If your child is diagnosed with hearing loss, you will be faced with many decisions about hearing loss treatment, auditory habilitation and speech and language therapy. The first important step toward hearing health will be having your infant or child fitted with hearing aids.
Between two and three of every 1,000 children in the U.S. are born deaf or with some degree of hearing loss. Other children will develop hearing loss later in childhood due to infection, medication, a genetic condition or exposure to loud noises. If you suspect that your child has hearing loss, visit your pediatrician or ear, nose and throat physician right away and ask for a reference to a pediatric audiologist. These hearing care professionals specialize in testing, treatment and follow-up for children with hearing loss.
Importance of hearing aids for your child
If the audiologist recommends hearing aids for your child, it's important that he or she wears them continuously, especially if the child is very young. Here's why:
- From birth to three years, children's brains are in a period of rapid development. Consistent sound input is critical for developing normal brain pathways for hearing, speech and language.
- Early listening and speaking are vital to language development. But when first learning a language, we can't exactly "teach" it to children the way one would teach a school subject. Instead, language is caught. Children pick up on words and spoken syntax and language structure by being exposed to language continuously. For children with hearing loss, this incidental learning will need to be supplemented by speech and language therapy that focuses on attending to this auditory input.
- Consistent hearing is important for children - especially infants and toddlers - in bonding with their parents. It builds trust and allows for the feeling of a predictable, consistent world.
How do I know if my child needs a hearing aid or a cochlear implant?
Most children with hearing loss are able to benefit from hearing aids, though some will do better with a cochlear implant. The audiologist and other hearing health care professionals will determine whether your child is a candidate for hearing aids or cochlear implant based on the type and severity of the hearing loss, as well as the structure and shape of the outer ear. As hearing loss is commonly identified in very young infants, children often start with hearing aids initially, and then become a candidate for a cochlear implant once they're older. A child with hearing loss will have frequent hearing tests to carefully track hearing ability and hearing aid benefit.
Hearing aid fitting
Almost all children are fit with behind-the-ear (BTE) hearing aids, regardless of the amount of hearing loss. There are small BTE sizes made specifically for children to ensure that the device will have a secure fit. The hearing aids deliver sound to the ear through a soft, plastic earmold that fits snugly in the outer ear. The advantage of BTEs is that the earmolds can be easily replaced as the child grows bigger without the expense of replacing the actual hearing aids.
Below is an overview of the hearing aid fitting process for children.
Taking ear impressions
The first step of a hearing aid fitting is to take impressions of the outer ear canals. These must be taken to ensure that the earmolds for your child's hearing aids fit perfectly. The hearing professional will place a cotton or foam dam deeply into the ear canal and then carefully fill the canal with impression material. In order to make sure all the ear structures are represented accurately, the impression material will fill the entire outer ear. The material takes a few minutes to set, so parents are often called on to hold the infant or child to keep inquisitive hands out of the way.
Earmolds can be ordered in a variety of colors; parents often choose a different color for each ear in order to make it easy to quickly determine which earmold fits which ear. As the child grows, new earmolds will be needed periodically and so colors can be changed up as desired. Older children often enjoy picking out the color. You can even choose a "clear" earmold, like the earmolds pictured to the right. The audiologist will mail out the ear impressions and it will take up to two weeks to receive the custom earmolds order.
Fitting the hearing aids and earmolds
During this appointment, the audiologist will make sure the earmolds fit your child's ears properly and program the hearing aids for your child's hearing loss. When the hearing aids are programmed and activated for the first time, your child will begin to hear new sounds right away. Infants tend to have an immediate reaction to mom or dad's voice, turning their head with interest toward the parent who now makes sound. A toddler might smile in response to the new stimulation. After the initial programming and activation, the audiologist will do some verification tests to make sure that soft sounds are loud enough, average sounds are comfortable and loud sounds aren't too loud.
