A Day In The Life Of An Independent Speech And Language Therapist
I often get asked how many clients/children I see per working day or what my working day/life looks like. I always reply that every day is different, which is true, but there is a sort of average working day which looks a bit like this:
I usually start preparing for my first client of the day at around 9.30 am: I clean the room, wipe down all the toys and materials (that’s if they are coming to my clinic room) and then it takes me about 30 minutes to select and sometimes make suitable materials, games and activities for the child’s therapy programme. Client arrives at 10.30 am and the fun begins. They leave around 11.30am, and the cleaning and wiping down starts again – yes it’s the pandemic but to be fair I would do this anyway. I quickly write up my notes and send home work to the client via email. Now it’s 12 noon and I start preparing for the next client at 12.30 pm. This might be online parent-child interaction coaching and so I need different materials and activities that are suitable for teletherapy. We finish around 1.30 pm and I will write up my notes before having some lunch.
Lunch tends to not be around 30 minutes. Around 2.00 pm I start prepping again for the next client: selecting activities, going over their last session, making sure I have everything I need to start at 2.45pm – we finish at 3.45pm, I write up my notes and then have a cuppa. The next client might be more on-line coaching or a child coming to see me: room cleaned and tidy, materials and activities prepared: client arrives at 4.30 pm and we finish at 5.30 pm. I clean the toys again, write up my notes and it is 6.00 pm ready for dinner. So that was four clients between 9 am and 6pm allowing for preparation, aftercare, cleaning and coffee and lunch.
Other days I might see three clients and do more admin like ordering toys or books or teletherapy activities, or making materials (we therapist make tons of materials, we’d put Blue Peter to shame!) Sometimes I do two home visits, one in the morning and one in the afternoon – the travelling/parking in London is so time consuming that it really reduces the number of clients I can see which is why I don’t do many of those.
I hand pick my clients to make sure that we are a good fit, and my service is bespoke: no one client gets the same treatment as another; each client is unique, usually very well-known and always highly valued. That takes time and means that in reality each client gets about 2 hours of my time, that is the actual session plus all the preparation and aftercare.
I love this way of working and would not ever want to return to seeing tons of clients each day, not knowing any of them really well, due to high caseload numbers, staff shortages and an overload of administration.
My way of working affords all my lovely clients the help they need to be able to feel empowered and to then support their children to make progress; when working with children they make the best progress they can make, fulfilling their potential. My lovely reviews and testimonials tell me that my clients appreciate the extra attention.
Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.
We use powerful motor learning principles to help children with CAS (Childhood Apraxia of Speech) learn how to produce better, clearer speech sounds in words, phrases and sentences.
What are these principles?
Principle 1: MASSED PRACTICE
This is where you see a child for lots of sessions in a shorter period of time, so for instance six weeks of three times weekly for 30 minutes.
This leads to motor performance or automaticity.
Principle 2. DISTRIBUTED PRACTICE
This is what I use, as most of my clients are not able to come and see me that often on a weekly basis. It is hard to travel in London and life is hectic. So I favour one session a week over say a term or two terms and a session is usually 45 minutes long.
This leads to improved Motor Learning and good generalisation.
During either Massed or Distributed Practice, we choose between 4 variables:
Principle 3: Constant vs Variable
Principle 4: Blocked vs Random
To explain:
Constant Practice is where we repeat the practice of a small handful of target words.
We practise the same target sound in the same word position, e.g. at the beginning of a word: ‘bee’, ‘bye’, ‘bow’, ‘baa’ or ‘key’, ‘car’, ‘cow’, ‘Kaye’ etc.
We keep the rate, pitch and intonation constant.
Variable Practice is where we vary the rate, volume, pitch and intonation of the targets
We use a larger number of sounds, and words that are motivating to say for the child.
For example, if a child loves Peppa Pig then I might choose the words: ‘Peppa’, ‘Daddy Pig’, ‘George’, ‘Mummy Pig’ and a couple of other favourite characters. My child might struggle with a number of sound sequences there but we will target them one by one.
