Hearing assessments for infants and young children at CHF

The hearing assessments for infants and young children at CHF are behavioral hearing evaluations, which are conducted based on children’s ages and capabilities. During the assessment, an audiologist plays test sounds, leads the procedures, and records the results. A hearing healthcare administrator stays with the child in the testing area to ensure a smooth assessment process.

The hearing assessment rooms at CHF are comparable to those in hospitals. Assessment results are compared with reports from hospitals. Hearing evaluations with hearing aids also help parents understand if the corrective benefits of hearing aids are facilitating the child’s auditory-verbal learning. Audiologists explain the reports in detail and answer questions to assist parents in clearly understanding the hearing status of their child.

Hearing assessments for adults and children at school age require receivers to respond to sounds, such as by pushing a button. However, if assessments are for children under three who do not usually understand instructions, how do the tests proceed? Or, if little children cry loudly and show resistance, what should examiners do to help?

(The above picture is a simulation photo and does not represent the real hearing assessment.)

Julie Ma, a CHF audiologist with years of experiences in hearing assessments for infants and young children, and Ariel Tsai, a hearing healthcare administrator who regularly assists in conducting hearing assessments, are sharing their experiences through a Q&A to provide our readers with a glimpse of hearing assessments at CHF. 

Question: How do you help children receiving their first hearing assessments at CHF to be less scared?

Ma: We have different approaches depending on the child’s age. However, there are still some general rules. For example, our hearing assessment rooms are painted colorfully and decorated with cute stickers. We hope children can sense that this environment is fun and friendly. Staff avoid wearing black or white, which kids associate with doctor gowns. Our work identification cards are also adorned with cute items, aiming to make children less scared and more willing to interact with us.

Question: How do you interact with shy children?

Tsai: If a child always hides behind his/her parents, I play with toys first and sometimes even play with the parents. The kid usually observes us at the beginning, and then he/she may begin to participate gradually and join us.

Ma: We play games to break the ice. However, there are fewer children in each family in recent years, and many children seldom have experience in interacting with peers. They tend to be shyer and sometimes even push toys away when we try to offer them.

Tsai: When this happens, I need to come up with other ways to make toys more fun and attractive.

Ma: Like cheering together or making the ball bounce higher, etc., to attract them and also divert their attention.

Question: If, during the assessment, children cry or are uncooperative, how do you react?

Tsai: If it is an infant, he/she may need to be held and comforted. He/she can also be hungry or need a diaper change. In this case, we ask parents to take care of it first.

Ma: If it is an older child, we use toys to divert his/her attention to prevent the kid from crying and asking to leave the assessment room. If the child is moody and throws toys away or even pushes and hits the healthcare administrator, we may hold his/her hands and tell him/her this behavior is not allowed; we want to help children understand how to cooperate with us.

Question: When children are old enough to understand instructions, we can conduct hearing assessments with games. Why are some of the children still unable to cooperate?

Ma: If the ice-breaking activity is not successful, children are still afraid. In this case, we need to give them more compliments and encouragement to build up a relationship with them.

Tsai: If a child is shy or afraid, I use toys to attract the child. Sometimes I have to bring more colorful toys or those with more parts. When the child hears the test sound, we let him/her play with one more part, and therefore help the child continue the assessment.

Ma: Sometimes children focus only on the game and forget that it’s actually a part of the assessment. When this happens, we have to use less interesting toys or even remove toys. If a child feels forced to receive assessment and is unwilling to cooperate, I make a deal with him/her such as “Two more test sounds, and we are done.” From our experience, children under two are more easily lured by toys, and usually children above three can be cooperative through making deals.

Question: In addition to making children cooperate, what challenges do you face when conducting hearing assessments?

Ma: When we perform assessments for infants and young children, we face not only kids but also anxious and worried parents. When we are conducting the assessment, the most important thing for children is to listen carefully to the test sounds. Therefore, healthcare administrators need to give short instructions, but sometimes accompanying parents keep talking to their children out of anxiety or high expectation. This actually interferes with assessments because it distracts children and prevents the audiologist from playing the test sounds at the right time. If necessary, we communicate with parents before resuming assessments. 

Question: What capabilities do CHF audiologists need to have besides being able to take care of infants and young children?

Tsai: During the checkup, I cannot always predict when the audiologist will play the test sounds. I need to rely on responses from the audiologist to identify if the child really hears the sound or just pretends to for the chance to play with the toys. If the child’s reaction is not authentic, I have to stop it appropriately without making the child unhappy. If the reaction is real, I need to encourage the kid and give various encouragement to keep it fresh. However, sometimes new audiologists or intern audiologists forget to provide hints, which makes it difficult for me to proceed.

Ma: Therefore, CHF audiologists must not only know how to deal with children but also pay attention to parents and healthcare administrators.This is what makes children’s hearing assessment different from that of adults.