Newborn Hearing Screening: What Refer Means
Someone at the hospital told you your baby was "referred" on one ear, or both, and then handed you a sheet of paper while you were running on two hours of sleep. It is a scary word to hear about a baby who is a day or two old.
Here is the plain answer: a refer result on a newborn hearing screening means your baby needs another test. It does not mean your baby has hearing loss. Most babies who are referred turn out to hear just fine, but the follow-up still matters, and in Illinois there is one time-sensitive step many parents never hear about.
What Refer Means on a Newborn Hearing Screening
Refer Is Not a Diagnosis
"Refer" is screening language for "did not pass." It simply means the equipment did not pick up a clear enough response, so your baby is being referred for more testing. You may also see it written as "fail" or "did not pass."
About 98% of babies born in Illinois hospitals get this screening shortly after birth. Ask for a written copy of your baby's results so you and your pediatrician have them.
The Two Screening Tests
Hospitals use one or both of these quick, painless tests while your baby rests or sleeps:
Otoacoustic emissions (OAE): A tiny earbud plays soft sounds and listens for an echo from the inner ear. A healthy inner ear sends that echo back.
Automated auditory brainstem response (AABR): Small stickers on your baby's head measure how the hearing nerve and brainstem respond to sound.
Why Babies Get a Refer Result
Common Reasons That Have Nothing to Do With Hearing
Newborn ears are still full of leftovers from birth. A refer result often comes from:
Vernix, the waxy coating babies are born with, sitting in the ear canal
Fluid in the middle ear from delivery
A baby who was wiggling, feeding, or crying during the test
How Often Babies Actually Have Hearing Loss
Between 2 and 10 percent of babies in the U.S. do not pass their first screening, yet very few of them have permanent hearing loss. For perspective, about 1 to 3 babies out of every 1,000 are born with hearing loss.
So the odds are strongly in your favor. The follow-up is how you move from "probably fine" to knowing.
What Happens After a Failed Newborn Hearing Screening
The Hearing Rescreen
Many babies get a second screening, either before leaving the hospital or shortly after. Often the fluid or vernix has cleared by then, and the baby passes. If your baby passes the rescreen in both ears, that is usually the end of it.
The Diagnostic Hearing Test
If your baby still does not pass, the next step is a full evaluation with an audiologist. This is more detailed than the screening. It usually includes an ABR test using a range of sounds, plus OAE to double-check.
A few tips for that appointment:
Plan for your baby to sleep during the test. A full test can take 45 minutes or more.
Ask whether to keep your baby awake on the drive and feed them once you arrive.
Bring your hospital screening results and a list of any questions.
The 1-3-6 Timeline
National guidelines give families a clear roadmap:
By 1 month: hearing screening complete
By 3 months: diagnostic evaluation for babies who did not pass
By 6 months: Early Intervention services started if hearing loss is confirmed
Those ages matter because babies are learning language from day one. If there is a hearing loss, finding it early gives your baby the most time to build speech and language. Our guide to speech and language milestones by age shows what that looks like as your baby grows.
The Illinois Step Most Parents Miss: CMV
Why Congenital CMV Testing Has a 21-Day Window
Cytomegalovirus, or CMV, is a common virus that can pass to a baby before birth. Congenital CMV is the most common non-hereditary cause of permanent hearing loss in children, and many babies who have it show no signs at birth.
The catch is timing. A CMV test for a newborn needs to be done by 21 days of age to confirm the infection was present at birth. After that window, doctors can no longer tell whether the virus was caught before or after birth.
What Illinois Hospitals Must Tell You
Under Illinois law, if your baby does not pass two hospital hearing screenings, the hospital must give you information about CMV, testing options (including testing before you go home), and Early Intervention.
If that conversation got lost in the discharge rush, call your pediatrician and ask directly: "My baby was referred on the hearing screen. Should we test for CMV before 21 days?"
Next Steps After a Newborn Hearing Screening Refer
Do Not Let the Follow-Up Slip
Newborn life is a blur, and follow-up appointments are easy to push back. Nationwide, roughly 3 in 10 babies who need diagnostic follow-up never complete it. If your baby passes, you get peace of mind. If not, you get a head start.
Keep in mind that a pass at birth does not rule out hearing changes later. If you ever notice your child not reacting to sounds or falling behind on words, get their hearing checked again. The same goes for older kids, as covered in our post on what to do after a failed school hearing screening.
Where to Get Help
Your pediatrician can order follow-up testing and help with CMV questions.
EHDI-PALS (ehdipals.org) is the directory Illinois points families to for finding a pediatric audiologist.
Illinois Early Intervention supports babies with confirmed hearing loss. Learn more in what early intervention is and who qualifies.
Talk to Us
Our audiologists at Midwest Children's Therapy provide hearing evaluations for children from birth to 18, and our team also offers speech therapy and developmental therapy if your child ever needs support. You can see everything on our services page. Call (309) 282-6704 or send us a message to ask whether our clinic is the right fit for your baby's follow-up.
