A helpful addition in my toolbox for lisp correction

ByLondon Speech and Feeding
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Meet the MUPPY – a vestibular orthodontic plate

I have become very well versed in Lisp Correction because so many children come to me with this problem! And I absolutely love lisp correction and Articulation Therapy! Please take a look at my blog on tips and tricks for correcting a lisp.

The MUPPY

Over the years I have created my unique style of remediating an Interdental Lisp and as part of my treatment I sometimes use an Orthodontic Tool, called the ‘MUPPY’, which I purchase directly from Germany. I first discovered it some years ago when working with a child with Down Syndrome. Back then I was searching for additional support with my student’s jaw grading and mouth closure difficulties and that’s when I first came across this little tool as recommended by one of my colleagues, a specialist orthodontist in Germany.

I was a bit sceptical at first but I have used it now many times for three years on a variety of clients with varying degrees of lisps. I find it really helps together and in addition to all my other techniques which are language and motor based.

How do I use it?

The MUPPY is a custom-made mouth plate that gently repositions the tongue, encouraging correct tongue placement for clearer speech. It sits comfortably between the lips and teeth; a thin wire sits right behind the teeth, inside the oral cavity.

The plate I like to use for lisp correction has a pearl in the middle. As soon as it is in situ the tongue starts fishing for the pearl and thereby keeps on moving up towards the correct place on the hard palate, just behind the front teeth. This is the place where the tongue tip needs to be for all the alveolar sounds our students find so hard to make.

How does this help reduce a lisp?

A lisp results mainly from incorrect tongue placement during sound production – though at times atypical dentition also contributes to the problem. Specifically, an interdental lisp occurs when the tongue protrudes between the teeth during the production of sounds like /S/ and /Z/. The tongue is often described by parents as ‘thrusting forward’ but I find that is rarely the case. Most often the tongue simply protrudes forward, which is different to tongue thrusting, a more forceful and involuntary movement. Most often I see a habitual tongue protrusion not only for /S/ and /Z/ but also for /T/, /D/, /L/ and /N/. Often /SH/ and ZH/ are also affected.

To visualise this:

  1. A correct /S/ sound looks like this: The tongue tip is raised and touches the alveolar ridge (the bony, slightly uneven ridge behind the upper teeth). The sides of the tongue touch the upper molars.
  2. Interdental lisp: The tongue tip protrudes between the front teeth, creating a /TH/ sound.
  3. Lateral lisp: Here the mechanics of the tongue are different. But using the MUPPY can help here too. To visualise a lateral lisp, the sides of the tongue are not raised high enough, allowing air to escape over the sides. This results in a ‘slushy’ or ‘wet’ sound.

Understanding the specific type of lisp is crucial for targeted therapy and successful correction.

The Vestibular Plate (Muppy) HELPS to guide the tongue towards the right place from where we shape the NEW SOUND.

Methods

Most important to my articulation work re lisping are the motor- and language-based techniques I use, as broadly described below:

  • A thorough oral examination, tongue movements, lip closure, dentition, jaw grading, breath coordination, cheek tonicity, palatal form
  • Discussion on awareness and motivation of child to work on their speech
  • Contrasting sounds at the beginning and end of words: sing vs thing / sink vs think / mess vs mesh etc to raise awareness that it matters what sounds we use in speech and that just one sound can change the meaning of a word completely
  • Mirror work, pulling faces, moving our tongue voluntarily
  • Exploring the oral cavity and thinking about all the parts of the tongue and the palate
  • Finding the alveolar ridge and placing the tongue there at rest
  • Then working towards a good baseline of the other alveolar sounds: /T/ /D/ /L/ /N/ and from there we work towards our NEW /S/ SOUND.

I use a variety of picture clues depending on what is most meaningful for my student:

The child likes a train set, I use the TIRED TRAIN SOUND.

The child knows about bike or car tyres, I use the FLAT TYRE SOUND.

With a student who loves a balloon I might use the FLAT BALLOON SOUND.

And we work our way from correct tongue placement to these long /SSSSSSSSS/ sounds with the help of these visual cues, but also gestural and hand cues such as Jane Passy’s Cued Articulation sound for /S/.

I really love helping children correct their speech sound, be it an articulatory difficulty like the lisp or a phonological difficulty such as ‘fronting’ or ‘gliding’ and I also love working with motor-based speech difficulties we see in Childhood Apraxia of Speech. Feel invited to get in touch if your child needs help in these areas.

