AV Strategies in daily life: months 3 and 4
Below is a summary for the third and fourth months, as posted on my Instagram @bridgesavp
1-3-6
If your baby has been diagnosed with hearing loss, you might have heard about the 1-3-6 recommendation from Early Hearing Detection and Intervention (EHDI) and endorsed by Joint Committee on Infant Hearing (JCIH). This concept is a plan outlined in the JCIH 2007 Position Statement principles.
1 month: All infants should have access to hearing screening using a physiologic measure
3 months: All infants who do not pass the initial hearing screening and the subsequent rescreening should have appropriate audiological and medical evaluations to confirm the presence of hearing loss
6 months: All infants with confirmed permanent hearing loss should receive early intervention services as soon as possible after diagnosis (but no later than 6 months)
Of course, this is not always what happens and sometimes this plan is not feasible for the specific child or family. It is an outline of recommendation in order to give the child and family access to language and supportive resources.
Where are you in the 1-3-6 timeline? How has it worked, or not worked, in your practice?
Here is the reported progress towards the 1-3-6 guidelines as detailed by the American Academy of Pediatrics
Only 86.0% of infants received hearing re-screening before 1 month of age.
Only 69.1% of infants who do not pass a hearing screening test are diagnosed with hearing loss before 3 months of age.
Of those diagnosed, only 67.1% receive intervention before 6 months of age.
Almost 36 percent of infants who do not pass a newborn hearing screening are considered Lost to Follow-up/Documentation.
At 3 months old…
While tickling, massaging, or gently rotating your baby, name their body parts and narrate how you are moving them. Ex. kick, kick, kick your legs. Marching, marching, marching. Knees up high. Rooooollllll over on your tummy. Now roooolllll on your back.
Slowing down and drawing out your vowel sounds such as the word roll in this example gives added interest to your baby. This sing song voice with elongated vowels is called Child Directed Speech, Motherese, or Parentese. It is typically something adults do naturally with babies and young children. Now let's step up this activity a notch. By adding Wait Time and Expectant Look, we are setting the foundation for conversational turn taking. As you roll your baby from their back, pause half way, raise your eyebrows, and lean in slightly.
If you don’t look this wild, step it up a notch! I usually say, if you don’t look a little eccentric, you’re probably not doing it right.
Wait Time and Expectant Look are like peanut butter and jelly, you can have them alone but it’s something special when they are used together!
I have to let go of my vanity and show you real expressions!
Vocalizations
We have set the stage for conversational turn taking by putting Wait Time and Expectant Look into practice with our daily routines and interactions with baby. At 3 months your baby might start cooing, gurgling or babbling to you. They will probably start with a gurgle in their throat, making spit bubbles, or vocalizing open vowel sounds. You can encourage these vocalizations by copying them right back to your baby. They love hearing these repetitive sounds and it creates value in their communication attempts. After you copy their vocalization, pause, give Wait Time, lean in with an Expectant Look, and give your baby another turn to coo to you. This back and forth exchange is also frequently referred to as Serve and Return.
(5 Step Guide to Serve and Return available here in English and Spanish)
Optimal Position
For children who are deaf and hard of hearing and are learning to listen and speak, knowing the Optimal Position for access to speech is important for communication. Knowing which side provides better or more clear access to speech sounds though hearing technology as well as what visual cues a child might need allow the adult to position themselves and the child for optimal communication. This strategy will become critical as the child ages so it is another skill to start developing early on, even though the impact at this young age is somewhat lower.
Tummy Time: if the left or right side has better access, try to position yourself to give input to that side
Feeding: think about how the hearing equipment might be compromised or ineffective depending on the position you use for feeding. Cradling a baby in your arm for long periods can create some feedback in hearing aids.
Playtime: give some thought to which side might have better access to sound as well as giving the child visual access to your face and the play materials. Later your child will work on learning to listen without seeing the speaker's face, but at this age it is a completely natural position
Grooming: do you always face your baby the same way in the tub or changing table? How does it affect their access to sound?
Daily routines and interactions lend themselves to exposing your 3 month old baby to rich language. Changing a diaper, washing hands, feeding, getting dressed- all these baby focused routines can be narrated where the adult tells the baby what they (the adult) are doing. This is called Self Talk. Adult or family centered routines such as cooking, laundry, checking the mail, gardening, shopping, driving, whatever hobbies you’re into...all these things can be narrated, as if you are a sports caster, to expose your child’s brain to a wide body of language.
At 4 months old…
Reaching and Rolling
At 4 months old your baby might start rolling either belly to back or back to belly or both (or neither like my youngest!) They might also begin to reach for objects they would like to hold or put in their mouths.
As they are reaching and rolling you can foster Joint Attention (when you and your baby both have attention on the same action or object) by narrating through Self Talk about the object you are focused on. While you and your baby have Joint Attention on a toy, for example, they are getting information in an Auditory First method (listening to your Self Talk before you point to or manipulate the toy).
Babies Love Faces
At 4 months old, babies love faces and they are still developing object permanence so peekaboo is an activity that will make them giggle easily! Peekaboo creates an opportunity for working on Wait Time and Expectant Look. Waiting while covering your face is a purposeful pause, followed by the raised eyebrows of an Expectant Look, creating the expectation that response is necessary from baby. Peekaboo! Get a feel for all the different ways you can adjust the Acoustic Highlighting with this word and how the emotion and meaning may change.
If you’re in a situation where you don’t have toys on hand and need to entertain your baby, use your face! Silly faces and sounds will grab their attention and keep them engaged. This is another opportunity to practice your Expectant Look, Wait Time and bring in Auditory Bombardment. Silly sounds such as /bbbbbbb/, /ooooooo/, or horse lips to accompany your silly faces take this experience to the next level. As babies grow, Auditory Bombardment will be focuses on meaningful words, but at this age isolated sounds are appropriate.
Each of these strategies and their definitions/resources/examples can be found by downloading the free ebook from the navigation at the top of the page. A single strategy handout can be found by visiting the blog post for each strategy and finding the link at the bottom. Enjoy!