A Gentle Call for Baby-Friendly Hearing Innovations!Table 1: Skin and Device Retention Challenges Reported by CaregiversTable 2: Device Attachment and Loss Concerns in Daily UseBack in June 2024, my entire world shattered when I was told that my one-month-old little angel had failed her hearing test and would likely need cochlear implants to hear. Tara Acharya was born with bilateral profound hearing loss due to a genetic disorder. Her future suddenly felt uncertain, as we knew no one with hearing loss and had no idea how to navigate this journey. But with the support of the incredible cochlear implant team at SickKids Hospital in Toronto, Canada, we gradually found the strength to cope. Through time, love, and unwavering faith in the divine, we prepared ourselves for the path ahead. It began with hearing aids: struggling with ear mold retention, monitoring and adjusting her ear molds every 45 days, regular visits to the hearing aid specialist, and carefully tracking Tara’s responses to sound. This challenging journey ultimately led to her bilateral cochlear implant surgery when she was 11 months old. THE FIRST SOUNDS It was a deeply emotional moment for us to see her startling to her first sound when her Nucleus® 8 Sound Processors were activated for the first time in the audiology clinic at SickKids. We are forever grateful for this miraculous technology which bypasses the damaged hair cells of cochlea and directly stimulates the auditory nerve to produce sound signals and send them to the brain. Salute to the team of devoted researchers, design engineers, audiologists, speech language pathologists, and other hearing professionals for their contributions in giving a chance to people like Tara to hear, speak, and thrive. I am sure, this was not possible a few decades ago. As the days passed, I realized that this journey is far from easy, and that surgery is only the beginning. The challenges grow steadily, making daily life increasingly exhausting. We have essentially committed to monitoring our baby throughout all her active hours. It is during this intense, hands-on experience that I recognized a significant gap: Cochlear implant researchers and manufacturers urgently need to develop baby-friendly audio processors, if they truly care about caregiver well-being. After all, we can only care for our children effectively if we ourselves are supported. We have been instructed to ensure that Tara wears her audio processors during nearly all her active hours—around 9 to 10 hours a day—so she can hear continuously and gradually develop spoken language like her hearing peers. While the implants have been transformative, one of most persistent challenges we came across is Tara’s constant pulling off of the external processors and coils. This often results in loss or damage, requires near-constant supervision, and has even created barriers to daycare acceptance. The daily management of these devices became a significant burden on us. Although these technologies are remarkable in enabling access to sound, they raise fundamental and practical questions. When infants at this age cannot tolerate even a small hairpin on their delicate heads, how did manufacturers expect them to comfortably wear bulky external processors secured with magnets and coils as well as components that frequently fall off or disconnect during sleep, play, or feeding? How are parents expected to continuously monitor, supervise, troubleshoot, and maintain these devices throughout the day? Managing this level of technical oversight alongside the demands of regular parenting is profoundly overwhelming. While cochlear implant manufacturers have introduced various retention solutions, none have been effective for my child. Tara consistently removes her processors along with retention bands and bows, underscoring the disconnect between device design assumptions and the realities of infant behavior and development. Auditory-verbal therapy over many years, along with continuous monitoring of speech and language development, is already a significant responsibility that demands immense commitment from families. In addition, parents are expected to maintain cochlear implant devices with constant vigilance. The surgery itself and the devices are extraordinarily expensive, and without adequate insurance coverage, families from lower- and middle-income backgrounds can face severe financial strain. This financial reality adds another layer of stress, particularly the fear of device loss or damage, knowing that replacement may be unaffordable. Importantly, when a child is not wearing their cochlear implant processors, they are functionally completely deaf, making consistent device use essential for access to sound, language development, and safety. While learning and using sign language can be valuable, it also requires significant time, training, and cognitive effort from families. For many parents already overwhelmed by medical appointments, therapy schedules, and daily device management, acquiring proficiency in sign language and consistently teaching it to their child can be extremely challenging, adding to an already substantial caregiving burden. As a result, parents live under continuous pressure, balancing long-term therapeutic commitments with the constant need to protect and preserve these life-changing yet fragile devices. FAMILIES FACING CHALLENGES WITH CURRENT DEVICES It was during this time that I began joining online caregiver support groups to understand how other parents were navigating similar challenges. Reading through countless posts, I came across deeply shared experiences of parents raising deaf children, including those who are also neurodivergent, such as children on the autism spectrum or with ADHD. Many caregivers spoke about how sensory sensitivities made it extremely difficult for their children to tolerate audio processors, often leading to frequent removal, distress, or complete refusal to wear them. Parents also described the constant struggle of keeping the devices on, alongside recurring issues such as magnet-related pressure, skin irritation, and rashes on their children’s delicate scalps. These stories were both heartbreaking and validating, making it clear that these challenges are widespread and that caregivers across the world are grappling