For Parents and Caregivers

An infant at a hospital.

General

About Universal Newborn Hearing Screening

What is Universal Newborn Hearing Screening?

Universal Newborn Hearing Screening is a mandatory screening to a check risk for hearing loss after birth, but before leaving the hospital or birthing center. If your baby is born at home, a hearing screening may be completed before he or she is 1 month old.

What are the Hearing Screening Tests?

Otoacoustic Emissions (OAE): This test uses small, soft foam or rubber tips. These tips are placed inside the baby’s ears and the baby hears soft sounds. Small echoes are recorded from the baby’s ear to see if there is good function in the inner ear.

Auditory Brainstem Response (ABR): This test uses three small patches are placed on the baby’s face, shoulder and neck, then small headphones placed over the baby’s ear or small ear tips are placed in the baby’s ears and the baby hears soft sounds. This test records information from the hearing nerve.  

What are the Hearing Screening Results?

PASS results: Your baby passed the hearing screening today. Hearing can change as a baby grows, so it is important to monitor the baby’s speech, language, and communication. Sometimes, babies with hearing loss pass the hearing screening test.  Always talk, sing and read to your baby this helps bond with your baby. Babies enjoy stories and songs and this helps babies learn to communicate. If there are any questions about the baby’s hearing, talk to your baby’s doctor and request a more detailed test.

Pass with risk factor(s): Your baby passed the hearing screening today, but there is a risk factor(s). The risk factor means that there may be a hearing loss that develops later or your baby may have a higher chance for hearing loss.  It’s important to follow the recommendations for follow up testing and monitor your baby’s communication. If a follow up test is recommended, make sure to take your baby in for the testing.

NON-PASS results: Your baby did not pass the hearing screening and a more detailed tests are needed. The diagnostic hearing evaluation is important and should be scheduled soon, between 2-4 weeks after discharge and testing should be completed by three months of age.  Your baby will need to see a pediatric audiologist who can find hearing loss through the diagnostic hearing evaluation. This step is important to find hearing loss early.  Sometimes it takes a few appointments to complete the testing.

My Baby Did Not Pass the Hearing Screening

What is a Diagnostic Hearing Evaluation?

A diagnostic hearing evaluation includes a number of diagnostic tests that give more detailed information about your baby’s hearing. These tests will help the audiologist find hearing loss, if any. Some or all of these tests may be completed on your baby.

When should I schedule the Diagnostic Hearing Evaluation?

The diagnostic hearing evaluation is important and should be scheduled soon, between 2-4 weeks after discharge and testing should be completed by three months of age. If the evaluation testing is done after three months, some testing may have to done under anesthesia.

What are the Diagnostic Hearing Evaluation Tests?

The three most common tests used during a diagnostic hearing evaluation are Otoacoustic Emissions (OAE) testing, Auditory Brainstem Response (ABR) testing and tympanometry.

  • Diagnostic Otoacoustic Emissions (OAE): This test uses small, soft foam or rubber tips. These tips are placed inside your baby’s ears and your baby hears soft sounds. Small echoes are recorded from your baby’s ear to see if there is good function in the inner ear.
     
  • Diagnostic Auditory Brainstem Response (ABR): This test uses three small patches are placed on your baby’s face, shoulder and neck, then small headphones placed over your baby’s ear or small ear tips are placed in the baby’s ears and the baby hears soft sounds. This test records information from the hearing nerve. There are several types of ABR that may be used at the follow up evaluation.
     
  • Tympanometry – This test looks at your baby’s middle ear. A small probe is placed in your baby’s ear and the air pressure is gently changed. The results show whether or not there is an ear infection or fluid in the middle ear. Sometimes fluid can prevent getting accurate hearing results. More testing may be needed or sometimes a referral to the baby’s doctor or ENT is needed.

How do I Prepare for the Appointment?

Appointment instructions may be provided when you schedule your baby’s appointment. Try not to let your baby nap before the appointment because your baby needs to sleep during the tests. It is best if you feed your baby about 20 minutes before the test to help your baby fall asleep. You may want to bring items your baby may need for comfort – extra diapers, change of clothes.

What are the Diagnostic Hearing Evaluation Results?

After your baby’s testing is completed, the audiologist will talk to you about the test results. The tests results will be for each ear and may or may not indicate hearing loss type and degree. Sometimes, more testing is needed to find hearing loss and additional appointments are needed.

My Baby was Diagnosed with Hearing Loss

What are my next steps once my baby has been diagnosed with hearing loss?

Once your baby has been diagnosed with hearing loss, your baby will be referred to receive Early Intervention services and you will need to decide on a communication option for your baby.

What are the Communication Options for My Baby?

Decisions about how to communicate in your family are very important to your child's early development. Because each baby and family is different, the decision about how to communicate must be made by the family.

American Sign Language (ASL)

American Sign Language is the predominant sign language of the Deaf Community in the United States. Parents who want to learn ASL benefit from meeting and interacting with people who are fluent in ASL.  To learn ASL efficiently, babies will benefit from access deaf adults who are fluent in ASL.  Bilingual-bicultural approaches include an emphasis on ASL, learning English, and learning about Deaf cultural traditions and perspectives.

