Synopsis
Detect visual and hearing impairment early, distinguish developmental concern from urgent acquired loss, select age-appropriate assessment, provide prompt sensory and communication support and coordinate surveillance for children at increased risk.
- A passed newborn screen does not exclude later, progressive or acquired hearing and visual impairment; act on current developmental concern.
- Ask about response to quiet speech, localisation, television volume, eye contact, tracking, bumping into objects, headaches and school access.
- Check pupils, red reflexes, ocular alignment, age-appropriate acuity and gross visual fields, and inspect ears before assuming behaviour explains poor response.
- Use objective electrophysiological testing when developmental or motor limitations make behavioural hearing or vision responses unreliable.
- Refer urgently for leukocoria, painful visual loss, ocular trauma, acute hearing loss or sensory change with neurological signs.
- Correct refractive error, treat indicated ocular disease and provide amblyopia therapy within the child's visual developmental window.
- For hearing impairment, combine audiological management with early language access, family choice and communication support; technology alone is insufficient.
- Notify and involve specialist education, habilitation and sensory-impairment services so adaptations reach home, nursery and school.
Key red flags
A white or asymmetrical red reflex, new squint with abnormal reflex or suspected retinoblastoma needs urgent ophthalmology assessment.
Painful red eye, photophobia, reduced vision, corneal opacity or ocular trauma is not a routine refractive problem.
Sudden sensorineural hearing loss is time critical and requires urgent ENT or audiovestibular assessment.
Hearing loss with facial weakness, severe vertigo, meningism or other focal neurology requires emergency evaluation.
Developmental regression, new imbalance or combined sensory loss may indicate neurological, metabolic, infectious or genomic disease.
Failure to respond to sound or visual social cues must prompt formal assessment even after a previously reassuring screen.
Investigation priorities
Measure each eye separately and identify asymmetry or reduced clarity.
Management branches
Family, school or clinician notices altered visual or auditory behaviour.
- Document onset, laterality, fluctuation, developmental effect and relevant risk factors.
- Perform an accessible focused eye, ear and neurological examination.
- Refer for age-appropriate optometric, ophthalmic or audiological testing.
- Provide interim communication and environmental adaptations while results are pending.