Hearing and vision tests for children
Newborn babies and children are routinely checked for problems with their vision and hearing to identify any problems early on in their development.
Although serious hearing and vision problems during childhood are rare, early testing ensures that any problems are picked up and managed as early as possible.
It is important that hearing and vision problems are identified early because any problems can affect speech and language development, social skills and educational development.
Routine hearing tests
Shortly after your baby is born, they will have their hearing tested as part of the Newborn Hearing Screening Programme.
The screen will usually be carried out before you leave the maternity unit, although in certain areas it may be carried out at home.
If your baby doesn't pass the hearing screen, he or she will be referred to an audiologist (a hearing specialist) for further tests. 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
When your child is between two and two-and-a-half years old, they will usually have a general review of their health and development. This review will include checking your child’s hearing and speech development.
Most children will also have another routine hearing test when they start school at around four or five years old.
If for any reason your baby's hearing is not tested soon after they are born, ask your midwife, health visitor or GP 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.
You can visit your GP if you have any concerns about your child's hearing at any stage of their development.
Routine eye tests
Your baby's eyes will first be examined within 72 hours of birth. This simple examination is used to check for obvious physical defects.
They will have a second eye examination when they are between six and eight weeks old, which will usually be carried out by your GP.
Shortly before or after having a baby, all new mums are given a Personal Child Health Record (PCHR), which highlights developmental milestones for vision. 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
Your child’s vision may also be checked when they start school at around five years of age, but this varies depending on where you live.
Visit your GP or tell your health visitor if you have any concerns about your child's eyesight at any stage.
Signs of hearing and vision problems
Even though you child will have routine hearing and vision tests, it is still important for you to look out for signs of any problems and see your GP if you have any concerns.
In older children, signs of a possible hearing problem include the following:
talking loudly and listening to the television at a high volume
being unsettled at school
Signs of a possible vision problem in a child include:
not seeming to recognise familiar faces
erratic eye movements or squint (misalignment of the eyes)
poking or rubbing their eyes
not making eye contact
poor attention at school
Why hearing and vision tests for children are needed
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.
Treatment is likely to be more effective the earlier any problems are detected, and early treatment should limit the impact of problems on a child's development.
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.
Recognising hearing problems
About one or two in every 1,000 babies in the UK are born with some degree of hearing loss in one or both ears. About 840 are born every year with permanent hearing loss in both ears.
Routine hearing tests are needed to identify babies and children with hearing problems because these problems can have a significant, long-term impact on a child's development. For example, hearing problems can affect a child's speech and language development, education, confidence and social skills.
Hearing tests carried out soon after birth can usually help identify most babies with significant hearing loss, and testing later in childhood can pick up any problems that have been missed or have been slowly getting worse over time.
Causes of hearing loss in children
There are a number of reasons why a child may have a hearing problem, including temporary hearing loss from common illnesses such as a cold.
Other possible causes of hearing loss that can be detected during routine tests 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 rubellaor 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)
Recognising vision problems
About two or three in every 10,000 babies in the UK are born with an eye problem that requires treatment, and about one in every 14 children will need glasses.
Routine eye tests are necessary because children with vision problems may not realise it themselves and any problems are often much easier to treat if detected while a child's vision is still developing (usually up to about seven years of age).
Like hearing problems, vision problems can have a significant impact on a child's development and education.
Vision problems in children
Routine eye tests can detect a number of different vision problems in babies and children, including:
cataracts – cloudy patches in the lens of the eye that are present from birth (congenital)
lazy eye (amblyopia) – where the vision in one eye does not develop properly
squint (strabismus) – where the eyes look in different directions; this affects about one in every 30 children in the UK
short-sightedness (myopia) – a very common eye condition that causes distant objects to appear blurred, while close objects can be seen clearly
long-sightedness (hyperopia) – where you can see distant objects clearly, but nearby objects are out of focus
colour blindness – difficulty seeing colours or distinguishing between two different colours
astigmatism – where the cornea (the transparent layer at the front of the eye) is not perfectly curved
damage to the optic nerve (optic atrophy)
a tumour or growth that presses on the sight centre of the brain and affects vision
problems related to premature birth, where the eyes have not had time to develop fully
How hearing and vision tests are performed
There are several tests that may be used to check your child's hearing and vision.
Newborn 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 (AOAE)
automated auditory brainstem response test (AABR)
These are outlined below.
An AOAE 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 AOAE 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.
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.
Hearing tests in older babies and children
A number of different hearing tests may be used to check for hearing problems in older babies and young children. These 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 earphones in your child’s ears so that each ear can be tested separately.
This test is usually used for children between six months and three years old.
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 usually only used for children who are over the age of three. It is often used to screen a child’s hearing before they start school, when it is sometimes referred to as the "sweep test".
Play audiometry is similar to pure tone audiometry, but instead of pressing a button to indicate that they have heard sounds played through headphones or a speaker, the child is asked to perform a simple task. For example, they may be asked to move a toy each time they hear a sound.
This test is more commonly used in children under three years old.
Bone conduction test
Most of the tests above can also be carried out using a small vibrating device placed behind the ear, rather than sounds produced by headphones or speakers.
This device passes sound directly to the inner ear through the bones in the head, in order to identify which part of the ear isn't working properly if a child is having hearing problems.
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 and air is gently blown down it. 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).
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.
As well as this examination, there are a number of tests that may be carried out to check for vision problems in babies and children. These 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.
Tests involving your child paying attention to objects can also be used to check the eyesight of older babies and young children who are not yet able to speak. If your child can speak, but is not yet able to recognise letters, pictures may be used instead of objects.
Snellen and LogMAR charts
When your child can recognise or match letters, their vision is tested using charts that have rows of letters and numbers of decreasing sizes. Your child will be asked to read out or match the letters they can see from a specific distance. 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. This tests each eye muscle in turn.
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.
One of the tests used to check for colour blindness is the Ishihara test. This involves looking at 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.
Colour blindness is much more common in males, with about one in every 14 being affected. The problem is very rare in females.
Hearing and vision support services
Hearing and vision tests for children