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All children,
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eye contact, shared attention, imitation, and taking

turns. The parent then needs to adapt his or her
language level to meet the childs level.

Tips for Establishing a Positive

Learning Environment

Although at birth a baby can only see vague figures,

All children, whether hearing or not, need to feel safe,

infants begin tracking objects with their eyes after only

secure, and a part of the family environment. Some

a couple of months. During the first four months, your

ways to promote this:

actions as a parent are normally directed toward the

Meeting your childs basic needs (feeding, changing,

Eye Contact

child. For example, you place yourself above the stroller

dressing, comforting) in a timely and loving manner

or bed and start communicating in a particularly

creates a feeling of trust and security.

expressive and melodic way. Around the age of four

Playing together and cuddling are almost as

important as meeting other basic needs.
Use a regular daily schedule (eating, bathing and
sleeping at a fixed time). This offers a feeling of

months, we see a change in eye contact. The baby

slowly starts to track you or even an object with her
eyes and starts pointing at it. In fact, this is the first
way the child takes turns.

security and promotes ease and peace.

Immediately after implantation, talk to your child as if
they can understand.
Give your child your attention if he is making sounds
or trying to say something. Say, I can hear you, nod
your head, and encourage him to go on. Try to

From the age of six months, we see that the child is

able to look at an object that the parent is looking at.
This milestone is often referred to as shared or joint
attention. It forms the basis for spoken language
development since she can then make the connection

respond, even if you dont understand. It is okay to

between the object and the words she is hearing

guess at what he is saying.

from you.

Clarify situations beforehand. The fact that you are

going outside is made clear to the baby very quickly
when you put on his jacket and get the stroller out.
Somewhat older children may want to know where
you are going. A picture (of granddad, grandma, or

As a parent, you probably spend a lot of time watching

your childs face. This encourages the development of
eye contact and at the same time, it creates a bond
between a parent and child. Babies are also extremely

the store) can come in handy to show where you

interested in expressive faces. You may find that it is

want to go.

very natural to keep the attention and interest of your

child by continuously changing your facial expression.

Before babies learn to talk, they communicate in a

This is the first lesson in communication: communicating

variety of non-verbal ways. The most important are:

with each other implies that you look at each other.

Parent
hears

Child

looks at

looks at

Object

Figure 1: Communication Triangle

Tait (2001) found that having a CI positively influenced
the development of eye contact as a communication
skill. At first, the children were quicker to look at the

moments, the parent and the child are both focused

parent or the object in question. As their auditory skills

on the same thing. Later, the child may even point at the

improved, the children needed less eye contact and

object, either to confirm that the adult is also looking at

participated more in conversations.

it or to request that the adult look at it.

Eye Contact is an Important Factor in

Preverbal Development

Important here is that the child hears your voice clearly.

She can look at the object you are talking about while
listening to you. If she does not respond to you talking,

Whenever possible, position yourself at eye level with

you can bring the object in the visual field between you

your child. Gently touch your child or the object that she

or use gestures to point out the object.

is holding. This way, you can easily get her attention. Be

sure to comment on or label the object she is holding.

The child not only reacts to what the parent says but can

For babies, the ideal distance for making eye contact is

also take initiative herself to communicate. The childs

about 25 to 30 cm / 10 to 12 in. The perfect opportunity

ability to point to an object in a communicative way is

for this is when holding her in your arms or your lap, as

a crucial aspect in the development of communication.

well as during changing or feeding. With older babies,

The parent responds by labeling the object (ball) or

this distance can be increased to 1.5 m / 5 ft. This way

action (bouncing) that the child is pointing out.

they see the whole body expression and also part of the
surroundings. Try reading a book or looking at pictures
with the child on your lap or sitting on the floor where

Communication and Shared Attention

she can see you as well as the [Link] children really

Make sure that during feeding, dressing, or playing your

enjoy peek-a-boo games or blowing bubbles. These

child can see what you are talking about. If you

games are also good for practicing eye contact.

say now you can have a drink, give him the bottle or
cup. Say his name to get his attention. If he does not

Let Your Baby Take the Lead

(Shared Attention)

respond, try using a toy or touch him to direct him

toward you. Once he looks at you, then say something.
You can say, I said your name, or You heard your

When parents communicate with their child, they look

name!. This reinforces responding to his name and

where the child is looking or at the object of the

attending to what you are saying. When your child points

childs interest. Afterwards, they usually start talking

to or is playing with an object, reinforce his interest by

about whatever it is they are looking at together.

describing the object or event in age-appropriate

Talking about things the child is looking at teaches the

language. Playing together or looking at a book together

child to understand the words being said. We also

while talking about what you are doing supports his

call this shared or joint attention because in these

language development.

