Child hearing screening: when it is done, the tests, and what a refer result means
About 2 or 3 in every 1,000 children in the United States are born with detectable hearing loss, and more lose hearing later in childhood. (NIDCD, 2024) Hearing loss can delay a child's ability to talk, understand spoken language and develop social skills, which is why MedlinePlus says to check for it as soon as possible. (MedlinePlus, hearing tests for children) This page covers the checks after the newborn period; the first test is on newborn screening results.
When children are screened
The American Academy of Pediatrics (AAP) Bright Futures schedule, updated February 2025, and MedlinePlus list these hearing checks: (AAP Bright Futures, 2025) (MedlinePlus, hearing tests for children)
| Age | What is done |
|---|---|
| Newborn | AAP: hearing screen. Screening by 1 month of age; see newborn screening results for that test. (AAP Bright Futures, 2025) (MedlinePlus, hearing tests for children) |
| 3 to 5 days | AAP: verify the newborn hearing results as soon as possible and follow up as appropriate. (AAP Bright Futures, 2025) |
| 1 month to 3 years | AAP: hearing risk assessment at each well-child visit from 4 months; none is listed at the 1 and 2 month visits. (AAP Bright Futures, 2025) |
| By 3 months, after a newborn screen that was not passed | Complete hearing tests (MedlinePlus); NIDCD says ideally by 2 to 3 months. (MedlinePlus, hearing tests for children) (NIDCD, 2024) |
| 24 to 30 months, after a passed newborn screen with high risk | Complete hearing tests. (MedlinePlus, hearing tests for children) |
| Before school | MedlinePlus: children should have their hearing checked before they enter school. NHS: some children have a hearing test when they start primary school, depending on where they live. (MedlinePlus, hearing tests for children) (NHS, hearing tests) |
| 4, 5, 6, 8 and 10 years | AAP: hearing screen; a risk assessment at 7 and 9. (AAP Bright Futures, 2025) |
| 11 to 14, 15 to 17 and 18 to 21 years | AAP: screen once in each age range with audiometry that includes the high frequencies 6,000 and 8,000 Hz. (AAP Bright Futures, 2025) |
Every U.S. state has an Early Hearing Detection and Intervention program, and about 98% of babies have their hearing screened before 1 month of age. (NIDCD, 2024) If your baby was not tested within 1 month of birth, or you have not been told the results, NIDCD says to ask your child's doctor. (NIDCD, 2024) NIDCD's timeline is screening by 1 month, a follow-up exam with a pediatric audiologist by 3 months at the latest for a baby who did not pass, and, if hearing loss is confirmed, intervention starting no later than 6 months. (NIDCD, 2024) All visits are on well-child checkup screenings by age.
The tests, in general terms
Which tests are used depends on the child's age and ability to follow instructions. (MedlinePlus, hearing tests for children)
- Otoacoustic emissions (OAE): a small device placed in the ear makes sounds that set off tiny vibrations from the hair cells in the inner ear, and measures them. Little or no response may point to sensorineural hearing loss. It does not need the child's cooperation and can be done while the child sleeps. (MedlinePlus, hearing tests for children)
- Auditory brainstem response (ABR): sensors on the scalp measure how the brain responds to sounds played through soft earphones. (MedlinePlus, hearing tests for children)
- Play and visual reinforcement audiometry: a young child does a simple task, such as putting a block in a box, each time they hear a sound; with infants and toddlers, the tester watches for a response such as turning toward the sound, sometimes rewarded with a toy or a screen lighting up. (MedlinePlus, hearing tests for children) (NHS, hearing tests)
- Pure-tone audiometry: the usual screening test for older children. The child wears headphones, or listens through speakers in a sound booth, and raises a hand, pushes a button or says when they hear a tone. A speech test has the child repeat words heard at different loudness levels. (MedlinePlus, hearing tests for children)
- Tympanometry: a small device in the ear sends air and sound in to make the eardrum move, and the child feels the air pressure. If the eardrum does not move normally, there may be fluid or wax in the ear, a hole in the eardrum, middle ear bones that do not vibrate well, or another problem. (MedlinePlus, hearing tests for children)
MedlinePlus says there are no special preparations and no risk. (MedlinePlus, hearing tests for children) In the NHS, results are usually given at the end of the appointment. (NHS, hearing tests) For how an audiogram is read, see hearing test: what to expect.
