Hearing loss affects approximately three to six out of every 1,000 newborns in Australia, and many more children develop hearing difficulties during early childhood due to ear infections, genetic factors, or noise exposure. According to Hearing Australia, around 12,000 children across the country live with some form of hearing impairment. A timely children's hearing test can identify problems before they interfere with speech development, literacy, and social confidence. This guide covers when children need hearing tests, what methods audiologists use for different ages, the warning signs parents should watch for, and what to expect during a paediatric hearing assessment.
When Should Children Have Hearing Tests
Hearing screening in Australia begins at birth and continues at key developmental stages. The Australian Universal Newborn Hearing Screening Program tests babies within the first few days of life, typically before they leave the hospital. This program detects congenital hearing loss early so that intervention can begin during the critical period for speech and language development.
Beyond newborn screening, children should have hearing checked at several points throughout childhood. The Australian Department of Health and Hearing Australia recommend hearing assessments at the following stages:
- At birth: Universal newborn hearing screening is offered to every baby born in Australia. This test uses Otoacoustic Emissions technology and takes only a few minutes.
- At 12 months: If your baby had risk factors such as a family history of hearing loss, premature birth, or time spent in a neonatal intensive care unit, a follow-up assessment at 12 months is recommended.
- Before starting school (ages 4 to 5): A comprehensive hearing test before your child starts school ensures they can hear clearly in a classroom. Undetected hearing loss at this stage can lead to learning difficulties that are often mistaken for behavioural or attention problems.
- Throughout primary school: Some states offer school-based hearing screening. If your child's school does not, or if you have concerns, book a test with an audiologist.
- After ear infections: Recurrent otitis media, or middle ear infection, can cause temporary hearing loss that becomes permanent if untreated. Children who suffer frequent ear infections should have their hearing monitored regularly.
- Whenever you notice warning signs: Trust your instincts. If something seems off with your child's hearing or speech development, a hearing test is the quickest way to find out.
Types of Hearing Tests for Children by Age
Audiologists select testing methods based on a child's age, developmental level, and ability to respond to sounds. A kids hearing test is designed to be comfortable, non-invasive, and accurate for the specific age group. Here are the main testing methods used in paediatric audiology.
Otoacoustic Emissions (OAE) Testing
OAE testing is the primary method used in newborn hearing screening. A small, soft-tipped probe is placed in the baby's ear canal. The probe plays a series of clicking sounds and measures the echo produced by the cochlea, the inner ear's hearing organ. If the cochlea is functioning properly, it produces a measurable emission in response to sound. This test takes only a few minutes per ear and does not require the baby to be asleep, though a quiet, settled state gives the best results. OAE testing detects cochlear hearing loss but cannot measure the severity of loss or test the auditory nerve pathway. If OAE results are abnormal, further testing with ABR is recommended.
Auditory Brainstem Response (ABR) Testing
ABR testing is used for babies under approximately six months of age, and is considered the gold standard for confirming hearing loss in infants. Small sensors are placed on the baby's head, and soft sounds are played through earphones. The sensors detect the electrical activity in the auditory nerve and brainstem in response to those sounds. The baby needs to be asleep for accurate results, so the test is often scheduled during nap time. ABR provides detailed information about hearing thresholds across different frequencies and can distinguish between different types of hearing loss. It is painless and carries no risks.
Visual Reinforcement Audiometry (VRA)
VRA is designed for children aged approximately six months to two and a half years. The child sits on a parent's lap in a sound-treated room. Sounds are played through speakers or earphones, and the child is taught to turn toward the sound source. When they turn correctly, a visual reward such as a moving toy or animated character activates. Over several repetitions, the audiologist builds a picture of the softest sounds the child can hear at different frequencies. VRA is engaging for young children and provides reliable results when performed by an experienced paediatric audiologist.
Play Audiometry
Play audiometry is used for children aged approximately three to five years. Instead of pressing a button when they hear a sound, the child performs a simple action like dropping a block in a bucket or placing a peg in a board. This turns the hearing test into a game, keeping the child engaged and cooperative. Sounds are presented through earphones at different frequencies and volumes, allowing the audiologist to create a full audiogram. Play audiometry provides detailed frequency-specific results and is one of the most widely used methods in paediatric hearing screening children assessments.