We can also select simpler words like ‘cape’ and ‘cake’ or ‘tick’ and ‘tip’.
Blocked Practice is where we practise one target word for say five minutes then we move to another target word for the next five minutes and then we revert back to the first target word again and so on, so blocks of practice.
RandomPractice means we practise several target words at the same time.
How do I decide on what to use?
Good question!
I always opt for distributed practice (weekly for up to 45 minutes).
Within that, I tend to find it most successful to start out with constant practice when a child is finding a certain sound sequence really hard and we need to just ‘nail it’. Bearing in mind I only pick sounds that my student can actually make in isolation, so we are not working on articulation! (where we focus on trying to elicit single sounds correctly – or even at all sometimes) Here in CAS work, we are working with sounds the student can make but is having trouble to add together, into a sequence that is needed to make a word sound right.
As soon as I feel we have some traction I will go to variable practice, i.e. I pick words that are either funny or interesting for the child and it can be a slightly larger number.
I tend to use blocked practice in the beginning or when working on vowels. That’s because it is more important we get our vowels right. They carry a word and are very important for overall speech intelligibility. Once we are on a roll, I tend to go more for random practice.
Example
Here in the video clip, we try and work the /e/ vowel in short words likes ‘bell’, ’fell’, ‘dell’, ‘sell’, ‘smell’ and I am using an AAC device to give a child’s voice as auditory feedback as well as using the PROMPT approach to help my student shape his vowels.
So this is:
Distributed (1 x week for 45 minutes)
Constant – we are practising the /e/ vowel in the same position in six different words
Blocked – we did this: several repetitions of each word and after the sixth we moved to another sound, and then later we came back to this.
Please feel free to contact me if your child has speech sound difficulties. It is my passion. I love supporting children with apraxia.
Sonja McGeachie
Early Intervention Speech and Language Therapist
Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice
The London Speech and Feeding Practice
Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.
When your child attends Speech and Language Therapy, it can look like your child’s therapist is playing. Therapy needs to be fun, which means carrying out therapy through the medium of play. But remember every approach used has evidence behind it. We need to know that therapy will be successful, so an evidence-based approach is essential.
One of the approaches used for Speech Therapy (i.e., working on speech sound production) is the Cycles Phonology Approach. This approach focuses on the patterns and processes rather than each individual sound. For example, it may be working on final consonant deletion, so the omission of the final sound in words. As Speech and Language Therapists we understand that children can get frustrated and fatigued working on the same sound every day. This approach attempts to solve that. Hodson suggests, the approach is also useful for children with more speech sound errors, as therapists see progress in areas not targeted.
How does the Cycles Phonology Approach work?
Your Speech and Language Therapist will assess your child’s speech development and will then analyse the results. They will also look for which sounds they can produce with support (this is called stimulability). They will analyse patterns in the results and will formulate a plan.
The Cycles Phonology Approach intervention allows your child to work in blocks. This might mean they work for half a week for 30 minutes on (e.g., clusters). Then the next half they’ll work for 30 minutes on a different process (e.g., omission of sounds at the end of words).
Research has found that the following error patterns respond well to this approach:
Syllables (identifying the different parts in a word e.g., “ae-ro-plane”)
Final Consonant deletion (omission of the final sound e.g., “ca” instead of “cat”)
Initial consonant deletion (omission of the first sound e.g., “at” instead of “cat”)
Fronting (instead of making a sound at the back of the mouth, it’s made at the front e.g., “tat” instead of “cat”)
Backing (instead of making a sound at the front of the mouth, it’s made at the back e.g., “gun” instead of “bun”)
S blends (e.g., “sl, sm, sn, sk, sw”)
Gliding of liquids (e.g., “lellow instead of yellow”, “wabbit instead of rabbit”)
What does a Speech and Language Therapy session look like when using the Phonology Cycles Approach?