The hearing professional will also spend a great deal of time teaching you how to place and remove the hearing aids, connect and disconnect the earmold from the aid and how to tell the difference between the right and left aids and earmolds. You will learn how to turn them on and off, how to do a listening check to make sure they're functioning and how to replace the battery. The battery typically needs to be replaced every seven to 10 days. You will also learn how to keep the hearing aids and earmolds clean and how to store them each night.
It will take time for your child to learn how to use the new sounds they perceive. Speech and language therapy will help the infant or child catch up to same-age peers and make sure milestones for speech, language and hearing are being met. Frequent follow-up appointments with the audiologist will be necessary to monitor hearing ability. If the child is fit as an infant, subsequent hearing tests will help quantify hearing ability across specific pitches. Behavioral hearing tests, the gold standard, will become easier to administer when the child is a toddler. Along the way, hearing aid programming will be modified to match these more specific hearing exam results.
The follow-up visits will also monitor the function and fit of the hearing instrument. A child's ear canals grow quickly, and sound leakage can cause the hearing aids to produce feedback. The earmold might need to be replaced as often as every two to three months for growing infants.
Tips for parents
As mentioned above, it is important that your child wear hearing aids continuously so they develop speech and language normally. Here are some tips for parents that will help as you get started on your journey.
Keeping them on
- Put the hearing aids on your child while you're working on a fun activity together, during which he or she will be less interested in pulling them out or off.
- Try a soft headband that you can secure over the hearing aids, but make sure the microphone isn't covered.
- Use special clips to keep the hearing aids attached to your child's clothes. Even if the hearing aids are pulled off, you won't lose the expensive devices.
Your audiologist can help you find headbands and clips that will work for your child.
Additionally, it's a good idea to develop a routine each day for putting your infant or child's hearing aids on. Spend time cuddling and holding your child when you put their hearing aids in to develop a positive association with them. When your curious child pulls the hearing aids off, be consistent but gentle in replacing them each time so he or she knows that's where they belong.
If your child repeatedly pulls on the hearing aids or his or her ears, this might be a sign of discomfort from a poorly fitting earmold. See your child's audiologist right away to find out if it's time to get a new pair of earmolds.
Children's hearing aids need to be checked daily, especially for children who are too young to tell you if there is a problem. You'll want to do a listening check, make sure the battery is working and check the hearing aids for debris and moisture. Remember, if you can't hear sounds amplified through the hearing aids then your little one will not be able to hear through it either.
Your child's audiologist will show you how to use a hearing aid stethoset to listen through each hearing aid when it's turned on. You may choose to purchase a custom listening mold, as pictured to the right, for convenience. It's a good habit to listen to the hearing aids every time you are getting ready to place them in your child's ears. If you don't hear amplified sound, check to make sure you've turned the hearing aid on. If it's still not working, test the battery. Hearing aid battery testers are easy to find online or at your local pharmacy.
If you don't have your hearing aid stethoset handy, you can at least do a quick check of the battery by closing your hand around each hearing aid. If it's on and functioning, you will hear a high-pitched feedback.
You'll also want to do a visual check before placing the hearing aids each time. Make sure the hearing aids and earmolds are clean and free of moisture. Disconnect the earmold from the hearing aid if it is dirty. Use an bulb syringe to blow any moisture out of the earmold or tubing and remove any debris from the earmold with a tissue or disinfectant wipe. When the earmold is thoroughly dry, connect it to the hearing aid again and place it back in your child's ear.
For infants and children, it's very important to choose hearing aids that have secure battery doors so they cannot get the hearing aid batteries out themselves. Always store batteries safely out of reach of children and pets. Babies like to put things in their mouths. If your child does swallow a hearing aid battery, immediately call the 24-hour National Battery Ingestion Hotline at 202-625-3333.
- Hearing Loss in Children, Centers for Disease Control and Prevention, http://www.cdc.gov/ncbddd/hearingloss/research.html