Hearing Loss and Speech: Why a Hearing Test Comes First
Children learn to talk by hearing speech, so hearing loss can delay speech and change which sounds a child says clearly — quiet sounds like s, sh, f, t, and k may be left out. That is why speech evaluations check hearing early. With early help, a child with hearing loss may speak or sign as well as hearing peers.
Why hearing comes first
Children learn speech by listening to it. ASHA explains that hearing sounds and words helps children learn to talk and understand; when a child has hearing loss, they miss out on some of those sounds, which can affect how they talk, read, learn, and interact with others.1
That is why hearing is checked early in any speech assessment. ASHA’s consumer page on speech sound disorders says hearing should be checked to rule out hearing loss, and lists hearing loss from ear infections or other causes among factors that can contribute to speech sound disorders. Its clinical guidance lists referral to an audiologist, if hearing loss is suspected, as one possible outcome of a speech screening.2,3
Which sounds suffer
Quiet, high-pitched sounds carry less sound energy and are easier to miss. ASHA notes that, depending on the type of hearing loss, children may leave out quieter sounds like s, sh, f, t, or k.1
A clue to watch for
If your child consistently misses the same quiet sounds — S at the ends of words, F, SH — and also sometimes seems not to hear you, ask for a hearing test before assuming it is only a speech issue.
Signs that point to hearing
- A baby who does not react to loud noises or other sounds.
- A child who does not turn or look when you call their name.
- Delays in speaking or understanding language as a child grows.
- Trouble hearing or responding to quiet sounds.
- Frequent ear infections, or fluid behind the eardrum.
The first three signs come from ASHA’s list of early signs of hearing loss; NIDCD lists trouble hearing or responding to quiet sounds among signs of an ear infection, and notes that five out of six children have at least one ear infection by their third birthday.1,4
Hearing also shows up in the research on persistent speech problems: in a UK population cohort, hearing impairment at age 7 and tympanostomy tube insertion were among the predictors of a persistent speech sound disorder at 8.5
What to do if you are worried
- 1Ask your pediatrician for a referral to an audiologist for a hearing test.
- 2If your child is under 3, contact your early intervention program; ASHA notes families do not have to wait for a professional’s referral.
- 3If hearing is normal, a speech-language pathologist can assess speech and language.
| Who | What they do |
|---|---|
| Audiologist | Tests your child’s hearing — ASHA calls this the most important step if you suspect hearing loss — and discusses treatment, which may include hearing aids, medical treatment, and/or speech and language therapy |
| Speech-language pathologist | Assesses speech and language, and refers to an audiologist if hearing loss is suspected |
| Early intervention program (under 3) | Evaluates development; families can contact it directly without a referral |
| Pediatrician | A first place to raise concerns about speech, language, or hearing |
ASHA says children with hearing loss can do better in school if they get help early, and that with early help a child may speak or use sign language as well as children who hear. The AAP encourages parents to raise any speech concerns with their pediatrician.1,6,7
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About SpeechStep
SpeechStep is speech practice, not a hearing test. If you have any concern about your child’s hearing, see an audiologist first.
Frequently asked questions
Can hearing loss cause speech delay?＋
Yes. ASHA explains that hearing sounds and words is how children learn to talk and understand, and that a child with hearing loss misses some of those sounds, which can affect how they talk, read, learn, and interact. ASHA lists hearing loss — from ear infections or other causes — among factors that can contribute to speech sound disorders.
Which speech sounds are affected by hearing loss?＋
Quieter sounds are often affected first. ASHA notes that, depending on the type of hearing loss, children may leave out quieter sounds like s, sh, f, t, or k.
Should my child have a hearing test for a speech delay?＋
Yes. ASHA’s consumer guidance on speech sound disorders says hearing should be checked to rule out hearing loss, and its clinical guidance lists referral to an audiologist, if hearing loss is suspected, as one possible outcome of a speech screening.
What are early signs of hearing loss?＋
ASHA’s early signs include a baby not reacting to loud noises or other sounds, a child not turning or looking when you call their name, and struggling to follow simple instructions; as a child grows you may also notice delays in speaking or understanding language. NIDCD lists trouble hearing or responding to quiet sounds among the signs of an ear infection.
Put this into practice today
Try the free speech milestone checker, or start daily AI speech practice — every child takes one SpeechStep at a time.
References
7 sources from authoritative bodies. Last reviewed October 2026.
- 1.ASHAEffects of Hearing Loss on Development — Consumer page.
- 2.ASHASpeech Sound Disorders — Consumer page.
- 3.ASHASpeech Sound Disorders: Articulation and Phonology — Practice Portal page.
- 4.NIDCDEar Infections in Children — Fact sheet.
- 5.Peer-reviewedWren et al. — Prevalence and Predictors of Persistent Speech Sound Disorder at Eight Years Old — Population cohort study (JSLHR), 2016.
- 6.ASHAEarly Intervention — Consumer page.
- 7.AAPHow to Raise Concerns about a Child’s Speech and Language Development — Parent guidance (HealthyChildren.org).