Hearing Exams in Toddlers

Between the ages of 7 months and 3 years, young children should be monitored for hearing impairment as needed, as recommended by a physician, or as required by law. Toddlers who did not receive newborn screening, those who demonstrate delayed speech or language development, and those who are at increased risk for hearing loss should be tested as soon as possible and should receive regular (e.g., every 6 months) follow-up care.

Screening tests that are used in young children usually can detect even slight hearing impairment. These hearing tests, which require the involvement and cooperation of the child, include visual reinforcement audiometry (VRA) and conditioned play audiometry (CPA). VRA often is used in toddlers between the ages of 6 months and 2 years, and CPA in children between 2 and 3 years old.

In visual reinforcement audiometry, the child is rewarded through visual reinforcement (e.g., appearance of a pleasing image, such as a colorful toy or flashing light) when he or she turns toward the source of a sound. In conditioned play audiometry, the child is instructed to perform a fun activity, such as putting a block into a box or a peg into a hole, each time he or she hears a sound.

VRA and CPA can be used to detect hearing impairment that involves high frequencies or low frequencies. If the child cooperates, the sounds can be emitted through earphones, allowing hearing loss in one ear to be detected. In some cases (e.g., if the child will not cooperate), hearing tests, such as otoacoustic emissions (OAEs) tests and auditory brainstem response (ABR) tests that are often used in newborns and infants, may be used in toddlers.

If hearing tests indicate hearing impairment in a toddler, the child should be re-evaluated 1–3 months later. A comprehensive evaluation should be performed by an audiologist if this test confirms the results.

Publication Review By: Stanley J. Swierzewski, III, M.D.

Published: 26 Aug 2008

Last Modified: 18 Sep 2015