Something that keeps surprising me…

ByLondon Speech and Feeding
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After thirty years of helping children with lisps, you’d think very little would still surprise me. And yet…

Girl looking at herself in a mirror and looking at her tongue

Every few weeks, a lovely, and well-informed parent will describe their five, six, or seven year-old’s slushy, sideways /S/ and then ask ‘So, how many sessions do we need to fix this? Perhaps five–six? ‘

And every time, I have to resist the urge to laugh, cry, and reach for the biscuits all at once. Because the honest answer, for an established lateral lisp in a school-aged child, is usually twenty sessions or more. Wait! Hear me out!…

‘Why so many?!’ … once you understand what’s actually going on inside your child’s mouth, the number 20+ does no longer sound outrageous and starts sounding rather reasonable.

First: not all lisps are equal

Most people picture a lisp as the gentle, even endearing /TH/ for /S/ — ‘thnake’ instead of ‘snake’. That’s an inter-dental lisp, where the tongue pokes forward between the teeth. It’s common, it’s developmentally normal in younger children, and this is the important bit, it’s usually visible. It’s still a bit tricky to correct at first but I often can show a child what to do, they can watch themselves in a mirror, and quite often we’re away. But it still takes a lot longer than parents think because just fixing the sound does not mean it will be produced correctly in normal, daily speech and conversation.

Lateral lisp

A lateral lisp on the other hand is an entirely different animal. Instead of the air flowing in a neat central stream down a groove in the middle of the tongue, it spills out over the sides, around the molars. The result is that wet, slushy, quality. It affects not just /S/ and /Z/, but very often /SH/, /CH/ and /J/ too which is a big chunk of English.

Here’s the snag: it’s happening where nobody can see it. There’s no mirror in the world that shows you the sides of your tongue as you are speaking, or chewing for that matter. We’re teaching a child to control a movement they can’t see, can’t easily feel, and have never once performed correctly in their life.

By five, six or even seven years old your child has said the /S/ sound about several hundred times a day, every day, for several years. It’s one of the most frequent sounds in English: it makes our plurals, our possessives, our verb endings. Every ‘cats’, ‘let’s’, ‘she runs’.

So we are now talking about a deeply ingrained motor habit, rehearsed tens of thousands of times, that now feels completely normal and correct to the child producing it. We’re not teaching a new skill onto a blank page; we’re overwriting a very strong habit. Think of a tennis player with a flawed serve who’s played for five years… You don’t fix that in a fortnight, and nobody expects you to.

The good news is: school children, seven-year-old and up, are brilliant at this work. They can self-monitor, they can practise independently, they can hear the difference. It just takes time.

The quiet culprit: where the tongue lives at rest…

Here’s the piece that most parents have never heard, and it explains a lot.

When the mouth is at rest, the tongue should sit up — tip resting lightly behind the top front teeth, body gently suctioned to the roof of the mouth, lips together, breathing through the nose.

Many children with a lateral lisp have a low, forward resting tongue posture. The tongue sits on the floor of the mouth, often with the lips slightly apart. This is frequently associated with a history of mouth breathing, blocked noses and allergies, enlarged tonsils or adenoids, prolonged dummy or thumb-sucking, and sometimes dental or orthodontic differences such as an open bite.

Why does this matter so much? Because a good /S/ requires the tongue’s sides to brace firmly against the upper back teeth to form that central channel. A tongue that spends 23 hours a day flopped on the floor of the mouth simply doesn’t have the habitual strength, position or awareness to do that on demand. We can teach a beautiful /S/ in the clinic — but if the tongue’s default setting is ‘down’, we’re swimming upstream all week.

So, for many children, part of the work is establishing a better resting posture alongside the sound itself. That’s foundational and it’s slow.

So what does twenty-plus sessions actually achieve?

Therapy for a lateral lisp moves through a strict hierarchy, and you cannot skip a rung:

  • Auditory discrimination: Can they hear the difference? (Often, initially, no.)
  • Eliciting the sound: Sometimes a single session, can be six.
  • Stabilisation: Building consistency in isolation, then syllables, then single words (beginning, middle, end).
  • Blends: Mastering challenging combinations like ‘spoon’, ‘street’, and ‘smile’.
  • Sentences: Moving to phrases, full sentences, and structured conversation.
  • Generalisation: Using it naturally with family, at school, when tired, or when telling a long story.
  • Self-monitoring: Training them to catch and correct themselves without therapist intervention.

