Professionals must first help parents identify the language their child needs to learn, based on their specific routines, in order to communicate successfully in their home environment. This begins with the first session, during which the professional and the caregivers talk through the child’s routines. Caregivers identify parts of the day which are successful and other times that are a struggle. Sometimes, difficult parts of the day can be improved by focusing on the language the child needs to successfully participate in that routine. By focusing on the language surrounding daily routines, the child gains valuable skills that will help him/her communicate with his/her family, rather than learning a specified set of vocabulary words associated with a particular toy or game. This allows for more practice, embedded in routines that happen naturally and regularly, and provides the child with functional tools to communicate.

One daily routine that can easily be enhanced with language development strategies is diapering. This repetitive activity performed multiple times per day provides ample opportunity for the practice of meaningful language as well as face-to-face interaction from an ideal distance for listening. Optimally, diapering should occur in a quiet environment with minimal background noise. The caregiver can take a little extra time to narrate what she/he is doing as she/he does it.

“It’s time to change your diaper. Let’s walk over there to the changing table. I’m going to lay you down right here on the changing table. Oh, look at these cute little feet. I’m going to kiss those feet. Let’s unzip your jammies. Down, down, down it goes. Now let’s take this foot out – one kiss for this foot. And then let’s take this foot out – one kiss for this foot. Let’s take off this wet diaper. It’s all wet. I’m going to throw it away. Let’s get the wipes. Pull! I got a wipe. Feel the wipe. It’s cold. Brr, the wipes are cold! Okay, let’s clean you up. There we go. Now we need a new, clean diaper. Bottoms up! Time to put your feet back in your jammies. One foot. Two feet. Zip, zip, zip. Zip your jammies. Now you have a nice clean diaper and we’re all done! How about a hug?”

Diapering also provides lots of opportunities to talk about body parts, items of clothing, or to play peek-a-boo or a tickle game. The caregiver can hang a small mirror on the wall next to the changing table and incorporate a few moments of mirror play. This simple activity can be enhanced to create a warm, language-rich interaction between caregiver and child, rather than a chore that must be rushed through many times a day.

Feeding is another repetitive routine that can easily be enhanced to incorporate listening and spoken language strategies with an infant. As with diapering, the professional can encourage caregivers to feed their baby in a quiet environment, with minimal background noise. Cradling the baby in the arms creates an optimal distance for listening and meaningful interaction, whether breastfeeding or bottle feeding. By taking the time to interact warmly with their baby, caregivers are helping to create a secure attachment as well as a motivating time for listening.

“Oh, sweet baby, you are really crying! Are you hungry? I hear you! Here it is. Here’s your bottle! Mmm, there you go. It’s yummy! That’s better. Now your belly feels much better!”

During feedings, the caregiver can sing songs, talk about body parts, or just speak softly and warmly about the day. Using a standard cradle hold to feed a baby is very natural, but can be tricky for a baby with hearing aids because of potential feedback. By simply altering the baby’s position from a standard cradle hold to a football hold, the caregiver decreases the potential for feedback and can be confident the baby is prepared for a wonderful listening opportunity.

Busy caregivers can even incorporate strategies while running errands to create meaningful listening and language experiences for their infants or toddlers. Putting the infant carrier or the toddler in the grocery cart, for example, is a good face-to-face interaction that can help minimize the distractions of a noisy environment at the grocery store. Professionals should encourage the caregiver to use self-talk as he/she chooses which apples to buy (“I wonder which apples I should get. I like the green apples, but the red apples are on sale. I think I’ll get the red apples today.”), or narration as they walk down the aisles and look for all of the items on their grocery list (“OK, we have the milk, the bread and the eggs. Next, we need to get cheese. Where is the cheese? Oh, here it is.”). These opportunities add to the baby’s listening and language exposure while allowing caregivers to accomplish the tasks of a busy day.

Playtime is an important routine in which caregivers can enhance listening and language. For an infant, this may mean simply holding the baby face-to-face, without obscuring the hearing technology, and singing or talking to him/her. Caregivers can get down on the floor next to the baby and talk to him/her about the toys he/she is batting or activate a musical toy while cuing the infant to listen. Reading books is a valuable experience for every child, and caregivers can learn the value of reading books, using a rhythm while reading aloud and just talking about the pictures.

Infants and babies benefit from time spent every day interacting directly with their caregivers during play. Caregivers can use parallel talk to provide the valuable language of play. For example, “I see you are building a tower. I see a blue block, a red block and a yellow block. Up, up, up, dowwwwn! Uh oh! You knocked them down!” Caregivers can use language to help the child initiate play (“Let’s ask Daddy. Daddy, do you want to play?”), ask for help (“Oh no! You can’t get the lid off of the box. Do you need help? You can say, ‘help me.’”), and appropriately negotiate play (“Oh, do you want a turn? You can say, ‘my turn.’”).

