This article summarizes the available evidence on pediatric cochlear implantation to provide current guidelines for clinical protocols and candidacy recommendations in the United States. Candidacy determination involves specification of audiologic and medical criteria per guidelines of the Food and Drug Administration. However, recommendations for a cochlear implant evaluation also should maintain flexibility and consider a child’s skill progression (i.e., month-for-month progress in speech, language, and auditory development) and quality of life with appropriately fit hearing aids. Moreover, evidence supports medical and clinical decisions based on other factors, including (a) ear-specific performance, which affords inclusion of children with asymmetric hearing loss and single-sided deafness as implant candidates; (b) ear-specific residual hearing, which influences surgical technique and device selection to optimize hearing; and (c) early intervention to minimize negative long-term effects on communication and quality of life related to delayed identification of implant candidacy, later age at implantation, and/or limited commitment to an audiologic rehabilitation program. These evidence-based guidelines for current clinical protocols in determining pediatric cochlear implant candidacy encourage a team-based approach focused on the whole child and the family system.

Objectives: Cochlear implants (CIs) afford an opportunity for children with a significant hearing loss to access spoken language through auditory input, but challenges post-implantation could impede success. Inconsistent device use occurs when a child wears their device less than full-time (<8 hours per day). Previous studies may underestimate the prevalence of inconsistent device use in pediatric CI users due to methodological issues (subjective parent report vs. objective measures). Methods: This retrospective chart review identifies risk factors (demographic, audiologic, and device) associated with poorer daily device use in children with CI using objective datalogging. Non-parametric correlations, Mann–Whitney U, and Kruskal–Wallis H tests were used to evaluate effects of demographic, audiologic, and device factors on daily device use via datalogging. Results: Participants included 71 children (age M = 7.0 years) with mean implantation age of 4.0 years and mean device experience of 3.0 years. Children with CIs used their device, on average, 7.6 hours/day (range: 0.1–15.5 hours). Half of the participants wore their device less than full-time. Fewer hours of device use coincided with younger chronologic age, presence of additional disabilities, lower maternal education, younger age at CI, use of Medicaid, and smaller dynamic range. Discussion: The prevalence of inconsistent device use may exceed previous estimations based on parent report. Conclusion: Professionals working with pediatric CI users should consider incorporating datalogging into clinical practice to counsel families at risk for poorer device use. Future studies should compare objective device use with communication outcomes in pediatric CI users.

Nearly one third of school-age children report being bullied, primarily enduring teasing or rumors. Children with hearing loss (HL) are at increased risk of victimization due to being “different” from the general population. This project assesses effects of auditory status on bullying by comparing incidence and type of bullying in 87 youth and adolescents with HL (7–18 years) to published national data from peers in the general population. All participants wore auditory technology (i.e., hearing aids or cochlear implants), communicated orally, and participated in mainstream education. Each participant completed the 2009 National Crime Victimization Survey’s School Crime Supplement. Adolescents with HL endured significantly higher incidence of bullying versus the general population (50.0% vs. 28.0%), particularly for exclusion (26.3% vs. 4.7%) and coercion (17.5% vs. 3.6%). Children younger than 12 years with HL report lower rates of bullying (38.7%) than adolescents with HL, but rates did not differ significantly. Future research should explore risk and protective factors for peer victimization in youth and adolescents with HL to reduce long-term consequences on quality of life.

Children with hearing loss are at risk for lower self-esteem due to differences from hearing peers relative to communication skills, physical appearance, and social maturity. This study examines the influence of generic factors unrelated to hearing loss (e.g., age, gender, temperament) and specific factors associated with hearing loss (e.g., age at identification, communication skills) on how children with hearing loss wearing cochlear implants or hearing aids appraise self-esteem. Fifty children with hearing loss wearing cochlear implants or hearing aids participated (Mean age: 12.88 years; mean duration of device use: 3.43 years). Participants independently completed online questionnaires to assess communication skills, social engagement, self-esteem, and temperament. Children with hearing loss rated global self-esteem significantly more positively than hearing peers, t = 2.38, p = .02. Self-esteem ratings attained significant positive correlations with affiliation (r = .42, p = .002) and attention (r = .45, p = .001) temperaments and a significant negative association with depressive mood (r = − .60, p < .0001). No significant correlations emerged between self-esteem and demographic factors, communication skills, or social engagement. Because successful communication abilities do not always co-occur with excellent quality of life, clinicians and professionals working with children with hearing loss need to understand components contributing to self-esteem to improve identification, counseling, and external referrals for children in this population.