The format of the session remains the same for whichever speech sound pattern your child is working on. Your child’s Speech and Language Therapist will review the previous session. Then they will use an activity to work on your child hearing the sound several times (this is called ‘auditory bombardment’). Then your child will practise saying the sound. Next, the Speech and Language Therapist will check if your child can say any of the sounds which they haven’t been able to produce before, with support. This is called a stimulability check. After this, your child will take part in an activity which builds their awareness of sounds in words (such as a rhyming or syllable activity). The session will finish with another auditory bombardment task (i.e., hearing their tricky sound repeatedly).
I will give you advice for practising at home, as it’s vital that your child learns in the correct way. We aim for 100 turns in therapy sessions, so it’s vital your child is motivated.
Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.
where the cause is NOT a swallowing problem, but we are having a “fussy eater” in the family, seeming for no obvious reason
When parents have a child who find mealtimes or eating difficult, it can put pressure on the whole family dynamics. Once we have observed a child’s eating and drinking skills and found that they are not swallowing impaired, but are for want of a better word “fussy” or “picky”, we can then start to look at what might be underpinning the food aversions/picky eating/food avoidance. Two of the main questions parents have (of course) are:
‘is my child getting the right nutrition?’
‘how can I have less anxiety-provoking and stressful mealtimes?’
We all tend to have an image in our minds about the ‘perfect mealtime’, and how mealtimes ‘should’ be. Speech and Language Therapists with a Feeding Specialism are the perfect professionals to help you unpick feeding issues. We are trained to look at swallowing and oral skills and we also know a lot about feeding behaviours and sensory difficulties which could be causing your child’s eating avoidance.
Here are some strategies that can support children with their eating:
Create and maintain a mealtime culture that suits your home and lifestyle. Then stick to that. We all need some routine in our lives to thrive. Mealtimes are no different. It might be that you eat in the same place for every meal, with the same knives and forks, concentrating on maintaining good posture. Children learn by repetition so the more familiar it is, the easier they will find it. In the physical sense, our bodies also need preparing for food, regardless of whether we are eating with our mouths or we are tube-fed. We want every child to connect all the dots of the process. It starts with their eyes, noses, expectations, memories of past experiences, feelings and then finally their mouths….
Be an excellent role model. Children learn through watching others, so your child will be observing you without you knowing. Ensure that you are positive about the food you are all eating, and talk about how delicious, tasty, juicy, and yummy the foods are. Make the atmosphere around the dinner table light hearted. Even though you are secretly stressed about your child not eating, try and not show this. Instead pick a topic or put on some nice music, or talk about something your child might be interested in, and try and avoid coercing your child to eat. Leave small finger foods on their plates and have a range of foods available on the table so that your child can see that everyone is eating a range of foods and enjoying them.
Use positive reinforcement. Try and think of mealtimes as fun and motivating. Children who are happy will likely be more inclined to try foods and take part in family mealtimes. Reward all interactions around food, so if your child merely touches a new food then praise this behaviour. Or if your child licks a food just once, again make a nice comment and praise your child for touching and licking the food. The takeaway here is to try and keep all messages positive around food.
Keep offering all types of food. What often happens is that parents stop serving foods they know will not be eaten. This makes sense in a way; we don’t want wastage! However, try and keep the doors open and re-offer all types of foods, even the ones that your child has not wanted in the past. Try and give your child one food they will like and one food they have tasted before and liked before, even a little, and then one new food to try. So, your child always has something to fall back on and they can join in with eating. But they can also try (or at least look at and think about trying) other foods that you and perhaps the siblings are eating.
Take a look at this website, I find it very helpful in showing parents what types of foods and how big a portion to offer
Have a go and try and implement some of the ideas above, and should you get stuck please get in touch!
Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.
