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In pediatric audiology, achieving reliable behavioral thresholds is often the most critical step in diagnosing hearing loss. For infants and toddlers, the method of choice is visual reinforcement audiometry (VRA). Recently, the study by Bonino et al. (2021) titled “Visual Reinforcers Designed for Children with Developmental Disabilities” has provided actionable insights for improving VRA system performance and outcomes. Understanding Visual Reinforcement Audiometry Visual reinforcement audiometry is a behavioral hearing test technique typically used for children from around 6 months to 2 years (and sometimes older). In this method, a child is conditioned to turn toward a sound source. When they respond, they are rewarded with a visual stimulus, such as a toy, video, or light. Reliable results depend on engagement and consistency. The Challenge: Testing Children with Developmental Disabilities Testing children with developmental disabilities can be particularly challenging. These children may face additional barriers, including: Sensory sensitivities Limited attention shifts Restricted interests Atypical response behaviors Difficulties with standard conditioning protocols These factors can significantly reduce the likelihood of completing a full audiogram. Breakthrough Study: Library of Visual Reinforcers Bonino developed a library of 45 themed reinforcer sets (photos/videos) selected based on common interests of children with developmental disabilities. Each set contains 20-40 unique items and is formatted for commercial VRA systems and custom slideshow setups. The library is freely downloadable under Creative Commons licensing. Key Findings & Takeaways for VRA Systems & Audiology Research Here are some key findings that can enhance VRA systems and audiology research: Tailored Reinforcers : Reinforcers designed for developmental interests may improve engagement, reduce the number of sessions, and enhance data yield (though clinical validation is pending). Flexible VRA Systems : VRA systems that allow easy switching of content/themes—and custom uploads—are better equipped to help overcome habituation and attention lapses. Open-Source Libraries : Research-backed libraries democratize access to better reinforcement materials for audiology clinics of all sizes. Future Research Directions : Future audiology research should quantify how tailored reinforcers impact completion rates, threshold reliability, session length, and cost reduction. What This Means for Clinical VRA Testing For audiologists and pediatric hearing centers, consider the following: Review Reinforcer Content : Examine the reinforcer content your VRA system uses. Does it include themes aligned to children with developmental disabilities? Modern VRA Systems : If using a modern VRA system (like Flex VRA), ensure it allows custom video uploads and rapid reinforcer changes. How Flex VRA Leverages the Research Flex VRA supports both video-based and toy-based reinforcement. It allows custom content uploads and offers a modern touch interface for ease of use. This aligns directly with the Bonino study’s emphasis on reinforcer customization and engagement. By integrating research-backed libraries and simplifying system configuration, Flex VRA positions your clinic to deliver better outcomes, particularly for populations that challenge standard VRA approaches. Conclusion: The Future of Pediatric Audiology As we move forward, the integration of tailored visual reinforcers into VRA systems will revolutionize how we approach pediatric audiology. By focusing on engagement and customization, we can improve the reliability of test results and enhance the overall experience for children undergoing hearing evaluations. By embracing these advancements, we can ensure that every child receives the best possible care and support in their hearing journey. Let’s make hearing evaluations more engaging and effective for children! For more insights on improving pediatric audiology practices, check out this study .

Disclaimer This content is provided for general educational purposes only and does not constitute billing, coding, or legal advice. CPT coding requirements, reimbursement policies, and payer guidelines may change and can vary by insurer and jurisdiction. Clinicians and practices should consult payer-specific policies, professional guidance, or qualified billing specialists to ensure accurate coding and compliance. Visual Reinforcement Audiometry is a commonly used behavioral hearing test within a pediatric VRA system, designed to measure hearing thresholds in infants and young children. Although most pediatric audiologists might be familiar with VRA testing, questions about VRA CPT codes and how to bill for VRA testing are a common question in our inbox. So, in this overvie, we'll address the most frequently asked questions about how to bill for VRA and which CPT codes are typically used. What CPT code is used for Visual Reinforcement Audiometry? The CPT code most commonly associated with visual reinforcement audiometry is 92579. This code is used for behavioral audiometric testing that relies on visual reinforcement techniques and is typically applied when testing infants or young children who are not developmentally ready for conditioned play audiometry. Is there one CPT code that covers all VRA system testing? No. There is no single CPT code that universally covers all testing performed during a VRA session. Billing for visual reinforcement audiometry is based on the testing method performed, not the VRA system or equipment used. While 92579 is often appropriate, additional audiometric CPT codes may be used depending on how thresholds are obtained and payer-specific guidance. When should CPT code 92582 be used instead of a VRA CPT code? CPT code 92582 is used for conditioned play audiometry and should only be billed when play-based testing is performed. It should not be used for visual reinforcement audiometry unless the child has transitioned developmentally to play audiometry during the session. Does soundfield versus ear-specific testing affect how to bill for VRA? In most cases, billing does not change solely based on whether testing is completed in the soundfield or with ear-specific transducers. However, documentation should clearly describe how stimuli were presented, how responses were obtained, and which behavioral method was used during visual reinforcement audiometry. What documentation is important when billing for VRA testing? Clinical documentation should include the patient’s age and developmental level, the behavioral testing method used, the reliability of responses, and any limitations encountered during testing. Clear documentation supports medical necessity and is especially important when billing for pediatric visual reinforcement audiometry. Do payer rules vary for VRA CPT codes? Yes. Reimbursement and coverage for visual reinforcement audiometry vary by insurance carrier, state Medicaid program, and individual payer policy. Practices should regularly review payer guidelines and confirm requirements such as prior authorization when applicable. Does the type of VRA system affect billing? No. CPT codes describe the clinical service performed, not the technology or reinforcement system used. Billing should always reflect the testing procedure and behavioral method rather than the specific VRA system.

