Children can only develop spoken language through consistent exposure to the acoustic cues that comprise speech and language. Until recently, hearing levels from the clinical audiogram were the primary measure used to define typical hearing and the presence or degree of a child's hearing loss. While the clinical audiogram remains an important diagnostic measure for audiologists, the degree of hearing loss from the audiogram is an inconsistent indicator of a child's functional hearing capacity, particularly once the child is fitted with hearing aids or cochlear implants. Speech audibility is an estimate of a child's access to the acoustic cues that comprise spoken language and have recently been used to accurately quantify a child's functional hearing levels with and without devices. This article will review the limitations of quantifying auditory access based on the clinical audiogram, as well as approaches for estimating speech audibility for children with hearing loss.