Chaining: A powerful tool for phonological development

ByLondon Speech and Feeding November 18, 2024November 13, 2024

Understanding chaining

Chaining is a therapeutic technique I like to use in my speech therapy work with children who have Childhood Apraxia of Speech (CAS) or phonological speech sound difficulties. It helps to break down a complex target behaviour into smaller, more manageable steps. By systematically teaching and reinforcing each step, I can help my students achieve their communication goals.

There are two types of chaining: Forward and backward chaining

Today I am going to show and talk about backward chaining. This technique involves starting with the last step and working backward to the first. This approach can be particularly effective for children with persistent speech sound difficulties where combining consonants into clusters, such as /BL/ or /FR/ or /SHR/ is very difficult.

Backward chaining allows my student to experience immediate success and build his confidence.

In my video I show you how I applied backward chaining to the words ‘Shriek’, ‘Shrub’, ‘Shrimp’ etc

My student struggles with both the /SH/ and the /R/ sounds and we have been working on both sounds for some weeks now. He has mild Childhood Apraxia of Speech and he has difficulties with coordinating his tongue movements, breathing and using his jaw effectively to make words. His sound repertoire has grown a lot since we started working together last year. Today in this session I show you how we pulled both the sound /SH/ together with /REEK/ to make ‘SHRIEK’. I love using the pictures and therapy materials from Adventures in Speech Pathology.

This is also part of the Complexity approach which I will explain in a separate blog post.

Step 1 (not shown in the video): I explain what the word means; I find that when my student understands what a word means he is much better at saying it. It increases his confidence and motivation to say a word that he knows the meaning of. Often this student does not tell me that he does not know what a word means, so I always remind myself to check that out first.
Step 2 (not shown in the video): We do a little rhyming game and think about what any one word rhymes with: ‘Shriek’ – ‘meek’, ‘weak’, ‘seek’.
Step 3: I show my student that there are two parts to this word /reek/ and the sound /SH/.
Step 3: We practise the easier part: /reek/ /reek/ /reek/.
Step 4: We add the /SH/ sound and pull it together to make our target word ‘Shriek’.

/REEK/ /REEK/ /REEK/ + /SH/ = ‘SHRIEK’
/RUB/ /RUB/ /RUB/ + /SH/ = ‘SHRUB’
/RUG/ /RUG/ /RUG/ + /SH/ = ‘SHRUG’

By breaking down the word into smaller, manageable steps, my student can focus on each syllable individually, get that right and then gradually build up to the full word. This approach can help to reduce frustration and increase motivation.

Forward chaining

Forward chaining is the same process but in reverse: we start with the front sound or syllable and work forward towards the next/last part of the word:

/SH/ + /REEK/ = ‘SHRIEK’
/SH/ + /RUB/ = ‘SHRUB’
/SH/ + /RUG/ = ‘SHRUG’

Benefits of chaining

Increased motivation: By starting with the last step, my student experiences success, which boosts his motivation to continue trying to say the word and trying other words.
Reduced frustration: Breaking down the target behaviour into smaller steps can make the task less overwhelming, reducing frustration and anxiety.
Improved confidence: As the little learner masters each of the step, his confidence and self-esteem increases. Again, this leads to increased motivation.
Faster learning: By focusing on the final step first, and practising lots of chaining (forward and backward), a student can quickly learn to generalise to other words.

Backward chaining (and forward chaining) is a really great tool for teaching complex speech sounds and words to children with phonological disorders.

Watch out for my next blog which is all about the complexity approach in Phonology.

Do get in touch if your child has a speech sound disorder, I would love to help.

Any questions or need help with supporting your little one’s language please contact me via my contact form, or you could also check out www.hanen.org for advice and lots of inspiration.

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.

Speech and Language Therapy · Top tips

Some ideas to encourage communication
ByLondon Speech and Feeding July 21, 2023June 21, 2023
Coming up with ideas for supporting your child’s speech, language and communication can be difficult especially during the holidays. All these activities are easy to implement and can be adapted to your child’s age and stage of development.

