When you have a child who uses Gestalts it is often difficult to think and adapt clinic activities into those to use at home. More importantly, you find that individualising your activities for your child who uses Gestalt are time-consuming. But you value its importance for their communication development.
You feel so busy, you are taking them to other appointments, or trying to get through your daily activities, all whilst still ensuring your child’s emotional needs are met. You know life should not get in the way of your child’s therapy activities at home, but it does. We know your spare time is precious and limited, so let us achieve your child’s or young person’s goals in the allotted time you have which meets their way of learning (using Gestalts).
We wanted to support you by exploring items which you may have at home, and we will give you some key phrases which you can start to model with your child. Whereas our last blog introduced the idea of gestalt language processors, we are now developing ideas to give you the tools to implement activities at home. We recognise how overwhelming it may feel, and this is one of the reasons to make activities as straight forward as possible. Therapy does not need to be complicated; it just needs to be carried out on a regular basis.
Explore the samples I’ve created to give you an idea of how this might look but please consult with a Speech and Language Therapist who knows about Gestalt Language Processing so that you can work together to develop great home activities for your child.
Want to learn more about gestalt language processing?
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.
Child-led therapy is essentially what it says, therapy sessions that are directed by your child. You may think how can my child’s Speech and Language Therapist focus on goals if sessions are led by my child.
Let us explain…
Your child will be more receptive and motivated to take part in therapy if they have some form of input. E.g., they can choose what toys they want to play with, or how they want to play with the resources available. If sessions are child-centred then they are much more likely to engage and reach their goals, making intervention valuable. They will also be able to regulate their emotions, and use movement to support their need for regulation. E.g., some children like to jump whilst others like to run. As Speech and Language Therapists we need to use what is meaningful to your child to get the most out of intervention. By focusing on child-led therapy, we can build trust, which will allow us, in time, to use new techniques and activities that your child may enjoy. We want children to be themselves, to show their true personality. Therapy is about enhancing their skills in their own individualised way and child-led therapy allows for this.
This way of working may seem daunting to some, but it doesn’t have to feel this way. Parents often feel if they are prepared then activities may go smoother. It might be the case, but perhaps it doesn’t give your child the opportunity for spontaneity. We’d like to suggest something that may lead to some surprises. Put out an activity that is your child’s favourite and then a completely new activity. Remember these activities don’t have to be complicated. Often, the simpler the better!
So, no need to plan, just place two activities out and see what happens! Look out for anything which surprises you, which activity did they prefer? Do they have any sensory preferences? The freedom of choice is a wonderful thing to explore. So, just go with the flow!
The kind of activities that are useful for child-led play can include:
Hide and seek
Cooking or baking
An Exercise ball
Small world play
Pretend play
Musical instruments (you could even have a go at making your own)
Child-led therapy is a very useful resource. We have it at our fingertips. We don’t need special resources. You just need yourselves and your child! Sometimes, child-led therapy can be tricky to put in place. It sounds easy but is much harder in reality. So, make sure you give it time and reflect on your experiences. Ask yourselves ‘what went well’, and ‘what could be improved’. E.g., perhaps you gave your child time to lead to begin with, but you didn’t give them enough time to think about their options during the activity.
How can parents become more child-led in the home environment?
Pause and use silence. This gives your child the opportunity to lead.
It’s perfectly natural to want to talk. Afterall, this is how adults maintain conversations. If you find yourself talking too much, count to ten! This will allow your child time to respond or initiate in the conversation or interaction.
Move down to your child’s level. It’s much easier to see what’s going on if you’re at the same height.
Videoing you and your child can really help you to see where your strengths lie. You’ll also be able to make minor tweaks to improve your communication during child-led play.
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.
As a Speech and Language Therapist specialising in infant feeding, I often hear from worried mums describing their breastfed baby’s fussiness. ‘My baby is so burpy and gassy,’ ‘might it be reflux?’ or ‘she just seems uncomfortable after every feed’. While these concerns are incredibly valid and distressing for both baby and mum (and dads!), the underlying cause isn’t always what you might think. Often, the culprit isn’t primarily a digestive issue, but rather a mechanical one: how effectively your baby is managing air during feeding.
