Parent Tips

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    How can I incorporate AAC into my speech therapy sessions?

    ByLondon Speech and Feeding

    Many parents are surprised when I bring AAC into a session, especially if they’ve come to see me primarily for speech sound work.

    They might wonder: ‘If we’re working on pronunciation, why are we using a communication device?’

    The simple answer is this: speech therapy is about communication first, and speech sounds second. Supporting a child’s ability to express themselves clearly and confidently is always the priority, and AAC can be a powerful tool alongside spoken speech.

    What do we mean by AAC?

    AAC stands for Augmentative and Alternative Communication.

    This can include:

    • A speech-generating device (such as LAMP Words for Life or GRID as I used in the photo below)
    • A communication app on a tablet
    • A symbol board or communication book
    • Gestures, signs, or visual supports

    AAC does not replace speech. Instead, it supports language development, reduces frustration, and builds communication success while speech skills are developing.

    Pretend Play using Speech and AAC in my clinic room

    But I mainly work on speech sounds… So how does AAC fit?

    Most of the children I see are working on:

    • Articulation difficulties
    • Phonological delay
    • Motor planning challenges (including apraxia/dyspraxia)
    • Unclear speech affecting confidence

    For these children, AAC isn’t a separate therapy. It’s simply woven naturally into what we are already doing.

    If a child brings their device to sessions, I actively include it. If they don’t yet use AAC but could benefit from visual or symbolic support, I may introduce simple options within activities.

    Using AAC to support speech practice

    Let’s say we are working on early speech targets like: ‘GO’.

    We might practise:

    • Saying the word verbally
    • Listening for the target sound
    • Using play (TOY TRAIN GOING ROUND A TRACK)

    Now we can extend this using AAC.

    On the device or communication board, we might model: ‘LET’S GO’ or ‘IT’s GOING up the hill’.

    This allows the child to:

    • Practise their speech sound target
    • Build a simple sentence
    • Experience successful communication even if speech is not fully clear yet

    All responses are valid and supported.

    AAC helps children communicate more than they can say

    Many children can understand and think in longer phrases than they can physically say.

    For example:

    • A child who verbally says single words may build longer phrases on AAC.
    • A child who struggles to plan speech movements may use AAC to communicate smoothly while still practising verbal attempts.
    • A child who becomes frustrated when misunderstood gains a reliable backup system.

    Rather than slowing speech progress, AAC often:

    • Reduces communication pressure
    • Increases participation in therapy
    • Encourages more attempts at speech
    • Supports language growth

    When children feel understood, they usually become more motivated to try speaking.

    There are no ‘prerequisites’ for AAC

    One of the biggest myths I hear is: ‘My child isn’t ready for AAC yet.’

    In reality, children do not need to:

    • Reach a certain speech level
    • Use pictures first
    • Prove they understand everything
    • Show immediate interest

    Instead, we presume competence and introduce AAC in meaningful, playful ways.

    That means:

    • Modelling words while blowing bubbles
    • Commenting during playdough activities
    • Choosing words during games
    • Building simple phrases in shared reading

    AAC should never feel like extra ‘work’. It’s simply another way to join in communication.

    My goal is always the same: to help each child communicate as clearly, confidently, and successfully as possible, using every helpful tool available.

    If your child uses AAC (or might benefit from it)

     Please feel free to:

    • Bring the device to sessions
    • Show me how your child currently uses it
    • Share advice from school or other therapists

    I am very happy to incorporate AAC into our work together so that speech practice, language development, and real communication all move forward hand-in-hand. Because ultimately, therapy isn’t just about producing perfect sounds. It’s about helping your child be heard and understood.

    If you’d like support or advice, please contact me and I can help guide the next steps.

    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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      Managing mealtime sensory overload at holiday gatherings: Supporting children with allergies and feeding differences

      ByLondon Speech and Feeding
      Managing mealtime sensory overload at holiday gatherings: Supporting children with allergies and feeding differences

      Holiday meals are meant to be joyful and something we all look forward to. But for many children and their families, these occasions can be overwhelming and be the cause of dread and worry. The combination of new smells, unfamiliar foods, loud environments, social expectations, and allergy anxieties can quickly turn what should be a festive time into a stressful one.