In pediatric audiology, two of the most commonly used behavioral hearing tests are Visual Reinforcement Audiometry (VRA) and Conditioned Play Audiometry (CPA). Although both tests are used to evaluate hearing in children, they are designed for different developmental stages and rely on different response behaviors. Understanding the difference between VRA and CPA testing helps audiologists choose the most appropriate method and obtain reliable hearing thresholds. What Is Visual Reinforcement Audiometry (VRA)? Visual Reinforcement Audiometry (VRA) is a behavioral hearing test used primarily with infants and young toddlers, typically between 6 months and 2.5 years of age. During VRA testing: Sounds are presented through speakers or earphones The child is conditioned to turn toward the sound A visual reinforcer (video, light, or toy) is activated after a correct response VRA testing relies on natural head-turn behavior rather than instructed responses as you can see in the video below. Example of VRA testing being done with a Flex VRA version 1 When VRA is typically used Infants and toddlers under 3 years old Children who cannot follow verbal instructions Early behavioral hearing assessments Pediatric patients with short or variable attention spans Visual Reinforcement Audiometry is most effective when the reinforcement is engaging but controlled, allowing the child to stay focused without distraction. What Is Conditioned Play Audiometry (CPA)? Conditioned Play Audiometry (CPA) is a behavioral hearing test commonly used with older toddlers and preschool-aged children, generally between 2.5 and 5 years of age, depending on developmental readiness. During CPA testing: The child is taught a simple play task (such as placing a block in a container) The task is performed each time a sound is heard Responses are intentional and conditioned CPA requires the child to understand instructions and complete a specific action in response to sound. When CPA is typically used Preschool-aged children Children who can follow simple instructions Patients with longer attention spans Diagnostic or follow-up audiology evaluations Conditioned Play Audiometry can produce reliable thresholds when the child is developmentally ready. Key Differences Between VRA and CPA Feature VRA CPA Full name Visual Reinforcement Audiometry Conditioned Play Audiometry Typical age range 6 months to ~2.5 years ~2.5 to 5 years Response type Head turn toward sound Conditioned play action Instruction required Minimal Moderate Attention demands Short and variable Longer and sustained Reinforcement Visual stimulus Play-based task Clinical goal Sound detection and early thresholds Behavioral thresholds Why Developmental Readiness Is Important Choosing between VRA and CPA is not based on age alone. A child may be chronologically old enough for CPA but not developmentally ready to: Understand instructions Perform a conditioned task consistently Maintain attention throughout testing Using CPA too early can result in: Inconsistent responses Increased test time Unreliable thresholds In these cases, Visual Reinforcement Audiometry may still be the more appropriate test method. Transitioning From VRA to CPA The transition from VRA to CPA often occurs gradually. Some children may move between methods during the same appointment depending on: Fatigue Engagement level Task understanding Audiology clinics benefit from testing environments that allow flexibility between VRA and CPA, rather than forcing a single testing approach. The Role of Flexible VRA Systems in Pediatric Audiology Modern pediatric audiology clinics increasingly rely on VRA systems that support: Multiple reinforcement options Adjustable visual engagement Controlled test environments Smooth workflow transitions These capabilities allow audiologists to adapt testing methods based on the child’s developmental stage rather than strictly following age-based guidelines. Choosing Between VRA and CPA There is no single “best” pediatric hearing test. Use VRA when the child responds best to visual reinforcement and natural head-turn behavior. Use CPA when the child can follow instructions and reliably complete a conditioned task. The most accurate pediatric audiology evaluations are achieved when clinicians can adjust testing methods in real time. This includes possible utilizing a VRA system with an interactive button for VROCA testing . Summary: VRA vs CPA Visual Reinforcement Audiometry and Conditioned Play Audiometry serve different but complementary roles in pediatric hearing testing. Understanding the difference between VRA and CPA allows audiologists to: Select the appropriate test method Reduce testing time Improve reliability of results Create a better experience for children and parents

