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Hearing tests for babies and children: what you need to know

It is not uncommon for infants and children to experience hearing loss at some time or another.

It’s not known exactly how many babies are born with hearing loss in the US – called congenital hearing loss – but estimates put the number at between 1-5 in every 1,000.

By age three, 80% of children have experienced an ear infection, which can cause temporary hearing loss.

And around 12% of children aged six to 12 have noise-induced hearing loss, caused by repeated exposure to loud noise.

Any degree of hearing loss in infants and children can cause problems with speech development and learning, so it’s important it’s identified as early as possible.

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What are hearing tests for children?

Hearing tests are used to assess how well your child can hear, and can identify if they have any hearing loss, the degree of hearing loss, and what’s causing it.

child with ear infection has ear inspected

Most newborn babies – around 98% – have hearing screening after birth to check whether they have any signs of congenital hearing loss.

Babies’ and kids’ hearing tests are quick and painless.

Does my child need a hearing test?

Your baby’s hearing should be tested before they reach one month old, and ideally before they leave the hospital after birth.

If they don’t pass, it doesn’t necessarily mean they have serious hearing loss, but they should be retested and have a full hearing test as soon as possible, and before three months old.

If your child is at risk of hearing loss later on – known as acquired hearing loss or delayed-onset hearing loss – it’s recommended that they have at least one hearing test by the time they reach two-and-a-half years of age.

Risk factors include having certain illnesses during infancy, neurological conditions, infections and head trauma. Their risk is higher if you had certain infections or problems during pregnancy, or a difficult birth.

It is recommended they have children’s hearing tests at the ages of four, five, six, eight, and 10 – and more often if they have signs of hearing loss or a diagnosed hearing impairment.

Signs of hearing loss in children


  • They don’t jolt or seem startled in reaction to loud sounds and noises
  • By three months, they don’t react to a parent’s or caregiver’s voice
  • By six months, they don’t turn their head in the direction of sound
  • By 12 months, they are not imitating speech or producing simple words

Infants/young children

  • Their speech is delayed or difficult to understand
  • They don’t respond when you call their name (they might turn when they see you)
  • They appear to not pay attention, or to be distracted
  • They have difficulty following instructions
  • They have behavioral problems

Older children/teens

  • They have communication difficulties
  • They struggle in school, with behavioral problems and seem distracted
  • They have difficulty understanding speech and following conversations
  • They turn up the volume on the TV or their music device
  • They have trouble hearing high-pitched sounds
  • They experience a ringing in their ears, called tinnitus

What hearing tests will my child have?

Depending on your child’s age and whether they are able to cooperate with the person conducting the test, they might have any of the following tests.

Newborn hearing screening tests include the otoacoustic emissions test (OAE test) and the auditory brainstem response test (ABR).

Otoacoustic emissions test (OAE test)

The OAE test is used to assess how well your child’s inner ear, or cochlea works. It’s normally used to screen newborn babies for hearing loss.

Like with other hearing tests, a small probe is placed into your child’s ear, and sounds are played through it.

In normal hearing, when you hear a noise your inner ear produces very quiet sounds back to the middle ear in response to the noise. These are called otoacoustic emissions, or OAEs.

During an OAE test, the probe picks up these emissions when your child hears the sounds, and they’re recorded on a monitor.

Auditory brainstem response testing

This kind of test is used to detect problems with the way the inner ear sends signals to the brain and the brain’s response to them. They are normally part of the newborn hearing test used to screen for congenital hearing loss in babies.

The test involves placing headphones in your child’s ear canals and stickers on their forehead and behind their ears. The stickers have tiny electrodes attached to them, which are painless and very safe.

Clicking sounds pass through the headphones. The electrodes measure how your child’s auditory nerve, which sends sound signals to their brain, responds to the sound. They also measure the response of your child’s brain to the sounds.

The following tests can be conducted on older children as well as infants, as they don’t require your child to actively engage.


This is a type of middle ear hearing test, and it’s used to check for any problems with your child’s eardrum.

It involves having a small probe placed into their ear canal. The probe is attached to a device that pushes air into the ear, and your child’s eardrum moves back and forth in response.

The way their eardrum moves is recorded on a graph, and your audiologist can use the readings to determine if there’s a problem with your child’s eardrum.

These include a tear or hole in the eardrum, fluid in the middle ear, a build-up of wax deep in the ear canal, or an infection.

Acoustic reflex measures

Also called middle ear muscle reflex (MEMR) test, this is another type of middle ear hearing test. It checks how your child’s ear responds to very loud sounds.

Inside the ear is a tiny muscle that tightens or contracts when you hear a loud noise. It’s an automatic response or a reflex, and how much this muscle moves in response to noise is called an acoustic reflex.

In an acoustic reflex test, sounds will play through a probe inside your child’s ear. The audiologist will measure how loud a sound it takes for their acoustic reflex to kick in.

That can help identify how bad your child’s hearing loss is. If they have very severe hearing loss they might not have any acoustic reflexes.

