How Can You Tell If A Newborn Is Deaf? | Early Clues Guide

What Newborn Hearing Screening Does

Every baby should get a quick, painless hearing screen before going home. Staff use two bedside tests. One checks tiny echoes from the inner ear. The other records how the brain reacts to a click. A pass means sound got through on that day. A refer means your baby needs a repeat screen or a full test with an audiologist. The goal is early answers, not labels.

Test	What it measures	Pass or refer
Otoacoustic emissions (OAE)	Echoes from hair cells in the cochlea picked up by a tiny probe	Pass: echoes present; Refer: weak or absent echoes
Automated auditory brainstem response (AABR)	Brainwave response to soft clicks via sensors on the skin	Pass: clear brain response; Refer: response below set level
ABR diagnostic test	Detailed thresholds across pitches while baby naps	Not pass or refer; gives ear-specific levels

How To Tell If A Newborn Is Deaf: Signs And Screens

The first clues often come from the screen at birth. Still, day to day behavior helps. A baby who hears usually startles to a sudden clap, settles to a known voice, and makes soft coos by a few weeks. A baby with reduced hearing may not flinch at a door slam, may watch lips more than eyes, or may stay quiet after two months. One clue alone is not proof. Patterns across days matter.

Early Behavior That Raises Concern

• No jump, blink, or stir with a loud sound close by
• No head turn toward a voice by three to four months
• Few coos or squeals after the newborn stage
• Looks at your lips but not your eyes during talk time
• Frequent ear fluid or long colds that muffle sound

If several of these show up, book a hearing check even if the hospital screen said pass. Some losses start later, and fluid can mask hearing for weeks.

Why Timing Matters

Hearing feeds bonding and early language. The faster we spot a gap, the sooner a team can fit tiny aids, coach communication, or plan care. Most programs aim for screening by one month, full testing by three months, and action by six months. You may see this as the EHDI 1-3-6 benchmarks in leaflets. That pace keeps language on track and helps the brain wire to sound during window when learning moves fastest.

What The Results Mean In Plain Language

A pass on both ears is good news. Still, keep watching behavior and milestones. A single refer is common and often due to ear fluid, noise in the room, or a wiggly baby. A second refer calls for a full test. If the full test confirms hearing loss, you will meet an audiologist and a medical ear team. They will map which pitches are soft, which are clear, and what tools can help.

Common Follow-Ups After A Refer

• Repeat OAE or AABR in a quiet room while baby sleeps
• Full ABR thresholds for each ear
• Middle ear check to rule out fluid
• Screen for CMV soon after birth if advised
• Referral to early services and parent coaching

Risk Patterns That Call For Extra Checks

Some babies pass the first screen yet still need repeat checks in the first year. Reasons include a long stay in the nursery, strong jaundice that needed treatment, certain medicines that can injure hair cells, a family history of childhood hearing loss, or a confirmed CMV infection. Babies with these risks often get a schedule of repeat tests through the year to catch late-onset changes.

The Newborn Screen Versus Daily Clues

Think of the screen as a snapshot. It is fast and reliable for most babies, but it is still just one moment. Daily cues add the rest of the story. Your notes about startles, eye contact during talk, and early babble are gold during appointments. Videos on your phone can help the audiologist see the pattern you see at home.

Ear Fluid Versus Permanent Loss

Fluid behind the eardrum is common in newborns. It can block sound like water in a straw and lead to a refer on OAE. As fluid clears, hearing may look better on a later check. Permanent loss comes from inner ear hair cells, the hearing nerve, or the brain pathway. That pattern shows up on ABR even if the eardrum looks normal. Both issues can exist in the same ear. This is why teams look at the middle ear and the inner ear on the same day.

Milestones That Point The Way

Hearing and speech grow month by month. The list below offers a quick guide you can pin on the fridge. Hitting every item on the exact week is rare, and small shifts are normal. What matters is steady progress from one age band to the next.

Age	Typical responses	See your pediatrician if…
Birth to 2 months	Startles to loud sound, quiets to a known voice, makes soft coos	No startle, no calming to voice, silent most of the time
3 to 4 months	Turns eyes or head toward a sound source, laughs, squeals	No turn toward sound, few vocal play sounds
6 months	Babbles with m, b, or p sounds, enjoys peek-a-boo, responds to name	No babble, no response to name even in quiet rooms
9 months	Imitates sounds, looks toward music or toys that beep	Rare imitation, little interest in sound-making toys
12 months	Says first word, follows simple one-step cues	No clear words, does not react when you call from behind

What Parents Can Do This Week

Track What You See And Hear

Keep short notes on startles, quieting to your voice, early coo, and head turns. Note the room noise. Note if the baby was drowsy, feeding, or wide awake. Patterns jump out over a few days.

Set Up The Right Test

If the birth screen was a refer, aim for a repeat screen within two weeks. If the repeat is still a refer, ask for an ABR diagnostic test. Book the visit near nap time, bring a full bottle, and dress your baby in easy layers so sensors can go on quickly. A calm, sleepy infant gives the clearest read. If travel is hard, ask about mobile teams or regional clinics that run infant ABR days to group visits and shorten wait times.

Reduce Noise During Screens At Home Or Clinic

Close doors, dim lights, and pause siblings’ toys. White noise machines and fans can mask clicks during OAE. A quiet space helps the probe sit still and pick up the tiny echoes.

Ask About CMV Timing

If your newborn is less than three weeks old and failed the first screen, ask the team about a saliva or urine test for CMV. A fast result can guide follow-up and later checks, since hearing can change over months in babies with this virus.

Getting Help After A Diagnosis

When hearing loss is confirmed, care starts right away. An audiologist will map the audiogram and fit tiny devices if needed. A speech and language pathologist or teacher of the deaf may join. Many babies do well with early sound access and rich face-to-face time. Families can pick one or more paths: hearing aids, bone conduction aids, cochlear implants for severe loss, or visual first approaches. Your team will walk through options with clear pros and cons for your baby’s pattern.

Hearing aids can be fitted within weeks. Soft bands hold devices in place on tiny heads. If the loss is severe and aids do not provide access to speech sounds, a cochlear implant team can assess around the first birthday, sometimes sooner. Many families also learn simple signs to keep language flowing during the wait for devices or mapping visits. No single path fits all babies, so plans are set ear by ear.

Everyday Tips That Boost Connection

• Talk close to the face so lip cues are easy to see
• Use short, rhythmic phrases during care routines
• Read the same simple book each night to build patterns
• Keep background noise low during play and feeding
• Use baby signs alongside speech to anchor meaning

Common Concerns In Clinic

Passing A Screen With Hidden Loss

Mild loss, fluid that clears, or neural patterns like auditory neuropathy can slip past a fast screen. That is why behavior and repeat checks matter, especially for babies with risk factors.

Ear Shape Myths

Not well. Small tags or folds on the outside can be present with normal hearing. The hearing parts sit deep inside the skull and cannot be judged from a photo.

Extended Nursery Stays

Babies who stayed five days or more often get AABR instead of OAE at birth and need repeat checks through the year. Ask for a plan before discharge so dates do not slip. Bring your screen printouts; clear notes and dates make next steps faster for everyone involved.

Trusted Places To Learn More

For age-by-age speech and hearing cues, the NIDCD checklist is handy to print and share. Share it with grandparents and caregivers so everyone uses the cues.

Main Takeaways For Parents

Screen early, watch daily, act on patterns. If the hospital screen said refer, repeat fast and push for an ABR. If the screen said pass but you see missed startles or quiet babble, book a check. Use video clips and a simple log to show what you see clearly. Early sound access, rich face time, and steady follow-up set babies up to thrive.