Your child’s speech, language and communication difficulties may impact their self-esteem. And they may show signs of increased frustration. You want them to be full of confidence, increasing their participation in school and fully engaging with their peers.
1. Practise active listening
Speech difficulties can mean that it’s more challenging to understand what your child says. It’s important to show that you’re paying attention, giving them time to express themselves. Focus on what your child says rather than how they are speaking. Remember to maintain eye contact, and actively listen. Active listening and giving time can be trickier than it sounds. I can provide strategies to support your active listening skills.
2. Give other means and forms of communication
Allowing children to express themselves in a variety of ways (e.g., gesture, signs, written, use descriptions to describe a word (e.g., sand – you find it out the beach, it can have pebbles on it, it’s not the sea), use of symbols or high-tech augmentative communication methods such as a computer). Using different ways is vital in reducing frustration and communicating their message. If you’re unsure of what other forms of communication you can use, please contact me for some top tips.
3. Praise efforts
Providing specific praise allows your child to understand what they’ve achieved. E.g., you could praise the way your child listens, or how they take turns, or their resilience (e.g., “I like the way you listened” or “good listening”). Think of different ways you could praise you child during different activities, so you are prepared with phrases that you can use.
4. Have clear start and end points in activities
Some children with speech, language and communication needs have difficulties with transitioning from one activity to another. They also have difficulties with changes in routine. This can add to their frustration and changes in behaviour. So, how do you show a clear start and end to an activity? You can have a visual timetable, or you could have ‘start’ and ‘finish’ boxes where you place all the materials in the box labelled ‘start’. And once the activity has finished, you put the items in the box labelled ’finished’. If you need support with transitions, please contact me.
5. Use visuals
Visuals can support your child to understand routine and spoken language. Visuals can range from symbols to online images, to photographs, or a combination. Explore which type of visuals work well for your children. Using visuals can be powerful if used correctly. Make the most of the opportunities that visuals can provide for your family.
Increase confidence and reduce frustration in children with speech and language and communication difficulties today. Please feel free to contact me if you need any support or tips on maximising these opportunities.
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 speech and language therapists, we often use a variety of techniques to help children develop their communication and cognitive skills. One incredibly valuable tool in our toolkit is the use of sequencing activities. But what exactly is sequencing, and why is it so beneficial?
What is sequencing?
Sequencing, at its core, involves arranging items, events, or actions in a specific order. This could involve putting pictures in the correct order to tell a story, following the steps in a recipe, or understanding the order of daily routines like brushing teeth or getting dressed.
The link between sequencing and language
Sequencing is fundamental to language development and is quintessential to executive functioning skills in several ways:
Narrative skills: Storytelling, whether oral or written, relies heavily on sequencing. A child needs to understand the order of events (beginning, middle, end) to construct a coherent narrative.
Explanations and instructions: Providing clear explanations or instructions requires the ability to sequence information logically. For example, explaining how to play a game or how to get from one place to another. In the video clip below we are working on ‘how do make a sandwich’.
Vocabulary development: Sequencing helps children understand temporal words and phrases like ‘first,’ ‘then,’ ‘next,’ ‘before,’ and ‘after’.
Sentence structure: Constructing grammatically correct sentences often involves sequencing words in a specific order (e.g., subject-verb-object).
Beyond language, sequencing plays a crucial role in developing executive functioning skills. These are higher-level cognitive skills that help us plan, organise, and manage our time and actions.
Sequencing activities can help children improve in the following areas:
Planning and organisation: Sequencing tasks require children to think ahead, plan the steps involved, and organise them in a logical order.
Problem-solving: When they are faced with a problem, sequencing helps children break it down into smaller, more manageable steps.
Working memory: Holding information in mind and manipulating it, such as remembering the steps in a multi-step direction, is supported by sequencing skills.
Cognitive flexibility: Being able to adjust to changes in a sequence or think of alternative sequences promotes cognitive flexibility.
