The child's journey, step by step
Hearing assessment in a child is a sequence, and the test changes as the child grows. The newborn screen finds the baby who needs a diagnostic test; the diagnostic ABR gives an ear-specific hearing level in the first weeks of life; behavioural tests take over as the child can respond, and by school age a standard audiogram is possible.
1. Newborn screen (first weeks): automated tests in the first 4 to 5 weeks. A clear response discharges the baby; no clear response sends the baby for a diagnostic ABR.
2. Diagnostic ABR (by 3 months): the test that gives an ear-specific, frequency-specific hearing level in a sleeping baby. It confirms or excludes permanent loss and identifies auditory neuropathy.
3. Behavioural tests (from about 6 months): visual reinforcement audiometry once the baby can sit and turn to sound, play audiometry from about 2 to 5 years, pure-tone audiometry from about 5 years. The test is chosen by what the child can do, not by birthday.
4. Middle ear tests at every stage: otoscopy and tympanometry, because glue ear is the commonest reason a child fails a hearing test.
5. Report and act: name the type, degree and which ear, say how reliable the result is, and start aetiology and hearing aids in parallel when permanent loss is confirmed.