1. Hearing loss in children
Hearing loss at birth: Significant effects on development of speech and language. May start to become more obvious as child grows.
Even mild hearing loss can have significant effects.
Risk factors for neonates: Low APGAR scores, family history, syndrome, illness, craniofacial disorders, in-utero infection and medications.
Universal hearing screening: Based on high-risk registry.

2. Objective tests for neonatal and infant hearing screening/testing
ABR
OAE
Tympanometry
Acoustic reflexes
Important to use age-appropriate norms and to multiple tests whenever possible.

3. Behavioral hearing tests in children
Important to know normal responses to differentiate them from children with problems.
Responses: Voluntary or involuntary movements, vocalization, electrophysiological.
Thresholds typically higher because of the nature of the response.

4. Behavioral methods for testing children upto 2 years of age
Behavioral observation audiometry (BOA): For very young children (First 6-8 mths of age). Present various stimuli and observe child’s reaction.
Sound-field audiometry: For older children (upto 2 years) Use of multiple loudspeakers, present stimuli, observe responses.
Conditioned orientation reflex (COR): Pair auditory stimulus with visual stimulus till child associates the two.
Visual reinforcement audiometry (VRA): Use reinforcers to encourage correct responses.

5. Behavioral methods for testing children between 2-5 years of age
Can use stimuli with greater frequency-specificity.
Use warble tones (frequency-modulated pure tones)
Speech audiometry using picture responses.
Pure tone audiometry in some cases.
Play audiometry: Example: Placing blocks into a bucket when a tone is heard.