      For parents of children with sensory processing differences, selective eating challenges, or food allergies, holiday gatherings often require careful planning and a big dose of tolerance and compassion. The good news is that with awareness and a few gentle strategies, you can support your child to feel safe, regulated, and included during festive meals without pressure, tears, or discomfort.

      Let’s explore how to make holiday mealtimes calmer, safer, and more connected this season.

      🎄 Why holiday meals feel so overwhelming

      Holiday gatherings usually combine several sensory triggers all at once:

      • Noisy, chaotic rooms
      • Strong smells from a mix of foods we don’t normally cook
      • Multiple conversations happening at once
      • Bright lights, Christmas décor, flickering candles
      • Unfamiliar foods with unexpected textures
      • Expectations to ‘try everything’ or ‘enjoy it’s sooo good!’
      • New environments, seating arrangements, or routines

      For children with sensory sensitivities, this can feel like a tidal wave of input. Research shows that children who are sensory-sensitive often have heightened responses to smell, taste, and texture, which may lead to avoidance or distress at mealtimes (Cermak, Curtin, & Bandini, 2010).

      Add food allergies into the picture and anxiety increases even further for both children and parents. A 2020 study by DunnGalvin et al. found that children with food allergies experience significantly higher stress in shared eating environments, especially when food preparation or contamination risk is hard to control.

      So, if your child becomes tearful, shuts down, or refuses to sit at the festive table, it isn’t ‘bad behaviour.’ It’s sensory overload, heightened vigilance, or discomfort communicating through their body.

      🌟 Preparing your child for a calmer festive meal

      Preparation is especially important for sensory-sensitive or allergy-aware children. Here’s how to set them up for success:

      1. Offer predictability through previewing

      Before the event, show your child pictures of:

      • where you’re going
      • who will be there
      • the types of foods that might be served
      • where they might sit

      A visual schedule or social story can help reduce anxiety and give your child a sense of control.

      2. Pack safe foods without apology

      If your child has allergies or selective eating, bring:

      • ‘Safe foods’ you know they will eat
      • Backup snacks
      • A separate (their own) plate, if needed
      • Emergency medication

      Announce clear, firm boundaries such as:

      ‘Ok people, these are Jamie’s safe foods — we’ll stick with these today.’ This will help relatives understand without pressure or judgement.

      3. Choose seating that supports sensory regulation

      If possible, seat your child:

      • at the end of the table
      • near a familiar adult
      • away from the kitchen (strong smells)
      • away from noise clusters
      • give them their favourite toy or fidget whilst waiting

      Let them take breaks when needed. This isn’t ‘rude,’ it’s self-regulation.

      🍽️ Supporting children during the meal

      1. Focus on connection, not consumption

      The holidays are not the time to expand your child’s food range. Keeping mealtimes low-pressure actually supports long-term progress.

      In fact, the research is clear: pressuring children to eat decreases acceptance and increases refusal (Galloway et al., 2006).

      So instead of ‘Just try it!’ try:

      • ‘You don’t have to eat it, you can look at it.’
      • ‘You’re in charge of what goes in your mouth.’
      • ‘You can keep your safe foods on your plate.’

      2. Protect your child’s allergy safety

      Holiday meals often include:

      • cross-contamination risks
      • shared utensils
      • buffets
      • homemade dishes without ingredient lists

      Use gentle but firm scripts:

      • ‘Because of Ellie’s allergies, we’ll keep her plate separate.’
      • ‘We’ll serve her food ourselves to make sure she stays safe.’

      Confidence in your boundary helps others respect it.

      3. Manage sensory load in real time

      Offer:

      • headphones
      • a small chew or fidget toy
      • a designated ‘calm corner’
      • time outside for fresh air
      • a predictable signal for breaks (e.g., a hand squeeze or card)

      Remember, sensory regulation is healthcare, not ‘giving in.’

      4. Model calm eating

      Children learn most from watching.

      Slow, happy bites and relaxed facial expressions tell the nervous system: ‘This environment is safe’.

