When a child is slow to talk or hard to understand, one of the first questions a pediatrician or speech-language pathologist (SLP) often asks is simple: how is their hearing? Children learn to talk largely by listening, so hearing and speech are closely linked. This post explains why hearing matters for speech and language, what newborn screening does and doesn't tell you, signs worth mentioning to your pediatrician, and how the process works in Arizona, based on guidance from the National Institutes of Health, the CDC, the American Academy of Pediatrics (AAP), and Arizona law.
This article is general information, not medical advice. If you have a concern about your child's hearing, talk with your pediatrician or an audiologist.
Why does hearing matter so much for learning to talk?
The National Institute on Deafness and Other Communication Disorders (NIDCD) explains that most children "learn to talk by imitating the sounds they hear around them and the voices of their parents and caregivers."[1] It adds that "The most important time for a child to learn language (spoken or signed) is in the first 3 years of life," and that children with typical hearing "begin learning speech and language in the first 6 months of life."[1]
The AAP puts it this way: normal hearing is needed "to understand spoken language" and then, later, "to produce clear speech."[2] The CDC notes that "Hearing loss can affect a child's ability to develop communication, language, and social skills."[4]
According to the NIDCD, about two or three out of every 1,000 children in the United States are born with detectable hearing loss in one or both ears, and "More lose hearing later during childhood."[1]
My baby passed the newborn hearing screening. Can I stop worrying?
A passed screening is good news, but it's a snapshot, not a lifetime guarantee. The NIDCD answers this exact question with "Not necessarily," explaining that "Hearing loss can occur at any time of life" and that "Some inherited forms of hearing loss don't appear until a child is older."[1] It lists childhood illness, ear infection, head injury, certain medications, and loud noise among the factors linked to hearing loss in children.[1]
The AAP also points out that a newborn who startles, blinks, or turns toward sounds may still have trouble: "Many newborns react this way but still have trouble hearing well enough to learn spoken language."[3] That's why the AAP recommends ongoing checks. It recommends that all kids have hearing tests "at ages 4, 5, 6, 8 and 10 years," with additional screenings during the preteen, teen, and young adult years.[3] Your pediatrician may suggest a different schedule if hearing changes run in your family.[3]
What happens if my baby doesn't pass the screening?
National guidance follows what's known as the "1-3-6" benchmarks. The CDC describes them as screening for hearing loss before 1 month of age, a diagnostic evaluation before 3 months of age, and enrollment in early intervention before 6 months of age.[4] If a baby does not pass the screening, the CDC says "it's very important to make an appointment for a full hearing test before 3 months of age."[4]
The NIDCD advises making an appointment with a pediatric audiologist, "a hearing expert who specializes in the assessment and management of children with hearing loss," ideally by the time the baby is 2 to 3 months old.[1] Its timeline for parents is direct: "If you must cancel the follow-up appointment, reschedule it!"[1] If hearing loss is confirmed, the NIDCD says intervention should begin as soon as possible, ideally by 3 to 6 months of age.[1]
A screening result that "falls outside the typical range" doesn't by itself mean a baby has hearing loss; the AAP notes that a repeat screen may be recommended, and if concerns remain, follow-up testing with a hearing professional should be done "as soon as possible—but no later than 3 months of age."[3]
Worth knowing: If your baby's hearing wasn't screened within the first month, or you were never told the results, the NIDCD's advice is to "ask your child's doctor today."[1]
How does newborn hearing screening work in Arizona?
Arizona law requires that when a birth is reported, the attending physician or person reporting the birth "shall order or cause to be ordered tests for certain congenital disorders, including hearing disorders," with results reported to the Arizona Department of Health Services.[5] The same statute directs the department to run a newborn screening program, and says that if tests indicate a newborn or infant may have a hearing loss, the program "shall provide follow-up services to encourage the child's family to access evaluation services, specialty care and early intervention services."[5]
For children under 3, Arizona's early intervention program is AzEIP. Our parent's guide to AzEIP explains how referrals and eligibility work.
Can ear infections affect my child's speech?
