Pediatric Audiology and Hearing Care

Pediatric audiology zeros in on hearing loss in children—finding it, measuring it, and treating it from birth through adolescence. At Audiology Island, Dr. Stella Fulman, Au.D. and Dr. Zhanneta Shapiro, Au.D. run everything from newborn screenings and full diagnostic evaluations to hearing aid fittings and long-term follow-up. Why the urgency? Children diagnosed before six months old develop markedly stronger speech and language than those caught later. Every month counts.

Understanding Pediatric Audiology

Think of it this way: you can hand an adult a pair of headphones and ask, “Can you hear this beep?” Try that with a six-month-old. Pediatric audiology exists precisely because children can’t tell you what they’re hearing—or missing. Their ears are physically smaller, sure, but the real complication runs deeper. A young brain is still wiring itself for language, and it relies on steady, clear sound to lay those neural tracks. Cut off that input—even partially—and the downstream effects on speech, reading, and social thinking can snowball fast (ASHA, 2024).

What catches parents off guard is how subtly hearing trouble disguises itself. A kid labeled “defiant” or “spacey” at school? Could be hearing loss, not attitude. The behavioral fallout—academic stumbles, social retreat, frustration that looks like acting out—often sends families to speech and language therapy before anyone thinks to check the ears. “Parents sometimes assume a child is just being stubborn,” notes Dr. Stella Fulman, Au.D., pediatric audiologist at Audiology Island. “But in a surprising number of cases, the child genuinely isn’t hearing what’s said to them.” Our audiologists see infants through teenagers, matching every evaluation to where that particular child is developmentally.

Why Hearing Tests Are Important for Children

Why do children need hearing tests? Because hearing loss you don’t catch steals speech before a child even gets started. About 2–3 per 1,000 U.S. newborns arrive with measurable hearing loss (CDC, 2023), and ear infections, noise, and certain medications push that count higher as kids grow. Dr. Zhanneta Shapiro, Au.D., at Audiology Island, stresses one consistent finding: children identified before six months gain language at dramatically better rates than those found later. Screening early is one of the single highest-yield things a family can do.

Two to three babies out of every thousand. On paper, that sounds rare. In practice, it means several thousand U.S. infants born each year already have a hearing deficit—and those are just the ones detectable at birth (CDC, 2023). Recurrent ear infections, noise exposure, ototoxic drugs: acquired losses keep stacking up through toddlerhood and beyond (ASHA, 2024).

Timing is the whole ballgame here. Kids identified before six months—and funneled into intervention quickly—build language skills that track much closer to their hearing peers. Wait a year or two? The gap widens, and it doesn’t just affect vocabulary. Literacy, classroom performance, even friendships take a hit (Joint Committee on Infant Hearing, 2019). Not a subtle difference, either. The research on this is frankly lopsided.

The 1-3-6 Rule: Screen by 1 month. Diagnose by 3 months if the screen flags anything. Start intervention by 6 months. These aren’t arbitrary deadlines—the Joint Committee on Infant Hearing set them because the brain’s language-learning window doesn’t wait. Hitting these marks is one of the most powerful things a family can do for a child with hearing loss.

Why Hearing Tests Are Important for Children

When should a child’s hearing be tested? Right away. Newborns should be screened before leaving the hospital—within the first month of life. A “refer” result triggers a full diagnostic evaluation by 3 months and intervention by 6 months (JCIH 1-3-6 guidelines). After infancy, the AAP and ASHA call for repeat screenings at ages 4, 5, 6, 8, 10, and in adolescence. Kids with risk factors—NICU stays, family history, CMV—need closer tracking, according to Dr. Stella Fulman and Dr. Zhanneta Shapiro at Audiology Island.

Most U.S. states mandate newborn hearing screening before hospital discharge. Good. But here’s the thing parents need to understand: a screening is a filter, not a verdict. Getting a “refer” result does not mean your baby has permanent hearing loss. It means something flagged and needs a closer look—quickly. The trouble? CDC data show that far too many infants who don’t pass that first screen never make it to the follow-up appointment (CDC EHDI, 2023). They just fall through the cracks. That gap is one of pediatric audiology’s most frustrating unsolved problems.

Past the newborn stage, screening shouldn’t just stop. AAP and ASHA guidelines call for checks at ages 4, 5, 6, 8, and 10, plus at least once during adolescence. And if your child spent more than five days in the NICU, has a family history of childhood hearing loss, or was exposed to cytomegalovirus in utero—the monitoring schedule tightens, even if that first newborn screen came back clean (JCIH, 2019).

Why Hearing Tests Are Important for Children

What are the signs of hearing loss in a child? It depends on age. Babies may not flinch at loud sounds or babble by 9 months. Toddlers ask “what?” constantly or ignore directions unless you’re making eye contact. School-age kids crank the TV way up or zone out in noisy classrooms. At every age, pulling away socially or acting out can mask a hearing issue. Dr. Stella Fulman and Dr. Zhanneta Shapiro at Audiology Island urge parents who spot these patterns to book a full diagnostic evaluation—not just a basic screening.

