My child isn't talking yet. Could it be hearing?

“He understands everything, he just doesn’t talk yet.” It is the sentence we hear most from worried parents, and it usually arrives with well-meant advice: boys talk later, his brother was late too, just give it time.

Sometimes waiting is the right call. But there is one check that should not wait.

Why hearing comes first

Speech delay has several possible causes, and hearing loss is not the most frequent one. Even so, it is the first to be ruled out, for three practical reasons:

• It is the simplest cause to confirm or exclude, with quick, painless tests.
• It is the one that most changes management when present.
• And it is the only one where waiting has a cost.

Children learn to speak from what they hear. If sound arrives incomplete, speech is built on an incomplete foundation, and no amount of effort at home compensates for that until hearing has been assessed.

What to watch for at home

Some signs deserve attention at any age:

• No startle response to sudden loud noises.
• No head turn towards a sound source from around 6 months.
• Little or no speech around age 2, when two-word combinations are expected.
• Hears better face to face and “doesn’t listen” from behind.
• Turns the television up louder than the rest of the household needs.
• Persistently swaps similar sounds when speaking.

A single sign settles nothing. The pattern, however, justifies a consultation.

The trap of recurrent ear infections

One type of hearing loss goes unnoticed precisely because it is temporary and silent: fluid trapped behind the eardrum after repeated ear infections. There is no pain, no fever, no complaint, and the child still hears as if underwater.

At an age when every month counts for vocabulary, successive months of muffled hearing leave a mark on speech. That is why, in a child with frequent ear infections and late speech, the two complaints are often the same story.

Which tests answer the question

The assessment does not depend on the child answering or cooperating:

• Tympanometry shows whether there is fluid behind the eardrum.
• Paediatric audiometry is adapted into play, with the child responding to sound.
• ABR measures the auditory nerve response with no cooperation at all — it is done while the baby sleeps.
• Auditory processing assessment comes in when hearing is normal but the child hears without understanding.

What to do with the answer

If hearing is intact, the investigation continues along other paths, usually with speech therapy and developmental follow-up, and the family moves on with one less open question — which is exactly what the test is for.

If there is hearing loss, the path depends on its type and degree, and that is where the real conversation begins. It is all set out on the page about childhood hearing loss.

Either way, the consultation is worth it. Ruling out is as useful as finding.