There are different types of LISPS. Let me explain:
A lisp is the difficulty making a clear ‘S’ and ‘Z’. Other sounds can also be affected by the tongue protruding too far forward and touching the upper teeth or the upper lip even. ‘T’ and ‘D’ can be produced with ‘too much tongue at the front’ and this can also have an impact on ‘CH’ and often also ‘SH’.
Interdental lisp
Protruding the tongue between the front teeth while attempting ‘S’ or ‘Z’ is referred to as interdental lisp; it can make the speech sound ‘muffled’ or ‘hissy’. Often, we associate a lisp with the person sounding a bit immature. The good news is that this type of lisp is the easiest to correct and, in my practice. I have a 100% success rate with this type of lisp.
Lateral lisp
In a lateral lisp the person produces the ‘S’ and ‘Z’ sounds with the air escaping over the sides of the tongue. This renders the ‘S’ as sounding ‘slushy’ or ‘wet’. This type of lisp is a bit harder to correct than the interdental lisp. In my experience this can be fixed but it might need a bit longer, more intensive therapy than the interdental lisp.
Palatal lisp
With a palatal lisp the ‘S’ sound is attempted with the tongue touching the palate, much further back than it should be. The ‘S’ sounds ‘windy’ and ‘hissy’. This is a quite rare lisp production but it is also not difficult to correct.
These types of speech difficulties come under the category of ‘speech delay of unknown origin’ and may persist into adolescence and adulthood as ‘residual errors‘.
Some thoughts on Treatment in general:
Lisps can be treated successfully by a Speech and Language Therapist. However, for the treatment to work well, a student needs to be able to cooperate and want to improve his or her speech. Lisp remediation entails a fair amount of repetitive work and very young children or unmotivated older children don’t make the best candidates for treatment for this reason. Often students present with other speech, language or social communication difficulties and here the lisp might not be the priority for treating. For example, it might be that due to a student’s Attention Deficit Disorder they are simply not able to focus on speech practice in their daily life.
When should treatment of lisp begin?
Waiting well past 4½ years is not advisable as the longer we wait and do nothing the stronger engrained the erroneous tongue/speech habit will become. The ‘right’ age for therapy for one child may be different from the ‘right’ age for another child even within the same family. So do make an appointment with a speech and language therapist to assess and see whether your child might be ready to start therapy.
Do lots of children lisp—is it normal?
Until the age of about 4–4.5 years old it can be a perfectly normal developmental phase for some children to have the interdental lisp. But when we see and hear a lateral or palatal lisp we ought to act and see a speech and language therapist for sure.
After the age of 4.5 or 5 years old most speech therapists would agree on at least having a look to see if treatment could be started. The longer we wait the harder it is to retrain the brain pathways to adopt new speech habits.
What happens during the first Speech and Language Consultation?
The first consultation takes about an hour and involves screening relevant areas of communicative function. We take a detailed history, examine the anatomy of the child’s mouth and tongue movements. We check for tongue tie, teeth formation, palate structure and function, as well as swallowing patterns.
Then we begin straight away to try and see if any of the alveolar sounds (T/D/L/N) can be produced correctly with the right tongue placement as that would be the starting point from where to shape a good, clear ‘S’ sound.
The first consultation usually ends with home practice being given, explained to parents and another appointment being made for follow up.
Therapy – what does a session look like?
Each therapy session consists of:
Listening to sounds, discriminating sounds, identifying sounds, listening to rhyming sounds, sound awareness. We call this Auditory discrimination of single sounds: can the student hear the difference between two words that are the same apart from the first sound: ‘sing’ and ‘thing’ or ‘sigh’ and ‘thigh’?
Sound production: using a variety of different prompts and cues we will teach how to physically make the new sound. Often, we work on making a NEW sound, instead of correcting the OLD one. We work on imitation of single sounds then gradually we try and make new sounds in short words, then longer words and then phrases and sentences.
Games! We play games and try and have fun in between listening and producing our new sounds to help students stay motivated and even enjoy the therapy session and process.
How long does it take to ‘fix up’ a lisp?
