All Waking Hours: Strategies to Maximize Hearing Aid Wear


by Michelle E. Graham, M.S., CED, LSLS Cert. AVEd

What is a parent to do when a child continually pulls out her/his hearing aid, loses it in the mulch at the playground, feeds it to the dog, or worse yet it’s in a pocket that just went through the wash? As a result of nearly universal newborn hearing screening, infants with hearing loss are identified and fitted with amplification within the first few months of life. Parents that have chosen listening and spoken language as a primary mode of communication for their child envision a future where their child reaches their potential thriving by listening to the language-rich world that surrounds them.

Graham article.baby in stroller image.207x300 pixelsIn partnership with their team of providers, including audiologists, educators of the deaf and hard of hearing, speech-language pathologists, and early interventionists, parents become their child’s first teachers of spoken language, which can only be learned through listening with hearing aids (or other hearing technology). Despite parents’ priceless dedication to researching, scheduling and keeping of appointments, caring for devices, and active participation in family sessions, device usage is a reoccurring concern for many parents. As a collaborative team using coaching strategies and applying adult learning theory, listening and spoken language professionals and parents can strive toward increased daily weartime facilitating optimal benefit for the child.

“Optimal benefit from amplification may only be achieved with consistent and appropriate hearing aid use” (Moeller, Hoover, Peterson, & Stelmachowicz, 2009; p. 14). It is recommended that children wear their devices all waking hours to access auditory information present throughout the day. The inverted recommended amount of daily hours of sleep per age group by the National Sleep Foundation (2015) are equivalent to the amount of waking hours per day that a child could be wearing their hearing devices. This gives professionals and parents an estimated amount of hours to strive towards in achieving the child’s usage of hearing devices during “all waking hours.”

The Need for Conversation
As outlined in the nine domains of knowledge for the Listening and Spoken Language Specialist (LSLS®) certification, it is the role of the professional to guide and empower parents as their child’s primary facilitator of language to create environments that support listening and to use hearing as a primary sensory modality by remaining consistent in device usage. Providers coaching families on their listening and spoken language journey establish elements that are critical for the success of the coaching relationship including support, collaboration, respect and trust (Hanft, Rush, & Shelden, 2004). In the September/October 2014 issue of Volta Voices, Jane Madell, Ph.D., and Karen Anderson, Ph.D., presented results of the Pediatric Hearing Aid Retention Project survey, which surveyed both parents and pediatric audiologists on the effectiveness and safety of hearing aid retention accessories and strategies. The results revealed that families have a significantly different view and ratings of the effectiveness of hearing aid devices and accessories.

Engagement in open and honest conversations on the challenges the parent faces is critical for ensuring consistent hearing aid usage by addressing acceptance of the hearing loss within the grieving process, device care, maintenance and usage, weartime awareness and concerns of the parents. Example questions generating a conversation in which the provider continues to guide the families include:  

  • DIAGNOSIS: How are you feeling about the hearing loss? What are your biggest worries? What cultural or societal pressures are you facing? How are you receiving emotional support? Would you like to connect and talk with others through parent groups or online communities? 
  • DEVICE CARE: What is your understanding of how the devices work? Have you had to do any troubleshooting? How do you test the batteries, listen with a stethoscope and blow out the tubing? What concerns do you have about device cost or warranty? 
  • DEVICE USAGE: Do you have concerns about device safety or programming? How comfortable are you with putting in the devices? How easily are you able to get them into place? What song do you sing while putting in the hearing aids? What do you do if you notice feedback? 
  • DEVICE WEARTIME: Why is the term “all waking hours” important? Is weartime a concern for you? How much does your child wear their device(s) throughout the day? What potential impact can you see from the amount of weartime? How can we increase weartime? 
  • DEVICE BENEFIT: What sounds does your child respond to without their hearing aids? What differences in listening behaviors or vocalizations do you notice when your child is wearing their devices? 

Conversations between provider and parent that explore these areas may reveal a contributing factor to a child’s inconsistent device usage. In the same way that Stowe and Wells discussed in their “Facilitating Change through Motivational Interviewing” article in the September/October 2013 issue of Volta Voices, it is important that a listening and spoken language professional takes into account a family’s experiences, helps them to identify the problem, and empowers them to make changes.

