Speech-evoked auditory brainstem response (speech-ABR) provides an objective documentation of temporal and spectral encoding of speech cues in the brainstem region. As such, the influence of peripheral hearing loss on speech-ABR has been studied but the current literature is limited. The aim of the present study was to compare speech-ABR findings between children with moderate-to-severe SNHL and their agematched normal peers. In this case control study, 17 hearing-impaired (HI) children (mean age = 7.1 ± 1.8 years) and 15 typically developing (TD) children (mean age = 6.1 ± 1.6 years) were enrolled. All HI children had bilateral moderately severe sensorineural hearing loss. The speech-ABR was recorded from HI and TD children to 40-ms speech syllable /da/ presented repetitively at 30 dB sensation level (SL). Statistically longer latencies were found in HI children than in TD children for onset peaks (V and A) and transition portion (peak C) (p < 0.05) with very large effect sizes (d = 1.16 -6.10). In contrast, the sustained components (peaks D, E and F) and offset portion (peak O) of speech-ABR were unaffected by hearing loss (p > 0.05). For speech-ABR composite onset measures, TD children revealed larger VA inter-peak amplitudes (d = 0.87) and steeper VA slopes (d = 1.36) compared to HI children (p < 0.05). Children with moderately severe sensorineural hearing loss had abnormal encoding of speech sounds within the brainstem region. Based on the study outcomes, the usefulness of speech-ABR can be expanded by studying the speech encoding ability in multi-handicapped children).