Many parents are told their baby has ‘colic’ or ‘reflux’ and are offered solutions that don’t quite hit the mark because they overlook a fundamental aspect of feeding: the suck-swallow-breathe sequence. Understanding this intricate dance can be the key to unlocking a calmer, happier feeding experience for your baby and you.
Understanding the suck-swallow-breathe sequence
Your baby’s mouth, tongue, jaw, and throat muscles work together in a precise rhythm like a beautifully orchestrated symphony. First your baby draws milk, then swallows it, and then takes a breath, all without interruption. This is the ideal suck-swallow-breathe (SSB) sequence.
When the SSB sequence functions optimally, a baby latches deeply, creates good suction, draws milk, swallows efficiently, and then pauses just long enough to take a gentle breath before the next suck. This smooth, coordinated process minimises the amount of air swallowed.
However, for various reasons (it could be a shallow latch, oral motor challenges, an uncoordinated suck, or even an overly fast milk flow) this sequence can get a bit out of sync. Instead of a smooth rhythm, you might see:
Suck-suck-swallow-gasp!: Too much air pulled in with the swallow.
Rapid, shallow sucking followed by gulping: Inefficient milk transfer and air intake.
Clicking noises during feeding: Loss of suction, indicating air entry.
Frequent detaching and re-latching: Often to ‘catch a breath’ or because of discomfort.
Each of these patterns can lead to increased air intake.
The root cause: Air trapping leading to a gassy breastfed baby
When a baby swallows too much air during a feed, that air must go somewhere. It builds up in the stomach, causing bloating, discomfort, and often leads to the familiar reflux-like symptoms parents describe: arching, spitting up, burping excessively, or simply appearing distressed.
It’s a common misconception that all gassiness or reflux symptoms in a breastfed baby are due to something in the mother’s diet or a genuine digestive disorder. While these can be factors, as an SLT, we first look at the mechanics of the feed. If a baby is constantly struggling to maintain a seal, sucking inefficiently, or having to gulp to keep up with flow, he or she is inevitably swallowing air. This air then creates pressure, which can push milk back up (silent reflux) or out (visible reflux).
Think of it like trying to drink through a straw with a hole in it. You’re sucking, but you’re also pulling in air, making it harder to get the liquid and leaving you with more bubbles in your stomach.
Why mechanical speech therapy assessment is key
This is where the distinction between a medical diagnosis (true gastro oesophageal reflux disease or GORD) and a functional feeding challenge becomes critical. A paediatrician will assess for medical causes and may prescribe medication to reduce stomach acid. This can be appropriate for severe cases of GORD.
However, if the primary issue is air being trapped due to a suboptimal suck-swallow pattern, medication only treats the symptom (acid burning) and not the root cause (air intake). This is precisely where a Speech and Language Therapist specialising in infant feeding comes in.
My role is to meticulously observe and assess your baby’s oral motor skills, latch, tongue function, and the efficiency of their SSB sequence. I look for subtle signs of inefficiency that contribute to excessive air swallowing.
Is the tongue elevating correctly to create suction?
Is the jaw stable, or is it excessively moving?
Is the latch deep enough to prevent air leaks?
Can the baby coordinate suck, swallow, and breathe without gasping?
By identifying these mechanical challenges, I can then implement targeted strategies to improve feeding efficiency and reduce air intake, often leading to a significant reduction in reflux-like symptoms and overall discomfort.
Strategies to optimise air management during breastfeeding
The good news is that many babies can learn to feed more efficiently with the right support. Here are some general strategies we might explore:
Optimise latch and position: A deep, asymmetric latch is crucial. Experiment with different positions that allow for a deeper latch and better head/neck alignment, such as laid-back feeding or upright positions.
Paced feeding (even at the breast): If your milk flow is very fast, consider removing your baby from the breast briefly if you hear excessive gulping or see him or her struggling to breathe. This allows him or her to catch up and manage the flow.
Support the jaw and cheeks: Sometimes, gentle support to the baby’s jaw or cheeks can help them maintain a more stable, efficient suck. I can demonstrate specific techniques for this.
Burping effectively: While burping won’t get rid of all swallowed air, upright burping positions and gentle back rubs can help release some of it.
Pre-feed oral preparation: Gentle oral massage or stretches before a feed can sometimes ‘wake up’ the oral muscles and improve coordination.