Rushing a level guarantees a collapse two levels later. I’ve never once regretted going slowly; I’ve frequently regretted going fast.

The bit that decides everything: home practice

Let me be blunt in a nice way 😊 The child who practises five to ten minutes a day, six days a week, will finish in half the time of the child who practises the night before their session.

An hour with me per week is roughly 1% of your child’s waking life. The other 99% is where habits are made or unmade. What I need at home is:

  • Short and daily beats long and occasional: Five focused minutes, ideally at a consistent time.
  • Practise only at the set level: If we’re on words, don’t leap to sentences. That’s how we go backwards.
  • Give specific feedback: Say ‘that one was lovely and sharps or ‘that one slipped sideways, try again’.
  • Hold back on everyday corrections: Don’t correct them in normal conversation until we’re ready.
  • Record them occasionally: Children love hearing their own tangible progress.

The bottom line

I’m good at this. I’ve been doing it for thirty years and I love it. But I’m a therapist, not a magician, and the parents who get the best outcomes are the ones who view this as a partnership. When we work together—combining expert clinic guidance with steady, gentle practice at home, that ‘twenty-plus’ number isn’t a sentence. It’s simply the guideline to giving your child a clear, confident voice for the rest of their life.

Do get in touch with me. I would love to hear from you and help you and your child.

Sonja McGeachie

Highly Specialist Speech and Language Therapist

Owner of The London Speech and Feeding Practice.

Health Professions Council registered
Royal College of Speech & Language Therapists Member
Member of ASLTIP

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.

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    The joy of container play: Exploring play development and understanding of how things work

    ByLondon Speech and Feeding
    The joy of container play
    Designed by Freepik

    Have you heard the term ‘Container play’? I use this very often with children in my sessions as it is so versatile and an enjoyable activity that can be done in parallel with a child or together. Container play is a powerful tool for fostering development in young children, especially those with developmental delays. This seemingly mundane activity provides a rich environment for sensory exploration, motor skill development, and cognitive growth.

    What is container play?

    Container play involves children interacting with various containers—boxes, buckets, bowls, cups, various bags, etc.—and filling, emptying, and transferring objects within and between them. Objects can include literally anything: small beads, bead chains, table tennis balls, wooden pegs, dinosaurs or any other little person toy, blocks of varying sizes, sand, water, or any other safe material. Larger containers obviously take larger items: socks, stuffed animals, bigger balls, bigger blocks etc really the choices are endless.

    Benefits for children with developmental delays:

    Sensory exploration:

    • Touch: Children explore different textures and temperatures of containers and objects.
    • Sight: They observe how objects look inside and outside the containers, how light reflects off them, and how colours change.
    • Sound: They listen to the sounds of objects clinking, rattling, and splashing.
    • Proprioception: Filling and emptying containers helps develop body awareness and spatial awareness.

    For neurodivergent children who might have sensory regulation difficulties, consider the following adaptions to accommodate your child’s sensory needs:

    • Over-stimulation: For children who are easily overstimulated, start with simple setups using a limited number of containers and objects. Gradually increase the complexity as they tolerate it.
    • Under-stimulation: For children who seek sensory input, provide a variety of textures and materials, such as sand, water, slime, or beans.
    • Temperature: Offer a variety of temperature options. Some children may enjoy warm water or cool sand.
    • Lighting: Adjust the lighting to create a calming or stimulating environment.
    • Focus on one sense at a time: Initially, focus on one sensory aspect, such as the feel of sand or the sound of water.
    • Weighted containers: Use heavy containers filled with rice or beans to provide deep pressure input.
    • Fidget toys: Incorporate fidget toys into the activity to provide sensory input and help with self-regulation.
    • Tactile exploration: Encourage exploration of different textures using objects with varying surfaces.

