Conquering the ‘slushy’ /S/: Your guide to treating lateral lisps

ByLondon Speech and Feeding August 13, 2025November 27, 2025

Conquering the ‘slushy’ /S/: Your guide to treating lateral lisps

As a speech therapist, few things are as rewarding as helping a child find their clear, confident voice. Among the various speech sound disorders, the ‘lateral lisp’ – often described as a ‘slushy’ or ‘wet’ /S/ sound – presents a unique challenge. While it can be tricky to treat, I’m thrilled to share that I’ve had significant success in helping children overcome this particular hurdle.

What is a lateral lisp?

Most people are familiar with a frontal lisp, where the tongue protrudes between the front teeth, resulting in a /TH/ sound for an /S/ (e.g., ‘thun’ for ‘sun’). A lateral lisp, however, is different. Instead of the air escaping over the front of the tongue, it escapes over the sides, often giving the /S/ and /Z/ sounds a distinct, muffled, or ‘slushy’ quality. This happens because the tongue is not forming the correct central groove, allowing air to spill out laterally.

The science behind a perfect /S/ vs. a slushy one

To understand how to fix a lateral lisp, it’s helpful to understand how a ‘perfect’ /S/ sound is made. Imagine a narrow, focused stream of air. For a clear /S/ sound, your tongue forms a shallow groove down its centre, directing a precise, thin stream of air right down the middle, over the tip of your tongue, and out through a tiny opening between your tongue and the roof of your mouth, just behind your front teeth. This focused airflow creates that crisp, sharp /SSSS/ sound we recognise.

Now, picture what happens with a lateral lisp. Instead of that neat, central channel, the tongue is often flatter or positioned in a way that allows the air to escape over one or both sides. Think of it like a river overflowing its banks – the air, instead of flowing in a controlled stream, spills out sideways, creating that characteristic ‘slushy’ sound. This lateral airflow is what we need to retrain.

Why is it tricky to treat?

Treating a lateral lisp can be challenging for a few reasons:

Habitual muscle memory: The way the tongue moves and positions itself for a lateral lisp is deeply ingrained. It’s a motor habit that needs to be unlearned and replaced with a new, more precise movement.
Subtle differences: The difference between a lateral lisp and a correct /S/ sound can be quite subtle to perceive, both for the child and sometimes even for parents. This makes it harder for the child to self-monitor and correct.
Oral motor control: It requires fine motor control of the tongue muscles to create and maintain that central groove for airflow.

My success with children aged six years and over

I’ve found great success in treating lateral lisps, particularly with children aged six years and older. Why this age group? By this age, children typically have:

Increased awareness: They are more aware of their speech and often more motivated to make changes. They can better perceive the difference between their ‘slushy’ /S/ and a clear one.
Improved cognitive skills: They can understand and follow more complex instructions and strategies.
Better self-monitoring: Their ability to listen to themselves and correct their own speech improves significantly.
Enhanced oral motor control: Their fine motor skills, including those of the tongue, are more developed, allowing for greater precision.

My approach focuses on a combination of auditory discrimination, tactile cues, and targeted myofunctional exercises to help children ‘feel’ the correct airflow and tongue placement. We use a variety of engaging activities to make the process fun and effective.

It is crucial to understand tongue functioning and focusing on correcting improper oral resting posture and muscle function, which are often significant contributors to a lateral lisp. For example, if the tongue rests low and wide in the mouth consistently, or if there’s a tongue thrust during swallowing, these habits can prevent the tongue from achieving the precise, midline placement necessary for a clear /S/ or /Z/ sound. Through targeted exercises I aim to re-educate the oral and facial muscles, promoting correct tongue posture at rest, during swallowing, and, ultimately, during speech production. By strengthening the muscles responsible for tongue lifting and encouraging a more appropriate swallowing pattern we can establish the correct oral motor skills needed to overcome a lateral lisp and achieve clearer articulation.

The recipe for success: Little and often

The single most crucial ingredient for success in treating a lateral lisp is daily home practice of all the strategies given. This isn’t about long, arduous sessions; it’s about consistency. Think of it like building a muscle: short, frequent workouts yield better results than sporadic, intense ones.

My recommended formula is ‘little and often’. This means:

Short, focused sessions: Aim for 5-10 minutes of practice, 2-3 times a day. This prevents fatigue and keeps the child engaged.
Integrate into daily routines: Practise while waiting for dinner, during a car ride, or before bedtime. Make it a natural part of their day.
Positive reinforcement: Celebrate every small success! Encouragement goes a long way in building confidence and motivation.
Parental involvement: Parents play a vital role in providing consistent cues and encouragement at home. I equip families with clear, easy-to-follow strategies.

