Hearing is one of the senses that develops earliest, and its role in language, communication, and social development is fundamental. Babies begin responding to sound in the womb, and by birth, they are already primed to respond to voices — particularly their mother's voice, which they have been listening to for months. This guide covers how hearing develops in the first year, what the newborn hearing screening involves, the signs of possible hearing loss to be aware of, and when and how to seek help.
The auditory system begins developing at around 18 weeks of pregnancy, and from around 24 to 28 weeks, fetuses can respond to sounds. In the final trimester, the fetus is routinely exposed to the sounds of the outside world — muffled by amniotic fluid and the body, but present.
Research has shown that newborns prefer their mother's voice over other voices, recognise stories that were read aloud during pregnancy, and show preferences for languages and music they were exposed to before birth. This is not simply a nice fact — it underlines how early auditory development begins and why the auditory environment matters from the very start.
The NHS Newborn Hearing Screening Programme (NHSP) offers a hearing screen to all babies in England, typically within the first few days or weeks of life. Similar programmes operate across Scotland, Wales, and Northern Ireland.
The screen is performed using one or both of two methods:
Automated Otoacoustic Emissions (AOAE): A small earpiece is placed in the baby's ear and a soft sound is played. The test measures the echo produced by the cochlea (the hearing organ in the inner ear) in response to sound. It takes only a few minutes and is entirely painless. The baby needs to be reasonably settled (ideally asleep) for an accurate reading.
Automated Auditory Brainstem Response (AABR): Small sensors are placed on the baby's head, neck, and shoulder, and soft sounds are played through earphones. The test measures the brain's response to sound. This is used when the AOAE gives an unclear result or as a primary screen for babies admitted to NICU.
The result is given as "clear" (hearing response detected) or "not clear" (further testing needed). A "not clear" result does not necessarily mean your baby has a hearing problem — it may be due to fluid in the ear, the baby moving during the test, or background noise. Around 1 to 2% of babies referred for further testing are ultimately found to have a permanent hearing loss.
If your baby is referred for further testing, an appointment with an audiology team will be arranged. This is usually a more detailed assessment using similar methods, and the results give a clearer picture of whether any hearing loss is present and, if so, its nature and degree.
0 to 3 months: Newborns respond to sudden loud sounds with a startle reflex (Moro reflex). They settle to a familiar voice and show awareness of sound by pausing activity, widening their eyes, or turning their head.
3 to 6 months: Babies begin to turn toward the direction of a sound with more purpose. They respond to their name and familiar voices with visible pleasure. Babbling begins — the production of vowel sounds and, later, consonant-vowel combinations like "ba" and "da."
6 to 9 months: Babies show clear head-turning toward sounds. They begin to understand some words, particularly frequently repeated ones like their own name. Babbling becomes more varied and more conversational in tone.
9 to 12 months: Most babies are actively listening to conversation and beginning to understand simple phrases ("where's the ball?", "come here"). Babbling includes strings of syllables that begin to take on the rhythm and intonation of speech. First words typically emerge toward the end of this period, though the range of typical development is wide.
Hearing loss in babies can range from mild to profound and from temporary (such as "glue ear," where fluid in the middle ear impairs hearing) to permanent. Early identification is critical because language development is profoundly dependent on hearing — the brain's language-learning systems are most sensitive and efficient in the first years of life.
Signs that should prompt discussion with your health visitor or GP include:
0 to 3 months:
3 to 6 months:
6 to 9 months:
9 to 12 months:
Glue ear (otitis media with effusion) is the most common cause of hearing impairment in young children in the UK. It occurs when the middle ear fills with a sticky, fluid-like substance rather than air, reducing the transmission of sound to the inner ear.
Glue ear is extremely common — affecting up to 80% of children at some point before the age of 10 — and is often temporary, resolving on its own within a few weeks to months. However, recurrent or persistent glue ear can affect language development and may warrant treatment (grommets surgery or hearing aids).
Signs include:
Do not wait for the next scheduled appointment if you have concerns about your baby's hearing. Contact your health visitor or GP, who can arrange a referral to audiology. In most areas, children can be referred for a hearing assessment at any age, and early assessment is always better than watching and waiting when there is a genuine concern.
You can also contact the National Deaf Children's Society (NDCS), which provides excellent information and support for families of babies and children with hearing loss. If your child is diagnosed with any degree of hearing loss, the NDCS is an invaluable first port of call.
Early identification and early support make an enormous difference. Trust your instincts — you know your baby, and if something feels off, it is worth getting it checked.
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