If your newborn just received a "refer" result on their hearing screening, your heart probably sank. Every parent dreads hearing that something might be wrong with their baby, and when it comes to hearing, the worry can feel overwhelming. But here is the reassuring truth: about 90% of babies who get a refer result pass the follow-up test with perfectly normal hearing. Approximately 1 to 3 out of every 1,000 babies are born with some degree of hearing loss, but when it is detected before 6 months of age and early intervention begins promptly, children can achieve near-normal language development. This guide covers everything you need to know about newborn hearing screening types and procedures, what to do if your baby gets a refer result, diagnostic testing, hearing development milestones by age, and why early detection matters so much.

What Is Newborn Hearing Screening?

Newborn hearing screening is a quick, painless test designed to detect potential hearing problems as early as possible after birth. The test is performed while your baby is sleeping and takes only about 5 to 10 minutes. In the United States, all 50 states and the District of Columbia have established Early Hearing Detection and Intervention (EHDI) programs, and approximately 98% of newborns are screened before leaving the hospital. This matters because hearing loss is one of the most common conditions present at birth, and the earlier it is identified, the better the outcomes for your child.

Newborn hearing screening should ideally be completed within the first month of life, preferably before hospital discharge. In the U.S., this screening is mandated by law in most states and is typically covered by insurance at no cost to families.

OAE vs AABR: Understanding the Two Screening Methods

There are two types of newborn hearing screening tests. Understanding the difference helps you know exactly what your baby's results mean and why one test might be recommended over the other.

Feature	OAE (Otoacoustic Emissions)	AABR (Automated Auditory Brainstem Response)
How It Works	Measures sound waves produced by the inner ear (cochlea)	Measures nerve responses from the auditory nerve to the brainstem
Test Duration	About 5 minutes	About 10-15 minutes
Procedure	Small probe placed in the ear canal	Electrodes placed on forehead and behind ears
What It Detects	Cochlear (inner ear) problems only	Cochlear + auditory nerve problems
Auditory Neuropathy Detection	Not possible	Yes
Cost	Covered by insurance/Medicaid	Covered by insurance/Medicaid

OAE testing alone cannot detect auditory neuropathy spectrum disorder (ANSD). This matters because babies who spent time in the NICU or have other risk factors should receive AABR testing to ensure this condition is not missed.

What a "Refer" Result Means

A "refer" result means your baby did not pass the hearing screening and needs further evaluation. However, a refer result does not automatically mean your baby has hearing loss. Here is why most families can breathe a sigh of relief.

Common Reasons for a Refer Result

Fluid (amniotic fluid) or vernix remaining in the ear canal (the most common cause)
Baby was moving or crying during the test
Fluid in the middle ear (otitis media with effusion)
Excessive background noise during testing
Actual hearing loss

What to Do After a Refer Result

1. Don't Panic

About 90% of babies who receive a refer result pass the retest. This is because the most common cause is simply residual fluid in the ear canal, which resolves on its own within days.

2. Schedule a Retest

If the refer occurred before discharge: retest within 1 month of birth
If the retest also shows a refer: diagnostic testing within 3 months of birth

3. Book an Appointment for Diagnostic Testing

See a pediatric audiologist or ENT specialist
University medical centers or children's hospitals are recommended because they have specialized pediatric audiology equipment

Getting a refer result can feel overwhelming, but remember that the vast majority of cases are due to temporary causes like residual amniotic fluid. Follow the recommended timeline for retesting, and try not to worry until you have more information.

Types of Diagnostic Hearing Tests

When a baby does not pass the screening, diagnostic tests are used to determine whether hearing loss is present and how severe it may be. These tests provide much more detailed information than the initial screening.