Some activities to support your family through the summer:

1. Create a story book / photo book of what you’ve been up to over the holidays

Collect photos of everyday activities and stick them into a file. You can print them out or you could just look at them on your phone or tablet. Create good little sentences or words / phrases for each picture: yummy ice cream / eating pizza / digging the sand / a sandcastle with mum.

This enables your child to develop
- their attention and listening
- sequencing of events
- expressive language (talking)
- and conversational skills.
2. Explore the outside world (e.g., water the flowers, dig in the soil)

Depending on your child’s language level keep it very simple: single words or short phrases. Or you could practise concepts such as ‘pronouns’: he is eating an ice cream / we are splashing in the pool / she is riding a bike.

3. Splashing in a paddling pool

This is a great activity to build attention. You can call “splash, splash, splash”, “ready steady go splish splash splosh”, ”pour pour pour”, “stir stir you’re stirring”.

Offer different sized containers. This is often so powerful and keeps your child occupied for a nice long time. No need to buy anything special: just bring out your kitchen utensils and some Tupperware containers.

4. Blow bubbles

Bubbles are a fantastic way to engage children. You can play ‘stop and go’ games, take turns and practise key concepts such as ‘under – blow bubbles under my hand’. Your child can practise their expressive language, creating sentences such as ‘blowing bubbles in the pool’.

5. Draw with chalk on pavement slabs to encourage speech sound production or just general nice communication

Use chalk outside to draw a ladder. Your child can practise their speech sound production without even realising it! You can go first to model the sound if needed. Drawing anything onto the pathway with coloured chalk can be really fun.

Afterwards you can wash the pathway and again there is lots of vocabulary you could use there to help your little one practise speech sounds. For example, if your child is practising the word “YELLOW” (as many of my children do) you can draw lots of little yellow things and then name them together:
- yellow banana
- yellow flower
- yellow submarine
- yellow balloon
You get the idea!

6. Walk in nature. Comment on what you see, smell, hear and feel

Make the most of where you live. Go for a walk. You can sing songs along your walk or comment about what you see, smell, hear and feel. For example: I hear the birds, they are singing; I smell the sea and can hear the waves crashing against the rocks. Make sure your comments are appropriate for the age and stage of your child.

7. Sing songs

This is a lovely way to get your child hearing language, rhyme and rhythm. You can take turns, and fill in the missing words such as “heads, shoulders, knees and ______”.

8. Word games (such as ISpy)

The beauty of this game is that it can be played anywhere and everywhere! The importance is that these word games develop phonological awareness (the ability to hear and manipulate sounds in words).

Contact me for speech, language and communication support.

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.

0
READ MORE Some ideas to encourage communication
Autism Therapy · Neurodiversity · Printables · Speech and Language Therapy · Top tips

Let’s ditch the ‘Fix-It’ approach to autistic play and stimming
ByLondon Speech and Feeding December 8, 2025December 8, 2025
December is often presented as a time of perfect, reciprocal play. Children are supposed to be unwrapping toys, sharing, and engaging in imaginative scenarios with family. But for parents of young autistic children, this high-pressure, socially demanding period can often feel like a battleground.

If you’ve been told to interrupt your child’s stimming, push for eye contact, or force them to play ‘functionally’ with toys, it’s time to take a deep breath. Those traditional approaches are not only stressful—they often miss the point of your child’s communication.

As a neurodiversity-affirming Speech and Language Therapist, I want to encourage you this December: You are allowed to follow your child’s lead, validate his or her unique interests, and trust that his or her play and movement are profoundly meaningful.

1. Stimming: not a distraction, but a regulator 💡

Stimming is short for self-stimulatory behaviour and includes repetitive movements or sounds like hand flapping, humming, rocking, finger flicking, or repeating phrases (called echolalia).

For years, parents were incorrectly advised to block or eliminate these behaviours. The neurodiversity-affirming view tells us the exact opposite: Stimming is a vital and essential tool for your child’s self-regulation.

