If your toddler isn't speaking well or doesn't have the number or words he or she should have by a certain age, talk with your pediatrician about a referral to an audiologist. Many children with speech delays have perfectly fine hearing, but hearing loss is one of the first things you'll want to rule out since speech is such an integral part of how you teach your child to communicate. After all, if he or she can't hear you clearly, how can your little one imitate your speech?

An audiologist can also test children for hearing loss due to other concerns, such as reacting abnormally to common noises, not responding when called or having physical problems with the ears, like frequent ear infections.

How Does an Audiologist Evaluate a Toddler?

Pediatric audiologists are very familiar with testing young children who don't always want to cooperate. You'll be able to be with your child and hold him or her on your lap through most or all of the testing. These are the main testing methods audiologists use when evaluating a toddler or older children who are speech or developmentally delayed.

  • Tympanometry and acoustic reflexes: This test checks for issues with your child's ear drum and middle ear. The audiologist will place small earbuds in your child's ears (while you hold him or her), and a machine will measure how your child's middle ear and eardrum respond to sound at different levels of air pressure.
  • Visual Reinforcement Audiometry (VRA): For this test, you'll hold your child on your lap in a soundproof booth. The audiologist will be outside the room. There will be a speaker on each side of the room in front of your child, and the audiologist will play sounds at different volumes through the speakers. When your child turns his or her head toward the sound, there will be a visual reward, such as a lighted toy moving around or a television screen with a short clip of a funny cartoon.
  • Conditioned Play Audiometry (CPA): For older toddlers who are 2 1/2 or older, the audiologist may test your child through playing with toys in a soundproof booth. This helps the audiologist test whether your child can hear and understand simple commands in a way that's fun for the child.

What Do I Do With the Results?

If the audiologist determines that there is cause for concern regarding your child's hearing, he or she will refer you to an ear, nose and throat specialist (ENT). The ENT doctor will perform a physical exam of your child's ears to help you determine the best treatment plan. The doctor might recommend medical treatment to resolve the issue, like surgery to drain fluid in the ears.

If your child has hearing loss and there's not a way to directly address the problem with medical treatment, the ENT doctor will discuss your options for assistive devices to help your child hear better, such as hearing aids or a cochlear implant. You'll also have a diagnosis so you can start speech therapy (if your child is not in therapy currently) to help your toddler learn to communicate better.