Little Ears takes hearing tests to newborns

About 17 babies are born with permanent hearing loss in South Africa every day. Yet fewer than 10% of newborns receive hearing screening, leaving many families unaware of a child’s hearing status until 20 to 30 months after birth.

The Western Cape Department of Health and Wellness and child advocacy campaign Hold My Hand is preparing to tackle that delay through a programme called Little Ears. It will introduce universal newborn hearing screening in the George, Oudtshoorn and Khayelitsha subdistricts late in 2026, with further implementation at participating sites early next year.

The test is quick, gentle and painless, according to the provincial health department. It is also more reliable than waiting for parents or health workers to notice how a baby responds to sound. Babies may react to facial expressions and other visual cues, which can conceal hearing loss during ordinary observation.

Objective screening uses equipment to measure a baby’s hearing response. The Western Cape health department recommends screening within the first month of life, before hearing loss can affect access to language and learning.

Early identification allows families to choose the combination of South African Sign Language, spoken language, hearing technology and other support that suits the child. It also gives parents and caregivers time to learn how to communicate with the child during the earliest period of development.

Nicolette Henney, deputy director of the Early Life Course Unit at the Western Cape Department of Health and Wellness, said newborn hearing screening had been prioritised within its Start Well portfolio, which covers the first 1,000 days of a child’s life.

“This is to ensure all children in the Western Cape thrive and reach their full potential by supporting them in the first 1000 days, with a specific focus on early intervention, particularly in the neonatal period,” she said.

“With the launch of Little Ears, a universal newborn hearing screening programme that integrates early hearing detection and intervention by leveraging public-private partnerships, we have focussed on strategic partnerships, integrated data management, systems strengthening, and civil society engagement.”

The need extends well beyond the Western Cape. Around 6,000 babies with permanent hearing loss are born in South Africa each year, according to a Hold My Hand policy brief. The organisation estimates the lifetime economic burden associated with one annual group of unidentified cases at R68.6-billion.

Cabinet approved the National Strategy to Accelerate Action for Children in December 2025. The strategy identifies newborn hearing screening as an intervention that can improve outcomes during the first 1,000 days, alongside early support for caregivers and inclusive services for children with disabilities.

The technology solves only the first part of the problem. A child identified through screening still needs a referral route and access to suitable services. Those may include early developmental support, hearing aids or cochlear implants, SASL and assistance for caregivers.

Families also need enough information to decide which forms of communication and support are right for their child. Deaf advocates emphasise that deaf children should have early access to a rich natural language and should never be defined solely by hearing loss.

South African Sign Language became the country’s 12th official language in 2023. For Deaf children and their families, early access to SASL can support communication, relationships and learning from infancy. Some families choose spoken language and hearing technology, while others use both SASL and spoken language.

Hold My Hand strategy lead Dr Noxolo Gqada said Deaf Awareness Month should be used to learn about Deaf culture and SASL, and to support the inclusion of Deaf people in South African life.

“We are also calling out to parents and caregivers to find out more about hearing screening for their child and remember that bonding does not depend on how they hear, it depends on how you communicate,” she said.

The screening gap can be difficult to recover from once a child reaches nursery school or the classroom without full access to language. Delayed identification may affect literacy and social development, while parents can spend months seeking explanations for delayed speech or inconsistent responses.

The Western Cape public health system already provides newborn screening and hearing services through clinics and hospitals. The Little Ears programme is designed to integrate screening, follow-up information and intervention across the selected sites, supported by shared data and partnerships with civil society.

Children with hearing loss also need schools and early learning centres that can accommodate their communication needs. Screening can identify the child’s hearing status, but inclusion depends on teachers, health workers and families having suitable training and resources.

“Healthcare workers, communities and governments, all have a part to play in making sure children with hearing loss get early access to language, communication and the support they need to thrive,” said Gqada.

* For more information, visit https://holdmyhand.org.za