10

Imitation

Imitation Shows that You Like Something

After only a few months babies are capable of imitating

Now that your child can hear with the cochlear implant,

an expressive face. It is normal at this stage for parents

encouraging and playing imitation games are important

to frequently imitate the facial expressions of their child.

first steps toward developing first words or language.

Babies understand this game easily. When they start

Imitate the sounds your child is making.

making noises like cooing, consonant or vowel sounds,

or gestures and the parents start to imitate this, this
inspires even more reaction from the baby. As mentioned
before, babies like to see that their efforts at
communication are working.

This may prompt even more sounds from him. Provide

extra stimulation for babbling by:
Repeating and expanding the sounds your child makes.
Initially, he will only repeat the same sounds but
eventually, there will be more variation in his babbling.

Like babies with normal hearing, babies who are deaf

vocalize with pre-speech sounds until the age of about
five to six months. They sometimes play with their tongue
and lips while making sounds such as /p/ or /f/. Around
the time that babies with normal hearing start to babble

Imitate the sounds he produces in front of a mirror and

make a funny face while doing it. Your child will
probably imitate this.
Imitate your childs facial expressions back and wait a
bit to see if he repeats this. Older babies or toddlers

(six to seven months), babies who are deaf often quit

also imitate mouth movements (sticking out the

babbling or babble with less variation of syllables.

tongue, opening the mouth, etc.). This is the ideal

opportunity to play games by making funny faces. The

Older babies spontaneously start to make babbling

mirror can be helpful here. Be sure to vocalize so that

noises like dada, mama, gaga, usually including

he will start to associate the movements of your

consonant and vowel sounds together. This forms the

mouth with certain sounds.

basis of their first words. It is necessary for the child to

hear before babbling will occur one of the main

Try introducing new sounds and encourage your child to

advantages of early CI use is the ability to take advantage

imitate new sounds. Use objects with associated

of a childs normal stages of babbling at approximately

sounds, i.e., the cow says, mo-o-o. Make the sound

the correct time. It is important for you to start imitating

while manipulating the toy, and then wait a minute

the early sounds your child makes. By imitating these

to see if your child will imitate this sound. His favorite

babble sounds, you show your child that the sounds he

animals and transportation toys are great for this fun

is making are very important and that you want to listen.

activity. Once you attach a sound to the object try to be

Also, this encourages your child to practice babbling

consistent with the same sound. Young children need lots

even more.

of repetition to imitate or say sounds, so be sure to do

this activity often or repeat it several times. Sounds
rather than words are easier for your child to imitate. He
will most likely do this before saying his first word.

11

Take turns
y car.
o
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a
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Taking Turns

Turn by Turn

Good communication assumes that its not always the

Around the age of nine months babies really enjoy

same person who is talking, but that both parties

playing games that involve taking turns.

(parent and child) take turns saying something. Even very

Examples:

young children that do not speak yet can take their turn

You make a tower (your turn) and your child knocks it

by pointing at something, smiling, or crying. You should

down (his turn).

react to this as if your child spoke. When it is his turn,

He throws an object on the ground and you pick it back up.

you may need to wait a bit so he has enough time to react.

You cover his face and then pull away the cover (peeka-boo).

Taking turns like this teaches your child how a

conversation works: one person communicates while the
other waits and then the next time, the roles reverse.

He not only imitates what you are doing but also your
facial expression and the sounds accompanying
the game.

Children are able to start taking turns by the age

of three months; turn-taking at this age may not involve

Toys can also stimulate turn taking.

vocalizations. Verbal turn taking will initially happen

Examples:

by making vowel like sounds (ie, oe, eeh, ooh, aah, ae,

Tossing a ball back and forth

uuh) and later, with consonants (such as d, b, m).

