The hearing status of children should be examined throughout early childhood, even if they have passed the newborn hearing loss because hearing loss can occur at any time and may affect their ability to learn. Preschool hearing screening (PHS) is vital to continue screening throughout early childhood. The current practice of PHS in the primary healthcare centers (PHCs) in Saudi Arabia is unknown. The purpose of this study was to investigate PHS in the PHCs. This cross-sectional descriptive study used an in-person-administered questionnaire to collect data. A total of 106 out of 120 participants (male = 61; female = 45) representing the PHCs in Riyadh were interviewed. Most of the participants were aged 31-40 years and held a bachelor's degree as the highest academic qualification with limited years of experience. PHS was mostly performed through subjective measures by asking the parents (71.7%) and the child (65.1%). The audiometric evaluation was conducted for preschool children in only half of the PHCs. General practitioners and nurses usually perform PHS. Substantial gaps in the practice of PHS were identified. The lack of training and appropriate instruments and the need for audiological services were the main challenges. Incorporating robust and objective protocols for PHS into the educational system is a valuable strategy for identifying hearing loss early and reducing its impact through the establishment of effective intervention plans.