Newborn Hearing Screening: What the Tests Measure, What Results Mean, and What Happens Next

Before most newborns go home from the hospital, a technician will stop by with a small device and run a quick hearing test while the baby sleeps. The whole thing takes about five to ten minutes, your baby barely stirs, and most families never give it much thought after a clean result. But if the result comes back as "refer" — meaning the test did not pick up the expected response — it can feel alarming in an already overwhelming week.

Here is what the newborn hearing screen actually measures, what the two types of tests involve, what a refer result does and does not mean, and what the AAP recommends for next steps. This is general information — your baby's pediatrician is the right first call with any specific questions about your child.

01What the test is and when it happens

Newborn hearing screening is required before hospital discharge in all 50 states, according to BabyHearing.org, a resource maintained by the National Center for Hearing Assessment and Management. For babies born at home, the screening should happen within the first month of life, per MedlinePlus (NIH).

The test is painless and requires nothing from your baby. A calm, sleeping baby actually gives the clearest results — any movement or fussing can interfere with the recordings. The purpose, as HealthyChildren.org (AAP) explains, is to identify newborns who are likely to have hearing that falls outside the typical range and who would benefit from early evaluation. Every year, an estimated 6,000 infants in the United States are born with a permanent hearing difference — roughly 1 to 3 per 1,000 births — and more than 98% of U.S. newborns are now screened.

02The two types of newborn hearing tests

Hospitals use one or both of two methods. Both are safe, take only minutes, and involve no needles or pain. The choice between them depends on the hospital's equipment and staffing.

Otoacoustic Emissions (OAE)

The OAE test uses a small probe placed gently in the ear canal. It plays a series of sounds and listens for the echo a healthy inner ear produces in response. As NICHD explains: "If the infant has normal hearing, the microphone picks up an echo reflected back into the ear canal. Failure to detect an echo means there may be a loss of hearing." On a sleeping newborn, this test takes less than a minute.

Auditory Brainstem Response (ABR)

The ABR test goes a step further. Small electrode stickers are placed on the baby's scalp, and sounds play through tiny earphones. The electrodes measure how the hearing nerve and the lower brain respond to those sounds. NICHD describes it as testing "the part of the auditory nerve that carries sound from the ear to the brain — and the brain's response to sound." If the brain does not respond consistently to the sounds, there may be a hearing difference. The test takes about five to ten minutes and is also done with the baby resting quietly.

Some hospitals screen first with OAE and move to ABR for babies who get a refer result. Others use ABR for all newborns from the start. BabyHearing.org notes that babies who do not pass on the first OAE test should receive a second screening, using OAE or ABR. Either way, both approaches are checking the same thing: whether the baby's hearing system is responding to sound the way it should.

03What "pass" and "refer" mean

If the test detects the expected responses, your baby passes. That is the outcome for the large majority of newborns. If the expected response is not detected, the result is labeled "refer" — a term that has largely replaced "did not pass" or "failed" in most hospital programs, because it more accurately describes what the result means: your baby is being referred for more testing, not diagnosed with a hearing problem.

04Why some babies get a refer result even with typical hearing

The OAE test is especially sensitive to the conditions inside the ear canal at the moment of testing. Newborns commonly have fluid, vernix (the waxy coating from the womb), or debris in the ear canal right after birth — any of which can muffle the echo and produce a refer result even when the ear itself is working normally. Background noise in the room or a baby who stirs during the test can also interfere.

The false-positive rate for newborn hearing screening — meaning babies who get a refer result but turn out to have typical hearing — runs roughly 3 to 8%, depending on the method used and how many screening passes are attempted. That means for every baby whose screening correctly identifies a hearing difference, several more will go through follow-up testing before being cleared. That follow-up testing is also painless and quick, but knowing why it happens can make it less worrying.