We’ve been hard at work throughout 2025 building some exciting new things at Flex. One project we’re especially excited to share in 2026 is the next generation of the Flex Toy Visual Reinforcement Audiometry System . The original goal was simple. We wanted to convert the Flex Toy to our zoned radio-frequency wireless technology to make installation easier and improve compatibility with our wireless video reinforcers. But once we opened the box and started updating internal components, it became clear that this was an opportunity to rethink Flex Toy entirely and push traditional toy VRA further. The problem with traditional toy VRA I’ll admit something up front. I’ve never been a huge fan of traditional toy VRA. At Flex, we design VRA systems to not only capture attention, but to hold  interest and genuinely delight patients and families during a hearing evaluation. The idea of lighting up the same box with the same figure inside, over and over, has always felt a bit underwhelming. So, if we were going to redesign the Flex Toy, it couldn’t just be another box that lights up a figure. It had to approach reinforcement differently. The flashing LED light bar had to go One early thought was simple: if novelty matters, maybe we change the color of the flashing light each time the toy activates. Old Flex Toy Still boring. So  we went further. We removed the traditional light bar entirely and replaced it with a dynamic light panel capable of producing different colors and  patterns on every activation. That change made an immediate difference. New Flex Toy Now, each activation produces a new light pattern dancing around the border of the toy. We placed early versions into trial sites, and the feedback was unanimous: “The kids LOVE it.” That was all the confirmation we needed to make it a permanent part of the new design. Reducing mechanical parts and breakage The original Flex Toy contained a number of moving parts, boards, speakers, and gears that were vulnerable to breakage during shipping or installation. If we were rebuilding the system, that risk had to go away. We upgraded the internal motors to a drop-resistant design, reinforced mounting for internal boards and speakers, and moved the external sound card inside the enclosure so it could not be accidentally disconnected. The result is a Flex Toy that is more durable and reliable than ever. Combined with wireless operation, the likelihood of mechanical issues is now extremely low. Rethinking power Wireless toys introduce a new challenge: power. Audiology booths are notorious for having limited outlets, and with Flex Combo systems capable of supporting up to 6 reinforcers, requiring one outlet per device simply wasn’t realistic. So we didn’t just rethink power for Flex Toy. We reworked power options across the Flex VRA system as a whole. After a lot of trial and error, it’s now possible to run up to five reinforcers  (monitors, toys, or any combination you can think of) from a single power outlet. Will that configuration be used every day? Probably not. But as someone who spent years installing systems, knowing you have flexible power options when you need them matters. The clinician may never notice, but the installation technician who’s an hour away from the nearest hardware store certainly will. Looking ahead To say we’re happy with the results of this redesign would be an understatement. Dare I say it...I’m genuinely excited about traditional toy VRA now. Thank you to the audiologists whose feedback guided each design decision, and to our distribution partners who have patiently waited for this release. We’re excited to usher in the new Flex Toy in 2026.