Examples of sequencing activities
Here are some practical examples of sequencing activities you can do with your child:
Picture sequencing: Use a set of picture cards to tell a short story or illustrate a process (e.g., making a sandwich, going to the park). Ask your child to arrange the cards in the correct order.
Story retelling: After reading a story, have your child retell it, focusing on the order of events.
Following instructions: Give your child multi-step instructions to follow (e.g., ‘First, get your shoes. Then, put on your coat. Next, go to the door.’).
Sequencing during play: Integrate sequencing into everyday play. For example, while building with blocks, talk about the steps: ‘First, we put this block here. Next, we add this one…’
Daily routines: Create visual schedules for daily routines, like getting ready for school or bedtime, to help children understand the sequence of events.
In the video clip below I am using an on-line language activity which is often fun for children as they can use their finger to swipe the pictures effortlessly into the right place and, if we realise at the end of the story that we have made a little error, we can then easily re-jig the pictures into their correct place.
In conclusion
Sequencing activities offer a powerful way to support children’s language development and enhance their executive functioning skills. By helping children understand and create order, we equip them with essential tools for communicating, learning, and navigating the world around them.
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.
Communication is the essence of human interaction, allowing us to express thoughts, feelings, wants and needs. For non-speaking children and their families finding an avenue to communicate effectively can be a really challenging journey.
Augmentative and Alternative Communication (AAC) offers a solution: with AAC Core Boards as a powerful ally and tool to empower and express more than requests: ideas, comments, surprise and delight, as well as saying no to something! Very important!
“AAC is a set of tools and strategies that an individual uses to solve every day communicative challenges. Communication can take many forms such as: speech, a shared glance, text, gestures, facial expressions, touch, sign language, symbols, pictures, and speech-generating devices” (RCSLT, 2023) to name just some.
AAC Core Boards are a powerful tool to empower non-speakers to express ideas. In this blog, we’ll explore the significance of AAC Core Boards and how they can unlock the world of communication for non-speaking children.
Let’s discover and understand AAC Core Boards
Firstly, let’s look at what a Core Board looks like…
AAC Core Boards are a specific type of AAC system that employs a grid-style board. This grid contains a set of core vocabulary words or symbols, which serve as a foundation for all communicative functions (e.g., initiating, greeting, requesting, negating, commenting, asking a question, and expressing surprise).
These boards incorporate high-frequency (most used) and versatile words. They enable us to construct sentences, express emotions, and take part in conversations, fostering a sense of independence and autonomy. By enabling communication, we also remove some of the frustration (from not being able to communicate) which contributes/or often leads to behavioural difficulties.
Building literacy skills
AAC Core Boards are not only tools for immediate communication. They also play a pivotal role in language and literacy development. By using these boards, non-verbal children engage with words and symbols. It reinforces their understanding of language structure and grammar.
As they consistently play with and then use their boards, they naturally absorb language patterns, laying the foundation for improved literacy skills. This immersive learning experience paves the way for future language acquisition and communication growth.
Customisation for individual needs
Every child is unique, and their communication needs can vary significantly. AAC Core Boards are designed with this diversity in mind, allowing for customisation to suit individual preferences and abilities. The boards can be adapted to include specific vocabulary relevant to a child’s daily life, interests, and activities. This personalisation ensures that the AAC Core Board is a true reflection of your child’s personality and needs, making communication more motivating, engaging and effective.
Collaboration between AAC Core Boards and Speech Therapy
AAC Core Boards are an excellent tool but we need to know one important aspect: they only work well when used regularly by the child’s family and key people in the first place.
The board needs to be used and modelled by adults consistently and regularly across environments. This is so our children know what to expect, take an interest and begin to use the boards themselves. Modelling the use of AAC Core boards is vital. Think how long it typically takes for a child to learn their first word. Around a year! During that time the adults talk constantly to their child without hesitation or expectation! The same goes for introducing this new way of communicating.
Collaborating with your child’s Speech and Language Therapist (SLT) ensures that your child receives the right guidance in using the AAC system. SLTs can assess your child’s communication abilities, recommend appropriate boards and provide guidance on how to best put them in place, so that your child can reach their communicative potential.
