A nurse is speaking with the parent of a toddler who believes the child has a hearing deficit. Which findings support this suspected diagnosis? Select all that apply.

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Hearing impairment in children may be related to family history, an infection, use of certain medications, or a congenital disorder. Toddlers with hearing deficits may appear shy, timid, or withdrawn, often avoiding social interaction. They may seem extremely inattentive when given directions and appear "dreamy." Speech is usually monotone, difficult to understand, and loud. Increased use of gestures and facial expressions is also common. (Option B) Children typically begin to use well-formed syllables such as "mama" and "dada" by approximately age 7 months. A referral for a hearing test should be made if there is an absence of well-formed syllables by age 11 months or intelligible speech is not present by 24 months. (Option D) Lack of attentiveness and appropriate response when given a direction is characteristic of a toddler who has a hearing impairment. Educational objective: Hearing impairment in infants delays development of intelligible speech. As these infants become toddlers, they often have a loud voice and monotone speech that is difficult to understand. They appear shy, timid, and inattentive.

A Nurse Is Speaking with the Parent of a Toddler