Baby Failed Newborn Hearing Screen - What Now?
The short answer
Failing a newborn hearing screen does not necessarily mean your baby has hearing loss. Many babies who fail the initial screen pass on follow-up testing. However, it is critical to complete follow-up testing by 3 months of age. If hearing loss is confirmed, early intervention by 6 months of age leads to significantly better language outcomes.
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By Age
What to expect by age
Most newborns receive a hearing screening before leaving the hospital. If your baby did not pass, a rescreen is typically scheduled. Common reasons for a "refer" result include fluid in the ear canal, debris, or a noisy testing environment. Many babies pass on retest.
Follow-up diagnostic testing, typically an Auditory Brainstem Response (ABR) test, should be completed by 3 months of age. This more detailed test can determine the type and degree of any hearing loss. Do not wait to schedule this appointment.
If hearing loss is confirmed, early intervention should begin by 6 months. Services may include hearing aids, sign language instruction, and speech-language therapy. Research shows that babies who receive intervention by 6 months develop language skills comparable to hearing peers.
Ongoing audiological monitoring and early intervention services support your baby's communication development. Your audiologist will track hearing thresholds and adjust hearing devices as needed. Speech and language milestones should be monitored closely.
Children with identified hearing loss who received early intervention continue to develop language skills. Regular hearing evaluations and speech-language therapy remain important. If hearing loss was not identified earlier, any speech or language delays at this age should prompt a hearing evaluation.
What Should You Do?
When to take action
- Your baby failed the initial hospital screening but there was fluid in the ear canal or the environment was noisy
- Your baby failed in one ear only, which may be due to positioning or temporary fluid
- Your baby is scheduled for a follow-up test and you are waiting for the appointment
- Your baby failed the follow-up hearing test and you need guidance on next steps
- Your baby passed the initial screen but you have concerns about hearing at a later age
- Your baby has risk factors for hearing loss like family history, NICU stay, or certain infections
- Your baby failed the initial screen and the follow-up test has not been scheduled by 1 month of age
- Your baby has been diagnosed with hearing loss and intervention has not started by 6 months
Sources
Related Resources
Trust your instincts. If something feels wrong, reach out to your pediatrician.
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Related Speech Concerns
Signs of Hearing Loss in Babies
Most babies are screened for hearing loss at birth, but some hearing problems develop later or are missed. Early signs include not startling to loud sounds, not turning toward voices by 6 months, or not babbling by 9 months. Catching hearing loss early is critical for language development.
Baby Not Responding to Sounds
Babies should respond to sounds from birth - startling at loud noises, calming to familiar voices, and turning toward sounds by 4-6 months. If your baby consistently doesn't react to sounds, a hearing evaluation should be your first step. Hearing loss affects about 1-3 in 1,000 newborns and is highly treatable when caught early - early identification leads to much better language outcomes.
Speech Delay Related to Hearing Loss
Hearing loss is one of the most common treatable causes of speech and language delay. Even mild or intermittent hearing loss (such as from chronic ear fluid) can significantly impact a child's ability to learn speech sounds and develop language. Children need to hear clearly and consistently to learn to talk. If your child has a speech delay, a hearing evaluation should always be one of the first steps, regardless of whether they seem to respond to sounds. Early identification and treatment of hearing loss can lead to dramatic improvements in speech and language development.
Accent vs Speech Disorder in Bilingual Toddlers
When toddlers grow up hearing more than one language, they naturally blend sounds, patterns, and accents from both languages. This is normal and healthy, not a speech disorder. A bilingual child may pronounce some sounds differently than monolingual peers because they are learning the sound systems of two languages simultaneously. True speech disorders affect both languages equally, while accent influence appears only in specific sounds borrowed from one language to another.
Ear Fluid Affecting Baby's Speech Development
Chronic or recurrent middle ear fluid (otitis media with effusion) can temporarily reduce hearing by 15 to 40 decibels, which is like hearing through water. During critical periods of language learning, this muffled hearing can impact speech and language development. If your baby has frequent ear infections or persistent fluid, discuss the potential speech impact with your pediatrician.
Will Ear Tubes Help My Child's Speech?
Ear tubes (tympanostomy tubes) can restore normal hearing by draining persistent fluid from the middle ear. Many children show speech and language improvement within weeks to months after tube placement, particularly if hearing loss from fluid was contributing to their speech delay. However, ear tubes alone may not resolve all speech delays, and some children benefit from speech therapy alongside tube placement.