Hearing tests for children

A newborn baby's eyes are checked for signs of abnormalities, such as congenital cataracts.


A newborn baby's eyes are checked for signs of abnormalities, such as congenital cataracts. Their hearing will also be tested at birth and several times during their early development.

Although serious hearing and vision problems during childhood are rare, early testing ensures that any problems are picked up and treated as early as possible.

It is important that hearing problems are identified early because a child's hearing is directly connected to their speech and language development. Their ability to see also helps with their social and educational development.

Routine hearing tests

Shortly after your baby is born, they will have their hearing tested . The test may be carried out before you leave the maternity unit.

If there is no reason for concern after the hearing test, you will be given a checklist to help monitor your child's hearing development. It outlines the sounds that babies normally make and the sounds that they should respond to as they grow older.

A baby’s hearing should develop in the following way over the first year of life:

  • from birth: jumps at loud noises
  • 1 month: starts to notice sudden and prolonged sounds
  • 4 months: shows excitement at sounds and smiles in response to the sound of a familiar voice
  • 7-9 months: babbles, gurgles and coos and turns to a familiar voice across a room or to very quiet noises made on each side
  • 12 months: responds to certain words, such as their name

If your baby doesn't pass the hearing screening test, they will be referred to an audiologist (a hearing specialist) for further tests.

Visit your doctor if you have any concerns about your child's hearing at any stage of their development.

Read more information about how newborn hearing screening tests are performed.

Routine eye tests

Your baby's eyes will be examined within 72 hours after they are born.

They will have their second eye examination when they are six-to-eight weeks old, which will usually be carried out by your doctor. Your child's vision will also be tested before they start school at around four-to-five years old.

A child’s vision should develop in the following way over the first year of life:

  • 6 weeks old: follows a colourful or interesting object, such as a face, with their eyes
  • 2-3 months old: starts to reach for things they see
  • 3-5 months old: starts to mimic facial expressions and look at objects more closely
  • 6-12 months old: focuses on objects that are both near and far away, sees simple shapes, scribbles with a crayon and is interested in pictures

When to seek medical advice

If for any reason your baby's hearing is not tested soon after they are born, ask your midwife, health visitor or doctor to arrange an appointment for you.

If you think there may be a problem with your baby's hearing or eyesight, mention it to the healthcare professional carrying out the screening tests.

In older children, signs of a possible hearing problem include the following:

  • inattentiveness
  • talking loudly and listening to the television at a high volume
  • mispronouncing words
  • being unsettled at school

Your child may have a temporary problem with their hearing, such as a cold or glue ear (a build-up of fluid in the ear), or they could have a hearing impairment or be developing one.

Signs of a possible vision problem include:

  • erratic eye movements
  • not turning towards the source of sounds (also a sign of hearing impairment)
  • poking or rubbing their eyes
  • not making eye contact

Your child might have a problem with their vision, such as short-sightedness (myopia), long-sightedness (hyperopia), a lazy eye (amblyopia) or a squint (where the eyes look in different directions).

Read more about why hearing and vision tests are necessary for your child.

How is it performed

There are several tests that may be used to check your child's hearing and vision.

Hearing tests

Newborn babies are usually screened for any potential hearing problems using two quick and painless tests. They are the:

  • automated otoacoustic emissions test (AOE)
  • automated auditory brainstem response test (AABR)

These are outlined below.

AOE test

An AOE test only takes a few minutes and can be carried out while your baby is asleep. A tiny earpiece will be placed in your baby's ear and quiet clicking sounds will be played through it.

If your baby's ear is working normally, reaction sounds (echoes) should be produced in a part of the ear known as the cochlea. A computer is used to record and analyse the reaction sounds.

Sometimes, the results from an AOE test are not clear. In such cases, the test may be carried out again, or an AABR test can be used.

It's common for babies to have a second screening hearing test. This doesn't necessarily mean they have hearing loss. It may be because your baby was unsettled during the first test due to background noise or they may have a temporary blockage in their ear.