Cued Speech

This is a visual approach to communication that uses handshapes and placements in combination with the mouth movements of speech to make the sounds of spoken language look different from each other. Many sounds look alike on the face. Cued speech is a way of showing English clearly. More information about cued speech.

Listening and Spoken Language (LSLS)

This type of program focuses on maximum use of hearing to develop speech and language. The approach fosters the reliance on spoken language for communication and learning.  

Manually Coded English (MCE)

Manually Coded English is a way of expressing the English language on the hands. Signs are used in combination with spoken English.  Some families use a manual code of English as a tool for learning English grammar and beginning to read.

Oral/Aural communication approaches

Many programs emphasize development of listening and they may support that with visual cues from speechreading. Like LSLS, the primary goal is for the child to develop spoken language. Your baby will need good technology (hearing aids, cochlear implants), a quiet environment, rich language stimulation, and help from you and your infant/family specialist in order to develop speech and language through spoken language.

About Early Intervention for Babies with Hearing Loss

What is Early Intervention?

Early Intervention (EI) is a statewide system that provides coordinated early intervention services to parents of eligible children under the age of three with developmental delays or disabilities. EI is grounded in the philosophy that young children learn best from familiar people in familiar settings. Every family served in EI will have a local EI team that consists of a service coordinator, service providers, and your family. Your team works with you in your home or other places you and your family spend time to develop a coordinated plan called an Individualized Family Service Plan (IFSP). You and your team will work through your IFSP plan to use your existing supports and resources—and build upon them—to learn to enhance your child’s learning and development.

Why is Early Intervention Important?

Enrollment in Early Intervention before your baby is six months old is best. Early Intervention provides family training and support to families. The earlier a child who is deaf or hard-of-hearing starts getting services, the more likely the child’s speech, language, and social skills will reach their full potential.

EI builds upon and provides supports and resources to assist parents and caregivers to enhance children’s learning and development through everyday routines. It is a collaborative, home and community-based system where you and a team work together to provide ongoing support to your child.

How Do I Enroll my Baby in Early Intervention?

If your baby has a confirmed hearing loss in one or both ears, you can refer your baby for Early Intervention services.

Ages & Stages Questionnaire (ASQ) Online Screening

Help Me Grow now offers the Ages & Stages Questionnaire (ASQ) Online screenings free for Ohio families!

Caregivers and anyone working with children under age three can use the screenings to understand how a child is developing. Screenings help parents celebrate their child’s milestones, know what to look for next, and figure out whether follow-up steps are needed. It’s an important first step in identifying if children have delays or disabilities in the critical early years before they start school.

Once a screening is completed, someone from Help Me Grow will contact the family to discuss the results.

Questions I Can Ask Medical and Early Intervention Professionals about My Baby’s Care

Screenings

Newborn Hearing Screening

Screening Facts

  • Language and communication are very important for everyone, especially babies.
  • State law requires babies born in a hospital to be screened before going home.
  • Newborn and infant hearing screenings are simple and safe.
  • Screening is done shortly after birth in the mother’s room or nursery.
  • Babies are only screened up to two times in the hospital before discharge.
  • Babies often sleep through the hearing screening test.
  • Screening time varies, generally around 15 minutes or less.
  • Screening shows risk for hearing loss.
  • Hearing loss is common in newborns and infants.
  • Finding hearing loss early is important so babies can learn to communicate and develop language skills. 
  • For babies who did not pass the second screening, additional audiological evaluation is needed to learn more about the baby’s hearing. The Pediatric Audiology Services Directory for hearing evaluations Pediatric Audiology Services Directory for hearing evaluations is provided to the parent along with a parent brochure.
  • The hospital will give the parent a written copy of the screening results. Results include the type of screening test, results for each ear and any risk factors for hearing loss. The same information is provided to the baby’s doctor.
  • Our program will contact families of babies who did not pass and have not completed follow up audiological testing by phone and by letters.  The pediatrician is also contacted to help families schedule the follow up audiologist testing. 

      Screening Tests

      One or both of the below hearing screening tests may be used to screen a newborn or infant. Both tests look for risk for hearing loss.

      Otoacoustic Emissions (OAE): This test uses small, soft foam or rubber tips. These tips are placed inside the baby’s ears and the baby hears soft sounds. Small echoes are recorded from the baby’s ear to see if there is good function in the inner ear.

      Auditory Brainstem Response (ABR): This test uses three small patches that are placed on the baby’s face, shoulder and neck; then, small headphones are placed over the baby’s ear or small ear tips are placed in the baby’s ears and the baby hears soft sounds. This test records information from the hearing nerve.   

      Screening Results

      Pass Results: The baby passed the hearing screening today. Hearing can change as a baby grows, so it is important to monitor the baby’s speech, language, and communication. Sometimes, babies with hearing loss pass the hearing screening test.  Always talk, sing and read to your baby this helps bond with your baby. Babies enjoy stories and songs and this helps babies learn to communicate. If there are any questions about the baby’s hearing, talk to your baby’s doctor and request a more detailed test called an audiological evaluation.