Hearing loss rarely announces itself with a neon sign. Usually it’s quieter than that—almost sneaky. A baby who doesn’t flinch when a door slams. A two-year-old whose words just aren’t coming. A second-grader whose teacher keeps writing “doesn’t pay attention” on report cards. Parents and caregivers tend to spot these threads first, sometimes before any formal test picks up a problem, and those gut observations matter clinically.

Infants: No startle when something crashes nearby; still not babbling at 9 months; won’t turn toward mom’s voice or a rattle shaking behind them.

Toddlers: Words arriving late or not at all; constant “huh?” and “what?”; can’t follow simple requests unless you’re standing right in front of them.

School-age: Struggles to keep up in loud classrooms; grades slipping without an obvious cause; headphones or TV volume cranked to levels that make you wince.

Any age: Pulling back from group play or conversation; frustration that gets blamed on attitude, defiance, or an attention disorder when the real culprit is their ears.

Sound familiar? Don’t wait to “see if they grow out of it.” That strategy almost never pays off. A diagnostic hearing evaluation—the thorough kind, not a quick pass/fail screen—is the move.

Why Hearing Tests Are Important for Children

What happens during a child’s hearing test? At Audiology Island, Dr. Zhanneta Shapiro or Dr. Stella Fulman starts with a detailed history—birth, milestones, family hearing background. Then they pick the right tools for the child’s age: painless OAE and ABR tests for babies (done while sleeping), animated visual reinforcement audiometry for toddlers, and game-based conditioned play audiometry for preschoolers. The youngest patients don’t need to talk or cooperate at all. Visits run 30–90 minutes, with plenty of built-in wiggle room.

“My kid won’t sit still for a test.” We hear this from nearly every parent before the first appointment. Here’s the honest answer: toddlers are chaos agents, and pediatric audiologists train specifically for that. The test battery gets tailored to what the child can actually do—behaviorally, developmentally—not what a textbook says a kid “should” tolerate.

Every visit at Audiology Island opens with a thorough case history. Birth details, milestone tracking, family hearing patterns, anything the parent has noticed at home. From there, the audiologist picks the right combination of tests. Babies and very young children get objective measures—no response needed from them at all. Older kids do play-based tasks that feel like a game, not a medical procedure. Dropping blocks in a bucket when they hear a beep? That’s a hearing test, and most kids enjoy it.

Plan for anywhere from 30 to 90 minutes depending on age and complexity. We don’t rush. If your child melts down or just needs a breather, we pause, adapt, and finish another day if necessary. Getting it right matters more than getting it done fast.

Why Choose Audiology Island for Pediatric Audiology

Audiology Island is built around one thing: children’s hearing. Pediatric audiologists Dr. Stella Fulman, Au.D. and Dr. Zhanneta Shapiro, Au.D. handle diagnostic evaluations, newborn screening follow-up, hearing aid fitting, and complex cases for kids of all ages. The clinic runs child-friendly test rooms, coordinates directly with pediatricians, ENTs, and early intervention teams, and treats parents as co-pilots—not spectators—throughout the process.

Not every audiology practice is set up to handle kids well. Testing a five-year-old requires different equipment, different techniques, and—frankly—a different temperament than testing a 65-year-old. Miss something during early childhood and the ripple effects on speech, reading, and classroom readiness compound in ways that are hard to reverse later.

The space itself is designed for kids—bright, low-stress test rooms, gear calibrated for tiny ears, and a staff that knows how to coax a wary two-year-old into cooperation without a meltdown. We also talk to your child’s other providers. Pediatricians, ENTs, speech therapists, early intervention coordinators—everyone stays in the loop, because hearing care that happens in a silo helps nobody.

And here’s what Dr. Fulman and Dr. Shapiro insist on: parents belong in the room and in the conversation. Findings get explained in plain language, not jargon. You’ll know exactly what the audiogram shows, why a specific path is recommended, and what happens next—whether that’s watchful waiting, a referral, hearing aids for children, or some mix of all three.

Methods of Pediatric Hearing Testing at Audiology Island

How is hearing tested in children? Dr. Fulman and Dr. Shapiro at Audiology Island choose from five core methods based on age: Otoacoustic Emissions (OAE) and Auditory Brainstem Response (ABR) for newborns, Visual Reinforcement Audiometry (VRA) for babies 6 months to 2.5 years, Conditioned Play Audiometry (CPA) for the 2.5–5 crowd, and Tympanometry for middle ear checks at any age. One test alone never tells the full story—so a thorough evaluation usually layers several together.

There’s no one-size-fits-all hearing test for kids. A complete picture usually takes a combination of methods, chosen based on the child’s age and whatever clinical question brought them in.