They can, at least temporarily. The AAP explains that "Most children experience mild hearing loss when fluid builds up in the middle ear from congestion, colds, or ear infections," and that this hearing loss "is usually only temporary."[2] In some children, though, "perhaps 1 in 10," fluid stays in the middle ear after an infection, and "Because of this, they sometimes have delays in talking."[2]
The AAP adds that antihistamines, decongestants, and antibiotics "are not effective in clearing up middle ear fluid," and that a doctor may recheck hearing in a few months or refer to an ear, nose, and throat specialist if fluid and hearing problems persist.[2] Those decisions belong with your child's doctor. If your child has had frequent ear infections and you've noticed speech concerns, it's worth mentioning both together.
What signs might point to a hearing problem?
The AAP lists signs that are worth a call to your pediatrician.[2, 3] They include a child who:
- Doesn't startle at loud noises by 1 month, or turn toward the source of a sound by 3 to 4 months
- Doesn't notice you until they see you
- Doesn't say single words such as "dada" or "mama" by 12 to 15 months
- Doesn't say 3 or more words besides "mama" or "dada" by 18 months
- Doesn't put 2 to 3 words together by 30 months
- Has speech that isn't understandable 50% of the time by two and a half years
- Doesn't always respond when called, especially from another room
- Seems to hear some sounds but not others
- Wants music or TV volume louder than other family members
One point stands out: the AAP notes that not responding when called "is usually mistaken for inattention or resistance, but could be the result of a partial hearing loss."[2] The AAP also says that if you or your pediatrician suspect hearing impairment at any age, you should "insist that a formal hearing evaluation be performed promptly."[2]
Several of these signs overlap with the milestones in our post on late talkers. A late start to talking can have many causes, which is one reason hearing is usually checked when there's a speech or language concern.
Where does a speech-language pathologist fit in?
An audiologist tests hearing; an SLP looks at speech, language, and communication. The NIDCD notes that families of children with hearing loss "may also be referred to a speech-language pathologist or a teacher who is experienced in working with children with hearing loss."[1] The NIDCD also describes several communication approaches families may consider, from listening and spoken language to American Sign Language, and advises that "regardless of the communication mode you choose, you should engage with your child and begin intervention as soon as possible."[1] The NIDCD states that "Research shows that children with hearing loss who get help early develop better language skills than those who don't," though every child's path is different.[1]
The AAP encourages a team approach, bringing a pediatrician together with an audiologist and a pediatric ear specialist.[3] If your child's hearing has been checked and you still have questions about speech or language, a speech-language evaluation can look more closely at how they understand and use language. You can also read more about our speech therapy services.
The bottom line
Children learn to talk largely by listening, so hearing is one of the first things to consider when speech or language seems behind.[1, 2] A passed newborn screening is reassuring, but hearing can change, and the AAP recommends checks throughout childhood.[1, 3] If your baby didn't pass a screening, follow up promptly with a pediatric audiologist, and if you notice any of the signs above at any age, talk with your pediatrician about a hearing evaluation.[1, 2, 4] An SLP can then help you sort out what's going on with speech and language.
Sources
- National Institute on Deafness and Other Communication Disorders (2024). Your Baby's Hearing Screening and Next Steps. NIDCD, National Institutes of Health.
- American Academy of Pediatrics (2026). Hearing Loss in Children. HealthyChildren.org.
- American Academy of Pediatrics (2023). Hearing Screening for Newborns, Children & Adolescents: AAP Policy Explained. HealthyChildren.org.
- Centers for Disease Control and Prevention (2025). EHDI 1-3-6 Benchmarks. CDC, Hearing Loss in Children.
- Arizona State Legislature (n.d.). 36-694 - Report of blood tests; newborn screening program; committee; fee; definitions. Arizona Revised Statutes.
Articles from Speech Me Therapy, a pediatric speech-language therapy practice in North Phoenix serving Scottsdale, Paradise Valley, and families across Arizona by telehealth. Our posts summarize published guidance from professional and public health organizations; sources are listed at the end of every article.