Test Name	What It Measures	Duration	Key Features
ABR (Auditory Brainstem Response)	Auditory nerve to brainstem pathway	30-60 minutes	Baby must be sleeping; determines degree of hearing loss
ASSR (Auditory Steady-State Response)	Frequency-specific hearing thresholds	60-90 minutes	Provides critical data for hearing aid fitting
Tympanometry	Middle ear function	About 5 minutes	Identifies middle ear fluid or dysfunction
Diagnostic OAE	Cochlear function	About 10 minutes	Detailed assessment of outer hair cell function

Types and Degrees of Hearing Loss

Hearing loss is classified by where it occurs in the ear and by severity. Understanding these categories helps parents have more informed conversations with audiologists and ENT specialists.

Classification by Location

Conductive hearing loss: Problem in the outer or middle ear (ear infections, earwax blockage). This type is often treatable and sometimes reversible, because the underlying causes are typically mechanical rather than neurological.
Sensorineural hearing loss: Problem in the cochlea or auditory nerve. This type typically requires hearing aids or cochlear implants, because the sensory cells or nerve pathways are damaged.
Mixed hearing loss: A combination of conductive and sensorineural hearing loss occurring simultaneously.

Degree of Hearing Loss	Hearing Threshold	Impact
Mild	26-40 dB	Misses soft sounds and whispered speech
Moderate	41-55 dB	Difficulty hearing normal conversation
Moderately Severe	56-70 dB	Can only hear loud sounds
Severe	71-90 dB	Only perceives very loud sounds
Profound	91 dB or higher	Little to no sound perception

The 1-3-6 Rule: Why Early Detection Matters

The JCIH (Joint Committee on Infant Hearing) recommends the 1-3-6 rule as the international standard for early detection and intervention of newborn hearing loss. Following this timeline gives your baby the best possible chance for language development.

1 Month: Complete hearing screening by 1 month of age 3 Months: Confirm diagnosis through diagnostic testing by 3 months of age 6 Months: Begin early intervention (hearing aids, therapy) by 6 months of age

Research shows that babies whose hearing loss is identified before 6 months and who receive early intervention develop language skills 20-40% better than those identified later. This is because the first 3 years of life are the critical period when the brain's auditory and language pathways are being formed.

Early intervention is so crucial because the brain's ability to develop auditory and language circuits depends heavily on sound input during the first three years of life. Without adequate sound stimulation during this window, language development can be significantly delayed. Conversely, babies who receive hearing aids or cochlear implants early can develop language skills comparable to their hearing peers. The reason this window matters so much is that neural plasticity, the brain's ability to form new connections, is at its peak during infancy.

Baby Hearing Development Milestones by Age

Babies develop hearing responses in a predictable sequence. Use this chart to check whether your baby's hearing development is on track. If you notice any delays, it does not necessarily mean there is a problem, but it is worth discussing with your pediatrician.

Age	Expected Hearing Response
0-1 month	Startles at loud sounds (Moro reflex), wakes from sleep
2-3 months	Smiles at parent's voice, moves eyes toward sound
4-5 months	Turns head toward sounds, begins babbling
6-7 months	Responds to name, varied babbling ("ba-ba", "ma-ma")
8-9 months	Understands simple words ("no", "bye-bye"), tries to imitate sounds
10-12 months	Follows simple instructions, says first meaningful words ("mama", "dada")

Home Hearing Checklist for Parents

Check the items below. If two or more items do not apply to your baby at the appropriate age, it is recommended to consult a pediatric audiologist or ENT specialist. Trust your instincts as a parent, because you know your baby best.

0-3 Months

Does your baby startle at loud sounds?
Does your baby calm down or smile at your voice?
Does your baby wake or flinch when a sudden loud noise occurs during sleep?

4-6 Months

Does your baby turn toward sounds?
Is your baby babbling?
Does your baby show interest in toy sounds or music?

7-12 Months

Does your baby respond when you call their name?
Does your baby stop what they are doing when you say "no"?
Does your baby react to music by bouncing or moving?

This checklist is a helpful guide but does not replace professional evaluation. If you have any concerns at all about your baby's hearing, do not wait. Schedule an appointment with a specialist right away, because early detection makes all the difference.