For non-speaking children, AAC Core Boards are more than just tools. They are bridges to a world of communication, connection, and empowerment. These boards harness the power of visual communication, foster language development, social interaction, and personal expression. They can be tailored to individual needs with the support of skilled professionals. AAC Core Boards offer a beacon of hope, helping to break through communication barriers and thrive in a world that is waiting to hear your child’s voice.
For answers to your questions and to explore the most effective support for your child, feel free to contact us.
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.
Have you ever stopped to think about how we learn to speak, understand, and communicate effectively? It’s a complex dance of various cognitive skills, and one often overlooked but absolutely crucial player in this orchestra is auditory memory. It’s not just about remembering sounds. It’s about remembering sequences of sounds, which is fundamental to language development.
What exactly is auditory memory?
At its core, auditory memory is our ability to take in, process, store, and recall information that we hear. Think of it as your brain’s internal recording studio. When someone speaks to you, your auditory memory is busy at work, capturing the individual sounds, the order in which they appear, and the rhythm and intonation of the words. This isn’t just for long-term recall; it’s also vital for working auditory memory, which allows us to hold onto a small amount of auditory information for a short period, just long enough to make sense of it.
For speech and language, auditory memory is essential for:
Understanding spoken language: To comprehend a sentence, we need to remember the beginning of the sentence by the time we hear the end.
Following instructions: Remembering a sequence of commands relies heavily on auditory memory.
Learning new words: We hear a word, remember its sound, and connect it to its meaning.
Developing phonological awareness: This is the ability to recognise and manipulate the sounds in spoken language, a critical precursor to reading. Auditory memory helps children distinguish between similar-sounding words (e.g., ‘cat’ vs. ‘bat’) and segment words into individual sounds.
Producing clear speech: To articulate words correctly, we need to recall the precise sequence of sounds that make up that word.
Developing conversational skills: Remembering what was just said helps us formulate appropriate responses.
When auditory memory falls short: The impact on speech
When auditory memory is poor, particularly in young children, the ripple effects on speech and language development can be significant. Children might struggle with:
Following multi-step directions: ‘Put on your shoes, get your coat, and meet me at the door’ can become an overwhelming jumble of sounds.
Learning new vocabulary: They might hear a new word repeatedly but struggle to retain its sound pattern, making it difficult to recognise or use later.
Understanding stories or conversations: Missing key details or losing the thread of a narrative because they can’t hold enough information in their working memory.
Developing phonological skills: Difficulty with rhyming, identifying initial sounds in words, or blending sounds together to form words, which can impact early literacy.
Speech production: They might mispronounce words, omit sounds, or struggle with the correct sequencing of sounds within words.
Social communication: Difficulty participating in group discussions, remembering names, or recalling what their peers have said.
Academic performance: Auditory memory challenges can impact a child’s ability to learn in a classroom setting, where much of the instruction is delivered verbally.
It’s important to note that poor auditory memory isn’t a sign of low intelligence, but rather a specific processing challenge that can be addressed with targeted support.
Nurturing auditory memory in under 5s: Preparing for schooling
The good news is that auditory memory is a skill that can be strengthened and developed, especially during the crucial early years. For children under five, laying a strong foundation in auditory memory is an invaluable gift as they prepare for the demands of formal schooling. Here’s what we can do to help:
Read aloud regularly: This is perhaps one of the most powerful tools. As you read, encourage your child to listen for specific words, predict what happens next, and retell parts of the story. Vary your voice, use different intonations, and pause to emphasise key words.
Play auditory memory games:
‘Simon says’: This classic game is fantastic for following multi-step instructions. Start with one command and gradually increase the number.
‘I Spy’ with sounds: Instead of colours, describe sounds. ‘I spy with my little ear something that goes “moo”.’
Rhyming games: Sing rhyming songs, read rhyming books, and encourage your child to come up with words that rhyme.
