A Baby Not Responding to Sound

When to get help

This is not an emergency topic, but it is a do-not-wait one, because early identification changes outcomes for language. Ask for a hearing test — through your health visitor, GP or local audiology department in the UK, your public health nurse or GP in Ireland, your paediatrician in the US or Canada, your GP or child health nurse in Australia and New Zealand — if:

• Your baby does not startle or blink at a sudden loud noise in the first months.
• By around four months, your baby does not turn their head or eyes towards a sound or your voice.
• By around seven to nine months, your baby does not turn to their name, does not look for a sound out of sight, or has not started babbling.
• Babbling started and then stopped, or your baby's sounds have become fewer.
• Your baby responds to you when they can see you but not when they cannot.
• You simply have a feeling that your baby is not hearing. Parental concern is one of the strongest reasons for referral and does not need to be justified.

See a doctor promptly if your baby has discharge from an ear, appears in pain, or has hearing that seems to fluctuate, because fluid behind the eardrum is a common and treatable cause.

What the newborn screen does

The NHS newborn hearing screen is usually offered before discharge from hospital, or in the first weeks by a healthcare professional or health visitor. Ideally it is done in the first four to five weeks and can be done up to three months of age.

The first test is the automated otoacoustic emission test, which takes a few minutes: a soft-tipped earpiece plays gentle clicking sounds and the response from the ear is recorded. If a clear response is not obtained, that is common and does not mean hearing loss — a baby may have been unsettled, the room may have been noisy, or there may be fluid in the ear. A second test is offered, which may be the automated auditory brainstem response test, with three small sensors on the head and neck and soft headphones, taking five to fifteen minutes. Neither test is uncomfortable.

What the newborn screen does not do

This is the part that matters most on this page. The NHS says plainly that a clear response in both ears makes permanent hearing loss unlikely, but that the newborn hearing test does not pick up all types of permanent hearing loss, and that children can also develop permanent hearing loss later on. That is why the personal child health record contains a checklist for checking hearing as your child grows, and why a passed newborn screen is not a reason to dismiss a later concern.

If you declined the screen, you should have been given the same checklists, and you can ask for a test at any point.

What to expect by age

In the first weeks, expect a startle to a sudden loud noise, and stilling or a change in sucking when you speak. By around three to four months, expect your baby to turn towards a voice or a sound, and to be soothed by a familiar voice. By around six months, expect turning to quieter sounds out of sight and the beginnings of babbling.

By around nine months, expect your baby to look around for a sound, to respond to their own name, and to babble with a range of consonants. By around twelve months, expect a response to simple requests and recognisable attempts at words.

Treat these as broad markers rather than deadlines. A baby who is meeting most of them and missing one is usually fine; a baby who is consistently behind across several, or who has lost a skill they had, is the one to have tested.

Testing your own suspicion at home

Do it out of sight and without vibration or air movement, because babies are extremely good at noticing both. Stand behind or to the side, out of your baby's field of view, and make a sound at a normal conversational level rather than a bang. Watch for stilling, a change in breathing, eye widening, or a turn.

Do not slam doors or clap loudly next to a baby's head as a test. A startle to a very loud noise can be a response to vibration rather than sound, and it will falsely reassure you. If you have doubts after a couple of attempts, ask for a proper test rather than repeating the experiment.

Glue ear and the fluctuating kind

Not all hearing loss is permanent. Fluid behind the eardrum after colds is very common in babies and young children and causes a temporary, often fluctuating reduction in hearing. It frequently follows recurrent ear infections, and it is one of the reasons a hearing test may be repeated after a few months rather than acted on immediately.

Signs include turning the television up, not responding when in a noisy room, being unusually irritable, and speech that is developing slowly. It often resolves on its own, but it is worth identifying because it affects language learning while it is present.

Why acting early matters

The NHS explains that finding hearing loss early gives babies a better chance of developing language, speech and communication skills, and helps them make the most of relationships with family and carers from an early age. The American Academy of Pediatrics makes the same case for screening and for follow-up when concerns arise.

Practically, that means a referral is worth asking for on the strength of a suspicion. Audiology appointments for babies are unhurried, painless and often play-based, and being told your baby hears perfectly well is a good outcome, not a wasted appointment.