The introduction of the Newborn Hearing Screening Programme in England has significantly reduced the average age at diagnosis of permanent childhood hearing loss (PCHL). However it has long been recognised that some children have a progressive or late onset hearing loss. Previous studies have estimated that for every 10 children with PCHI >40 dB (average), a further five to nine would manifest with such a hearing impairment by the age of 9 years. This presentation looks at the route to diagnosis for children with PCHI (both unilateral and bilateral) in one Newborn Hearing Screening site over a 5 year period (up until March 2010). Of 31 children with bilateral PCHI, 12 were not identified in the newborn period. Numbers are small but a relatively high proportion had an acquired (16%) or late-identified (26%) hearing loss. Meningitis is still an important cause of PCHI despite the introduction of immunisation programmes. To conclude: a high level of awareness of potential hearing impairment is required by all professionals working with children; responsive, high-quality services equipped to assess children at all developmental stages are necessary; commissioners, managers and public health professionals need to be aware of the resources and funding required to achieve this.