Think of stimming as an internal volume dial:
- Too loud/overwhelmed: Your child may stim to reduce incoming sensory input (e.g., rocking to ground himself or herself in a busy room).
- Too quiet/under-stimulated: Your child may stim to increase sensory input and focus (e.g., running back and forth to maintain alertness).
The shift: validate, don’t block

Instead of saying, ‘Stop flapping your hands’, try to understand the message behind the movement.
- Observe: When does the stimming happen? Is it before a meltdown? When your child excited? When your child is bored?
- Validate: Name the need, not just the behaviour. You might say, ‘I see your body needs to move fast right now. That helps you calm down!’
- Co-regulate: If the stim is unsafe (e.g., head-banging), help your child find a safer, alternative stim that meets the same sensory need (e.g., pushing hard against a wall, squeezing a stress ball).
By validating your child’s need to regulate, you are building trust, reducing anxiety, and teaching him or her critical self-awareness.

2. Autistic play: Meaningful, even if it’s monologue

The traditional idea of ‘good play’ often involves turn-taking, pretending, and specific toy functions (e.g., pushing a train around a track). When an autistic child spends 30 minutes lining up cars, spinning their wheels, or scripting whole scenes from a favourite movie, it can often be dismissed as non-functional or repetitive.

In neurodiversity-affirming practice, we recognise that autistic play is authentic play. These activities are crucial for learning, deep focus, and imaginative development.
- Lining up toys may be an exploration of patterns, visual organisation, and order.
- Spinning wheels may be a deep interest in cause-and-effect and visual sensory input.
- Scripting is often a way to process language, regulate emotions, and practise complex social situations in a safe, controlled way.
Make a change: Join your child’s world, don’t drag them to yours.

Stop trying to force the ‘right’ way to play. Instead, try these neuro-affirming strategies:
1. Be a co-regulator, not a director: If your child is lining up cars, sit down next to him or her. Instead of moving a car, try handing him or her another car to line up. Focus on the shared interest rather than forcing interaction.
2. Narrate (don’t question): Avoid constantly asking, ‘What are you doing?’ or ‘What does this car say?’ This puts pressure on your child to perform. Instead, narrate your observations using his or her interest: ‘I see you made a long, straight line of red cars. Look at all the wheels spinning!’
3. Validate the interest: Show genuine appreciation for your child’s focus. ‘Wow, you know so much about how magnets stick together! That’s incredible.’
3. The communication revolution: Honouring gestalt language processing

Many young autistic children communicate in ways that don’t fit the traditional model of building language word-by-word. Many use Gestalt Language Processing (GLP).

A gestalt language processor learns language in chunks or scripts (e.g., ‘what’s-in-there?’ or ‘ready-go!’). These chunks (or gestalts) are not random; they are often tied to an emotional memory or meaning. Over time, the child breaks down these big chunks into individual words then learns to recombine those words creatively.

If your child repeats movie phrases or whole sentences that seem unrelated, he or she is likely a gestalt language processor!

Affirm the script, then model something useful.
1. Affirm the script: When your child says a script, respond to the meaning or emotion behind it, not the literal words. If he or she says, ‘We’re going to need a bigger boat’, and he or she is looking at a messy toy pile, he or she may be trying to express overwhelm or a need for help. You can affirm: ‘That pile is too big! I can help you move it.’
2. Model new ‘mix and match’ scripts: To help your child move from whole scripts to single words, you can model shorter, slightly changed versions of the script, also called ‘mitigated gestalts’. If they say, ‘I want to go home now’, you might model, ‘Let’s go home, now’ or ‘I wanna go home’.
By honouring your child’s communication style, you validate his or her experience and naturally support his or her path to language development—a core part of neurodiversity-affirming SLT.

Your December gift to your little one:

This December, stop trying to make your child fit into a neurotypical box. Instead, make your home a safe space where he or she can be his or her authentic selves.

Prioritise regulation and connection over compliance.

Trust that when your child is regulated, his or her communication, learning, and engagement will flourish naturally. This is the true gift of neurodiversity-affirming practice.

Download and print my neuro-affirming quick reference guide and keep this guide handy on your fridge and/or in your child’s play area for a quick reminder to prioritise connection over conformity.

