Tune In to Newborn Hearing Screening

All children should have the opportunity tocommunicate with their family. Every day, 33 infantsare born with significant hearing loss. Until recently,almost half of them would have been missed untillater in childhood.1 A hearing loss that is undetec-ted for even the first six months of a child’s life cancritically compromise their speech, language,cognitive and social skills compared to childrenidentified earlier.2

In the last decade, states have successfully tackledthis issue through newborn hearing screeningprograms. The percentage of babies screened forhearing loss at birth has risen to an all time high ofalmost 90 percent — a 65 percent increase in the pastfive years.3 Currently 38 states have laws thatrequire newborn hearing screening. However, thesuccess of screening programs depends on follow-up services and connecting families to earlyintervention programs, not just testing. To provideexemplary care for these infants requires thatscreening programs be connected to pediatric audi-ology services, appropriate early interventionprograms, family support (including appropriateeducational materials), and tracking and datamanagement activities.4

The State RoleMaternal and child health programs (MCH) in thestates and territories coordinate screening andfollow-up services. MCH programs, supported inpart by the Title V Maternal and Child HealthServices Block Grant, are devoted to improving thehealth of all women and children, particularly theunder- and uninsured. These programs collectannual data to evaluate and monitor newbornhearing screening programs across the states.

The Federal RoleSignificant federal support provides the foundationfor state newborn hearing screening. In 1993 the Na-tional Institutes of Health Consensus DevelopmentConference recommended that all babies be screenedfor hearing loss before hospital discharge. In 1999Congress established federal grants to address this“silent” epidemic. Congress also passed the

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Children’s Health Act of 2000 (P.L. 106-310) thatincluded support for early hearing screening andevaluation of all newborns, coordinated interven-tion and rehabilitation services, and provided forongoing research.

In 2000 the Joint Committee on Infant Hearingendorsed the goal of universal detection of infanthearing loss before one month of age and the provi-sion of intervention services by six months of age.Later in 2000 the federal Maternal and Child HealthBureau awarded the first grants to 22 states to assistwith early hearing detection and interventionprograms (EHDI). Six months later, the Centers forDisease Control and Prevention awarded 15 stategrants to assist with developing EHDI tracking anddata management systems.

The EHDI programs have allowed states to rapidlyexpand their ability to screen newborns for hearingproblems. However, as increasing numbers ofnewborns across the country are being screened,MCH programs are acutely aware that effectiveEHDI programs require more than an initial hear-ing test. Follow-up has been hindered by the lack ofadequate tracking information, changes in the namesor addresses of families, absence of a designatedmedical home for the infant, a lack of audiologistsequipped and trained to work with young infants,and health insurance that refuses to cover follow-upservices.5 Currently, only half of infants with a diag-nosed hearing loss are enrolled in early interventionprograms at their six-month birthday. There is morework that needs to be done.

RecommendationsTo achieve the national Healthy People 2010 goal ofhearing screening of 100 percent of newborns by onemonth of age, the Association of Maternal and ChildHealth Programs (AMCHP) recommends thatCongress consider the following changes as it movesforward with the reauthorization of the newbornhearing screening programs.

1. Maintain funding for newborn hearing screen-ing activities within the Health Resources and Ser-vices Administration.6 Currently, HRSA receives an

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annual appropriation through the Labor, Healthand Human Services, and Education appropria-tions bill to fund universal hearing screening in thestates. This funding has contributed significantlyto the gains in the number of newborns screenedfor hearing loss. As states reach the end of theirfirst round of EHDI grants, most have successfullyestablished universal screening programs but needmore assistance to further develop follow-upsystems. Without funding specifically for EDHIprograms, progress will be lost. Now is not the timeto stop the progress or the funding.

2. Strengthen newborn hearing screening byinvesting in follow-up. Although nearly 90 percentof newborns in the U.S. are screened for hearing loss,making sure that babies receive appropriate andtimely diagnostic and intervention services remainsa significant challenge. States need the flexibility toshift funds from testing to follow-up services basedon their success with their EHDI program. Statesshould have the option to use CDC and MCHBEHDI funds to:• Expand existing systems, where appropriate, for

the timely reporting of newborn hearing screen-ing results.

• Remove barriers and initiate effective strategiesto provide families timely follow-up services.

• Coordinate ongoing follow-up treatment withindividuals, families, primary care physiciansand specialists.

Endnotes1 White, K.R. (October 1997). The scientific basis for newborn hearing screening: Issues and evidence. www.infanthearing.org/summary/index.html2 Yoshinaga-Itano, C., Sedey, A., Apuzzo, M., Carey, A., Day, D., & Coulter, D. (July 1996). The effects of early identification onthe development of deaf and hard-of-hearing infants and toddlers.3 American Academy of Pediatrics Press Release “Annual Report Card on Infant Hearing Screenings Shows Positive ProgressTowards the Detection of America’s Number One Birth Defect” May 2004.4 Newborn Hearing Screening State Report Card, World Council on Hearing Health. May 2004.5 Joint Committee on Infant Hearing 2000 Position Statement. www.jcih.org/posstatemts.htm6 President proposed in FY 2003, 2004, and 2005 to eliminate funding for the HRSA Universal Hearing Screening program andmove program authority to the MCH Block Grant.

3. Promote federal policies that improve coordi-nation of services for children with hearing loss.Policies should support stronger coordination ofservices for children with hearing loss. Familiesraising children with hearing loss have to navigatecomplex medical, social and educational systemsthat may be new to them. MCH programs promotecoordination through a medical home, which useshealth professionals to help families through thesesystems. Social and educational services, such asthe Individuals with Disabilities Education Act,offer help for children with hearing loss, but,without guidance, some families may not find theirway to them. Legislation that strengthens linkagesamong federal-state programs (e.g., EHDI, Medic-aid, Part C of IDEA) will help meet the needs offamilies and ensure that no child is left behindbecause of a hearing loss.

The Association of Maternal and Child HealthPrograms represents state public health leadersand others working to improve the health and

well-being of women, children, youth and families,including those with special health care needs.For more information contact Meg Booth at

mbooth@amchp.org or (202) 775-0436.