A Clinician's Pledge: Follow Up on Audiology Evaluations

Georgina Peacock, MD, MPH


February 09, 2015

Editorial Collaboration

Medscape &

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More than one third of newborns who fail their hearing screening tests are not documented to have received needed follow-up. The good news, however, is that we can help all children reach their full potential.

Hi. I'm Dr Georgina Peacock, and I am a practicing developmental-behavioral pediatrician with the Division of Human Development and Disability at the Centers for Disease Control and Prevention. A recent report on newborn hearing screening in the CDC Morbidity and Mortality Weekly Report[1] highlights the fact that more than 95% of newborns are being screened for hearing loss, thanks in part to concerned healthcare professionals such as you. Since 2005, hearing screening has been almost universally performed on newborns prior to hospital discharge, which has led to the identification of more than 34,000 infants in the United States with permanent hearing loss. This is something the medical community can be proud of.

Unfortunately, there is still a lack of follow-up for infants who fail their hearing screening, a gap that can lead to problems with a child developing critical communication, language, and social skills. We know from experience that any type of screening without recommended follow-up will be ineffective and not in the best interest of our patients, young and old.

It is important that hearing screenings and follow-up testing are conducted early in life, because any delay in a hearing loss diagnosis can compromise a child's development. In fact, early identification of infants with hearing loss is endorsed by the American Academy of Pediatrics and the US Preventive Services Task Force.

There is a solution to close this gap. CDC's Early Hearing Detection and Intervention (EHDI) program supports the "1-3-6" approach to make sure children receive necessary services.

We can work with families to do the following:

Make sure that all infants are screened no later than 1 month of age, ideally before they leave the birth hospital.

If the screening resulted in a "did not pass" or "refer," make sure the infant has a diagnostic audiologic evaluation no later than 3 months of age. The health professional performing the evaluation should be experienced in testing infants.

Infants who are diagnosed as deaf or hard of hearing should receive early intervention services no later than 6 months of age. These intervention services can include medical, audiologic, educational, and general support.

In summary, earlier is better when it comes to newborns and potential hearing loss. It's important to verify that the referral for the prescribed evaluation has been completed. Confirming this will help make sure that infants with hearing loss can start receiving the services they need to reach their full potential.

CDC is here to help. There are two resources that you can review: The Pediatric Audiology Links to Services (PALS) website lists some organizations able to provide evaluation services. Summaries of key clinical points are available for immediate download from Just look under "Hearing Loss in Children" and click on "Free Materials."

Web Resources

American Speech-Language Hearing Association EHDI Pediatric Audiology Links to Services (PALS): A National Pediatric Audiology Facilities Directory

CDC. Use of Selected Clinical Preventive Services to Improve the Health of Infants, Children, and Adolescents — United States, 1999-2011. MMWR Morb Mortal Wkly Rep. 2014.

Georgina Peacock, MD, MPH, is a developmental-behavioral pediatrician with the Division of Birth Defects and Developmental Disabilities in the Centers for Disease Control and Prevention's National Center on Birth Defects and Developmental Disabilities. Dr Peacock promotes children's health and development. She is recognized as a developmental disabilities expert and continues to see patients in a developmental clinic at the Good Samaritan Health Center.

Dr Peacock publishes and presents nationally about the "Learn the Signs. Act Early." program and promotes awareness of developmental milestones and autism among parents, teachers, and healthcare professionals. She also addresses specific public health issues in children, including those with special healthcare needs. In 2009, she co-led CDC's Children's Health Desk for the H1N1 influenza response and has published multiple articles about its effects on children with chronic medical conditions. She currently promotes flu prevention and early treatment for children with neurologic conditions, who are at a higher risk for death and hospitalization from the flu. Dr Peacock also helps guide CDC's emergency preparedness and response planning for children.

Dr Peacock received her doctor of medicine and master of public health degrees from the University of Kansas. She is also a former Leadership Education in Neurodevelopmental & Related Disabilities (LEND) trainee who completed her developmental-behavioral pediatrics fellowship at Developmental Disabilities Center at the University of Kansas Medical Center. She initially joined CDC as an Association of University Centers on Disabilities (AUCD) fellow.