Hearing Tests for Babies: What Parents Need to Know

The Newborn Hearing Screening Programme: Your Baby's First Hearing Check

Every baby born in England is offered a hearing screening test within the first few weeks of life as part of the Newborn Hearing Screening Programme (NHSP). This programme, commissioned by NHS England, screens around 670,000 newborns each year and is one of the most successful public health initiatives in the country — identifying around 1,000 babies with permanent hearing loss annually.

Hearing loss is one of the most common conditions present at birth, affecting approximately 1 in 1,000 babies in the UK. When it is detected early — ideally before three months of age — children can receive support and intervention during the critical window when the brain is developing its language and communication pathways. Without early identification, hearing loss can significantly affect speech development, literacy, and emotional wellbeing.

The NHSP is typically offered before you leave the maternity unit, or shortly after at a community clinic. It is completely free, painless, and takes only a matter of minutes. As a parent, understanding what happens during these tests — and what comes next — can make the experience feel far less daunting.

The AOAE Test: Automated Otoacoustic Emissions

The first test used in the newborn screening programme is the Automated Otoacoustic Emissions (AOAE) test. This is a quick, non-invasive test that checks how well the inner ear (cochlea) is responding to sound. You can read more about the full diagnostic version of this test on our otoacoustic emissions test page.

During the AOAE test, a soft silicone earpiece is gently placed in your baby's outer ear. A series of quiet clicking sounds are played through the earpiece, and a microphone within it picks up the tiny sounds — called otoacoustic emissions — that a healthy cochlea produces in response. The whole process takes just a few minutes per ear.

The result is either a clear response or no clear response:

• Clear response: The inner ear is responding as expected. No further hearing tests are needed at this stage.
• No clear response: This does not necessarily mean your baby has a hearing loss. Fluid in the ear canal after birth, a noisy environment, or your baby moving or crying can all affect the result. A second screening step will be offered.

It is important not to panic if your baby does not get a clear response on the first attempt. Around 3 in every 100 babies will need further testing, and the vast majority of these will go on to have normal hearing.

The AABR Test: Automated Auditory Brainstem Response

If your baby does not get a clear result from the AOAE test — or if the test cannot be completed — they will be offered an Automated Auditory Brainstem Response (AABR) test. This test is also used as the primary method for babies who have spent time in a neonatal intensive care unit (NICU), as they are at a slightly higher risk of a specific type of hearing loss that the AOAE may not detect.

The AABR test measures how the auditory nerve and brainstem respond to sound. Small sensors are placed on your baby's head and neck, and soft headphones are placed over their ears. Gentle clicking sounds are played, and the sensors pick up the brainwave responses. Your baby needs to be settled and still — ideally sleeping — for the best result, so it is often carried out after a feed.

Again, the result is reported as clear response or no clear response. If there is no clear response in one or both ears following the AABR test, your baby will be referred to a specialist audiology centre for a full diagnostic assessment. This is not a cause for immediate alarm — it simply means more detailed testing is needed to understand your baby's hearing clearly.

Understanding Your Baby's Screening Results

The language used in hearing screening can feel confusing at first. Here is a straightforward guide to what each outcome means and what happens next.

• Clear response in both ears: Your baby's hearing has responded normally during screening. Continue to monitor their hearing development as they grow (see the milestones section below).
• No clear response in one ear: Your baby has been referred for a diagnostic assessment on that ear. Many babies with this result will turn out to have normal hearing once the more detailed assessment is completed.
• No clear response in both ears: A referral to a specialist audiology centre will be made as a priority. Assessments are usually completed within four weeks of the referral.
• Incomplete screening: If testing could not be completed — for example because your baby was unsettled — you will be offered another appointment.

If your baby is referred for further assessment, you may be seen at an NHS audiology department or a specialist children's hearing clinic. Tests at this stage are more detailed and may include tympanometry (to check middle ear function) and bone conduction tests (to identify whether any hearing loss is conductive, sensorineural, or mixed). These tests are all safe, non-invasive, and adapted to work with very young babies.

The NHS hearing services guide provides a broader overview of what support is available through the NHS, including specialist paediatric audiology.

Health Visitor Checks and Ongoing Monitoring

The newborn screening programme is just the beginning of your child's hearing health journey. Your health visitor plays an important role in monitoring your baby's development, including their hearing and communication, throughout the first few years of life.

As part of the Healthy Child Programme in England, children are offered a series of development reviews. The two-year developmental review (usually between 24 and 30 months) includes checks on communication and language development that can flag potential hearing concerns. In Scotland, a 27–30 month review serves a similar purpose.

