Equipment and Babies: Mission Not Quite Impossible

Sara Kennedy,
Colorado H&V
and H&V Headquarters

Sylvia Thomas sports a pilot cap

Imagine giving your baby or toddler an accessory to wear that costs $3,000 or perhaps much more, is small enough to be a choking hazard, with tiny, toxic batteries. While you may harbor misgivings about the whole idea of this accessory, you are told that it is important for a little one to wear at all waking hours for language and brain development, and let’s keep in mind that this accessory can easily be pulled apart, lost, and is mysteriously beloved by dogs everywhere as a potential chew toy. Between all those issues and the predictable postpartum or life with toddler chaos, it is no wonder that parents choosing amplification find that the baby and equipment mix makes for quite a challenge.

Since all those little ones and their parents are wired differently, some parent/child teams sail through this period of adjustment, others have momentary troubles, and some parents earn master’s degrees in behavior analysis. Some babies wear them fine as little ones, but begin to object at six months (finding that their little hands work to pull at all manner of fun things, and mom’s hair, too) and often again sometime during the toddler years, as a child is learning to be more independent and assert their own opinions. First time wearers have had a pretty quiet world and will take some adjustment time to get up to the goal of wearing aids during all waking hours.

Audiologists set the aids and maps very conservatively with this in mind, and often give parents ways to dial up the power as the child adjusts. If you know the baby is extra sensitive to sensory stimulation in general, this would be something worth mentioning to the parents and audiologist: sensory processing difficulties are found at a higher rate among children with hearing loss than typically hearing children. If a child won’t keep aids or a processor on, parents may jump to the conclusion that the child is rejecting any use of amplification. Parents often aren’t sure themselves about using amplification. (“Does it really help?” “Does it hurt the baby?” “What will the other parents at church/soccer/the family reunion think?” “Is it really necessary when our baby seems to respond to sound?”) For reluctant or frustrated parents, any perceived negative reaction from their baby is even harder to overcome.

The Importance of a Good Pediatric Audiologist

What’s a parent to do? First of all, make sure that their audiologist is a pediatric audiologist, with experience fitting babies and toddlers. A pediatric audiologist can help parents select the most appropriate aids that can make a difference in adjusting to wearing them. Think… locking battery doors, bright colors (easier to find when dropped!) knowledgeable about accessories like Critter Clips and EarGear, and able to make earmolds that have both a good helix lock, have a long enough canal to reduce feedback and stay in better, and perhaps even have one of the new coatings that make them easier to put in without adding a second step with a lubricant such as Oto-ease (or, as one budget-conscious parent suggested, Astroglide). No parent knows everything they need to know about wearing hearing aids after that first fitting, and that’s where early intervention, H&V parent guides, and connecting with other parents can really support them to learn the vocabulary they need, and the ins and outs of managing this on a daily basis. An experienced pediatric audiologist can help prevent difficulties caused by ineffective programming or mapping; a poorly matched aid or processor is about as useful as an expensive earplug. Babies and toddlers will quickly learn to pull out devices that aren’t giving them useful information.

Audiologists can also play a key role in educating the parents, along with the early intervention parent facilitators, in avoiding rookie mistakes like having the T coil setting on accidentally, accidental volume changes, and even getting the batteries in incorrectly. (Ahem, I have done that myself.)

Parents can learn to see the hearing aids or processors as just one more think the child needs to wear – matter of factly, just like wearing clothes for the day. Parents are routinely told “if they take it off 100 times, put it back on 101 times.” I know more than a few parents who would just love to have their clinicians move in for a week of real life with a young child who has other ideas. Parents are hungry for support with a difficult child; those clinicians who roll up their sleeves to help solve the problem will be remembered forever! Yes, put the device back on, as positively as possible, and treat this as a non-issue, the same as wearing shoes outside on a cold day. We don’t make a big deal of the rules -- just routinely replace the shoes, or brush the teeth, or comb the hair, or put the hearing aids back on while making this routine task as pleasant as possible for both. Remember to see parents and babies as individuals. With my bad vision, it took me 20 minutes to get two aids in, and then if our then-toddler pulled them out, another 20 minutes to do it all again…and this process quickly eats up a day! But it does get easier, faster, and pretty soon, a mom or dad can put aids on a moving child, backwards. Even I could, eventually.

