Hearing Aids in Children: Adjusting to Hearing Aids
Small Children and Hearing Technology
Children who require hearing aids may have a congenital hearing loss (i.e. the hearing loss is present at birth) or may have an acquired hearing loss (the hearing loss develops at a later stage).
Adjusting to hearing aids can be a difficult process for some children, while others accept their technology immediately. Acceptance of wearing hearing aids is particularly troublesome between the ages of 9 months to 3 years, when children are in the toddler stage.
Why do children need to wear their hearing devices during all waking hours? According to Carol Flexor (Children With Hearing Loss: Developing Listening and Talking Birth to Six, 2007), children with typical hearing already have 20 weeks of auditory experience prior to birth. Children with congenital hearing loss miss this important developmental stage, and the auditory centers of the brain must make up for lost time. Auditory stimulation must occur early and often to develop healthy hearing pathways in the brain. The development of the auditory pathways in the brain are an absolute requirement for the development of speech and language skills in children.
The younger the child, the more "plasticity" they have in the brain. In other words, the brain of a young child is extremely flexible and will learn auditory skills very rapidly once hearing aids are provided: it is easier to make up for lost time when a child is very young. The more a young child wears his or her hearing aids, the stronger the auditory pathways in the brain will become.
Our son is currently a ten year old who happily wears his cochlear implant and hearing aid and is in a mainstream school setting. When he was an infant, we struggled with keeping his technology on. We knew every moment was vital to develop his listening skills, and developed coping mechanisms. Our most challenging time was from ages 18 months to 3 years of age, when it felt like we were putting his equipment back on every 10 seconds!
Why Children Reject Hearing Aids
Infants: Infants who have worn their hearing equipment from birth may suddenly start to remove their hearing aids, starting at about the age of six months. This is generally due to curiosity – the baby is starting to explore his/her own body at this stage, and that includes hearing aids. Unfortunately, hearing aids often end up in the mouth at this stage: parents must be particularly vigilant to prevent small parts from detaching and posing a choking hazard. In addition, the button-cell batteries used in hearing aids are toxic: it is vital to obtain hearing aids with locking battery doors for all infants and small children.
Toddlers: In addition to curiosity and exploration, some toddlers may begin expressing their newfound independence by ripping out their hearing aids – much to their parent’s dismay. A toddler may make their technology the object of an intense power struggle.
Preschoolers: Unlike toddlers, preschoolers are less likely to take their hearing aids apart out of curiosity. Power struggles may become evident over wearing the technology, though this issue decreases as the child gets older.
First Time Wearers: Children who are receiving hearing aids for the first time are experiencing a new (and sometimes overwhelming) sensation. The volume of their world has been turned up in an instant: the brain takes some time to adjust to the increased intensity of sound.
Discomfort: Sometimes there is a physical issue or a sensory processing disorder. The earmold may be creating a sore spot in the ear. If it has been a while since the child had a hearing exam, the volume level may not be set appropriately. If the child’s ears seem red or bruised, examine the earmolds for rough patches or for a poor fit. Monitor the child for reactions like blinking or wincing with sound, or for missing Ling Sounds during morning hearing aid checks. Over- or under-amplification may cause a rejection of the hearing aids. Ear infections or even impacted earwax may cause discomfort when the hearing aid is inserted each morning. If any discomfort is suspected, consult an audiologist or ENT immediately.
Pilot Caps are One Solution for Babies
Solutions for Infants
Babies will begin to explore their bodies at about the age of six months. The hearing aids may turn into teething toys, which is unsafe for the baby and damaging to the hearing aids. The simplest solution in this case is prevention. There are many accessories available to prevent damage to hearing aids: the use of Pilot Caps will prevent the baby from reaching his or her hearing aids. Neoprene hearing aid covers (Ear Gear) will help protect the hearing aid case from damage, though the neoprene casing will be ineffective against particularly determined chewers.
While Pilot Caps (such as those by Hanna Andersson) are wonderful for preventing access to hearing aids, it is recommended to use a hearing aid clip under the cap. The cap prevents the parent from seeing the hearing aids, making it difficult to determine if one has accidentally fallen off. To prevent the accidental loss of a hearing aid, always attach the hearing aids to a pediatric clip when a Pilot Cap is worn.
Our son was four months old when he first received his hearing technology. We used a pilot cap with success from the age of 4 months to approximately 12 months of age. After 12 months of age, our son learned how to reach under the cap and would sometimes remove his aids. At this point, the cap prevented us from seeing his ears and visually verifying his equipment was still on, so we discontinued the use of the pilot cap.
Solutions for Toddlers
Toddler-hood is, by far, the most difficult time for children who are deaf and hard of hearing. The curiosity factor is still at play, and hearing aids may be removed and disassembled frequently. Small pieces of the equipment pose a choking hazard, and the batteries are toxic. Toddlers are often able to take off pilot caps, so prevention is more difficult at this stage of development. In addition, toddlers may enter a power struggle with the hearing aids. Some strategies for helping a toddler to accept hearing aids include:
- Obtain toy hearing aids: Build-a-Bear and other companies sell pretend hearing aids for dolls and stuffed animals. Have the child place the toy hearing aids on the child’s stuffed animals or dolls, and go through the normal routine of hearing aid checks. Role play with the toy hearing aids, then say, “Now it is time for your hearing aids!” Place the hearing aids in the child’s ears and go through the same hearing aid checks.