Overcoming a lateral lisp requires dedication, but with the right guidance and consistent practice, a clear, confident /S/ sound is achievable. If your child is struggling with a ‘slushy’ /S/, please don’t hesitate to reach out. Together, we can achieve success!

Sonja McGeachie

Highly Specialist Speech and Language Therapist

Owner of The London Speech and Feeding Practice.

Royal College of Speech & Language Therapists Member

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.

Autism Therapy · Neurodiversity · Speech and Language Therapy

Neurodiversity affirming Speech and Language Therapy
ByLondon Speech and Feeding November 24, 2023November 24, 2023

Introduction

I am a neurodiversity affirming therapist and I love and endorse play-based therapy. I use it alongside a strengths-focused approach in all my sessions. Find out why we should use these transformative therapy methodologies in all our work and play with our children.

I always have a range of different toys and activities up my sleeve so that when one toy is no longer interesting, that’s fine. ‘Look here’s a new one, how about we try this one?’ When therapy feels like play, children are more likely to be engaged and attentive, which leads to better outcomes.

By using play as a context for Speech and Language Therapy we can create opportunities for children to use and practise their communication skills in a natural, real-life setting. This helps bridge the gap between the therapy room and everyday life.

Goals and targets

What about goals and targets I hear you say? Of course, as Speech and Language Therapists we always have our goals for any particular child. They can be speech goals (we want Bobbi to produce a ‘k’ sound at the end of words) or communication goals (we want Fatima to ask for something by pointing to it rather than grabbing it). And these goals can be achieved where there is a reciprocation and a positive, playful relationship between the adult and the child. That relationship comes through play and fun.

Play and fun

Play is how a child interacts and learns. If it’s fun, interesting, exciting or pleasurable then that is where the magic happens. And that is what we need to return to repeatedly and then see if we can fold our targets into the activity as we go.

As soon as we expect our child to do something and we try and shape their behaviours towards a certain outcome we no longer ‘play’. We are now in teaching mode, where we direct and where we are ‘in charge’. As a neurodiversity affirming therapist, I believe that all play is valid. We must not get into the trap of thinking that only functional play is valid, that there is only one way to play with that car ramp/puzzle/potato head. Our autistic children often need to play in a particular way to navigate their world and we must not try and stop that.

When we affirm and validate our child’s play and copy their play with enthusiasm and respect then, in my experience, all children regardless where they are on the neurodiversity spectrum will begin to engage with us, copy us, and learn how to communicate effectively about things that matter to them.

Play-based therapy allows therapists to tailor interventions to each child’s unique interests and abilities. This individualised approach increases the likelihood of success and progress.

Strengths-Focused Speech Therapy

Strengths-focused therapy emphasizes a child’s strengths and abilities rather than their deficits. It recognises that every person has unique strengths that can be harnessed to overcome challenges.

Focusing on strengths helps us build a positive self-image. This is especially important for children with communication disorders, as it can boost their confidence and self-esteem.

When we encourage children to play in ways that they enjoy and are good at they feel empowered and more in control of their lives and play. This can lead to increased motivation and a sense of ownership over their progress.

Now, imagine the powerful impact that can be achieved by combining play-based therapy and strengths-focused therapy in speech therapy sessions. This dynamic combination brings out the best of both worlds. It creates a therapeutic environment that is not only effective but also enjoyable for children and their families.

As Speech Therapists we can use the child’s strengths and interests as a foundation for play-based activities. This personalisation not only makes therapy more engaging but also more effective.

An example

Charlie, a 3-year-old with social communication challenges, had a deep interest in anything that spins. We used this strength and interest to create a variety of spinning activities. As he is allowed to engage in his spinners, we can practise lots of speech and language and provide great phrases alongside his interest and activities: Ready steady go! Stop! ‘another one’ ‘the red one’ ‘again again’ ‘I love it’ ‘it’s a spinner’ ‘Charlie loves this toy’ ‘it’s going fast’ ‘it’s so fun’ etc..

Over time Charlie started to copy some of these word models and then used them to create his own little phrases, such as ‘the blue one again’. When this occurred, we felt like celebrating because it had come naturally and appropriately to the situation without any coercion or direction. That is what communication is about! Well done Charlie!

