Sound Check: Newborn Hearing Screening Best Practices & Follow-Up

A baby passes their hearing screen — great. But what if they don’t? Or what if they pass, but there’s still risk for hearing changes down the line?

As pediatricians, we’re the frontline in making sure hearing differences are identified early and managed with care. That means knowing how to interpret newborn hearing screen results, when to refer, and how to support families through the next steps, without overwhelming them.

As a former AAP chapter champion for Early Hearing Detection and Intervention, I have a special passion for working with the Deaf community. I sat down to talk with fellow Peds RAP host Karen Hovav, MD, about how pediatric clinicians can confidently interpret hearing screen results, navigate follow-up, and support families without overwhelm. Tune into our Peds Reviews and Perspectives podcast episode to hear the full conversation.

Why Newborn Hearing Screening Matters

Before universal newborn hearing screening, most children with hearing changes weren’t identified until age 2 or later. By that time, language delays were often already entrenched.

Today, with early detection and intervention (ideally before 6 months), children with hearing differences can achieve language and literacy outcomes on par with their hearing peers before even starting school.

The “1-3-6” hearing screening timeline is key:

• Screen by 1 month: All infants should have a hearing screen by 1 month of age.

• Diagnose by 3 months: Infants who don’t pass the hearing screen should see a specialist for a diagnostic evaluation by 3 months of age.

• Enroll in early intervention by 6 months: Infants diagnosed as deaf or hard of hearing have the best chance of language development when intervention begins before 6 months of age. So refer early for services such as Speech Therapy, hearing aids, sign language, ENT, and Audiology.

Understanding the Screening Tools

Otoacoustic Emissions (OAE)

This tool measures how well the inner ear (cochlear hair cells) responds to sound. A small probe delivers sound into the ear canal and records the echo that bounces back. No echo? That’s a red flag.

Screening Automated Auditory Brainstem Response (ABR)

Used especially in NICU infants, but increasingly common in healthy newborns, ABR screening uses scalp electrodes to measure brainwave activity in response to sounds. Just like in the OAE, sounds are delivered via small probes placed in the ear canal. It screens the auditory pathway up to the brainstem and results in real time.

OAE and Screening ABR are screening tools, not diagnostic hearing tests.

What Happens After a Newborn Hearing Screen Is Not Passed?

If a newborn does not pass:

1. Rescreen in the hospital

2. Rescreen again one week later

3. If not passed again, refer for a complete Diagnostic ABR with pediatric audiology

Some families may delay further testing if their baby startles to sound or “seems to hear.” It’s important to explain that hearing changes may be progressive, subtle, or frequency-specific early on. So, timely audiology follow-up is essential.

After a Passed Hearing Screen, Who Might Still Need a Repeat Hearing Screen?

Even if the newborn hearing screen is passed, ongoing hearing surveillance is important. Re-evaluation may be needed if:

• There’s a family history of hearing changes

• The baby spent 5 or more days in the NICU

• There are speech or developmental delays

• The child has other medical or genetic risk factors (ex, congenital CMV, hyperbilirubinemia, certain syndromes)

In these cases, plan for a repeat hearing evaluation by 9 months, or earlier if concerns arise.

Confirmed Hearing Changes: What’s Next?

Most babies with sensorineural hearing changes (SNHC) are born to hearing parents, who may be surprised or unsure of what to do next.

Your job isn’t to prescribe a single communication method. It’s to ensure early, consistent access to language, in whatever form the family chooses.

Use affirming language

Terms like “failed hearing test” or “hearing loss” can feel alarming or deficit-focused to families. Use affirming language like “did not pass” instead of “failed,” and “hearing differences” or “deaf/hard of hearing” rather than “hearing loss.”

Discuss these pathways:

• Sign language

• Auditory-oral approach (hearing aids, cochlear implants)

• Bilingualism (sign + spoken language)

For auditory-oral families:

• Refer early for hearing aids, speech therapy, and audiology follow-up

• An ENT evaluation is required before a hearing aid fitting

For ASL families:

• Refer early for Deaf education and mentor programs

• Ensure exposure to a rich, consistent manual language environment

For all families:

• Refer to ophthalmology (especially for syndromes like Usher)

• Offer genetic testing (Connexin 26 is common)

• Consider an EKG to rule out Jervell and Lange-Nielsen Syndrome (SNHC + long QT)

Screening isn’t Diagnosis, and Language is the Goal

OAE and ABR assess whether the hearing pathways function, but not how well the child understands sound. Behavioral hearing tests, including visual reinforced audiometry, can be done even in the toddler period to help fill in that picture.

The most important thing? Access to language as early as possible. Whether that’s through hearing technology, sign language, or both, early exposure drives outcomes.

Top Takeaways for Your Practice

• Stick to the 1-3-6 model: screen by 1 month, diagnose by 3, intervene by 6

• Push for diagnostic follow-up if a screen is not passed

• Refer early for audiology, ENT, speech, and sign language support

• Re-evaluate high-risk kids—even if they passed their newborn screen

• Use affirming language: say “did not pass” instead of “failed”; use terms like “hearing differences” or “deaf/hard of hearing” rather than “hearing loss”

Want more insights (and some real talk) on how to approach newborn hearing screens with confidence and compassion? Check out our Peds Reviews and Perspectives podcast episode, “Sound Check: Hearing Screens,” for the full conversation.