Setting the Stage for Development
New parents spend much of their time staunchly attuned to every smile or plaintive cry from their newborn. Equally important to a baby's early development, however, is their own relationship to sound.
Because babies begin to learn communication, language and social skills by listening to and interacting with those around them, newborn hearing screening is an important, informative tool for new parents.
Without newborn hearing screening and resources, hearing differences are typically not identified until around two years of age and can lead to significant delays in development. These simple screenings and follow up evaluations can help quickly identify any potential issues and connect caregivers with early intervention services, including sign language and hearing technology. The earlier deaf and hard of hearing children begin receiving services that align with their family goals, the more likely they are to develop crucial developmental skills.
State-based Early Hearing Detection and Intervention (EHDI) programs coordinate these statewide screening and referral systems and collect data on whether these screenings were completed, as well as their timing and location. To ensure that babies receive timely intervention, EHDI recommends screening for hearing before 1 month of age, a diagnostic audiology evaluation before 3 months of age and enrollment in early intervention before 6 months of age–known as 1-3-6 benchmarks.
A newborn receiving an infant hearing screening using the Otoacoustic Emissions (OAE) test.
An infant receives a follow-up test using the Brainstem Auditory Evoked Response (BAER) test
The initial screening itself, called an Otoacoustic Emissions (OAE) test, is simple—a little headphone goes into the newborn’s ear, then a small machine plays a series of beeps and records a returning echo, which must pass a certain volume threshold to be correlated to typical hearing.
While infants born in hospitals and birthing centers usually receive these first screenings before they are discharged, those born at home must separately visit a clinic or hospital to be screened.
Bridging Gaps in Oregon
Shelby Atwill, AuD, a pediatric audiologist working with Oregon’s EHDI program, connects families choosing community-based births with newborn screenings and follow-up tests.
Because many new parents are unaware hearing screenings are recommended for newborns and may feel uncertain about having a hearing screening done, Dr. Atwill’s team works directly with midwives and naturopathic primary care providers, who provide critical pediatric care for families and can help bridge those gaps in understanding. Her staff visit midwifery clinics when new families are set to visit and conduct the hearing screening during the infant’s checkup, eliminating the need for families to schedule a separate visit.
Though progress has been made reaching more families for initial screenings, EHDI staff around the country are working to engage more families whose infants may require the 3-month follow-up or 6-month intervention. Caregivers of infants in this range are often unaware of what resources are available or may be nervous about the results of a follow-up. This has led to significant drop-offs in the number of infants seen for evaluation and intervention.
At a local hearing screening site in Oregon, newborn hearing screener performs an Otoacoustic Emissions (OAE) test for a baby born at home. (Left and right photo)
“The drop-off between the initial screening and follow-up is something that has plagued the EHDI program over the last ten years and is something each state has looked into and tried to explore different strategies to help,” explained Dr. Atwill.
In larger states like Oregon, where a third of the population lives in rural areas, challenges in reaching a clinic or health facility have further contributed to this drop-off in follow-ups.
“The biggest barrier we’ve seen is how far the drive is from the family’s home,” said Dr. Atwill. “In frontier parts of our state, there’s no audiology clinic for anyone, let alone children.”
The Role of Data
Using geographic data to identify gaps in both screenings and subsequent diagnoses, Dr. Atwill’s team travels to these areas to provide screenings.
“I can run [EHDI data] reports by county or birth facility to figure out who’s missing either their initial screening or follow-up testing and reach out to say ‘Hey, we’ll be there next week if you want me to add you to the schedule,’” said Dr. Atwill.
To help states better understand the reach and effectiveness of their EHDI programs, the CDC Foundation shares insights from individual-level jurisdictional data. The Foundation team looks at socio-demographic factors, like marital status, education, ethnicity and access to federal assistance programs, and explores potential associations between these factors and missed hearing screenings and follow-up appointments.
Once the information is analyzed, the Foundation team meets with states to discuss trends, bright spots and areas for improvement. By identifying where gaps in the data exist, states have a more nuanced picture of what is and isn’t working in their outreach.
With these data in hand, Dr. Atwill’s team is better able to focus their outreach on families who have missed their screenings and follow-ups, offering services close to home and in a setting that feels safe and comfortable.
And Oregon’s program is working. In 2022, 68.7 percent of infants who did not pass their hearing screening were diagnosed by 3 months of age, compared with 39.9 percent nationally; 64.9 percent of infants diagnosed as deaf or hard of hearing were enrolled into early intervention by 6 months of age, compared with 40.7 percent nationally.
The first months of a baby’s life set the stage for their entire adulthood. By connecting states like Oregon to informative and actionable data, the CDC Foundation is helping them better serve their tiniest citizens, ensuring their children have the best chance to thrive.
The project described above is supported by the Centers for Disease Control and Prevention (CDC) of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $300,000 with 100 percent funded by CDC/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by CDC/HHS, the U.S. Government or the CDC Foundation.