    Fine motor skill development:

    • Hand-eye coordination: Scooping, pouring, and transferring objects require precise hand-eye coordination.
    • Pincer grasp: Picking up small objects helps develop fine motor skills like the pincer grasp.
    • Strength and dexterity: Manipulating containers and objects strengthens hand muscles and improves dexterity. Opening and closing containers can be a huge area of interest; how does the top screw back on, or off?

    Cognitive development:

    • Cause and effect: Children learn that their actions (e.g., pouring water or sand) have consequences (e.g., the water spills).
    • Spatial awareness: They develop an understanding of concepts like inside, outside, full, empty, and over/under; also how big is the vessel and how much goes in before it’s full or spills over. How small is the vessel opening and what do I need to do to get the beads into the container.
    • Problem-solving: Children learn to solve problems, such as how to get an object out of a narrow container or how to transfer water without spilling.

    Social and emotional development:

    • Communication: Container play can encourage communication as children interact with others, sharing toys and commenting on their actions. Asking for help to open and close a container is often a great opportunity to practise ‘help me’ or ‘open it’
    • Turn-taking: Sharing containers and materials helps children learn to take turns and cooperate.
    • Sensory regulation: For children with sensory sensitivities, container play can be a calming and self-regulating activity.

    Tips for engaging children in container play:

    • Create a safe and inviting environment. A shower curtain on the floor makes things easier for tidy up afterwards. And it allows for spillages.
    • Provide a variety of containers: Use different sizes, shapes, and materials. Use containers that are visually interesting and pleasing, perhaps a festive biscuit tin, or a tin that looks like train engine. Use see-through containers at first which make the filling and emptying more obvious. This is important for children who have no previous experience with this type of play and need to ‘warm up’ to it. Once a child loves and is used to container play you can go wild with all types of containers.
    • Offer a variety of objects: Include balls, blocks, sand, water, and other age-appropriate materials.
    • Join in the fun! Start off the process, show your child what the joy of the activity is for yourself, how fun it is to fill and empty containers, provide enough containers for your child to start playing alongside you, and comment on their actions.
    • Follow your child’s lead: Allow them to explore and experiment at their own pace.
    • Adapt activities: Adjust the level of challenge based on your child’s abilities and interests.

    Container play is a simple yet powerful tool that can support the overall development of young children, especially those with developmental delays. By providing a rich and engaging sensory experience, container play can help children build essential skills in motor, cognitive, social, and emotional domains.

    If you have any questions or would like to have more in-depths demonstration of this or other play styles for your child please contact me.

    I look forward to hearing from you.

    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.

    1
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    Explore activities for Gestalt Language Processors to aid communication

    ByLondon Speech and Feeding
    Speech Therpaist in London

    When you have a child who uses Gestalts it is often difficult to think and adapt clinic activities into those to use at home. More importantly, you find that individualising your activities for your child who uses Gestalt are time-consuming. But you value its importance for their communication development.

    You feel so busy, you are taking them to other appointments, or trying to get through your daily activities, all whilst still ensuring your child’s emotional needs are met. You know life should not get in the way of your child’s therapy activities at home, but it does. We know your spare time is precious and limited, so let us achieve your child’s or young person’s goals in the allotted time you have which meets their way of learning (using Gestalts).

    We wanted to support you by exploring items which you may have at home, and we will give you some key phrases which you can start to model with your child. Whereas our last blog introduced the idea of gestalt language processors, we are now developing ideas to give you the tools to implement activities at home. We recognise how overwhelming it may feel, and this is one of the reasons to make activities as straight forward as possible. Therapy does not need to be complicated; it just needs to be carried out on a regular basis.

    Explore the samples I’ve created to give you an idea of how this might look but please consult with a Speech and Language Therapist who knows about Gestalt Language Processing so that you can work together to develop great home activities for your child.

    Want to learn more about gestalt language processing?

    Please contact me for help.

    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.

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  • A day in my life as an Independent Speech and Language Therapist

    ByLondon Speech and Feeding

    During the pandemic I wrote a blog on what my working day looked like. Now a good year has passed since coming back to some sort of normality and I thought I would update this ‘day in the life of an SLT’ as my working life has changed of course to reflect the ‘new normal’.