Behavioral audiometry evaluation

This test involves a healthcare professional observing your child’s responses to sounds through play and interaction. The exact methods will vary depending on your infant or child’s age.

child completing a behavioral audiometry evaluation

Speech and other sounds are played to your child, while the audiologist observes how they respond. For example:

  • Infants may suck on a pacifier or turn toward the sound
  • Younger children might repeat the word or select a picture
  • School-aged children may raise their hand

The audiologist notes how your child responds according to certain measures, and will interpret the results. They might recommend that your child has further hearing tests.

The following tests are carried out with children old enough to understand instructions and respond accordingly.

Pure-tone testing

This test involves your child wearing headphones that play beep sounds into each ear in turn. When they hear a sound through the headphones, they indicate they’ve heard it usually by raising their hand or pressing a button.

The sounds are played at different levels of loudness and pitch. This helps to find the quietest sound they can hear at different pitches, in each ear.

This test is used in older children as it requires their response input.

Tuning fork testing

This is a simple test that can quickly signal what type of hearing loss your child might have. It’s sometimes called a Weber hearing test or a Rinne hearing test.

Sensorineural hearing loss occurs as a result of damage to a part of the inner ear, or the auditory nerve that carries sound waves to the brain. Conductive hearing loss occurs when sound waves are blocked from moving through the outer or inner ear, stopping sound from reaching the inner ear.

During a tuning fork hearing test, the audiologist will hold a two-pronged metal tool called a tuning fork behind your child’s ear or on top of their head.

They’ll strike the tuning fork so it makes a sound. It’s completely painless and takes a few moments.

Your child is asked to tell the person conducting the test when they hear the sound, whether they hear it at different volumes, and whether they hear it in one ear or both ears.

How they respond when the fork is struck both behind their ear and on their head will help determine whether they have sensorineural or conductive hearing loss and whether it affects one ear (unilateral) or both ears (bilateral).

Speech reception threshold testing

This test is similar to pure-tone testing, but rather than beep sounds it uses speech. It assesses how well your child recognizes speech and words. They wear headphones and the audiologist will say different words at different volumes, which play through the headphones.

audiologist performing a speech therapy test with child

When your child hears the word, they repeat it. This will help to identify if they have trouble hearing speech, and whether they struggle with particular speech sounds.

Children who are old enough to understand speech and words might have this hearing test.

Want to speak with a trained audiologist on your child's hearing?
Book a free consultation today

What happens after my child’s hearing test?

Which tests your child has will depend on their different factors, including their age and whether they have experienced any symptoms or shown signs of hearing loss.

When they’ve undergone the hearing loss tests they need, the audiologist will look at all the results together to get a broad picture of:

  • Whether your child has hearing loss
  • What type of hearing loss they have
  • What might be causing their hearing loss
  • The degree of hearing loss
  • Whether one or both of their ears are affected (unilateral or bilateral)
  • Whether their hearing loss is likely to be permanent

The test results can also help identify what kind of treatment you are likely to benefit from.

Treatment options will depend on all of these factors, but will also take into account your preferences.

The United States Early Hearing Detection and Intervention (EHDI) program is aimed at diagnosing hearing loss in babies before they’re three months old, and starts treating babies who have permanent hearing loss by the time they are six months old.

Often, the best treatment will be to wear a hearing aid. They work by amplifying sound, making it louder, and enabling your child to hear more clearly.

If your child is diagnosed with very severe or profound hearing loss and hearing aids aren’t of benefit, they might be a candidate for a cochlear implant.

Depending on the cause of your child’s hearing loss, certain medications might help and in some cases, surgery could be an option. Your audiologist or healthcare provider can discuss these options with you.

Your child might also benefit from additional support, such as speech and language therapy, educational support, and other types of therapies to help them to learn key skills, like social skills.

Early detection of hearing loss in children, along with access to the most appropriate services and support, can greatly improve your child’s development and help them to reach their potential.

Written by:

Allie Anderson is a health writer and editor with many years of experience creating accurate, evidence-based content for consumer and professional audiences. Allie is passionate about making medical information as accessible as possible, empowering people to make informed choices about their health and well-being.


Allie holds a first-class honours degree in Linguistics from University College London, a Russell Group institution that’s ranked in the top 10 universities globally. She trained as a journalist with the UK’s NCTJ (National Council for the Training of Journalists) and after working as a news reporter for local newspapers and B2B titles, began writing about health.


Published in medical journals, peer-reviewed magazines for healthcare professionals and a broad range of consumer titles, Allie has covered all manner of health and medical topics throughout her career, most recently focusing on hearing health and hearing loss.


Allie has conducted in-depth research into the mechanisms underpinning hearing and has developed an understanding of the nuanced impact hearing loss can have on individuals and their loved ones.

Reviewed by:
Audiologist Ana Paula de Lima Rodrigues (Audiology and Speech Therapy BSc) is extremely passionate about providing exceptional care, advice and support for people with hearing loss. Ana trained at the University of Vale do Itajai in Brazil in 2001 and currently works in London where she is registered with The Health and Care Professions Council (HCPC).
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