Sonja McGeachie

Highly Specialist Speech and Language Therapist

Owner of 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.

2
READ MORE Let’s ditch the ‘Fix-It’ approach to autistic play and stimming
Feeding · Neurodiversity · Speech and Language Therapy

The hidden impact of mouth breathing and open mouth posture on speech and feeding
ByLondon Speech and Feeding November 17, 2025November 17, 2025
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

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.

2
READ MORE The hidden impact of mouth breathing and open mouth posture on speech and feeding
Autism Therapy · Neurodiversity · Printables · Speech and Language Therapy · Top tips

What to do when words don’t come fast enough
ByLondon Speech and Feeding November 26, 2025November 26, 2025
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

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.

2
READ MORE What to do when words don’t come fast enough
Speech and Language Therapy

Learn why ‘watchful waiting’ isn’t the answer
ByLondon Speech and Feeding December 5, 2022January 31, 2023
As a Speech and Language Therapist, I am a big advocate of early intervention. And I’m always encouraging you (as parents and carers) to seek intervention as early as possible. But you might be thinking, “my child just needs more time.” Have you ever wondered why early intervention is important? Read on to learn more.

Watchful waiting is not the answer

Early intervention

By intervening at a later age or stage of development, you may be leading your child to develop consequences as a result. One consequence can be challenging behaviour due to their inability to express their wants and needs. They may have difficulty in understanding and following directions. This will not only affect their ability in the classroom but also socially, maintaining friendships. Early intervention can support understanding. This can also help you support your child in breaking down activities so they can fully take part in home and school life. The Early Intervention Foundation (2021) suggest that providing early intervention can develop a young person’s strengths. You can use these activities to support their needs which creates better outcome measures. This allows young people to reach their full potential across a range of settings. It can positively impact on mental health and self-esteem.n

Positive outcomes

Also, we are protecting our young people from harmful situations by giving them a voice. And by giving them a voice, they are:
- more likely to achieve and
- less likely to have in negative experiences such as crime and with the justice system.
We know that social and emotional skills (such as developing self-awareness, social skills, and emotional regulation) are crucial to a young person’s development. Research has found that children with a higher level of social and emotional skills are more likely to:
- achieve in education,
- graduate from university,
- have career prospects,
- have positive work and family relationships,n
- maintain good mental and physical health.
By having these positive aspects in their lives, they are less likely to engage in antisocial behaviour and related crime. It’s easy to think this feels like a long way off for your family. But by giving them the best possible start, you are promoting a positive future in all aspects of their life.

Contact me today to get started with speech, language and communication intervention.

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
READ MORE Learn why ‘watchful waiting’ isn’t the answer
Feeding · Reviews

Transforming Mealtimes
ByLondon Speech and Feeding June 1, 2022January 31, 2023

Transforming Mealtimes

Below are two reviews I got from grateful clients over the past 4-6 weeks; this blog is more about how Feeding Therapy can help you than blowing my own trumpet…. though that said, it is always so nice and gratifying to hear when parents are happy and hopeful about their little one’s feeding journey. Feeding Therapy is a substantial part of my work as a Children’s Speech and Language Therapist. One of my specialist subjects is Autism and we find that many children on the Autism Spectrum are very specific about eating, and will often refuse a range of typical family foods in favour of a narrow range of foods/snacks.

Mostly, feeding difficulties are a combination and complex cocktail of factors that have contributed to the current status quo: sure, there may have been some physical problems to start off with, such as reflux causing the baby discomfort, constipation, a very tight tongue tie or a swallowing problem caused by neurological difficulties and of course sensory processing difficulties are also very physical experiences. We always begin with a very thorough case history taking and information gathering, followed by an oral assessment and observation of the actual swallow to establish what might have been – or still might be – the cause for the feeding difficulties.

In most of the cases I see in my practice, the original obvious cause is no longer present, especially with older children. So, if the swallowing is fine, the reflux is no longer present, the tongue was divided (twice!) why are they still not eating much, refusing to try new foods, only accept certain textures etc.

