see that every child requires individual assessment to ensure that the child’s communication needs and the family’s agreement on communication style match
  • Children with atypical development on top of hearing loss are more complicated to assess and may be more reliant on total communication (oral, sign, gesture, body language)

Total Communication (see full Glossary) is a method of instruction for people with hearing loss or hard of hearing. It combines the oral method plus signing and fingerspelling.


To learn about hearing losses or hard of hearing in the middle childhood years, please visit the six to 12 part of this course.

February 8, 2011   No Comments