Conclusion

Play-based and strengths-focused speech therapy approaches are powerful tools and by combining these approaches, we create a therapeutic environment that is not only effective but also enjoyable and empowering for our clients.

Contact me if you would like your child to have neurodiversity affirming speech and language therapy.

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 Neurodiversity affirming Speech and Language Therapy
Autism Therapy · Neurodiversity · Speech and Language Therapy

Stage 2 NLA
ByLondon Speech and Feeding February 23, 2024February 15, 2024
Image by Freepik

Last time we asked: is our child ready tp move to Stage 2 NLA (Natural Language Acquisition stage 2) and we looked at how we can know. Now we know: he/she is ready, they are mixing and matching those scripts quite liberally! Hurrah!

So for example we hear phrases like:
- ‘let’s go’+ ‘downstairs’
- ‘it’s’ + ‘downstairs’
- ‘I see it’ + ‘downstairs‘
- ‘I want to’ + ‘shoes downstairs’ (I want to put my shoes on downstairs)
To recap, it’s important to listen out to a variety of contexts because if we only hear the single version of a gestalt —this is so great, hurrah!— but that’s not yet Stage 2.

What we can now do on a daily basis to help and support at this time:

1. We need to offer more ‘mix and match’ phrases to help our child establish this new way of communicating.

Good phrases:
- It’s … raining / cooking / eating / washing / brushing
- That’s … great / cool / amazing / wow / so good
- Let’s … see / look / go / run / chase
- How’bout … some food / playing / I’ll chase / sleeping / we read a book
- I see a … bird / large car / fire engine
- I wanna … have a biscuit / have a book / have a snuggle
- We’re … going out / going home / going in the car / going upstairs
Here in my video clip of train play I use:
- Let’s go
- It’s going up the hill
- It’s coming down
- Ooops it falls!
- It’s stopping
- Let’s put on another parcel
- Ready steady go
- Off we go
- It’s come off!
- Let’s fix it
- I can do it
- I don’t need help
You can offer these gestalts either with an AAC as you can see me do in the video clip or you can just verbally offer these.

2. Watch out for Pronoun confusion or reversal:

Gestalt kids repeat gestalts, so we don’t want to create ‘pronoun reversal’.

Instead model from a:
- first person perspective: ‘I’ / ‘Our’ / ‘Us’
- joint perspective: ‘We’ / ‘Let’s’ or a
- neutral perspective: ‘It’
You can turn almost any sentence into a good language model once you get used to it. And you can avoid ‘you’ and ‘your’ at the same time!

So instead of saying, ‘Do you want to go to the park?’

You could say:
- We wanna go to the park?
- Let’s go out?
- Shall we go out / to the park?
3. Start providing ‘variation’ in your language modelling:

Instead of just modelling something one way, start thinking about offering a pattern in a couple of other ways, in a couple of different situations, then several ways in several different situations.

Example: once you hear your child saying: ‘it’s raining’ and you know it’s a mitigation, because you don’t often say ‘it’s raining’, or haven’t said it in a while and you know your child says other ‘it’s’ phrases.

Repeat: ‘it’s raining!’

Then: ‘it’s’ + ‘raining hard’ / ‘it’s wet out there’ / ‘It’s’ + ‘raining lot’s’.

Then later think of other combinations for ‘it’s’ + ‘something’:
- (rice) ‘It’s’ + ‘cooking’
- (water/tap) ‘It’s’ + ‘running’
- (radio) ‘It’s’ + ‘singing
- (dog) ‘It’s’ + ‘peeing’ / ‘it’s’ + ‘running’ / ‘it’s’ + ‘jumping’
In my train video clip:
- Let’s go
- It’s going
- Let’s make it go
- Ready steady go
- Oops its gone
4. Use natural intonation that shows you really mean what you’re saying.

You can be animated or try for musical if your child prefers that / doesn’t mind you singing —they might not like it if their hearing is pitch perfect and your singing is off key…—
- ‘I’m’ + ‘trying to find you!’ (animated, goofy face)
- ‘I’m’ +’ getting tired!’ (exaggerated stretch and yawn)
- ‘I’m’ + ‘catching up with you!’ (animated goofy)
- ‘I’m’ + ‘gonna get you!’ (animated goofy)
- ‘I’m’ + ‘sad right now’ (exaggerated face and tone of voice)
5. USE SILENCE!

Important, I might not have said this before but we need to hold back sometimes (hard I know) and not constantly offer models. Let our child sit in a bit of silence with us there just observing and waiting for their own offers. This is a very important point. Silence is golden sometimes. Try it out. I am not talking about the silence that comes with a person scrolling on their phone though, we do need to be present and receptive.