Adapting the VRA System to the Patient, Not the Other Way Around A modern VRA system needs to do more than just present visual reinforcement. It needs to adapt to the wide range of patients seen in pediatric audiology clinics every day. Most children respond well to standard visual reinforcement. Bright lights, engaging videos, or a familiar toy are often enough to elicit reliable head turns. But every clinician has encountered the difficult-to-test patient. The child who only engages with one specific type of stimulus, character, or motion. This is where Targeted Content in the Flex VRA system becomes valuable. The Traditional VRA System Approach Most VRA systems are designed around a one-to-many model. The system provides several different stimulus options, and the clinician cycles through them during testing to see what captures the child’s attention. This works well in the majority of cases and remains an important part of the Flex VRA workflow. The Flex remote includes four stimulus options that can be accessed instantly during testing, giving audiologists flexibility and control in real time. However, some patients do not respond to variety. They respond to specificity. When a VRA System Needs to Be More Targeted Certain patients will only engage with very specific content. A particular category of video. A familiar character. A known visual preference. In these cases, switching between multiple generic stimuli can actually reduce engagement rather than improve it. Instead of asking the child to adapt to the VRA system, it can be more effective to adapt the VRA system to the child . What Is Targeted Content in the Flex VRA System? Targeted Content allows the clinician to customize what specific content appears when pressing the Video and Custom buttons on the Flex remote before the test begins. Importantly, this does not remove flexibility during testing. The clinician still has access to all four stimulus options throughout the session. The difference is that when Video or Custom is selected, the content that appears is intentional and pre-defined. This allows the VRA system to be tailored to the patient rather than relying on trial and error during the test. Example Use Case in a Pediatric VRA System Imagine a patient coming in for testing who you already know loves trains and Paw Patrol. Before the session starts, you configure the VRA system as follows: -Video stimulus set to a category such as “Vehicles” -Custom stimulus set to Paw Patrol content that you have uploaded Now, during testing, when you activate Video or Custom, that specific content appears instantly. The testing environment is now aligned with what you already know engages that patient. Why Targeted Content Matters Will Targeted Content be used on every patient? Probably not. But for the difficult-to-test patient, the one who struggles to stay engaged or fatigues quickly, having the right stimulus at the right moment can make a meaningful difference in obtaining reliable results. A flexible VRA system should give clinicians options. A great VRA system gives them control. Targeted Content is another way the Flex VRA system helps clinicians adapt to real-world testing challenges while keeping the focus where it belongs, on the child and their family.

Hearing tests can feel intimidating for both children and parents, especially if it’s the first time. The good news is that today’s pediatric audiology technology, like Visual Reinforcement Audiometry (VRA) , makes testing more fun, engaging, and accurate than ever before. Still, a little preparation can go a long way in helping your child feel comfortable and confident during their appointment. In this guide, we’ll explain what to expect during a VRA test and share simple, effective tips to ensure a smooth experience for you and your child. What Is a Visual Reinforcement Audiometry (VRA) Test? Visual Reinforcement Audiometry  is a specialized hearing test designed for infants and toddlers, typically between 6 months and 2.5 years old. The test helps audiologists measure how your child responds to sounds at different volumes and pitches. Here’s how it works: Your child sits on your lap in a sound-treated room. Sounds are played through speakers or headphones. When your child turns their head toward the sound, they’re rewarded with a visual stimulus  like a moving toy, flashing light, or a short, fun video clip. This reinforcement encourages participation and helps the audiologist determine the quietest sounds your child can hear. With modern systems like   Flex VRA , the process is even more engaging. Instead of mechanical toys, children see bright, animated clips—such as Hey Bear Sensory videos—that capture attention and make the test feel more like play than evaluation. Why Preparation Matters Even though VRA tests  are designed to be child-friendly, unfamiliar environments and new faces can still make some children nervous. Preparing ahead of time helps reduce anxiety and ensures the most accurate results possible. A calm, cooperative child responds more consistently, allowing audiologists to gather complete and reliable hearing data in a shorter session. Tips to Prepare Your Child for a VRA Test Here are some practical ways to help your child get ready for their upcoming hearing test: 1. Talk About the Appointment in Simple Terms A few days before the test, explain to your child that they’re going to visit a “ hearing doctor ” who will play sounds and show them fun videos when they listen carefully. Keeping the explanation short, positive, and age-appropriate helps set the right tone. 2. Practice Listening Games at Home You can prepare your child by playing simple sound games. Try hiding a small bell or toy that makes noise and encourage your child to find where it’s coming from. This builds familiarity with responding to sounds just like in a VRA test. 3. Schedule the Appointment Wisely Book the test at a time when your child is usually alert and well-rested. Avoid scheduling right before nap time or meals to reduce irritability or distraction. 4. Bring Comfort Items If your child has a favorite toy, blanket, or pacifier, bring it along. Familiar objects provide comfort in a new environment and help them feel more secure during the test. 5. Avoid Ear-Blocking Accessories Before the test, remove any hats, hairbands, or earrings that might cover your child’s ears. This ensures the audiologist can place the equipment properly for accurate testing. 6. Be a Calm and Reassuring Presence Your child will likely sit on your lap during the test. Try to stay calm and positive—children easily pick up on their parents’ emotions. Smiling and encouraging them helps create a relaxed atmosphere. 7. Ask Questions Before and After the Test Don’t hesitate to ask your audiologist to explain what will happen or to share the results in clear, simple language. Pediatric audiologists are trained to work with families and will appreciate your engagement. How Flex VRA Makes the Process Easier Traditional toy-based VRA systems were effective but often limited in flexibility and appeal. Flex VRA  brings the process into the digital age with fully customizable, screen-based visual reinforcements. Using vibrant, motion-rich clips from Hey Bear Sensory , Flex VRA systems keep children focused and motivated throughout testing—resulting in faster, more reliable outcomes. Audiologists can even adjust content based on each child’s interests or developmental level, making the experience uniquely personal and engaging. Modern innovations like these help transform what could be a stressful appointment into an interactive and positive experience for families. Give Your Child a Better Hearing Test Experience At Flex VRA , we believe hearing tests should be accurate, efficient, and child-centered. Our virtual reinforcement systems are trusted by hospitals, universities, and private clinics across the U.S. for their reliability and ability to keep children engaged. Call us:  512-777-0016 Email:   sales@flexvra.com   Visit us:  100 E. Whitestone Blvd., Ste. 148, #160, Cedar Park, TX 78613 Request a quote or schedule a demo today →  and discover how Flex VRA can make pediatric audiology testing easier for your patients—and your practice.