      💛 What to say to well-meaning relatives

      Families often have big feelings about food. You can prepare nice phrases like:

      • ‘We’re focusing on helping him feel safe around food today.’
      • ‘She has allergies, so we’re sticking to our plan.’
      • ‘We’re avoiding pressure because it helps him eat better long term.’
      • ‘We’re celebrating together, eating is not the goal today.’

      Setting expectations ahead of time can reduce awkward moments later.

      🎁 The bigger picture: It’s about safety, not ‘picky eating’

      Children with allergies, sensory differences, or feeding challenges aren’t trying to be difficult. They are trying to stay safe, regulated, and comfortable.

      Your calm presence, gentle boundaries, and preparation create the conditions for a holiday that feels peaceful, not pressured.

      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.

      📚Research References

      Cermak, S. A., Curtin, C., & Bandini, L. G. (2010). Food selectivity and sensory sensitivity in children with autism spectrum disorders. Journal of the American Dietetic Association, 110(2), 238–246.

      DunnGalvin, A. et al. (2020). APPEAL-2: A pan-European qualitative study to explore the burden of peanut-allergic children, teenagers and their caregivers. Clinical & Experimental Allergy, 50(11), 1238–1248.

      Galloway, A. T., Fiorito, L. M., Francis, L. A., & Birch, L. L. (2006). ‘Finish your soup!’ Counterproductive effects of pressuring children to eat on intake and affect. Appetite, 46(3), 318–323.

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    • · · · ·

      What to do when words don’t come fast enough

      ByLondon Speech and Feeding
      What to do when words don’t come fast enough

      When children find talking hard, parents often face a difficult question: ‘Should we wait and keep encouraging speech? Or introduce something like AAC?’

      AAC (Augmentative and Alternative Communication) can sound intimidating, but it simply means any way we support or replace spoken words, from simple gestures and picture boards to high-tech speech-generating devices. Far from ‘giving up on speech,’ AAC often becomes the bridge that helps children find their voice, in whatever form that takes.

      💡 What is AAC, really?

      AAC is a spectrum of tools and strategies that help people express themselves when speaking is difficult. It might include:

      • Low-tech supports: Gestures, key word signs (like Makaton), picture symbols, or printed boards
      • High-tech systems: Apps on tablets that speak aloud when pictures or words are tapped

      AAC is not just for children who will never talk. It’s for anyone whose speech isn’t meeting their communication needs right now.

      🤔 When to introduce AAC

      There’s a common myth that you should only try AAC after ‘exhausting’ other speech therapy options. In fact, AAC can be introduced at any stage, even alongside speech development.

      Here are some helpful signs that AAC might support your child:

      • Your child understands much more than they can say.
      • They rely on gestures, sounds, or behaviour to communicate.
      • They become frustrated trying to express themselves.
      • You find yourself ‘reading their mind’ to interpret needs.
      • Speech progress feels slow or inconsistent.

      If you recognise these patterns, AAC isn’t a ‘last resort’. It’s a communication support, not a replacement for speech.

      Recent research consistently shows that AAC does not stop children from talking. In fact, it can encourage speech to develop. A 2024 systematic review and meta-analysis published in the Journal of Autism and Developmental Disorders found that children who received interventions combining naturalistic developmental behavioural approaches with aided AAC showed improved language outcomes, and that AAC ‘does not negatively impact speech development and may even facilitate spoken language growth’ (Smith et al., 2024).

      🌉 How AAC supports speech development

      Speech and AAC aren’t competing paths: they’re parallel tracks that often feed each other.

      Here’s how AAC helps speech grow:

      1. Reduces frustration: When a child can express their needs, they’re more relaxed and ready to learn.
      2. Provides a visual model: Seeing symbols or words while hearing spoken language strengthens understanding and word recall.
      3. Builds consistent language structure: AAC systems follow the same grammar and word order as speech, helping children internalise how sentences work.
      4. Encourages turn-taking and social connection: AAC lets children join conversations even before speech is fluent, giving them more practice in real communication.

      AAC is not ‘giving up on speech’. It’s giving a child more ways to succeed while speech continues to develop.

