« Parental Guidance (P.G.) is an integral part of the care of the child and its family from the first announcement of hearing deficiency (Rec. 25/1) » whether or not the fitting of a cochlear implant may be planned.  In the case of a multiple disability with hearing damage, P.G. must pay attention to the specificity of the situation.

As soon as the child answers to the parameters of the cochlear implant indication the surgical team is called upon.

The « moment » of this eventuality is a special moment involving a particular dynamic for both parents and the teams concerned with respect to a renewal of hope that the child’s disability will be « cured ».

Parental Guidance must be an open space for free expression of the emotions aroused by this prosthetic alternative which involves surgical intervention.

The conditions necessary for a parental decision are present if a space, a time, and the right persons are engaged and available :

•  each discipline provides the information corresponding to its profession,
•  each discipline respects the parents’ « free will » in its discourse.

In addition to the pre- and post-implant information to be given to parents (cf. Rec. 07/01) and to the content of Parental Guidance already described (cf. Rec.25/01), it is essential to give specialised attention to parents faced with the planned fitting of a cochlear implant.

If the surgical team is separate from the caring team, it has an obligation to collaborate with the latter in order to ensure, on both sides, a coherent but not necessarily identical discourse.  It must maintain contact with both parents and child throughout the peri-implant process and present the reality tactfully and honestly.
 

PARENTAL GUIDANCE (P.G.) must be a long-term commitment at all stages of the process.  It must be particularly felt at the time of the surgical act and of the electrode activation.  It must take into account the global profile of parents and child, especially during the information period if it uses video-documents or proposes meeting other parents of cochlear-implanted children.
P.G. must take notice of the parents’ recent emotional fragility and their need for renewed energy in dealing with their « future differently hearing » child : the cochlear implant-fitting alternative revives all the emotions and appears as a « renewal of hope », a « re-entry into the possible ».

The preceding parent-child communication modalities must give rise to a new project which includes hearing education.
 

P.G. is psychologically specific :

•  It deals with the parents’ anxiety and culpability in face of whatever decision they make.
•  It deals with the possible renewal of the imaginary ‘deafness cure’.
•  It addresses with the parents the possible modification of their parental identity.
•  It has an indirect action through the consideration of certain emotions present within the team.

P.G. should help parents not to confuse « oral expression and communication », not to make all education depend on mastery of oral language, not to exclude the use of communication- aids.
 
 
 

         Montpellier, May 2000