05The 1-3-6 timeline — what happens when

Newborn hearing programs across the U.S. follow an "EHDI 1-3-6" framework — three numbers that stand for target ages in months. The AAP, HRSA, and the CDC's Early Hearing Detection and Intervention program all support this timeline.

The AAP's updated 2023 guidance, summarized at HealthyChildren.org, adds an important note: "Screening tests should not be repeated more than once before referral to audiology." If a second screen also shows a refer result, the right next step is the diagnostic evaluation — not a third screening pass.

06What happens if follow-up testing confirms hearing loss

Most families who go through follow-up testing get reassuring news. For the smaller number where a hearing difference is confirmed, the next step is a care plan, not a crisis. The AAP describes a team approach: the pediatrician, a pediatric audiologist, and often a pediatric otolaryngologist (an ear, nose, and throat specialist) work together to understand the type and degree of hearing difference and what would help most.

• Hearing aids can be fitted even for very young infants. Modern hearing aids for babies are small, fit behind the ear, and can be adjusted as the baby grows.
• Cochlear implants are considered for some types of more significant hearing loss, typically after six months of age.
• Early intervention services are available through every state for children under three and include speech-language therapy, family communication support, and connection with specialists who work with deaf and hard-of-hearing children.
• Ongoing audiologist visits to monitor hearing as the baby grows, since some hearing differences change over time.

The AAP's 2023 update emphasizes that "birth to 5 is a critical time of brain development and language acquisition" — which is exactly why the 1-3-6 timeline exists. Early identification does not predict limits; it opens doors to support at the point when it makes the most difference.

07Factors that may call for closer monitoring

Some babies are at higher risk for hearing changes that may develop or worsen after the newborn period — meaning even a passed newborn screen calls for closer monitoring over the first years of life. The AAP's 2023 guidance identifies several risk factors worth knowing:

• Congenital cytomegalovirus (cCMV). The AAP's 2023 clinical report notes that cCMV "accounts for 25% of deaf or hard-of-hearing children by age 4." CMV can cause hearing changes that develop gradually, even in babies who pass the newborn screen.
• A NICU stay. Babies who spent time in the neonatal intensive care unit — especially those who received certain medications or had infections — are at higher risk for hearing differences.
• Family history. A first-degree family member with childhood-onset hearing loss puts a baby at higher risk.
• Certain infections. Meningitis and some other infections can cause hearing changes that develop after birth.

If any of these apply to your baby, mention them to your pediatrician at the first well-child visit. They may recommend follow-up hearing testing even after a pass on the newborn screen, and earlier than the standard schedule.

08Hearing checks continue well beyond the newborn period

The newborn hearing screen is the first check, not the only one. The AAP recommends objective hearing testing at ages 4, 5, 6, 8, and 10, with additional screenings between ages 11-14, 15-17, and 18-21, according to HealthyChildren.org. Some hearing differences develop gradually over childhood and would not have been detected at birth.

Between those scheduled checks, the clearest early signal comes from watching your baby. By three months, babies typically startle at loud sounds and settle at the sound of a familiar voice. By six months, they start turning toward sounds. If your baby is not reaching those milestones on schedule, bring it up at the next well-child visit rather than waiting for the next scheduled hearing check.

09One test down, a full first week to go

The newborn hearing screen is one of several routine checks that happen before you leave the hospital — alongside the heel-stick blood test, the vitamin K shot, and the first eye drops. Most families walk out with a pass and move on. If your baby gets a refer result, remember what it actually means: not a diagnosis, not a certainty, and not something that has to wait long to sort out. The follow-up timeline is short, the testing is painless, and the team who will work with you if anything is confirmed is a practiced one.

Our first-week guide walks through all of the newborn checks, the first pediatrician visit, and what the first seven days actually look like at home. For the bigger picture of the newborn stage — sleep, feeding, diapers, and when to call the doctor — the newborn basics guide has it all in one place.

Questions parents actually ask

Newborn Weeks is planning help, not medical advice — always follow your own doctor, midwife, or pediatrician.