Parents can distract their child with a song or a silly rhyme or dance moves as soon as the hearing aids are replaced. Older toddlers, if not just exploring “hey, this comes out!” may be searching for even the sometimes negative attention they get from taking them out.

Overreacting can create a power struggle. If a baby doesn’t happily accept the distraction, try again in a while, perhaps in conjunction with a favorite activity, food, reading a book – whatever works for the individual child.

Outsmarting the aids is important for sensitive children… if a baby can hear the feedback, turning the aids off or removing them before breastfeeding or changing a shirt or cuddling in a chair at least on the one side is necessary. Some youngsters will wear their equipment fine for other adults, and save their best removal tricks for mom and dad, which can be especially frustrating.

Preventing loss and damage is another challenge. Clips to keep the aids or processor pinned to the child’s clothing are favored by many parents (though my child objected to that… she liked to play with her hair and change her clothes often even as a two year old). Thin cotton pilot caps (think Hanna Andersen) are a favorite of many parents – not too hot to wear in Colorado’s summers usually. Clips should be used with the caps, though, since a parent won’t be able to see if the aids are still on after the hour at the park has passed. One experienced mom also suggests taking in the caps so they have a more contoured fit and prevent little hands from getting up and under and unhooking the devices.

Neoprene covers such as Ear Gear can protect aids from babies’ chewing, as well as excess moisture or the occasional accidental wetting. So many more aids now are water resistant, too. Wide headbands have also been used successfully, and any cap or headband can help keep aids on a little longer.

Toupee or double sided tape was successful in our house, but I just learned from a northeast Colorado parent that she put the tape against the ear (pinna) and not against the scalp side. Tape definitely helps children who have ears that are very soft and lack the cartilage to hold the aids in place, and is less likely to pull on the hair when removed. (I know what you are thinking here… I think my daughter is a little bald right behind her ears. She still likes the toupee tape for volleyball, skiing, and rollercoasters.) For some it is a deterrent to pulling off the aids; for others, it just isn’t. If the aid is moving around, it could begin to bother the child and become a target for removal.

Thinking about situations ahead of time is important for prevention. We did not see time in the car in those early years as a good communication opportunity (all those siblings, with a toddler stationed in the car where I couldn’t reach her if she did pull them out/put them in her mouth, etc.) so we took off aids until our daughter was more trustworthy… in her case, she could wear them when she was three pretty reliably for trips. Older siblings can be rewarded with extra fun parent time for supervising!

Expect some listening fatigue and a low toleration for competing background noise. If the house is generally chaotic or other siblings love nothing more than singing and dancing to the latest pop song, a little one learning to use hearing aids or a processor may need extra care to have some listening breaks and reduction of background noise.

The Magic of Routines

Creating a routine where a child knows that taking off and putting on aids or processors if for mom or dad or a caregiver to do, and not the child himself, is important. (There’s plenty of time to establish more independence later!) A parent in the Colorado western mountains raising a child with developmental delays and hearing loss said that this paid off for her over the long term as her son learned to keep the aids in that way. If he took them off, she would put them back on, and then take them off in a few minutes if wearing time had clearly been maxed out. Unless there is some concern about discomfort, replace them after they have been pulled out and repeat that it is for mom or dad to take out (even if you take them out in just a few more minutes.) The pulling out behavior will eventually slow if a child is receiving some benefit from aids or processors and stop altogether—but it does take some wearing time to allow enough connection to sound/meaning to show benefit. It’s quite a circular problem.

Having a designated, special place to keep the aids and supplies (out of reach of children, dogs, and in the same regular place so that we can find them in the morning!) is important for sleep deprived parents and is helpful should another child find the aids in the house. (It happens.) In the same way, parents can learn to do “listening checks” routinely. My daughter would definitely flip her aids out of her ears if the batteries died…before she learned to tell me, loudly, that she was “dead.” This was really attention getting in public. Later, we learned the signs for and how to say the battery is dead.

