Ages and Stages, Hearing, Speech & Language

Let’s talk about hearing and Down syndrome

May is Better Hearing and Speech Month and in honor of the this I am excited to start with a post on hearing. Why hearing? Well, without hearing other areas of communication may be significantly impacted. Even if it is a mild loss.

When should a child with Down syndrome have their hearing checked?

The Down syndrome Healthcare Guidelines are as follows for hearing:

  • Birth to one month – an Auditory Brainstem Response (ABR) or Otoacoustic Emission (OME) test
  • By 3-months – An ABR if it hasn’t been completed or the first test was inconclusive
  • 1-year to 3-years of age – Behavioral audiology testing every 6 months until 3-years.
  • 4-years until 18-years of age: Behavioral audiology testing yearly. Testing becomes very important as changes in hearing during adolescence are frequently misdiagnosed as mental health problems.

There are a number of factors that influence the development of the child’s speech and language development:

  • type and degree of hearing loss
  • frequency of the loss (if it is a fluctuating conductive loss)
  • age at identification of the hearing loss
  • type of treatment that is received
  • cognitive abilities
  • amplification age and use
  • family support

Children with Down syndrome and a hearing loss may have particular difficulty with communication in the following areas:

  • understanding the speech of others
  • communicating in noisy places
  • expressing themselves
  • developing vocabulary skills
  • developing clear speech
  • listening and learning in a classroom
  • learning to read
  • interacting with peers or making friends due to troubles with understanding games, rules, and directions
  • maintaining attention and controlling behavior

My child has persistent fluid in her ears. Are there things I can do to help her?

Yes! There are a variety of language-learning and listening strategies to help your child. It is important to gain your child’s attention before speaking to them; then talk at eye level. Next, use a normal tone and normal loudness. When asking questions keep them simple, pause, and waiting for their response. Children with Down syndrome and fluid in the ears need extra time to process. Give your child praise when they talk to you even if it is unclear. This will provide motivation to speak more frequently.

When riding in the car, turn off music or the DVD system. This background noise, in addition to the in-cabin noise, makes it difficult for a child to hear what is said to them. When my son Louis was little he called the highway “the noisy road,” because of how much louder the car interior became at high speeds. Before 18 months old he had 12 ear infections making it very difficult to hear when background noise was present – even though he only had a mild, fluctuating, conductive loss. He didn’t like the noisy road and I didn’t understand why until I thought about how challenging it was for him to hear!

My child has hearing aids. Do they really need to wear them all the time?

Well… the short answer is yes. I need glasses. Without them I can’t see (and can’t legally drive). I wear them nearly all the time otherwise I can’t function as well. Sure I can get by, but I have to put more effort into what I’m trying to do. Ask your audiologist for recommendations. Your child may not be able to give you feedback about how it helps. Also, it may take a while to notice a marked improvement in speech and listening comprehension once your child is aided. Despite this we know without hearing aids the child is missing key bits of information throughout the day. Therefore, if you child needs hearing aids then it is essential to have them worn as frequently as possible.

To celebrate Better Hearing and Speech Month have your physician refer your child for a hearing test. In Cincinnati, Children’s has audiology services at many outpatient locations, including the building where the Thomas Center is located. Appointment times may be coordinated with therapy visits too! For more information or to schedule an audiology appointment at CCHMC call (513) 636-4236. Outside of Cincinnati you can locate an audiologist here: or

(Special thanks to CCHMC Speech Pathology, Audiology, & ENT for the information and resources used in this post)

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