From newborn to toddler - Pediatric hearing assessment essentials

Newborn hearing screening is a critical first step in ensuring hearing ability, but it doesn’t stop there. It forms part of a more holistic approach required to support childhood hearing health. Some children pass their initial screening but develop hearing loss later on due to genetic conditions, infections, or middle ear conditions. Others may need follow-up testing after a "refer" result.

In this article we examine the most common causes of pediatric hearing loss, the different types of hearing assessments available, and why accessible, ongoing screening remains essential to support optimal development and wellbeing.

Types of hearing loss

Hearing loss is generally categorized as one of the following:

• Conductive hearing loss (CHL)
• Sensorineural hearing loss (SNHL)
• Mixed hearing loss

Possible causes of pediatric hearing loss

1. Conductive Hearing Loss (CHL)

CHL occurs when sound is blocked from going through the outer- or middle ear. Common causes include middle ear fluid, earwax buildup, eardrum perforation, or congenital malformations of the outer or middle ear.

2. Sensorineural Hearing Loss (SNHL)

SNHL occurs when there is damage to the inner ear, or the nerves that travel from the cochlea (inner ear hearing organ) to the brain. Common causes include – but aren’t limited to – age, noise, genetics, infections (e.g. meningitis or cytomegalovirus), ototoxic medications, or Meniere’s disease.

3. Mixed hearing loss

Mixed hearing loss occurs when there is both a Conductive- and Sensorineural Hearing loss. This means there may be damage to the outer or middle ear and nerve pathway to the brain.

Why ongoing screening and monitoring are critical

Hearing loss can emerge or become noticeable after birth, which is why continued monitoring through hearing screening is so important.

The U.S. Centers for Disease Control and Prevention (CDC) recommends following the 1-3-6 guideline:

• Screen by 1 month

• Diagnose by 3 months

• Begin intervention by 6 months

Pediatric hearing assessments: Available options

As children grow, different hearing assessments are used depending on their age, developmental level, and medical history. Below is a table of the most commonly used pediatric hearing assessments:

Assessment type	Use cases
Otoacoustic Emissions (OAE) (O)	Assesses cochlear function by measuring sound waves produced by the inner ear in response to auditory stimuli.
Tympanometry (O)	Evaluates the movement of the eardrum and middle ear function, helping identify conductive hearing loss caused by fluid, earwax, or middle ear infections.
Auditory Brainstem Response (ABR) (O)	Often used when children are too young or unable to participate in behavioral testing. It measures the brainstem’s response to sound via electrodes.
Conventional audiometry* (B)	Assesses a child’s hearing sensitivity by presenting sounds through headphones at different frequencies and volumes. The child responds by raising their hand or pressing a button when they hear a sound.
Speech audiometry* (B)	Measures a child’s ability to hear and understand speech at different volumes. Speech is presented through headphones and the child may respond by pointing to pictures.
Visual Reinforcement Audiometry (VRA) (B)	VRA conditions a child to turn toward a sound source in response to auditory stimuli. When they respond correctly, they are rewarded with visual stimuli like lights or animated toys.
Conditioned Play Audiometry (CPA) (B)	Children are trained to perform a simple play task (e.g., drop a block in a bucket) in response to a sound. Different pitches of sound are used to get an indication of a child’s hearing profile.

(O) - Objective assessment - Doesn’t require an active response from the child.

(B) - Behavioral assessment - Requires the child to actively respond to sounds. Ideal to assess how well a child can hear in different environments and situations.

*Conducted as a supplementary to other evaluations and not conducted in isolation.

How early detection can enable better developmental outcomes

Hearing loss can affect a child’s ability to learn, communicate, and form social relationships. But when it’s identified early – and monitored regularly – children can thrive with the right support. Whether at birth, in preschool, or beyond, pediatric hearing screening is an essential part of lifelong hearing health.

The role of digital hearing screening technologies

Thanks to digital innovation, hearing screening is no longer limited to hospitals or conventional sound booths. Portable screening audiometers and OAE devices are enabling hearing care providers to identify hearing issues earlier and in a wider variety of settings – from schools and early childhood centers to clinics with limited resources.

By making pediatric hearing assessments more accessible, scalable, and affordable, these technological developments help to close gaps in follow-up care, reduce delays in intervention, and ultimately improve long-term outcomes for children.

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For parents:

Concerned about your child’s hearing?

Early detection can make all the difference. Speak to your pediatrician or hearing care provider about screening options. For more information, visit www.asha.org.

For hearing care professionals:

Looking to expand your pediatric screening capability?

Learn how the hearX product suite can help you conduct scalable assessments accurately, cost-effectively, without a sound booth. To find out more, email sales@hearxgroup.com.