The Joint Committee on Infant Hearing guidelines recommend that children who are deaf and hard of hearing should begin early intervention by six months of age. However, prior work has revealed a substantial percentage of children who receive a diagnosis of hearing loss by three months of age, but do not enroll in early intervention by six months of age (Grey et al., 2022). To further understand barriers to enrollment in early intervention for these families, we completed qualitative semi-structured interviews with 10 caregivers whose children were diagnosed with hearing loss by three months of age but did not begin early intervention by six months. We recruited from participants in Grey et al. (2022). Interviews were coded using the Bioecological Model of Human Development (Bronfenbrenner & Morris, 2006) as a guiding framework. The interviews revealed widespread barriers encountered by families of children who are deaf and hard of hearing across ecological systems, ranging from child characteristics to macro-level issues like insurance coverage. To ensure that all children who are diagnosed with hearing loss have timely access to early intervention, changes to current policy and practice are needed across multiple ecological systems.

Previous position statements by the Joint Committee on Infant Hearing (JCIH) have recommended the presence of hyperbilirubinemia requiring exchange transfusion as a risk factor for childhood hearing loss. This article examines the strength of the evidence to support this recommendation. A PubMed® query using the keywords hyperbilirubinemia and hearing loss identified 77 original papers. All abstracts were reviewed for consideration of full article review and 44 articles were reviewed for consideration of inclusion and grading, with 21 articles graded using structured evidence-grading forms. Nineteen articles were included to provide supporting rationale for recommendations. Evidence grading was completed by recommendation. A moderate level of evidence supports hyperbilirubinemia requiring exchange transfusion as a risk factor for elevated hearing thresholds among infants and young children. It is recommended to employ Automated Auditory Brainstem Response screening in this population of infants. These recommendations are based on the findings across multiple graded studies where the net benefit is moderate or substantial. Intervals for on-going monitoring of hearing previously recommended by JCIH are supported by expert consensus. If an infant with hyperbilirubinemia requiring exchange transfusion passes the newborn hearing screening, close monitoring of hearing, speech, and language milestones are important and should lead to improved outcomes for the child.

Guidelines created by the American Academy of Pediatrics ([AAP], 2010) and the Joint Committee on Infant Hearing ([JCIH], 2019) were designed to aid in the early identification of infant hearing loss. Despite these guidelines, a quarter of children who do not pass their initial screening are lost to the follow-up process and many more do not receive care in line with the 1-3-6 guidelines (Centers for Disease Control and Prevention [CDC], 2018; JCIH, 2019). To acquire more information about the experiences of families and identify specific barriers to timely diagnosis and intervention, interviews were conducted with 13 parents of children who are deaf or hard of hearing whose children were enrolled in a larger longitudinal study. These interviews revealed common themes regarding delayed identification, frustrations about timely intervention, and confusion when choosing communication modalities. Common themes amongst families who felt well-supported were also identified.