Worried about your baby’s hearing? get the insider scoop from a pediatric audiologist

October 14, 2022

I'm katie, OTD, OTR/L, NTMTC, CNT & founder of blooming littles

Guess who has the greatest influence on a baby's NICU stay? It's YOU! Let's get you the tools, info, and resources needed to create positive NICU experiences, one interaction at a time.

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As a NICU mama (or dad) finding ways to connect with your newborn is a critical part of yours and your baby’s experience. The NICU environment can make this challenging and sometimes even intimidating. You may be wondering how you can connect with your baby if in some cases you aren’t even able to hold them? Or what to do if your baby has hearing loss? This is where your baby’s hearing can play a critical role in their connection and development.

Auditory (Hearing) Development

For most babies, by 20 weeks gestation the structural parts of their auditory (hearing) system are fully developed. The auditory system consists of three major components. The outer ear, middle ear, and inner ear. 

The outer ear includes your pinna (the visible part of the ear) and ear canal. The middle ear includes your eardrum and 3 tiny bones that vibrate in response to sound. The inner ear includes your cochlea, which is known as your hearing organ, and your hearing nerve. All three of these structures must work together in order to properly send sounds to your baby’s brain.

Image from Baby Centre UK

From 20 weeks gestation your baby’s ears will begin sending signals to their brain, and they will start putting meaningful connections to sound. 

They will begin to recognize their mother’s voice, heartbeat, or even start moving to music. This is known as auditory (hearing) development, and this continues well into childhood until your little one eventually learns how to talk.

But what if your baby is born early? How can you help support the development of their hearing?

There have been several studies completed on how noise levels in the NICU environment can create added stress for premature babies. Their brains are not developed enough to know how to block out all of the alarms, conversations, and abrupt noises that occur in the NICU. 

Many hospitals have made changes to the environment to try and minimize noise levels such as acoustic paneling, individual rooms, and even noise level meters to measure sound on the baby’s crib. Despite all of the tools and efforts, the environment can still remain loud. 

Interested in learning some other NICU-specific sensory strategies? Check out this post all about supporting your baby’s sensory systems (like vision, tough, and hearing!)

Do not be afraid to advocate for your baby by asking the hospital staff to take conversations away from the bedside or to silence their cell phones and alarms as quickly as they are able. 

Creating a quiet environment is the best thing you can do for your baby while they are growing and healing.

Connecting with your baby through meaningful auditory experiences

Once you have maintained a calm and quiet environment that minimizes unnecessary or disruptive noise, it’s important to slowly incorporate meaningful sound to connect with your baby and help their hearing development. 

Meaningful sound can include talking to your baby, reading to them, singing, or even playing music.

The SENSE (Supporting and Enhancing NICU Sensory Experiences) Program was created by developmental researchers in order to better engage NICU families in providing developmentally appropriate, positive sensory exposures to optimize outcomes for their infant(s).

Here are some suggestions to support your premature baby’s hearing development as they grow based on current developmental research. 

24 weeks gestation

  • Engage in quiet conversations near the bedside during meaningful moments such as diaper changes.
  • Maintain a quiet environment, ideally under 55 dB at all times.

32 weeks gestation

  • Give at least 1 ½ hours of positive sound each day (can be broken up into 30 minute periods several times per day). Positive sounds can include playing soft music, reading, singing, and/or talking to your baby.
  • Maintain a quiet environment, ideally under 55 dB at all times.

Minimizing excessive background noise and slowly incorporating meaningful auditory input (like your quiet voice!) will help build the positive connections in your baby’s brain for learning new sounds.

What to do if you’re worried about your baby’s hearing

Worrying about your baby’s hearing and development is completely valid, but it can also be hard to know what to look for when they are so little. 

Want to know how to prepare for your baby’s follow-up test if they did not pass their newborn hearing screening? Download this FREE guide to your child’s first hearing assessment. 

One thing that is important to understand are the risk factors for hearing loss in infants. Many newborns who have spent a significant amount of time in the NICU are at high risk for being born with hearing loss or developing hearing loss later on. Below are the common risk factors that can be associated with hearing loss.

Risk Factors for Hearing Loss

  • A family history of childhood hearing loss
  • Complications at birth that may have required the following:
    • A Neonatal intensive care unit (NICU) stay of more than 5 days
    • Medications that can cause hearing loss such as gentamicin or amikacin used for more than 5 days
    • Extreme jaundice that may have required an exchange transfusion
    • The need for assisted ventilation or extracorporeal membrane oxygenation (ECMO)
  • Infections during pregnancy such as congenital cytomegalovirus (cCMV) or zika
  • Infections after birth such as meningitis
  • Genetic syndromes associated with hearing loss
  • Head injury including skull fracture

Before your baby goes home from the hospital, they will receive a newborn hearing screening.

If your baby passes the hearing screening but has any of the above risk factors it is important to monitor their hearing throughout childhood. 

For most infants with any of the above risk factors it is recommended that they have their hearing tested again around 9 months of age. 

In the meantime, be on the lookout for any signs or symptoms that they may have had a change in their hearing. If you’re concerned that your little one has developed hearing loss, talk to your pediatrician or schedule an appointment with your local audiologist as soon as any concerns arise.

If your baby did not pass their newborn hearing screening or was recently diagnosed with hearing loss, just know that those connections are not lost. 

Continue to talk, sing, read, cuddle, and love your baby during this time. An audiologist will soon become a valuable member of your child’s care team and work with you to help support their hearing development. 

If you’re looking for additional support while you navigate through your child’s hearing journey, I would love to be a resource for you. You can reach out at any time at hello@kelseykerkhoveaud.com or schedule a phone call, so I can learn more about you and your baby’s hearing journey.

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