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Hearing and vision tests for children

 

Hearing and vision tests are given to children from birth to check that their senses are developing properly. As well as checking that hearing and vision are normal for the child, the tests look for any conditions that make it difficult to hear or see, such as glue ear or a squint.

Serious hearing and vision loss in childhood is uncommon. It is estimated that 1 to 2 babies in every 1,000 are born with hearing loss in one or both ears, and 6 out of every 10,000 children become severely visually impaired or blind by the time they are 16. It is important that hearing and vision problems are diagnosed as early as possible. If left, they can have a big impact on a child's development.

Although you will be offered routine tests for your children, if you have any concerns about your child's eyesight or hearing at any time, take them to your GP. If your GP thinks there may be a problem, your child will be referred to a consultant who specialises in eye or ear health.

Alternatively, your child may need to visit an optician, who can spot problems such as untreated diabetes (which can affect the eyes), growths behind the eyes and poor vision. If necessary, an optician can provide a prescription for glasses to correct poor vision.

Ear specialists

Audiologists: specialists trained to evaluate how well you can hear. If your GP cannot find what is causing your hearing loss, you will probably be referred to an audiologist for further testing.
Otolaryngologists (ENT consultants): medical doctors trained to diagnose and treat diseases of the ears, sinuses, mouth, throat, larynx and other parts of the head and neck. They are commonly called ENT (ear, nose and throat) consultants.
Otologists: otologists specialise in problems with the ear. They may be involved in the treatment of ear infections, facial paralysis, dizziness, hearing loss, tinnitus (ringing in the ears), tumors and surgery of the head and neck.

Eye specialists

Opticians (optometrists): specialists in the diagnosis and treatment of poor eye sight. Depending on their training, they may also screen for some eye disorders and treat eye conditions.
Ophthalmologists: eye specialists, some of whom specialise in eye surgery.
Orthoptists: specialists in the diagnosis and treatment of eye disorders. They usually work in a hospital.

Routine tests at birth

Babies can respond to sights and sounds from an early age. Midwives and hospital staff carry out a number of hearing and vision tests on every newborn baby. These tests help identify any problems that a child is born with. This can include:

  • genetic (inherited) conditions, such as being born with cataracts, or
  • conditions that are the result of infections caught by the mother during pregnancy. For example, there is a small risk that a woman who catches rubella during pregnancy might have a child with a hearing impairment or eye problems.

Hearing test

Some newborn babies in Ireland are give a hearing test during the first few weeks of life. It is either carried out in hospital straight after birth, or by a nurse at home. The test checks your baby's ability to hear and is called the Automated Otoacoustic Emission (AOAE). It only takes a few minutes.In parts of the country where this test is not performed you should be offered a screening test by a public health as part of a routine development check at or soon after your baby reaches seven months of age.

Vision tests

Newborn babies are checked for eye conditions such as cataracts, corneal abnormalities and glaucoma.

Some babies have a higher risk of developing visual disorders. Premature babies and those with a low birth weight are more likely to have early problems. This is because the eyes finish developing late in pregnancy. All premature babies and babies with low weight are tested for a condition called retinopathy of prematurity. This occurs when the blood vessels that supply the eyes with oxygen and nutrients have not fully formed.

Many eye conditions detected at birth get better without treatment as the baby gets older, but it is worth monitoring them in case treatment is needed.

School screening tests

In most areas of Ireland children are tested for vision and hearing as part of a school health check soon after school entry.

Additional tests

See your GP or ask your public nurse if you are worried about your child's hearing or vision.

Hearing tests

Symptoms of hearing loss may include:

  • being inattentive,
  • talking too loudly and listening to the TV at a high volume,
  • mispronouncing words, and
  • being unsettled at school.

Hearing tests should also be given to your child after certain conditions that can cause hearing loss, including:

  • bacterial meningitis,
  • prolonged treatment with ototoxic drugs (certain antibiotics or non-steroidal anti-inflammatory drugs that may cause hearing loss), and
  • severe head injury.

Treatment

Pre-school and school children up to the age of 16 referred to public hospitals and treated in out-patient departments are entitled to be treated free of charge.

Children do not always realise they have a sight problem. It is important to look out for signs that your child may be struggling to see, such as:

  • regular headaches,
  • sitting very close when watching the TV,
  • erratic eye movements and not making eye contact,
  • mannerisms such as eye poking and rubbing,
  • poor attention at school, and
  • reading difficulties.

Glossary

Genetic
Genetic is a term that refers to genes, the characteristics inherited from a family member.
Antibiotics
Antibiotics are medicines that can be used to treat infections caused by micro-organisms, usually bacteria or fungi. Examples of antibiotics include amoxicillin, streptomycin and erythromycin.
Hearing tests
Audiometry is any testing that checks hearing.