    I have become truly busy, perhaps busier than I have ever been to be honest. It’s probably mostly due to the fact that I do most of the aspects of my work myself — though I want to mention two invaluable people here without whom I could not function as well as I do: the excellent Nathalie Mahieu () helps me with my SEO, Insta posts and blog uploading and the wonderful Sue Bainbridge () makes sure that my accounts don’t get into trouble with His Majesty’s tax office.

    Attached to our role as Speech and Language Therapists is an arguably enormous amount of administration/paperwork and preparation required for each and every client. This needs to be factored in when deciding how many families I can realistically see each working day. For me it works out as typically 3–5 clients a day, Monday to Friday.

    So how does my day typically look? Each day varies a lot depending on what type of client I have, but on average it looks a bit like this:

    First thing in the morning — after having a coffee and a quick check-in with my besties on WhatsApp — I do my Buddhist chanting for about an hour. My Buddhist prayers are the base of all I do and get me connected to my higher purpose and how to create value with each activity and each person I see that day. It sets me up for the day, I keep in mind who is going to come and see me and how I can best help them.

    Next up, I do the daily ‘spring-clean’ of my therapy room (on all fours! no joke ???? those kids see every speck!), vacuum the floors, wipe down the toys with flash-wipes and tidy up all my boxes, making sure that the battery toys are working, and everything else is in place. On to the guest toilet, the hallway needs to be rid of all the men’s shoes and trainers and coats… It’s endless what needs tidying when you are living with three men… This takes about 45 minutes.

    An articulation activity – packaging practice into a little game

    Then I prep for all my clients that day. I have now got so much quicker about selecting therapy materials. For one thing I have purchased so many toys and materials over the past five years that I can literally now open a shop and need to consider building an extension! ???? The upside is that it is now very easy for me to select a good handful of toys or games for any one child, even at a minute’s notice. Though, on average, I spend about 30 minutes per child preparing activities.

    Hurrah, it’s 11 am and my first client of the day arrives and the fun begins.

    When they leave around an hour later, the cleaning and wiping down starts again, this time less extensively. I write up my notes and send homework whilst enjoying a cuppa.

    The next client comes at 12.30 pm and once they have left, floor cleaned, toys wiped, notes written it is time for a quick lunch. No more than half an hour usually.

    Afternoon clients tend to be one more little one (nursery age) at 2.15 pm and thereafter I see mostly older school children for a variety of reasons (mainly speech production but also some language-based activities). I tend to say farewell to my last client of the day around 6 pm. I spend another hour, sometimes more, on writing up notes, answering new enquiries, blogging and phone calls to keep my service fresh, inspirational and exciting.

    And then dinner and the rest of the day rushes by. I tend to finish my day with some more Buddhist chanting, not a lot, perhaps 10–20 minutes to reflect on what has gone well and what could have been better — re-determine to improve or make better as needed.

    Tele therapy activity using online materials plus a coreboard

    In terms of where I provide a service, I still do a good mix of online clients (tele-therapy) and in-person clients in my clinic, which I love. Occasionally, I visit children in their nursery or at home but this service is now only available for long-standing clients.

    Each client is hand-picked to make sure that we are a good fit: no one client gets the same treatment as another; each client is unique, we get to know one another well over the time we work together and they are always highly valued. That takes time and, in reality, each client gets about two hours of my time. That is the actual session plus all the preparation and aftercare, i.e., bespoke hand holding, tweaks, problem solving and reassurance in between sessions.

    I absolutely love this way of working and would not ever want to do anything else. Nearly three decades of working both in the NHS and in private practice, countless courses (continual professional development) have enabled me to flourish as a therapist and I know that I offer something special and very valuable to my clients.

    My unique way of working affords all my lovely clients the help they need to support their children to make progress; and it gives me the right balance of job satisfaction and work life balance for now. My lovely reviews and testimonials tell me that my clients appreciate my service and this at the end of the day is the most important.

    If you are interested in exploring Buddhism/buddhist chanting then check out this link (https://sgi-uk.org/), and feel free to contact me about that specifically, regardless of whether you want speech therapy. I am always happy to chat about Buddhism, it has been so enriching for the last 43 years of my life.