Another way to enhance familiar routines is to teach the caregiver to make a snack together with the child. Caregivers may not realize how much language can be incorporated into this routine by simply extending it. Rather than giving the child the snack completely prepared, for example, the caregiver can cut up fruit with the child, for example, and use repetitive language such as “cut,” “take a bite,” “mmm, yummy” and “more.” If the child is eating crackers, the caregiver can prompt the child to ask for them, and then only give him/her a few at a time, so he/she has lots of opportunities to ask for “more crackers.”

Additionally, the professional can coach the caregiver to create a meaningful listening experience by listening for the microwave to beep indicating that the oatmeal is ready, and then encourage talking by expecting his/her child to verbally request “more” when he/she wants another bite. These simple extensions can turn snack and meal times into meaningful listening and language experiences, during which the practitioner can coach the caregiver to incorporate strategies such as wait time, withholding, narrating and sabotage. Meal time is usually very appealing for a young child, so caregivers can capitalize on that natural interest to create a motivating reason for communicating. Caregivers can be coached to incorporate sabotage by pretending to pour juice without taking the lid off so the child has to request that the lid be removed, withholding by only giving the child two or three crackers at a time so he/she has to repeatedly request more, narrating by describing the food preparation or talking about what the child is eating, and wait time by asking the child a question and waiting patiently and expectantly for a response.

Caregivers can also be coached to use simple household chores to provide fun, meaningful language opportunities. By taking a little extra time to complete these chores, the caregiver can enrich the language associated with the chores in addition to taking advantage of a toddler’s natural desire to “help.”

For example, a caregiver can provide a toddler with a damp paper towel to wipe down the table or a dry one to help with dusting; or fill a squirt bottle with water and teach the child to “squeeze” and “wipe” the windows. The child can help the caregiver match socks, roll them into a ball, and throw them into the laundry basket, working on color words and sorting, sequencing (first, then), as well as simple vocabulary like “sock” and “throw.” Sorting laundry can become an auditory exercise as simple as “hand me the pants” or as complex as listening for two critical elements: “Give me the red shirt.” Caregivers can turn washing dishes into an engaging sensory experience, during which one can build vocabulary by naming items, work on counting and color words, and practice adjectives such as “hot,” “cold,” “wet” or “dry.”

The most natural experiences a child has each day are based on the family’s daily routines. Daily routines are the single most important resource for activities to encourage listening and language development. After all, young children should be able to talk about the activities of their daily lives. Busy caregivers might go through these routines, such as eating breakfast or getting dressed, with the intention of accomplishing the task at hand quickly and efficiently rather than teaching the language.

Professionals can point out that these daily routines are big opportunities for language development with the child. During sessions, professionals can promote listening and language of daily routines by coaching caregivers through the activities. The practitioner can demonstrate how to talk about what the child is experiencing, label objects and incorporate songs while performing the task of the activity. Caregivers can practice enriching the language of these routines, while encouraging the child to listen, imitate and respond. Everyday routines provide ample opportunities for meaningful repetition and this repetition reinforces the language of daily activities often and naturally. Additionally, these daily activities are familiar to caregivers, so they feel more comfortable talking about what they are doing than they might with less familiar activities.

Many professionals plan various craft activities and games to motivate young children to improve their language during home visits. However, the language of crafts or games that are only played during sessions is less useful for the caregiver and child on a regular basis, and therefore less “bang for the buck.” Materials brought in to be used in the session but not left with the caregivers only allow for infrequent and potentially less useful language practice. Caregivers may learn from their listening and spoken language professional strategies for using certain games and toys for language development, yet may not be able to generalize those strategies with their own toys or during routine activities. If the professional brings toys for visits and then leaves them for parents to use between visits, this allows for more practice time. Yet, this means caregivers must set aside additional time during their already busy day to play with these specific toys that they might not otherwise do. They may also feel less comfortable with the strategies or language associated with toys or games that don’t belong to them. It makes sense for children to understand and use the language of their daily routines and activities because that will be most meaningful to them. Helping caregivers enrich this language is the most efficient use of the professional’s limited time and resources.

Ultimately, practitioners work with parents through active and timely coaching to teach them how to use natural, everyday activities and proven techniques to prepare their infant with hearing loss to become a 3- to 4-year-old chatterbox whose daily life is filled with singing, reading, conversation and games with peers regardless of hearing ability in a variety of acoustic environments, so that children with hearing loss are ready for a mainstream school environment, self-advocacy and wholehearted participation in their community of choice.