Factors Influencing Device Usage
A variety of factors may influence a young child’s device usage and their average daily weartime. Child related behaviors accounting for inconsistent device usage can include resistance or removal of the devices either due to discomfort, illness, sleepiness, developmental cognitive milestones or play.

Graham article.baby and mom at daycare.280x300 pixelsOne solution is for professionals to coach parents to better understand stages of cognitive and play development and behavior management techniques. This will aid them in applying strategies that distract or replace one interest with something more interesting along with purposeful caregiver responses.

As a child gets older, parents are able to establish the expectation of device usage through behavior management techniques. An example of this is a scenario in which participation in preferred activities requires the wearing of devices, such as “When you’re wearing your hearing aids, you’ll be ready to play!” Another solution to maximize usage of hearing aids is the use of conventional accessories available on the market designed to help with hearing aid retention. Providers working with parents can guide them through the usage of such accessories and their inclusion into the family’s daily routines. Children are evolving individuals and what works for one may not work for another, and what works today may not work tomorrow.
  
Adult behaviors can also have an impact on the amount of time a child wears their devices. A provider needs to work with a parent as an adult learner on developing applicable strategies to put into practice working towards an increased weartime during daily routines. The provider works to “effectively support the parents’ educational process as they attain the necessary skills to help their child each day” (Munoz, Blaiser, & Barwick, 2013; p. 13). Just as a provider coaches a family in learning strategies that facilitate listening and language throughout the day, the provider coaches the family on developing strategies to foster management of the hearing devices and consistency in device usage.

Every Little Bit Counts
Parents can ask themselves the question: How can I set up the situation so that my child is more successful with wearing her/his devices for longer amounts of time throughout the day? A provider coaches a parent through actively examining their daily routines and learning strategies, practicing them throughout the day, and reflecting on how they worked (Raab, Dunst, & Trivette, 2010). It is important for a parent to establish routines relating to the storage of the devices, set up expectations for themselves, and recognize that every little bit counts in terms of access to sound.

A busy parent may dismiss 20 minutes between the time a child gets out of the bath and goes to bed. However, by not wearing their hearing aids during this time they are missing out on exposure to listening opportunities and language in the bedtime routine that may include clothing and body parts vocabulary, singing of songs, and the “I love yous” exchanged with sweet kisses goodnight.

Tips and Strategies for All Waking Hours
Bedtime routine is just one of the many routines that parents encounter throughout the day. Strategies parents can put into place during daily routines may include the following list of examples.
  

  • MORNING: Store hearing aids near the crib in the child’s room so that you put them in first thing in the morning allowing your child the opportunity to hear your good mornings and language associated with waking up and getting your day started, including getting dressed or changing of diapers. Children laying on a changing table are in close proximity to their parent during a diaper change and focused on the interaction. Use this opportunity to sing songs, play peek-a-boo and other engaging games.  
  • MEALTIME: Children are often interested in mealtime and having an expectation that they are wearing their hearing aids while at the table for snacks or meals is important. Set up the expectation ahead of time and build it into the routine of getting ready to eat. If devices are being disturbed during nursing or bottle feeding, try to reposition the baby or use the football hold in which the ears are not pressed up against the adult. 
  • PLAYTIME: As a child gets older and begins holding her/his head up more or sitting upright, devices may stay in place more and produce less feedback by not being up against a solid object such as the floor or a caregiver’s chest/shoulder. Establish routines in which devices are worn during all playtime activities incorporating listening to a variety of environmental and speech sounds.
  • OUTINGS: If you are taking out hearing aids while riding in the car, buckle your child in the car, take out the aids and place them in their container on the floor of the backseat. After arriving, put the hearing aids back on your child before unbuckling her/him. This routine allows the child to experience the language and vocabulary associated with the anticipation of going on an outing and ensures that your child will be wearing their devices when you walk out of the car.
  • DAYCARE: Getting to daycare with hearing aids on not only takes responsibility off caregivers but also demonstrates that you really are making the wearing of the hearing aids a priority. Providers can visit with caregivers to inform and answer questions in regards to the child’s hearing loss, device care and usage. Caregivers should establish routines that encourage weartime throughout the day while the parents are not present.
  • BATHTIME: Take the hearing aids out just before placing your child in the water so that they are able to listen to the tub fill and hear language associated with the gathering of bath toys, getting undressed, and playing games while looking in the mirror. Store the hearing aids out of reach of the water, but accessible, so that you are able to put them back in right after getting your child out of the water. Talking to your child about why you take out her/his hearing aids before getting into the water helps build a child’s understanding of usage and a sense of responsibility for her/his devices. 