It's a common request from audiologists using the Flex VRA system. "The videos on Flex look great, but during visual reinforcement audiometry I want the center monitor to be less engaging. I need children turning toward the left and right reinforcers, not focusing on the middle screen." Because Flex VRA is a software-driven VRA system, these kinds of refinements have been easy to work around. However, after hearing this request from multiple clinics across the country, we decided to build a dedicated feature into the platform. We're calling it House Rules. What Is House Rules? House Rules is a simple but powerful control inside the Flex VRA system that lets you determine exactly how stimulating (or intentionally unstimulating) the center reinforcer should be during testing. When enabled, House Rules: 1. Keeps a reinforcer stimulus the same regardless of content changes made to the Left and Right reinforces from the remote control. 2. Can always display a subtle, non-distracting moving pattern on the center monitor instead of the more engaging Flex VRA videos. 3. Allows you to determine if the Flex VRA monitor will use it's physical LED light bar. 4. Gives you the option to mute audio entirely on the Flex monitor without affecting the left and right reinforcers sound controls. This lets you set “house rules” for how you want your center reinforcer to behave. It ’s a small feature that can make a meaningful difference in the effectiveness of visual reinforcement audiometry, especially with children who fixate easily. Why House Rules Improves Visual Reinforcement Audiometry During VRA testing, the center monitor often becomes unintentionally attractive, especially when high-quality animated content is displayed like that on the Flex VRA. House Rules helps clinicians: -Reduce over-fixation on the center reinforcer -Improve left/right head turns -Maintain clearer localization responses -Streamline the flow of pediatric testing -Keep the child’s attention where it matters most Flex VRA continues to evolve into one of the most customizable and clinician-friendly VRA systems available, and House Rules is another tool designed to support accurate and efficient pediatric audiology workflows. Availability House Rules will ship standard on all new Flex VRA systems beginning January 2026. If your clinic already owns Flex VRA and would like access to this feature, email our team at sales@flexvra.com , and we will provide an upgrade path for your existing VRA equipment.

For pediatric audiologists and parents alike, keeping a child engaged during a hearing test can be a serious challenge. But what if the solution lies in a vibrant world of smiling fruits, upbeat music, and dancing characters? That’s where Hey Bear Sensory content comes in—a game-changer in pediatric audiology, especially when paired with advanced tools like the Flex VRA system . In this blog, we’ll explore how Hey Bear Sensory videos significantly enhance the effectiveness of pediatric hearing tests by improving attention, cooperation, and test accuracy. What Is Hey Bear Sensory? Hey Bear Sensory is a YouTube-based channel known for its brightly colored, rhythmic, and animation-rich videos designed to stimulate young minds. Originally created for babies and toddlers to support sensory development, Hey Bear’s content has found a powerful application in pediatric medical environments—especially in hearing evaluations. Why Visual Engagement Matters in Pediatric Hearing Tests During Visual Reinforcement Audiometry (VRA) , a child's attention must be quickly captured and redirected based on auditory cues. Without engaging visual stimuli, children may lose interest or become uncooperative, making it difficult to obtain accurate hearing thresholds. This is where Hey Bear Sensory content excels. With its vibrant characters, bouncy music, and fast-paced visuals, it captivates a child’s attention better than traditional reinforcement toys or outdated animations. The Flex VRA Advantage: Hey Bear + Modern Tech Flex VRA has partnered exclusively with Hey Bear Sensory to provide the most up-to-date and exciting visual stimuli for young patients. When children see their favorite dancing fruits appear on the screen after responding to a sound, they are much more likely to stay focused and participate consistently. This innovative combo results in: Improved child cooperation Faster test completion More reliable hearing data Related: How Can You Tell If Your Child Has Impaired Hearing? Real-World Results from Audiologists Clinics across the country have seen tangible improvements in patient behavior and testing outcomes. “My 4-year-old son was so engaged with the Hey Bear clips that he signed for more when they ended. Definitely the most willing participation we’ve ever had!” — Parent via Instagram @flexvra “It creates a better environment and keeps kids distracted during tympanometry and otoscopy.” — Audiologist, Texas Such feedback illustrates just how transformative sensory video content can be when integrated into the right technology. Where Else Is Hey Bear Sensory Being Used? Hey Bear Sensory’s reach has extended beyond audiology clinics. It’s used in: Pediatric dental offices to reduce anxiety Therapy settings for children with autism or developmental delays Sensory rooms in schools and hospitals Their YouTube channel ( Hey Bear on YouTube ) now has millions of followers , affirming its popularity and