Vocalizations and Hearing

As the infant develops, it is important for the clinician to assess the type and frequency of vocalizations. Clinician often use standardized screening tools which are available to assess developmental milestones. Failure to meet developmental milestones in this area may be indicative of oral-motor, auditory, and/or cognitive difficulties that may ultimately affect communication development. Most infants should "coo" at around three months and use various cries for different needs. Strings of "babbling" sounds are usually heard by age six to seven months. Infants typically are capable of expressing emotion by age seven months by squealing and/or laughing. By approximately the eighth month, babies should begin imitating the speech sounds of significant persons in their environment. By twelve months of age, the infant should pay more attention to speech, make simple gestures (such as shaking head), use expressive "jargon", say "mama" and/or "dada", try to imitate words, and use short exclamations. Licensed speech/language pathologists can evaluate theses areas of infant development from birth.

Hearing is the most missed disability and clinical assessment of communication is paramount in infants and young children. The Joint Committee on Infant Hearing and the U.S. Public Health Services for Healthy People 2010 recommend that babies be identified by 3 months of age and receive intervention and amplification by 6 months of age. Excellent documentation regarding the efficacy of early amplification (Yoshinago-Itano, Sedey, Coutler, & Mehl, 1998) showed that those who are identified and receive intervention before 6 months of age develop significantly better speech and language skills than those who are identified and receive intervention after 6 months. Infants as young as 4 weeks of age can be fitted for hearing aids.

Hearing problems may be suspected should any of the following occur: the infant fails to move his/her eyes toward sounds or speaker; is unable to respond to changes in voice tone (e.g., loud /angry vs. soft/gentle); does not notice toys that make noise or music; does not react to loud, sudden noises in the environment; or fails to develop imitative sounds. Some infants with hearing problems may coo like other infants, but at about eight months sound production may diminish and the infant may fail to or be delayed in putting consonants and vowels together into utterances. Clinicians should gather information about the infant's communication abilities through observation, interaction, medical history and gathering parent/caregiver report information. Parent/caregiver report of the child's typical performance in the home is of great importance, since many children become quiet in the clinic setting. When communication concerns are discovered through the screening process, or through review of medical history (e.g., hearing test prior to hospital discharge around the time of birth) or through clinical observation, a follow-up plan should be made to address the child's needs.

For more information, you may visit the American Speech-Language-Hearing Association online at http://www.asha.org/default.htm

Batshaw, M.L., & Shapiro, B.K. (1997). Mental retardation. In M.L. Batshaw (Ed.), Children with disabilities (pp. 339). Baltimore, MD: Paul Brookes Publishing.

Yoshinago-Itano, C., Sedey, A.L., Coutler, B.A., & Mehl, A.L. (1998). Language of early and later-identified children with hearing loss. Pediatrics, 102(5), 1168-1171.

Also taken in part from the American Academy of Pediatrics online medical library, retrieved 12/07/04 from http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZWKQVIQDC&sub_cat=105