Children's hearing and balance assessment (Paediatric hearing and balance assessment)
Age-appropriate tests to check a child's hearing and, where needed, balance, and to plan any support they may need.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- Tests are tailored to the child's age, from newborn screening to play-based tests for older children, and are not painful.
- A clear result is reassuring, but children can develop hearing problems later — keep watching their listening and speech.
- An unclear newborn screen is common and does not necessarily mean hearing loss; it leads to a fuller follow-up test.
- If hearing loss is found, support is planned early — from monitoring or treating glue ear to hearing aids — to protect speech and development.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Measures a child's hearing accurately using age-appropriate tests
If a child has sudden hearing loss, severe ear pain or acute dizziness, this needs urgent medical assessment rather than a routine booking.
The tests are usually not painful and often play-based. Babies having an ABR usually sleep through it. Your child can have breaks if needed.
Clear explanation of the results and plan, with a written report for school or GP where needed.
The tests are usually not painful and often play-based. Babies having an ABR usually sleep through it. Your child...
The audiologist usually explains the results and what they mean, and discusses next steps with you.
A plan is made — often watchful waiting for glue ear, which frequently clears on its own, or referral if treatment...
Support is arranged early, which may include hearing aids (fitted to babies from a few months old) and specialist...
What is a children's hearing and balance assessment?
A children's hearing and balance assessment is a set of age-appropriate tests carried out by paediatric audiologists to check how well a child hears and, where needed, how their balance system is working. The tests are chosen to suit the child's age and development, from newborn babies to older children.
Hearing is assessed for many reasons: as part of newborn screening, because of concerns about speech, listening or behaviour, after ear infections or glue ear, or because parents, nursery or school have noticed a problem. Balance is assessed less often, usually when a child has dizziness, unsteadiness or delayed motor development.
The purpose is to measure the child's hearing accurately, identify any hearing loss and its type, and plan support — which may be monitoring, treatment of a treatable cause such as glue ear, or hearing aids. For balance, it helps explain unsteadiness and guide management.
It is helpful for parents to know what the tests can and cannot do. They measure hearing and balance at that point in time; a clear result is reassuring but children can develop hearing problems later, so ongoing watchfulness matters. The tests are designed to be child-friendly and are not painful.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Options at a glance
These are the main approaches described in this guide. The right option depends on the diagnosis, your goals and what your clinician thinks is safe.
Newborn hearing screening (AOAE and AABR)
Quick, usually not painful screens soon after birth. A soft earpiece plays sounds (AOAE), and if needed sensors measure the hearing nerve's response (AABR). An unclear result...
Auditory brainstem response (ABR)
A detailed test, often for babies, measuring how sound travels along the hearing nerve using small sensors. The baby usually needs to be asleep or settled, and it can take up...
Behavioural and play tests
For toddlers and young children, hearing is tested through play — turning to sounds (visual reinforcement), or putting a toy in a bucket when a sound is heard (play...
Pure-tone audiometry
For older children who can follow instructions, the same headphone-based test used for adults, signalling when they hear tones.
Preparing for your test
- A parent or carer should attend and stay with the child throughout.
- Note what you have observed: responses to sound, speech and listening, ear infections, dizziness or unsteadiness.
- Bring reports from nursery, school or health visitor, and any previous hearing results.
- For baby sleep tests (ABR), follow any advice about timing feeds and naps so the baby settles or sleeps.
- Bring comfort items, a favourite toy, and snacks for longer appointments.
- Tell the team about any developmental concerns, family history of hearing loss, or relevant illnesses.
- Explain the visit to an older child in simple, reassuring terms so they know it will not hurt.
What happens
What happens depends on the child's age. For newborns, a soft earpiece plays gentle sounds; if the response is unclear, sensors may be used. For babies needing detailed testing, an ABR is done while they sleep, with small sensors on the head.
Toddlers and young children are tested through play, so it feels like a game — turning towards sounds or responding with a toy. Older children may have a standard headphone test. The team often checks the eardrums with tympanometry to look for glue ear.
Where balance is a concern, child-friendly balance tests are done, such as watching how the child moves and how their eyes respond. The audiologist usually explains the results at the end and discusses any next steps, from monitoring to treatment or hearing aids.
Is this test right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- If a child has sudden hearing loss, severe ear pain or acute dizziness, this needs urgent medical assessment rather than a routine booking.
- A single routine test is not enough on its own if you remain concerned — ongoing watchfulness and re-checks matter in children.
- Some tests are not suitable if a young child cannot settle; a different method or another visit may be needed.