You will see this works wonders!

Do get in touch if you would like some in-person or on-line 1:1 support with this. It can be overwhelming to figure it all out alone.

You can also check my friend’s lovely handmade jewelry on her website.

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 Stage 2 NLA
Speech and Language Therapy

Submucous cleft palate: What is it and how does it impact on speech?
ByLondon Speech and Feeding August 26, 2025November 17, 2025
What exactly is a submucous cleft palate?

A submucous cleft palate (SMCP) is much less obvious than its counterparts, cleft of lip and/or palate, and can profoundly impact a child’s speech development. It leads to often extreme hyper nasal speech and difficulty with producing many sounds (/K/ /G/ /T/ /D/ /P/ /B/ /S/ /Z/ /F/ /V/).

In short, the muscles and bone of the soft palate, and sometimes the hard palate, do not fuse completely during foetal development and the mucous membrane that lines the roof of the mouth remains intact, effectively camouflaging the underlying muscular and bony deficit.

So, while the surface of the palate appears normal, the essential muscle and functions responsible for sealing off the nasal cavity from the oral cavity during speech are compromised. This cleft (or lack of muscle) can be seen as a bluish midline discoloration of the soft palate, often a bifid (split) uvula, and at times a notch in the posterior border of the hard palate can be felt upon palpation. However, these signs aren’t always present or easily discernible, contributing to the difficulty arriving at a diagnosis.

Diagnosing a submucous cleft palate is often akin to searching for a needle in a haystack, especially for the untrained eye. Unlike overt clefts that are visually apparent at birth, an SMCP can go undiagnosed for years, sometimes well into childhood or even adolescence. Paediatricians and even ENT surgeons have been known to miss it during routine checks due to the intact mucosal lining. Parents might notice their child’s speech sounds ‘different’ or ‘nasal’ but struggle to pinpoint the cause. Children might undergo extensive speech therapy without a proper diagnosis, as the underlying structural issue continues to hinder progress.

My experience as a speech therapist in private practice:

Over my years of practice, I have encountered several children presenting with persistent hyper-nasal speech and significant difficulties producing plosive and fricative sounds.

It has been incredibly rewarding, though at times challenging, to successfully diagnose SMCP in a number of these children. My approach often involves:
- a meticulous oral motor examination,
- careful listening for the specific qualities of hypernasality,
- and a deep understanding of the physiological requirements for clear speech sound production.
When I suspect an SMCP, I refer these children to Great Ormond Street Hospital where a fantastic multidisciplinary team, typically including ENT surgeons and a specialist speech-language therapist can conduct more definitive assessments. These assessments often involve instrumental analyses such as videofluoroscopy or nasoendoscopy, which provide objective measures of velopharyngeal function and visual confirmation of the anatomical deficit.

The path to resolution: surgery, therapy, and successful outcomes

Surgery

The journey for these children, once diagnosed, often involves surgical intervention. It’s not uncommon for children with SMCP to undergo multiple operations to achieve optimal velopharyngeal closure. These procedures aim to reconstruct or augment the velopharyngeal mechanism, enabling it to effectively separate the oral and nasal cavities during speech. The specific surgical approach depends on the individual child’s anatomy and the severity of the velopharyngeal insufficiency. It’s a testament to the skill of these specialised surgeons that such intricate repairs can be performed with remarkable success.

Speech therapy

Following surgery these children embark on the crucial phase of speech therapy. While surgery addresses the structural problem, speech therapy helps a child learn to utilise their newly improved anatomy. It involves intensive work on developing oral airflow, establishing correct articulatory placement, and reducing learned compensatory strategies that have developed due to the original structural deficit. It is immensely gratifying to witness the transformation. Children who once struggled to produce basic sounds, whose speech was difficult to understand, gradually develop clear speech.

Next steps?

If you’re a parent concerned about your child’s speech and feeding, you’re not alone. The journey can feel confusing, but professional guidance can make all the difference. Never hesitate to have a second opinion when you have that niggling feeling that there is something that has not yet been explored. At London Speech and Feeding I specialise in being thorough and thinking outside the box.

I am here to provide the support you need. Reach out to schedule a consultation and take the first step towards helping your child communicate and thrive.

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.

1
READ MORE Submucous cleft palate: What is it and how does it impact on speech?
Speech and Language Therapy

What is Speech and Language Therapy (SLT) and what does a Speech Therapist do?
ByLondon Speech and Feeding September 9, 2021January 31, 2023
What is Speech and Language Therapy (SLT) and what does a Speech Therapist do?