Sound matching: Use everyday objects to make sounds (e.g., shaking keys, tapping a spoon) and have your child identify or match them.
‘Memory chain’: Start a sentence and have your child add to it, remembering everything that came before: ‘I went to the market and bought an apple.’ ‘I went to the market and bought an apple and a banana.’
Sing songs and nursery rhymes: Repetitive songs and nursery rhymes are excellent for developing auditory memory, rhythm, and phonological awareness. The predictable patterns help children anticipate and remember sequences of sounds and words.
Give multi-step instructions (and praise!): Start with two-step instructions and gradually increase the complexity as your child’s skills improve. Always give positive reinforcement when they succeed. ‘Please pick up the red block and put it in the box.’
Engage in active listening: Model good listening skills yourself. When your child is speaking, give them your full attention. Ask clarifying questions to encourage them to elaborate and organise their thoughts.
Reduce background noise: A quiet environment makes it easier for young children to focus on auditory information. Minimise distractions like TV or loud music during activities that require listening.
Use visual cues: While we’re focusing on auditory memory, sometimes pairing auditory information with visual cues can be helpful, especially initially. For example, when giving instructions, demonstrate the action as you say it.
Be patient and consistent: Developing auditory memory takes time and consistent practice. Celebrate small victories and create a playful, supportive environment for learning.
By actively engaging in these strategies, we can empower our youngest learners to build robust auditory memory skills, setting them up for success not only in speech and language development but also in their overall academic journey. It’s an investment that truly pays dividends in their future communication and learning abilities.
Any comments or if you need help and support with your child’s speech please do not hesitate to get in touch with me: simply fill out the contact form here on the website. I endeavour to reply within 48 hours.
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.
If you’ve found yourself wondering ‘Why can my child say a word one day, but not at all the next?’ it might be that your child has a motor speech difficulty. This means the challenge isn’t that your child doesn’t know what they want to say; it’s that their brain finds it harder to plan and coordinate the movements needed for clear speech. This speech difficulty is called Childhood Apraxia of Speech (CAS)
In this post, I’ll explain what CAS can look like in 2–5 year olds, what an assessment usually involves, and what you can start doing at home to support your child without turning life into ‘speech homework all day long’.
What is childhood apraxia of speech (CAS)?
Children with CAS often have lots to communicate about (and strong ideas!) but their speech may come out as:
Unclear
inconsistent
hard to ‘copy’ on demand
frustrating for them and for you
CAS is not caused by laziness and it is not a parenting issue. It is also not something children simply ‘grow out of’ without support. But with the right therapy approach, children can absolutely build clearer speech over time.
Many families come to me after months (or years) of being told:
‘She’ll talk when she is ready’
‘He’s just shy’
‘It’s probably a speech delay’
‘It’s normal for toddlers’
And sometimes it is a general delay. But sometimes it’s something more specific, like CAS.
There’s also been a huge rise in parents seeking information online, and CAS is often mentioned alongside speech sound difficulties such as:
phonological delay (pattern-based speech errors)
articulation difficulties (one sound that won’t come out clearly)
inconsistent speech disorder
These can look similar at first glance, which is why a specialist assessment matters.
Signs of childhood apraxia of speech in 2–5 year olds
Children develop speech at different rates, and not every unclear speaker has CAS. But here are some common features that may raise a flag, especially when you notice several together.
1) Inconsistent speech errors
Your child might say the same word in different ways:
‘banana’ → nana / baba / mana
‘daddy’ → gaga / daddy / dadi
This inconsistency is one of the biggest clues.
2) Difficulty copying words on request
Some children speak more easily in natural play, but when asked ‘Say ___’, they freeze or the word becomes much harder.
3) Limited sound repertoire
They may use only a small set of consonants (like /M/, /N/, /B/, /D/) and avoid others.
4) Vowel distortions
Many children with typical delays mainly struggle with consonants. But in CAS, vowels can also sound ‘off’ or change between attempts.