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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    Why pointing matters: Unpacking the power of this simple gesture

    ByLondon Speech and Feeding

    As a speech and language therapist, I’m often asked about the significance of seemingly simple gestures in child development. One question that comes up frequently is, ‘Why is pointing so important?’ It might seem like a trivial action, but pointing is a powerful communication tool and a critical milestone in a child’s development.

    Why is pointing so important?

    Let’s delve into the theory behind why pointing matters:

    1. Pointing as pre verbal communication:

    Before children can use words, they use gestures to communicate their needs and interests. Pointing is one of the earliest and most important gestures. It allows children to:

    • Request: ‘I want that!’
    • Protest: ‘No, not that!’
    • Direct attention: ‘Look at that!’
    • Share interest: ‘Wow, cool!’

    2. Pointing and language development:

    Pointing is not just about communicating in the here and now; it also plays a crucial role in language development. Research shows that:

    • Early pointing predicts later language skills: Children who point more often tend to have larger vocabularies and better grammar later on.
    • Pointing helps children learn new words: When children point at something, adults tend to label it, providing valuable language input.
    • Pointing supports joint attention: Joint attention, or the shared focus of two individuals on an object or event, is essential for language learning. Pointing helps establish joint attention, creating opportunities for communication and learning.

    3. Pointing and social-emotional development:

    Pointing is not just about language; it’s also about social interaction. It allows children to:

    • Engage with others: Pointing invites others to share their focus and participate in their world.
    • Express emotions: Pointing can convey excitement, curiosity, or concern.
    • Develop social understanding: By observing how others respond to their pointing, children learn about social cues and communication.

    4. Pointing and cognitive development:

    Pointing is linked to cognitive skills, such as:

    • Understanding object permanence: The ability to know that objects exist even when they are out of sight.
    • Categorisation: The ability to group similar objects together.
    • Problem-solving: Pointing can be used to ask for help or to indicate a problem.

    5. Types of Pointing:

    It’s important to note that there are different types of pointing, each with its own significance:

    • Imperative pointing: To request something.
    • Declarative pointing: To share interest or direct attention.
    • Informative pointing: To provide information.

    If you have concerns about your child’s pointing or overall communication development, don’t hesitate to seek professional guidance from a speech-language therapist. Early intervention can make a significant difference in supporting your child’s communication journey.

    How can we create opportunities for pointing?

    • ‘Where’s the…?’ games:
      • Play games like ‘Where’s the doggy?’ or ‘Where’s the ball?’ and encourage your toddler to point to the object.
      • Start with familiar objects and gradually introduce new ones.
    • Reading together:
      • When reading picture books, ask your toddler to point to specific objects or characters on the page.
      • Use phrases like, ‘Can you point to the puppy?’
    • Everyday activities:
      • During daily routines, ask your toddler to point to things they want or need.
      • For example, ‘Do you want the apple or the banana?’
      • When walking outside say ‘LOOK’ and encourage pointing.
    • Use of toys:
      • Use toys that have buttons or points of interest that when pressed make a noise. Encourage your toddler to point to the area that makes the noise.
      • Use toys that have many different parts, and ask the toddler to point to a specific part.

    Model pointing:

    • Point yourself:
      • When you see something interesting, point to it and say the name of the object.
      • For example, ‘Look! A bird!’
    • Point to show choices:
      • When offering choices, point to each item as you name it.
      • For example, ‘Do you want the blue cup or the red cup?’ (Point to each cup).
    • Point to indicate direction:
      • When giving directions, point in the direction you want your toddler to go.
      • For example, ‘Let’s go that way!’ (Point).

    Make it rewarding:

    • Respond to pointing:
      • When your toddler points, immediately respond to their communication.
      • Give them the object they want, or acknowledge what they are pointing at.
    • Use positive reinforcement:
      • Praise and encourage your toddler when they point.
      • Say things like, ‘Good pointing!’ or ‘You showed me the car!’
    • Show excitement:
      • When they point to something, show excitement, this will encourage them to point again.

    Use specific techniques:

    • Use gestures and verbal cues:
      • Combine pointing with verbal cues and other gestures.
      • For example, say ‘Look!’ while pointing and nodding your head.
    • Simplify the environment:
      • Reduce distractions to help your toddler focus on the object you want them to point to.
    • Use exaggerated movements:
      • Use large, exaggerated pointing movements to draw your toddler’s attention.

