FACT: While babies can have fluid or wax in their ears after birth, your primary care doctor cannot see deep enough inside a newborn's tiny ear canal to confirm this. Waiting for it to possibly clear on its own can delay your baby's speech and language development. That is why pediatric audiologists (a doctor for children’s hearing) urge families to get a diagnostic hearing test before your baby turns 3 months old if they did not pass their first screens. It is the best way to make sure their language development stays right on track.

Action: If your baby did not pass their initial birth hearing screening(s) or their follow up outpatient screening, they should be seen by a pediatric audiologist for a diagnostic audiological assessment. If you need help finding an audiologist, you should use the EHDIPALS directory, an online database that will help to find pediatric audiologists in your region. Texas families can email the Texas Early Hearing Detection and Intervention (TEHDI) program at TEHDI@dshs.texas.gov or call (800-252-8023) for more assistance.

While other medical issues may call for more immediate attention, having your child's hearing checked is equally as important for language development and communication.

FACT: Families receive a lot of information when a baby is born. Parents might not fully understand how important the test was, or the primary care doctor might not get the report. This leaves both parents and doctors unclear about what to do next. Any missed screening or referral always needs to be checked out right away.

Action: If your baby missed or did not pass your newborn hearing screening, they should go back for an outpatient hearing screening. If they do not pass that screening, they should see a pediatric audiologist for an audiology evaluation. If you need help finding an audiologist, use the EHDIPALS directory. The TEHDI program also has professionals who Texas families can talk to about the importance of hearing screening and getting your baby cleared or identified. Texas families can email the Texas Early Hearing Detection and Intervention (TEHDI) program at TEHDI@dshs.texas.gov or call (800-252-8023) for more assistance.

Some families are told not to worry if their baby did not pass the test in only one ear. Doctors might say it is fine to wait and check it again much later. Families who live far away from big cities are often told it is not worth traveling a long distance just for one ear.

FACT: Both ears matter. Even if a baby can hear well out of one ear, a problem in the other ear can still make it difficult to learn language. It can also make it hard to do well in school and figure out where a sound comes from. If your baby does not pass the test in one ear, they need a full hearing evaluation right away.

Action: If your baby did not pass their initial birth hearing screenings (and if needed follow up outpatient hearing screening) on one or both ears, a pediatric audiologist should see your baby. If you need help finding an audiologist, use the EHDIPALS directory. Texas families can email the Texas Early Hearing Detection and Intervention (TEHDI) program at TEHDI@dshs.texas.gov or call (800-252-8023) for more assistance.

Families may believe that newborn hearing screening is unreliable in newborns or premature infants and that “their hearing isn’t fully developed yet,” and they might wait too long to get help. Testing early before your baby is 3 months old is the best way to make sure they get the care they need.

FACT: Birth facilities typically screen hearing while the baby is sleeping by using specialized sensors that measure tiny responses to sounds from the ear and brain. Two common tests include Otoacoustic Emissions (OAEs), which measure sound waves from the inner ear, and Automated Auditory Brainstem Responses (AABRs), which track how the auditory nerve and brainstem respond to sound. The diagnostic hearing evaluation used by pediatric audiologists is called ABR, for Auditory Brainstem Response. It is made to work with babies, even those born early, and it provides clear information about what your baby can and cannot hear. Some babies sleep through the test with tiny stickers on their heads to measure responses to sound.

Action: If your baby did not pass after two hearing screenings (and if needed, follow up outpatient hearing screening) on one or both ears, you should be seen by a pediatric audiologist for an ABR. If you need help finding an audiologist, use the EHDIPALS directory. Texas families can email the Texas Early Hearing Detection and Intervention (TEHDI) program at TEHDI@dshs.texas.gov or call (800-252-8023) for more assistance.

The best way to get your baby ready for an ABR is to get them ready to sleep at the audiologist’s office. Babies who are ready for feeding and a nap usually have no problems with the test.

Families may believe that waiting until the child is older makes sense, especially when it is challenging to find an audiologist close by, and when there are no obvious delays at an early age. However, testing early is the best way to make sure babies get the care they need.

FACT: Primary care doctors do not have the special equipment and training to test a baby's hearing accurately using ABR (Auditory Brainstem Response). Waiting too long to see an audiologist can cause delays in a baby's learning. Even if the audiologist is far away, getting evaluated early by 3 months of age is very important. Families should also know that it is not a family doctor, pediatrician or even an ENT doctor that figures out whether a child is deaf or hard of hearing. Only an audiologist identifies hearing loss.

Action: If your baby has “referred” on two hearing screenings, on one or both ears, you should be seen by a pediatric audiologist for an ABR. If you need help finding an audiologist, use the EHDIPALS directory. Texas families can email the Texas Early Hearing Detection and Intervention (TEHDI) program at TEHDI@dshs.texas.gov or call (800-252-8023) for more assistance.

Families may not understand the difference between a hearing screening and a diagnostic hearing evaluation. A screening only tells us that there might be a problem. A diagnostic hearing evaluation measures the level of hearing accurately, and this requires an audiologist completing an ABR (Auditory Brainstem Response) testing. Some medical offices may perform repeated hearing screenings rather than referring to a diagnostic hearing evaluation after the outpatient hearing screening is not passed. This does not follow recommended practices. 

FACT: If a baby does not pass a hearing screening test, doing the same quick screening test repeatedly is not the best course of action, and can lead families to delaying services. Instead, the baby needs to see an audiologist for an ABR. A baby who “refers” on one or both ears at the outpatient screening should see a pediatric audiologist for an ABR.