with the same daily battles. In seeking better solutions, I reached out to multiple researchers, engineers across continents, and senior leaders within cochlear implant manufacturing companies to share these concerns and explore potential advancements. The response was largely silence. While a small number acknowledged the challenges faced by families, none were willing to offer concrete commitments or timelines for change. This lack of engagement was deeply disappointing, particularly in an era defined by rapid advancements in artificial intelligence, bio-compatible materials, biomedical engineering, brain computer interfaces, 3D printing, MEMS etc., where technology is evolving at an unprecedented pace. Despite these breakthroughs, children with cochlear implants remain heavily dependent on external hardware that is fragile, expensive, and failure prone. Even when manufacturers develop improved technologies, regulatory pathways through agencies such as the FDA and other approval bodies are often prolonged and opaque, significantly delaying the availability of new solutions. The disconnect between technological potential and real-world implementation leaves families waiting indefinitely, bearing the consequences of a system that struggles to keep pace with innovation. It is time for cochlear implant manufacturers to place infants and young kids—not legacy hardware constraints—at the center of their design priorities. If caregiver well-being truly matters, innovation must move toward fundamentally different solutions, such as highly miniaturized external processors or fully implantable processing systems that do not require additional surgeries. We are in 2026, not the early 2000s, and incremental reductions in processor size, while welcome, are not a permanent or sufficient answer. I remain deeply grateful for the technology that enables my child access to sound, yet I am equally disappointed by the continued reliance on fragile external hardware. The current product cycle, where new audio processors are released only once every five years reflects a pace that is incompatible with both modern technological capability and the urgent developmental needs of infants. Families cannot afford to wait decades for meaningful change; solutions must arrive sooner, with urgency that matches both the science and the human cost of delay. Meaningful progress requires faster timelines, transparent communication, and active collaboration with families, so that future innovations are guided not only by engineering feasibility but also by the lived realities of caregiving. WHAT SHOULD BE THE NEXT STEPS? It is time to recognize that pediatric cochlear implantation cannot remain a derivative of adult device design. Infants and toddlers are not smaller adults; they represent a distinct developmental and behavioral population. While adult processors may reasonably follow a five-year product cycle, early childhood auditory development unfolds in months. Pediatric innovation deserves its own accelerated pathway. In the near term, incremental but meaningful steps could significantly improve the lived experience of families. For children under five, during the most critical window for speech and language acquisition: manufacturers should consider expanding replacement allowances for lost or damaged processors to at least once annually. Toddlers are uniquely prone to device loss during rapid motor development, and increasing replacement allowances during these early years would reduce parental stress and ensure consistent auditory access during critical language acquisition windows. From an engineering standpoint, pediatric processor miniaturization should be treated as an urgent design priority. Rapid advances in integrated electronics, ultra-compact microphones, improved battery efficiency, and flexible circuitry are making it possible to imagine processors that are wafer-thin and less obtrusive. For young children, reducing bulk (for processors like Kanso series of Cochlear Americas and Rondo series of Med El) can directly address common retention challenges faced by families. In parallel, advances in breathable, skin-friendly materials and stronger protective finishes could decrease irritation and improve durability in the active, high-contact environment of toddlers and young children. Looking ahead, custom-fitted, anatomically designed processors and even fully in-ear systems may become feasible, offering discreet, stable, and comfortable solutions as technology in miniaturization and wireless power continues to advance. The FDA and other regulatory bodies should prioritize fast-tracking approvals for pediatric hearing devices and actively encourage a greater number of pediatric clinical trials in the hearing field. Children cannot afford long regulatory delays, as early auditory access is directly tied to language, cognitive, and social development. The FDA should also support and expedite innovation in device miniaturization, as smaller and lighter processors significantly reduce physical discomfort and caregiver burden. In parallel, the pathway for pediatric fully implantable systems should be accelerated, enabling manufacturers to begin trials sooner so that children can benefit from safer, more discreet, and developmentally supportive technologies without unnecessary delay. Recent innovations in 3D-printed temporal bone models, such as those developed by a South African surgical team to improve otologic training and planning, demonstrate how 3D printing is already transforming clinical practice in hearing care. That same engineering spirit, applied to hearing device design, could help drive the next generation of child-centered cochlear implant systems that are lighter, more comfortable, and better suited to the unique needs of young children. This perspective is shared not as criticism, but as a contribution. Coming from a research background myself and with a PhD in materials engineering, I have deep respect for the design engineers, scientists, and clinicians working in this field. At the same time, I witness the daily lived reality: fear of losing the devices, the discomforts, frequent adjustments, and continuous effort required from both young children and their families.
Sai Sravanthi Suravajhala (Fri,) studied this question.