    Consider developmental factors:

    • Age-appropriate expectations:
      • Remember that pointing develops at different rates for different children.
      • Be patient and supportive.
    • Underlying issues:
      • If your toddler is not pointing by 18 months, or if you have any concerns about their development, consult with a speech and language therapist.
      • There may be underlying sensory or motor issues.

    Key points:

    • Consistency is key. Practise these strategies regularly.
    • Make it fun and engaging for your toddler.
    • Celebrate every success, no matter how small.
    • If you have any concerns about your child’s development, contact your local health services.

    Great toys and items for pointing

    1. Interactive books:

    • Touch-and-feel books: Books with different textures, flaps to lift, and sounds encourage interaction and pointing. ‘Where’s the…?’ questions prompt pointing to specific features.
    • Books with simple pictures: Clear, uncluttered pictures make it easier for toddlers to focus and point to objects or characters.

    2. Cause-and-effect toys:

    • Activity cubes: These often have buttons, dials, and levers that produce sounds or actions when manipulated, prompting pointing and exploration.
    • Pop-up toys: Toys where figures pop up or things happen when a button is pressed encourage anticipation and pointing to the action.
    • Simple musical instruments: A toy piano, drum, or xylophone encourages pointing to the keys/surfaces to make sounds.

    3. Toys with parts to manipulate:

    • Shape sorters: Encourage pointing to the shapes and the matching holes.
    • Stacking cups or rings: Nesting cups or stacking rings invite pointing to select the correct size or order.
    • Puzzles with knobs: Simple puzzles with large knobs are easier for toddlers to grasp and point to the pieces.

    4. Toys that encourage joint attention:

    • Bubbles: Blowing bubbles and following them with your eyes and pointing encourages joint attention (shared focus).
    • Balls: Rolling a ball back and forth and pointing to where it’s going can promote joint attention and turn-taking.
    • Wind-Up Toys: Wind-up toys that move across the floor can be exciting to follow with pointing.

    5. Pretend play toys:

    • Toy telephones: Encourage pointing to the buttons and pretending to dial.
    • Dolls and stuffed animals: Pointing to the doll’s eyes, nose, mouth, etc., or asking the child to point to these features on themselves.
    • Toy food and dishes: Pretend play with food and dishes can involve pointing to request items or indicate actions (e.g., ‘Can I have the apple?’).

    Tips for using toys to encourage pointing:

    • Get involved: Play alongside your toddler, modelling pointing and using language to describe what you’re doing.
    • Follow their lead: Observe what your child is interested in and use that to encourage pointing.
    • Limit distractions: Reduce background noise and visual clutter to help your child focus.
    • Use gestures and words: Combine pointing with words and other gestures (e.g., ‘Look!’ while pointing).
    • Be patient and positive: Celebrate all attempts at pointing and provide lots of encouragement.

    Remember, the most important factor is the interaction you have with your child while playing. Use these toys as tools to create opportunities for communication and joint attention, and your toddler will be well on their way to mastering pointing!

    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.

    1
  • · ·

    Living life with a lisp

    ByLondon Speech and Feeding

    You may be questioning ‘will my child grow out of having a lisp?’ There are so many myths out there that it’s sometimes difficult to find your way out of a complex maze of information.

    The good news: lisps can be successfully treated by a Speech and Language Therapist and the earlier it’s resolved, the better. We know from the evidence base that some children’s lisps will resolve and, as always, it is completely age appropriate to have this speech pattern up until aged 4 ½.

    As with any speech and language targets your child will need to be motivated to practise their newly acquired techniques, at home and in other settings. They will eventually be able to generalise this skill, but it takes lots of practice. So, think carefully about if your child is ready and motivated before commencing Speech and Language Therapy.

    There are essentially two ways in which your child has acquired a lisp. It’s key here to mention that parents have no blame in this.

    1. They’ve mis-learned it and now incorrect production has become a habit
    2. Children have difficulties organising the sounds to make a clear production

    You may be surprised to realise that there are different types of lisps. But all the techniques will be the same.

    1. Interdental lisp

    When your child pushes their tongue too far forward, they will make a /th/ sound instead of /s/ and /z/

    1. Dental lisp

    This is where your child’s tongue pushes against their teeth

    1. Lateral lisp

    Air comes over the top of the tongue and down the sides

    1. Palatal lisp

    Your palate is the roof of your child’s mouth. Sometimes they will touch their palate when making certain sounds (e.g., /s/ and /z/)

    It’s useful for you to know what type of lisp your child has because you can then support them to make the correct production. You’ll be able to talk about where in the mouth their tongue is and where it needs to be to produce a clear sound. Your Speech and Language Therapist will be able to help you with this.