It is critical that all the adults in a house play a part in keeping aids on. I have heard so many parents say that hearing aids go back in the case if a baby takes them out and they are not home. This is stressful stuff and shouldn’t be up to one parent for the future health of those relationships – all caregivers play a critical role.

If Equipment Seems to Hurt

Sometimes there is a physical issue with the hearing aid. Poorly fitting earmolds can cause a sore spot in the ear or annoying feedback if the earmold is too small. Earmolds are fit every few months in the early years, and once a twice a year as a child matures. There’s no knowing when a growth spurt can happen. Lubricants, as mentioned (and even saliva in a pinch! – it is organic, sort of…) or otofirm can be useful to ease the time before the new mold arrives, but otofirm can make the earmold harder to get in and out as it can get “tacky.” Hearing levels can fluctuate, so volume levels become problematic. If a child can move the volume controls or their own hearing has changed, sound might be too loud or too soft, and a child may reject wearing the aids either way. Excessive ear wax can cause discomfort and mimic a progressive hearing loss, and ear infections or tubes migrating outward may cause discomfort and change in hearing levels as well. In rare cases, a child may be allergic to the earmold material (or toupee tape) so watch for redness/rash. If a baby appears to have any pain or discomfort with the earmold or sound levels, that is reason for a call to the fitting audiologist right away.

Sometimes a parent needs to go through a whole host of potential solutions to help a child adjust, or help a toddler/preschooler through a behavioral challenge. Here is a laundry list of potential actions to consider:

Find an activity the child loves and pair wearing time with that fun in building up wearing time, especially with a child who is late identified. Explain to the child that playdough or video or fingerpainting will only continue as long as the hearing aids stay in place (e.g. “You can play and listen! If the hearing aids come out, we will put the paint away so they don’t get messy.”)
Letting a child choose earmold colors and accessories. Play up the fun factor and make them easier to find on the playground – a double win. Tube-riders, stickers, and the many crafty ideas on You Tube can bring some extra bling that might appeal to some children. (For others, this is just one more reason to take them off and examine them.)
Positively respond to all wearing times: extra hugs, positive remarks, bragging to other people in front of your child, a little playtime with a special toy at the end of longer wearing times, a special box or purse to keep the aids in; whatever might appeal to your child.
Some families celebrate a “hearing birthday” as a positive way to recognize the helpfulness of equipment. Proceed with caution, as this shouldn’t appear to a child that they needed “fixing.” In the same way, an “All About Me” day at childcare or church preschool can be reinforcing for some young children and can help educate playmates (and help them know to bring equipment to the adult in charge if found!)
Making an effort to connect with other children and young adults who use equipment, even at a very young age.
The toy hearing aids and processors available from companies like Build a Bear and American Girl can be rewarding for some children.
Be creative. Some babies just don’t deal well with the touch factor. Are there other wearing options? Some toddlers just really want to do it themselves. Are there parts of the wearing that they can control while keeping the equipment safe? Maybe mom or dad hands them the equipment and supervises putting it on.
Consider all behavior as communication. Does your child want more attention, different attention, is the aid not working properly, has their hearing changed? If the child wears the equipment well at school and not home, or vice versa, what is different in each setting?

Finally, parents and their teams can be a huge support to each other in being persistent. Professionals who see this as non-negotiable but remember to take a mental walk in the parents’ shoes during this often very stressful time are so appreciated by parents. While other parents might be celebrating the typical developmental miracles of Junior, our parents are up at night dreading the next professional visit if they will have to report that wearing times haven’t improved or the equipment is lost somewhere in the house. Not all families find this to be smooth sailing. Celebrate what your child is learning and doing in other areas. If your child benefits from hearing aids, this stage, too, shall pass. We welcome other ideas on our H&V Facebook page or chapter pages. There are as many creative solutions as there are unique, loveable children in the world.