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Hearing and vision tests for children

Introduction

Hearing and vision tests are given routinely to children to check that their senses are developing properly. As well as checking that vision and hearing are normal for the age of the child, they look for any treatable conditions that make it difficult to hear or see, such as glue ear or a squint. The tests also help to check for any problems that might cause them to have an effect on their hearing or vision in the future.

If you have any concerns about your childs eyesight or hearing at any time, you can take them to your GP for initial tests. If your GP thinks there might 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) or growths behind the eyes. If necessary an optician can also provide a prescription for glasses.

When should it be done?

Routine tests

Babies can respond to sights and sounds from an early age. Midwives and hospital staff carry out a number of tests on every newborn baby. These tests help find any problems that a child is born with. These include genetic (inherited) conditions such as being born with cataracts, or the results of any 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 hearing impairment.

Premature babies are more likely to have early problems with their hearing and sight, such as crossed eyes or a squint. These may get better without treatment as the baby gets older, but it is worth detecting them in case treatment is needed. All premature babies and babies that have low weight when they are born should have routine eye tests for retinopathy of prematurity and other eye problems, as the eyes finish developing late in pregnancy.

A trained health professional will usually check your babys hearing and vision sometime between birth and a few weeks of age.

You will also be invited to take your baby for further development checks at 6-9 months, 18-24 months, 3-3.5 years, and around the time your child starts primary school.

Hearing tests will either be carried out in hospital straight after birth or by a Health Visitor during a routine development check at home. This will depend on the policy of your local primary care trust (PCT). In the future, the government plans that a sight test should be given by an orthoptist (a specialist in vision and eye abnormalities) between the ages of 4 and 5 years. In some areas this already happens, or a school nurse carries out hearing and sight tests when a child first starts school.

The school nurse often carries out a further health check in Year 7, the start of secondary school, when children are aged 11. After this age it is usually up to the individual child to visit their school nurse with any health concerns.

You can always see the health visitor or school nurse at any time, if you have any concerns. You do not have to wait for a routine appointment.

Additional tests

Eye tests are free to children up to the age of 16. Its worth taking advantage of this for regular eye checks at your optician, even if you and your child are not aware of any particular sight problem. You might also be referred to an optician for an eye test if your child has regular headaches, which can be caused by straining the eyes.

Hearing tests should be given after certain conditions that can cause hearing loss. These include:

  • bacterial meningitis,
  • prolonged treatment with ototoxic drugs (drugs that can cause hearing loss, such as certain antibiotics or non-steroidal anti-inflammatory drugs, if given in particular situations or doses), and
  • severe head injury.

You should always visit your GP for initial tests if you are worried about your childs hearing or vision.

Why is it necessary?

The standard hearing and vision tests are carried out so that any problems can be detected as early as possible. Doctors can then monitor and if necessary treat the condition, or provide equipment to improve the childs hearing or vision, such as glasses or a hearing aid. It will also enable the child and his or her parents to access special learning support services.

Hearing tests

Routine hearing tests, given as part of the normal tests carried out by the health professional or the school nurse, detect whether a childs hearing is within the normal range of volume (loudness) and pitch (high and low sounds).

In between these regular checks, a parent, health visitor, or carer might notice that a childs hearing is not developing properly. Babies should jump or start at loud noises from birth, and children should turn to find out where a sound is coming from. By the age of 12 months children are often starting to copy whole words. If normal child development doesnt happen, the cause should be investigated. It could be a hearing impairment that has always been there, one that is currently developing, or a temporary hearing problem, such as reduced hearing caused by a cold.

Possible causes of hearing impairment include:

  • glue ear (build up of fluid in the middle ear). This is common in small children and they normally grow out of it,
  • damage to the cochlear or auditory nerves (that take hearing signals to the brain). This can 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 working properly,
  • infections that affect the child while it is in the womb, or that are caught at birth, for example rubella or cytomegalovirus,
  • being starved of oxygen at birth (birth asphyxia), or
  • illnesses such as meningitis or encephalitis (which involve swelling in the brain), or head injury, after birth.

Vision tests

Routine eye tests, during school nurse and child development checks, detect whether there is any visible defect or deformity in the eyes themselves, such as a cataract, squint or crossed eyes. They also check that a child can follow movement in the normal field of vision (looking up, down, and side to side), and is not short-sighted or long-sighted. Secondary school age children may also be tested for colour-blindness.

