Developmental Milestones and "Red Flags" in Children's Listening

The lists provided describe developmental milestones marking children with normal ear functioning and how to identify a child who may have hearing loss.

Infancy to One Year

• Startles to loud or strange noises.
• Orients head in direction of sound.
• Responds differentially to different types of music (e.g., lullaby vs. lively tune).
• Vocalizes in response to music and other sounds.
• Looks at speaker.
• Begins to understand words accompanied by appropriate gestures (e.g., up, hi, more).

Developmental "Red Flags" for Infants

• The infant does not react to sounds by blinking, widening the eyes, startling, or crying.
• At 4 months, the baby does not orient toward a sound outside her or his view.
• At 7 months, the baby does not immediately turn toward the sound of a voice across the room.
• At 9 months, the baby does not babble or stops babbling.

One to Two Years

• Recognizes own name.
• Associates words with actions.
• Understands simple instructions that include familiar key words (e.g., "Bring me your book," "You can ride in the [grocery] cart.").
• Learns simple games like Peek-a-Boo and Pat-a-Cake.
• Understands no, bye-bye.
• Points to body parts (e.g., eyes, nose, mouth).
• Listens to and attempts to join in nursery rhymes and songs.
• Listens to books for babies that label common objects (e.g., Pat the Bunny).
• Responds correctly to basic questions (e.g., "Where is your blanket?")
• Attempts to imitate words even when not fully understanding them, often drops or confuses syllables or letters (e.g., "kepical" for "skeptical").
• Distinguishes pronouns (e.g., her, him, we).
• Understands there is a category of things called colors and may know an example or two, but does not necessarily match colors with words accurately (e.g., uses the word red in every situation where a color is called for).

Developmental "Red Flags" for Toddlers

• At 12 months, the baby does not respond to simple words like no and bye-bye.
• At 18 months, the child's speech does not have a natural quality to it. It may be particularly loud, soft, nasal, high pitched, or monotone. It may lack the prosody (musical quality) of speech.
• The toddler's speech does not include a variety of vowels and consonants. People outside the immediate family find the child's language incomprehensible.
• The child is not yet using telegraphic speech, putting together two words (e.g., "Mommy work," "more cheese").
• The child has difficulty with simple directions. Children with moderate hearing losses often mistake one word for another (e.g., returns with book after an adult says "Go and get your ball.").
• At 2, the child often turns up the sound on the TV or radio.