Addressing the ‘Great Air Debate’ isn’t about blaming anyone; it’s about empowering parents with a deeper understanding of their baby’s feeding mechanics. By focusing on the how, not just the what, we can often resolve persistent feeding challenges, reduce discomfort, and make breastfeeding a more joyful, peaceful experience for both you and your little one.
If you suspect your baby’s gassiness or reflux symptoms are related to how they are managing air during feeds, don’t hesitate to reach out for a specialist assessment.
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.
As a speech and language therapist, I often get asked by parents what toys and books they should buy for their toddlers. It can feel overwhelming with so many options available! So, I’ve put together a list based on my experience and what I’ve found works well.
Remember, every child is unique!
Observe your toddler’s interests and play style. Some toys that are popular might not be engaging for your child.
Here are a few ideas to get you started:
Sensory Toys:
Stacking cups: These are fantastic for developing hand-eye coordination, fine motor skills, and understanding size relationships. (Various brands available) Note: You can stack many things you have around the house, like bowls or measuring cups, for a similar experience!
Shape sorters: Help with shape recognition, hand-eye coordination, and problem-solving. (Melissa & Doug, Vtech)
Sensory balls: Balls with different textures (soft, bumpy, squishy) provide tactile stimulation. (Various brands)
Push and pull toys: Encourage gross motor development and exploration. (Vtech, Fisher-Price)
Communication-focused toys:
Picture books with flaps: Engage curiosity and encourage language development. (Various brands)
Talking toys: Introduce new vocabulary and encourage imitation. (Vtech, Fisher-Price)
Musical instruments: Encourage exploration of sounds and develop auditory skills. (Bright Starts, Fisher-Price)
Now, let’s talk about books:
The Very Hungry Caterpillar by Eric Carle: A classic with repetitive text and vibrant illustrations, great for introducing vocabulary and concepts like days of the week.
Brown Bear, Brown Bear, What Do You See? by Bill Martin Jr. and Eric Carle: Simple, repetitive text and engaging illustrations make this a favourite for many toddlers.
Goodnight Moon by Margaret Wise Brown: A soothing bedtime story with calming illustrations.
Pat the Bunny by Dorothy Kunhardt: An interactive book with textures and flaps to engage young children.
Corduroy by Don Freeman: A heartwarming story about a teddy bear who loses his button.
Remember:
Observe your child’s interests: Choose toys and books that capture their attention and encourage exploration.
Engage with your child: Play with the toys together and read books aloud with enthusiasm.
Keep it simple: Start with a few toys and books and gradually introduce new ones.
Rotate toys: Keep playtime fresh by rotating toys and books regularly.
Most importantly, have fun! Reading and playing with your child should be a joyful experience for both of you.
Also consider the power of open-ended play
In today’s world filled with electronic gadgets, it’s easy to overlook the value of open-ended play. Open-ended toys lack specific functions or prescribed outcomes, allowing children to use their imaginations to explore and create. Unlike toys with pre-determined ways to play, open-ended toys encourage:
Creative thinking: Children can use them in countless ways, developing their own rules and narratives. A block can become a car, a house, or a spaceship, depending on the child’s imagination.
Problem-solving skills: Children learn to figure out how to use the toys, experimenting and adapting as they go. Don’t immediately rush in and fix things for your little one, let them think for themselves and then communication incentive: let them come and find you!
Fine motor skills: Many open-ended toys, like blocks, encourage the development of fine motor skills like grasping, stacking, and building.
Cognitive development: Children learn about cause and effect, spatial relationships, and problem-solving as they play with open-ended toys.
Social-emotional development: Open-ended play can foster social interaction and cooperation as children play together and share ideas.
Simple toys with big impact
Some of the best toys for toddlers are often the simplest ones. Here are a few examples:
Wooden blocks: Building towers, bridges, and forts encourages creativity and problem-solving.
Balls: Throwing, kicking, and rolling balls promote gross motor skills and hand-eye coordination.
Fabric: Bits of fabric can be draped, draped, and used for imaginative play.
Empty boxes: From cardboard boxes to tissue boxes, these can be transformed into anything a child can imagine: a car, a house, a spaceship!
Natural materials: Sticks, leaves, pinecones, and rocks can be used for imaginative play and sensory exploration.
Remember, the key to open-ended play is to let children explore and discover
Step back and observe, allowing your child to use his or her imaginations without too much direction. You might be surprised at the creative ways he or she uses simple toys!
