How do we play with our Gestalt Language Processors?

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Child-led therapy

When working with Gestalt Language Processors, it is always advisable to use child-led therapy. What does that mean? Child led therapy involves following a child’s interests and allowing her/him to lead the play activity throughout the speech and language therapy session. In other words, instead of having my own ideas of what we might want to play with or what activities I might try and use, I provide a range of toys I know the child likes or has played well with before; then I wait for the child to pick what she/he enjoys doing.

Play can be very repetitive and we can often see our child cycling back to the same one or two toys throughout the session. But this is what she/he needs to do at that time and it means that we have focused attention and engagement. This in turn is very helpful for the therapeutic process, which is to offer great scripts and phrases/words alongside what she/he is playing with.

Monotropic minds

Often the mind of autistic children is more strongly pulled towards a smaller number of interests or hobbies as I like to call them. Dr Dinah Murray, Dr Winn Lawson and Mike Lesser have found in 2005 that autistic people have ‘monotropic’ minds. They explain that autistic children focus their energy on a narrow range of activities as the energy required to switch between several toys is much higher than we would see in the neuro-typical population.

Gestalt Language Processors are often also Gestalt Cognitive Processors. This is when experiences are retained as episodic events and memories. An event is remembered by specific parts of the same event. And, therefore, these specific parts should always be part of that event, when the event is repeated.

Should any of the specifics be changed or are missing, then this can cause great upset to Gestalt Cognitive Processors. So, for example, if the last two times in speech therapy we had the train set out and this was played with happily, then this becomes a specific part of the whole session. If, I then don’t offer the train set the third time a child comes to see me, this could be very upsetting.

This is why I tend to try this out and see what happens. Usually in the 3rd or 4th session: I might not bring out the car run that has hitherto been super successful to see if we are able to transition well to other toys. If yes, then we can have new experiences but if not then I will re-offer the car run/or whatever toy pretty quickly so as not to cause complete dysregulation.

A few pointers below which help with child-led play:

Introduce a few new toys and see what happens

Parents are encouraged to bring some familiar toys their child likes to the session. We can then introduce a couple of different toys to see how we go. Try offering a new toy alongside the familiar one; try offering new toys without the familiar one present, but be prepared to re-offer the “old” toy should our child get upset.

Rotate toys and don’t offer out too many toys

I find that children can get overwhelmed and overstimulated by too many items out all at once. I always talk to parents about toy rotation at home and I encourage storage and ‘tidy up’ of toys so that we can increase attention focus, and also maintain freshness and new interest in older toys.

Some children are not yet ready to play with toys

Here I suggest people games: these are games where the adult becomes part of a more motor-based activity. Some call it ‘rough and tumble play’ but it can be nursery rhymes such as sleeping bunnies/row row the boat or peek-a-boo for the younger ones.

Copy/Imitation is so important – try getting two identical or similar play items

When we are copying our child, it is often not desirable to ‘take turns’ with their toys/blogs/cars etc as our child may not be ready to let us take a turn. Instead, if we have the exact same toy that our child is having then we can play alongside our child and copy them perfectly without interrupting their play.

References:

Murray, D., Lesser, M., & Lawson, W. (2005). Attention, monotropism and the diagnostic criteria for autism. Autism9(2), 139-156.

If you need help with your child, please do not hesitate to contact me.


Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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    Transforming Mealtimes

    Speech Therpaist in London

    Transforming Mealtimes

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

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

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

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

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

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

    Here are the main points of her approach:

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

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

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

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

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

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

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

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

    Lovely Reviews

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

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

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

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


    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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    Understanding Angelman Syndrome: A guide for parents

    Angelman Syndrome (AS) is a complex neurological disorder that affects development. It’s caused by a missing or functionally incorrect gene (UBE3A) on chromosome 15. While AS is rare, understanding its characteristics is crucial for parents and caregivers.

    What are the key characteristics of Angelman Syndrome?

    Children with AS typically exhibit a range of unique characteristics, which can include:

    • Developmental delay: Significant delays in reaching developmental milestones, such as sitting, crawling, and walking.
    • Speech impairment: Limited or absent speech. Individuals with AS may use few or no words.
    • Movement and balance issues: Difficulties with coordination, balance, and movement, sometimes causing a jerky or unsteady gait.
    • Happy demeanour: Frequent smiling, laughter, and a generally happy, excitable personality.
    • Intellectual disability: Varying degrees of intellectual disability.
    • Seizures: Seizures are common and often begin in early childhood.
    • Sleep difficulties: Disrupted sleep patterns and difficulty falling asleep.