Speech and language therapists provide treatment, support and care for children and adults who have difficulties with communication, eating, drinking and swallowing. We help children and adults who have problems speaking and communicating.

How to find the perfect therapist for my child/client:

There are a huge number of speech and language difficulties, or feeding and swallowing problems that we can help with and the first thing to think about is what age group the person is you are seeking help for. Most SLT’s specialise in a range of disorders and treatments and they often treat specific age ranges. This could be, for instance, very young children up to 3 years, or school aged children, adolescents or just adults. Once you have narrowed it down to age and general area of difficulty you can then go and seek your perfect SLT match.

Generally it is my view that SLT’s with a narrow area of specialist interest are most likely to help you better if the problem you or your child/adult is having is significant and/or profound. For example, if your child has a very severe stutter/stammer but is otherwise developing fine and has good skills all round, then I would recommend to look for an SLT who only specialises in stammering/stuttering, or has only a small range of other specialist areas related to stammering , such as speech and language delay.

The reason is that it is a tall order for any professional to stay up to date with latest research, latest clinical developments and training for more than, say, five distinct areas of interest.

However, a more generalist Speech therapist who has lots of experience in many different areas could be a very good option for your child or adult who has more general speech and language delay in a number of areas, perhaps a global delay or a syndrome which means that their learning is delayed in general. It also means that your child might benefit from a Generalist SLT because they have many more tools in their SLT bag and your child might need a variety of approaches for several areas.

A good place to start is www.asltip.com which is the Association for Independent Speech and Language Therapists in the UK. Any SLT registered with ASLTIP will also be registered with the HCPC (Health Care Professionals Council), as well as RCSLT (Royal College of Speech and Language Therapists). These two important UK professional regulatory bodies ensure all its members are fully qualified, and are fully up to date with latest developments within their areas of work.

Here you can enter your post code and look for a therapist near you and you can look for specific problems such as stammering for example and narrow down your search. Most therapists have a website which you can then access too. I would recommend you speak to a few therapists on your list and then go with the person you had the best rapport with. You and the therapist will be spending a lot of time together and you will need to feel that you trust them and that you can relax into the process.

How I can help you:

I have 3 main areas of specialism:

Parent Child Interaction Coaching

This is an amazing way to help children with the following difficulties:
- Social Communication Difficulties, Autistic Spectrum Disorders and
- Speech and Language Delay – for children under the age of 4 years old, this is my preferred way of working because it is so very effective and proven to work. If your child is not developing words or not interacting, has reduced attention and listening and you feel is not progressing or, in fact even regressing, then this way of working is the best. For anyone wanting to read a bit more about the efficacy of this method, below are some research articles. You may also like to check out www.hanen.org which is the mainstay of my work and method when it comes to Parent-Interaction Coaching. You can also look at my latest blog, entitled: Tele-therapy, does it work?
In brief, what’s so great about Parent Coaching is that it empowers you the parent to help your child in daily life! This is where speech, language and social communication develop typically, in a naturalistic way and environment. Simple steps and strategies are discussed and demonstrated every week and you are encouraged to use these strategies with your child in daily routines: getting dressed, having breakfast, on the school run, whilst out in the park or shopping or simply playing at home or having dinner or bath time. Whatever your family routine happens to be, every strategy I teach you will help create a responsive communication environment; generally, if your child is able to develop speech then they will do so in direct response to your changed interaction style.

Speech Sound Disorders, Verbal Dyspraxia, Phonology and Articulation

I love working with children of all ages on developing their speech sounds. Whether your child has a lisp, or a couple of tricky sounds they simply cannot produce quite right, or perhaps your child is really unintelligible because he/she is having lots of different sound errors, making it really hard to understand them. I typically work on getting “most bang for your buck” , meaning I address the sounds that cause the most problems and, therefore, when they are fixed your child/person’s speech becomes that much clearer fairly quickly.

Feeding and Swallowing Difficulties

Having worked for over 20 years in NHS Child Development Clinics and Special Needs Schools I trained and worked with feeding and swallowing difficulties early on in my SLT career. I later trained as a Lactation Consultant and so I am well placed helping and support all types of Infant feeding, both breast or bottle, as well as toddler weaning. I aim to ensure that your little one swallows the right kind of foods and drinks for their abilities. I am experienced in managing and supporting children with physical needs and mobility problems, Cerebral Palsy, Down Syndrome or any other type of syndrome or presentation.

