Hospitals in the United States do not perform a DNA paternity test at birth as part of routine newborn care. Every baby is screened for health conditions in the first day or two of life, but none of those screenings identify who the biological father is. If you want paternity confirmed at or around delivery, you arrange it yourself through an outside laboratory, and the choice you make about what kind of test to order matters more than the test itself.
What the Hospital Actually Tests
The screenings your baby receives in the hospital look at the baby’s health, not the baby’s parentage. The Apgar score checks heart rate, breathing, and reflexes in the first minutes after birth. Hearing and pulse oximetry screenings happen before discharge. Between 24 and 48 hours after birth, a provider pricks the baby’s heel and sends a few drops of blood to a state lab, which screens for treatable conditions like phenylketonuria, cystic fibrosis, and sickle cell disease.1U.S. Department of Health & Human Services. Newborn Screening Process2Centers for Disease Control and Prevention. General Information – Newborn Screening
The heel-stick test analyzes the baby’s own genetic and metabolic markers. It does not compare the baby’s DNA to anyone else’s. Paternity testing is a separate service, and no hospital in the country does it as part of standard delivery.
How a Newborn Paternity Test Works
Paternity tests compare genetic markers between the child and the alleged father. Because half the child’s DNA comes from each biological parent, matching enough markers produces a probability above 99.9% when the tested man is the father. A negative result is definitive; a positive result is a probability rather than an exact 100%, because standard tests examine a targeted set of markers rather than sequencing the full genome.
Collection is a buccal swab. A soft-tipped applicator is rubbed against the inside of the cheek for about 20 seconds on each side. For a newborn, it is painless and takes under a minute. Most labs return routine results within three to five business days.
One detail specific to nursing infants: wait at least 60 minutes after breastfeeding before swabbing. Maternal cells in breast milk can contaminate the sample and produce unreliable results.3PubMed. Guidelines for Buccal Smear Collection in Breast-Fed Infants Wiping the baby’s inner cheek with a clean cotton swab before collection helps too.
Legal Test or At-Home Kit
This is the decision that trips people up, and it is worth getting right the first time. Legal tests and at-home kits use the same science and the same cheek swab. The difference is chain of custody.
A legal paternity test, also called a chain-of-custody test, requires a trained collector at an approved facility. The collector verifies each person’s identity with government-issued photo ID, photographs the participants, documents the process, and seals the samples in tamper-evident packaging. That paper trail is what makes the results admissible in court for child support, custody, inheritance, or immigration matters.4AABB. AABB-Accredited Relationship (DNA) Testing Facilities
An at-home kit lets you swab in your kitchen and mail the samples in. The result is scientifically accurate for your own knowledge, but no court will accept it, because nothing proves who actually provided the samples. If there is any chance you will need the result for a legal proceeding, order a legal test from the start. It costs more upfront and less overall.
Arranging the Test and What It Costs
The single most important factor when choosing a lab is AABB accreditation. AABB (formerly the American Association of Blood Banks) has set the industry standard for relationship testing since 1982, and its accredited labs are the ones USCIS accepts for immigration cases and courts recognize nationwide.5AABB. Standards for Relationship Testing Laboratories The current edition of AABB’s relationship testing standards took effect January 1, 2026.
For a legal test, both the mother and the alleged father generally need to consent, or you need a court order. Every adult participant must show government-issued photo ID at the appointment. If a court has ordered the test and someone refuses, they can face contempt or a default judgment of paternity.
A legal chain-of-custody test typically runs $300 to $500, depending on the lab and whether collection is included or billed separately. At-home kits often cost under $200, with the tradeoff already described. Health insurance generally does not pay for paternity testing done for legal or personal reasons; insurers are more likely to cover genetic testing when a doctor orders it to diagnose a medical condition.6MedlinePlus. Will Health Insurance Cover the Costs of Genetic Testing? When a court orders the test through the state child support agency, the agency usually pays up front and seeks reimbursement from the father if paternity is confirmed.7Office of the Law Revision Counsel. 42 USC 666 – Requirement of Statutorily Prescribed Procedures to Improve Effectiveness of Child Support Enforcement
You Do Not Have to Wait Until Birth
Non-invasive prenatal paternity testing is available as early as the seventh week of pregnancy. The mother gives a blood sample, the alleged father gives a cheek swab, and the lab isolates fetal DNA circulating in the mother’s blood to compare against the father’s profile. Because it uses a routine blood draw, it carries no risk to the pregnancy. It costs more than a postnatal test, but it answers the question months before delivery, which is often the real reason people are asking about testing at the hospital in the first place.
The Birth Certificate Question at the Hospital
The hospital will not run a paternity test, but it will ask an unmarried couple whether the father wants to sign an Acknowledgment of Paternity. Federal law requires every state to offer this at the hospital around the time of birth.7Office of the Law Revision Counsel. 42 USC 666 – Requirement of Statutorily Prescribed Procedures to Improve Effectiveness of Child Support Enforcement Once the AOP is properly signed and filed, it has the same legal effect as a court order of paternity, and the father’s name is added to the birth certificate.
The rescission window is short. Under federal law, either parent can rescind within 60 days of filing, or before any court proceeding involving the child, whichever comes first.7Office of the Law Revision Counsel. 42 USC 666 – Requirement of Statutorily Prescribed Procedures to Improve Effectiveness of Child Support Enforcement After that, undoing the AOP means going back to court and proving fraud, duress, or material mistake of fact. If there is any real doubt about biology, get a DNA test before signing the acknowledgment.
A different rule applies when the mother is married. In every state, her husband is presumed to be the legal father at birth, and his name goes on the birth certificate automatically. Rebutting that presumption requires clear and convincing evidence, and the process varies by state.