The EHDI system of services refers to families, providers, services, and programs that work towards developing coordinated and comprehensive state and territory systems so that families with newborns, infants, and young children who are deaf or hard of hearing (DHH) receive appropriate and timely services that include hearing screening, diagnosis, and intervention.

Primary care provders (PCPs) are a consistent point of contact for families and play a critical role in the EHDI system. PCPs help ensure that screening results are followed up, referrals are completed, and families receive the information and care they need to support their child’s development.

EHDI system partners collectively work to achieve the EHDI national benchmarks* which include:

  • 1 month: Newborn hearing screening (before hospital discharge or by 1 month of age)
  • 3 months: Diagnosis of hearing status
  • 6 months: Enrollment in Early Intervention (EI)

Meeting the 1-3-6 benchmarks is important to ensure early access to services for children and families, leading to optimal communication/language, social/emotional, and cognitive developmental outcomes.

Nationally, states/territories have achieved near universal 1-month newborn hearing screening, but challenges remain in diagnosing hearing status by 3-months and 6-month enrollment in EI.  Some infants pass the newborn hearing screen but still require additional audiologic follow-up if risk factors are present. The Joint Committee on Infant Hearing (JCIH) 2019 Position Statement, Table 1, outlines conditions that increase the likelihood of delayed-onset, progressive, or acquired DHH status. PCPs can use these risk factors to guide ongoing developmental surveillance, referral for diagnostic audiology, and family counseling.

*These benchmarks are established by the Joint Committee on Infant Hearing (JCIH), (2019). Year 2019 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs. Journal of Early Hearing Detection and Intervention, 4(2), 1-44. DOI: https://doi.org/10.15142/fptk-b748.

Myth Busters

   

“I don’t have any DHH children in my practice, so there is no role for me as a PCP in the EHDI system.”  → Let’s learn more. If you follow at least 1,000 children, statistically you are likely to have 3+ children who are DHH. Additionally, all babies you see in your practice will have undergone newborn hearing screening and are therefore part of the EHDI system. Finally, it is important to engage in ongoing monitoring of infants for risk factors associated with differences in hearing status.

“The baby passed their newborn hearing screen, so there are no concerns and no need for future action.” → False. Ongoing surveillance is essential to support optimal child development and identify any potential developmental delays early.

“The baby did not pass their newborn screening, but this is usually not a cause for concern. We can wait and see what happens before further action.” → False. A baby not passing their newborn hearing screening should be treated with the same urgency for action as a baby not passing a metabolic newborn screening. Timely follow-up and diagnostic evaluation are critical to ensure early identification and access to supports and services, including family supports through family based organizations.

“The baby has fluid in their ears, so we should wait for diagnostic evaluation and any next steps such as referral to EI until the fluid clears up” → False. Diagnostic audiology should not be delayed.


This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $300,000 with 0% financed with nongovernmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS or the U.S. Government.

Last Updated

11/02/2026

Source

American Academy of Pediatrics