What does a speech therapy session look like?

All sessions differ slightly depending on the age of the child and the nature of the difficulties.

However, mostly our sessions look like FUN! After arrival and washing hands we tend to start off with the tricky work straight away whilst our child still has energy and the will to engage. So, for speech work we will focus on the target sounds first: this could be sitting at a table doing work sheets together, playing games using the target sound and really any type of activity that gives us around 70-100 repeats of the target pattern. For example, a child who is working towards saying a ‘K’ at the end of the word I will try and get around 100 productions of words like: pack/sack/lick/ pick/bike/lake and so on.

Then we often play a fun game where I might try for a ‘rhyming’ activity or other sound awareness type activities, for perhaps 10 minutes and within that time I aim to trial the next sound pattern we need to improve on; I will test which sound your child can do with help from me. During he last 10 minutes we might look at a book, again listening to and producing whatever sound we are working on. If I did not get 100 sounds earlier on in the session I will try and practice them now as part of the story. In total I aim to have about 40-45 minutes of activities, all aimed at the target sound we are working on.

What does a Coaching session look like?

During a Parent Coaching Session we meet online for about an hour and we discuss how the week has been for you trying out the strategies. Typically parents start off recalling what went well, what progress was made and what had been more tricky. We work through it all, and then follow on to the next strategies: I will show you examples and demonstrations of each strategy and I will get you to think about how you can use this with your child and in what situation you might use it. I will explain what we are doing and what the purpose is. You might want to write down what you are going to work on for the week. Over the course of about sessions we can cover all the major strategies that are proven to help kickstart spoken language and/or help your child to connect more with you. Through that connection spoken words most often develop.

Research Papers on the Efficacy of Parent Child Interaction Coaching
- The It Takes Two to Talk Program has been shown to be effective in changing how parents interact with their children, and that children’s communication and language skills improve as a result.
- Baumwell, L.B., Tamis-LeMonda, C.S. & Bornstein, M.H. (1997). Maternal verbal sensitivity and child language comprehension. Infant Behavior and Development, 20(2), 247-258.
- Beckwith, L. & Cohen, S.E. (1989). Maternal responsiveness with preterm infants and later competency. In M.H. Bornstein (Ed.). Maternal responsiveness: Characteristics and consequences: New directions for child development (pp. 75-87). San Francisco: Jossey Bass.
- Bronfenbrenner, U. (1974). Is early intervention effective? (Publication No. (CDH) 74-25). Washington, DC: Department of Health, Education, and Welfare, Office of Child Development.
- Girolametto, L. (1988). Improving the social-conversational skills of developmentally delayed children: An intervention study. Journal of Speech and Hearing Disorders, 53, 156-167.
Sonja has been a real help for my 5 year old daughter. Due to her support, my daughter is now able to clearly and correctly enunciate ‘th’ ‘f’ and ’s’. She was also helpful in making positional changes to her seating to help her concentrate better and kept her engaged throughout all the lessons which is a feat in itself on zoom!
Helen, Mother of Catherine Age 5.

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 What is Speech and Language Therapy (SLT) and what does a Speech Therapist do?
Speech and Language Therapy

Could mouth breathing be affecting your child’s speech, sleep and development?
ByLondon Speech and Feeding June 15, 2026June 11, 2026
Understanding Orofacial Myofunctional Disorders (OMDs)

Many parents contact me at London Speech and Feeding because they are worried about their child’s speech. Perhaps their child is difficult to understand, has a persistent lisp, struggles with feeding, snores at night, or always seems to have their mouth open.

What many families don’t realise is that these concerns may all be connected.

Increasingly, research and clinical experience are highlighting the important role of Orofacial Myofunctional Health, the way the muscles of the face, mouth, tongue and airway work together to support breathing, eating, sleeping and communication.

When these muscles are not functioning optimally, children may develop what are known as Orofacial Myofunctional Disorders (OMDs).

What Is Orofacial Myofunctional Health?

Orofacial Myofunctional Health refers to the healthy function and coordination of the:
- lips
- tongue
- jaw
- cheeks
- facial muscles
- airway.
These structures play a vital role in:
breathing

swallowing

chewing

speaking

facial growth

dental development

sleep quality.
When everything is working well, the lips remain gently closed at rest, breathing occurs through the nose, and the tongue rests against the roof of the mouth.

This seemingly simple posture has a profound influence on how a child’s face, teeth and airway develop.

What is an Orofacial Myofunctional Disorder?