5) Speech that sounds effortful
You might notice your child:
pauses between sounds
tries multiple times
looks like they’re ‘searching’ for the right mouth movement
6) Longer words are much harder
‘Car’ might be easier than ‘carry’, and ‘carry’ easier than ‘caterpillar’.
7) Prosody differences (rhythm and stress)
Some children with CAS sound a little unusual in their speech rhythm, stress, or intonation.
8) Frustration or reduced confidence
When a child is frequently misunderstood, they may:
talk less
use gestures more
become upset when asked to repeat themselves
Important note: none of these signs alone prove CAS but they are a strong reason to seek a speech assessment rather than waiting.
CAS vs phonological delay vs articulation difficulty (quick guide)
These are some of the most common questions I hear.
If it’s mainly an articulation difficulty…
A child may consistently say one sound incorrectly (for example, ‘thun’ for ‘sun’- lisp- but everything else is developing well.
If it’s mainly a phonological delay…
You might notice clear patterns, like:
leaving off the ends of words (‘ca’ for ‘cat’)
swapping back sounds for front sounds (‘tar’ for ‘car’)
Patterns are often consistent and respond well to phonology-based therapy.
If it might be CAS…
Speech often feels less predictable, harder to imitate, and more impacted by word length and complexity.
If you’re unsure, that’s completely normal, and exactly why assessment matters.
What happens in a CAS assessment?
A high-quality speech assessment for possible CAS usually includes:
1) Parent discussion and developmental history
We talk about:
pregnancy and birth history (where relevant)
feeding history
early sounds and babbling
first words and how speech has progressed
family history of speech/language needs
2) A speech sound assessment
Your child might be shown pictures or play-based prompts so we can hear:
what sounds they can say
what they simplify
whether errors are consistent or inconsistent
3) An oral-motor and movement check
This isn’t about ‘strength’. It’s about coordination and planning. We look at how your child manages speech movements and transitions.
4) Stimulability testing
This means: how easily can your child learn a new sound or word with support?
For CAS, we often explore how they respond to:
slowed-down speech
visual cues
rhythm/tapping
short, simple syllable shapes
5) Functional communication and confidence
We look at how speech impacts daily life:
being understood at nursery
joining in with peers
asking for help
managing emotions when misunderstood
At the end, you should leave with:
a clear explanation of what we think is going on
a therapy plan
practical home strategies
realistic next steps
What parents can do at home
Here are CAS-friendly strategies you can start right away.
1) Choose ‘power words’
Pick 1–2 words that matter most in your child’s daily life, such as:
more
help
mummy
again
stop
open
These words are motivating and functional.
2) Keep it short and successful
For many children with CAS, the goal is quality over quantity.
Try five minutes a day rather than 30 minutes of struggle.
3) Support speech with rhythm
Some children benefit from:
tapping a beat on the table
clapping syllables
using a gentle ‘marching’ rhythm
This can help the brain organise the sequence of movements.
4) Celebrate approximations
If your child says ‘moh’ for ‘more’, that’s communication!
We want them to feel:
safe
understood
proud to try again
Confidence is a key part of progress.
A short parent story (anonymised)
One mum said to me:
‘We kept being told to wait. But I could see my child understood everything; they just couldn’t get the words out. Once we had an assessment and a plan, it felt like we finally knew what to do. The biggest change was his confidence. He started trying more.’
When should you seek support?
You don’t need to wait until school.
It’s worth getting an assessment if your child is:
hard to understand compared with peers
becoming frustrated or withdrawing from talking
inconsistent with words they used to say
struggling to imitate speech sounds
showing signs that match CAS
Early support can reduce stress for the whole family and help your child feel successful in communication.
Here’s how I can help:
✅ A detailed speech assessment (including whether CAS is likely)
✅ A clear therapy plan with realistic goals
✅ Practical home strategies you can use immediately
✅ Support for nurseries and schools (where needed)
✅ In-person sessions in North-West London and online options
Your child is communicating the best way they can, and with the right support, speech can become easier, clearer, and more confident.
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.
