Donna Christiano is an award-winning journalist, specializing in women and children's health issues. She has been published in national consumer magazines and writes frequently for leading health websites.
Lyndsey Garbi, MD, is double board-certified in pediatrics and neonatology. She is an assistant professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and chief pediatrician at Blueberry Pediatrics.
Two to three of every 1,000 babies born in the United States are born with a hearing loss. Hearing is essential to language and speech formation. All babies should have their hearing screened within one month of birth and, ideally, before a baby leaves the hospital or birthing center.
The screening is quick—taking roughly five to 10 minutes—and painless. Using computers, ear probes, and, sometimes, electrodes (small devices that can record brain activity), a trained professional will test how the baby’s ear and brain respond to sound.
This article will discuss the different hearing screening methods used for newborns, What the results mean, what happens next if the screen shows reduced hearing, and what hearing screens may be done later.
The baby will be given one of two hearing tests—and some babies may be given both.
Using an ear probe placed inside the baby’s ear, this test measures the sound the baby’s inner ear makes when soft tones and clicks are played. These tones and clicks cause vibrations within the inner ear, also known as the cochlea .
When the cochlea is stimulated by sound, hair cells inside it vibrate. These vibrations produce low-frequency sound—or otoacoustic emissions (OAEs)—that echo into the middle ear, a part of the ear that helps carry sound waves.
If a baby is born in a healthcare facility, the newborn hearing screening will be performed by the healthcare provider without consideration of whether the infant or family has health insurance coverage. If born outside of a facility, testing can be provided by community organizations, midwives, hospitals, or audiology clinics.
These tests are often covered by private insurance or Medicaid. Check with the facility and your health insurance provider (if any) to determine if you will have any out-of-pocket costs.
This is a test that measures how well the brain and nerves involved in hearing respond to sound. Electrodes are painlessly attached to a baby’s head and connected to a computer via wires. The baby will also be fitted with earphones.
As sounds play through the earphones, the electrodes will send information to the computer about how the baby’s hearing nerves respond to sound. The baby must be asleep or completely still when performing the test to get the most accurate results.
The results of the hearing screening determine the next steps.
Even if a child sails through the initial newborn hearing test with flying colors, don’t hesitate to get them screened if you notice problems with their hearing as they grow. Reach out to their pediatrician (a children's physician) if your child:
Roughly one to two of every 100 newborns will fail the initial hearing screening tests.
While that’s concerning, keep in mind that failing a test doesn’t necessarily mean a baby has hearing loss. It could be that the baby has excess fluid in the middle or inner ear from the birth process, which can impact screening results.
If a baby fails the initial screenings, they’ll probably be given a repeat AABR test within two weeks at an outpatient facility.
If a baby passes that test, the healthcare provider will give you speech milestones to watch for at certain ages (for example, reacting to loud sounds, turning their head when you speak, etc.). If the baby isn’t reaching those milestones, contact a pediatrician.
If the baby fails this follow-up test, they’ll likely be referred to a pediatric audiologist (a healthcare professional who can diagnose and treat hearing problems) for additional testing.
They might also be referred to an otolaryngologist (a physician who specializes in the ear, nose, throat) to determine if there are any structural problems with the baby’s ear.
Early intervention services are available for babies with hearing loss so they can receive therapy to develop communication skills. Early Hearing Detection and Intervention (EHDI) guidelines call for a diagnosis of hearing loss by an audiologist by 3 months and intervention to begin by 6 months.
Your state EHDI program can provide more information on how your baby will be evaluated and the types of services available. These early intervention programs are supported by the Individuals with Disabilities Education Act (IDEA).
While state EHDI programs are available, about a quarter of infants that had an abnormal infant hearing screen do not get follow-up testing. Barriers to this include living in a rural area, parental education, low socioeconomic status, and insurance status.
A speech-language pathologist or a teacher experienced in working with children with hearing loss can provide therapies to help your child develop communication skills. A combination of approaches may be used to help children with hearing loss communicate and interact with others. These include:
If a baby is identified as deaf or hard of hearing, there are options that may lead to better hearing.
Cochlear implants are used for people with “profound” hearing loss. Profound hearing loss is defined as hearing only very loud noises. The Food and Drug Administration (FDA) has approved the use of cochlear implants in babies as young as 9 months.