    If you need help with your child, please do not hesitate to contact me.

    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.

    1
  • ·

    Rethinking the PECS Approach

    ByLondon Speech and Feeding

    I want to talk about some concerns of SLTs, parents and increasingly autistic adults who explain to us how this communication method did not really work so well and why.

    What is PECS in a nutshell:

    PECS (Picture Exchange Communication System) is based on the idea of exchanging pictures in return for desired items. For more advanced users, it is used to communicate different functions such as emotions, comments, negations using the exchange of a sentence strip. It was founded on the principles of Applied Behavioural Analysis (ABA).

    How does that look in practice?

    In my experience, having been trained in the approach myself, the overall aim is eventually for the child to spontaneously go and get their picture book (PECS book), open it, look through a range of pages to select the correct picture of what they want to have or say, then go and find their communication partner, and finally place that picture onto the communication partner’s outstretched palm to be rewarded with an item or with a response of some sort. Or the child selects a range of pictures to create a little sentence, such as: ‘the blue fish swims in the sea’, ‘the red bird flies in the sky’ or ‘I see a red bird’ for example. This can be part of a structured table top activity.

    The system follows a series of phases, starting from simple picture exchanges to eventually construction of sentences using symbols. PECS’s aim is to promote communication initiation and reduce frustration for those who struggle with speech.

    So far so good one might say, why not? Before I go into the various concerns, I would want to add my own working experience with PECS, and whilst it is my opinion, I would say I have NEVER seen a working PECS book being used spontaneously!

    My experience

    I have seen attempts of stages 1 and 2 done quite well, in schools, and where people knew that I was coming in “to have a look at how PECS is working with child X”. Yes, in those instances an effort was made of course to try and show me how it worked. I must add that have never been very impressed. I cannot recall it used for any other items than: biscuits/quavers/crisps/ raisins and bubbles/puzzle pieces or spinners.

    If we want to see a child trained to exchange for these items in a structured setting, i.e., the child sits at a little table with the adult sitting opposite enticing the child with one or other item, then yes that can be done successfully. I have seen children exchange 25 pictures with a crisp on it, for said crisp and they might have asked for another 25 of those crisps given half the chance. Yes. Good. But. I have yet to see a child go to their PECS book and go through all the motions that I mentioned above to get a crisp. In school they don’t need to: they know that crisps are only available when the PECS book is being practised. Otherwise, let’s be honest, it’s fruit at 10.30 am!

    So, they don’t get a spontaneous opportunity to ask for highly motivating items as that is not how school works, is it? ‘SIR! Can I have a crisp?’ At 10.02am, in the middle of maths? Didn’t think so… So in reality this does not get practised in my experience.

    A few concerns in no particular order:

    Limited Generalisation

    One issue often raised is the limited generalisation of skills learned through PECS. The structured nature of the program may result in a child only being able to communicate effectively within the specific contexts where they were taught to use the system (as I suggest above: crisps: yes, please let’s do the PECS for it). This limitation can pose challenges when trying to apply communication skills in new or unstructured/spontaneous situations.

    Lack of Spontaneity

    Critics suggest that PECS can sometimes lead to scripted and less spontaneous communication. This is also what I have observed. Since the method is designed to follow a structured progression, there is a concern that individuals might struggle to initiate communication outside of the established framework, potentially hindering their ability to engage in more natural interactions.

    Narrow range of communication functions being practised

    While PECS is quite successful in focusing on requesting and naming items, there are many other important communication functions, such as expressing emotions, asking questions, giving opinions or greetings for instance. We can argue that a communication core board where we have a whole range of different core words available lends itself much better to practising a range of communicative functions.

    The Pictures are movable

    They are attached to the book via Velcro. They are constantly being picked and exchanged and then returned to the book. This means that the pictures tend to be always in different places. This goes against the motor planning that takes place when one is learning a new skill: imagine you want to learn to touch type and the letters always move and are at different places? How can you be quick about finding a letter? You can never get to “automatic” with this type of approach.