Useful Links citizens information.ie

Hearing and vision tests are carried out on children from a young age so that any problems can be detected as early as possible. Your GP can monitor and treat the condition or, if necessary, refer you to a specialist to provide equipment to improve your child's hearing or vision, such as glasses or a hearing aid. Early diagnosis will also ensure that a child has access to any special learning support services that they need.

Hearing tests

Routine hearing tests check whether a child's hearing is within the normal range of volume (loudness) and pitch (high and low sounds).

In between these checks, a parent, public health nurse or carer may notice that a child's hearing is not developing properly. A baby's hearing should develop gradually over the first year.

  • From birth: a baby will jump or start at loud noises.
  • 1 month: they will start to notice sudden and prolonged sounds, and may turn towards the noise.
  • 4 months: they will show excitement at sounds and smile in response to the sound of a familiar voice.
  • 7 months: a baby will turn to a familiar voice across a room or to very quiet noises made on each side.
  • 12 months: they will respond to certain words, such as their name.

If you think your child's hearing is not developing normally, talk to your public health nurse or GP about your concerns. They may have always had a hearing impairment, or they may be developing one. They may have a temporary hearing problem, such as reduced hearing caused by a cold.

Possible causes of hearing impairment include:

  • Glue ear: a build-up of fluid in the middle ear, which is common in small children.
  • Damage to the cochlear or auditory nerves (which take hearing signals to the brain). This could be caused by a serious head injury, exposure to loud noise or other factors, such as head surgery.
  • Genetic (inherited) conditions, such as otosclerosis, which stop the ears or nerves from working properly.
  • Infections that affect the child while they are in the womb or which are caught at birth, such as rubella.
  • Being starved of oxygen at birth (birth asphyxia).
  • Illnesses such as meningitis or encephalitis (which involve swelling in the brain).
  • Head injury after birth.

Vision tests

Routine eye tests check whether there is any visible defect or deformity in the eyes, such as a cataract, lazy eye (amblyopia) or squint. They also check that a child can follow movement in the normal field of vision (looking up, down and side to side) and that they are not short sighted or long sighted. Children of secondary school age may be tested for colour blindness.

A child's vision develops gradually from birth.

  • 0-2 months: a baby should be able to see from birth. After six weeks, they should be able to follow a colourful or interesting object, such as a face, with their eyes.
  • 2-3 months: they will start to reach for things they see.
  • 3-5 months: they will start to mimic facial expressions and look at objects more closely.
  • 6-12 months: a baby's vision quickly develops over this time. They will be able to focus on objects near and far away, see simple shapes, scribble with a crayon and will be interested in pictures.

Parents may be able to spot problems before they are picked up in tests.

Other signs that a child may have vision problems include erratic eye movements, not turning towards the source of sounds (also a sign of hearing impairment), mannerisms such as eye poking and rubbing, and not making eye contact.

Possible causes of visual impairment in babies and children include:

  • Long or short sightedness (which are usually inherited).
  • Other genetic (inherited) conditions, such as astigmatism, where the eye has not formed in quite the right shape, or choroidoretinal degeneration, where part of the eye gradually stops working properly.
  • Damage to the optic nerve (optic atrophy), which takes sight messages to the brain. This may be present at birth (inherited) or may appear because of a condition such as diabetes.
  • A tumour or growth pressing on the sight centre of the brain which affects vision.
  • Cataracts that a child is born with (congenital), which may be caused by conditions such as Down's syndrome or the effects of an infection caught during pregnancy, such as rubella.
  • Problems related to premature birth, where the eyes have not had time to finish forming fully.

When sight problems are detected, treatment and educational support can be given. The earlier this happens, the better because untreated sight problems can often get worse.

Glossary

Brain
The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.
Congenital
Congenital means a condition that is present at birth. The condition could be hereditary or develop during pregnancy.
Genetic
Genetic is a term that refers to genes, the characteristics inherited from a family member.

Hearing tests

Newborn babies are usually screened using two quick and simple tests to see if further investigation is needed:

  • Automated Otoacoustic Emissions test (OAE), and
  • Automated Auditory Brainstem Response test (AABR).

Both tests are painless for your baby.

Automated Otoacoustic Emission (AOAE) test

A tiny earpiece is placed in the baby's outer ear and quiet clicking sounds are played through it. This should produce reaction sounds (echoes) in a part of the ear called the cochlea, which a computer can record and analyse. The test can be done while the baby is asleep, and it only takes a few minutes.

