How to Spot Signs of Hearing and Vision Problems in Babies and Toddlers

If your baby or toddler is having trouble hearing or seeing, early intervention is key to keeping their development on track. However, little ones can’t express themselves as well as older children can, so how can you tell if their hearing or eyesight is off?

The good news is that the pressure is not all on you. Routine screenings at the hospital and doctor’s office are designed to ensure your child can see and hear as expected. At home, you can be aware of warning signs of potential vision or hearing problems.

UNC Health pediatrician Edward Pickens, MD, shares how providers check for hearing and vision problems, as well as what indicators parents can watch for at home.

How Doctors Monitor Hearing in Babies and Toddlers

Even if your baby seems to respond to sounds, it is still possible that they can have some degree of hearing loss. That’s why doctors want to monitor your child’s hearing from the start of life.

Most states, including North Carolina, require providers to perform a newborn hearing screening at the hospital. The screening is painless and only takes a few minutes. Electrodes are placed on the baby’s head to measure the brain’s response to sounds that are played through soft earphones. It is often done while the newborn is asleep.

If your baby was not born in a hospital, the American Academy of Pediatrics recommends the baby’s hearing be checked in the first month of life.

One in 10 babies don’t pass the screening, but that doesn’t necessarily mean they have a hearing abnormality, Dr. Pickens says. Often, fluid or vernix (a protective skin coating on newborns) can get trapped in the ear. If that happens, your provider will drain the fluid and repeat the test. If it’s failed again, your baby will be referred to an audiologist who has experience treating babies.

One to 3 in 1,000 babies have some degree of hearing loss that can be identified at birth.

“The newborn hearing screen is a really crucial first step in identifying any hearing problems,” Dr. Pickens says. “Beyond that, you’ll have to wait several months before you start to see any indicators.”

Your child’s pediatrician will continue to monitor their hearing by assessing their language development starting when they are 9 months old. They will also perform hearing testing throughout their childhood, starting when they are between 3 and 4 years old. Hearing loss can develop later in childhood, but it is rare.

Watch for Hearing Problems at Home

Hearing problems in babies can appear in the first few months of life, but warning signs can be difficult to identify before the child is about 10 months old, Dr. Pickens says.

Contact your pediatrician if your child is 10 months old and doesn’t:

  • Respond or startle when hearing loud noises.
  • Seem to enjoy when you read books to them.
  • Hear you coming.
  • Make consonant sounds.

“If your baby is only making vowel sounds when they are 9 or 10 months old, it’s a good idea to talk with your pediatrician about getting a formal test with an audiologist,” Dr. Pickens says.

Your child’s pediatrician can connect you with an audiologist who has experience working with babies.

How Doctors Look for Vision Problems in Babies and Toddlers

Unlike the newborn hearing screening, providers can’t formally screen newborns for vision issues until they are between 6 months to 1 year old.

Many health organizations, including UNC Health, use a handheld vision screener to check for healthy eye development in 1-year-olds. During the screen, the provider uses the camera inside the device to capture pictures of the child’s eyes. All the child has to do is sit still for a few seconds. The device then assesses the images for eye alignment and shape to detect signs of conditions such as astigmatisms (blurring of vision due to curvature of the eyeball), nearsightedness (difficulty seeing objects that are far away) and glaucoma (damage of the optic nerve in the back of your eye). Importantly, it also checks for issues that could lead to amblyopia, better known as “lazy eye.”

“Amblyopia occurs when one eye is not as strong as the other eye, and the mismatch can cause the child’s developing brain to ignore the weaker eye. Even if the weaker eye is not blind, the child can lose vision because the brain has trouble processing the discrepancy,” Dr. Pickens says.

Amblyopia is the most common cause of vision loss in children but can be treatable when caught early.  Indicators of the condition are commonly missed during more traditional eye screenings, such as when the provider has a baby follow an object with their eyes or measures their pupil’s response to light.

If the vision screener detects an abnormality, your child will be referred to a pediatric ophthalmologist or optometrist for further testing.

Dr. Pickens says the vision screening device is very accurate. Of the patients who have been referred for further testing, more than 95 percent have been diagnosed with an eyesight condition, he says.

The American Academy of Ophthalmology recommends that your child’s vision be formally checked again when they are between 3 and 5 years old.

Watch for Vision Problems at Home

Babies are born with mostly blurry vision that starts to clear up when they’re 1 or 2 months old. By that age, your baby should be:

  • Making eye contact with you.
  • Developing a “social smile” (smiling intentionally at you).

By 3 months old, they should be able to track an object that’s moving across their field of vision.

If those milestones are not occurring, let your provider know.

After your baby is 3 months old, the American Academy of Pediatrics recommends you reach out to your provider if you notice any of the following symptoms:

  • Eyes that are misaligned (look crossed, turn out or don’t focus together).
  • White or grayish-white color in the pupil.
  • Eyes that flutter quickly from side to side or up and down.
  • Eye pain, itchiness or discomfort reported by your child.
  • Redness in either eye that doesn’t go away in a few days.
  • Pus or crust in either eye.
  • Eyes that are always watery.
  • Drooping eyelids.
  • Eyes that often appear overly sensitive to light.

If you notice yellow goop or crust in one or both of your baby or toddler’s eyes, it could be a nasolacrimal duct obstruction, or a clogged tear duct. A blocked duct can persist for several months, but it usually resolves as the baby grows, Dr. Pickens says. You can massage the inside corner of the eye to help bring up plugs and use a warm washcloth to wipe away the goop.

Another possible culprit for eye gunk? Conjunctivitis, a mild eye infection better known as pinkeye. It is extremely contagious and can cause redness and itching. Conjunctivitis can go away on its own and is also easily treatable.

Reach out to your provider for help whenever you have questions about your child’s hearing, vision or overall health.

Concerned about your child’s hearing or vision? Talk to your child’s pediatrician. Need a pediatrician? Find one near you.