    Communication is not taught via behavioural means

    Only if you say “banana” in the way that I dictate that you should will you get a piece of banana. Who does that? Nobody. Typically, child points to the counter where there is a banana and says: ‘ba’ or ‘ana’ and mother/carer will look over there and say ‘oh banana! You want a banana? Ok there you go have a piece.’ Or something like it. Mother will not say: ‘SAY BANANA or else you won’t get it.’ Child hears mum saying ‘Banana’ each time and with time will point and say ‘banana’ or ‘I want-a-nana’ or something. This is how communication is learned: through the adult modelling it cheerfully all day long and the child hearing it and then gradually copying it.

    One other gripe I personally have but I am reliably informed by all my parents that they share this about PECS:

    IT IS SO LABOUR INTENSIVE!

    There are 10, 50, 100’s of little pictures that first of all need laminating… then velcroing, then finding and replacing. As I said above, it’s a constant moveable feast for one, but also you LOSE them. Yep. You want to find the picture for “trampoline”. ‘Where is it? I saw it yesterday… We had it outside when we practised you asking for the trampoline. I am sure we put it back? Where is it??? Ok. We need to print off a new one.’

    It is also labour intensive for the first stage where you need to have TWO adults to ease the exchange (pick up and release of picture into the communication partner’s hand). Who has two adults available for what can be weeks until the child is able to pick up and release by themselves?

    YEP. So it’s really not for me you can tell! I much prefer Core boards (see my previous post on using one) or electronic speech generating AAC devices like GRID, or LAMP or TOUCHCHAT. These are all great to use and there is good support out there for introducing these.

    Finding a Balance

    While the concerns surrounding the PECS approach are valid, it’s fair to note that the method also has some merits. There is anecdotal evidence of many individuals who have successfully improved their communication skills and quality of life through PECS. But, finding a balance between using PECS as a stepping stone and ensuring the development of more comprehensive and SPONTANEOUS communication is key.

    As educators and therapists, we need to extend the focus beyond requesting and labelling by incorporating symbols that represent emotions, actions, and more complex ideas. This expansion encourages a broader range of communication functions. When the time is right, gradually transitioning from PECS to more advanced communication methods such as Core boards or electronic AAC tools and speech-generating devices is the way forward.

    We want to value all communication equally and our approach ought to be playful and child-led and to focus on intrinsic motivation instead of extrinsic rewards and reinforcers.

    If you have any questions or if you are looking for a therapist who endorses play-based and child-led therapy approaches, please do reach out.

    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.

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    Why tongue lateralisation matters: The hidden feeding skill that every toddler needs

    ByLondon Speech and Feeding

    When parents think about feeding milestones, they often focus on what their child is eating. Are they accepting lumps? Will they eat vegetables? Are they managing finger foods?

    However, one of the most important skills happening behind the scenes is something many parents have never heard of: tongue lateralisation.

    Tongue lateralisation simply means the tongue’s ability to move from side to side inside the mouth. Although this sounds like a small movement, it is one of the key building blocks for safe chewing, efficient eating and later speech development.

    As a Speech and Language Therapist specialising in infant feeding, I frequently assess children who have delayed or absent tongue lateralisation. The encouraging news is that this skill can often be developed. But like many areas of development, there is an optimal window during which children learn it most naturally.

    What does the tongue actually do during eating?

    Eating is an incredibly complex process involving the lips, jaw, cheeks, tongue and swallowing muscles all working together.

    For mature chewing, the tongue needs to:

    • move food from the centre of the mouth onto the back gums and molars
    • keep the food positioned while the jaw chews
    • collect scattered pieces of food from around the mouth
    • reform the chewed food into a single cohesive bolus
    • move that bolus safely to the middle of the tongue before swallowing.

    Without good tongue lateralisation, food often stays in the middle or front of the mouth where it cannot be chewed effectively.

    Children may compensate by:

    • swallowing pieces whole
    • mashing food with the front teeth only
    • relying on sucking instead of chewing
    • holding food in their cheeks
    • gagging frequently
    • refusing more challenging textures altogether.

    These children are often described as ‘fussy eaters’, when in reality they may simply lack the oral motor skills needed to manage more advanced textures comfortably.

