When Does Newborn Screening Happen
The timing of newborn screening is very important. Babies need screening during the first few days of life, because some of the conditions found by screening require treatment or intervention right away.
NBS happens after birth, usually when your baby is between 24 and 48 hours old. If a baby is tested before 24 hours, they may need to be retested.
Some babies who have had treatments such as transfusions or dialysis may be tested later or may need further testing after their blood has returned to normal. In addition, babies who are born too early, or who receive nutrients or medicines before screening, may need further testing.
There are two models that states use to screen all newborns: the one-screen model or the two-screen model.
To learn more about the differences in NBS across different states, visit the State pages.
How Will I Know If My Child Has Trouble Hearing
My husband has had a hearing loss since he was a child. How will I know if our baby also has a hearing problem? Joyce
A family history of hearing loss does put a newborn at higher risk for having a hearing loss. But rest assured, your baby’s hearing can be monitored closely so that if there is a problem, treatment can begin as soon as possible.
In most states, hospitals do a newborn hearing screening before the baby goes home. If it’s not done then, or the baby was born at home or a birthing center, it’s important to get a newborn hearing screening within the first 3 weeks of life.
A baby who doesn’t pass a hearing screening doesn’t necessarily have a hearing loss. A retest to confirm the hearing loss should be done within the first 3 months of life. If it confirms a problem, doctors should start treatment by the time the child is 6 months old.
Even if your newborn passes the initial hearing screening, watch for signs that he or she is hearing well. Hearing milestones that should be reached in the first year of life include:
- Most newborns startle or “jump” to sudden loud noises.
A child may be at higher risk for hearing loss if he or she:
- was born prematurely
- was given medicines that can lead to hearing loss
- had complications at birth
What Does The Screening Involve
A trained hearing screener carries out the hearing screening test. Two main tests are done to screen a newborn:
ABR The tester attaches leads to your baby’s forehead, back of their neck and behind their shoulder, using sticky pads. Small earphone ‘cups’ are then placed over the baby’s ears. The earphones make soft clicking sounds and the leads measure the response from your baby’s ears.
OAE A small soft-tipped earpiece is placed in the outer part of your baby’s ear, which sends clicking sounds down the ear. When an ear receives sound, the inner part, known as the cochlea, usually produces an echo. The screening equipment can pick up a response.
These tests only take a few minutes and do not hurt your baby. The hearing screening test will usually be done while your baby is asleep or settled. You can stay with your baby while the screening test is done.
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Why Newborn Hearing Screening Is Important
Your babys sense of hearing is a crucial piece to the development puzzle. According to the American-Speech-Language Hearing Association , untreated hearing loss can cause delays in speech and language communication skills which affect academic achievement and may lead to social isolation and poor self-concept. Studies show hearing loss even affects infant babble.
Children who receive treatment and/or learn American Sign Language are statistically better equipped to develop the language skills they need to succeed in school and the work environment.
The earlier hearing loss is detected, the sooner your family can enroll in age-appropriate intervention programs. Fortunately, all 50 states fund Early Hearing Detection and Intervention programs designed to screen all babies for hearing loss by one month of age. Follow-up screenings by three months of age confirm whether a baby is deaf or hard of hearing and provide enrollment into early intervention programs by 6 months of age. And, thanks to the Individuals with Disabilities Education Act , all children who have hearing loss are entitled to receive free services throughout their education to age 21.
In the U.S., all children who have hearing loss are entitled to receive free services throughout their education up to age 21.
Monitoring Your Babys Hearing
Some babies who pass their hearing screen or diagnostic testing may develop a hearing loss later. It is important that you continue to monitor your childs hearing.
If you have concerns about your childs hearing you should talk to your midwife, GP, Well Child provider or early childhood teacher. There are checklists in the Well Child/Tamariki Ora Health Book to help you figure out if your baby can hear well.
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When Will My Babys Hearing Be Screened
Your babys hearing should be screened before he or she leaves the hospital or birthing center. If not, make sure the baby is tested during the first month of life. If your babys hearing was not tested within 1 month of birth, or if you havent been told the results of the hearing screening, ask your childs doctor today. Quick action will be important if the screening shows potential hearing loss.
