Why Hearing Screening Matters
Since 2000, when Congress passed the Early Hearing Detection and Intervention (EHDI) act, newborn hearing screening has become a standard practice across the United States. While this legislation exists at the federal level, each state manages its own tracking and follow-up systems for babies who need additional testing.
Hearing screening is crucial because there’s a critical period for language development during the first five years of a child’s life. During this time, a child’s brain can learn language easily and efficiently. If hearing loss is present but undetected, valuable time in this critical window may be lost. Additionally, hearing loss is invisible—babies cannot tell us they’re not hearing well, making screening the only reliable way to identify potential issues early.
The Screening Process
In the United States, hospitals typically use one of two screening methods: Auditory Brainstem Response (ABR) or Otoacoustic Emissions. The ABR test is more commonly used and is typically performed by a nurse or medical assistant rather than an audiologist.
During an ABR screening, small electrodes are gently placed on your baby’s forehead and behind both ears—these stick to the skin like band-aids and are completely painless. Earphones are then placed in your baby’s ears, and the test begins. The screening presents one sound to each ear separately, looking for a specific nerve response. For a complete pass, both ears must respond appropriately during the same screening session. If one or both ears don’t show the expected response, the result is a “refer,” indicating that more testing is needed.
Understanding Results
Recent data from the CDC (2021) shows that about 98% of babies born in the United States receive hearing screenings, and of those screened, about 98% pass. This means approximately 2% of babies refer on their initial screening in one or both ears.
Of the babies who refer, about half will pass their follow-up diagnostic evaluation. About 10% will be diagnosed with a permanent hearing loss. Unfortunately, about one-third of babies who refer never return for follow-up testing, leaving their hearing status unknown. This underscores the importance of completing all recommended follow-up care.
Important Timelines
If your baby refers on the initial screening, there’s a recommended timeline for follow-up:
By one month of age, babies should be rescreened. Many hospitals automatically rescreen before discharge, which simplifies this step for parents.
By three months of age, babies who still need follow-up should have a diagnostic ABR evaluation with an audiologist.
By six months of age, if hearing loss is confirmed and spoken language is the family’s goal, babies should begin using amplification or hearing aids.
What to Expect at Follow-up Testing
A diagnostic ABR evaluation uses the same basic setup as the newborn screening but is much more comprehensive. While the screening tests just one sound, the diagnostic test presents multiple sounds of different pitches and loudness levels to each ear. This thorough assessment can take two to three hours to complete.
The test proceeds more quickly if your baby is asleep during the appointment. While it can be challenging to have your baby sleep in a new environment with strangers touching them, your audiologist will work with you to create the best possible conditions for a successful test.
Tips for Follow-up Appointment Success
To help your appointment go smoothly, bring diapers and wipes to keep baby clean and dry, feeding supplies (bottle/formula or plan to breastfeed), and comfort items like a swaddle or pacifier. Remember to bring snacks and water for yourself too, as these appointments can be lengthy.
After this comprehensive evaluation, you should leave with complete information about your baby’s hearing status in both ears and clear guidance on next steps.
When Special Considerations Apply
For babies with a NICU stay, hearing screening should be completed at the end of their hospital stay rather than earlier. For home births, the pediatrician should perform the hearing screening at your first appointment.
Remember that while hearing loss concerns can feel overwhelming, getting proper follow-up testing is the only way to know your baby’s hearing status and make informed decisions for your family.
Source: Sondheimer, Alyx. “Understanding Newborn Hearing Screening.” The Baby Audiologist, 2023.