The hearing aid fitting process begins when the infant or small child is identified with a permanent hearing loss that is not complicated by unresolved middle ear dysfunction (e.g., middle ear effusion). Individual-ear, frequency-specific hearing thresholds should be obtained if the child is old enough to participate reliably in behavioral testing (as early as 6 months, but valid behavioral hearing thresholds are often not obtained until 8 to 9 months for children with hearing loss).