Sometimes, the results from the AOAE test are not clear. In this case, the test may be done again or a different test called the Automated Auditory Brainstem Response (AABR) can be used.

It is common for babies to have a second screening hearing test. This does not necessarily mean they have hearing loss. It may be because your baby was unsettled due to background noise or a temporary blockage in their ear.

Automated Auditory Brainstem Response (AABR) test

Three small sensors are placed on your baby's head and neck. Specially designed soft headphones are then placed over your baby's ears and quiet clicking sounds are played through the earphones. A computer analyses how well your baby's ears respond to the sound. The AABR test can take between 5 and 30 minutes.

Other hearing tests that may be given to your child include:

Infant distraction test

An infant distraction test may be carried out during your baby's routine health check-ups. Your baby sits on your lap while one tester keeps their attention visually. The other tester makes various sounds around the baby and watches to see if they turn towards the sound.

The theory is, if hearing is normal, the child will turn their head to respond to the noise. It is not a very accurate test and other things can influence the result, such as your baby's interest in the type of sound and poor vision.

Play audiometry

The child performs a simple task in response to sound to show the tester that they have heard it. The sound can either be played through a speaker or an earphone.

Pure tone audiometry

A machine called an audiometer generates sounds at different volumes and frequencies. Sounds are played through headphones and a child is asked to respond when they hear them, for example by pressing a button. By decreasing the level of the sound, the tester can work out the quietest sounds that the child can hear. This test is only usually used for children over four years of age and is often used to screen your child's hearing before they start school.

Speech perception test

This test assesses a child's ability to recognise words that they hear without being able to see a person move their lips. Words can be played through headphones or a speaker, or a person may say them directly to the child without showing their lips. The child will then have to identify the words by picking out matching pictures or words on a list.

Tympanometry

This test shows 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 if there is fluid or 'glue' behind it, the sounds bounce back off the eardrum instead of passing through it.

A small tube with a soft rubber tip is placed at the entrance to the ear. This measures the sound that is bounced back from the ear. If most of the sound is bounced back, the tester will know that the eardrum is rigid and that your child may have glue ear, a condition where fluid builds up in the middle ear.

Vision tests

The eyes of newborn babies are examined for any obvious physical defects, including squints, cloudiness (a sign of cataracts) and redness. Tests that may be done include:

The pupil reflex test

The pupil reflex test is done by shining a light into each of your baby's eyes from a distance of 10cm. It checks the reflex of their pupils to light.

Your baby's pupils should automatically shrink in response to the brightness of the light. If they do not, it suggests there is something affecting the reflex response of their pupils.

The red reflex test

This test is carried out using a magnifying instrument with a light on the end called an ophthalmoscope. Light is directed into your baby's eyes and a red reflection should be seen as the light is reflected back. If the reflection is white instead of red, your child will be referred to a specialist. This response can be a sign of eye conditions such as cataracts.

Attention to visual objects

This is a simple test to check whether a newborn baby pays attention to visual objects. A midwife or doctor will try to catch a baby's attention with an interesting object. They then move it to see if the child's eyes follow.

The rolling ball test

In older babies and toddlers of around up to two years, the focus and sharpness of eyesight can be checked using the rolling ball test. Differently sized white balls are rolled across the floor. It shows the range of vision and how small an object your baby can spot. Another simple test is to use small blocks, or tiny objects like buttons, to find out whether a child can see them and reaches for them. Each eye can be tested separately by covering the other with a patch.

Snellen and LogMAR charts

After six years of age, charts with rows of letters and numbers of decreasing sizes can be held up at a distance of several metres. A child is asked to read out as many of the letters as they can see. These charts are called Snellen charts or logMAR cards.

Range of movement tests

To test the range of movement of each eye, a child's attention will be drawn to an interesting object, which is then moved to eight positions: up, down, left, right, and halfway between each of these points. The test involves checking how well each eye follows the object and how far the movement of the eye stretches in each direction.

Colour blindness test

Colour blindness (colour vision deficiency) tests are usually carried out at secondary school age if a problem is suspected. Ishihara colour vision tests involve images made up of dots in two different colours. If colour vision is normal, the child will be able to recognise the letter or number that is highlighted in the image. A child who cannot tell the difference between two colours (such as red and green) will not be able to see the number or letter highlighted and may have a colour vision problem.

Glossary

Brain
The brain controls thought, memory and emotion. It sends messages to the body controlling movement, speech and senses.
Deficiency
If you have a deficiency, you are lacking in a particular substance needed by the body.
Useful Links Health A-Z: glue earHealth A-Z: squint

Content provided by NHS Choices www.nhs.uk and adapted for Ireland by the Health A-Z.