Hearing Aids and Cochlear Implants

When hearing loss is confirmed, the appropriate hearing device is selected based on the type and severity. The goal is to provide your baby with access to sound as early as possible to support language development.

Hearing Aids

Used for mild to severe hearing loss
Amplify sounds so they become audible
Can be fitted as early as 4 to 6 weeks of age
Behind-the-ear (BTE) models are standard for infants
Most insurance plans and state programs provide financial assistance

Cochlear Implants

Used for severe to profound sensorineural hearing loss
Surgically implanted electrodes directly stimulate the auditory nerve
Surgery is typically performed around 12 months of age
Consistent auditory rehabilitation after surgery is essential, typically lasting 1 to 2 or more years
Covered by most insurance plans, including Medicaid

Feature	Hearing Aids	Cochlear Implants
Suitable For	Mild to severe hearing loss	Severe to profound sensorineural hearing loss
How It Works	Amplifies sound	Directly stimulates the auditory nerve
When to Start	From 4-6 weeks of age	Around 12 months of age
Advantage	Non-invasive, immediate use	Enables sound perception in profound hearing loss
Rehabilitation	Auditory training recommended	Auditory rehabilitation required (1-2+ years)

Risk Factors for Newborn Hearing Loss

Babies with the following risk factors need ongoing hearing monitoring even if they pass the initial screening. This is important because some forms of hearing loss are progressive or late-onset and may not be detectable at birth.

Family history of permanent childhood hearing loss
NICU stay of 5 days or longer
Hyperbilirubinemia requiring exchange transfusion
In-utero infections (CMV, rubella, toxoplasmosis, etc.)
Craniofacial anomalies (cleft lip/palate, microtia, etc.)
History of bacterial meningitis
Use of ototoxic medications
Birth asphyxia (low Apgar scores)

Even if a high-risk baby passes the initial hearing screening, the AAP recommends hearing evaluations every 6 months until age 3. The reason is that some types of hearing loss develop gradually or appear later in infancy, so ongoing monitoring is essential.

Track Baby Hearing Development with BabySnap

Monitoring your baby's hearing development requires consistent observation and documentation. BabySnap makes it easy to stay organized and catch any concerns early.

Developmental Milestones: Record hearing-related milestones like first babbling and first words
Health Records: Store hearing test results and ENT visit history in one place
AI Consultation: Ask our AI chatbot any questions about your baby's hearing development

👉 Get parenting advice from BebeSnap AI Chatbot

Frequently Asked Questions (FAQ)

Q: My newborn got a refer result in only one ear. Should I be worried?
A: A single-ear refer is very common and is usually caused by residual amniotic fluid or vernix in the ear canal. Most babies pass the follow-up test with no issues. However, you should still complete the recommended retesting on schedule. Even if unilateral hearing loss is confirmed, proper management can support normal language development.

Q: How much does newborn hearing screening cost?
A: In the United States, newborn hearing screening is mandated in all 50 states and is typically covered at no cost by insurance or Medicaid. If diagnostic tests like ABR or ASSR are needed, most insurance plans cover these as well, though copays may range from approximately $30 to $100 depending on your plan.

Q: My baby seems to respond to sounds just fine. Is screening still necessary?
A: Yes, absolutely. Mild to moderate hearing loss is very difficult for parents to detect in everyday life, and unilateral (one-ear) hearing loss is even harder to notice. Because early detection has such a significant impact on language development, hearing screening is recommended for every newborn without exception.

Q: By when should my newborn's hearing screening be completed?
A: Following the 1-3-6 rule, ideally the initial screening should be completed by 1 month of age. If a refer result occurs, diagnostic testing should confirm whether hearing loss exists by 3 months. If hearing loss is confirmed, early intervention should begin by 6 months of age to maximize language development outcomes.

References

Newborn Hearing Screening Guide | OAE vs ABR, Refer Results & Baby Hearing Milestones