Quick answer. In Singapore, all newborns are offered hearing screening before they leave hospital, using painless tests called OAE and AABR. About 4 in 1,000 babies are born with significant hearing loss, and early detection matters because the first months are critical for speech and language development. Singapore’s programme follows the internationally recognised goal of screening early, diagnosing by around 3 months and starting intervention by about 6 months. Children are screened again at Primary 1 through the Health Promotion Board’s School Health Service. Watch for signs such as not startling to sounds, not babbling, delayed speech or turning up the TV, and seek assessment if you are concerned.
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Hearing is essential for a child’s speech, language and learning, so Singapore screens hearing from the very first days of life. This guide explains the Universal Newborn Hearing Screening programme, why early detection matters, the Primary 1 school screening, the signs of hearing problems by age, common causes, and what happens if your child is referred. It is general information about audiology services and not a substitute for assessment by a doctor or audiologist.
At a glance
| Stage | Test | Timing |
|---|---|---|
| Newborn | OAE and/or AABR | Before hospital discharge |
| If not passed | Repeat then diagnostic test | Weeks after birth |
| Primary 1 | Audiometer with headphones | Annual school health visit |
Universal Newborn Hearing Screening
Singapore offers hearing screening to all newborns in hospitals before they are discharged. Two safe, painless tests are used. Otoacoustic emissions (OAE) places a small probe in the ear that plays soft clicks and measures the ear’s echo. Automated auditory brainstem response (AABR) uses gentle sensor tabs and soft earphones to record how the hearing nerve responds. The screen takes about 15 to 30 minutes. Hospitals vary slightly in their protocol, with KKH and SGH using AABR for all babies and NUH using OAE for all babies, and at-risk infants receiving both. A pass means normal hearing at the time of testing, while babies who do not pass have a repeat test and, if needed, a referral to an ENT specialist for diagnostic testing.
Why early detection matters
About 4 in every 1,000 babies are born with significant hearing impairment. The first months of life are a critical window for developing speech, language and social skills, so undetected hearing loss can cause lasting delays. Singapore’s programme is built around the internationally recognised 1-3-6 benchmark: screen by around 1 month of age, complete diagnostic evaluation by around 3 months, and begin appropriate intervention by around 6 months. Public hospital sources note that with early, appropriate therapy many children can go on to develop normal speech and language, which is why acting quickly on a referral is so important.
School hearing screening
A pass at birth does not guarantee hearing stays perfect, so screening continues in school. The Health Promotion Board’s School Health Service screens Primary 1 students for hearing as part of the annual school health visit. The child wears headphones and is tested with an audiometer; if they cannot hear some sounds, their ears may be examined and they may be referred for further assessment. The Primary 1 visit also covers vision, height and weight, and immunisation. These services are provided free during school hours, and parents are asked to give consent and keep their child’s health information updated.
Signs of hearing problems by age
Parents are often the first to notice a problem. In the first 6 months, watch for a baby who does not startle at loud sounds, does not react to your voice, or is not making soft cooing sounds. From 6 to 12 months, concern signs include not responding to their name, reduced or absent babbling, and no first words by around 12 months. In toddlers and older children, look for delayed speech, difficulty following directions, frequently asking you to repeat, turning the TV volume up, or struggling at school. A child who passed the newborn screen can still develop hearing loss later, so keep watching developmental milestones.
Causes of childhood hearing loss
Causes fall into a few groups. Genetic factors account for more than half of congenital hearing loss. Infections around birth, particularly congenital cytomegalovirus (CMV), as well as rubella and herpes, can affect hearing, along with prematurity, low birth weight and severe newborn jaundice. Acquired causes include otitis media with effusion, often called glue ear, which is the most common cause of conductive hearing loss in children, plus illnesses such as meningitis and mumps that can damage the inner ear. Identifying the cause helps guide the right treatment and follow-up.
What happens after a referral
If your child does not pass screening, they are referred for diagnostic audiology, mainly at tertiary centres such as KKH and NUH, which have paediatric audiology teams and early intervention services. Depending on the type and degree of loss, options include hearing aids for mild to moderate loss, cochlear implants for severe to profound loss, and bone-anchored devices in some cases. KKH is one of only two centres in Singapore performing paediatric cochlear implants. Early intervention also includes auditory-verbal and speech-language therapy to support your child’s communication development. A referral is not a diagnosis, but it is important to attend promptly so any hearing loss can be addressed early.
If your baby is referred after newborn screening
Not passing the newborn hearing screen does not necessarily mean your child has permanent hearing loss. Sometimes a baby does not pass because of fluid or debris in the ear canal, movement, or background noise during the test. The next step is usually a repeat screen and, if needed, a fuller diagnostic assessment with a paediatric audiology team. The most important thing is to attend the follow-up promptly, because Singapore’s programme aims to confirm any hearing loss by around three months and begin support by around six months, when it makes the biggest difference to speech and language.
Supporting your child’s hearing and language
Whether or not there is a hearing concern, everyday interaction strongly supports language development. Talk, sing and read to your child often, name objects during daily routines, and respond to babbling and gestures. Reduce background noise such as a television left on when you are speaking with your child. If your child has frequent ear infections or repeated bouts of “glue ear”, mention this to your doctor, as recurrent middle-ear fluid is a common cause of temporary hearing difficulty in young children and can affect how they pick up sounds and words.
Common questions
My child passed the newborn screen. Can hearing still change later?
Yes. Some hearing loss develops after birth or in childhood, which is why school screening continues at Primary 1 and why parents should keep watching developmental milestones and raise any concerns.
Are the newborn tests safe and painful?
The OAE and AABR tests are safe and painless. They use soft sounds and gentle sensors, and many babies sleep through them.
Related guides
- Best Hearing & Audiology Clinics in Singapore — our editorial shortlist
- hearing & audiology clinics directory
- Hearing tests
- Hearing aids
- Noise and hearing
Sources
- HealthHub – Universal Hearing Screening Programme
- NUH – Universal Newborn Hearing Screening Programme
- SingHealth – Universal Newborn Hearing Screening
- HealthHub – Health Screening for Primary School
- KKH – Children's ENT Centre
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