Graham article.baby bath.255x300 pixelsEven though your child may not be able to wear their devices during water play activities, parents should establish a routine for removal just before entering the water and reinsertion as the child ends the activity. Dry off the child’s hair and head first, put in the hearing aids, then dry off the rest of the body. The child may have missed information while they were not able to wear their device but afterwards they’ll be able to listen to conversations recalling the fun times and laughter. If a child takes a break from playing in the water and sits on a towel watching the action, put their hearing aids back in. This way they’ll be able to listen to the water splashing, children’s laughter, lifeguard’s whistle and parents’ narrative language and self-talk in reference to all the activities going on around them.

The usage of devices all waking hours is a team effort and consistency amongst caregivers will benefit the child. Through a collaborative learning process, "daily hearing aid management [becomes] a fundamental component of effective intervention" (Munoz, Preston, & Hicken 2014; p. 380) and parents feel empowered to make changes that benefit their child’s listening and spoken language development. Families and professionals alike want children to reach their potential and working as a team applying adult learner theory through coaching and the establishing of routines can help make that happen!

References
AG Bell Academy for Listening and Spoken Language (2015). Principles of LSLS. Available at http://www.agbell.org

Madell, J., & Anderson, K. (2014). Hearing aid retention for infants and young children. Volta Voices, 21(5), 22-25.

Hanft, B., Rush, D., & Shelden, M. (2004). Coaching families and colleagues in early childhood. Baltimore, MD: Paul H. Brookes Publishing Company.

Moeller, M. P., Hoover, B., Peterson, B., & Stelmachowicz, P. (2009). Consistency of hearing aid use in infants with early identified hearing loss. American Journal of Audiology, 18(1), 14-23.

Munoz, K., Blaiser, K., & Barwick, K. (2013). Parent hearing aid experiences in the United States. Journal of the American Academy of Audiology, 24(1), 5-16.

Munoz, K., Preston, E., & Hicken, S. (2014). Pediatric hearing aid use: How can audiologists support parents to increase consistency? Journal of the American Academy of Audiology, 25(4), 380-387.

National Sleep Foundation (2015). Expert panel recommends new sleep durations. Available at http://www.prnewswire.com/news-releases/expert-panel-recommends-new-sleep-durations-300028815.html

Raab, M., Dunst, C. J., & Trivette, C. M. (2010). Adult learning process for promoting caregiver adoption of everyday child language learning practices: Revised and updated. Practically Speaking, 1(2), 1-8.

Stowe, D. L., & Wells, S. P. (2013). Facilitating change through motivational interviewing. Volta Voices, 20(5), 32-35. 

Michelle Graham, M.S., CED, LSLS Cert. AVEd, is the Lead Early Intervention Therapist at St. Joseph Institute for the Deaf (SJID) in St. Louis, Missouri. She is an experienced Listening and Spoken Language Specialist (LSLS®) in the field of deaf education, currently providing in-person family sessions and working with school-age children via SJID’s ihear Internet Therapy program. She maintains certification in the area of Deaf/Hearing Impaired in several states in addition to Missouri certification in Early Childhood Special Education and Cross Categorical Disabilities: Mild/Moderate. Graham is adjunct faculty at Lindenwood University in St. Charles, Missouri, teaching a graduate course related to characteristics of young children who are deaf and hard of hearing.

Source: Volta Voices (2015), Volume 22, Issue 2