When a child’s speech is difficult to understand, it can feel overwhelming for everyone involved. As a parent, your instinct is often to focus on helping your child ‘talk properly’. And that makes complete sense. Speech is important. But here’s the key message I want to share with you:
Speech is just one way to communicate.
And when speech is not yet clear, not yet reliable, or not yet available, children need other ways to get their message across.
This is where Total Communication comes in.
What is Total Communication?
Total Communication is an approach that encourages the use of all available ways to communicate, not just speech.
This can include:
spoken words
gestures and pointing
facial expressions
signing (such as Makaton)
pictures or symbols
drawing
electronic AAC (Augmentative and Alternative Communication), such as apps like LAMP Words for Life
It’s not about replacing speech. It’s about supporting communication in every possible way.
Think of it like this: if speech is currently unclear or limited, why restrict a child to the hardest route? Why not give them more tools to succeed?
‘But won’t this stop my child from talking?’
This is one of the most common concerns I hear in clinic.
Parents often worry that if a child starts using signs or a communication device, they will become ‘dependent’ on it and stop trying to talk.
The research tells us something very different.
Studies consistently show that AAC does not prevent speech development. In fact, it often supports it.
A review by Millar, Light & Schlosser (2006) found that AAC interventions do not reduce speech production and may actually increase it.
Romski & Sevcik (2005) demonstrated that children given AAC often develop stronger overall communication skills, including spoken language.
More recent work continues to show that providing AAC early can accelerate language development, not delay it.
So rather than ‘giving up on speech’, using AAC is actually building the foundations that speech needs.
Why Total Communication matters, especially for unintelligible children
When a child is very difficult to understand, they are often experiencing a hidden frustration:
‘I know what I want to say, but no one understands me.’
Over time, this can lead to:
reduced confidence
behavioural frustration
withdrawal from communication
fewer opportunities to practise language
If a child cannot successfully communicate, they communicate less. And when they communicate less, their language development slows down.
Total Communication breaks this cycle.
By giving a child reliable ways to be understood, we:
reduce frustration
increase interaction
build confidence
create more opportunities for language learning
And importantly, we allow them to show us what they already know.
AAC is a bridge, not a barrier
Using AAC (whether that’s pointing to pictures, signing, or using a device) does something powerful:
It separates language from speech.
A child might have lots of ideas, vocabulary, and understanding but their speech system (especially in cases like phonological disorder or childhood apraxia of speech) cannot yet keep up.
AAC allows the child to:
express complex ideas now
practise sentence structure
develop vocabulary
take part in conversations
All while their speech is still developing.
In other words, AAC doesn’t replace speech. It keeps language moving forward while speech catches up.
What does this look like in real life?
In therapy, I often use a combination of approaches:
modelling simple signs alongside speech
pointing to symbols while talking
encouraging children to gesture or show
using drawings to support understanding
incorporating an AAC device such as LAMP Words for Life
You might see a child:
say part of a word
point to a symbol
use a gesture
and look at you expectantly
That is communication success.
And success builds motivation.
‘I just want them to talk’
Of course you do. And I do too!! That’s always the goal.
But here’s the important shift in thinking:
Children learn to talk by communicating, not by waiting until speech is perfect.
If we hold out for clear speech before allowing other communication methods, we risk:
limiting their ability to interact
reducing practice opportunities
increasing frustration
But if we support all communication, we give them:
more chances to express themselves
more positive communication experiences
more input and feedback
And that is what drives progress.
A balanced approach
Total Communication doesn’t mean ‘speech is no longer important’.
It means:
we continue targeted speech therapy
we work on sounds and clarity
and we support communication in the meantime
It’s not either/or.
It’s both/and.
Final thought
If your child’s speech is difficult to understand, the most important question is not:
‘Are they talking clearly yet?’
It’s:
‘Can they successfully communicate?’
Because communication is the foundation of:
relationships
learning
confidence
wellbeing
And every child deserves a voice, in whatever form that voice takes right now.
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.
