A successful Early Hearing Detection and Intervention (EHDI) program must include detection, diagnosis, and appropriate timely management of hearing loss in children beyond infancy. Children who pass newborn hearing screening may subsequently acquire hearing loss that interferes with speech and language acquisition, communication, and later educational achievement. The 2007 Joint Committee on Infant Hearing has identified 11 risk indicators for permanent congenital, delayed-onset or progressive hearing loss in children. Evidence from large-scale research studies confirms that the likelihood of permanent childhood hearing loss increases substantially in preschool years from birth to school entry. The prevalence of hearing loss in the school-age population may be two to three times higher than the prevalence in infancy. In addition, a substantial proportion of children are "lost to follow up" after failing newborn hearing screening. In other words, UNHS does not lead to universal diagnosis and intervention. Widely accepted guidelines for preschool hearing screening are lacking. The presentation begins with a brief description of techniques available for preschool hearing screening. Then, literature on preschool hearing screening is briefly and critically reviewed. This is followed by a summary of the advantages and disadvantages of pure tone versus otoacoustic emissions techniques in hearing screening of preschool children. Transient evoked OAEs and distortion product OAEs are considered separately. The remainder of the presentation is devoted to discussion of an effective, efficient, and evidence-based strategy for hearing screening of children, especially those from age 3 years to school age.