Children's Hearing
When to Refer a Child for Hearing Assessment
A practical guide for parents, teachers, health visitors and professionals — recognising the signs that a child's hearing deserves a closer look.
Children do not always tell us when they are struggling to hear. They adapt, they compensate, and they find ways to manage — often without anyone realising there is a difficulty at all. By the time a hearing problem becomes obvious, it may already have been affecting a child's speech, language and learning for some time.
This guide is for parents, carers, teachers, health visitors, GPs and other professionals who want to understand the signs that suggest a hearing assessment is appropriate — and why acting on those concerns promptly is always the right thing to do.
Why hearing matters so much in childhood
Hearing is the primary channel through which children learn language. In the early years, children absorb vocabulary, grammar and the rhythms of communication almost entirely through listening. Even a mild or fluctuating hearing loss during this period can slow the development of speech and language, affect literacy, and make it harder for children to engage fully in learning.
In school-age children, the demands on hearing increase significantly. Classrooms are noisy environments, and children are expected to listen, process and respond to spoken language for much of the school day. A child with an unidentified hearing difficulty may appear inattentive, disruptive or slow to learn — when in fact they are simply struggling to hear.
Early identification and appropriate support can make a significant difference. A hearing assessment does not commit a family to any particular course of action — it simply provides information that allows the right decisions to be made.
Signs in babies and toddlers (0–2 years)
In very young children, hearing concerns can be subtle. Signs that may suggest a hearing assessment is appropriate include:
- Not startling or waking to sudden loud sounds
- Not turning towards a voice or familiar sound by around 4–6 months
- Not babbling or making a range of sounds by 6–9 months
- Not responding consistently to their name being called
- Fewer words than expected for their age — or words that were present beginning to disappear
- Appearing to rely heavily on watching faces and lip patterns
- A history of recurrent ear infections or glue ear
A clear newborn hearing screen does not rule out hearing difficulties developing later. If you have concerns at any point, a further assessment is always appropriate.
Signs in pre-school children (2–5 years)
As children develop language and begin to socialise, hearing difficulties may become more apparent. Signs to look out for include:
- Speech that is difficult to understand, or significantly delayed compared to peers
- Frequently saying 'what?' or 'pardon?', or asking for things to be repeated
- Turning up the volume on the television or tablet
- Not responding when called from another room, or when not looking at the speaker
- Appearing to mishear words — substituting similar-sounding words
- Difficulty following multi-step instructions
- Recurrent ear infections, or a history of glue ear
- Concerns raised by a nursery key worker, speech and language therapist, or health visitor
Signs in school-age children (5 years and over)
In school-age children, hearing difficulties may present as learning, attention or behaviour concerns rather than obvious hearing problems. Signs include:
- Difficulty following classroom instructions, particularly in noisy environments
- Appearing inattentive, distracted or easily fatigued during lessons
- Struggling with phonics, reading or spelling despite appropriate teaching
- Mishearing words or giving responses that suggest they have heard something different
- Preferring to sit close to the teacher or television
- Complaints of earache, blocked ears, or a feeling of fullness in the ears
- Concerns raised by a class teacher, SENCO, educational psychologist or speech and language therapist
- A known condition associated with hearing loss, such as Down syndrome, cleft palate, or a history of meningitis
A note on glue ear
Glue ear (otitis media with effusion) is the most common cause of hearing difficulty in young children. It occurs when the middle ear fills with fluid, reducing the ability of sound to pass through to the inner ear. It is particularly common in children under five, and in children who have frequent colds or upper respiratory infections.
Because glue ear often comes and goes, the hearing loss it causes can be fluctuating and inconsistent. A child may seem to hear well on some days and struggle on others. This inconsistency can make glue ear difficult to identify — and can lead to a child being described as 'not listening' when they are in fact struggling to hear.
Glue ear often resolves on its own, but while it is present it can have a real impact on speech, language and learning. If glue ear is suspected, a hearing assessment is appropriate — even if the child has had a clear hearing test in the past.
Guidance for professionals
GPs, health visitors, speech and language therapists, paediatricians, SENCOs and teachers are often the first to identify concerns about a child's hearing. A low threshold for referral is appropriate — a hearing assessment is non-invasive, causes no distress, and provides valuable information regardless of the outcome.
Hearing Pathways accepts direct referrals from professionals as well as self-referrals from families. We provide detailed written reports following assessment, and are happy to liaise with other professionals involved in a child's care.
If you are unsure whether a referral is appropriate, we are happy to discuss the child's presentation informally before a formal referral is made. Please contact us directly.
- No GP referral is required — families can self-refer directly
- Professional referrals are welcome from GPs, SLTs, paediatricians, health visitors and schools
- Detailed written reports are provided following all assessments
- We are happy to discuss cases informally before a formal referral
Key takeaways
Concerned about a child's hearing?
At Hearing Pathways, we offer specialist paediatric hearing assessments for children from infancy through to school age and beyond. Assessments are tailored to each child's age, developmental stage and individual needs. No GP referral is required.
Frequently asked questions
Further reading
Children's audiology
Specialist hearing assessment for children — the service this article helps you navigate to.
ReferralsProfessional referrals
Information for GPs, SLTs, paediatricians and other professionals referring to Hearing Pathways.
ArticleWhat to expect at a child's hearing assessment
A practical guide to help families prepare for their appointment.
ArticleHow children's hearing develops
Understanding the stages of auditory development and the milestones to watch for.