Hearing Screening for Infants and Children

What is pediatric audiology?

Pediatric audiology is a type of healthcare offered to both infants and young children who are experiencing hearing problems or sound recognition issues.  Identifying hearing problems early in a child’s life is essential for normal speech and language development, as well as social development.

Speech, learning or behavioral issues are often the first indicators of a possible hearing problem. These problems can arise when a child has a hearing deficit. Doctors of audiology can diagnose and treat hearing disorders.

Indicators of hearing loss in children:

  • Speech and language delays
  • Listens to TV or music at loud levels
  • Speaks loudly
  • Asks to have things repeated
  • Attention problems
  • Only responds when face-to-face
  • Has a delayed reaction when spoken to
  • Has no response when called upon
  • Has trouble following directions

What services do we offer for pediatrics?

The services offered by Alexandria Hearing Centers doctors of audiology vary according to the condition and symptoms as well as the age of the patient. The audiologist will perform hearing tests in order to determine the type and degree of the child’s deficit. These tests may include distortion product oto-acoustic emissions (DPOAE), Visual Reinforcement Audiometry (VRA), Conditioned Play Audiometry (CPA), Tympanometry and/or Pure Tone testing.   After the examination and diagnosis, the audiologist will work to find the best method of treatment for your child. They may recommend certain devices, such as hearing aids, to treat problems with hearing.

What can I expect at an audiology appointment for my child?

When you bring your child in for a pediatric audiology appointment, you will be asked to describe what areas of concern you have regarding the child’s hearing, speech and language or balance. At the time of the testing, the audiologist will review the test results with you, and make recommendations for additional follow up or referral as necessary.

The audiologist will take a medical history which may include questions about any medications taken during pregnancy, if any complications occurred during delivery and if a NICU stay was necessary.  They will also need to know any medications given to the baby during the NICU stay.  Additionally, they will want to know if there is a family history of hearing loss.

What tests will be done?


A hearing screen will begin with an otoscopic examination (physical examination of the outer ear, ear canal, and eardrum).

DPOAE (Distorted Product Otoacoustic Emissions)

This testing is appropriate for newborns and infants up to twelve months of age.  A soft tip is placed in your baby’s outer ear canal. The tip’s speaker emits brief tones and a microphone measures a response from the inner ear (OAE).  This test is quick and painless and provides the screener with immediate results. Most newborns respond well to OAE testing and may sleep throughout the test.

Visual Reinforcement Audiometry (VRA)

This screening tool is used to assess hearing in children too young for traditional hearing testing (in the booth with headphones).  It is designed for children 12 months and up to age 3 to 4 years old.  Using sound field speakers the audiologist presents a tone. At first, the audiologist lights up a picture on the screen in conjunction with the sound. This “trains” the child to respond by moving his/her eyes or turning their head toward the sound.  The process is repeated as the audiologist reduces the intensity of tone until the child’s minimum hearing threshold is reached. Tests continue using different frequencies until the audiologist has a complete set of data about your child’s hearing.

Conditioned Play Audiometry (CPA)

Like VRA, this screening tool is used to assess hearing in children too young for traditional hearing testing.  It is designed for children between ages 2 to 5 years old.  Using earphones, the child is conditioned by playing a sound at a comfortable volume, at a level that is likely to be heard. The audiologist will show the child what activity they get to do when they hear the sound (i.e. when you hear the beep you throw the ball in the bucket) and guide them to this response until they understand the task. As the process is repeated the audiologist is able to determine the hearing level of the child in each ear and across different frequencies.


This tool is used for patients of all ages.  A soft tip is inserted into your child’s ear to measure the tympanic membrane’s response to changes in pressure.  Tympanometry is used to determine the health of the ear canal and the middle ear.

Pure Tone Audiometry

Once a child is old enough to keep headphones or earphones on and respond reliably to sounds, pure tone audiometry can be done. During this testing, “beeps” are played in the child’s ears at different volumes and pitches. The child is asked to respond in some way when they hear the sound (i.e. raise their hand, push a button).  Pure-tone testing determines the quietest tones that a person can hear at different frequencies.

What can Parents do before a hearing test to prepare them:

  1. Help your child get used to having something in the ears by putting headphones or earbuds on them while they are doing something they enjoy. You can play music through the headphones as long as it is not loud.
  2. Have your child repeat words to you. For example, ask them “say baseball, say hotdog, say ice cream”. If they are too young to repeat words, ask them “where is your nose? where is your mouth?” while having them listen and point.
  3. Bring their attention to sounds they may hear in the environment. If the telephone rings, say “Listen, do you hear that?”
  4. Practice playing the “listening game” with your child. Cover your mouth and say “beep, beep” softly and have them do something every time they hear it (i.e. toss a block into a bucket).

Alexandria Hearing Centers offers pediatric testing in two locations.  Both offices are equipped for testing children over the age of five with comprehensive pure tone audiometry and tympanometry.  However, our Sherwood Hall Lane office is equipped to test children between the ages of 1-5 years with Visual Reinforcement and/or Conditioned Play audiometry.  The Walker Lane office is equipped to screen infants under the age of 1 year with DPOAE testing.   Regardless of which test is best for your child, at least one parent will be needed to assist with the testing.  Therefore, Alexandria Hearing Centers recommends if young siblings need to come to the appointment that another adult comes to the appointment to watch the children.

Audiologists are specialists in hearing and hearing rehabilitation. Never hesitate to ask your audiologist for clarification or further information on anything you do not understand.