Child hearing and speech: warning signs

You can tell whether a child hears well and whether their speech is on track by watching what they do at each age. This guide gives you hearing and speech signs by age, what to do if you suspect your child cannot hear well, and how to help at home. Finding hearing loss early improves language development. It does not replace an assessment by a doctor.

What is this guide for?

To give you a reference for what most children do at each age and which signs should make you seek advice. It cannot diagnose: if you have a doubt, see us even if your child seems to be within the expected range.

Studies show that the earlier hearing loss is identified and support begins, the better the language outcomes. That is why there is no need to wait and see whether they talk.

Before you start

• Children do not all develop at the same pace. These ages show when most children manage something.
• If your child was born prematurely, was in intensive care, has a family history of deafness, had a serious infection (meningitis, infection in pregnancy) or frequent ear infections, watch more closely.
• A normal hearing screen at birth does not rule out hearing loss that appears later.
• Observe your child calmly and without background noise.

How to do it

1. Watch what your child does at each age

Age	What they usually do
0-3 months	Startles at loud noises. Settles to your voice. Looks at you when you talk
4-6 months	Turns their head towards sounds and voices. Makes sounds (“aah”, “ooh”) and responds when you talk
6-9 months	Babbles (“ba-ba”, “ma-ma”). Responds to their name
12 months	Says “mama” or “dada” meaningfully. Understands “no”. Waves bye-bye
15-18 months	Says several words (3 or more by 18 months). Follows simple instructions without gestures
24 months	Puts two words together (“more water”). Points to body parts and pictures when you name them
30 months	Says about 50 words and combines words
3 years	Holds a simple conversation. Asks questions. People outside the family understand them most of the time

2. Warning signs

See us if your child:

• 0-6 months: does not startle at loud noises, does not settle to your voice, does not turn towards sounds or babble.
• 6-12 months: does not respond to their name, does not babble with syllables, does not understand “no” or use gestures (pointing, waving).
• 12-18 months: says no meaningful word or does not use gestures or sounds to ask for things.
• 18-24 months: says fewer than 3 words, does not put two words together or follow simple instructions.
• 2-3 years: does not regularly use 2-3 word phrases or follow two-step instructions.
• Over 3 years: hardly anyone outside the family understands them, they do not use correct sentences or hold a simple conversation.
• At any age: loses skills they already had, turns the TV up very loud or often says “what?”

3. If you suspect they cannot hear well

1. Do not wait. Book an appointment with your paediatrician or an ENT specialist as soon as possible.
2. Hearing tests suited to the child’s age are done. Some are done even in sleeping babies and do not hurt.
3. We may check for fluid in the ear (glue ear), which is a common and treatable cause of poorer hearing. Read middle ear infection.
4. If hearing loss is confirmed, treatment (hearing aids, implants or other options) and speech and language therapy support start as early as possible.

4. How to encourage hearing and speech at home

1. Talk face to face, close up and in a natural tone. Let them see your mouth.
2. Name what you see and do: “look, the dog”, “now we put on our coat”.
3. Read stories and sing every day.
4. Take turns: when they babble or say something, respond and wait for their turn.
5. Cut background noise: switch off the TV or radio when you talk to them.
6. Limit screens: not recommended before 2 years and, from 2 to 4, no more than an hour a day, and less is better. Screens do not make a child speak.
7. If they use hearing aids, make sure they wear them as long as we advise.

Routine

Routine	What to do
How often	Watch your child at every well-child check. Encourage language every day
For how long	While they grow, especially in the first 3 years
When to seek advice	As soon as you notice a warning sign, without waiting for the next check

Always follow the routine your doctor gave you, which may be different.

Common mistakes

• “They will talk in time”: waiting months without seeking advice.
• Assuming they hear well because they turn to loud noises, to vibrations, or when they see you.
• Relying only on the newborn screening test.
• Letting screens do the talking instead of you.
• Shouting so that they can hear you.
• Putting everything down to “he is shy” or “she is bilingual” without ruling out a hearing problem.

What is normal and when to seek advice

It is normal for:

• Every child to have their own pace: some talk earlier, some later.
• Words to get mixed up, and difficult sounds to be mispronounced until 4-5 years.
• Hearing to be poorer during a cold.

Seek advice soon if:

• Your child has any of the warning signs for their age.
• You notice they hear less well after an ear infection, or they have frequent ear infections.
• They lose skills they already had.

Go to A&E if they suddenly stop hearing, after a blow to the head or with a high fever, stiff neck, repeated vomiting or marked drowsiness.

Frequently asked questions

They passed the newborn screening. Can I relax? Largely, but not entirely: some hearing loss appears later, from infections or other causes. Watch your child and seek advice if you have any doubts.

My child hears but does not talk. Is it a hearing problem? Not always, but it needs to be ruled out. A child who hears but speaks little may need a language assessment.

Do ear infections affect hearing? They can. Fluid behind the eardrum makes hearing poorer, sometimes for months. That is why we monitor it.

At what age can a hearing test be done? At any age, even in newborns. Tests are adapted to the child’s age.

Do screens delay speech? It is recommended to limit them because they do not help children talk: language is learnt by conversation.

Do I need to repeat the screening? If there are risk factors or doubts, the doctor may arrange hearing checks throughout childhood.

References

1. Zubler JM, Wiggins LD, Macias MM, et al. Evidence-informed milestones for developmental surveillance tools. Pediatrics. 2022;149(3):e2021052138.
2. Yoshinaga-Itano C, Manchaiah V, Hunnicutt C. Outcomes of universal newborn screening programs: systematic review. J Clin Med. 2021;10(13):2784.
3. Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline: otitis media with effusion (update). Otolaryngol Head Neck Surg. 2016;154(1 Suppl):S1-S41.
4. World Health Organization. Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age. Geneva: WHO; 2019.

For general information only. It does not replace a medical consultation and cannot be used for diagnosis. In an emergency in Spain, call 112.

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