      🧩 How to introduce AAC gently and effectively

      1. Start small and meaningful: Begin with a few key messages your child wants to say, not just what adults want to hear. Think ‘I want’, ‘stop’, ‘help’, ‘more’, ‘all done’, ‘no’, ‘again’. These are powerful words for real interaction and autonomy.
      2. Model, model, model: The most important part of AAC success is modelling—using the system yourself as you talk. For example: ‘You want banana 🍌’ and you tap the ‘want’ and ‘banana’ symbols. Children need to see and hear AAC used naturally before they try it themselves.
      3. Use it throughout the day: AAC isn’t a therapy tool to take out once a week. It’s a living part of communication. Model a few words during mealtimes, play, and routines. The more consistently it’s embedded, the more fluent both you and your child will become.
      4. Keep it accessible: If using a device or picture board, make sure it’s always nearby. If it’s in a bag or drawer, it can’t be used in real moments.
      5. Celebrate all communication: If your child points, signs, uses a sound, or taps a symbol, it all counts. Respond warmly and naturally to reinforce communication in any form.

      🧠 What parents often worry about

      • ‘Won’t AAC stop them from talking?’: No. Research shows AAC use either has no negative effect on speech or leads to increased spoken output (Smith et al., 2024). When children feel understood, their motivation to communicate grows.
      • ‘What if I model it wrong?’: There’s no perfect way to start. Your effort and consistency matter far more than accuracy.
      • ‘Will they get ‘stuck’ using pictures?’:  Some children do continue using AAC long-term; others move naturally toward more spoken language. The goal is always functional communication, not replacing one form with another.

      🪞 Bringing AAC into daily life

      Here are a few simple, parent-friendly ideas:

      • Create visual spaces: Post symbols or core words on the fridge, mirror, or play area.
      • Narrate routines: Use AAC during toothbrushing, dressing, or mealtimes; consistent contexts build understanding.
      • Pair speech and touch: Always say the word aloud when you point to or tap a symbol.
      • Involve siblings and friends: Model how they can respond to AAC too. ‘Oh, you said go! Let’s go fast!’
      • Use shared books and songs: Pause and model key words in stories or songs.

      🌱 The takeaway

      AAC doesn’t mean giving up on speech; it means opening more doors to communication. When words don’t come easily, AAC gives children a way to connect, share, and be heard.

      It helps parents move from guessing to understanding, and gives children the power to express themselves on their own terms.

      If you’re unsure where to start, reach out to a speech and language therapist experienced in AAC. Together, you can find a system that fits your child’s strengths, build confidence in modelling, and help every word (spoken or tapped) feel like a step forward.

      And download and print my one page summary.

      Because when communication is possible, everything else begins to grow.

      Sonja McGeachie

      Highly Specialist Speech and Language Therapist

      Owner of The London Speech and Feeding Practice.

      📚 Reference

      Smith, K., et al. (2024). The Effect of Naturalistic Developmental Behavioral Interventions and Aided AAC on the Language Development of Children on the Autism Spectrum with Minimal Speech: A Systematic Review and Meta‑Analysis. Journal of Autism and Developmental Disorders, 55, 3078–3099. https://doi.org/10.1007/s10803-024-06382-7

      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 hidden impact of mouth breathing and open mouth posture on speech and feeding

      ByLondon Speech and Feeding

      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.

      1. 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.
      2. 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.
      3. 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.

      1. 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.
      2. 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.
      3. 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

      1. 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.
      2. 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.
      3. 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.
      4. 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.
      5. 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.

      Sonja McGeachie

      Highly Specialist Speech and Language Therapist

      Owner of The London Speech and Feeding Practice.

      References

      Alhazmi, A., Alshamrani, A., Alhussain, A., et al. (2022). Mouth Breathing and Speech Disorders: A Multidisciplinary Study. Journal of Pharmacy and Bioallied Sciences 14(5):911. https://www.researchgate.net/publication/361978128_Mouth_breathing_and_speech_disorders_A_multidisciplinary_evaluation_based_on_the_etiology

      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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