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.
There are various great ways to treat speech sound disorders and I use all the approaches available selectively; I decide what works with each individual child and I also vary the approach depending on the child’s frame of mind at any given time during my session.
Some of the approaches are more “drill-based” and require a child to be able to pay attention and really participate actively in the therapy, and this is what I am showing you today with this video clip.
My little student here has been working with me for some time and from only saying a handful of words which were not very easy to understand he has come a long way. He does have some features of Verbal Dyspraxia which I shall briefly outline here:
Making sounds in general is a struggle, especially when asked to copy certain sounds, example: ‘can you say: a ee ou oo?”
Repeating sound sequences or words sequences is hard, for example: “say p-t-k in sequence” or “say fish chips fish chips fish chips
When saying the same word again and again, different mistakes can be heard
Intonation difficulties: speech sounds monotonous
Vocabulary is very limited
Some therapy approaches are more play based, for example the Core Word method: here we pick a few words at a time which are very significant to the child and therefore highly motivating to try and say. These could be characters of Pokemon or Minecraft for example, or simple words like “GO!”
When you watch the video you will see that I use a lot of visual prompting, such as showing him where the tongue is moving to or from. I do this with my index finger and this approach is called Tactile Cueing or “Cued Articulation”. Part of the approach is to give a visual prompt and then reduce the prompt as the learner is more able to produce the correct sounds. Once he can produce the sound on its own, we quickly move to the sound within a word.
I do mix and match my approaches and in fact here I am drilling but I also use the Core Word which for him (YELLOW) — it’s his favourite colour and I happen to have quite a few good games where a YELLOW something or other can be asked for….. WHO KNEW!? 🙂
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.
Childhood Apraxia of Speech (CAS) is a complex neurological disorder that affects a child’s ability to plan and coordinate the movements necessary for speech production. Children with CAS often have difficulty with articulation, prosody, and fluency, making it challenging for them to communicate effectively. While there is no cure for CAS, speech and language therapy can significantly improve a child’s communication skills and overall quality of life. Understanding the principles of motor learning is crucial for both parents and speech therapists to support children with CAS on their speech journey.
What is MOTOR LEARNING?
Motor learning refers to the process of acquiring and refining new skills through practice and experience. This applies to all aspects of movement, including speech production. The brain constantly receives sensory information about the movements being made and adjusts them based on the desired outcome. A breakdown or interruption of this process can make it difficult for children to plan, sequence, and coordinate the intricate movements involved in speech.
What key principles do we use in speech and language therapy for motor learning?
Task Specificity: Speech Therapy activities that directly target the specific speech sounds or skills your child is working on. For example, if your child is struggling with /p/, practising isolated /p/ sounds, words with /p/, and phrases with /p/ would be most beneficial.
Massed vs. Distributed Practice: We consider the optimal amount and distribution of practice sessions throughout the day. Massed practice involves concentrated practice in a single session, while distributed practice spreads practice sessions throughout the day. The best approach depends on the individual child’s learning style and attention span.
Feedback: We provide clear and immediate feedback to help your child understand the accuracy and effectiveness of their attempts. This feedback can be auditory, visual, or touch based.
Error Correction: We aim to gently correct errors so that we can help your child refine their movements and avoid developing bad habits. The focus is on providing specific cues and guidance rather than simply pointing out mistakes.
Variety and Progression: We gradually introduce new challenges and variations in speech therapy activities to prevent plateaus and maintain motivation.
Motivation and Engagement: A big part of our work is to make therapy sessions fun and engaging to keep your child motivated and actively participating. We use games, songs, and activities that your child enjoys while incorporating targeted practice opportunities.
What about home work?
Yes we need your help and here are some examples of how this could look:
Task Specificity: During story time, focus on practising target sounds present in the story. Have your child repeat words or phrases containing the sound and encourage them to identify the sound in other words.
Massed vs. Distributed Practice: Instead of one long practice session, try shorter, more frequent sessions throughout the day. This can help maintain focus and prevent fatigue. It is recommended to go for 100 repetitions of the target sound per day, every day in between the sessions. We can decide together how you can best do that through either massed or distributed practice. We can decide after the session.
Feedback: Use a mirror to provide visual feedback on lip and tongue placement during sound production. Record the child’s speech and play it back to help them self-monitor their accuracy.