Conventional Audiometry
Children aged five and older can usually complete conventional pure-tone audiometry, the same basic test used for adults. The child wears headphones and presses a button or raises a hand each time they hear a sound. Speech audiometry, which measures the ability to hear and repeat words, is also used. By school age, most children can provide reliable results with standard testing methods.
Signs of Hearing Problems in Children by Age Group
Hearing loss in children is not always obvious. Babies with mild to moderate hearing loss may startle at loud sounds and appear to respond to voices, even though they are missing critical speech sounds. Knowing the age-specific warning signs helps parents act early.
Babies (Birth to 12 Months)
- Does not startle or react to sudden loud sounds
- Does not turn toward the source of a voice or sound by six months
- Does not babble or produce a range of vowel and consonant sounds by 12 months
- Seems unresponsive when you call their name
- Does not imitate sounds or respond to music
- Failed the newborn hearing screening and has not had a follow-up assessment
Toddlers (1 to 3 Years)
- Delayed speech development compared to peers, such as not using single words by 12 to 15 months or two-word phrases by age two
- Does not follow simple verbal instructions
- Frequently says "what?" or seems to ignore you when spoken to
- Watches your face intently when you speak, relying on lip movements
- Turns the TV or tablet volume to a level others find too loud
- Has had multiple ear infections or has persistent fluid in the middle ear
- Becomes frustrated or has behavioural outbursts linked to communication difficulty
Preschool Children (3 to 5 Years)
- Speech is unclear or difficult for unfamiliar adults to understand
- Struggles to follow multi-step instructions
- Has difficulty hearing in noisy environments like childcare or playgroup
- Speaks at a volume that is consistently too loud or too soft
- Shows signs of language delay, such as using short, simple sentences when peers use complex ones
- Appears inattentive or easily distracted, which can be misidentified as a behavioural issue
School-Age Children (5 Years and Older)
- Frequently asks the teacher to repeat instructions
- Sits close to the front of the classroom or strains to hear
- Struggles with reading, spelling, or phonics tasks
- Has trouble following group conversations or participating in class discussions
- Complains of ear pain, ringing in the ears, or a feeling of fullness
- Achievement at school does not match their apparent ability
- Seems fatigued or irritable after school, which can result from the effort of straining to hear all day
If you recognise any of these signs, the next step is a professional paediatric hearing assessment. Early identification makes a measurable difference. Research published in the journal Paediatrics found that children whose hearing loss was identified before six months of age had significantly better language outcomes than those identified later, regardless of the degree of hearing loss.
What Happens During a Paediatric Hearing Assessment
Understanding the process helps parents prepare their child and reduces anxiety on the day. A paediatric hearing assessment at a Melbourne clinic typically follows this structure.
Case History and Consultation
The audiologist begins by asking about your child's medical history, developmental milestones, and any concerns you have noticed. This includes questions about ear infections, family history of hearing loss, pregnancy and birth complications, and your child's speech and language progress. Be specific about what you have observed. Details like whether your child responds better to one parent's voice than the other, or whether they hear the TV but not your instructions, help the audiologist tailor the assessment.
Physical Examination of the Ears
The audiologist examines your child's ears using an otoscope to check for wax buildup, signs of infection, or structural issues with the eardrum and ear canal. Tympanometry may also be performed. This test measures how the eardrum moves in response to changes in air pressure, which reveals whether there is fluid in the middle ear. Middle ear fluid is one of the most common causes of temporary hearing loss in young children and is easily treatable once identified.
Hearing Testing
The audiologist selects the appropriate testing method based on your child's age and developmental level, as described in the section above. Testing takes place in a sound-treated room. For younger children, one parent usually stays in the room. The audiologist guides you and your child through each step. The entire testing session generally takes between 30 and 60 minutes, depending on the methods used and your child's cooperation.
Results and Discussion
Results are available immediately after the assessment. The audiologist explains what the results mean in clear terms, discusses whether any hearing loss was detected, and outlines recommended next steps. If treatment or further evaluation is needed, the audiologist provides a clear plan. This may include referral to an ear, nose, and throat specialist, a recommendation for hearing devices, or a schedule for monitoring and follow-up testing.