It tends to take about one term with weekly sessions to help a student make good ‘S’ sounds in phrases and sentences. If the student can do the home practice every day in between the weekly sessions, then in most cases I am able to pronounce the lisp as ‘fixed’ after about one term.
After that the student needs to practise, practise, practise, at home and in daily life to keep reminding themselves of their new skills and their new sound production.
It is a matter of reminding and wanting to get it right. Occasionally a student returns to me for another term of simply practising their skills together with me as they are finding it hard for any number of reasons to practise at home. But generally, 8/10 students will be fine after some 12–13 sessions and their speech will be perceived as perfectly typical by family and friends.
Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.
There are various great ways to treat speech sound disorders and I use all the approaches available selectively; I decide what works with each individual child and I also vary the approach depending on the child’s frame of mind at any given time during my session.
Some of the approaches are more “drill-based” and require a child to be able to pay attention and really participate actively in the therapy, and this is what I am showing you today with this video clip.
My little student here has been working with me for some time and from only saying a handful of words which were not very easy to understand he has come a long way. He does have some features of Verbal Dyspraxia which I shall briefly outline here:
Making sounds in general is a struggle, especially when asked to copy certain sounds, example: ‘can you say: a ee ou oo?”
Repeating sound sequences or words sequences is hard, for example: “say p-t-k in sequence” or “say fish chips fish chips fish chips
When saying the same word again and again, different mistakes can be heard
Intonation difficulties: speech sounds monotonous
Vocabulary is very limited
Some therapy approaches are more play based, for example the Core Word method: here we pick a few words at a time which are very significant to the child and therefore highly motivating to try and say. These could be characters of Pokemon or Minecraft for example, or simple words like “GO!”
When you watch the video you will see that I use a lot of visual prompting, such as showing him where the tongue is moving to or from. I do this with my index finger and this approach is called Tactile Cueing or “Cued Articulation”. Part of the approach is to give a visual prompt and then reduce the prompt as the learner is more able to produce the correct sounds. Once he can produce the sound on its own, we quickly move to the sound within a word.
I do mix and match my approaches and in fact here I am drilling but I also use the Core Word which for him (YELLOW) — it’s his favourite colour and I happen to have quite a few good games where a YELLOW something or other can be asked for….. WHO KNEW!? 🙂
Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.
When most people think about speech or feeding difficulties, they picture the tongue, lips, or chewing skills, but how a child breathes at rest plays a surprisingly big role too.
Mouth breathing and open mouth resting posture can quietly influence everything from how a child’s face grows to how clearly they speak, to how confidently they chew and swallow. It’s something many parents never think about, until they start noticing the subtle signs.
Let’s explore why this happens, what to look for, and how to gently support better breathing and oral posture.
Recent research supports this link between mouth breathing and speech difficulties. For example, a 2022 study by Alhazmi et al., published in the Journal of Pharmacy and Bioallied Sciences, found that 81.7% of children aged 9–17 who breathed primarily through their mouths presented with speech sound disorders. The study highlights how mouth breathing can significantly influence orofacial development and articulation patterns.
💨 Why we’re designed to breathe through our nose
Our bodies are made for nasal breathing. When we breathe through the nose, the air is filtered, warmed, and humidified before reaching the lungs. The tongue naturally rests against the roof of the mouth, the lips close gently, and the jaw stays relaxed, all of which encourage healthy oral development.
In contrast, mouth breathing often means the tongue rests low in the mouth and the lips stay apart. Over time, this posture can subtly reshape how the muscles and bones of the face grow.
Children who breathe through their mouths most of the time may develop:
A longer face and narrower palate
Forward head posture
Slightly open lips and low tongue position at rest
A tendency toward drooling or noisy breathing
A dry mouth and consequently bad breath
At times the tongue pushes constantly against the front teeth causing them to grow forward (buck teeth)
These changes are not anyone’s fault, as they often start because of blocked noses, allergies, enlarged adenoids, low facial muscle tone or habits formed when a child was younger. But understanding the pattern helps us know how to support change.