effectiveness in child-centered care. The Science Behind Visual Reinforcement Understanding the science behind visual reinforcement can help audiologists appreciate why Hey Bear Sensory content is so effective. Children are naturally drawn to colorful and dynamic visuals. This attraction helps maintain their focus during auditory tests. By integrating visual stimuli, we create a more holistic testing environment. The combination of sound and sight engages multiple senses, making the experience more enjoyable for children. Enhancing Patient Participation One of the biggest challenges in pediatric audiology is ensuring that children actively participate in their hearing evaluations. Traditional methods often lead to frustration for both audiologists and young patients. With Hey Bear Sensory , children are not just passive observers. They become active participants in their own evaluations. The engaging visuals encourage them to respond to sounds, leading to more accurate results. The Future of Pediatric Audiology As technology continues to evolve, so too does the potential for enhancing pediatric audiology practices. The partnership between Flex VRA and Hey Bear Sensory is just the beginning. Imagine a future where every hearing test is a fun, interactive experience! By embracing innovative solutions, we can transform the way children perceive audiology. Final Thoughts When paired with Flex VRA , Hey Bear Sensory turns pediatric hearing evaluations into a fun, interactive experience—making audiologists' jobs easier and young patients more cooperative. Ready to improve your clinic’s pediatric outcomes? Learn more about Flex VRA’s customizable systems and how they use Hey Bear Sensory content to revolutionize auditory care. Let’s make hearing evaluations engaging and effective for every child!

When it comes to testing young children’s hearing, traditional methods used for adults just won’t work. That’s where pediatric audiology steps in—a specialized field that tailors hearing evaluations to match the developmental and behavioral needs of infants and toddlers. One of the most effective tools in this space is Visual Reinforcement Audiometry (VRA) , which relies heavily on how children respond to visual cues. At Flex VRA , we’ve developed innovative VRA systems to support audiologists in delivering accurate, engaging, and stress-free hearing tests for pediatric patients. But why do visual cues work so well—and what’s the science behind it? Why Pediatric Audiology Is Different Children, especially those under the age of three, can’t simply raise their hand or press a button when they hear a sound. Pediatric audiology uses behavior-based methods to gauge responses. One of the most common methods, VRA, involves pairing auditory stimuli with entertaining visual rewards—like moving animations or engaging lights—to condition a child to respond to sounds. This method is particularly effective because it leverages the principles of classical conditioning, which help reinforce auditory behavior through a visual reward. The Power of Visual Cues in Pediatric Audiology Young children are naturally drawn to visual stimuli. Their developing brains are highly responsive to color, movement, and light—making visual cues ideal for grabbing and holding attention during a hearing assessment. Here’s how the process works: Conditioning Phase:  When a sound is presented, a corresponding visual stimulus (like a dancing bear) appears immediately afterward. Over time, the child learns to look toward the sound source expecting a reward. Testing Phase:  The audiologist presents a sound without the visual cue to determine if the child still responds. A correct head turn indicates the sound was heard and processed. By using visual cues in this way, audiologists can collect reliable hearing thresholds even in preverbal children. Flex VRA’s Innovation in Visual Reinforcement Audiometry Flex VRA is proud to be at the forefront of technology in pediatric audiology. Our systems allow clinics to: Customize video content to keep children engaged. Control visual cues remotely for ease of use. Integrate seamlessly with existing audiometers. Provide sensory-rich stimuli from trusted creators like Hey Bear Sensory . With feedback from over 1,000 clinics, we continue to refine our systems to make pediatric hearing tests more fun, flexible, and functional than ever. Clinical Benefits of Using Visual Cues The advantages of using visual reinforcement in pediatric hearing assessments extend beyond engagement: Improved Accuracy:  When children stay focused, audiologists get more reliable results. Reduced Testing Time:  Engaged children are more cooperative, allowing for faster assessments. Positive Patient Experience:  When testing feels like play, children are less fearful and more relaxed. Incorporating technology that matches children’s cognitive development helps create a smooth testing experience for clinicians, parents, and patients alike. Final Thoughts Visual cues are more than just fun distractions—they are essential tools grounded in behavioral science. At Flex VRA, we understand the unique challenges of pediatric audiology and are committed to providing solutions that improve both the testing experience and its outcomes. Want to see how our VRA system works in real time? Contact us  for a free demo and discover why hundreds of clinics trust Flex VRA to support their youngest patients.

