Doctors and Infant Hearing

Medical homes should obtain, document, and discuss all hearing screening results. Physicians should provide education and support to families.

How Children Can Be "Lost" to the Early Hearing System

For infants who do not pass the newborn hearing screening:

Lost to follow-up means failure to receive the next step of treatment, either rescreening or comprehensive audiologic evaluation.

Lost to documentation means failure to report the results from the hearing screening, rescreening, diagnostic services, or treatment services to the state EHDI program and the medical home. These data are needed for comprehensive surveillance and monitoring to ensure that infants receive recommended services.

Lost to treatment means a child with an identified hearing loss did not receive needed therapeutic services. It also means that families did not receive needed information to support decisions about treatment options.

Practice Considerations

AAP recommends that medical homes take specific actions to reduce the percentage of infants who do not receive follow up, or whose care is not reported properly:

Medical homes should obtain, document, and discuss all screening results and risk factors as follows:

• Confirm that initial newborn hearing screening results have been obtained for all infants as soon as results are available, but no later than 1 month of age. If results are not received, obtain results from the screening hospital or state EHDI program. Accuracy in reporting is improved when information is received directly from the hospital rather than from a verbal report from the family.
• Ensure that all newborn hearing screening results (initial screen and rescreen, if applicable) are recorded in the patient's chart.
• Review all hearing screening results (whether passed or not) and stress the importance of follow-up/monitoring with families, because hearing loss can occur at any time (see Supporting families section below).

If a child (1) has a "do not pass" screening result or (2) you cannot obtain the documented screening results, coordinate care using these steps:

(1) For a child with a "do not pass" screening result

Confirm with family whether rescreening has occurred.

• If yes, obtain results of rescreening from either the hospital or audiologist that conducted the rescreen. Discuss results with the family and confirm the rescreen results with state EHDI program within 48 hours of receiving results.
• If no (including those babies for whom you cannot obtain results)

For Practices that do not Conduct Rescreening:

• Ensure that a rescreening is scheduled and completed by 1 month of age.
• Confirm rescreening results with state EHDI program within 48 hours of receiving results.

For Practices that can Perform a Rescreening in the Office:

• Communicate the results with the family.
• Report results back to the state EHDI Program within 48 hours (refer to AAP Guidelines for Rescreening in the Medical Home Following a "Do Not Pass" Newborn Hearing Screening) [89 KB]

(2) For an infant for whom you cannot obtain the documented screening results by 1 month of age:

For Practices that Do Not Screen in Office, the medical home needs to:

• Arrange hearing screening immediately and obtain the results after the screening has been completed.
• Then follow the recommended steps above.

For Practices that can Perform a Screening in the Office:

• Follow the recommended steps above.

Supporting Families

Medical homes should provide education and support to families:

• Share information about hearing, speech, and language milestones using one of the following resources:
  • AAP Bright Futures: Recommendations for Preventive Pediatric Health Care [118 KB]
  • Learn the Signs, Act Early
• Help arrange transportation and social service support for families, as needed. The practice staff may want to develop a relationship with the state EHDI coordinator/program, because the state has access to additional resources to assist families.
• Provide culturally- and literacy-appropriate information to educate families. Include referral to Hands & Voices, Family to Family Health Information Centers, or other parent support groups.
• Ensure the family is referred to the local Part C Early intervention Program.
• Encourage families to sign a release of medical information/records to the primary care physician to improve care coordination. This includes information from early intervention, audiologists, and all specialists. (Sample release forms)
• Review Joint Committee on Infant Hearing (JCIH) risk factors in the publication below.

There are many more recommendations for the overall EHDI process that are not listed here. For additional information, please see the 2007 Joint Committee on Infant Hearing Position Statement and EHDI Guidelines for Pediatric Medical Home Providers.

Helpful EHDI Resources

Almost every state or AAP chapter has an AAP EHDI pediatrician champion who serves as an EHDI expert and resource. To find out who the chapter champion is in your state, visit: Early Hearing Detection and Intervention (EHDI) By State. To obtain contact information for the chapter champion in your state, call 800/433-9016, extension 7081.

State EHDI Coordinators are also available to help ensure that children with hearing loss have timely and appropriate services. They are a valuable resource in every step in the EHDI process. To contact your state coordinator, visit Contacts for Early Hearing Detection & Intervention.

Below is a list of helpful EHDI resources for providers and to share with parents/families:

• American Academy of Pediatrics Early Hearing Detection and Intervention Program
• Early Hearing Detection and Intervention Program – Centers for Disease Control and Prevention
• Family to Family Health Information Centers
• Boys Town National Research Hospital
• Hands & Voices
• National Center for Hearing Assessment and Management (NCHAM)
• National Association of the Deaf (NAD)

This information was adapted from materials developed by the American Academy of Pediatrics Task Force on Improving the Effectiveness of Newborn Hearing Screening, Diagnosis and Intervention.