- Routine audiology is not the right route if symptoms point to a neurological problem needing specialist care.
Delay or rearrange if…
- The child has a current ear infection or heavy cold affecting the ears (though glue-ear testing may still be useful).
- The child is too unsettled or unwell on the day to complete the test reliably.
- A baby sleep test cannot be done because the baby will not settle — it is rescheduled rather than forced.
- Sudden or worsening symptoms are present — these should be escalated urgently instead of waiting.
Alternatives to discuss
- Watchful waiting and re-testing, especially for glue ear which often clears on its own.
- The NHS pathway (including newborn screening and community audiology) rather than private testing.
- ENT referral for treatment of a treatable cause such as persistent glue ear.
- Speech and language therapy and educational support alongside hearing care.
- Repeat or alternative test methods if a young child could not complete the first.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Measures a child's hearing accurately using age-appropriate tests
- Finds treatable causes such as glue ear so they can be managed
- Identifies hearing loss early, protecting speech, language and learning
- Guides support, from monitoring to hearing aids or onward referral
- Reassures parents when hearing is found to be within the normal range
- Helps explain balance problems and guide management where present
Risks & complications
- The tests are usually not painful and low-risk — the main issue is keeping a young child settled
- A child may be unsettled or tired, which can mean repeating or rescheduling a test
- An unclear newborn screen can cause parental worry, even though it is common and often normal
- More than one visit may be needed to complete testing in a young child
- A test result may be inconclusive and need repeating or a different method
- Balance tests using air or movement can feel briefly odd to the child
- A hearing problem is found that needs prompt specialist referral and further investigation
These assessments are safe and child-friendly. The main thing for parents to understand is that results reflect that moment in time: a clear result is reassuring but does not guarantee hearing will stay normal, and young children sometimes need more than one visit. Trust your own observations — if you remain concerned about your child's hearing, keep raising it.
Published figures to discuss
These tests are safe, so the focus is on the meaning and reliability of results rather than procedure risk. Results can be affected by a child's age, cooperation, and temporary problems such as glue ear or a cold, which is why more than one visit is sometimes needed. A clear result is reassuring but does not rule out hearing problems developing later. Precise percentages are not meaningful here, so expectations are described qualitatively.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Hearing loss missed because the child copes or lip-reads | Common presentation issue | Children may appear inattentive or delayed rather than complain of hearing loss. | Guide sourcesClinical context |
| Test reliability affected by age and cooperation | Age-dependent | Behavioural audiometry, OAE and tympanometry each have limitations; repeat or objective testing may be needed. | Guide sourcesClinical context |
| Glue ear or temporary conductive loss | Common in childhood | Middle-ear fluid can fluctuate and affect speech, listening and school performance. | Guide sourcesClinical context |
| Urgent neurological or infection signs missed | Uncommon but important | Sudden hearing loss, meningitis history, facial weakness, severe vertigo or developmental regression needs prompt medical review. | NHS — Newborn hearing screeningnhs.ukSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
There is no physical recovery. Children carry on as normal afterwards. What matters is understanding the results and following any plan, whether that is monitoring, treating glue ear, or arranging hearing aids or further tests.
- A child being tired or unsettled after concentrating, especially the very young
- Needing a second visit to complete testing in babies or toddlers
- Worry while waiting after an unclear newborn screen — this is common and often normal
- No change to the child's hearing from the tests themselves
- Glue ear that comes and goes and often clears on its own over weeks
Aftercare
- Make sure you understand the results and the plan before you leave.
- Follow any plan for glue ear, which is often watchful waiting with review.
- Keep watching your child's responses to sound, speech and listening, and report changes.
- Attend follow-up hearing checks, especially after ear infections or glue ear.
- If hearing aids are recommended, attend fitting and adjustment appointments.
- Tell nursery or school about any hearing needs so they can support your child.
- Seek prompt advice if your child develops sudden hearing loss, severe ear pain or dizziness.
- A parent or carer free to attend and stay throughout
- Notes on your observations of the child's hearing, speech and balance
- Reports from nursery, school or health visitor
- Any previous hearing test results
- Feeds and naps planned for baby sleep tests
- Comfort items, a toy and snacks for longer visits
- The clinic's contact details for questions or concerns
⚠ Get urgent help if…
- A sudden drop in your child's hearing — seek urgent assessment
- Severe ear pain, discharge or a high fever
- Sudden dizziness, repeated falls or being unable to stand
- A baby or child not responding to sound as they used to
- Delay or going backwards in speech, language or listening
- Facial weakness, severe headache or drowsiness with ear symptoms — seek urgent care
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
The results show how well your child hears, and whether any loss is present, how severe it is and what type. A clear result is reassuring. If glue ear is found, it is often managed by watchful waiting, as it frequently clears by itself; persistent glue ear or other loss is treated or referred.