If at any point your health visitor has concerns about your child's hearing or speech, they can refer them for a formal hearing assessment. You do not need to wait for a scheduled review — if you are worried, raise it at any contact with your health visitor or GP. Parents often notice hearing difficulties before professionals do, and your concerns should always be taken seriously.

It is worth noting that glue ear — a build-up of fluid in the middle ear — is extremely common in young children and can cause temporary, fluctuating hearing loss. It affects around 8 in 10 children at some point before they start school. Glue ear often resolves on its own, but in persistent cases it can affect speech and language development and may require treatment.

Developmental Milestones: What to Listen and Watch For

Even if your baby passed their newborn hearing screening, it is important to continue monitoring their hearing and communication development as they grow. Some types of hearing loss — including that caused by glue ear or progressive genetic conditions — may not be present at birth but can develop over time. For a detailed overview of what to expect at each stage, see our guide to children's hearing development.

Here is a general guide to the milestones most babies reach:

• 0–3 months: Startles at loud sounds; is soothed or awakened by your voice; begins to recognise familiar sounds.
• 3–6 months: Turns eyes or head towards sounds; responds to changes in your tone of voice; begins babbling and making a range of vowel sounds.
• 6–9 months: Turns towards sounds from across the room; responds to their own name; babbling becomes more varied and rhythmic.
• 9–12 months: Imitates sounds; understands simple words like "no" and "bye-bye"; produces a wider range of consonant sounds.
• 12–18 months: Uses a few single words with meaning; points to familiar objects when named; follows simple instructions.
• 18–24 months: Vocabulary growing to around 50 words; starting to combine two words; clearly understands more than they can say.
• 2–3 years: Uses short sentences; can be understood by familiar adults most of the time; follows two-step instructions.

Missing multiple milestones, or a regression in skills already achieved, warrants a prompt referral for a hearing assessment. Trust your instincts as a parent — you know your child best.

Signs That Your Baby or Toddler May Have a Hearing Problem

Between formal checks, there are signs you can watch and listen for at home. It is not always easy to spot hearing difficulties in young children — they are often very good at picking up visual cues and adapting to their environment — but the following can be indicators that a hearing assessment is needed:

• Does not startle at sudden loud noises
• Does not respond when you call their name from behind them (without visual cues)
• Frequently says "what?" or asks for things to be repeated
• Seems to hear some sounds but not others
• Turns the television up very loud or sits very close to it
• Speech development is delayed or difficult to understand compared to peers
• Seems inattentive or easily distracted — especially in noisy environments
• Pulls at or rubs one or both ears (which can also indicate ear infections)
• Appears to hear better on some days than others (a hallmark of glue ear)

If you notice any of these signs, speak to your GP or health visitor promptly. A referral for a hearing assessment can usually be arranged quickly through the NHS, and early investigation is always the right approach. There is no such thing as being "too cautious" when it comes to your child's hearing and speech development.

The Importance of Early Intervention

If your baby or child is diagnosed with hearing loss, it can feel overwhelming at first. But one of the most important things to understand is that early identification leads to significantly better outcomes. Research consistently shows that children whose hearing loss is identified and supported before six months of age develop language skills much closer to those of their hearing peers than children identified later.

Early intervention can take many forms depending on the type and degree of hearing loss:

• Hearing aids: Even very young babies can be fitted with hearing aids. Modern devices are small, powerful, and designed specifically for paediatric use. Your audiologist will guide you through the options. Our guide to choosing hearing aids is a helpful starting point for families navigating this decision.
• Cochlear implants: For children with profound sensorineural hearing loss who do not benefit sufficiently from hearing aids, cochlear implants may be considered — often from as young as nine months. NHS criteria apply, and specialist teams will assess suitability.
• Communication support: Speech and language therapy, signing (such as British Sign Language or Makaton), and specialist early years support through programmes like the National Deaf Children's Society's Family Support service can all play a vital role.
• Grommets: For children with persistent glue ear affecting development, surgical insertion of small tubes (grommets) to drain fluid from the middle ear may be recommended. This is one of the most common surgical procedures carried out on children in the UK.

Providers such as Boots Hearingcare, Specsavers Audiology, and Hidden Hearing offer paediatric hearing assessments and can work alongside NHS services. Our guide on how often to have a hearing test can also help you plan appropriate follow-up for your child.

For families navigating a new diagnosis, the National Deaf Children's Society (NDCS) provides outstanding resources, a helpline, and peer support networks. The RNID (formerly Action on Hearing Loss) is another valuable source of information and advocacy in the UK.

Remember: a hearing diagnosis is the beginning of a journey, not the end of one. With the right support in place early, children with hearing loss grow up to thrive — academically, socially, and emotionally. The first step is always knowing what to look for, and asking for help when something does not feel right. You are already doing that.