What pass and refer mean
- Pass: if a screening test shows normal hearing, a child usually will not need more hearing tests until the next routine screening. With concerns or risk factors, MedlinePlus says to talk with the provider about more complete tests. (MedlinePlus, hearing tests for children)
- Refer, or did not pass: screening tests cannot diagnose anything on their own; they only show if a child needs more testing. More complete tests can then diagnose hearing problems, and the child is likely to be referred to a pediatric audiologist or a pediatric ear, nose and throat doctor. (MedlinePlus, hearing tests for children)
- What complete tests show: how severe any hearing loss is, which ear is affected more, and whether it is conductive (sound cannot reach the inner ear, for example because of earwax or fluid), sensorineural (damage to the inner ear or hearing nerve), or both. (MedlinePlus, hearing tests for children)
- A pass is not the end: some hearing loss can develop later or get worse, so new concerns should be discussed with a provider even after a normal test. (MedlinePlus, hearing tests for children)
Risk factors and signs
MedlinePlus lists these risk factors for hearing loss in infants and children: (MedlinePlus, hearing loss in infants) (MedlinePlus, hearing tests for children)
- Family history of hearing loss, and low birth weight. (MedlinePlus, hearing loss in infants)
- Infections passed to the baby in the womb (such as cytomegalovirus, toxoplasmosis, syphilis, rubella or herpes simplex), and infections after birth that can damage the brain, such as meningitis or measles. (MedlinePlus, hearing loss in infants)
- Genetic disorders, problems with the structure of the ear, and exposure to certain toxic chemicals or medicines in the womb or after birth. (MedlinePlus, hearing loss in infants)
- Ear infections, which are a common cause of conductive hearing loss in infants and young children. (MedlinePlus, hearing tests for children)
- Premature birth, low birth weight and jaundice, linked to auditory neuropathy spectrum disorder. (MedlinePlus, hearing tests for children)
If your child has risk factors, NIDCD says to ask an audiologist how often their hearing should be monitored. (NIDCD, 2024) Signs MedlinePlus lists in babies are not being startled by loud noises, not turning toward a sound after 6 months, and not saying simple words such as "dada" or "mama" by 12 months; in children, unclear speech, not following directions, often saying "Huh?" or "What?", turning the TV volume up too high, and learning problems. (MedlinePlus, hearing tests for children) Some children are not diagnosed until they are in school, and inattention and falling behind in class work may be signs. (MedlinePlus, hearing loss in infants)
MedlinePlus, when to contact a medical professional:
"Contact your child's provider if your baby or young child displays signs of hearing loss, such as not reacting to loud noises, not making or mimicking noises, or not speaking at the expected age.
If your child has a cochlear implant, contact the provider right away if your child develops a fever, stiff neck, headache, or an ear infection." (MedlinePlus, hearing loss in infants)
The NHS says to ask for an urgent GP appointment or get help from NHS 111 for sudden hearing loss in 1 or both ears, hearing that has got worse over the last few days or weeks, or hearing loss with other symptoms such as earache or discharge from the ear. (NHS, hearing tests)
Where they differ:
- AAP: hearing screens at 4, 5, 6, 8 and 10 years and once in each of the ranges 11 to 14, 15 to 17 and 18 to 21, with high frequencies in the teen checks. (AAP Bright Futures, 2025)
- USPSTF: no current statement for children. Its newborn hearing topic is marked inactive and will not be updated, and its 2021 statement covers adults 50 and older. (USPSTF, newborns (inactive)) (USPSTF, 2021)
- UK: after its April 2019 review, the UK National Screening Committee recommends school-entry hearing screening only where it is already in place, while more research is done. School-age screening continues in many, but not all, parts of the country. (UK NSC, 2019) The NHS says children may also have a hearing test as part of their health and development reviews. (NHS, hearing tests)
Your doctor decides what your result means for you.
This page does not give treatment advice, including on hearing aids, implants or other devices. If your child has a refer result, see after an abnormal screening result for questions to ask.
Questions people ask
At what ages should a child have a hearing screening?
The AAP schedule lists a hearing screen at birth, at 4, 5, 6, 8 and 10 years, and once each between 11 and 14, 15 and 17, and 18 and 21, with a risk assessment at the other well-child visits. MedlinePlus says children should have their hearing checked before they enter school. (AAP Bright Futures, 2025) (MedlinePlus, hearing tests for children)
What does it mean if my child did not pass a hearing screening?
It means more testing is needed, not that your child has hearing loss. MedlinePlus says screening tests cannot diagnose anything on their own; they only show if your child needs more testing. A more complete set of tests can then diagnose hearing problems. (MedlinePlus, hearing tests for children)
My child passed the newborn hearing screen. Can hearing loss still develop?
Yes. Hearing loss can develop in children who had normal hearing as infants, and NIDCD says more children lose hearing later in childhood. MedlinePlus says new concerns should be discussed with a provider even after a normal test. (MedlinePlus, hearing loss in infants) (NIDCD, 2024) (MedlinePlus, hearing tests for children)
Does a hearing test hurt or need preparation?
MedlinePlus says there are no special preparations and no risk. It suggests telling your child they will hear sounds, and letting them try on headphones if you have a pair. (MedlinePlus, hearing tests for children)
Does the USPSTF recommend hearing screening for children?
The USPSTF has no current statement on it. Its newborn hearing topic is marked inactive, and its 2021 hearing statement covers adults 50 and older. (USPSTF, newborns (inactive)) (USPSTF, 2021)