Results reflect that point in time. A normal result does not guarantee hearing will stay normal, as children can develop hearing problems later, so your ongoing observations remain important. If hearing loss is confirmed, early support — including hearing aids where appropriate — helps protect speech, language and learning. The assessment guides care; it does not by itself fix a hearing problem.
A child's hearing can change, especially with glue ear and ear infections, so results may need repeating and hearing is often monitored over time. Hearing aids for children are re-tuned as they grow and as their hearing changes. Keep watching your child's listening and speech, and seek a re-check if you have new concerns or if hearing changes suddenly.
Related tests, treatments or support
Hearing assessment is often combined with checking the eardrums for glue ear, and may be linked with ENT review, speech and language therapy, or hearing aid fitting. Balance assessment may be combined with hearing tests where a child has both hearing and balance concerns.
Follow-up & long-term care
Follow-up depends on the findings. Glue ear is usually reviewed after a period of watchful waiting. Confirmed hearing loss leads to hearing aids and specialist support, with regular re-checks as the child grows. Newborns with an unclear screen are seen for a fuller assessment, usually within a few weeks. You should always be told who to contact with concerns between appointments.
- Attend scheduled follow-up hearing checks
- Keep watching your child's listening, speech and responses to sound
- Have hearing aids re-tuned as the child grows and hearing changes
- Manage ear infections and glue ear with the team as advised
- Update nursery or school about your child's hearing needs
Repeat, follow-on and what comes next
- Young children sometimes need more than one visit to complete reliable testing.
- Tests may be repeated if a child was unsettled or had a cold or glue ear on the day.
- Hearing is monitored over time, especially after ear infections or glue ear.
- Children's hearing aids are re-tuned as they grow and as hearing changes.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- Clear explanation of the results and plan, with a written report for school or GP where needed.
- A safeguarding-aware, child-friendly approach with the parent present throughout.
- Scheduled follow-up and re-checks, especially after glue ear or where change is likely.
- Early hearing aid fitting and support if hearing loss is confirmed.
- A named contact and clear advice on urgent symptoms and when to seek help.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether the assessment is on the NHS (including screening) or paid for privately
- The type and number of tests needed for the child's age
- Whether more than one visit is required to complete testing
- Whether balance assessment is included alongside hearing
- Whether hearing aids and their fitting are needed
- Follow-up appointments and onward referrals
- Exactly which tests are included for your child's age
- Whether a second visit, if needed, is included or charged separately
- Whether a written report for school, nursery or your GP is included
- Whether hearing aids and fitting, if needed, are part of the cost
- What happens, and what it costs, if results are inconclusive
- Follow-up arrangements and who to contact with concerns
On the NHS? Children's hearing and balance assessment, including newborn screening, is provided on the NHS; private assessment is available and may be faster but the NHS is the usual pathway.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Being told a single clear result means hearing will always be normal.
- An assessment linked to selling hearing aids without this being clear.
- Not explaining that glue ear is common, often clears on its own, and is usually watched first.
- No clear plan for follow-up or for who to contact if concerns continue.
- Not respecting the child's comfort, assent and need for breaks.
Marketing red flags
- Claims that a one-off private test rules out all current and future hearing problems.
- Pressure to buy hearing aids or treatments before proper assessment.
- Recommending surgery for glue ear before a period of watchful waiting.
- Dismissing parental concern or sudden symptoms instead of acting on them.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- Which tests will my child have, and what do they involve at their age?
- What do the results mean for my child's hearing now and as they grow?
- If glue ear is found, what is the plan and how long do we watch and wait?
- If hearing loss is confirmed, what support is available and how soon?
- How often should my child's hearing be re-checked?
- What signs should make me seek a re-check or urgent assessment?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my test, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this test not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
My baby's newborn hearing screen was unclear — should I worry?
Will the tests hurt my child?
Can my child be tested on the NHS?
What is glue ear and is it serious?
My child passed a hearing test before but I'm still worried — what should I do?
When is balance tested in children?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: NHS — Newborn hearing screening NICE — Otitis media with effusion (glue ear) in under 12s (NG233) British Society of Audiology — Paediatric guidance ENT UK — Patient information
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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