Taking turns driving a toy car

12

Communicate with your child about

everything that he experiences: what he
sees, hears, smells and feels.
Taking turns using the play phone

what you are saying. Another typical characteristic

Stacking blocks or rings

of early communication is frequent repetition. Parents

Putting blocks in a box

continuously talk to their children about the same

Putting shapes into a shape sorting toy

events or routines (e.g. changing the diaper, dressing,

Put words to these turn taking games. Talk about pushing

meal time, etc.). These are all things that involve the

the toy car, stacking the blocks, count the blocks.

child personally. The words and sentences that are used

are frequently repeated. All of this repetition creates an

Use words such as in and on. In other words,

ideal situation for learning language, enabling the child

describe what you and your child are doing. Dont be

to more easily catch the meaning of the language that

afraid to use a variety of words or vocabulary. This is how

is directed towards them. This early repetition should be

your child will learn language. Remember that a lot of

in the form of simple short sentences or phrases.

repetition is necessary!

A childs memory typically cannot handle more than that

yet. It is best to limit your language to one or two levels

Introducing the Concept of Turn Taking

higher than what the child has already mastered. This

At the time of their first birthday, children already play

means that when the child talks in one-word sentences,

simple role plays. They actively take turns and pretend,

you should talk in two- or three-word sentences.

for instance, feeding a doll. They also enjoy looking at

other children or imitating them. From this moment on,

In this phase of development, the child really loves

you can more formally introduce the concept of turns

simple nursery rhymes and lullabies. Children love

and make turn-taking a big part of the game: Now

rhythm, intonation, simple sentences, and plenty

its mommys turn. This is an especially important step

of repetitions. They love songs with accompanying

because it will set the stage for more structured activities

fingerplay or actions. These activities also prompt

later. By demonstrating a skill you want to work on (your

imitation as the young child tries to twist his little hands

turn) you can then prompt the child to practice that skill

and sing along.

during his turn. Turn-taking games give you some control

over the situation and allow you to focus your child on a
specific task while still making the activity fun.

Adjusting the Language Model

Adapting the Language Model to Meet

Your Childs Needs
This is an especially fun stage of development because
you will begin to see real progress in your childs

Adults talk differently to babies and young children.

communication skills. Here are some things to keep in

They use a higher pitched voice, with a slower pace

mind:

and with more intonation (even a singsong voice).

Communicate with your child about everything that he

We call this the use of baby talk (sometimes we use

the terms Motherese or Parentese). All parents do
this naturally with their children. These adjustments
in language and tone make your child more interested in

experiences: what he sees, hears, smells and feels.

Speak clearly at a sufficient volume but a bit slower
than you would to an adult. This gives your child
more time to process the spoken language.

13

With a young child, you may speak with a slightly

singsong voice (Parentese). Studies have shown that
babies and toddlers pay special attention to speech
with extra intonation and melody. While lifting up
your child, pair the action with a sound like wheeeee,
up, up, up high. Repeat these games regularly, to
increase the chance that your child will associate your
words with the movement. Wait a minute, and if your
child does not initiate another turn, say, Do you want
up? and repeat the game. Encourage your child to
imitate these sounds, actions, and simple words to
request the game.
Make sure there is adequate turn taking. Wait briefly

books over and over. It is never too early to introduce a

child to storybooks. Be sure to choose books that are
engaging for your childs age level.

after your child finishes babbling and take your turn.

Brief pauses give your child the chance to take his turn.