    Top therapy tips for lisps

    1. Awareness is key. Does your child know where their tongue and teeth are (i.e., are they behind their teeth)? Do they notice the air escaping? Use a mirror so that your child can see not only themselves but also you in the mirror.
    2. Repetition! As with most therapeutic intervention, practice makes perfect. So little and often is key!
    3. Make sessions fun, perhaps around your child’s interests or allow them to drink from a straw
    4. Comment on how the sound is produced (e.g., /z/ is like a bee, /s/ is like a snake)
    5. Use tactile cues. Your child’s vocal folds vibrate when they produce a sound like /z/ but not with /s/. You could use the words ‘loud’ and ‘quiet’ to describe this.
    6. Start with a /t/ sound and gradually elongate the sound to an /s/

    Having a lisp may not be problematic for some, but for other children, it can have a significant impact on their emotional wellbeing. Intervening at an early age can prevent this from happening. We always advocate for early intervention!

    Contact Sonja for support on resolving your child’s lisp.

    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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  • ·

    How to model AAC with our minimally speaking students?

    ByLondon Speech and Feeding
    modelling AAC

    How should we start? Should we use prompts? What kind of prompts? hand-over-hand or just pointing? Should we wait, and, if so, how long? Introducing an alternative communication system (AAC) to our child is for many of us a confusing and sometimes scary prospect, but it needn’t be! Let me reassure you and share some tricks of my practice in this area.

    Once we have decided to try for a picture based communication system, I usually start with a paper-based single page with between 48–88 core-words. I choose the number of words depending on where the child is developmentally and also verbally.

    If a child does have a small handful of words already, I might start with the 88-cell board below. If, on the other hand, my student is completely non-speaking and still quite little then I might go for the 48-cell below here or I might have even less cells to start with. Again, sometimes I start with an electronic device in my clinic just to trial and introduce the idea and to see if, or how, a student responds. 

    Below are some samples: a 49-cell board which I made for a child in a nursery setting

    Below a Saltillo WordPower board that can be downloaded from the Saltillo website:

    Example of a slightly more advanced board, again from the Saltillo Website

    And here below one example of a board I made for a specific activity for a child who loves water and sand play:

    It is perfectly possible to be very flexible and create a suitable board for any student, starting with as few as 2–5 cells and working up to over a 100 (very small ones) on a sheet of A4 or A3 paper.

    So once we have a good board for our child, what now? How do we start introducing this into our daily life?

    We can start by showing/pointing to the word GO within a play activity. For example:

    • a car run,
    • or a marble run,
    • or a spinner activity,
    • a wind-up toy,
    • anything that can be stopped and started easily.

    How to start?

    I will talk us through each of the steps using the example for the word ‘GO’.

    First phase

    The first phase is a TEACHING/ LEARNING PHASE. In this phase we do not expect our student to do anything, to copy us or to point to the board. If they do that it is of course a huge bonus and we will celebrate it.

    Our job is to simply MODEL/SHOW/GIVE EXAMPLES of how we can use the board, by steadily and regularly pointing to the chosen word or words. We do so across the day and across settings:

    • play
    • meal time
    • getting dressed/undressed
    • bath time
    • going to the car/shops
    • etc

    Once we can be sure that our student has been submerged and SOAKED in seeing the coreboard being used, say after some 3–4 weeks of using it consistently…

    Second phase

    We can begin to move into the second phase which is the PRACTICE PHASE. By now the student has seen the boards and he or she has seen the word GO (as a example) modelled many times.

    Now we can start to see if we can tempt our student into trying this out for themselves.

    What sort of TEMPTING are we talking about? Take a look at the Prompt Hierarchy below, which shows us what to do to get our student to be independently communicating as soon as possible. 

    The PROMPT HIERARCHY: what sort of prompting should we do, should we expect something from our student or how should we view this stage?

