Switch-on, ongoing care and support for cochlear implants

Around 2 to 4 weeks after surgery, your child will have an appointment with the cochlear implant team to fit their sound processor (the external part of the cochlear implant). 

When your child's cochlear implants are switched on, they won't be able to hear everything right away. It’ll take some time to programme their sound processor to match their deafness. Your child will also need time and practice to learn how to interpret the new signals from their implant.

Find out what to expect at the switch-on appointment, how to support your child's language development, and what ongoing care and support will be provided.

Tuning and mapping sound processors

During your child’s first appointment, the team will start programming the sound processor to suit your child's hearing needs. This is also known as ‘tuning’ or ‘mapping’. The team will stimulate the electrodes in the cochlear implant and measure the levels that are comfortably loud for your child.

How your child may respond

When the implant is activated, your child may react in different ways. Be prepared that their initial response may not always be positive. Some children smile or look surprised, while others might cry or seem scared.

How your child reacts may depend on their previous experience with sound, and it’s perfectly normal for every child to respond differently. Some children need lots of encouragement and time to adjust to the new sounds. 

“We were expecting a massive reaction, even though we were told there might be no reaction. Harry’s eyes went wide but he didn’t cry. But audiology don’t give them the full volume and range to start with as they don’t want to scare them.” 

Lucie, mum to Harry, who is profoundly deaf and got cochlear implants when he was 1

Follow-up appointments

In the beginning, the implant team will need to make regular adjustments as your child starts to adapt to the new sounds and the electrode beds into the cochlea. This means your child will need frequent appointments, with most children attending at least 6 appointments in the first year.

After the first year, review and programming appointments will occur once or twice a year.

“There have been gradual changes to his behaviour since – it’s been a longer process than we thought. He has to go back for appointments every few weeks for tuning and mapping. But in the first week he started turning for his name, which was an emotional thing for us, and then started repeating ‘mama’.” 

Lucie

Ongoing care and support

The implant team will be there to support you and answer any questions you have. They will guide you on how to help your child's development and explain what progress to expect.

In addition to tuning appointments, you may also have sessions with a Teacher of the Deaf (ToD) and a speech and language therapist (SLT) from the implant team. The ToD and SLT may visit your child at home or school to observe and record their progress. However, the ToD and SLT from the implant team will not replace any local services your child is receiving – such as support from your community’s ToD or SLT.

It’s also a good idea to keep your own notes on your child's progress and bring up any concerns with the implant team during appointments. Our app for parents, My NDCS, has a notes feature you could use for this.

If your child develops glue ear or an infection in the implanted ear, contact your GP for treatment and inform your cochlear implant team.

As your child gets older, they’ll need to learn how to care for their implant, including when to contact the implant centre for adjustments, repairs or advice. Find out about maintaining cochlear implants.

Communication and language development

It may take a long time for your child to learn to interpret new sounds using the implant. It will take a lot of patience and practice.

“The implant was turned on and it wasn’t like you see in the news. Nothing happened. Those internet videos are so misleading. It took a long time and a lot of work for Genevieve to process sound.” 

Mary, mum to Genevieve (8), who is profoundly deaf after contracting meningitis at 5 weeks old

Activities to practice listening

Wearing the cochlear implant as much as possible will help your child become familiar with the sounds around them and develop their listening skills. You can support their learning by engaging in activities like playing games, singing and reading stories.

Ask your SLT and ToD for a list of games and activities that will help your child learn new sounds and develop their listening skills. 

Learn more about language and communication and communicating with babies and toddlers.

Cochlear implant manufacturers also offer online resources for children of all ages to support listening and language development:

• BabyBeats (Advanced Bionics website)
• Hearing activities for babies and preschoolers (Cochlear website)
• Rehabilitation resources (MED-EL website)
• Music listening for young CI users (University of Southampton website)

“In the beginning I did a lot of singing to her. The doctor said she’d be more likely to pick up on sing-song noises.” 

Mary

Listening conditions

To help your child hear clearly, keep the environment as quiet as possible. Reduce background noise and make sure the sound processor fits comfortably and securely so that your child can wear it consistently throughout the day.

How to keep technology on babies and young children

Sign language

Before receiving their implant, your child might have relied on sign language as their primary way of communicating if they couldn't hear enough to understand spoken language.

As your child adapts to the implant, they may start to use less sign language and rely more on spoken communication. This transition typically happens naturally, but for some children, sign language will remain an important part of their communication and identity. 

Allow your child to continue communicating in the way that feels most natural to them. Whether your child uses speech, sign language or both, the most important thing is that your child can develop fluent language skills in whichever form works best for them.

Having an alternative method of communication, such as sign language, can be helpful in situations when your child is not wearing their sound processor, like during bathtime or in the middle of the night, or when the sound processor is faulty. 

“If [Olive] is cross and has had enough, or if she’s tired, she’ll take her implants off. She’s getting better at telling us when she takes them off and she’ll tap her ears or tell us that she wants them back on too. On the days she wears her implants, it’s clear she loves listening and enjoys sound.

“We try not to make her put them on though, as the whole reason we got implants for her was so that she could make the choice. If she’s said no, we try and respect that and we then sign.” 

Jenny, mum to Olive (4), who is profoundly deaf and has cerebral palsy

Useful resources

• Hearing Success (Advanced Bionics website): Online communities where parents of deaf children can connect and share experiences.
• Your Cochlear stories (Cochlear website): Personal stories from people who have gotten cochlear implants.
• HearPeers forum (MED-EL website): A forum where cochlear implant users from around the world share advice and experiences.