An Orofacial Myofunctional Disorder occurs when there is an abnormal pattern of muscle function involving the face, mouth, tongue or airway.

Children with OMDs may experience difficulties with:
- speech
- feeding
- swallowing
- sleep
- breathing
- dental development
- facial growth.
In many cases, these difficulties are linked to chronic mouth breathing.

Signs your child may have an Orofacial Myofunctional Disorder

Breathing and sleep signs
- mouth open at rest
- mouth breathing during the day
- snoring
- noisy breathing
- restless sleep
- frequent waking
- dark circles under the eyes
- chronic congestion
- fatigue despite a full night’s sleep.
Speech signs
- lisping
- unclear speech
- distorted speech sounds
- difficulty producing certain sounds
- persistent articulation difficulties
- reduced speech intelligibility.
Feeding and swallowing signs
- picky eating
- messy eating
- food remaining in the cheeks
- gagging easily
- difficulty chewing
- long mealtimes
- tongue thrust swallowing.
Facial and dental signs
- narrow palate
- crowded teeth
- open bite
- overbite
- underbite
- long face appearance
- receding chin
- poor lip seal.
If several of these signs sound familiar, a comprehensive assessment may be worthwhile.

Why does mouth breathing matter?

Many parents assume mouth breathing is simply a habit.

In reality, mouth breathing is often a symptom that something is preventing efficient nasal breathing.

Common causes include:
- enlarged tonsils
- enlarged adenoids
- allergies
- chronic nasal congestion
- recurrent infections
- structural airway differences
- tongue tie
- prolonged dummy use
- thumb sucking
- poor oral posture.
When nasal breathing becomes difficult, children naturally begin breathing through their mouths.

Over time, this can affect how the face, jaws and airway develop.

What does healthy oral posture look like?

Healthy oral posture is surprisingly simple:
- lips
  
  gently closed
- tongue
  
  resting against the roof of the mouth
- teeth
  
  slightly apart
- breathing
  
  through the nose.
This posture helps guide healthy jaw growth, facial development and airway formation.

Think of the tongue as a natural orthodontic support system. When it rests in the correct position, it helps shape the upper jaw and supports healthy facial growth.

The consequences of chronic mouth breathing

1. Speech difficulties

Children who breathe through their mouths often have altered tongue posture and reduced oral stability.

This can contribute to:
- lisping
- distorted sounds
- reduced speech clarity
- difficulty learning new speech sounds.
2. Feeding and swallowing difficulties

A low tongue posture may affect:
- chewing efficiency
- swallowing patterns
- food management
- oral motor coordination.
Many children develop a tongue thrust swallow, where the tongue pushes forward instead of moving efficiently during swallowing.

3. Poor sleep quality

Mouth breathing can contribute to:
- snoring
- restless sleep
- frequent waking
- daytime fatigue
- reduced concentration.
Poor sleep can have a significant impact on learning, behaviour and emotional regulation.

4. Changes to facial growth

Over time, chronic mouth breathing may influence:
- jaw development
- facial proportions
- dental alignment
- airway size.
This can result in:
- narrow palates
- crowded teeth
- long facial appearance
- increased orthodontic needs.
5. Oral health concerns

The nose acts as a natural filter and humidifier.

When children breathe through their mouths:
- The mouth becomes dry.
- Saliva protection is reduced.
- Risk of tooth decay increases.
- Gum health may be affected.
Why this matters for speech therapy

Speech does not develop in isolation.

The tongue, lips, jaw and airway work together to support clear communication.

At London Speech and Feeding, we look beyond speech sounds alone.

A child who presents with:
- persistent speech difficulties
- lisping
- feeding challenges
- open mouth posture
- snoring
- poor sleep
may benefit from an assessment that explores underlying orofacial myofunctional factors.

Addressing these foundations can often support more effective progress in speech and feeding therapy.

How London Speech and Feeding can help

A comprehensive assessment may include observation of:
- breathing patterns
- lip posture
- tongue posture
- swallowing function
- feeding skills
- speech sound development
- sleep concerns
- oral structures.
Where appropriate, recommendations may include:
- orofacial myofunctional therapy
- speech therapy
- feeding therapy
- home programmes
- ENT referral
- orthodontic referral
- collaborative multidisciplinary support.
The good news

Orofacial Myofunctional Disorders are often highly treatable when identified early.

