Advice for New Pediatric Audiologists

Advice for New Pediatric Audiologists
Jane Madell
June 14, 2022

Spring time and a bunch of newly minted people will graduate as audiologists. Some will even be pediatric audiologists. (Hurrah – we need as many as we can get!! )

What does it take to become a good (or great) pediatric audiologist? Pediatric audiology is different than adult audiology. For both you need to understand  all the basics of testing and diagnosis. But there are a few other things you need to know. It is not until you start testing children that you start to understand. 

What does a good pediatric audiologist need to know?

  1. First you need to feel comfortable working with little people. If you have not had a chance to get to know little people well, volunteer in a nursery school, and visit friends, relatives and neighbors who have little ones, so that you can become comfortable and figure out what makes little ones tick and how to entertain them and get the to cooperate.
  2. Over the years I developed a reputation for being able to test difficult children. I think this was because I refused to give up. When I was a clinical fellow testing a young child I walked into my mentor (David Luterman) office and told him the child was not testable. He looked at me and said “You will have to write in the report – I was not able to test this child.” I definitely did not want to write that often so I was determined not to have to write that often so I developed the skill to work with difficult children.

Don’t just give up if a child doesn’t want to cooperate. I developed a reputation for being  able to test children with autism. I remember the first autistic child I tested. His mom called and asked if I could test autistic children. She wanted to know if he had hypersensitive hearing. I asked why and she told me that an ENT physician in France who had developed  a treatment that reduced symptoms for children with autism. Needless to say I was suspicions but I agreed to test him. I ended up sitting on the floor under the play table with the child and a portable audiometer to test. I succeeded. I had learned not to give up (and I didn’t want to write in the report that I was unable to test the child)

Years ago a friend who was a psychologist brought her niece to me for a hearing evaluation. The little girl did not want to cooperate but I wouldn’t give up. I pushed ahead and at the end my friend said she learned something – you are kind but firm. I think it is a good description of how we should behave when testing children. We don’t want to yell at them or be overly firm but we need to be gentle but firm.

  1. Understanding some basics. Once we test we have some information about what a child is hearing (and what they are not hearing) we have to plan for management. The audiologists primary goal is to be certain that children are hearing maximally. The better they hear the better they will learn to listen and talk. Good enough is not good enough. In order to plan management you need to really understand speech perception. We need to know what a child hears and what they are not hearing. Understanding speech perception will be critical. If a child does not hear the voicing component of sounds (confuses /d/ and /g/) then we know they are not hearing the low frequency voicing component. If they are not hearing /s/ or /z/ and cannot differentiate between shoe and shoes they are missing the high frequency component with information above 4000 Hz. We really need to know this because we need to adjust technology settings to be sure that the child can hear all phonemes (not just the Ling 6 or the Ling-Madell-Hewitt 10 phonemes.)
  2. Providing support is a critical part of pediatric audiology. Families need support in dealing with a diagnosis of hearing loss. As my friend Johnnie Sexton says, we need to be there and be empathetic. We are in a hurry to fit technology and to get a family into therapy but for that to succeed we need to understand what they are going through and help them get to acceptance. We also need to understanding children with hearing loss also need support. We explain everything about hearing loss to parents at the time of diagnosis. We need to provide support to children after that. Once children are between 6 and 8 they may go through their own grieving about having a hearing loss and we need to be there for them. No matter how wonderful your audiology skills are, if you cannot provide support you cannot succeed.
  3. Understand all there is to know about the child. Not just audiology. How is the child’s speech and language? How is the child doing in school? Does the child have friends? It takes a village to raise a child with hearing loss. We need to work with everyone who is also working with the child to be sure the child is getting everything they need to get.
  4. Have high goals. Good enough is not good enough. We sure technology is providing everything it needs to provide. Be sure children are hearing all they need to hear so they can develop good listening, language and literacy skills.  We need to help everyone we work with have high goals. Be optimistic.  We need to believe that children can succeed and be who they want to be and until we believe it we cannot help the family believe it.
  5. Ask for help. It is okay not to know everything but it is not okay not to ask when you do not know. Our children are entitled to competent professionals. That means, we need to ask for help, we need to be available to discuss cases with our colleagues, we need to continue to read and to learn. I jokingly say when you stop learning you should be selling shoes. Maybe it isn’t such a joke.
  6. Enjoy every minute of your job. Well, maybe not every minute, but most of them. Working with kids should be fun. Succeeding in making a diagnosis and watching children progress should be exciting. Some days it is challenging but if you are finding that most days are not happy maybe we need to rethink the way we are doing the job. I have loved almost every day of the more than 50 years I have done this job. I love the kids and their families. I love watching them grow. I love trying to solve the mysteries of hearing loss. I have loved working with other clinicians and helping new clinicians develop pediatric skills. It has been an adventure. I have been very lucky indeed.

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