The Childcare Challenge

Published by Editorial Staff at March 11, 2015

Three-year-old Nora spends two days a week at her neighborhood daycare. She plays with her buddies, doing the kinds of things that preschoolers do: stacking blocks, finger painting, and chasing friends in a serious game of tag. Despite a day punctuated by group play, Nora’s mom says the preschooler, who wears bilateral cochlear implants, also spends a lot of time by herself. “She can’t hear very well in that environment,” explains Deb Callahan. “It’s acoustically terrible. She just kind of sits there a lot.”

Trusting the care of a child to someone else is one of the hardest things a parent has to do. When that child has hearing loss, finding the right childcare provider becomes even more challenging. Not only are parents faced with finding a safe and engaging environment, the right cultural fit, and something that is within budget, they also have to pay attention to a whole host of other details. Does the provider have any experience with children who have hearing loss? Is the staff willing to learn and implement effective communication strategies? And, as Nora’s situation illustrates, how are the acoustics at the facility—because noise can wreak havoc on a child’s ability to communicate with the other kids?

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“I didn’t want to make her a burden to her teacher. I didn’t want the staff to look at her and say, “Oh god, here comes Nora.”

[/stextbox]Lisa Mancl, a pediatric audiologist with the Center on Human Development and Disability at the University of Washington Medical Center, says success with childcare is dependent on several factors. “The quality of the childcare providers, how the family communicates, and their relationship with providers completely dictates how things will go,” says Mancl. She recommends that parents provide clear “instructions” on the care of their child with hearing loss. “We all have some kind of manual that goes with our kids, right? You know, ‘My kid can’t have peanuts,’ or ‘He uses this kind of diaper cream, because he’s allergic to the other.’” Mancl says information about hearing loss is just another bit of information to add to the list.

Nora’s mom is acutely aware of how delicately she has to balance Nora’s needs in the daycare, with the needs of the staff to effectively care for all the children. “I didn’t want to make her a burden to the teacher,” Callahan admits. “I didn’t want the staff to look at her and say, ‘Oh god, here comes Nora.’”

The San Diego mother did, however, provide the childcare center with a basic overview of communication strategies. She described the importance of getting Nora’s attention before talking to her, and the need to make eye contact and ensure Nora can see the speaker’s lips and read facial expressions—important pieces in the communication puzzle. Callahan also provided in-depth information about Nora’s cochlear implants.

Mancl says the kind of information that daycare providers need is really two-pronged: communication-specific and device-specific. Communication-specific information includes providing details about the importance of getting a child’s attention before talking, facing the child during conversation, and maintaining eye contact, as well as:

Reducing competing noise
Improving the environmental acoustics with rugs, carpet, and other materials that help absorb noise
Standing or kneeling close to the child with hearing loss when having a conversation
Talking, talking, talking to the child with hearing loss

The key to success, Mancl says, is to talk about things that the child is truly interested in. “Once you are engaged in communication and talking to the child, then you’re treating the child like all other children,” the audiologist says. She also notes that, according to research, children learn language best by interacting with other humans and having social conversations. They don’t learn it by watching a television.

In addition to communication know-how, childcare providers also need device-specific information, including:

Why it’s important for the hearing aids or cochlear implants to be on when the child is awake
How to put the devices on—and keep them on!
How to operate the hearing devices
How to protect the devices from water
When to change the batteries
Why a hearing aid that whistles means the child may have outgrown the device or ear mold

Since Callahan and her wife both work full time, Nora also spends three days a week attending San Diego’s Early Childhood Special Education (ECSE) program with other children who have hearing loss. Callahan says the ECSE program, which is held at a city high school, provides important support and resources to their family. “It’s where we get educated teachers who give us a heads up on things that we might not see or notice,” Callahan says, adding that she would love to have that kind of classroom support in Nora’s community daycare.

In fact, Nora’s teacher from the ECSE program came into the little girl’s community daycare to provide specialized training for the staff. “The early intervention teacher came in and talked for just a little bit with the daycare providers,” Callahan says, “but they weren’t very interested in working with her. She [the early intervention teacher] ended up just sitting and playing with Nora.”

Despite her frustration at the daycare’s apparent lack of interest, Callahan remains committed to Nora’s neighborhood childcare center, knowing that the relationships her daughter builds there could have an important affect on the girl’s K-12 experience. “If she ends up in public school, it’s important to me that she is in the classroom with the neighborhood kids, the ones she’s been going to daycare with for years,” says Callahan. The trick for Callahan and other parents like her is to ensure that childcare providers realize and accommodate the special needs of children with hearing loss.

Looking for helpful resources? Check out this primer by educational audiologist Karen Anderson: “Welcoming the Child with Hearing Impairment into Child Care.”