A newborn hearing screening is a quick, painless test performed on babies shortly after birth to check whether they can hear normally. About 1.7 out of every 1,000 babies screened have some degree of hearing loss, and this test is the fastest way to catch it early. As of 2022, more than 98% of newborns in the United States are screened before leaving the hospital.
Why Early Screening Matters
Babies begin learning language from the moment they’re born, long before they say their first word. A child with undetected hearing loss can fall behind in speech, language, and social development in ways that become harder to correct over time. The national benchmark, known as the 1-3-6 guideline, lays out three milestones: screen by 1 month of age, complete a diagnostic evaluation by 3 months if needed, and enroll in early intervention services by 6 months. Children who receive support before 6 months of age develop communication and language skills on par with their hearing peers far more often than those identified later.
How the Test Works
Hospitals use one of two screening methods, sometimes both. Neither requires your baby to do anything, and most infants sleep right through it.
Otoacoustic emissions (OAE) testing checks whether the inner ear is responding to sound. A tiny earphone with a built-in microphone is placed in your baby’s ear canal. When sound enters the ear, the hair cells inside the cochlea vibrate and produce a faint echo that bounces back out. The microphone picks up that echo. If it’s present, the inner ear is working as expected. The whole process takes about 10 to 20 minutes, and the baby just needs to be calm and relatively still.
Auditory brainstem response (ABR) testing goes a step further. Small sensor pads are placed on your baby’s scalp and earlobes, and soft earphones deliver clicking sounds. The sensors detect electrical activity as the sound signal travels from the ear through the nerve pathways to the brainstem. This tells screeners not just that the ear itself is working, but that the nerve connection carrying sound to the brain is intact. ABR screening works best when the baby is asleep, and it takes anywhere from 15 to 60 minutes depending on how settled the baby is.
The key difference: OAE measures the ear’s physical response to sound but doesn’t test the auditory nerve. ABR measures the nerve and brainstem pathways directly. Some hospitals use OAE as a first pass and follow up with ABR if there’s any concern.
What “Pass” and “Refer” Mean
The screening produces one of two results. A “pass” means the ear responded normally to sound at the levels tested. A “refer” means the test didn’t pick up the expected response in one or both ears, and a follow-up is recommended.
A refer result does not necessarily mean your baby has hearing loss. Babies commonly fail the initial screening for temporary, harmless reasons: vernix (the waxy coating from the womb) blocking the ear canal, fluid lingering in the middle ear from delivery, or simply too much movement or crying during the test. Many babies who are referred pass on the second attempt once these factors clear up. That said, every refer result should be followed up promptly rather than assumed to be a false alarm.
What Happens After a Refer Result
If your baby doesn’t pass the initial screen, the hospital will typically repeat the test before discharge or schedule a rescreen within a few weeks. If the baby still doesn’t pass, the next step is a full diagnostic evaluation with a pediatric audiologist, ideally before 3 months of age. This evaluation uses a more detailed, clinical version of ABR along with other tests to measure exactly what type and degree of hearing loss is present, and whether it affects one ear or both.
If hearing loss is confirmed, the 1-3-6 guideline recommends enrollment in early intervention services by 6 months. These services can include hearing aids, speech therapy, sign language instruction, or a combination, depending on the type and severity of the loss. The specific path varies widely from one family to the next, but the consistent finding is that earlier intervention leads to better long-term outcomes for language development.
Risk Factors Worth Knowing
Some babies are at higher risk for hearing loss even if they pass the initial screening. A family history of hearing loss and low birth weight are two well-established risk factors. Certain infections passed from mother to baby during pregnancy, including toxoplasmosis, measles, and herpes, can damage the structures of the inner ear. Infections after birth, particularly meningitis, also pose a risk. Exposure to certain medications or toxic chemicals in the womb or after delivery, structural differences in the inner ear, and genetic conditions round out the list.
For babies with any of these risk factors, pediatricians often recommend continued monitoring of hearing and speech milestones throughout infancy and early childhood, even after a normal screening result. Some forms of hearing loss develop gradually or appear months after birth, so a single passed screening doesn’t guarantee permanent normal hearing in every case.
What the Screening Does Not Test
Newborn hearing screening checks whether your baby’s ears and auditory pathways respond to sound at specific levels. It does not evaluate how well a child will process or understand language later on. Conditions like auditory processing disorder, where the ears hear fine but the brain has difficulty interpreting what it hears, won’t show up on a newborn screen. The test also won’t catch mild hearing loss that falls below the screening threshold, or hearing loss that develops after the newborn period. Staying attentive to speech and language milestones as your child grows remains important regardless of the screening outcome.