Hearing Aid Fitting and Evaluation for Infants

A child's early years are important for speech and language learning. Finding the best hearing aids for your child will help ensure the child has access to speech and sounds in the surrounding environment.

It is important to work with a pediatric audiologist who has experience fitting and testing hearing aids on young children. Testing hearing aids on children is not the same as testing adults. Adults can tell the audiologist if the hearing aid is too soft or too loud, or if it is working correctly. Babies and young children cannot do this, so different fitting and testing procedures must be used.

Recently, you may have heard about Over-the-Counter (OTC) hearing aids that can be purchased through the mail, online, or in retail stores and pharmacies. It is important to know that these OTC hearing aids are not approved for use in children under the age of 18 years. You can learn more about why it is important to work with a pediatric audiologist to get hearing aids for your child in this article: Children and Over-the-Counter Hearing Aids.

Hearing Aid Evaluation and Selection

Hearing aids must be selected carefully for each child. When choosing what hearing aids are needed for a child, the audiologist will consider some important information:

  • The degree and type of the child's hearing loss
  • The durability of the hearing aid
  • The service from the manufacturer
  • The hearing aid's ability to connect to other devices

If a baby or young child has hearing loss in both ears, pediatric audiologists almost always recommend hearing aids for both ears. Listening with both ears is needed to help speech and language learning and is important for a child's safety because it helps them know from what direction sounds are coming.

After discussing the options with the family, the hearing aids will be selected and the audiologist will order them. The audiologist may also take impressions of the child’s ear to order earmolds. The hearing aid fitting appointment will be scheduled a few weeks later once the hearing aids and earmolds have arrived.

On the Day of the Hearing Aid Fitting

The day that your child is fit with hearing devices is very exciting, but may also be filled with uncertainty. It is natural to feel a range of emotions, and also to expect a range of reactions (excited, frightened, withdrawn) from your child when being fit with the hearing device for the first time.

Many parents find the amount of information provided on this day to be overwhelming. It is important that your questions are answered on the day of the hearing aid fitting—you may want to write down your questions or take notes during the appointment to help you remember. You can always follow-up with your child’s audiologist if you forget something. Often, your child’s early interventionist can help fill in the gaps, but your child’s audiologist may also be able to provide written or online resources for you to refer to whenever needed.

On the day of the hearing aid fitting, the audiologist will:

  • Put the hearing aids and earmolds on your child’s ears to ensure they fit properly.
  • Complete some tests to see if speech can be heard adequately at different levels through the hearing aids.
  • Make programming adjustments to customize the hearing aid settings for the child’s hearing needs.
  • Teach you how to put the hearing aid and earmold on your child’s ear and take them off.
  • Show you how to take care of the hearing aids and check if they are working, (e.g. change the battery, clean the earmold, listening check).
  • Share information about hearing aid warranties and follow-up appointments.

How to Test Hearing Aid Benefit

Infants and young children cannot tell us what they hear. The best way to test hearing aid benefit is to see how the hearing aid is working in the child's ear. Audiologists measure the sound from the hearing aid in the ear with a probe microphone system. Probe-microphone testing helps the audiologist judge how much speech will be heard, or audible, through the hearing aid. This is called aided audibility of speech. Using measures of aided audibility, the audiologist can compare different hearing aid settings and different listening situations. The differences between speech access with and without the hearing aid also can be compared.

Probe Microphone Testing Steps

  • A thin, soft tube is placed in the child's ear with the ear mold.
  • The tube is attached to a microphone held in place by a soft, rubber band-like loop that goes around the ear.
  • A passage of speech is played from a speaker and the microphone measures the amount of sound coming out of the hearing aid while it is on the ear.
  • The hearing aid programming is adjusted to your child’s hearing prescription using these results and then testing may be repeated.

Children have much smaller ears than adults, so it's important to take measures on every individual child's ear to make sure their hearing aids make speech audible. These measures will be repeated many times as the child grows to account for their growing ear canals.

Sometimes babies or young children are unable to sit quietly or be still long enough to make the probe microphone measurements with the hearing aid in the ear. A special test designed specifically for babies and young children, called the Real-Ear-to-Coupler Difference (RECD), can be used at those times. The RECD test is easy and safe for babies and young children and only takes a couple minutes to complete.

Probe microphone testing on toddler 

Real-Ear-to-Coupler Difference (RECD) Steps​

  • The audiologist makes a quick probe-microphone measure, very similar to the probe microphone testing described above, with just the child's earmold or an insert earphone in his or her ear.
  • A thin, soft tube attached to a microphone is placed in the child's ear and held in place by a soft, rubber band-like loop that goes around the ear.
  • A small speaker is attached to the child’s ear mold or an insert earphone that is placed in the ear.
  • A quick sound is played and the probe microphone measure of the child’s ear canal is made.
  • The aided audibility of speech for the hearing aid can then be tested in a separate testing box using the RECD results.
  • The hearing aid can be adjusted for the child, and the child does not have to keep the probe microphone in their ear for more than a few minutes.