Tips for Testing Pediatric Patients

Completing conventional audiometry with adults is one thing, but what about obtaining hearing thresholds on a 19-month old? Tympanometry on a 4-year-old who doesn’t want to sit still? Read on for additional tips and tricks for providing patient-centered care to your pediatric patients so that you can get the most out of each and every audiology appointment.

1. Build rapport with child AND parent. Providing services to the pediatric population really means you are serving the entire family. This may require you to wear multiple hats to ensure the needs of all in the appointment are being met. It is important to establish rapport with the child, as well as his or her parent. You can do so by addressing every person at the beginning of the appointment as you introduce yourself–make note of their names and relationship to the patient. Working with pediatric populations means you’re balancing a professional demeanor with child-appropriate language and mannerisms. For younger children, you’ll go a long way to get on their level by sitting down, smiling, and talking to them in a calm voice. If appropriate, based on the child’s age and developmental abilities, direct some of your case history questions to them as well as the parent. Connect with older children by asking about their lives outside of the audiology booth. If they mention a specific hobby or interest, attempt to join in on the conversation—and bring it up again at a future appointment!

2. Team work makes the dream work! The parent is an important part of the testing team, as they interact with their child more frequently than you do. Involving the family can improve the outcome of the appointment. For children who are difficult to test, ask the parent for tips to encourage their child to feel more relaxed and willing to participate. Ask parents if the child likes particular sounds (i.e. animal sounds) or songs (i.e. Moana!) that you can use to obtain a speech awareness threshold. Ask if they would like to watch a certain movie during OAE testing. If the child is motivated by treats or snacks, ask the family to bring those items in prior to the appointment. Being prepared and working as a team with the family will go a long way to get good test results.

3. Be flexible and patient. Working with children requires on-the-go thinking and adapting. You may have to show the child what will happen during otoscopy by practicing on Mom first. Or you may have to transition from game to game in the booth to keep the child engaged during conditioned play audiometry. Although being flexible takes extra time in an appointment, you’ll be more likely to get the information you need. Always be on your toes to see when you may need to change things up! Sometimes you will not be able to get all the testing you need, and you may feel frustrated. Instead, stay patient and calm as you attempt to get what you can in that appointment.

4. Offer choices during testing. Some children may not want to participate in testing. Make sure you are firm but kind when providing instructions. Instead of asking, “Do you want to play a game with me?”, say, “We are going to play a game. Do you want to make a pizza or build a tower?” You may also allow the child to help with testing, such as pushing the button to run a tympanogram or putting on the headphones. Providing children with the opportunity to make autonomous decisions during testing may interest them in participating, allowing you to obtain additional audiological information.

5. Reward their successes: Recognize that the hearing evaluation appointment may be scary or tiring for a child, especially if it is their first time in the booth. Notice when a child has been particularly brave or willing to stick it out during an appointment. Provide praise and encouragement as acknowledgement of a good day’s work. A high five and a sticker also go a long way to say “good job!”

And remember, last but certainly not least, it is important to think about what happens AFTER the testing is complete. Talking about hearing testing results may be overwhelming for a family, regardless of the outcome. When diagnosing hearing loss, most are born to families without hearing loss and they may not even know anyone else with this diagnosis. Even though you talk about audiograms and hearing aids daily, a new diagnosis of hearing loss is very new information for a family. Practice talking through an appointment (tympanometry, audiometric results, recommendations including amplification, etc.) with a friend or family member who is not familiar with audiology. Ask them for feedback about what may or may not be clear to them. This will help you develop your counseling skills and ensure you are providing understandable test results and recommendations for all your pediatric patients and their families.

Hilary Davis joined the Pediatric Audiology team at Vanderbilt University Medical Center in 2014 after graduating from Vanderbilt. She currently provides pediatric diagnostic and rehabilitative services and contract educational audiology services to local school districts. She also serves as Project Coordinator of the Listening and Learning Lab, under the direction of Dr. Fred Bess, studying listening-related fatigue in school-age children with hearing loss. She loves working with remote microphone technology and ensuring children with hearing loss receive excellent school-based care.