From preschool to primary school: What influences caregiver stress as children with hearing loss grow?

Ask any pediatric hearing care professional what concerns parents bring up during follow-up appointments, and the answers often extend beyond hearing aids and speech scores.

Questions about friendships, behavior at school, emotional well-being, or whether a child is keeping up with peers often become part of the conversation as children grow. Understanding how these concerns evolve can help clinicians support families in ways that extend beyond hearing outcomes alone.

Why caregiver well-being matters

When a child is diagnosed with hearing loss, much of the early focus is understandably on hearing technology, appointments, and intervention services. But this evolves as children grow.

Families help children in many ways, from learning to communicate and build friendships to navigating behavioral and emotional challenges in everyday life. As children grow, these priorities often evolve, and so do the factors that influence family wellbeing.

To better understand this journey, researchers analysed caregiver stress among families participating in the Longitudinal Outcomes of Children with Hearing Impairment (LOCHI) study at two important stages of childhood: when children were 5 years old, as they transitioned from preschool to primary school, and again when they were 9 years old, when the social and educational demands of primary school become more established. Across both studies, caregivers completed the Parents’ Hearing Impairment Caregiver Experience (PHICE) questionnaire, which measures stress across different aspects of family life.

What shapes family well-being?

One interesting observation from these studies is that many of the factors influencing caregiver wellbeing are not necessarily unique to hearing loss itself. Rather, they reflect the broader experience of raising a child who is developing socially, emotionally, and academically. This highlights the importance of considering hearing loss within the context of a child’s everyday participation and family life, rather than focusing solely on audiological measures.

Key Findings

• Between about 5 and 9 years, caregivers reported generally low levels of stress across all eight areas assessed by the PHICE questionnaire: communication, education, emotion, equipment, financial matters, healthcare, social participation, and support.
  
• Children’s communication and behavior were the two factors consistently linked to family well-being, often more so than hearing-related factors alone. Challenges with peer relationships, emotional regulation, and everyday behavior were linked to increased stress for caregivers at both ages.
  
• Stress among parents of children using cochlear implants reduced over time.

What this means for clinicians

Caregiver experiences and the factors influencing well-being evolve over time. While hearing thresholds and device performance remain important, a family’s well-being is closely connected to their child’s communication, behavior, social participation, and how children function in their everyday environments.

These findings may encourage broader conversations during follow-up appointments. Asking parents how their child is managing friendships and adjusting to changing expectations at school may provide insights that audiological assessments alone cannot capture. Such discussions may also help identify families who could benefit from additional support from teachers, psychologists, speech-language therapists, or other members of the multidisciplinary team.

For hearing care professionals working with school-aged children, the findings serve as a reminder that successful intervention is not measured solely by access to sound or language outcomes. Equally important is supporting children to participate confidently in the social and educational experiences that shape their well-being and that of their families.

We invite you to read the full publication to learn more.:

Factors that influence stress in caregivers of 5-year-old children with hearing loss wearing hearing aids or cochlear implants – ScienceDirect

Full article: Factors that influence stress in caregivers of school-age children with hearing impairment

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Reference:

Söderström, P. & Easwar, V. (2026). Factors that influence stress in caregivers of school-age children with hearing impairment. International Journal of Audiology. 25:1-14. doi: 10.1080/14992027.2026.2628708. Epub ahead of print. PMID: 41742692.

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 Authors:

Viji Easwar, Head of the Paediatric Hearing Research Program at the National Acoustic Laboratories, Sydney, Australia.

Viji Easwar is an audiologist by training and completed her Bachelor’s degree in Audiology in India, Master’s in Audiology at the University of Southampton (UK), and a PhD at the National Centre for Audiology in Canada. Viji’s research focuses on developing clinical tools, including EEG-based measures, to evaluate and optimize hearing outcomes children with hearing loss. 

Pelle Söderström, Senior Research Scientist in Paediatric Hearing Loss at the National Acoustic Laboratories, Sydney, Australia

Pelle has a passion for languages, linguistics, music and neuroscience. His work at NAL focuses on developing tools to investigate and improve language outcomes in children and adolescents with hearing loss.