    When should tongue lateralisation develop?

    Tongue lateralisation begins to emerge during the second half of the first year of life as babies start exploring textured foods.

    Between approximately 6 and 12 months, babies naturally begin learning to move food sideways towards their gums for early chewing. As molars develop during the second year, these movements become more refined and efficient.

    This period represents an important developmental window because babies are biologically programmed to experiment with increasingly varied textures. Repeated opportunities to chew different foods strengthen the tongue, jaw and cheek muscles while building the complex movement patterns needed for mature eating.

    If a child remains on smooth purées or very soft foods for too long, they may miss hundreds of opportunities to practise these essential movements.

    Why does this developmental window matter?

    Like learning to crawl, walk or ride a bicycle, oral motor skills develop through repeated practice.

    Children who do not experience enough chewing opportunities during infancy can sometimes continue to rely on immature sucking and munching patterns well into toddlerhood.

    This does not mean the opportunity is completely lost after infancy. Many toddlers can still learn tongue lateralisation successfully with the right support. However, the longer an immature pattern is used, the more established it becomes, making change more challenging.

    That is why early assessment is so valuable.

    Signs your toddler may have poor tongue lateralisation

    You may notice your child:

    • chews mainly with the front teeth
    • bites but does not chew efficiently
    • keeps food in the centre of the mouth
    • pockets food in the cheeks
    • frequently spits out textured foods
    • gags on lumps
    • prefers soft foods
    • swallows before food has been adequately chewed
    • takes a very long time to finish meals.

    Not every child showing these signs has an oral motor difficulty, but they do warrant further assessment.

    How can we encourage tongue lateralisation?

    The good news is that the tongue learns through experience.

    One of the best ways to encourage side-to-side movement is by offering long, resistive foods that naturally encourage the tongue to move food towards the side gums for chewing. We also call them sometimes HARD MUNCHABLES – they look like on the following image.

    Hard munchablers

    Examples include:

    • mango pits with most of the flesh removed
    • pineapple core strips
    • thick steak strips
    • cooked pork strips
    • peeled celery sticks
    • thick cucumber spears
    • roasted pepper strips
    • corn on the cob cut into manageable rounds
    • dehydrated apple rings
    • large clean cooked rib bones with a little meat remaining for supervised chewing practice.

    These foods are not intended for children to consume large pieces quickly. Instead, they provide resistance that encourages the jaw, cheeks and tongue to work together while giving valuable sensory feedback.

    A simple technique that can help

    Some toddlers struggle because they never naturally move food to the side of their mouths.

    In these cases, placing a long strip of food gently onto the side gums can sometimes trigger the chewing pattern automatically. This gives the tongue an opportunity to experience where chewing should occur.

    This should always be done calmly, with the child sitting upright and under close adult supervision.

    Every child develops differently

    Some children are more likely to experience delayed tongue lateralisation than others.

    This may include children who:

    • remained on purées for an extended period
    • have developmental delays
    • have low muscle tone
    • were born prematurely
    • have significant sensory processing differences
    • have experienced prolonged tube feeding or medical conditions affecting feeding.

    A feeding assessment can identify whether tongue movement, jaw stability, sensory processing or another factor is contributing to the difficulty.

    Early intervention makes a difference

    One of the biggest misconceptions I hear is:

    ‘They’ll grow out of it.’

    Some children do. Others don’t.

    Without intervention, inefficient chewing patterns can persist for years, affecting food variety, mealtime confidence and nutritional intake. In some cases, immature oral motor patterns may also contribute to unclear speech production later on, although feeding and speech skills do not always develop at the same rate.

    The earlier we identify a problem, the easier it usually is to help children develop more mature, efficient chewing patterns.

    Final thoughts

    Tongue lateralisation may not be a term many parents recognise, but it is one of the foundations of successful feeding.

    By offering opportunities to chew a variety of safe textures during infancy, parents help build the complex tongue movements needed for efficient eating throughout childhood.

