Early one morning a mother playfully interacts with her 12-month-old daughter. The little girl wears two tiny pink hearing aids, fit when she was 3 months old. Her mild-to-moderate sensorineural hearing loss was identified through newborn hearing screening. Her mother naturally encourages her daughter's listening and language development and takes pride in her daughter's first spoken words. As I watch this, all seems right with the world. But moments later, two chubby hands reach for the hearing aids and out they come. The mother calmly reinserts them, and a few seconds later, out they come again. After seven rounds of this, I am impressed with the mother's persistence—and I wonder why a baby who was so well-adjusted to hearing aids suddenly is experiencing challenges.
I must admit that I was naïve when this new generation of babies with hearing loss began to wear hearing aids so young. I figured that babies would adjust to wearing their devices before their motor skills matured to the point at which they could easily grab their ears. I clearly underestimated various factors that complicate the process of hearing aid adjustment.
As we watched more families over time in the Infant Language Development Laboratory, several patterns related to hearing aid use were evident. A few families established early and consistent use with minimal difficulty. Others experienced trouble enforcing consistent use only during certain phases of the infant's development or in specific daily settings. Others were challenged by periods of non-use throughout the child's second year of life. These families were all motivated, educated, and wanting to do the best by their children. Why was the goal of "full-time waking-hour use" easy for some and difficult for others?
These observations and questions led to qualitative analysis of seven families' experiences with hearing aid use over their infants' second year of life. Our research, reported in the June issue of the American Journal of Audiology (Moeller et al., 2009), examined infant, situational, and parental adjustment factors that affected device use consistency. We created a structured interview that included 15 five-point Likert scale items and open-ended questions. Because adults are known to over- and under-report their total device use times (Humes, Halling, &Couglin, 1996; Taubman, Palmer, Durrant, & Pratt, 1999), we asked parents to rate use consistency (on a scale from "never" to "always") across a variety of daily situations. The interview was administered four different times (from 10.5 to 28.5 months) to sample various developmental stages in the infants' lives.
As we have all seen clinically, some infants are easygoing and adjust readily to new routines. Others are not as adaptable; their temperament is to react when pushed. Mothers reported less success with reinserting hearing aids with infants who tended to react strongly. In this circumstance, mothers gave the infant some wait time rather than engaging in a contest of wills. Mothers also reported the need to be sensitive to the infant's states (e.g., recovering from ear infection or other illness) when reinserting the devices.
Interestingly, some of these infants were more prone to remove their hearing aids at certain developmental stages. The discovery of causality concepts around 12 months may prompt a baby to take the hearing aids out, because the infant realizes that doing so gets immediate parental attention. Several parents reported the onset of tantrums when their toddlers reached around 16 months, with consequent barriers to hearing aid use. The main point is that consistency of hearing aid use can change as the baby develops new skills; we need to anticipate these variations, ask parents about them, and be ready with management strategies.
We also found that situations in which the infant can be closely monitored (e.g., book reading) were easier for families than other settings (e.g., car rides, outdoor play). Most families experienced difficulties with car rides, and audiologists may need to query parents about this situation and offer appropriate resources or technologies.
Family adjustment issues also may complicate the process (Sjoblad, Harrison, Roush, & McWilliam, 2001). Some families in our study reported that their infants with mild impairments responded similarly with or without devices. For families struggling with this scenario, we may need to clarify the links between consistent use and speech and language outcomes. In addition, because families report clear benefits of talking with veteran parents, family-to-family supports should be encouraged.
The audiological goal is to optimize infants' auditory experiences through consistent device use. We will support parents in achieving this by anticipating and addressing the various challenges that arise along the infants' developmental journey.