EHDI: Early Hearing Detection and Intervention

EHDI stands for Early Hearing Detection and Intervention. It is a coordinated system designed to identify hearing loss in infants as early as possible and connect families to support, evaluation, and services — ideally within the first months of life.

EHDI programs exist in every state. They are supported by the Health Resources and Services Administration (HRSA) and the Centers for Disease Control and Prevention (CDC). Each state runs its own program, which means timelines, processes, and available services can vary — but the core goals are the same everywhere: find hearing loss early, confirm it accurately, and connect families to support quickly.

The goal of EHDI is not just early identification. It is early access — access to language, to services, and to the information families need to make good decisions for their child.

Most babies are screened for hearing loss before they leave the hospital — typically within the first day or two of life. The screening is quick, painless, and can be done while your baby is asleep.

Two screening methods are commonly used:

– OAE (Otoacoustic Emissions): A small device measures sound responses in the ear canal.

– ABR (Auditory Brainstem Response): Sensors measure how the auditory nerve responds to sound.

A “refer” result does not mean your child has hearing loss. It means the screening was not conclusive and a follow-up is needed. Many babies who receive a “refer” result have typical hearing.

Timeline guidance: The Joint Committee on Infant Hearing (JCIH) recommends that all babies be screened by one month of age, diagnosed by three months, and enrolled in early intervention by six months if hearing loss is confirmed. This is known as the 1-3-6 goal. The 2019 JCIH position statement updated this to a 1-2-3 benchmark to reflect best practice.

If your baby did not pass the newborn screen, the next step is a full diagnostic evaluation by a pediatric audiologist — a specialist trained to evaluate hearing in infants and young children.

This evaluation will:

• Determine whether hearing loss is present
• Identify the type and degree of hearing loss
• Assess both ears independently

Ask for an audiologist who has specific experience with infants and young children. The evaluation may take more than one appointment.

After the diagnostic evaluation, the audiologist will review the results with you. If hearing loss is confirmed, they will explain the type and degree of loss and discuss next steps, which may include:

• Hearing technology options (hearing aids, cochlear implant referral)
• Referral to Early Intervention services
• Connection to a Deaf Mentor program or ASL resources
• Follow-up audiological monitoring

You do not have to make any decisions immediately. Ask for time to process, and ask as many questions as you need.

If your child is diagnosed with hearing loss, they are typically eligible for Early Intervention services under IDEA Part C (34 CFR Part 303). Your audiologist, EHDI coordinator, or hospital social worker can help connect you to your state’s Early Intervention program.

Early Intervention services are free and available from birth to age three. They may include speech-language therapy, developmental therapy, family education, and support from specialists in Deaf and hard-of-hearing child development.

Early Intervention will conduct its own evaluation and, if your child is eligible, will work with you to develop an Individualized Family Service Plan (IFSP). The IFSP outlines the services your child and family will receive.

EHDI is not a one-time event. Your child’s hearing should be monitored regularly, even if early results were typical. Hearing loss can change over time, and some types of hearing loss are not present at birth.

Your EHDI coordinator can help you understand what monitoring your child needs and connect you to community resources, family networks, and Deaf community contacts if you are interested.

The EHDI process can feel fast and overwhelming at the same time. Here is what to expect at each stage:

• At the hospital: A hearing screen before discharge. If the result is “refer,” you will be given information about next steps and a follow-up appointment.
• In the first weeks: A diagnostic audiological evaluation, if needed. Results will be shared and explained.
• By three months: A confirmed diagnosis, if hearing loss is present.
• By six months: Enrollment in Early Intervention, if your child is eligible and you choose to participate.

Timelines are goals — not guarantees. If your state program is moving slowly, ask your EHDI coordinator for help or contact your state’s Part C lead agency directly.

You have rights throughout the EHDI process. These rights are protected by federal law.

– Right to information: You have the right to receive clear, complete information about your child’s hearing status, what it means, and what options are available.

– Right to language access: You have the right to receive all information — including screening results, evaluation reports, and service plans — in your preferred language. If your family uses ASL or another signed language, the program must provide a qualified interpreter at no cost to you. (34 CFR § 303.25; Title VI of the Civil Rights Act)

– Right to choose: You have the right to choose your child’s communication approach. No program can require you to choose a specific approach. That includes hearing technology, spoken language, ASL, or a combination.

– Right to decline: You have the right to decline screening or services. You also have the right to understand what declining may mean for your child, and to change your mind at any time.

– Right to a second opinion: If you have concerns about the evaluation or diagnosis, you have the right to seek additional evaluation from another qualified provider.

Language access is not something to think about later. It is something that matters from the very first days of your child’s life.

Research consistently shows that Deaf and hard-of-hearing children who have consistent access to a fully accessible language — whether spoken or signed — from birth have better long-term outcomes in literacy, communication, cognition, and social development (Humphries et al., 2012, Language, Cognition and Neuroscience; Hall et al., 2017, Maternal and Child Health Journal).

American Sign Language is a complete, natural language. It is not a communication tool of last resort. For many Deaf children — with or without hearing technology — ASL provides the most reliable, fully accessible language input available. Hearing aids and cochlear implants do not guarantee access to spoken language in all environments.

If you are interested in ASL, Deaf mentors, or Deaf community connection, ask your EHDI coordinator or Early Intervention provider. Many states have Deaf Mentor programs specifically for hearing families of Deaf children.

At every step of the EHDI process, you have the right to ask questions. Here are some to consider:

At the screening stage:

• What does a “refer” result mean for my baby?
• What happens next, and how soon?
• Who should I contact to schedule a follow-up?

At the diagnostic evaluation:

• What type and degree of hearing loss does my child have?
• Which ear or ears are affected?
• Will this change over time?
• What options are available to us?

When considering Early Intervention:

• What services is my child eligible for?
• Are there specialists in Deaf and hard-of-hearing child development available?
• Can we learn about ASL and Deaf community resources?
• What does the IFSP process look like?

The EHDI system is designed to work well — but it does not always work as it should. Watch for these signs that you may need to advocate for your child:

• You have not received a follow-up appointment after a “refer” result within a few weeks.
• The audiologist does not have experience evaluating infants.
• You are not receiving information in your preferred language.
• No one has mentioned Early Intervention or the IFSP process.
• You feel pressured toward a specific communication approach without being given full information about all options.
• ASL and Deaf community resources were not offered or mentioned.

If any of these apply, contact your state’s EHDI program coordinator directly. You can also contact your state’s Part C lead agency or a family advocacy organization for help.

You do not have to navigate this alone. There are people and programs ready to help.

Source: Content written with JCIH 1-3-6 and 2019 1-2-3 update; IDEA Part C citations (34 CFR Part 303); language access rights (34 CFR § 303.25; Title VI); Hall (2017) and Humphries et al. (2012) citations integrated inline. All sections parent-facing.