🗣 How mouth breathing affects speech
Speech depends on precise coordination between the lips, tongue, and jaw. The resting position of these structures affects how ready they are to move.
Reduced tongue strength and placement, i.e. the tongue rests low in the mouth (as it does in mouth breathing), it’s harder for children to lift it efficiently for sounds like /T/, /D/, /N/, /L/, and /S/. This can lead to speech that sounds slightly slushy or unclear, or a frontal lisp.
Open mouth posture and resonance: An open mouth at rest may affect how air vibrates in the oral and nasal cavities. Children might have speech that sounds a bit ‘muffled’ or lacks crispness because the lips and jaw aren’t fully supporting articulation.
Fatigue and breath control: Mouth breathing can lead to drier mouths and less efficient breath support. That can make longer sentences or conversations feel tiring, especially in noisy environments.
🥄 How mouth breathing affects feeding and chewing
Feeding involves the same structures that control speech, so posture and breathing patterns matter here, too.
Chewing efficiency: Children who habitually keep their mouths open often have low tongue tone and reduced jaw stability. They may prefer softer foods, chew slowly, or struggle with mixed textures.
Swallowing pattern: A tongue that rests low may push forward when swallowing. This ‘tongue-thrust swallow’ can interfere with efficient chewing and even affect dental alignment over time.
Breathing while eating: Since it’s hard to chew, swallow, and breathe through the mouth simultaneously, children who can’t comfortably nasal breathe may rush bites or pause to catch their breath. This can contribute to coughing, choking, or food refusal.
Common signs to watch for
Parents often notice subtle clues before realising mouth breathing is a pattern. Some red flags include:
Lips habitually open at rest
Drooling after the toddler years
Snoring or noisy breathing during sleep
Preference for soft foods or grazing eating habits
Dark circles under the eyes due to allergies
Frequent colds, congestion, or mouth odour
Speech that sounds slushy or unclear despite good effort
If several of these sound familiar, it’s worth mentioning them to your child’s GP, dentist, or speech and language therapist.
👩⚕️ What can help
Address the underlying cause: If nasal blockage, allergies, or enlarged adenoids are making nasal breathing difficult, a medical assessment is the first step. ENT specialists can rule out or treat physical causes.
Encourage closed mouth rest: Gentle reminders like ‘Lips together, tongue up, breathe through your nose’ can help older children become aware of their resting posture. For younger ones, visual cues (stickers or mirrors) can make it a game.
Build oral-motor strength and awareness: Speech therapists can design activities to strengthen the tongue and lips, improve jaw stability, and encourage balanced breathing. This might include blowing games, tongue-tip lifts, use of dental-palatal devices or oral-motor exercises disguised as play.
Support good posture: Sometimes mouth breathing goes hand-in-hand with forward-head posture. Encouraging upright sitting during meals and screen time helps keep the airway open and supports better breathing habits.
Make nasal breathing part of daily routines: Gentle nose-breathing practice during calm times (reading, bedtime, car rides) helps normalise it. Avoid making it a battle: calm, consistent reminders work best.
🌱 A gentle note on change
Patterns of mouth breathing develop over time, and change doesn’t happen overnight. It’s important to approach this with curiosity, not criticism. The aim isn’t ‘perfect breathing,’ but to give your child the tools and awareness to breathe comfortably and efficiently.
Small improvements in nasal breathing and resting posture can lead to big gains in speech clarity, eating confidence, and even sleep quality.
💡 The takeaway
Breathing seems automatic, and it is! but how we breathe matters. Mouth breathing and open-mouth posture can quietly shape how a child speaks, eats, and grows.
By noticing early signs, addressing underlying causes, and building supportive habits, you can help your child move toward stronger, clearer speech and more comfortable mealtimes.
Just like every area of development, progress starts with connection, patience, and gentle consistency, one calm breath at a time.
Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.
