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Switch-on process for cochlear implants

Last reviewed: 25 June 2024

Switching on your child’s cochlear implants doesn’t mean they’ll be able to hear everything right away. It’ll take some time to programme their speech processor to match their deafness. Your child will also need to practise listening to learn how to interpret the new signals from their implant.

Find out what to expect at your child’s switch-on appointment, how you can help with their spoken language development, and what ongoing care and support will be provided.

Tuning or mapping speech processors

Two to four weeks after surgery, your child will have an appointment with the cochlear implant team to fit their speech processor (the external part of the cochlear implant).

At this appointment, the team will start programming the speech processor to suit your child. This is also known as ‘tuning’ or ‘mapping’. During a tuning appointment, the team stimulates the electrodes in the cochlear implant and measures which levels create sounds which are comfortably loud for your child.

How your child may respond

When your child’s implant is activated, they may react in a variety of different ways. Be prepared that it may not be a positive reaction. They may smile or look surprised, or they may cry or look frightened.

This may depend on your child’s previous experience with sound. Your child may need lots of positive encouragement and time to adjust to the new signal. Every child is an individual, and it’s perfectly normal for every child to respond differently.

Lucie is mum to Harry who is profoundly deaf. Harry got cochlear implants when he was one year old.

“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.”

Number of tuning appointments

In the beginning, the team will need to make lots of adjustments as your child starts to adapt to the new sounds and the electrode beds into the cochlea.

This means your child will need regular appointments during the first year. While the number of sessions can vary, most people go to at least six appointments in the first year.

After the first year, your child will attend the implant centre for a review and programming once or twice a year.

Lucie says,

“There’ve 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’.”

Ongoing care

The implant team will be able to answer your questions, talk to you about how you can help your child, and explain how you can expect your child to progress.

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, and later at school, to observe and record your child’s progress. The implant team’s ToD and SLT do not replace any services you’re getting from your local ToD or SLT. You should still be getting regular input from your local ToD and SLT.

It’s also a good idea to keep your own notes and observations so you can discuss any concerns with the implant team.

If your child develops glue ear or an infection in the implanted ear, you should contact your GP and get it treated quickly. You should also let your cochlear implant team know.

As your child grows up, they’ll need to learn about their implant and how it works so they can be responsible for looking after it. They’ll learn when to contact the implant centre for changes to the tuning and for repairs, spares, testing and advice.

Communication and language

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.

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

“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.”

Activities to practice listening

It’s important that your child wears their cochlear implants as much as possible so they can learn to recognise sounds and make sense of the sounds around them. Your child needs to use these new sounds to develop their communication skills and spoken language. Playing games, singing songs and reading stories will help develop these skills.

Ask your SLT and ToD for a list of games and activities that will help your child learn about new sounds and develop their listening skills. Cochlear implant manufacturers have online resources aimed at children of all ages to help them learn to listen and help with their language skills:

Mary says,

“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.”

Listening conditions

Always be aware of the listening conditions and keep background noise at a reasonable level. Make sure your child’s processors fit comfortably and securely so that they can wear them continuously when they’re awake.

Sign language

Before implantation, sign language may have been your child’s main communication method if they did not have enough hearing to understand spoken language.

Most parents find that once their child has adapted to the implant, they start to rely less on signing. The process of changing from sign-based communication to spoken communication occurs 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.

Regardless of whether your child uses speech, sign or a combination of both, the most important thing is that your child can develop fluent language skills to communicate by whichever method is appropriate and most effective for them.

Having an alternative method of communication, such as sign language, is often beneficial in situations where your child cannot wear their implant, such as at bathtime or if the speech processor is faulty.

Jennie is mum to Olive (4) who is profoundly deaf and has cerebral palsy.

“If she’s 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.”

Useful resources

Chloe Gets Cochlear Implants

For a fun and child-friendly way to explain cochlear implants to your child, check out our free comic, Chloe Gets Cochlear Implants.