Implementation of systematic programs for early identification of hearing impairment in the newborn and infant is increasing in Canada and worldwide. This article outlines the rationale for these programs, methods of screening, audiologic assessment and intervention, program outcomes and the crucial role of physicians. Sources of high-quality, current evidence on key aspects of these programs are identified. There is an emerging, evidence-based consensus that a systematic approach based on universal newborn hearing screening (UNHS) and timely, appropriate follow-up services is practicable and will yield substantial net benefit for many affected children and families. Early identification programs lead to physicians being faced with infants under six months of age who already have detailed and accurate audiometry. Important challenges include a systematic approach to etiologic evaluation of the young infant with permanent hearing impairment and the facilitation of prompt, non-medical interventions.