AABR test

During an AABR test, three small sensors will be placed on your baby's head and neck. Soft headphones will be put over your baby’s ears and quiet clicking sounds will be played through them. A computer will then be used to analyse how well your baby’s ears respond to the sound.

Other hearing tests are described below.

Visual reinforcement audiometry

During visual reinforcement audiometry (VRA), your baby will sit on your lap while sounds are played through speakers. If your baby turns towards the sound, a toy will be lit up as a reward.

The loudness and pitch of the sound will be varied to determine the quietest sound level your baby is able to hear at each pitch. This test is also carried out using tiny ear phones in your child’s ears so that each ear can be tested separately.

Play audiometry

Here, the child performs a simple task in response to a sound to show the tester that they have heard it. The sound can either be played through a speaker or an earphone.

The tests described below may be carried out if a problem with your child’s hearing is suspected.

Pure tone audiometry

During pure tone audiometry, a machine called an audiometer generates sounds at different volumes and frequencies.

Sounds are played through headphones and the child is asked to respond when they hear them – for example, by pressing a button. By decreasing the level of the sound, the tester can work out the quietest sounds that the child can hear.

Pure tone audiometry is only usually used for children who are over the age of four. It is often used to screen a child’s hearing before they start school.

Speech perception test

The speech perception test assesses a child’s ability to recognise words that they hear without being able to see a person move their lips.

Words can be played through headphones or through a speaker, or a person may say them directly to the child without showing their lips. The child will be asked to identify the words by picking out matching pictures or words on a list.


Tympanometry is a test that shows how flexible the eardrum is. For good hearing, your eardrum needs to be flexible to allow sound to pass through it.

If the eardrum is too rigid – for example, because there is fluid behind it – sounds will bounce back off the eardrum instead of passing through it.

During the test, a small tube with a soft rubber tip will be placed at the entrance of your child's ear. The tube measures the sound that is bounced back from the ear.

If most of the sound is bounced back, it will indicate to the tester that your child's eardrum is rigid and that they may have a condition called glue ear (where fluid builds up inside the ear).

Vision tests

The eyes of newborn babies are checked for any obvious physical defects, including squints (where the eyes look in different directions), cloudiness (a possible sign of childhood cataracts) and redness.

Some of the tests that may be carried out are described below.

The pupil reflex test

The pupil reflex test involves shining a light into each of your baby’s eyes from a distance of 10cm to check the reflex of their pupils to light.

Your baby’s pupils should automatically shrink in response to the brightness of the light. If they don't, it suggests there is something affecting the reflex response of their pupils.

The red reflex test

The red reflex test involves using an instrument called an ophthalmoscope, which magnifies images and has a light at one end of it.

When light is shone into your baby's eyes, a red reflection should be seen as it is reflected back. If a white reflection is seen, it could be a sign of an eye condition such as cataracts. In this case, your baby will be referred to a specialist.

Attention to visual objects

This is a simple test to check whether a newborn baby pays attention to visual objects. A midwife or doctor will try to catch your baby's attention with an interesting object. They then move it to see if the child's eyes follow.

The rolling ball test

In older babies and toddlers of around two years of age, the focus and sharpness of their eyesight can be checked using the rolling ball test.

A number of different sized white balls are rolled across the floor and the tester checks whether the baby notices them. It shows the range of vision and how small an object your baby can spot.

Another simple test is to use small blocks or tiny objects like buttons to find out whether a child can see them and reaches for them. Each eye can be tested separately by covering the other one with a patch.

Snellen and LogMAR charts

After the age of six, charts that have rows of letters and numbers of decreasing sizes can be positioned at a distance of several metres. Your child will be asked to read out as many of the letters as they can see. These charts are called Snellen or logMAR charts.

Range of movement tests

To test the range of movement of each eye, a child's attention will be drawn to an interesting object, which is then moved to eight different positions: up, down, left, right, and halfway between each of these points.

The test involves checking how well each eye follows the object and how far the movement of the eye stretches in each direction.