    1.  TEMPT AND PAUSE

    I have the AAC near to the toy and each time the child starts another round of the activity I say clearly ‘GO’ and I point to the picture as do so. I then pause and wait to see what happens. NOTHING? Then…

    1. USE SIGNS AND BODY LANGUAGE

    Next time the child starts another round I might be very animated and do a Makaton sign for GO as I say ‘GO’ and I make a very over point to the picture again. Then I wait. STILL NOTHING? OK then…

    1. OPEN-ENDED QUESTION

    Now I might say ‘GO’ and follow with: ‘OOH I WONDER IF THERE IS A PICTURE TO POINT TO…’

    ‘OH LOOK HERE IS GO!’ I then point to GO.

     STILL NO RESPONSE?

    1. ASK FOR A RESPONSE

    I might say ‘GO’ followed by ‘LOOK! LET’S POINT TO GO HERE ON THE PICTURE.’

    STILL NO RESPONSE? 

    1.  PHYSICAL TOUCH

    Next time I say ‘GO’ I will try and take the student’s hand, help isolate their finger and help him or her to point to the actual picture.

    REMEMBER: Prompting serves a very important function in scaffolding learning for students BUT if we are constantly prompting kids, then we are teaching them to only communicate when someone tells them to. We want our student to become as independent in speaking and using words as possible.

    So once I have done Physical Prompting I will try and phase back down to number 1 where all I need to do is point to the picture or look at the board with the aim that the student will then point to the picture.

    Take away points:

    • Keep the learning phase pressure-free and model without expecting our student to jump in. In other words, let’s model first without expectation. Later we can have a little bit of expectation.
    • After they’ve been exposed to and have been ‘soaked’ in plenty of AAC input, then, YES, we can create an opportunity to help them say or point to the word on their own.
    • We can model BOTH with and without expectation.
    • Only after LOTS of exposure, use the least to most prompting hierarchy and start creating opportunities for a student to become an independent communicator.

    Do get in touch if you have any questions or comments or if you would like some practical help.

    I am always pleased to hear from you.

    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 power of babble: Why your baby’s ‘talk’ matters

    ByLondon Speech and Feeding

    That adorable string of ‘ba-ba-ga-ga-ma-ma’ might sound like baby gibberish, but it’s actually a crucial milestone in your little one’s language development. Babbling or babble, as we call it, is far more than just cute baby noises. It’s a sequence of sounds that lays the foundation for future communication.

    Image by freepik

    What is babbling?

    Babbling typically begins around six months of age, though the timing can vary slightly from baby to baby. It involves your baby experimenting with different sounds, stringing together consonants and vowels. You might hear them repeating sounds like:

    • ‘Ba-ba’
    • ‘Da-da’
    • ‘Ma-ma’
    • ‘Ga-ga’

    As they progress, the babbling becomes more complex, with variations in pitch, rhythm, and intonation. It might even sound like they’re having a conversation with you!

    Why is babbling so important?

    1. Laying the groundwork for speech: Babbling is like a vocal workout for your baby. By practising these sounds, they’re strengthening the muscles in their mouth, tongue, and vocal cords that are essential for speech.
    2. Developing phonological skills: Through babbling, babies begin to understand the sound patterns of their native language. They’re learning which sounds go together and how they’re used.
    3. Enhancing social interaction: Babbling is a social activity. Babies often babble back and forth with their caregivers, which helps them learn about the give-and-take of communication.
    4. Cognitive development: The act of babbling requires babies to use their brains in new ways. They’re learning to control their vocalisations, pay attention to the sounds they’re making, and connect those sounds to the responses they receive from others.

    How can you encourage babbling?

    • Talk to your baby: Even though they can’t understand your words yet, talking to your baby exposes them to language and encourages them to respond with their own vocalisations.
    • Imitate their sounds: When your baby babbles, imitate them! This shows them that you’re paying attention and encourages them to keep ‘talking.’
    • Respond to their babbling: Treat your baby’s babbling as if it’s a real conversation. Respond with words, smiles, and gestures.
    • Play sound games: Make different sounds for your baby and encourage them to imitate you. This could include animal sounds, silly noises, or simple words.
    • Read to your baby: Even before they can understand the words, reading to your baby exposes them to the rhythm and sounds of language.
    • Sing songs: Singing is a fun and engaging way to introduce your baby to new sounds and words.
    • Use mirrors: Babies often enjoy watching themselves make sounds in a mirror.
    • Tactile stimulation: Gentle massage around the mouth and face can increase oral awareness and encourage vocalisations.
    • Vary textures: Offer different textured teethers.
    • Read books with sound effects: Choose books with animal sounds or other engaging noises.
    • Blow bubbles: The act of blowing and popping bubbles can encourage vocalisations.
    • Use visual aids: Show pictures of objects and say their names, emphasising the consonant sounds.
    • Use exaggerated facial expressions: When you make sounds, exaggerate your mouth movements to help your baby see how sounds are made.
    • Increase joint attention: Follow the child’s gaze and point to objects that they are looking at and say the name of the object.

