Ears, eyes and the checks that catch things early

Sensory problems in infancy are largely silent, which is why the checks are systematic rather than symptom-driven.

Newborn hearing screening

Offered in most countries within the first weeks.

It uses otoacoustic emissions and sometimes automated auditory brainstem response, both painless and often done while the baby sleeps.

A clear response means permanent hearing loss is unlikely at that point.

A referral for further testing does not mean the baby is deaf — fluid or debris in the ear after birth is a common cause of an unclear result.

Early identification matters enormously: intervention before around six months is associated with substantially better language outcomes than later identification.

Hearing after the newborn period

The critical point that screening does not cover.

Hearing loss can be acquired or become apparent later, and a clear newborn screen does not rule out later problems.

Which means parental concern about hearing at any age should always lead to a test.

Signs to act on: not startling to sudden sound, not turning towards sound by around four to six months, not responding to their name by around a year, delayed babbling or speech, needing things repeated, and turning the television up.

Risk factors: family history, prematurity, neonatal unit admission, jaundice requiring exchange transfusion, certain infections in pregnancy, meningitis, head injury, and some medications.

Glue ear

The most common cause of hearing loss in early childhood.

Fluid in the middle ear, frequently following colds and ear infections, causing fluctuating conductive hearing loss.

It is very common, particularly between around one and six years, and the majority resolves spontaneously within three months.

Which is why watchful waiting for a period is standard before intervention.

Persistent glue ear with hearing loss affecting speech or learning may be treated with grommets or hearing aids.

Signs: not hearing well, speech unclear, inattention, being tired or irritable, and recurrent ear infections.

Risk factors include exposure to tobacco smoke, which is a modifiable one worth acting on.

Ear infections

Common and mostly self-limiting.

Acute otitis media causes ear pain, fever and irritability, and in babies may present as pulling at the ear, crying when lying flat and poor feeding.

Most resolve without antibiotics within a few days, which is why guidance in many countries recommends analgesia and a delayed prescription approach in otherwise well children over a certain age.

Antibiotics are recommended for younger infants, bilateral infection in young children, discharge, and those who are systemically unwell.

Discharge from the ear may mean the eardrum has perforated, which relieves the pain and usually heals.

Urgent review is needed for swelling or redness behind the ear, a pushed-forward ear, severe headache, neck stiffness or an unwell child.

Newborn eye checks

Part of the newborn and six-to-eight-week examinations.

The red reflex test uses an ophthalmoscope to check that light reflects back evenly from the retina.

An absent or abnormal reflex can indicate congenital cataract or, rarely, retinoblastoma — a cancer where early detection substantially affects outcome.

Which is why an absent red reflex is an urgent referral rather than a routine one.

Photographs occasionally reveal this, when one eye shows white rather than red in a flash photograph, and this should always be checked.

Vision development and squint

What is normal and what is not.

Newborn vision is blurry and improves rapidly over the first months.

Intermittent crossing or wandering of the eyes is common in the first three months.

Persistent squint beyond around three months, or any constant squint at any age, requires assessment.

Untreated squint can cause amblyopia — reduced vision in the affected eye from lack of use — which is treatable in early childhood and much less so later.

Treatment may include glasses, patching or surgery.

Other signs to act on: not fixing on faces, not following objects by around three months, an unusual head position, persistent watering or discharge, sensitivity to light, or a white pupil.

What parents can do

Attend the routine checks, which are the whole system for catching these.

Raise concerns early and specifically, since parental observation is a recognised part of screening.

Ask for a hearing test rather than accepting reassurance, if you are worried.

Avoid smoke exposure, which affects ear health.

Reduce loud noise exposure, and use ear protection at loud events.

And take any white pupil in a photograph seriously, which is the single most useful thing a parent can notice at home.

General information only, not medical advice. Seek prompt assessment for a white pupil, persistent squint, or any concern about your child's hearing or vision.