Why Is It Important To Have My Babys Hearing Screened Early
The most important time for a child to learn language is in the first 3 years of life, when the brain is developing and maturing. In fact, children with typical hearing begin learning speech and language in the first 6 months of life. This is why it is so important to screen and start interventions for hearing loss as early as possible. Research shows that children with hearing loss who get help early develop better language skills than those who dont.
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Can My Baby Taste Or Smell
Newborns can taste and smell and will favor sweet tastes over bitter ones. For example, a newborn will choose to suck on a bottle of sweetened water, but will turn away or cry if given something bitter or sour to taste. Likewise, newborns will turn toward smells they favor and turn away from bad odors.
Though sweetness is preferred, taste preferences will continue to develop during the first year of life. In fact, studies show that a mother’s diet can affect the way her breast milk tastes. These first flavors can help shape flavor preferences later on. For example, a mother who ate spicy foods while nursing is likely to have a child who grows up to favor spicy foods.
For now, breast milk or formula will fully satisfy your baby.
Oaes And Abrs Is One Test Better Than The Other
Both tests have advantages and disadvantages when used for screening, and depending on the program and experience of the audiologist, either one can be utilized successfully.
- The OAE is easy and cost-effective. However, the false-positive rate may be higher for an OAE than for an ABR.
- The false-positive rate for ABR testing is approximately 4% when testing is done during the first three days of life.
- The false positive rate for OAE testing is 5%-21% for testing done during the first three days of life.
- This large variation between ABR and OAE testing is commonly felt to reflect the OAE testing device’s increased sensitivity to residual amniotic fluid and vernix that is commonly found in the neonate’s ear canal.
The two tests, however, rely on different mechanisms of hearing for the screening. For in-depth testing and a complete hearing evaluation of infants, these tests work best together as a complement to each other.
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Test Within 1 Month Of Birth
Your baby will usually have their hearing screening test in hospital before they’re 1 month old, either:
- before they’re discharged from hospital
- at a hospital outpatient clinic
If you have a home birth, your public health nurse will arrange an outpatient appointment with your local newborn hearing screening service.
If the screening test does not show a clear response from both of your baby’s ears, your baby will be given a second screening test. This will usually happen in hospital before they’re discharged.
The Aim Of The Programme
The aim of the programme is to identify babies born with a permanent childhood hearing impairment at an early stage, to allow timely intervention and improved outcomes.
Approximately one to two babies in every 1,000 are born with a permanent hearing loss in one or both ears.
This screening test is recommended for your baby, even if there is no history of hearing loss in your family.
Finding hearing loss early is important for your babys development.
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Hearing Speech And Language Milestones
Some of the things most children will do at different ages:
Birth to 3 Months
- Quiets to familiar voices or words
- Reacts to loud sounds – baby startles, blinks, stops sucking, cries or wakes up
- Makes soft sounds when awake, baby gurgles
3 to 6 Months
- Turns eyes or head toward sounds, voices, noise-making toys, dog barking
- Starts to make speech-like sounds “ga,””ooh”
- Reacts to a change in your tone of voice
6 to 9 Months
- Responds to own name and looks when called
- Understands simple words: “no,””bye-bye,””juice”
- Babbles, “da da da,””ma ma ma,””ba ba ba”
9 to 12 Months
- Responds to both soft and loud sounds
- Repeats single words and imitates animal sounds
- Points to favorite toys or foods when asked
12 to 18 Months
- Uses 10 or more words
- Follows simple spoken directions, “get the ball”
- Points to people, body parts or toys when asked
- “Bounces” to music
- Uses 20 or more words
- Combines two or more words: “more juice,””what’s that?”
- Uses many different consonant sounds at beginnings of words: b, g, m
- Listens to simple stories and songs
2 to 3 Years
- Uses two to three word sentences
- At two years, people can understand what the child says some of the time
- At three years, people can understand what the child says most of the time
- Follows two-step instructions, “get the ball and put it on the table”
Is It Common For A Newborn To Fail Hearing Test
Between 2 and 10 percent of all babies across the United States do not pass their first hearing screen, but very few of these babies have permanent hearing loss. Babies can fail the newborn hearing screening due to vernix in the ear canal, fluid in the middle ear, or because of movement or crying during the test.