Supporting healthy breathing, tongue posture and oral muscle function can positively influence:

If your child regularly breathes through their mouth, snores, struggles with speech clarity or has feeding difficulties, a specialist assessment may help identify the underlying cause.
speech clarity

feeding skills

sleep quality

facial growth

dental development

overall wellbeing.
At London Speech and Feeding, we are passionate about looking beyond symptoms and understanding the whole child. Contact me!

Sometimes the key to clearer speech starts with a simple question:

‘Is my child breathing through their nose?’

Sonja McGeachie

Highly Specialist Speech and Language Therapist

Owner of The London Speech and Feeding Practice.

Frequently Asked Questions

Can mouth breathing cause speech problems?

Yes. Mouth breathing can alter tongue posture, lip strength and oral stability, which may contribute to articulation difficulties and lisps.

Should I be worried if my child snores?

Regular snoring is not considered normal in children and may indicate airway obstruction or sleep-disordered breathing.

Can enlarged tonsils affect speech?

Yes. Enlarged tonsils may affect resonance, tongue positioning, swallowing and breathing patterns.

What age can children be assessed?

Children of all ages can be assessed if parents have concerns about speech, feeding, breathing or oral development.

What is Orofacial Myofunctional Therapy?

Orofacial Myofunctional Therapy focuses on improving breathing patterns, tongue posture, lip seal and oral muscle function to support overall health and development.

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.

3
READ MORE Could mouth breathing be affecting your child’s speech, sleep and development?
Autism Therapy · Speech and Language Therapy

Explore how Intensive Interaction develops Autistic children’s communication
ByLondon Speech and Feeding July 31, 2023June 21, 2023
Intensive Interaction is an approach that I might suggest for your child. Here is an overview of this approach to increase your knowledge. There are a range of approaches that overlap and having trained in them all I use them all interchangeably to tailor to each child individually. This approach is particularly good for children who work mostly to their own agenda and find it hard to engage with others.

So, what is Intensive Interaction?

According to its founder, Hewett (1980), the approach “involves mirroring a person’s actions, sounds and facial expressions.” This allows your child to recognise and form communication between themselves and another, in a fun, play-based setting. Attention and listening are the fundamentals to speech and language development. By using the Intensive Interaction approach, we can increase the time your child can attend for and with another person. We are working towards a child enjoying another person’s presence. We are hoping to make gains with playing together with a child, taking turns and achieving reciprocity. That is the platform which we need to start with to build communication, language, words and perhaps even speech.

There are many aspects that this approach supports:
- such as using facial expressions
- being in the presence of other people
- having a shared space
- attending to others
- recognising and using non-verbal behaviours (e.g., gestures)
- making sounds/noises (vocalisations) that have meaning
- and eye contact. Although, we must be careful when suggesting ‘improving’ the use of eye contact. For some individuals making eye contact can be physically painful. So be aware that we are not making our children ‘look’ we are encouraging their natural behaviour.
Who benefits from Intensive Interaction?

Children with more complex communication and learning delay can benefit from the Intensive Interaction approach. Each session can be adapted to the needs of the individual and the sessions can be designed to use the whole or part of the approach. It is especially useful for children who are finding it hard to engage in any way socially with another person. Autistic children who tend to work to their own agenda often benefit from this approach.

How is Intensive Interaction implemented?

You need to have an environment that your child is comfortable in, and to be able to come down to their level so that you can see each other. This is why I often visit children in their own homes to ensure that they are comfortable and that they can withdraw for periods of time if they need to as well.

Ensure your child knows you’re there and you are 100% present. This is very important. I would recommend that you put your phone away for some 10 minutes or so and give your undivided attention to your child for that period of time.

Waiting

Waiting is very important: we need to give your child time to process what is happening around them. After waiting for a response, you might want to start copying any gestures they use, any facial expressions they make, or perhaps imitate any sounds. You’ll want to continue with this for a few minutes to see if the communication between you and your child changes. Remember always take the cues from your child; if they communicate a message with you, respond. It might be that they are ready to finish and that they’ve shown this by walking away or signing.

Giving your child a way to respond is vital. We can use visuals to support their communication. We can create ‘yes’ and ‘no’ symbols so they can use them in a functional way.

A top tip in these sessions is to use mirrors, so that your child can see and begin to recognise their own facial expressions.

There are other programmes that overlap with Intensive Interaction such as Hanen with following your child’s lead and the Gina Davies Curiosity Programme.

Now you know a bit about Intensive Interaction, why not book a call to discuss how we can support your Autistic child’s communication using this evidence-based approach.

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 Explore how Intensive Interaction develops Autistic children’s communication