The main issue is, of course, lack of hearing which comes and goes, so you can never be totally sure when the child is hearing to their best potential and when they are missing most of what is being said.
The best thing is to plan for total hearing loss all the time and make sure the child gets lots of one-to-one with a clear speaking adult. The adult needs to understand about looking directly at the child and must practice using language which is pitched to his level of understanding and development... the child will not manage, for example, off the cuff comments but will respond well to non-verbal cues such as claps, thumbs up etc.
During group times, of course, the child will need to be at or near the front and the person leading should use more hand and body gestures to keep attention - but this might not be enough and the child will benefit from repeating the group activity / extra help to understand what has been said, maybe from an interested adult on the fringes of his play or by sending a reading book home for parents to read again and reinforce.
Puppets are a very useful tool, as the child is watching rather than listening and an adult adept at using them is very helpful. Playing with other children using puppets is also an excellent activity and should be encouraged.
The child might well shout - this needs to be dealt with sensitively - of course, he cannot hear himself so he doesn't know he's doing it! His behaviour might also change for the worse if he cannot hear and a child who is angrier or more unhappy than usual, especially after a cold, should be recommended for a hearing test.
Hope this helps - I did part of a dissertation on this subject so it's not exactly a full answer LOL :reading:
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