Conventional Audiometry — The audiologist presents tones at different pitches and loudness levels and the child’s responses are observed and recorded. Speech stimuli are also used and responses are observed and recorded.
Behavioral Observational Audiometry (BOA) — The audiologist observes changes in behavior, such as sucking pattern, widening eyes, or searching for sound in response to various stimuli.
Visual Reinforcement Audiometry (VRA) — The audiologist uses behavioral conditioning to train your child to respond to sounds presented through a speaker system. Reinforcement is provided immediately by activating a toy that lights up and moves.
Play Audiometry — The audiologist teaches your child to respond with some action, such as holding a block to the ear and placing it in a bucket whenever a sound is heard.
Tympanometry — This test measures the movement of the eardrum and the ability of the middle ear to conduct sound to the inner ear.
Acoustic Reflexes — In a normal ear, the stapedius muscle in the middle ear contracts in response to loud noises at about 70-100 dB (decibels).
Otoacoustic Emissions (OAE) — A probe in the ear canal measures echoes from the inner ear in response to sound. A normal cochlea creates its own sound in response to sound coming into the ear. If no response is observed, a hearing loss may be present.
Auditory Brainstem Response (ABR) — Electrodes are placed on your child’s head to pick up the brain’s responses to sound directly. No voluntary response is necessary, so it is often used with infants and very young children. It can even be done while the child is asleep. Audiological management is crucial for children who have a history of otitis media and accompanying hearing loss. A multi-disciplinary approach, which may include the primary care provider, pediatrician, ENT physician and speech-language pathologist, should be used. These children should receive periodic hearing evaluations by a licensed audiologist even when they appear to be symptom-free. In particular, hearing assessment should be completed at the onset of the school year for preschool and elementary students, and at least once during the winter months.

Our Doctors of Audiology

Dr. Stella Fulman

Dr. Fulman completed her Doctor of Audiology degree at Northwestern University, followed by specialized fellowship training in vestibular assessment and rehabilitation. Her 22 years of clinical practice spans pediatric through geriatric populations, with particular expertise in complex diagnostic cases and tinnitus management.

Dr. Zhanneta Shapiro

Dr. Shapiro earned her AuD from the University of Florida, subsequently completing advanced training in hearing aid technology and real-ear verification techniques. Over 20 years, she’s fitted thousands of patients with amplification, developing refined strategies for addressing difficult-to-fit configurations and the adjustment process.

Our Office Locations and Hours

Main Office

11 Ralph Place, Suite 304,
Staten Island, NY 10304

Phone: (888) 995-5655

info@audiologyisland.com

Office Hours

Mon & Thur

8:30AM – 7:00PM

Tue, Wed & Fr

8:30AM – 5:00PM

Sat-Sun

Clossed

Bricktown Office

245 Unit E, Bricktown Way, Staten Island, NY 10309

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Richmond Avenue Office

1855 Richmond Ave, Staten Island, NY 10314

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Holmdel Office

2080 NJ-35 Holmdel, NJ 07733

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Request Your Appointment

Failed newborn screen? Something just feels off? Pediatrician said to get it checked? Whatever brought you here, Dr. Stella Fulman and Dr. Zhanneta Shapiro are ready. Book a pediatric hearing evaluation at Audiology Island—the sooner, the better.

Patient Testimonials

Patient Information

At what age should my child first have their hearing tested?

Before leaving the hospital, ideally. The JCIH’s 1-3-6 guidelines say: screen by 1 month, get a diagnostic evaluation by 3 months if the screen flags anything, and start intervention by 6 months. These aren’t suggestions—they exist because the brain’s language-building window is narrow. At Audiology Island, Dr. Stella Fulman and Dr. Zhanneta Shapiro handle follow-up evaluations for infants who didn’t pass that initial screen.

Does my child need to be able to talk or cooperate for a hearing test?

Nope. Tests like OAE and ABR are completely objective—they measure the ear’s and brain’s responses to sound without the child doing a thing. These work beautifully on sleeping newborns. For toddlers, visual reinforcement audiometry uses animated rewards to gauge hearing without needing a single word from the kid. Dr. Fulman and Dr. Shapiro pick whichever approach matches the child’s developmental stage.

What causes hearing loss in children?

Lots of things, unfortunately. Genetics drive 50–60% of cases. Prenatal infections, premature birth, severe jaundice, ototoxic medications, and chronic ear infections account for most of the rest. And sometimes, even after thorough testing, no clear cause turns up. Dr. Zhanneta Shapiro at Audiology Island can pinpoint the type and severity through comprehensive diagnostics so treatment starts on the right track.

Will my child need hearing aids?

Maybe, maybe not. It hinges on the type, degree, and shape of the hearing loss. Some kids benefit from medical or surgical treatment; others do best with amplification. A few need a combination. The only way to know is a full audiological evaluation—Dr. Stella Fulman or Dr. Zhanneta Shapiro at Audiology Island can walk you through the options once the picture is clear.

How long does a pediatric hearing test take?

Depends on the child. A newborn screening wraps up in 15–20 minutes. A full diagnostic evaluation for an older kid can run 60–90 minutes. Dr. Fulman and Dr. Shapiro block generous appointment slots—there’s no assembly line. If the child needs a break, the schedule flexes.