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Which child should a nurse refer for a more extensive hearing evaluation during community health screenings?

  1. An 18-month-old toddler who has unintelligible speech.

  2. A 3-month-old infant who has an exaggerated startle response.

  3. A 4-year-old preschooler who prefers playing with others rather than alone.

  4. An 8-month-old infant who is not yet making babbling sounds.

The correct answer is: An 8-month-old infant who is not yet making babbling sounds.

Referring the 8-month-old infant who is not yet making babbling sounds for a more extensive hearing evaluation is crucial because the absence of babbling at this age can indicate a potential hearing impairment. By around 6 to 9 months, infants typically begin to experiment with sounds and may start to babble. This development is critical as it reflects their ability to hear and process speech sounds. A delay in babbling could suggest that the child might not be hearing adequately, which can impact language acquisition and communication skills as they grow. In contrast, while an 18-month-old toddler with unintelligible speech might have challenges related to language development, this is less directly indicative of hearing loss than the lack of babbling in an 8-month-old. The 3-month-old infant with an exaggerated startle response could show responsiveness to auditory stimuli, indicating that hearing may be functional, and further evaluation is not yet warranted. The preference of the 4-year-old preschooler for playing with others instead of alone does not provide sufficient evidence for hearing issues, as social play preferences can vary greatly among children.