Testing a child’s hearing can be one of the most demanding tasks an audiologist faces. Since Flex VRA’s inception in 2018, we’ve had the privilege of observing clinicians across the country perform visual reinforcement audiometry evaluations and one thing is clear. . . Every session with a young child has a limited window of focus. Once that attention window opens, the clock starts ticking. The moment you begin testing, distractions are always waiting. Wiggling, snack requests, movement, or tears can mean lost data and lost cooperation. At Flex VRA, our mission is to help clinicians make the most of that precious window. That means removing friction from the testing process so attention stays where it matters most: on the child, not the VRA system's remote control. One of the results of this mission is Flex PC. Flex PC is a lightweight software tool that runs alongside any computerized audiometer (Interacoustics, Otometrics, MedRx) and lets clinicians create custom hotkeys to control their Flex VRA system directly from the testing computer. No more reaching for the remote and no more divided attention. Just fast, intuitive control at your fingertips. And now, Flex PC is completely wireless. Simply plug in the USB dongle and go. It uses our new zoned radio-frequency protocol for instant, reliable activation up to 30 feet with no pairing, drivers, or setup required. We believe every pediatric audiologist deserves that level of simplicity and focus, so starting now, every Flex VRA ships with Flex PC. Because when seconds count, the best reinforcement isn’t just for the child. It’s for the clinician, too. Check out Flex PC in action   here   and if you have questions, feel free to reach out to us directly at   sales@flexvra.com .

You celebrate every sound your baby makes—from the first cry to the first giggle. But what if something seems off? Maybe they’re not responding to your voice, or their speech isn’t developing like you expected. These moments can raise big questions—especially when it comes to your child’s hearing health . One of the most important, yet often overlooked, parts of early childhood care is the hearing test . Knowing when and how often your child should have their hearing tested can make all the difference in their ability to learn, speak, and connect. At Flex VRA , we specialize in child-friendly hearing assessments designed to detect issues early—when support can be most effective. Let’s break down the recommended timeline for hearing tests and how to know if your child needs one. Why Early Hearing Tests Matter Hearing is the foundation for your child’s language, social, and emotional development. If a child can’t hear clearly, it can affect how they learn to speak, connect with others, and interact with the world around them. In fact, according to the   American Academy of Pediatrics , early detection of hearing loss—preferably before 3 months of age—leads to better outcomes for speech and language development.  That’s why newborn hearing screening is now standard practice in hospitals across the U.S. Recommended Hearing Test Timeline Here’s a breakdown of when your child should get hearing tests: Newborn Screening (Birth–1 Month) Most babies receive a hearing screening before leaving the hospital . If your baby didn’t, or if you’re unsure of the results, schedule one right away. These tests are painless and only take a few minutes. Follow-Up Testing (By 3 Months) If your baby didn’t pass the initial screening, a comprehensive diagnostic test  should be done by 3 months of age to confirm whether hearing loss is present. Infants and Toddlers (6 Months – 3 Years) Even if your child passed their newborn screening, it’s important to monitor for developmental signs and schedule tests if you notice delays in speech, lack of response to sounds, or ear infections. Preschool and Beyond (4–5 Years) Routine hearing tests before starting school help ensure your child can thrive in learning environments. Many pediatricians or school systems include these screenings as part of a regular checkup. You can read more about hearing development and milestones at   KidsHealth’s Hearing Guide for Parents . What Hearing Tests Look Like at Different Ages At Flex VRA, we use age-appropriate techniques  to assess hearing in children of all developmental stages: Visual Reinforcement Audiometry (VRA)  for infants and toddlers Conditioned Play Audiometry  for preschoolers Standard Audiometry  for older children and teens Each test is designed to be fun, stress-free, and highly accurate—giving both you and your child confidence in the results. Signs Your Child May Need a Hearing Test Sooner Even if your child has passed early screenings, keep an eye out for: Speech delays or unclear speech Frequent ear infections Not responding to their name Turning up the volume excessively Difficulty following instructions If you notice any of these signs, trust your instincts and schedule a hearing evaluation. Early action leads to better outcomes. Schedule a Hearing Test Today Hearing tests are one of the most powerful tools we have to support your child’s development. If it’s time for a screening—or if you’re concerned about your child’s hearing— contact your local audiologist today .

