Physical Health

Early Childhood Hearing Screening and Follow-up

Newborn Hearing Screening in Health Care Settings

Hearing loss in infancy is more common than most people realize, affecting about three in every 1,000 babies. If not identified early, it is likely to delay or impair a child's development. Hearing problems are difficult to detect through observation alone, so almost all newborns have their hearing checked with special equipment before leaving the hospital. The screening is simple, painless, and takes only a few minutes when a baby is quiet. If hearing loss is found early, the child may receive help to communicate and learn.

Parents and professionals serving young children should be sure they know the results of the newborn hearing screening. If the baby:

  • Passed on both ears, no further testing is typically needed until the baby is 6 months of age or older
  • Did not pass, or was not screened, ask the hospital or the baby's doctor how and where to get the next required test

If you need more help getting the hearing test, contact your state's Early Hearing Detection and Intervention (EHDI) coordinator.

Hearing Screening and Follow-up in Head Start

Hearing loss can occur at any time in a young child's life. By 6 years of age, about six in every 1,000 children have a hearing loss. Without appropriate screening, the condition can remain undiagnosed, or misdiagnosed, for years as the child falls further behind in cognitive, social, and emotional development. Children need to be able to hear clearly to develop spoken language skills. Periodic screening during the early childhood years will help to ensure that children are able to communicate and learn.

Hearing screening and follow-up requirements are outlined in Child Health Status and Care, 45 CFR § 1302.42, of the Head Start Program Performance Standards:

(b) Ensuring up-to-date child health status.

(2) Within 45 calendar days after the child first attends the program or, for the homebased program option, receives a home visit, a program must either obtain or perform evidence-based vision and hearing screenings.
(3) If a program operates for 90 days or less, it has 30 days from the date the child first attends the program to satisfy paragraphs (b)(1) and (2) of this section.

(d) Extended follow-up care.

(1) A program must facilitate further diagnostic testing, evaluation, treatment, and follow-up plan, as appropriate, by a licensed or certified professional for each child with a health problem or developmental delay, such as elevated lead levels or abnormal hearing or vision results that may affect child's development, learning, or behavior.

(2) A program must develop a system to track referrals and services provided and monitor the implementation of a follow-up plan to meet any treatment needs associated with a health, oral health, social and emotional, or developmental problem.

Otoacoustic emissions (OAE) hearing screening is an objective and reliable screening method often used with newborns. Because it is accurate, quick, flexible, and requires no behavioral response, it is also the most appropriate way to screen children 0–3 years of age in early childhood care and education settings. Children ages 3 to 5 are most commonly screened with pure tone audiometry or OAE screening technologies. 

The Early Childhood Hearing Outreach (ECHO) Initiative at Utah State University serves Head Start as the National Resource Center on Early Hearing Detection and Intervention. It assists grantees and delegate agencies in their hearing screening efforts. The goals of the ECHO Initiative are to ensure early childhood education and health care providers have:

  • Up-to-date information about recommended hearing screening practices
  • Tools to effectively implement hearing screening so that children with hearing-health needs are identified as early as possible and provided with appropriate follow-up services and support
  • Strategies for using hearing screening as an opportunity to promote language development in all children as an integral part of school readiness

To learn more, visit Use the free, comprehensive instructional video tutorial modules and implementation tools to improve your hearing screening program and practices.