A newborn hearing screen is one of the first health checks your baby will be offered, and it matters for communication, learning and social development. If you’re wondering when your baby should have their first hearing test, the short answer is: as soon as possible after birth, ideally within the first few weeks of life and often before you leave hospital.
Knowing the timing and the process helps you make sure your baby gets prompt follow-up if it’s needed, while the brain is most receptive to sound and language.
Why Early Hearing Screening Matters
Hearing plays a fundamental role in speech and language development from the moment a baby is born. Even before birth, babies begin responding to sounds in the womb, and this auditory stimulation continues to shape neural pathways throughout infancy. The first few years of life are a period of high neuroplasticity, when the brain readily forms new connections in response to sound.
Research shows that babies whose hearing loss is identified and managed early tend to have better language outcomes than those identified later. Delays in identification and intervention can lead to gaps in speech, language, cognitive development, and academic achievement that become increasingly difficult to address as children grow older.
Permanent hearing loss is one of the more common conditions present at birth, and many babies with hearing loss have no obvious risk factors. That is why universal newborn hearing screening is standard practice across Australia.
Universal Newborn Hearing Screening in Australia
Every Australian state and territory runs a universal newborn hearing screening program. In NSW this is the Statewide Infant Screening – Hearing (SWISH) program. The screen is offered as soon as possible after birth and can be done in hospital before or after discharge, or at a local community location.
The screening process uses objective, automated technology that doesn’t require any active response from your baby. Two primary methods are employed:
Otoacoustic Emissions (OAE) testing measures tiny sounds produced by healthy hair cells in the inner ear (cochlea) when stimulated by sound. A small probe placed gently in the baby’s ear canal delivers soft clicks or tones and measures the ear’s response. This test takes only a few minutes and is completely painless.
Automated Auditory Brainstem Response (AABR) testing measures the auditory nerve’s response to sound by placing small sensor pads on your baby’s head and ears. Soft clicking sounds are presented through small earphones, and the equipment measures electrical activity from the hearing nerve and brainstem. Like OAE testing, AABR is quick, non-invasive, and conducted whilst your baby sleeps.
Some programs use both technologies in combination, particularly for babies in neonatal intensive care units or those with specific risk factors for hearing loss. The screening is administered by trained health professionals, often specialist hearing screeners, depending on the hospital and state program.
The 1-3-6 Guideline: A Framework for Timely Care
A widely used benchmark, set out by the US Joint Committee on Infant Hearing and used by newborn hearing programs internationally, is the 1-3-6 principle:
- Screen by 1 month of age: All babies should complete hearing screening before one month old
- Diagnose by 3 months of age: Babies who don’t pass screening should receive comprehensive diagnostic testing by three months
- Intervene by 6 months of age: Babies confirmed with hearing loss should begin appropriate intervention (such as hearing aids, cochlear implant assessment, or early intervention programs) by six months of age
The timeline reflects how important the early months are for auditory brain development and language. Meeting these benchmarks gives children with hearing loss the best chance to develop communication skills on time.
What Happens If Your Baby Doesn’t Pass the Initial Screen?
It’s important to understand that not passing the initial hearing screen doesn’t necessarily mean your baby has permanent hearing loss. Several temporary factors can affect screening results, including:
- Fluid or vernix (the waxy coating on newborns) in the ear canal
- Middle ear fluid from birth
- Movement or unsettled behaviour during testing
- Background noise in the hospital environment
If your baby receives a “refer” result (meaning they didn’t pass the screening), you’ll be offered a second screen. Many babies pass this once temporary factors have resolved. If your baby does not get a clear result from the first two screens, you’ll be referred for a diagnostic assessment.
Comprehensive Diagnostic Testing
Diagnostic auditory brainstem response (ABR) testing is the standard way to assess hearing in young infants who don’t pass screening. Unlike the automated screening version, diagnostic ABR provides detailed, frequency-specific information about hearing thresholds in each ear. It is carried out by audiologists experienced in assessing babies.
In NSW, babies referred from SWISH have their diagnostic assessment at a hospital audiology service. It works best while your baby sleeps naturally, so plan to set aside a morning or afternoon.
Additional tests may include tympanometry to assess middle ear function, otoacoustic emissions testing, and sometimes behavioural observation audiometry. Together these allow accurate identification of the type, degree, and configuration of any hearing loss, which directly informs intervention planning.
What If Your Baby Missed Newborn Screening?
Some babies miss newborn hearing screening, perhaps because of a home birth, early discharge or a gap in follow-up. If your baby missed the screen, it’s never too late to arrange testing, though earlier is better. In NSW, contact your local SWISH coordinator, your GP or your child and family health nurse. From six months of age, babies can also have a behavioural hearing test such as visual reinforcement audiometry.
As your baby grows, keep an eye out for signs that might suggest hearing difficulties:
- Not startling to loud, sudden sounds
- Not turning toward voices or sounds by 3-4 months
- Not babbling by 6-7 months
- Not responding to their name by 9-10 months
- Speech and language development concerns at any age
Any concerns about your child’s hearing warrant prompt professional assessment, regardless of previous screening results. Hearing can change, and some types of hearing loss develop after birth due to illness, medication, or progressive conditions.
Moving Forward with Confidence
Universal newborn hearing screening is one of the most useful advances in children’s preventive health care. The process is quick and safe, and it gives parents either reassurance or early information that allows timely intervention.
If your baby is diagnosed with hearing loss, support is available throughout Australia. Children and young people under 26 receive government-funded hearing services through Hearing Australia, and early intervention programs connect families with specialist educators, speech pathologists, and audiologists who provide family-centred care tailored to each child’s needs. Hearing aids and cochlear implants work best when fitted early and supported by good habilitation.
If you have any concerns about your baby’s hearing, speak with your GP or child and family health nurse, or contact an audiologist. At The Audiology Place we offer children’s hearing tests from six months of age at our Epping and Forestville clinics.
In short, your baby’s first hearing screen should happen within the first month of life, and often before you leave hospital. It opens the door to timely help if it’s needed, while the early years still offer the best opportunity for communication development.
