Children's Hearing: From Newborn Screening to School Age

AudiologyOctober 6, 20268 min read

Children's hearing is usually first checked with a quick newborn hearing screening soon after birth, and then watched through infancy, the toddler years and school age. Hearing can change after a newborn screening, so parents' observations and timely hearing tests remain important as a child grows.

Good hearing supports speech, language, learning and social development. When a hearing difficulty is found early, children and families can get the right support sooner. If you are unsure about your child's hearing at any age, a pediatric hearing test is the clearest way to find out.

Why does hearing matter so much in childhood?

Children learn to understand and use language largely by listening to the people around them. Even a mild or temporary hearing difficulty can make speech sounds less clear, which may affect how a child learns new words, follows instructions and joins in conversation. Hearing also plays a part in safety, play and friendships. That is why hearing is checked early and why concerns are best looked into rather than waited out.

What is newborn hearing screening?

Newborn hearing screening is a quick, painless check usually done before a baby leaves hospital or soon after. It is often carried out while the baby is asleep. Two common methods are:

Otoacoustic emissions (OAE): a small soft probe in the ear canal checks for a faint "echo" that a healthy inner ear produces in response to sound.
Automated auditory brainstem response (AABR): small sensors on the head measure how the hearing nerve responds to sounds.

A "pass" means hearing was adequate for the screening at that time. A "refer" result does not mean a baby has hearing loss; it means further testing is needed. Babies can fail a screening for simple reasons such as fluid in the ear or movement during the test. The important step is to complete the follow-up assessment promptly rather than wait.

Can hearing change after the newborn screening?

Yes. Some hearing loss develops or becomes noticeable later in childhood, and temporary problems such as fluid behind the eardrum are common in young children. A pass at birth is reassuring but does not rule out later changes. Our guide to the signs a child may not be hearing well, by age explains what to watch for at each stage.

Common causes of hearing problems in children

Hearing difficulties in children can be temporary or permanent.

Temporary causes include:

fluid in the middle ear, often called glue ear, which is common after colds and ear infections;
middle ear infections (otitis media), which are frequent in young children;
earwax blocking the ear canal, or a small object placed in the ear.

Permanent hearing loss may be present from birth, for example due to genetic factors or problems during pregnancy or birth. It can also be acquired later, for example after certain serious infections, some medicines, a head injury or loud noise exposure. Only a hearing assessment, together with medical review where needed, can determine the cause in an individual child.

Globally, the WHO estimates that over 5% of the world's population, 430 million people, need rehabilitation for disabling hearing loss, and this includes many children. Much of the impact can be reduced when hearing loss is identified early and managed well.

How are children's hearing tests done?

The test depends on the child's age and stage of development, and it should feel like a game wherever possible. Our article on hearing tests explained covers the methods in more detail.

Babies: OAE and auditory brainstem response (ABR) tests measure the ear's and hearing nerve's responses, without the baby needing to do anything.
Older babies and toddlers: in visual reinforcement audiometry, the child learns to turn towards a sound and is rewarded with a lighted toy or screen.
Preschool children: play audiometry turns listening into a game, such as dropping a block in a box each time a sound is heard.
School-age children: many can respond to sounds through headphones by pressing a button or raising a hand, much like adults.
Middle ear check (tympanometry): a soft probe briefly changes the air pressure in the ear canal to show how well the eardrum moves, which helps identify fluid behind the eardrum.

School hearing screening and school age

School screening is useful for picking up children who need a full assessment, but it is a quick check, not a diagnosis. A child who passes a screening may still develop a hearing problem later, and a child who does not pass needs a proper hearing test. At school age, possible signs include seeming inattentive, often asking for repetition, struggling in noisy classrooms, turning up the television, or a teacher raising concerns.

Hearing, speech and language

Hearing and speech are closely connected. A child who is not hearing clearly may be late to talk, have unclear speech or find it hard to follow conversations. Speech delay has many possible causes, but checking hearing is usually one of the first steps. See signs of speech delay in children and when to see a specialist for more guidance.

What happens if a child has hearing loss?

The next steps depend on the type and degree of hearing loss and on the child and family. Temporary problems may need medical review and monitoring. For permanent hearing loss, options may include hearing aids and, for some children, cochlear implants, alongside listening and language support. Services such as pediatric auditory rehabilitation and auditory-verbal therapy help children learn to make the most of their hearing technology, with parents closely involved in everyday practice. Regular follow-up is important because a child's needs change as they grow.

Protecting children's hearing

Keep the volume of headphones, tablets and toys moderate, and limit long listening sessions.
Use hearing protection designed for children at very loud events.
Do not put cotton buds or objects into a child's ears.
Follow up promptly on ear infections, ear pain or discharge with a doctor.

When to see a specialist

Arrange a pediatric hearing test if:

your baby did not pass the newborn screening, or the follow-up test was missed;
you have any concern about how your child responds to sounds or voices;
speech or language seems behind, or speech is unclear;
your child has frequent ear infections or seems to hear less after a cold;
a teacher, doctor or school screening has raised a concern.

See a doctor promptly if your child has ear pain with discharge, a high temperature, or seems to have lost hearing suddenly. You can book an appointment online, and no referral is needed for a hearing assessment.

Frequently asked questions

Can a newborn have a hearing test?

Yes. Newborn hearing screening is quick and painless and is often done while the baby sleeps, using methods such as OAE or automated ABR. If a baby does not pass, a fuller assessment can be done. Babies' hearing can be measured without them needing to respond.

Is a school hearing screening enough?

School screening is helpful for identifying children who need a full test, but it is not a diagnosis. Hearing can change between screenings. If you or a teacher notice signs of hearing difficulty, arrange a proper hearing test rather than waiting for the next screening.

How is a toddler hearing test done?

Toddler tests are designed to feel like play. In visual reinforcement audiometry, the child turns towards a sound and is rewarded with a lighted toy; older toddlers may do play audiometry. A gentle middle ear check may also be used to look for fluid behind the eardrum.

Sources

This article is general information and does not replace advice from a qualified professional.

Children's Hearing Tests & Assessment Ashfeera Ashraf