Colour-blindness test

Colour blindness tests, also known as colour vision deficiency tests, are usually carried out at secondary school age if a problem is suspected.

Ishihara colour vision tests use images that are made up of dots in two different colours. If a child's colour vision is normal, they will be able to recognise a letter or number within the image.

A child who can't tell the difference between two colours won't be able to see the number or letter, which means that they may have a colour vision problem.

Why it is necessary

It is very important for a child's hearing and eyesight to be tested several times when they're young so that any problems can be picked up and treated early on.

If testing identifies a condition that is affecting your child's hearing or vision, your doctor may be able to monitor and treat it.

Alternatively, your child may be referred to a hearing or eye specialist who will be able to provide equipment, such as glasses or a hearing aid, to help improve their hearing or vision.

Read more information about the different types of hearing and eye specialists.

Diagnosing a hearing or vision problem early will also ensure that you and your child have access to any special learning support services that are needed.


Routine hearing tests check whether a child's hearing is within the normal range of volume and pitch.

Recognising hearing problems

A baby’s hearing should develop gradually during the first year of his or her life.

When a baby is about one month old, they will notice sounds and may turn towards the source of the noise. At around four months, they will be excited at hearing sounds and smile in response to the sound of a familiar voice.

At around seven months old, a baby will turn to a familiar voice across a room or to very quiet noises made on each side. At around 12 months, they will respond to certain words, such as their name.

In older children, the symptoms of hearing loss may include:

  • inattentiveness
  • talking loudly and listening to the television at a high volume
  • mispronouncing words
  • being unsettled at school

Talk to your doctor if you think that your child’s hearing is not developing normally. They may have a hearing impairment or be developing one, or they may have a temporary hearing problem, such as reduced hearing that is caused by a cold.

Other possible causes of hearing impairment include:

  • glue ear: a build-up of fluid in the middle ear which is common in young children
  • infections that develop in the womb or at birth, such as rubella or cytomegalovirus, which can cause progressive hearing loss
  • inherited conditions, such as otosclerosis, which stop the ears or nerves from working properly
  • damage to the cochlear or auditory nerves (which transmit hearing signals to the brain); this could be caused by a severe head injury, exposure to loud noise or other factors, such as head surgery
  • being starved of oxygen at birth (birth asphyxia), or having had severe jaundice (yellowing of the skin caused by a build-up in the blood of a substance called bilirubin)
  • illnesses, such as meningitis and encephalitis (which both involve swelling in the brain)


Routine eye tests check whether there is any visible defect or deformity in the eyes, such as a cataract (cloudy patches in the lens of the eye), lazy eye (amblyopia) or squint (where the eyes look in different directions).

The tests also check that the child can follow movement in the normal field of vision by looking up, down and side to side, as well as checking for short-sightedness (myopia) and long-sightedness (hyperopia).

Children of secondary-school age may also be tested for colour blindness (difficulty seeing colours or distinguishing between two different colours).

Recognising vision problems

Young children don't always realise that they have a problem with their vision, so it is important to be aware of signs that may indicate this. Signs of a possible vision problem include:

  • erratic eye movements
  • not turning towards the source of sounds (also a sign of hearing impairment)
  • poking or rubbing their eyes
  • not making eye contact

In older children, the symptoms of a vision problem may also include the following:

  • regular headaches
  • sitting very close to the television
  • poor attention at school
  • reading difficulties

Possible causes of vision problems in babies and children include the following:

  • long- or short-sightedness (which are usually inherited)
  • astigmatism, where the cornea (the transparent layer at the front of the eye) is not perfectly curved or choroidoretinal degeneration (where part of the eye gradually stops working properly)
  • damage to the optic nerve (optic atrophy)
  • a tumour or growth that presses on the sight centre of the brain and affects vision
  • cataracts that are present at birth (congenital)
  • problems related to premature birth, where the eyes have not had time to develop fully

After vision problems have been detected, treatment and educational support can be given. The earlier this happens, the better because untreated vision problems can often get worse.

Content supplied by NHS Choices