Treatment Options for Childhood Hearing Loss
Treatment for childhood hearing loss depends on the type, severity, and cause. The most common forms of hearing loss in children fall into two categories.
Conductive Hearing Loss
Conductive hearing loss occurs when sound cannot pass efficiently through the outer or middle ear. In children, the most common cause is otitis media with effusion, also known as glue ear, where fluid builds up in the middle ear space. Other causes include earwax blockage, structural abnormalities, or damage to the eardrum. Conductive hearing loss is often temporary and treatable. Treatment options include watchful waiting with regular monitoring, medication to clear infections, or the surgical insertion of ventilation tubes, known as grommets, to drain fluid and restore normal hearing. Most children with conductive hearing loss recover fully with appropriate treatment.
Sensorineural Hearing Loss
Sensorineural hearing loss results from damage to the cochlea or the auditory nerve and is permanent. Causes include genetic factors, certain infections during pregnancy, complications at birth, and exposure to loud noise. Treatment focuses on maximising the hearing that remains and supporting communication development. Options include hearing aids fitted specifically for children, which are adjusted as the child grows, and in cases of severe to profound hearing loss, cochlear implants. Early intervention services, including speech therapy and educational support, play a critical role alongside these devices. Children who receive hearing aids or cochlear implants before 12 months of age consistently demonstrate stronger language development than those fitted later, according to research from the National Acoustic Laboratories.
Ongoing Monitoring
Children with diagnosed hearing loss need regular monitoring throughout their development. Hearing can change as a child grows, and hearing device settings need adjustment accordingly. Your audiologist will recommend a monitoring schedule based on your child's specific needs. This ongoing care is essential for ensuring that treatment remains effective and that your child continues to meet developmental milestones.
Frequently Asked Questions
At what age should a child have a hearing test?
Children should have their first hearing screening within days of birth through the Australian Universal Newborn Hearing Screening Program. Follow-up testing should occur at 12 months, before starting school around age 4 to 5, and at any point if you notice signs of hearing difficulty. The Australian Department of Health recommends hearing checks at key developmental milestones throughout childhood.
How do audiologists test hearing in babies and toddlers?
Audiologists use age-appropriate methods. For newborns, Otoacoustic Emissions testing measures inner ear responses to sound. For babies under 6 months, Auditory Brainstem Response testing detects brain wave activity in response to sounds while the baby sleeps. For toddlers aged 6 months to 2.5 years, Visual Reinforcement Audiometry teaches the child to turn toward a sound source to activate a visual reward like a moving toy.
What are the signs of hearing loss in children?
Signs vary by age. In babies, watch for not startling at loud sounds or not babbling by 12 months. In toddlers, delayed speech, not responding when called, or turning up the TV volume are warning signs. School-age children may struggle to follow instructions, frequently ask for repetition, or fall behind in class. Persistent ear infections and complaints of ear pain also warrant a hearing assessment.
Is a children's hearing test covered in Australia?
The Australian Universal Newborn Hearing Screening Program provides free hearing screening for all newborns. Additional testing through Hearing Australia is available for eligible children. Private audiology clinics also offer paediatric hearing assessments. Speak with your audiologist about available options for your child's hearing care.
Works Cited
Australian Institute of Health and Welfare. "Ear and Hearing Health of Children and Young People." AIHW, Australian Government, 2024, aihw.gov.au/reports/children-youth/ear-and-hearing-health.
Hearing Australia. "Children's Hearing Services." Australian Government, 2024, hearing.com.au/services/children.
Kennedy, C. R., et al. "Language Outcome After Early Versus Late Diagnosis of Permanent Childhood Hearing Impairment." Paediatrics, vol. 112, no. 3, 2003, pp. 549-556.
National Acoustic Laboratories. "Longitudinal Outcomes of Children with Hearing Impairment." NAL, Australian Government, 2023, nal.gov.au.
Wake, M., et al. "Hearing Impairment: A Population Study of Australian Children." The Medical Journal of Australia, vol. 184, no. 2, 2006, pp. 69-72.