Simple board or cloth books are best in the beginning, and

Use a lot of onomatopoeic sounds (these are words

over time you can move up to more elaborate stories.

that imitate the sound of the object, such as choo

choo, tick tock, woof woof,). This attracts the
attention of your child and stimulates him to associate

However, even a simple books story and characters can

be made more complex (with a little imagination) as the
child matures.

the sound with the object. Sometimes use the name of

the object with the sound (Oh listen, the dog says
woof woof!.)
Try to attract the attention of your child by calling his
name. If he looks up, make sure you have a message
or some other reward. Calling games are good for a
short while, but often the child loses interest if there

Transitioning on from the Preverbal Stage

We mentioned earlier that a childs preverbal utterances
usually have a goal and that, as a parent, you have to
react positively to them as much as possible. But how do
you do that? An answer to this question is described in a

isnt an interesting reason to look.

course developed by The Hanen Centre (Toronto), in which

Nursery rhymes and songs with a lot of expression are

parents learn how they can adjust and fine tune their

ideal for learning language. By frequently

repeating the song or the rhyme, the baby will learn to

language to best meet their childs needs. We mention

these strategies at the preverbal level, but they can also

respond with words and gestures that go with these

be applied at later stages of speech and language

rhymes, and will even make his first attempts at singing

development. To empower parents as facilitators of their

and making music.

childs communication, Hanen recommends using the 3A

Looking at books or photos together provides an

opportunity to repeat the same words and phrases.
Children seem to never tire of hearing their favorite

Approach. The three As stand for: Allow Your Child to

Lead, Adapt to Share the Moment, and Add New
Experiences and Words (Manolson et al., 1996). The
following is a summary of these Hanen Program principles:

14

ild to
Allow your ch
ans you
lead: this me
ake the
t
d
il
h
c
r
u
o
y
let
opic for
lead on the t
n.
communicatio

opportunity to add something new or teach him

something.
If you repeat the same words over and over again in
a well-known situation, you encourage your child to
start using language. However, at some point, language
has to expand and grow, so you add language and
experiences to games he already knows. We call this
language expansion. For example, if your child is
Allow Your Child to Lead

already saying something, you can add an extra word

This means that you let your child take the lead on the

or two or an extra detail. By adding something extra

topic for communication and you follow him by talking

to what your child is saying, you give him the tools to

about what he is doing and the things in which he takes

broaden his message. (see example on next page)

an interest. A child is more likely to learn language about

activities that are of interest to him. By following his

Since expanding language is so important to the

lead, you have the opportunity to even further enhance

development of a broad vocabulary and a more well-

his language development because he has shown you he

rounded language repertoire, we want to spend some

is interested in the topic. You might want to read a story

time talking about it in more detail.

about zoo animals, but if the child is more interested

in playing house, then adapt your plan to the game of

Expanding Language

playing house and talk about that activity instead.

Depending on your childs language skills and

developmental level, you can expand on what he is

Adapt to Share the Moment

saying in a variety of ways. Make sure your language

Your child goes his own way sometimes and it can be

level is just slightly above the level of your child. You

difficult to really connect with him or to focus on a

do not want to speak in long sentences if your child

specific goal. To have meaningful interactions with your

is communicating in one-word utterances. This can be

child, you must adapt your interests to his. This means

discouraging for the child. If your child talks in one-

that you try to adapt to the play level and the subject of

word utterances, then answer with two- or three-word

your childs game. You play along with him and talk about

sentences.

whatever he is busy with in a way that he likes. You will

still achieve your goal, but this way you can connect with

If your child is playing with a car and produces sounds like

your child more easily and meaningfully while doing so.

bbrrr or even a whole sentence like the second example

below, there are several ways you can respond appropriately

Add New Experiences and Words

and add information to what your child is saying:

Once an interaction is happening, you have the

15

Child says:

Adult can...

By adapting your language to match or approach your

Bbrrr. Uh, oh

Accept: Uh, Oh, bbrrr

childs language level, then adding more language, you

Adapt: Oh, no. What happened?

are giving your child the opportunity to understand

Your car is broken?

what you have said and learn more language. When

Add: Yes, one of the wheels has

your language example (model) is simple but slightly

broken off. Lets fix it.

beyond the childs level, it is more accessible to your

child and easier for the child to transition to more

An older child

Adult can...

may say:

16

complex language. And, because you are following his

lead, it is also a topic that your child wants to talk and

Boom!

Accept: Im sorry, your car broke

learn about. Dont worry about making a grammatically

Car broken.

Adapt: The lights and the tires are

perfect sentence. You will refine your language as

broken

you go and as your child progresses. This is especially

Add: Let me try to fix the car.

true with younger children or with children who have

Lets go find a different car.

learning challenges.

Should we put on a new wheel?