I quite like this mirror below but any table top mirror will work as long as it is not too small. Your child should see their whole face easily.
Error Correction: If the child makes an error, gently model the correct sound or movement without shaming or criticising. Provide specific cues such as ‘lips together’ for /p/ or ‘tongue up’ for /t/.
Variety and Progression: We will guide you on exactly what words to practise so this is something you need not worry about.
Motivation and Engagement: Use games, songs, and activities that your child enjoys. Play a game of ‘I Spy’ focusing on words with the target sound or create silly sentences with the sound to make practice fun.
Let’s work together!
It is crucial for parents, therapists, and other caregivers to work collaboratively to ensure a consistent and comprehensive approach to supporting your child’s speech development. Speech and Language Therapists can provide guidance and resources on implementing these principles at home, while parents can share observations and progress updates to inform therapy sessions.
Remember, every child with CAS learns at their own pace. By understanding and applying the principles of motor learning, parents and speech therapists can create a supportive and stimulating environment that empowers children with CAS to reach their full communication potential.
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.
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.
Spinning and swinging are often observed behaviours in autistic children. While these actions might seem repetitive or unusual to some, they serve crucial functions for these children. Understanding the underlying reasons for spinning and swinging can provide valuable insights into how to support autistic children and incorporate these activities into therapeutic settings.
Why do children spin?
Spinning is a common sensory-seeking activity in autistic children. Sensory seeking means that the child actively looks for sensory input to regulate their nervous system. Here’s why spinning can be beneficial:
Vestibular input: Spinning stimulates the vestibular system, which is located in the inner ear and is responsible for balance and spatial orientation. For children with sensory processing difficulties, spinning can provide essential sensory input.
Calming effect: For some children, spinning can be a self-regulating strategy. The rhythmic motion can help to calm the nervous system and reduce anxiety.
Sensory exploration: Spinning allows children to explore their sensory experiences. It can help them understand their bodies and how they move in space.
The allure of swinging
The rhythmic back-and-forth motion of a swing offers several benefits:
Vestibular input: Like spinning, swinging stimulates the vestibular system, helping to improve balance and coordination.
Proprioceptive input: Swinging provides proprioceptive input, which is the sense of where your body is in space. This information is crucial for motor planning and coordination.
Calming and organising: The rhythmic motion of swinging can have a calming effect on the nervous system, helping to regulate emotions and improve focus.
Social interaction: Swinging can be a shared experience, fostering social interaction and communication.
Facilitating communication: While swinging, children are so much more relaxed and open to communication. The rhythmic motion can also help facilitate singing, humming, listening to my singing, non-verbal communication for sure but also more verbal and mouth words can be heard from children on my swing. If nothing else, it is so fun and helps build trust and rapport between my child and me.
Therapeutic Activities Combining Spinning, Swinging, and Speech and Language Therapy
Here are some therapeutic techniques that I use at London Speech and Feeding to combine movement with speech and language development:
Swinging with verbal prompts: While the child is swinging, I provide simple verbal prompts such as ‘up’, ‘down’, ‘fast’, and ‘slow.’ This helps to develop receptive language skills and improve auditory processing.
Sensory-motor play: I like to combine swinging with tactile activities like playing with textured balls or bean bags. This can facilitate language development through descriptive language, words and scripts like: ‘that’s so soft’, ‘oooh tickle tickle tickle!’
Storytelling on the swing: Often I manage to create a story while the child is swinging. This can improve narrative skills, vocabulary, and imagination. Recently I did the ‘Tiger who came to tea’ story and each time the swing stopped the tiger came and ‘ate some more cakes’ and ‘tickled their tummy’ whilst eating. It may make not much sense but my child loved it and we had ‘more tiger eat more’.
Song and rhyme time: Often I sing the ‘rumble in the jungle’ song while swinging my child to enhance phonological awareness, rhythm, and timing.
Visual supports always help: I use LAMP Words for Life AAC support during swinging and show core words such as: ‘go’ / ‘stop’/ ‘more’ / ‘tickle tickle’ etc. #lampwordsforlife #aac
Movement-based activities: We can incorporate activities that require sequencing, such as imitating animal movements or following simple commands while swinging. This can improve motor planning and language comprehension.
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.
