Failed Newborn Hearing Test Follow-Up
The short answer
A "refer" or failed result on a newborn hearing screen does not necessarily mean your baby has hearing loss. About 2-10% of newborns do not pass their initial screen, but most pass on retest. It is important to follow up promptly (within 1 month) with a comprehensive hearing evaluation. If hearing loss is confirmed, early intervention by 6 months leads to the best outcomes.
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By Age
What to expect by age
Newborn hearing screening is performed before discharge from the hospital. A "refer" result means the test could not confirm normal hearing in one or both ears. This can happen due to fluid in the ear canal (common in newborns), environmental noise, or actual hearing issues. About 90-95% of babies who fail the initial screen have normal hearing on retest. Follow-up testing should occur within 1 month. If the rescreen is also abnormal, a comprehensive audiologic evaluation (diagnostic ABR) should be done by 3 months of age.
If the rescreen was passed, no further action is needed unless you have concerns about hearing later. If the rescreen was also failed, a diagnostic ABR (auditory brainstem response) test should be completed by 3 months to confirm or rule out hearing loss. Early diagnosis is key to optimal outcomes for language development.
If hearing loss is confirmed, intervention should begin by 6 months. This may include hearing aids, early intervention services, and speech-language therapy. The AAP and Joint Committee on Infant Hearing recommend the 1-3-6 guidelines: screen by 1 month, diagnose by 3 months, intervene by 6 months.
Babies with hearing loss who receive early intervention develop language skills comparable to hearing peers. Even if the initial hearing screen was passed, be alert to signs of hearing loss: not responding to sounds, not babbling by 6-9 months, or not turning toward voices. Report any concerns to your pediatrician.
What Should You Do?
When to take action
- Baby passed the rescreen after an initial "refer" result
- Baby responds to sounds and voices appropriately
- Baby is babbling and developing language on track
- Your baby failed the initial hearing screen and you haven't scheduled the retest yet
- You have concerns about your baby's response to sounds even after passing the screen
- Family history of hearing loss
- Failed hearing screen without follow-up testing scheduled - do not delay the retest
- Baby does not respond to loud sounds, does not startle, or seems unaware of voices at any age
Sources
Related Resources
Trust your instincts. If something feels wrong, reach out to your pediatrician.
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Related Medical Concerns
Failed Newborn Hearing Screening
A "refer" or "fail" result on the newborn hearing screening does not necessarily mean your baby has hearing loss. Many babies who do not pass the initial screening have normal hearing on follow-up testing. Common reasons for an initial fail include fluid in the ear canal, vernix debris, or background noise during the test. However, follow-up testing is essential, as early identification and intervention for true hearing loss significantly improves language and developmental outcomes.
Congenital Hearing Loss Types
Congenital hearing loss affects approximately 1-3 out of every 1,000 newborns. It can be sensorineural (involving the inner ear or auditory nerve), conductive (involving the outer or middle ear), or mixed. About 50-60% of cases have a genetic cause, while other causes include prenatal infections, prematurity, and certain medications. Early identification through newborn hearing screening and early intervention (by 6 months of age) significantly improves language, speech, and cognitive outcomes.
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.
My Baby's Head Shape Looks Abnormal
Many babies develop temporary head shape irregularities that are completely normal. A cone-shaped head from vaginal delivery reshapes within days. Mild positional flattening (plagiocephaly) from sleeping on the back is very common and usually improves with repositioning and tummy time. However, head shape changes involving ridges, a persistently bulging fontanelle, or rapid head growth changes should be evaluated to rule out craniosynostosis.
Achondroplasia (Dwarfism) in Babies
Achondroplasia is the most common form of short-limbed dwarfism, affecting about 1 in 15,000 to 40,000 births. It is caused by a mutation in the FGFR3 gene and is usually apparent at birth with characteristic features including short limbs, a larger head, and a prominent forehead. Intelligence is normal. With monitoring for specific complications and supportive care, children with achondroplasia lead full, active, and independent lives.
Adenoid Hypertrophy and Breathing
Adenoids are lymphoid tissue located behind the nose that help fight infection in young children. When adenoids become enlarged (adenoid hypertrophy), they can block the nasal airway, causing chronic mouth breathing, snoring, nasal speech, and sleep-disordered breathing. Enlarged adenoids are most common between ages 2-7 and are a leading cause of obstructive sleep apnea in young children. Treatment ranges from watchful waiting and nasal steroids to surgical removal (adenoidectomy) if breathing or sleep is significantly affected.