Research shows that cochlear implants in children younger than 12 months are safe and can promote more natural language development.
Hearing aids are devices that typically fit behind the ear and are used to make sounds louder. Babies as young as 1 month can wear hearing aids.
If a baby has a structural problem that’s impacting their hearing, surgery to correct the problem (and improve hearing) may be recommended.
Babies with repeated ear infections (three or more in six months or four or more in a year) may get ear tubes to help air circulate into the middle ear and prevent fluid from building up. These tubes can lower the chance of ear infections, which can muddle hearing and impact speech development.
Yes, all newborns should be screened for hearing loss. In 2019, for example, 98% of U.S. newborns were screened, and 6,000 were identified with permanent hearing loss.
Experts point out that hearing loss can be an invisible condition in newborns—and approximately 95% of babies born deaf have parents with normal hearing. Identifying and addressing a baby’s hearing loss early in life helps their language and speech development.
Children should be screened for hearing loss throughout childhood, and specifically at ages:
With insurance, hearing screening may be free to $75. Without insurance, it may be free to $250.
It’s important that all babies receive a hearing test shortly after birth, preferably before they leave the hospital or birthing center.
If hearing problems are detected, a baby may be referred to a hearing specialist called an audiologist, who can suggest ways to improve hearing. Depending on the source of the hearing problem, options may be a cochlea implant, surgery, and hearing aids.
Because speech and language development starts at a young age, diagnosing and treating hearing problems early on is essential.
No one likes to see a baby poked and prodded, but hearing tests are painless—and necessary. That’s because early diagnosis of hearing problems is key to language and speech development.
You can ease some anxiety by remembering that most babies pass the screenings just fine. And if a hearing problem is detected, there are effective options that can help a baby optimize their hearing and stay on track developmentally.
One to two of every 100 babies will not pass their first newborn hearing test.
This doesn’t necessarily mean they have a hearing loss. Fluid or vernix (the protective coating babies are born with) in the ear can produce inaccurate results. This is also true if the baby moves or cries during the test.
The tests are fairly accurate, but they have limitations. For example, the tests can give inaccurate results if the baby cries during the screening. And they don’t look at hearing across all frequency levels.
Most newborns will get a hearing test in the first few days of life, often before they leave a hospital or birthing center. And they absolutely should be checked by 1 month of age.
National Institute on Deafness and Other Communication Disorders. Your baby’s hearing screening and next steps.
Eunice Kennedy Shriver National Institute of Child Health and Human Development. How is newborn screening done?
National Institute on Deafness and Other Communication Disorders. Your baby’s hearing screening and next steps.
American Speech-Language-Hearing Association. Otoacoustic emissions (OAEs).
Eunice Kennedy Shriver National Institute of Child Health and Human Development. Who pays for newborn screening?
State of Washington Department of Health. Infant hearing screening test sites in Western Washington.
UPMC Children’s Hospital of Pittsburgh. Auditory brainstem response (ABR) test.
American Academy of Pediatrics. Newborn hearing screening FAQs.
UT Southwestern Medical Center. Why follow-up care is crucial when a newborn fails ABR hearing screening.
Yoshinaga-Itano C, Sedey AL, Wiggin M, Chung W. Early hearing detection and vocabulary of children with hearing loss. Pediatrics. 2017;140(2):e20162964. doi:10.1542/peds.2016-2964
Bush ML, Taylor ZR, Noblitt B, et. al. Promotion of early pediatric hearing detection through patient navigation: A randomized controlled clinical trial. Laryngoscope. 2017;127 Suppl 7(Suppl 7):S1-S13. doi:10.1002/lary.26822
Nemours. What are cochlear implants?
Centers for Disease Control and Prevention. Types of hearing loss.
American Speech-Language Hearing Association. FDA approves cochlear implantation at nine months.
Karltorp E, Eklöf M, Östlund E, Asp F, Tideholm B, Löfkvist U. Cochlear implants before 9 months of age led to more natural spoken language development without increased surgical risks. Acta Paediatr. 2020;109(2):332-341. doi:10.1111/apa.14954
March of Dimes. Hearing loss and your baby.
Centers for Disease Control and Prevention. Data and statistics about hearing loss in children.
American Academy of Audiology. Newborn hearing screening.
American Speech-Language Hearing Association. Newborn hearing screening.
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