    When to seek help

    If you notice that your baby is not babbling by eight months, it’s a good idea to talk to your speech and language therapist. You might also notice a lack of variation in tone when your child is making sounds, is your baby sounding a little ‘flat’ or monotonous? While every child develops at their own pace, a lack of babbling can sometimes indicate a developmental delay or hearing issue.

    Remember, babbling is a gift. So, enjoy those precious moments of ‘baby talk’ and take comfort in knowing that your little one is on the path to becoming a chatterbox!

    Do get in touch via my contact form if you are concerned about your child’s development or if you simply want some reassurance that your baby is developing well. We will be delighted to arrange a screening appointment for you and give you support and reassurance.

    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.

    1
  • · · · ·

    Holiday disruptions & New Year routines: How to support your child’s feeding, communication and regulation over the festive season

    ByLondon Speech and Feeding
    Holiday disruptions & New Year routines

    The festive season is a wonderful time for many families, but for children with feeding challenges, sensory differences, or autism traits, December can feel overwhelming. Changes in routine, busier environments, travel, new foods, disrupted sleep, and well-meaning relatives giving ‘advice’ can all affect a child’s feeding, communication and overall regulation.

    As a speech and language therapist specialising in Early Years, I see the same pattern each year: children often make progress during the term, only to struggle in late December when everything becomes unpredictable. The good news? With a bit of preparation, children can not only cope better, but they can actually make significant developmental gains during the holidays.

    This blog will help you feel confident, supported and prepared for the transition from ‘festive mode’ to a smoother, regulated start in January.

    1. Why routines matter so much. Especially now

    Young children thrive on predictability. For neurodivergent children or those with sensory, feeding or communication needs, routine isn’t just helpful: it’s the backbone of emotional regulation.

    In December, typical patterns change:

    • Mealtimes shift or become irregular
    • Bedtime slides
    • New foods appear
    • Loud social gatherings overwhelm
    • Travel disrupts naps and comfort routines
    • Therapies pause
    • Childcare closes

    Any one of these can lead to feeding refusals, more meltdowns, increased stimming, reduced communication attempts or regression in speech sounds.

    It’s simply the nervous system responding to too much change.

    2. Protecting feeding progress during holiday mealtimes

    My last blog and insta post have a nice social story on festive meals. They are often the trickiest part of the season for families I support. Children with sensory-based feeding challenges, or ARFID traits may find holiday foods completely unfamiliar and challenging.

    What helps:

    • Offer one ‘safe food’ at every meal
    • Keep portion sizes tiny
    • Use the ‘buffet rule’
    • Rehearse tricky moments

    3. Supporting communication when routines are disrupted

    Holiday time actually offers more opportunities for communication, just in different ways.

    Strategies:

    • Slow down and follow your child’s lead
    • Use everyday routines as language opportunities
    • Keep AAC going even if casually

    4. Understanding holiday ‘regressions’ and know they’re temporary

    This is almost always due to nervous system overload. Children don’t truly ‘lose’ skills; they temporarily prioritise regulation over learning.

    5. A gentle January reset: How to start the New Year smoothly

    • Re-establish predictability early
    • Return to preferred foods
    • Book early support if needed
    • Focus on regulation first

    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.

    Reference:

    Bronson, M. (2000). Self-regulation in early childhood. Guilford Press.

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  • · ·

    When speech difficulties overlap: Helping children with phonological delay and childhood apraxia of speech

    ByLondon Speech and Feeding

    One of the questions parents often ask is:

    ‘What kind of speech difficulty does my child have?’

    It’s a very understandable question. We often hear different terms such as phonological delay, articulation difficulties, or Childhood Apraxia of Speech (CAS), and it can be confusing.

    The reality is that many children don’t fit neatly into one single category.

    In fact, quite often I see children whose speech profile includes a mixture of difficulties. They might have some phonological patterns (where they substitute one sound for another) alongside challenges with motor speech planning, where coordinating the movements needed for speech is harder.

    When this happens, therapy needs to be flexible, responsive, and tailored to the child sitting in front of us.

    Example

    Recently I filmed a short clip from one of my therapy sessions which shows exactly how this works in practice.

