Toddler Not Responding to Their Name: What to Check

What is expected, and when

The American Academy of Pediatrics places responding to a name early. Among the things most babies do by 1 year, it lists: look for and find where a sound is coming from, and "respond to their name most of the time when you call it." Note the wording — most of the time, not every time. A toddler absorbed in something who ignores you three times in a row is not unusual.

What is worth looking into is a child who consistently does not turn, does not startle at sudden noises, or seems to hear some things and not others.

Hearing first

This is the part that gets skipped. Parents who search this question usually land straight in neurodevelopment, but temporary hearing loss in toddlers is common, treatable and easy to miss.

The AAP explains why: "most children experience mild hearing loss when fluid builds up in the middle ear from congestion, colds, or ear infections", and in perhaps 1 in 10 children fluid stays in the middle ear afterwards. Children with this problem "don't hear as well as children typically do. Because of this, they sometimes have delays in talking." The loss is often partial and fluctuating, which is exactly why it produces a child who responds sometimes and not others.

The AAP's list of things that should prompt a call to a doctor includes several that apply directly here: a child who does not always respond when called — which it notes "is usually mistaken for inattention or resistance, but could be the result of a partial hearing loss" — a child who seems to hear some sounds but not others, a child who does not notice you until they see you, and a child whose speech is delayed or hard to understand.

It also gives speech-based markers that often accompany hearing difficulty: not saying single words such as "dada" or "mama" by 12 to 15 months, not saying three or more words besides mama or dada by 18 months, not putting two to three words together by around two and a half, and speech that is not understandable half the time by two and a half.

How to get hearing tested

The NHS says a GP can refer you or your child to a hearing specialist for a free test on the NHS, and that children may also have a hearing test as part of their health and development reviews. It lists the tests used for children — visual reinforcement audiometry, play audiometry, pure tone audiometry, tympanometry to check how the eardrum is moving and whether there is fluid behind it, and bone conduction testing — all of which are painless and are done as games at this age.

The NHS advises seeing a GP if you think your child's hearing is getting gradually worse, or if they have had treatment for an ear infection or earwax build-up and their hearing has not come back. It advises asking for an urgent GP appointment or calling 111 for sudden hearing loss in one or both ears, hearing that has been getting worse over days or weeks, or hearing loss with other symptoms such as earache or discharge from the ear. For children under 5, call 111 rather than using the online service.

The other ordinary explanations

• Concentration. Toddlers have a genuinely narrow attention. A child deep in a task may not process their name at all.
• Selective response. Many two-year-olds hear perfectly and simply do not come. The test parents use instinctively — whispering "chocolate" from the next room — is actually informative, because it separates hearing from motivation.
• Background noise. A child with mild hearing loss copes fine one-to-one in a quiet room and struggles badly in a busy nursery. Nursery staff are often the first to notice.
• Too many names. Children called by several nicknames sometimes take longer to respond to any one of them.

Where autism fits, carefully

Not responding to their name is one of the things the NHS lists among the possible signs of autism in young children, alongside a long list of other differences in how a child communicates, plays and responds. It is also clear that "many autistic people will not show all the signs of autism", and that autism looks different in different people.

What that means in practice is that this behaviour on its own does not indicate anything. It is one observation, and it needs to be placed alongside everything else about how your child communicates — whether they point at things to show you, bring things to you, look between an object and your face, use gestures, respond to your expressions, and enjoy back-and-forth games.

Nothing on this page can tell you whether your child is autistic, and it would be wrong to suggest a list could. What a page can do is point you at the people who can look properly.

Who to talk to

Two routes, and they are not alternatives — use whichever is quicker.

• A GP, for a hearing referral, and for a broader developmental concern if you have one. The NHS advises speaking to a GP if you think your child might be autistic, and the GP can refer for an assessment.
• A health visitor, through your child's health and development reviews. The NHS offers these regularly until around age 2, and sends an Ages and Stages Questionnaire before the 9 to 12-month and 2-year reviews. If you have concerns at other times, the NHS says you can contact a health visitor or GP or go to your local baby clinic without waiting for a review.

The AAP's advice to parents is to trust their instincts: if the doctor is not concerned but you still are, ask for a second opinion or a referral, because "if there is a speech and/or language delay, it can be treated in a timely manner", and if there is not, the result is peace of mind.

What helps in the meantime

Get close and get their attention before you speak: face them, at their level, and use their name once rather than repeatedly from across the room. Reduce background noise when you want a response, especially the television. Pair the name with a gesture or a touch on the arm. And notice what does get a response — a whisper, a song, a particular voice — because that detail is genuinely useful information to hand to whoever assesses your child.