      Pass with Risk Factor(s): The baby passed the hearing screening today, but there is a risk factor or risk factors. The risk factor means that there may be a hearing loss that develops later, or your baby may have a higher chance for hearing loss.  It’s important to follow the recommendations for follow-up testing and to monitor your baby’s communication. If a follow-up test is recommended, make sure to take your baby in for the testing.

      Non-Pass Results: The baby did not pass the hearing screening, and a more detailed test is needed. The hearing evaluation is important and should be scheduled soon, between 2-4 weeks after discharge, and testing should be completed by three months of age.  The baby will see a pediatric audiologist who can find hearing loss or deafness. This step is important to find hearing loss early.  Sometimes it takes a few appointments to complete the testing.

      Home Births

      Home Births

      • Babies born at home are not required to have a newborn hearing screening.
      • Hearing screening is strongly encouraged to be completed for babies born at home. Communication development in babies is very important and helps your baby develop important skills for school readiness and overall development.
      • Parents receive the home birth parent brochure and a list of sites that can perform the screening when registering the birth at the local health department.
      • The Pediatric Audiology Directory has a list of screening locations for babies born at home.
      • Screenings for babies born at home should be completed by 1 month of age. Older babies may need additional testing due to age.
      • Additional testing may be needed to find hearing loss or deafness.
      • If hearing loss or deafness is found, your baby/family will be referred to receive early intervention servicies from our partner agency, Department of Developmental Disabilities.
      • Provide insurance information when scheduling the screening appointment. Payment for screenings is through the baby’s insurance plan.

      Hearing Screening - Home Birth Parent Handout:

      Evaluations

      Hearing Evaluation Facts

      • A follow up hearing evaluation is scheduled when the baby did not pass the second hearing screening at the hospital

      • This test is very important in order to find hearing loss

      • Babies who do not pass their hearing screening need more complete testing before they reach 3 months of age

      • A hearing evaluation is safe and painless

      • Hearing evaluations may be scheduled by the hospital or birthing center

      • Hospitals and birthing centers will provide a list of audiologists close by that do hearing evaluations

      • Finding hearing loss early is important so babies can learn to communicate and develop language skills

      • The Infant Hearing Program will work with the PCP to obtain hearing evaluation results

      • The Infant Hearing Program will contact families if the hearing evaluation has not been completed by three months and six months.

      Tests

      A follow up evaluation includes a number of tests. These tests will help the audiologist find hearing loss. Some or all of these tests may be completed. All of the tests all diagnostic and not screening tests which give more detailed information about your baby’s hearing.

      The three most common tests used during a hearing evaluation are Otoacoustic Emissions (OAE) testing, Auditory Brainstem Response (ABR) testing and tympanometry.

      Diagnostic Otoacoustic Emissions (OAE): This test uses small, soft foam or rubber tips. These tips are placed inside the baby’s ears and the baby hears soft sounds. Small echoes are recorded from the baby’s ear to see if there is good function in the inner ear.

      Diagnostic Auditory Brainstem Response (ABR): This test uses three small patches are placed on the baby’s face, shoulder and neck, then small headphones placed over the baby’s ear or small ear tips are placed in the baby’s ears and the baby hears soft sounds. This test records information from the hearing nerve. There are several types of ABR that may be used at the follow up evaluation.

      Tympanometry – This test looks at your baby’s middle ear. A small probe is placed in your baby’s ear and the air pressure is gently changed. The results shows whether or not there is an ear infection or fluid in the middle ear. Sometimes fluid can prevent getting accurate hearing results. More testing may be needed or sometimes a referral to the baby’s doctor or ENT is needed.

      Results

      • After the testing is completed, the audiologist will talk about the tests that were completed and share the evaluation results with the parents

      • If a hearing loss is confirmed, the audiologist will talk to the parents about the type and  degree

      • If a hearing loss is undetermined, more testing in needed to find hearing loss

        Diagnostic Staff

      • Information about hearing, speech and language milestones will be provided to families

      • Resources about early intervention services will be provided to families

      • Resources on how to connect with families of children with hearing loss will be provided to families

      • Parents will receive resources on non-biased communication options

      • Approximately 5% of babies in Ohio who do not pass their newborn hearing screen are identified with a permanent hearing loss.

      Risk Factors

      • Caregiver concern

      • Family history of childhood hearing loss

      • Craniofacial anomalies

      • Chemotherapy

      • Head trauma

      • Ototoxic medication

      • In utero infection (Herpes, Rubella, Syphilis, Toxoplasmosis, CMV)

      • Culture positive postnatal infections (herpes, varicella, meningitis)

      • Neurodegenerative disorders (Hunter syndrome)

      • Syndromes associated with hearing loss (Usher, Waardenburg, Alport, Pendred, Jevell, Lange-Nielson)

      • Physical findings associated with hearing loss

      • Neonatal intensive care unit (NICU) stay

      Reference: Joint Committee on Infant Hearing, 2007 Position Statement

       

      Parent Resources