    The child I was working with has difficulties with several speech sounds. Part of the challenge relates to a phonological pattern called fronting.

    Fronting is when sounds that should be made further back in the mouth (like /K/ or /G/) are produced further forward instead.

    At the same time, this child also shows signs of motor speech planning difficulty, which means the brain has to work harder to organise and sequence the movements of the tongue, lips and jaw for speech.

    This type of profile can sometimes overlap with characteristics seen in Childhood Apraxia of Speech (CAS).

    When difficulties overlap like this, therapy cannot rely on a single approach. Instead, it needs to draw on multiple evidence-based strategies.

    That is exactly what you see happening in the clip. We started out generalising the /K/ sound which until recently had been replaced by a /T/ sound. Whilst looking at a sound loaded picture of /K/ sounds we somehow got talking about a ‘dent’ (I don’t recall how we got there!) but the ‘dent’ was a ‘det’ and I decided to tackle this there and then because there are other great words that end in ‘nt’ like : ‘count’ ‘giant’ ‘point’ or ‘paint’.

    Using visual cues to support motor planning

    Speech is incredibly complex. For children with motor speech difficulties, the challenge is not only knowing what sound they want to say, but also how to move their mouth to produce it.

    This is where visual cues can be incredibly helpful.

    In the clip, you can see me using a whiteboard with pictures and simple visual prompts. These help to:

    • Focus attention on the target sound
    • Understand where the sound occurs in the word
    • Remember the sequence of sounds needed

    Visual supports can act almost like a map for the mouth, guiding children as they practise new speech movements.

    For children with motor planning difficulties, this type of cueing can make a huge difference.

    Why repetition of a single word (massed practice) is so important

    Another key feature you will notice in the clip is lots of repetition.

    This is very deliberate.

    When we are supporting children with motor speech challenges, the brain needs repeated opportunities to practise the correct movement patterns. Just like learning a musical instrument or a new sport, repetition helps the brain build stronger and more efficient pathways.

    In therapy we call this massed practice.

    Rather than saying a word only once or twice, we practise it many times in a structured way, helping the child stabilise the new speech pattern.

    But repetition alone is not enough. The child also needs to understand why the sound matters.

    Showing children that sounds change meaning

    This is where another powerful therapy approach comes in: minimal pairs.

    Minimal pairs are word pairs that differ by only one sound. For example:

    • debt
    • dent

    In the clip, I use these two words to help the child realise that the /N/ sound makes a meaningful difference.

    Without the /N/, the word becomes something else entirely.

    This approach helps children recognise that speech sounds are not random: they carry meaning. If a sound is missing or substituted, the message may change.

    Helping children notice these differences can be a very motivating moment in therapy. Suddenly the sound is no longer just an abstract exercise; it becomes part of real communication.

    Blending approaches for the best outcomes

    In this short therapy moment, I am combining:

    • Visual cueing

    • Motor speech practice

    • High repetition (massed practice)

    • Minimal pair contrasts

    • Listening and awareness of sound differences

    Each element supports a different part of the speech system.

    Some strategies help with motor planning, others support phonological awareness, and others build accuracy and consistency.

    Together they create a therapy session that is both structured and responsive.

    Every child’s speech journey is unique

    One of the most important things I want to convey is that speech development is not always straightforward.

    Two children may both struggle with speech sounds, yet the underlying reasons may be very different.

    This is why careful assessment is essential, and why therapy needs to stay flexible as we learn more about how a child’s speech system works.

    Sometimes a child needs more motor-based work.

    Sometimes the focus shifts towards phonological contrasts.

    Often, as in this example, the most effective therapy uses both.

    Small steps lead to big progress

    Every session helps us understand a little more about how a child’s speech system works and what support will help them move forward.

    And when the pieces start to come together, when a child realises that one tiny sound can change a whole word, that is when the real progress begins.

    If you are concerned about your child’s speech sounds, clarity of speech, or possible motor speech difficulties, early support can make a significant difference. A detailed assessment can help identify the nature of the difficulty and guide a therapy approach tailored to your child’s individual needs.

    Feel free to contact me on www.londonspeechandfeeding.co.uk

    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.

    Reference

    McNeill, B. C., Gillon, G. T., & Dodd, B. (2009). Effectiveness of an integrated phonological awareness approach for children with childhood apraxia of speech (CAS). Child Language Teaching and Therapy, 25(3), 341-366.

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