Testing Hearing in Children (Subjective)

PLAY AUDIOMETRY (Conditioned Play Audiometry, CPA)

Testing young children’s hearing can be an exciting challenge for audiologists! Each child requires a unique approach. The goal is for them to feel it’s a game- not a test- and are motivated to focus, attend, listen and perform the task. The task can be filling a peg board, throwing sandbags into a bucket, or building a tower. The conditioning is in showing the child that when they hear a sound, they will do the desired action, but only when they hear it, aiming to time-lock their response to the stimulus. In addition to the child’s developmental ability and conceptualย 


understanding, audiologists must take into account his or her gross and fine motor skills, visual acuity, excitability, and personality. Impulse control is necessary and often children need to be reminded to wait for the sound to come. The way the “directions” are given is also extremely variable, with modeling being the most concrete approach. Hand-over-hand training/conditioning is also very successful and thus having an additional tester or assistant can be very valuable.



With younger children, a different strategy may be more appropriate based again on their developmental age and ability. An audiology booth can be fitted with toys inside of a black box that the audiologist can activate from the tester’s side. It is again a conditioning task in which the child associates the introduction of a sound with the reward of a toy moving or lights flashing in the box.


The least reliable or valid method is one of simple observation. Getting an estimate reaction to loud sounds is a basic starting point. BOA can be used to evaluate if an infant or young child exhibits eye movement, a stop in movement, increased sucking, or any other noticeable change that appears time-locked to a presentation of sounds.

These methods are all subjective, meaning they necessarily require the patient’s participation and engagement with the sound. The audiologist also has objective diagnostic and screening tools (eg. OAE, ABR) that do not require the patient to respond or even to be awake.

Tips for Audiologist for testing children:

  1. Manage the environment. – Don’t have any extraneous toys, books or even chairs that can distract the child.
  2. Make them feel safe and comfortable. – Children can sit on the lap of their parent or caregiver to make them feel safe even in an unfamiliar environment. If they have a comfort object (stuffed animal or blanket), they can definitely hold it. I would recommend against any bottle or snack since a. it makes noise and b. can be too lulling when you want the child alert.
  3. Motivate the child. – A sticker can go a long way in encouraging a toddler to engage with you. Bubbles, cars, and other prizes can be incredibly motivating to children.
  4. Start by conditioning and ensure proper understanding of the task, and an ability to perform it independently, before beginning the testing phase.
  5. Re-condition as needed. When changing frequencies, a review of the task with the new stimulus may be necessary.
  6. Set the right tone. -Exude fun and excitement while at the same time asserting control so that the child senses this “game” is the current activity that they are expected to participate in.

Tips for Parents Taking Children for a Hearing Test:

Practice at home for several days before the appointment (For children old enough/able to understand.)

  1. Practice putting headphones on just to get used to the sensory experience of something large and heavy covering their ears.
  2. Practice playing a “listening” or “music” game in which they have to hold a block up to their ear and only place it into a bucket when you sing a certain song, or play a beep, or bang on a drum etc.
  3. Prepare them with an exciting motivator for “playing nicely” at the appointment. This could be a small token prize or a treat for the way home (go to your favorite park, get ice-cream etc.)
  4. Do not refer to the appointment/office as a “doctor’s appointment.” Kids generally associate their doctor’s office with shots, being sick, being undressed, poked and prodded. A typical audiological appointment is much more laid back. I would often see children with wide eyes in the waiting room who were visibly relieved when I’d introduce myself and ask them “Are you ready to play a game with me?!”

Please share any additional tips so we can all learn from one another! That’s a major goal for me with this blog- to encourage growth and dialogue around what I’m passionate about!


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