When a child isn’t talking as expected, families often assume the answer is speech therapy. Sometimes it is. But there’s a critical step that should happen early in the process:
Make sure hearing has been considered.
NIDCD notes that a hearing test is often included in the evaluation because hearing problems can affect speech and language development.
ASHA also emphasizes that hearing is important for speech and language development and learning.
This article explains how hearing affects communication development, what signs to watch for, and what next steps typically look like.
Hearing affects more than volume
Many people think hearing issues mean a child can’t hear at all. In reality, hearing concerns can look like:
- mild hearing loss
- hearing loss only in certain frequencies
- fluctuating hearing due to fluid or recurring ear infections
- difficulty hearing speech in noisy environments
A child can seem “fine” at home and still miss important sound information in daycare, school, or busy environments.
How children learn speech and language through hearing
Children learn spoken language by:
- hearing speech sounds clearly and repeatedly
- noticing patterns in words and sentences
- hearing speech in different contexts and voices
- linking words to meaning through everyday routines
ASHA summarizes this clearly: hearing sounds and words helps children learn to talk and understand.
If access to sound is inconsistent or reduced, language learning becomes harder—not because a child isn’t smart, but because the input is compromised.
What hearing-related speech and language delays can look like
Speech clarity concerns
If a child doesn’t consistently hear certain sounds, they may:
- omit quiet consonants
- substitute sounds
- have reduced intelligibility
- show slower speech sound development
Language comprehension concerns
If a child misses words and sentence patterns repeatedly, they may:
- follow directions less reliably
- learn new words more slowly
- struggle with grammar development
- rely more heavily on context and routines
NIDCD explains that hearing problems can affect speech and language development and that hearing tests are often included in evaluation for that reason.
Signs it’s worth checking hearing
Bring hearing up with your child’s pediatrician if you notice:
- inconsistent response to name or everyday sounds
- difficulty following directions compared with peers
- “selective hearing” patterns that are inconsistent across environments
- delayed speech milestones
- unclear speech that doesn’t steadily improve
- watching mouths closely or relying heavily on visual cues
- frequent ear infections or chronic congestion
ASHA’s guidance is straightforward: the most important thing you can do is have your child’s hearing tested if you suspect hearing issues.
Why hearing issues are sometimes missed
Kids compensate
Children are excellent at using context:
- routines
- facial expressions
- gestures
- environmental cues
That compensation can make hearing issues look like “stubbornness,” attention issues, or behavior.
Hearing can fluctuate
Some children have periods of better and worse hearing. This can lead to confusing patterns where skills seem to progress, then stall.
What comes first: audiology or speech-language evaluation?
Often, the best answer is: both, coordinated.
NIDCD describes that a child’s doctor may refer them to a speech-language pathologist for evaluation, and that a hearing test is often included because hearing problems can affect speech and language development.
A practical pathway looks like this:
- Start with a speech-language evaluation if communication is the concern.
- Confirm hearing has been screened recently or request an audiology referral.
- Use results to guide whether therapy targets speech, language, or both.
What parents can do at home right now
These don’t replace hearing assessment, but they reduce frustration and support understanding.
- get face-to-face before giving important directions
- reduce background noise during communication-heavy moments
- use short phrases and repeat key words
- pair speech with gestures
- confirm understanding by having your child show you, not just say “yes”
If you start doing these and notice your child improves significantly with environmental adjustments, that’s another sign hearing should be assessed.
If you’re searching “speech therapy near me”
If your child has a speech delay or language delay and you’re searching speech therapy near me, ask this during intake:
- Has hearing been screened recently?
- Do you recommend an audiology referral?
NIDCD explicitly notes that hearing tests are often included because hearing problems can affect speech and language development.
If you’re in a rural area, traveling is hard, or scheduling is tight, virtual speech therapy or online speech therapy can still help while referrals are in progress, especially for caregiver coaching and language-building routines. Just keep in mind: teletherapy supports communication strategies but does not replace hearing assessment.
Where BreatheWorks fits
BreatheWorks is a speech-language pathology practice with a whole-patient approach that supports patients from infancy through geriatrics. Care may include speech/voice, feeding/swallowing, orofacial myofunctional therapy (OMT/OMD), and TMJ, with an emphasis on root-cause assessment across areas like sleep and breathing when relevant. You can start with in-person care at a clinic or choose secure virtual therapy with the same patient-centered model.
rocess can help identify whether an audiology referral is appropriate and provide a plan you can use at home immediately.
FAQ
Can hearing issues cause speech delay?
Hearing problems can affect speech and language development, and a hearing test is often included in evaluation for that reason.
Are ear infections related to speech and language delay?
They can be, particularly if they create fluctuating access to sound over time. If ear infections or fluid are frequent, ask about hearing screening and audiology.
Should we do speech therapy if we suspect hearing issues?
Often, yes—especially if the child has communication needs right now. But hearing assessment should happen in parallel because it can change the therapy plan.
Does online speech therapy help if hearing is part of the issue?
Online speech therapy can support caregiver coaching, communication strategies, and language growth, but it does not replace hearing assessment and medical management. ASHA emphasizes the importance of hearing testing and audiology involvement when hearing loss is suspected.