    If your toddler still struggles with chewing, gags on textured foods, or seems unable to move food around their mouth, don’t simply wait and hope they will outgrow it. A comprehensive feeding assessment can identify exactly where the difficulty lies and provide practical strategies tailored to your child’s needs.

    Sometimes a few small changes at the right time can make a lifetime of difference. Do get in touch with me. I would love to hear from you and help your little one develop good chewing skills and eating habits.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

    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.

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  • · ·

    The picky eater’s plate: Introducing solids to toddlers with ARFID

    ByLondon Speech and Feeding
    Designed by Freepik

    Mealtimes can be a battleground for parents of picky eaters, especially toddlers with Avoidant/Restrictive Food Intake Disorder (ARFID). I see a great number of toddlers with Autism traits and many of my clients are picky eaters from mild to severe. Take a look at my blog for an outline of what the issues are and how to try and help.

    ARFID goes beyond typical ‘picky eating’ and can significantly impact a child’s growth, nutrition, and social-emotional well-being. If your toddler is resistant to trying new foods or has a very limited diet, here are some strategies to navigate the introduction of solids:

    1. Understand ARFID:

    ARFID is a diagnosable eating disorder characterised by:

    • Limited food variety: Eating only a small range of foods, often with specific textures or colours.
    • Fear of new foods: Intense anxiety or aversion to trying unfamiliar foods.
    • Sensory sensitivities: Heightened sensitivity to taste, smell, texture, or appearance of food.
    • Lack of interest in eating: May show little interest in food or mealtimes.

    2. Seek professional guidance:

    • Paediatrician and/or gastroenterologist: Rule out any underlying medical conditions.
    • Registered dietitian: Assess nutritional needs and create a balanced meal plan.
    • Speech and language therapist (SLT): If oral-motor skills or sensory sensitivities are contributing to feeding difficulties.
    • Occupational therapist (OT): If sensory processing challenges are affecting mealtime behaviours.
    • Child psychologist: If anxiety or emotional factors are contributing to ARFID.

    3. Strategies for introducing solids:

    • Start small: Introduce one new food at a time, in small amounts, alongside familiar favourites.
    • Patience is key: It can take multiple exposures (up to 10–15 times!) for a child to accept a new food. Don’t give up!
    • Positive reinforcement: Praise and encouragement for any interaction with the new food, even just touching or smelling it.
    • No pressure: Avoid forcing or pressuring the child to eat. This can create negative associations with food.
    • Make it fun: Present food in playful ways, use cookie cutters for fun shapes, or involve the child in food preparation.
    • Sensory exploration: Encourage exploration of food through touch, smell, and sight before tasting.
    • Role modelling: Show the child that you enjoy eating a variety of foods.
    • Use fun utensils: your child might like characters from ‘Frozen’ or ‘Dinosaurs’ or ‘Diggers’ there are a host of character-based cutlery and cups/plates to be had. Also, I really rate these two items very highly they are so good so I want to share these with you. Both are available online. But warning: the cup is outrageously expensive as it comes from the United States and is sold by a small scale company. But I feel this is cup very worth trying, I have had good results with this.
    NumNum Baby Spoons Set
    TalkTools Recessed Lid Cup with Handles
    • Gradual desensitisation: Start with foods that are similar in texture or taste to accepted foods, then gradually introduce more challenging options.
    • Food chaining: Introduce new foods that are similar in taste, texture, or appearance to accepted foods.

    4. Mealtime Environment:

    • Positive and relaxed: Create a calm and enjoyable mealtime atmosphere.
    • No distractions: Minimise distractions like TV or toys.
    • Consistent schedule: Offer meals and snacks at regular times.
    • Child-sized portions: Offer small, manageable portions to avoid overwhelming the child.
    • Involve the child: Let the child choose their utensils, plate, or cup.

    5. Remember:

    • Every child is different: What works for one child may not work for another.
    • Progress takes time: Be patient and celebrate small victories.
    • Focus on the positive: Praise any positive interaction with food.
    • Seek support: Connect with other parents or support groups.

    Introducing solids to toddlers with ARFID can be challenging, but with patience, persistence, and professional guidance, you can help your child develop a healthier relationship with food.

    Get in touch with me via my contact form if you need support

    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.

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