Introduction: Engagement Is Everything in Pediatric Audiology In pediatric audiology, keeping a child’s attention  during testing can be the difference between a successful appointment and inconclusive results. Traditional animated toys and static visual cues often fail to hold interest, especially for children with sensory needs, autism, or Down syndrome. That’s where Hey Bear Sensory Toys , now exclusively integrated into the Flex VRA system , are making a difference. By combining engaging sensory video content  with Flex VRA’s cutting-edge technology, audiologists can deliver a more accurate, enjoyable, and stress-free testing experience for their youngest patients. What Are Hey Bear Sensory Toys? Hey Bear Sensory Toys  aren’t your average clinic distraction tools. Designed by Hey Bear Sensory — a YouTube sensation with over 3 million subscribers and 2.5 billion views — these colorful, rhythmic, and visually stimulating characters (often dancing fruits and vegetables) are specifically crafted to captivate young minds. Their vibrant colors, smooth animations, and synchronized music create an ideal visual reinforcement tool  for audiology testing, especially for: Infants and toddlers Children on the autism spectrum Kids with sensory processing challenges Children with Down syndrome Why Hey Bear Sensory Toys Excel in Visual Reinforcement Audiometry Visual Reinforcement Audiometry (VRA)  depends on rewarding a child’s correct head turn toward a sound source with an engaging visual stimulus. When the stimulus is boring or repetitive, participation drops — and so does test accuracy. Here’s why Hey Bear Sensory Toys   stand out: 1. Instant Attention-Grabbing Content The bright colors, smiling characters, and rhythmic music immediately capture attention, even for children with short attention spans. 2. Longer Engagement Time Instead of losing interest after a few trials, children often want “more,” helping audiologists collect more reliable data in fewer sessions. 3. Sensory-Friendly Design The animations are smooth, predictable, and non-threatening, making them suitable for children with sensory sensitivities. 4. Customizable for Each Child Through the Flex VRA interface , audiologists can select and tailor Hey Bear clips based on the child’s preferences, increasing cooperation. Real-World Results From Audiologists Audiologists nationwide are seeing dramatic improvements: “My 4-year-old son with Down Syndrome… was excited and attentive… Definitely the most willing participation we’ve ever had from him at an audiology screening!” — Parent testimonial via Instagram @flexvra “We LOVE the new Flex VRA system… It has definitely improved patient engagement and reliability of results.” — Brooke Hammond, Au.D., Primary Children’s Hospital These results aren’t just about keeping kids happy — they directly impact test accuracy, appointment efficiency, and clinical workflow . The Flex VRA + Hey Bear Sensory Advantage Flex VRA is the only VRA system with an exclusive content licensing agreement  with Hey Bear Sensory, meaning your clinic gets high-quality, preloaded content ready to use from day one. With Flex VRA, audiologists can: Instantly switch between Hey Bear Sensory videos and other reward options Control lights, volume, and video playback from a single remote Use the same system for BOA, VRA, OAE , and ABR preparation Keep children engaged even during otoscopy and tympanometry Why This Matters for Your Clinic Incorporating Hey Bear Sensory Toys  into your audiology practice isn’t just a “fun” upgrade — it’s a clinical improvement . Engaged children mean: Fewer retests More reliable thresholds Shorter appointment times Happier families who recommend your clinic Final Thoughts Hey Bear Sensory Toys  have redefined what’s possible in pediatric audiology. By pairing their captivating content with Flex VRA’s advanced technology , audiologists can create a testing environment where children are relaxed, engaged, and eager to participate. If your clinic is ready to take Visual Reinforcement Audiometry  to the next level, it’s time to experience the Flex VRA + Hey Bear Sensory  difference. Learn how Flex VRA can transform your pediatric audiology testing.   Request a Quote Today  and see why clinics nationwide are making the switch.