- Some children will repeatedly pull out their equipment after a short period of time. Find an engaging activity the child loves: this may be playing with play-dough, watching a video, or any other activity which appeals to the child. Explain to the child that the activity will only continue as long as their hearing technology stays in place (e.g. “If the hearing aids come out, we will put the play-dough away: we don’t want them to get messy!).
- Be persistent. Young toddlers must learn that their hearing technology is non-negotiable. Unless discomfort is suspected, always replace them after they have been pulled out. This may require replacing the hearing aids every 10 minutes on some days, but the behavior will eventually wane.
Use common sense: for young toddlers who frequently remove or dismantle hearing aids, leave them off while riding in the car. Many young children don’t like the amplified sound of the road noise, and may pull the hearing aids out while unsupervised in the back seat.
Solutions for Preschoolers
Preschoolers will probably not dismantle their hearing equipment on a regular basis, but other issues are on the rise. A three year old may pull his hearing aids out during a temper tantrum, and throw them across the room. A four year old may insist she “doesn’t need them right now.” A calm and rational response is always the best way to address a tantrum-throwing preschooler in the midst of a power struggle.
There are many ways to help a preschooler develop a sense of responsibility and pride over his or her technology. Giving the child the power to decorate or select the color of the earmolds is one way to increase a preschooler’s acceptance of the hearing aids. Allow the preschooler to select the color of his earmolds at the audiologist’s office: bright green-and-yellow earmolds may not be high style to an adult, but to four year old children, they’re cool.
Small stickers to decorate the hearing aid case are another way to decorate the hearing aids. Little jewel stickers or monster truck stickers are a fun way to personalize hearing aids for preschoolers. Tube Riders are cute beads that attach to the earmold tubing, and are another fun hearing aid accessory.
Having an “All About Me” day at preschool is another way to instill pride in a preschooler with hearing loss. Bringing in the hearing aids and having a “show-and-tell” will not only let the child become the star of the class for a day, but will educate and create understanding among the child’s classmates. Many hearing aid companies offer coloring sheets and other informational material for young children.
Many parents celebrate Hearing Birthdays, celebrating the year when a child first received full access to sound with their hearing aids or cochlear implants. Celebrating this milestone each year is a fun way to celebrate the child’s hearing age (the adjusted age for the child’s ears). Any child would be thrilled to have two birthdays, and this is yet another way to celebrate the gift of sound with a preschooler.
Older Children May Adjust Quite Happily to Hearing Aids
The First Time Hearing Aid User
Adjusting to amplification takes time. Sound may come in through the ears, but listening (interpretation of sound) occurs in the brain. When the sound signal is suddenly amplified, it may be overwhelming and disconcerting to a child, particularly if the child has had an undiagnosed hearing loss for a number of years. Some children will become tired after a day of listening with their new “ears,” and others may become crabby from the exertion. Still others may adjust with little or no difficulty at all.
Hearing technology has gotten much better over the course of time, and aren’t prone to as much signal distortion as they used to be. Unfortunately, hearing aids cannot correct the distortion caused by the child’s inherent hearing loss. Children with a sensorineural hearing loss may experience sound distortion: in general, the distortion of sound increases with the level of hearing loss, though this is not always true. Imagine the sound distortion as a radio turned slightly off station, so that static interferes with the quality of the sound signal. A hearing aid would act like the volume dial: it can turn up the sound signal, but the static is still there. Children have to learn to listen to the sounds to discriminate the meaningful components, and this can be an exhausting task.
In addition, background noise is a particular problem with hearing aids. Children with hearing loss need a higher signal-to-noise ratio to understand speech clearly. Crowded, noisy restaurants (or classrooms, for that matter) are not ideal listening environments. Background noise is another factor that must be adapted to for new hearing aid wearers: it adds to the listening fatigue of the child. Ear-level personal FM systems are a great way to overcome background noise, and are typically used in educational settings. Families can purchase FM systems for personal use – while expensive, they can make communication in noisy places much easier.
It is good to set targets for hearing technology usage per day, and increase the amount of time the equipment is worn over a period of a week or so. For the first day, the child may only wear the hearing aids for ½ hour at a time. Increase the time “in aids” over the course of a week, so that the child is wearing the hearing aids for all waking hours by the time the week is over.
When a Child Refuses to Take Hearing Aids Off
It may be to believe, but a time will come when young children might refuse to remove their hearing technology. As the child reaches a certain cognitive stage, they understand they hear better with the hearing aids, and they want to be able to hear the television and their friends talking. Unfortunately, hearing aids must be removed for certain activities: swimming, the beach, and sleeping.
The child may even be frightened of removing the hearing aids in certain circumstances: this is common at bedtime. For a child who cannot hear very well, the dark can become a frightening place.
Investing in a night light is a good idea, so the child can still see when the lights are out. A dimmer switch is another option, allowing the parent to slowly dim the lights as the child drifts off to sleep during this phase. Role playing with a stuffed animal is also a good idea: have the child remove the stuffed animal’s hearing aids, and repeat the routine with the little one.
When all else fails, it might be wise to allow the child to fall asleep in his or her hearing aids, removing them after the child is asleep. Always inform the child the hearing aids will be removed after he/she is asleep. Some preschoolers need the security of being able to hear while they go to sleep. As the child gets older, this will likely become a fear of the past and the hearing aids can be put away without issue in the evening. With our son, we had to allow him to fall asleep with his hearing aids on from the ages of four to six years old. We would remove them after he had fallen asleep, and he was much happier being able to hear as he drifted off. After the age of six, he took responsibility for his own equipment and would place it into the drying box after his shower each night.