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Identifying Babies At Risk For Permanent Hearing Loss
Babies with certain risks for hearing loss will be monitored. The same sample collected by the hospital or midwife for the newborn blood spot screening can be screened for:
- Cytomegalovirus infection babies usually show no symptoms at birth but hearing loss could develop later
- Some common genetic risk factors there is usually no family history of hearing loss
New Version Of The Nhstc
Please Note: As of 10/1/2021, we are introducing an updated version of the NHSTC course NHSTC 2020!
If you are in the process of taking the current NHSTC course we highly recommend you discontinue it and begin taking the updated version as it has lots of great, new information. If you choose not to start the updated version, you will have one week to complete the old course before it is no longer available.
To start the updated version simply log in with your current Moodle account. If you have never enrolled in the past, simply create an account to get started.
Recertification Test UPDATE:
If you took the old course in the past and wish to get re-certified, please log in to the new version and retake the full course, as the pre-test, core curriculum, and post-test are all new. In the future, you can log back in using your same account and re-certify by simply taking the Recertification Test.
We are happy to announce the release of the updated Newborn Hearing Screening Training CurriculumNHSTC 2020.
This version has a new look and feel and improved navigation and accessibility for use with mobile devices. It includes the latest standard of care in newborn hearing screening practices, consistent with the Joint Committee on Infant Hearing 2019 Position Statement.
The screening equipment used throughout the NHSTC is for the purpose of assisting the learner through demonstration. NCHAM and the NHSTC do not endorse the use of any specific type of equipment.
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Reimbursement And Program Funding
Newborn hearing screening funding varies from state to state. States procure funds from fees, Medicaid, the Title V Maternal and Child Health Block Grant program, and state general revenues. The trend is to identify funding sources other than grants to ensure program continuity should grant support become unavailable. Costs associated with newborn hearing screening include those associated with the tests and those associated with program management .
Early Periodic Screening, Diagnostic, and Treatment Program
Through the EPSDT program, a set of services and benefits are mandated for all individuals under age 21 years who are enrolled in Medicaid. Federal rules encourage partnerships between state Medicaid and Title V agencies to ensure better access to and receipt of the full range of screening, diagnostic, and treatment services. EPSDT funds are an appropriate reimbursement source for screening and diagnostic services.
Current Procedural Terminology Codes
There are a number of CPT codes used to describe early hearing detection testing to a payer. Codes are defined by the payer or program. For specific instructions, see NCHAM State Contacts.
Alexander, D., & Van Dyck, P. C. . A vision of the future of newborn screening. Pediatrics, 117, S350-S354.
American Academy of Pediatrics. . Early Hearing Detection and Intervention . Retrieved from
Hearing Loss In Babies
1 to 2 babies in every 1,000 are born with permanent hearing loss in 1 or both ears.
This increases to about 1 in every 100 babies who have spent more than 48 hours in intensive care.
Most of these babies are born into families with no history of permanent hearing loss.
Permanent hearing loss can significantly affect babies’ development.
Finding out early can give these babies a better chance of developing language, speech, and communication skills.
It will also help them make the most of relationships with their family or carers from an early age.
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Why Is It Important To Screen For Hearing Loss In All Newborn Infants
Significant hearing loss is the most common disorder at birth. Approximately 1%-2% of newborns are affected.
Several national committees, including the National Institutes of Health, the American Academy of Otolaryngology/Head and Neck Surgery, and the American Academy of Pediatrics, have recommended that hearing loss in infants be identified, and when possible treated, prior to 6 months of age.
This recommendation is based on studies that have shown that children identified with hearing loss prior to 6 months of age have a better chance of developing skills equivalent to their peers by the time they enter kindergarten.
Children not identified until later may ultimately suffer from irreversible and permanent impairments in speech, language, and cognitive abilities when compared to their peers.
Prior to the implementation of hearing screen programs, it was customary to only test those newborns who had known significant risk factors for hearing loss. This group included infants whose mothers suffered from illness during pregnancy, those who had a family history of hearing loss, or those who were exposed to drugs known to affect hearing. In addition, infants with the following conditions were included for hearing screening:
However, despite the testing of all infants who fell into this “high-risk registry,” over half of all newborns with hearing loss were missed!