The answer is extremely complex and multi-faceted and this little blog is not covering any factors in detail (we would be here all night) -I mentioned sensory processing difficulties earlier on. These are mostly still present but often not acknowledged or recognised by parents. And it is certainly the case that one of the contributors is parental anxiety; this tends to run very high and has been for many months, sometimes years. This in turn often leads to very tense and unpleasant, endlessly long meal times and many times children are force-fed several times a day in order to “get something down there” as otherwise they would probably starve themselves.

Additionally, parents end up only offering a very narrow range of foods because that is all their child will eat. This ends up in a vicious cycle of children being fed porridge-style food for all meal times and of course they won’t progress to more mature foods if these mature foods are never on offer.

In order to help address and disentangle some of the issues I often introduce the “Division of Responsibility in Feeding” as researched and recommended by Ellyn Satter (The Satter Feeding Dynamics Model)

Here are the main points of her approach:

Children have a natural ability with eating, they eat as much as they need and they grow in the way that is right for them and they learn to eat what their parents eat. (E Satter). The parent is responsible for WHAT the child eats, WHERE and WHEN the child eats. The child is responsible for HOW MUCH they eat or WHETHER to eat. Satter proposes that parents should guide their child’s transition from nipple feeding through semi-solids, then thick and lumpy foods to finger foods and then on to normal family meals.

Please note: this model is only appropriate for children where the original physical cause is no longer present!

Of course it’s not easy! It requires a huge shift in thinking about feeding and it requires to trust our children to know what is best for them. This is very big for most parents, as it is not how we were brought up and it is not commonly known that babies and children know what is good for them!

However, it is certainly true that parents who follow this particular approach and make small, steady changes in the way the offer foods, and in the way they create family meal times differently, children make very nice, pleasing progress and over some months we often see remarkable positive changes.

I like to work in a team and especially for this type of problem it is essential to have a multi-disciplinary approach. A knowledgeable dietician is an enormous plus in any feeding team as is of course a

Paediatrician and/ or a Gastroenterologist and the most important people in the team are the parents!

Feeding Therapy is all about collaboration and a ‘team around the child” approach. When we have this in place and there is trust amongst the team members then we make fantastic progress.

Do get in touch with me if you would like some help with your tricky feeder.

Lovely Reviews

I visited London Speech and Feeding a couple of days ago with my 8-month-old granddaughter and her mother. Sonja made us feel comfortable and at ease from our first introductions. She was able to pinpoint my granddaughter’s mum’s anxiety around weaning very quickly. She not only gave her the tools to do this successfully, but also really encouraged my granddaughter’s mum and instilled confidence that she had everything she needed to make this sometimes-difficult transition without further anxiety.

Sonja was very thorough in her initial assessment of my granddaughter’s physical milestones and her developing speech. My granddaughter felt very comfortable with Sonja and happily played along with her. Then came the big moment – trying out various foods! We were amazed to see just how easily my granddaughter, with Sonja’s expert encouragement, took to sampling the wonderful array of different delicious morsels Sonja had prepared for the session. My granddaughter even drank from a cup for the first time! Wonderful!

Sonja then emailed a summary of the session and an extensive array of resources with suggestions for my granddaughter’s mum which she has now put into action. My granddaughter’s mum couldn’t thank Sonja enough for her caring attitude, extensive knowledge, and warm professionalism. I have no hesitation in recommending Sonja, she’s a fantastic Feeding Therapist!

–

Sonja (and her lovely colleague, Sandra) were stupendous. I had brought my one-year-old son to see them as I was concerned that he wasn’t eating enough. They looked at his history and we ate together to make sure they had all the information they needed to give an accurate diagnosis. Whilst our outcome was that Henry was in fact doing brilliantly (and I just needed to chill out a bit!), I would imagine if there was something more serious going on, Sonja would make you feel just as supported and empowered as she did with us. Excellent follow-ups too. Money well spent for a bit of reassurance for a stressed out mama. Thank you, Sonja!

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.

READ MORE Transforming Mealtimes