Action: If your baby did not pass the follow up outpatient hearing screening one or both ears, you should be seen by a pediatric audiologist for an ABR. If you need help finding an audiologist, use the EHDIPALS directory. Texas families can email the Texas Early Hearing Detection and Intervention (TEHDI) program at TEHDI@dshs.texas.gov or call (800-252-8023) for more assistance.

Families may feel uncertain about the need to follow up with a specialist when everything seems “normal” during the first year or two before most babies start talking. This can delay the identification of hearing loss.

Fact: Waiting until a child is two is much too late! Babies need to be exposed to language right away to help their brains grow. Specialists use a 1-3-6 rule to help babies. These are considered “best practices” by the Joint Committee on Infant Hearing:

• By 1 month old: Get a hearing screening.

• By 3 months old: See a pediatric audiologist for an ABR that can diagnose or rule out hearing loss if they do not pass the screening.

• By 6 months old: Get support right away from early intervention if your child has been diagnosed with hearing loss.

If you wait until a child shows noticeable communication delays, they have already missed a lot of learning time.

Action: If your baby has referred on two hearing screenings, on one or both ears, you should be seen by a pediatric audiologist for an ABR. Texas families can email the Texas Early Hearing Detection and Intervention (TEHDI) program at TEHDI@dshs.texas.gov or call (800-252-8023) for more assistance.

Families may assume a single passed newborn screening guarantees normal hearing indefinitely. However, children with certain risk factors can develop progressive or delayed-onset hearing loss over time. Relying solely on the initial birth screening without ongoing follow-up does not align with recommended clinical guidelines and can delay essential interventions.

FACT: Passing a newborn hearing screening shows a child's hearing is clear at birth, but it does not rule out hearing loss that develops later in childhood. Children with specific risk factors require regular monitoring by a pediatric audiologist to ensure any changes are identified early.

Action: If your child has a known risk factor for hearing loss—such as a stay in the Newborn Intensive Care Nursery (NICU), family history of childhood hearing loss, congenital cytomegalovirus (CMV), or craniofacial anomalies—schedule routine diagnostic monitoring with a pediatric audiologist. Contact your pediatrician for a referral or visit the EHDIPALS directory to find a provider near you. Texas families can email the Texas Early Hearing Detection and Intervention (TEHDI) program at TEHDI@dshs.texas.gov or call (800-252-8023) for more assistance.

Families want to feel confident that their healthcare decisions are based on sound research and expert guidance. Because childhood hearing loss is relatively rare, not all medical professionals are fully familiar with the latest recommended practices. It is always okay to ask questions, share information, and work with your family’s healthcare provider as a partner. Remember: You are the expert on your child.

FACT: These trusted national organizations offer reliable, research-based information that has been used to develop the Texas Hands & Voices Guide to Informed Decisions:

• Joint Committee on Infant Hearing (JCIH)

  • Year 2019 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs

    Supports: The national "1-3-6" EHDI benchmarks, guidelines for diagnostic ABR testing over repeated screenings, and monitoring timelines for infants with risk factors (e.g., NICU stays, CMV).

• Centers for Disease Control and Prevention (CDC)

  • CDC Guide to Early Hearing Detection and Intervention (EHDI)

    Supports: Public health benchmarks for early evaluation and state-by-state contact resources for early intervention services.

• National Center for Hearing Assessment and Management (NCHAM)

  • NCHAM State Guidelines & EHDI Resources

    Supports: National standards for pediatric audiology referrals, early intervention tracking, and access to national provider databases like EHDIPALS.

• National Institute on Deafness and Other Communication Disorders (NIH / NIDCD)

  • Your Baby's Hearing Screening and Next Steps

    Supports: Detailed explanations of newborn screening technologies (OAE and AABR) and procedural expectations for diagnostic audiologic care.

• American Speech-Language-Hearing Association (ASHA) / AAP Alignment

  • Newborn Hearing Screening Clinical Practice Overview

    Supports: Clinical consensus on avoiding ineffective in-office repeat screenings in primary care, confirming the accuracy of early ABR testing, and emphasizing the developmental impact of unilateral (one-ear) hearing loss

ACTION: Texas families can email the Texas Early Hearing Detection and Intervention (TEHDI) program at TEHDI@dshs.texas.gov or call (800-252-8023) for more assistance or for additional resources.

It can feel overwhelming to call a doctor's office or audiology clinic when you are not sure what kind of appointment your child needs. You may worry that you will use the wrong words or that the person answering the phone will not understand why your child needs to be seen.

FACT: You do not need to be an expert to ask for a hearing evaluation. You can simply explain what happened and why you are calling. If your baby did not pass a newborn or follow-up hearing screening, or if you have concerns about your child's hearing, it is okay to say so clearly.

TRY SAYING:

“My baby did not pass their hearing screening, and I need to schedule the next recommended hearing test. I was told my child needs to see an audiologist. Can you help me schedule an appointment?”

If your child is older and you are concerned about their hearing, you can say:

“I have concerns about my child's hearing, and I would like a complete hearing evaluation with an audiologist. What do I need to do to schedule an appointment?”

If you are told that you need a referral, you can contact your child's primary care provider and say:

“I am concerned about my child's hearing and would like a referral for a complete hearing evaluation with an audiologist. Can you help me with the referral?”

ACTION: Write down the name of the person you spoke with, the date you called, and what they told you to do next. If you are having trouble finding an audiologist or getting connected to the right provider, ask for help. You do not have to navigate the process alone. Texas families can email the Texas Early Hearing Detection and Intervention (TEHDI) program at TEHDI@dshs.texas.gov or call (800-252-8023) for more assistance.