Why is a hearing screening often required at birth?

One screening often required for newborns is a screening for risk for hearing loss. The hearing screening is a process involving earbuds or headphones connected to sensors playing soft sounds in a newborn’s ears. The sensors measure the baby’s response to determine whether there is potential hearing loss.

If the initial screening fails, the infant will undergo a second screening. A few states require that infants who fail the initial screening be specifically screened for cytomegalovirus (CMV), a congenital condition associated with hearing loss. In a hospital, hearing screenings generally occur between 12 hours after birth until discharge.

Hospitals in every state almost always have a hearing screening as part of standard procedure. Most states require that the attendant at a birth outside a hospital refer parents for a hearing screening. Some states also lay this responsibility on parents. Noncompliance can potentially even lead to departmental investigations and sometimes even criminal penalties.

Several states allow parents to refuse screening for any reason while others limit the options to religious exemptions only. A few states do not specifically allow for any parental refusal by law, but examination of the refusal forms for other kinds of screenings indicates that parents may be able to refuse a hearing screening as well.

If the parents object to the test, the health department is typically notified of the refusal, sometimes by the exemption form being submitted to the department or the Early Hearing Detection and Intervention (EHDI) program. This “reporting” to the health department is not the same as a report to CPS or similar agencies for suspected child abuse or neglect. However, sometimes parents have been threatened with reports to CPS for refusing the test.

However, there are a few states in which hearing screenings are not addressed as a matter of law. Yet hearing screenings appear to still be the norm in these states as a matter of medical practice. This is likely a result of the EHDI Act, signed into law in 2017 and renewed in 2022.

The EHDI Act authorized the Administrator of the Health Resources and Services Administration (HRSA), Centers for Disease Control and Prevention (CDC), and National Institute of Health (NIH) to “make awards of grants or cooperative agreements to develop statewide newborn, infant, and young child hearing screening, evaluation, diagnosis, and intervention programs and systems.” This incentivised every state to develop its own EHDI program.

Part of the funding agreement requires that all hearing screening results are reported for national studies and analysis.

Most states have statutes or codes regulating their respective EHDI programs, but others simply have enacted the program because of CDC funding. So parents can expect hospitals to perform hearing screenings regardless of whether it is actually required by state law.

Generally, state EHDI programs seek to follow the national “1-3-6” guidelines. These advise that newborns be first screened for hearing loss within 1 month of birth. Children who fail the first screening will then have a “diagnostic audiological evaluation” before 3 months of age. Those who are identified as having hearing loss will then be offered early intervention before 6 months of age.

Note that these screening timelines and exemptions can be different for babies who need to be in the Neonatal ICU (NICU), and our research does not address that in detail. However, parental rights to refuse screening generally should apply in the same way. Most often, parents may object in writing on religious grounds only.
Be sure to visit our law and policy page to learn your state’s law. Learn more about newborn hearing screening in general at https://newbornscreening.hrsa.gov/newborn-screening-process#hearing. Whatever your position on agreeing to newborn hearing screenings, Heritage Defense supports your parental right to make informed medical decisions for your children.