Routine hearing tests are offered to newborn babies and children to identify any problems early on in their development.

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

Hearing tests carried out soon after birth can 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.

Without routine hearing tests, there's a chance that a hearing problem could go undiagnosed for many months or even years.

It's important to identify hearing problems as early as possible because they can affect your child's speech and language development, social skills and education.

Treatment is more effective if any problems are detected and managed accordingly early on. An early diagnosis will also help ensure you and your child have access to any special support services you may need.

Your child's hearing may be checked:

• Within a few weeks of birth – this is known as newborn hearing screening and it's often carried out before you leave hospital after giving birth. This is routine for all children and even those having a home birth will be invited to come to hospital to have this.
• From 9 months to 2.5 years of age – you may be asked whether you have any concerns about your child's hearing as part of your baby's health and development reviews, and hearing tests can be arranged if necessary.
• At around 4 or 5 years old – some children will have a hearing test when they start school, this may be conducted at school or an audiology department depending upon where you live.

Your child's hearing can also be checked at any other time if you have any concerns. Speak to a GP or health visitor if you're worried about your child's hearing.

Newborn babies can be screened for any potential hearing problems using 2 quick and painless tests. The tests are normally conducted on the ward before you leave hospital.

Read more about newborn hearing screening

A number of different hearing tests may be used to check for hearing problems in older babies and young children. These are usually undertaken at an audiology department.

Some of the main tests that may be carried out are described on this page.

Visual reinforcement audiometry

Visual reinforcement audiometry (VRA) is usually used to test hearing in children from approximately 6 months of age up to 2.5 years old.

During the test, your child will sit on your lap or a chair while sounds are presented. Your baby will be taught to link the sound to a visual reward such as a toy or computer screen lighting up.

Once your child is able to associate the sound and the visual reward the volume and pitch of the sound will be varied to determine the quietest sounds your child is able to hear.

Play audiometry

Young children between 1.5 and 5 years old may have a play audiometry test.

During the test, sounds will be played through headphones or speakers and your child will be asked to perform a simple task when they hear the sound. This may vary from putting a ball in a bucket to completing a puzzle.

As with VRA, the volume and pitch of the sound will be varied to determine the quietest sounds your child is able to hear.

Pure tone audiometry

Older children may have a test called pure tone audiometry. This is the test often used to screen a child's hearing before they start school, when it is sometimes referred to as the "sweep test". It's similar to a hearing test an adult might have.

During pure tone audiometry, a machine generates sounds at different volumes and frequencies. The sounds are played through headphones and your child is asked to respond when they hear them by pressing a button.

By changing the level of the sound, the tester can work out the quietest sounds your child can hear.

Bone conduction test

In addition to using speakers or headphones, most of the tests above can also be carried out using a small vibrating device placed behind the ear.

This device passes sound directly to the inner ear through the bones in the head, which can help identify which part of the ear is not working properly if your child is having hearing problems.

Tympanometry

Tympanometry is a test to assess 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 (glue ear) – sounds will bounce back off the eardrum instead of passing through it.

During the test, a soft rubber tube will be placed at the entrance of your child's ear. Air is gently blown down the tube and a sound is played through a small speaker inside it. The tube then measures the sound that's bounced back from the ear.

There are a number of reasons why a child may have a hearing problem, including temporary hearing loss from a common illness such as a common cold.

Some possible causes of hearing loss that may 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 rubella (german measles) or cytomegalovirus, which can cause progressive hearing loss
• inherited conditions 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 head surgery, for example
• being starved of oxygen at birth (birth asphyxia)
• illnesses such as meningitis and encephalitis (which both involve swelling in the brain)

Although your child will be offered routine hearing tests as they grow up, it's still important for you to look out for signs of any problems and seek advice if you have any concerns.

For babies, the checklist in your baby's personal child health record (red book) can be used to help you check your child's hearing as they grow up.

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

• inattentiveness or poor concentration
• not responding when their name is called
• talking loudly and listening to the television at a high volume
• difficulty pinpointing where a sound is coming from
• mispronouncing words
• a change in their progress at school

Speak to a GP or health visitor if you're concerned about your child's hearing. Your child can have a hearing test at any age.