This article reflects on both the past 20 years and the next 20 years of research and service provision for children who are deaf or hard of hearing. The authors describe how universal newborn hearing screens have had a dramatic impact on outcomes for this population. Earlier diagnosis has resulted in most children who are deaf or hard of hearing spending more time in a typical classroom than ever before. Consequently, the language and educational milestones of these children has improved; on standardised testing children with hearing loss are on average half of one standard deviation away from the mean of their age-matched peers. The authors do however flag that it can now be difficult for children to access appropriately trained educators, speech and language therapists and other professionals to support them in their development. The authors go on to propose future areas for potential development that could address some of these need including the use of technology such as the internet to enable remote access to training and translators (enabling lessons to be simultaneously subtitled or translated to sign language for example). They also suggest the continued development of rehabilitation techniques to reorganise cortical neural networks through passive auditory training while infants are asleep. The authors acknowledge there are challenges to these developments but in reflecting on past success they also acknowledge previous challenges such as the need for more relevant research by interested researchers. This is a barrier common to many aspects of health research. Clinically relevant research requires appropriately designed, well-considered trials with willing participants. Integrating research into clinical training for health professionals and daily clinical practice within health services can have an impact and change practice at the grassroots level.