Tongue-tie, or ankyloglossia, is a condition where the lingual frenulum, the thin piece of tissue that connects the underside of the tongue to the floor of the mouth, is too short or tight. Tongue-tie is quite common in babies and is often not detected after birth. Tongue-tie can lead to a difficult start with breast feeding as it makes it very difficult for the baby to latch effectively.
In my clinical experience as a feeding therapist, I have seen many babies who were not able to latch well due to the frenulum being tight. In many cases an experienced feeding speech therapist/lactation consultant can really make a difference and help a new mum to latch the baby even though the tongue is tethered to the floor of the baby’s mouth. In some cases the frenulum can be divided and once this has been done, in some cases, feeding improves immediately or soon after the division. But this is not always the case. I have seen several babies who have had as many as four tongue-tie divisions and feeding was still difficult.
It is important to say that while tongue-tie can sometimes impact speech and feeding, it’s important to note that it’s not always the root cause of these difficulties. In recent years, there has been a surge of interest in tongue-tie division surgeries, with some cases being unnecessary. It’s crucial to understand the complexities of tongue-tie and the role of speech therapy in addressing related challenges.
The impact of tongue-tie on speech and feeding
When tongue-tie is severe, it can interfere with the tongue’s ability to move freely, affecting speech production and swallowing. Some common speech and feeding difficulties associated with tongue-tie include:
Feeding difficulties: Challenges with sucking, chewing, and swallowing.
Drooling: Excessive drooling due to difficulty controlling saliva.
Speech problems: Difficulty producing certain sounds, such as /l/, /r/, /t/, /s/ and /d/.
The importance of comprehensive assessment
Before considering any surgical intervention for tongue-tie, it’s essential to undergo a thorough evaluation by a qualified speech-language therapist (SLT). An SLT can assess the severity of the tongue-tie, its impact on speech and feeding, and determine if surgery is necessary.
Functional assessment: The SLT will assess the tongue’s range of motion, its impact on speech sounds, and the child’s overall oral motor skills.
Feeding evaluation: The SLT will observe the child’s feeding patterns and identify any difficulties related to tongue-tie.
Differential diagnosis: The SLT will rule out other potential causes of speech and feeding difficulties, such as apraxia of speech, dysarthria, or sensory processing disorders.
The role of speech therapy
Even in cases where tongue-tie is present, speech therapy can often be highly effective in addressing speech and feeding difficulties. Here’s how speech therapy can help:
Articulation therapy: Targeting specific speech sounds that may be affected by tongue-tie.
Childhood Apraxia of Speech (CAS): if the diagnosis by the SLT has shown that in fact the child has motor planning difficulties then there are very specific and effective treatment programmes that help with this and can make a real difference over time.
Feeding therapy: Strategies to improve swallowing, chewing, and oral-motor skills.
Sensory integration: Addressing underlying sensory processing issues that may contribute to feeding difficulties.
London Speech and Feeding Case Study: The importance of comprehensive assessment
One of my clients was initially diagnosed with tongue-tie and recommended for surgery at the age of eight years old. His speech had been perceived by parents and teachers as ‘mumbled and unclear’.
However, after a thorough evaluation, I was able to determine that the child’s primary issue was apraxia of speech, a neurological disorder that affects motor planning for speech. Parents decided to wait with surgery and trust my judgment and we proceeded with weekly intensive speech therapy to address motor planning difficulties around tricky sounds and words. I am delighted to say that the child’s speech has improved significantly, demonstrating the importance of comprehensive assessment and individualised treatment. He is no longer seen as a candidate for an operation, which would have been traumatic for him at his age and, as it turned out, entirely unnecessary.
Below is a short video clip of my working on the /l/ sound with this child.
Tongue-tie is a complex issue that requires careful evaluation and individualised treatment. While surgery may certainly be necessary in some cases, it’s essential to consider the potential benefits and risks. Speech therapy can be a highly effective approach for addressing speech and feeding difficulties associated with tongue-tie, even in cases where surgery is still required. By working with a qualified speech-language therapist, parents can ensure that their child receives the best possible care and support.
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.