Parents and other people who interact with a child may be able to spot problems before they are picked up in tests. A baby should be able to see from birth, and by six weeks from birth he or she should be able to follow a colourful or interesting object, such as a face, with his or her eyes. Some babies are born with a squint or their eyes roll away from each other occasionally. If this happens all the time you should mention it to your health visitor and GP. Other signs that a child may have vision problems include purposeless roving 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. Another sign of some rare eye problems such as growths in the eye, is that one eye looks white and the other red when a colour photograph is taken using a flash. If this happens you should take your child for urgent eye tests.

Possible causes of visual impairment include:

  • long- or short-sightedness (which tended to be 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, which takes sight messages to the brain. This is also called optic atrophy, and 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,
  • cataracts that a child is born with (congenital), which may be caused by conditions such as Downs syndrome, or the effects of an infection caught during pregnancy, such as rubella, and
  • problems related to premature birth, because 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. Children themselves dont always realise they have a sight impairment (their vision is normal, to them) so it is important to take advantage of all the free eye checks you are offered, up to the age of 16.

How is it performed?

Hearing tests

Newborn babies are usually screened using the Automated Otoacoustic Emission (AOAE) test. A tiny earpiece is placed in the babys outer ear and quiet clicking sounds are played through it. This should produce reaction sounds in a part of the ear called the cochlea, and the computer can record and analyse these. It is painless and can be done while the baby is asleep.

Sometimes clear results are not obtained from the AOAE test. A different method can be used, called the Automated Auditory Brainstem Response (AABR). Small sensors are placed on the babys head and neck, and soft headphones are placed over the ears. Quiet clicking sounds are played through the earphones and a computer analyses the response to the brain, using information from the sensors.

When an infant is 6 months of age or older a distraction test can be carried out.. If hearing is normal, the child will turn his or head to respond to the noise. In children 2 years and older, the hearing can be tested by whispering the name of an object. The child has to point to the correct object. This is called the McCormick Toy Test.

At school age (between 4 and 5) children may have the hearing sweep test. This an audiogram test across the main speech frequencies (high and low pitches) and using sounds of different volumes (loudness), which are played through earphones. The child has to indicate whether they have heard them, or perform various actions depending on the type of noise.

Vision tests

The eyes of newborn babies are examined for any obvious physical defects, include cross-eyes, cloudiness (a sign of cataracts), and redness.

  • The pupil reflex is checked by shining a light into each eye from a distance of 10cm. The pupils should automatically shrink in response to brightness.

  • A test called eliciting the red reflex is carried out using a magnifying instrument with a light on the end, called an opthalmoscope. Light is directed into the babys eyes and a red reflection should be seen as the light is reflected back. If the reflection is white instead, the child should be referred to a specialist immediately, as it can be a sign of a cataract or other eye condition.

  • To test whether the newborn baby pays attention to visual objects, the midwife or doctor catches the babys attention with an interesting object such as a face, then moves it and sees if the childs eyes follow.

In older babies and toddlers up to around 2 years, the focus and sharpness of eyesight can be checked using the rolling ball test. This involves rolling differently sized white balls rolled across the floor, and shows the range of vision and how small an object can be spotted. Another simple test is to use small blocks or tiny objects like buttons, to find out whether the child can see them and reaches for them. Each eye can be tested separately by covering the other with a patch. Older children can be asked to count the number of fingers held up. From age 5 years, charts with rows of letters of decreasing sizes can be held up at a distance of several metres, and the child reads out as many of the letters as he or she can see. These charts are called Snellen charts or logMAR cards.

To test the range of movement of each eye, the childs attention is drawn to an interesting object, which is then moved to eight positions: up, down, left, right, and half-way in between each of these points. The test involves checking how well each eye follows and how far the movement of the eye stretches in each direction.

In children 5 years and older, the visual field is often tested with the wiggly finger test. Each eye is covered in turn, and the examiner gradually brings a wiggly finger into the childs field of vision.

Colour blindness (colour vision deficiency) tests are not carried out at primary school age, but usually around age 11 if a problem is suspected. These use the Ishihara colour vision tests, which involve images made up of two different colours of dots. If colour vision is normal, the child will be able to recognise the letter or number that is highlighted. A child who cannot tell the difference between two colours (such as red and green) and therefore cannot see the picture, may have a colour vision problem.

Selected Links

  • RNID - (RNID)
    http://www.rnid.org.uk
  • Newborn hearing screening programme - (NHS)
    http://www.nhsp.info/
  • Pre-school hearing, speech, language and vision sc - (NHS Centre for Reviews and Dissemination)
    http://www.york.ac.uk/inst/crd/ehc42.pdf
  • Breaking the sound barrier - (RNID)
    http://www.breakingthesoundbarrier.org.uk/home/
    Breaking the sound barrier - RNID

Last updated on 27 June 2007 04:48 PM

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