Newborn hearing tests are quick, painless screenings done while your baby sleeps, usually before you leave the hospital. The entire process takes just a few minutes per ear and requires no needles, no sedation, and no preparation on your part. About 1.7 out of every 1,000 babies screened have a permanent hearing loss, making this one of the most important routine checks your newborn will receive.
The Two Screening Methods
Hospitals use one of two tests, and sometimes both. Which one your baby gets depends on the equipment your hospital uses and its screening protocol.
Otoacoustic emissions (OAE): A technician places a small, soft earphone into your baby’s ear canal. The device plays quiet sounds and then listens for a faint “echo” that healthy inner ear cells naturally produce in response. If the ear picks up that echo, the inner ear is working as expected. If there’s no echo, it may indicate hearing loss. The test doesn’t require any electrodes or sensors on your baby’s skin, which makes it especially fast and simple.
Automated auditory brainstem response (AABR): This test goes a step further by measuring how your baby’s brain responds to sound. Small sensors are placed on your baby’s head, and soft earphones deliver a gentle clicking or chirping sound at a low volume (typically 35 decibels, roughly the level of a whisper). The sensors detect whether the auditory nerve carries the sound signal to the brain. No anesthesia is needed. Babies are tested during natural sleep.
The OAE checks whether the inner ear itself is functioning. The AABR checks the entire pathway from ear to brain. Some hospitals run both to get a more complete picture, while others start with one and use the second only if needed.
What Happens During the Test
Most babies are screened right in the hospital nursery or in your room, often within the first day or two after birth. The goal is to complete screening before discharge, and ideally before your baby is one month old. You don’t need to do anything special to prepare. The screener will likely wait until your baby is calm, drowsy, or asleep, since movement and crying can interfere with the readings.
For the OAE, you’ll see a small probe (about the size of an earplug) gently placed in each ear. The whole thing is over in a minute or two per ear. For the AABR, the technician will place small adhesive sensors on your baby’s forehead and behind each ear, then fit soft earphones. This version can take slightly longer, but still only a few minutes. Your baby won’t feel any discomfort from either test.
The screening devices are handheld, portable units approved by the FDA. They automatically analyze results and display a “pass” or “refer” outcome, so no subjective interpretation is involved. Many modern devices can perform both OAE and AABR testing in a single unit.
What “Pass” and “Refer” Mean
A “pass” result means your baby’s hearing responses fell within the normal range on the day of testing. A “refer” result (sometimes called a “fail”) means the test didn’t detect a clear response, and your baby needs follow-up testing. A refer result does not automatically mean your baby has hearing loss.
Temporary factors cause many initial refer results. Fluid in the middle ear from delivery is common in the first hours of life and can block sound transmission. Debris or vernix (the waxy coating on newborn skin) in the ear canal can also muffle the signal, particularly for the OAE test, which is sensitive to anything obstructing the outer ear. Background noise in the room and a restless baby can also affect readings. In many cases, a rescreen done a few hours or days later comes back normal once these temporary conditions clear.
If Your Baby Doesn’t Pass
Federal health guidelines known as the 1-3-6 benchmarks lay out a clear timeline. Screening should happen before one month of age. If your baby doesn’t pass, a full diagnostic hearing evaluation with a pediatric audiologist should happen before three months. And if hearing loss is confirmed, enrollment in early intervention services should begin before six months.
The diagnostic evaluation is more thorough than the initial screening. An audiologist will use clinical versions of the same technologies (OAE and brainstem response testing) along with other assessments to determine the type and degree of hearing loss in each ear. These tests can pinpoint whether the issue is in the outer or middle ear (which is often treatable) or in the inner ear or auditory nerve (which is typically permanent but highly manageable with early support).
Hitting that six-month window for intervention matters enormously. Babies identified and supported early develop communication and language skills on a timeline much closer to their hearing peers. The earlier hearing loss is addressed, the less it affects speech development, social skills, and learning down the road.
Why the Test Is Done So Early
More than 6,000 infants born in the U.S. in 2022 were identified with permanent hearing loss. Before universal screening programs existed, many children weren’t diagnosed until age two or three, when delayed speech became obvious. By then, critical windows for language development had already narrowed. Screening every newborn before hospital discharge catches hearing loss months or even years earlier than waiting for signs to appear on their own.
All 50 states now have Early Hearing Detection and Intervention programs, and the vast majority of newborns are screened before leaving the hospital. If your baby was born outside a hospital or was discharged before screening could happen, you can arrange for the test through your pediatrician or a local audiology clinic within the first few weeks of life.