    The role of Speech and Language Therapy

    Speech development and social communication is significantly affected in Angelman Syndrome, and therefore, Speech and Language Therapy plays a vital role in helping individuals with AS to communicate. As Speech and Language Therapists (SLT) we can work with the child and family support any of the following:

    • Assess communication skills: We evaluate the child’s current communication abilities, including any vocalisations, gestures, or signs they may use. With younger children we do this through play and playful social games as well as observation of a child playing and interacting with their siblings or caregivers.
    • Develop alternative communication strategies: Since spoken language may be limited, SLTs can help the child learn other ways to communicate, such as nonverbal communication, e.g
      • Gestures: use of pointing, waving and miming certain activities.
      • More formal sign language: Teaching basic signs to express needs and wants.
      • Core boards: Using pictures and symbols to represent everyday common words, actions, and feelings.
      • Augmentative and Alternative Communication (AAC) devices: Providing electronic devices that can produce speech.
    • Encourage vocalisations: When words don’t readily develop, SLTs can encourage the child to make vocalisations and sounds, as these can be a form of communication.
    • Support language development: SLTs can work on understanding of language, even if expressive language is limited.
    • Educate and support families: SLTs provide families with strategies and techniques to support their child’s communication at home.

    The importance of a multidisciplinary approach

    Caring for a child with Angelman Syndrome requires a team effort. A multidisciplinary approach, involving various healthcare professionals, is essential to address the diverse needs of the individual. This team may include:

    • Paediatrician: Provides overall medical care and monitors the child’s health.
    • Physiotherapist: Helps with movement, balance, and coordination.
    • Occupational therapist: Works on daily living skills, such as feeding, dressing, and self-care.
    • Speech and Language Therapist: Addresses communication and language needs.

    By working together, we can provide comprehensive care, address the unique challenges of Angelman Syndrome, and help the child reach their full potential.

    Conclusion

    Angelman Syndrome presents unique challenges and opportunities. With early diagnosis, appropriate interventions, and a strong multidisciplinary team, children with AS can make good progress and live fulfilling, joyful lives. As Speech Therapists we delight in supporting parents in their role in advocating for their child.

    Do get in touch via my contact form if you are concerned about your child’s development.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.


    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

    1
  • · ·

    Feeding therapy: A guide for parents and caregivers

    Feeding therapy is a specialised form of therapy and support that helps children develop healthy eating habits and overcome challenges related to food. It’s often used for children with picky eating, feeding disorders, or sensory processing issues.

    What is feeding therapy?

    Feeding therapy involves a series of techniques designed to improve a child’s eating skills and attitudes towards food. In the UK it’s typically provided by speech and language therapists and dietitians. These professionals work closely with parents and caregivers to create a personalised treatment plan tailored to each child’s unique needs.

    How does feeding therapy work?

    Feeding therapy sessions are typically 30–60 minutes long and involve a variety of techniques, including:

    • Family counselling: Providing support and guidance to parents and caregivers. This can help address any practical, behavioural and emotional issues that may be impacting the child’s eating.
    • Play-based activities: Engaging children in fun activities while introducing new foods or textures. This can help alleviate anxiety and make mealtimes more enjoyable.
    • Sensory exploration: Helping children become more comfortable with different tastes, smells, and textures. This can be achieved through activities like touching, smelling, and tasting various foods.
    • Oral motor exercises: Improving chewing, swallowing, and lip coordination. These exercises can help children develop the necessary skills for eating independently.
    • Behavioural techniques: Using positive reinforcement to encourage healthy eating habits. This can involve rewarding children for trying new foods or eating a variety of meals.

    When is feeding therapy needed?

    Feeding therapy may be beneficial for children who:

    • Are picky eaters: Refuse to eat a variety of foods or have strong preferences.
    • Have feeding disorders: Experience difficulties with eating, such as swallowing or chewing.
    • Have sensory processing issues: Are sensitive to certain textures, smells, or tastes.
    • Have medical conditions: Such as autism, cerebral palsy, or gastrointestinal disorders.

    Feeding therapy strategies you can try at home

    While professional feeding therapy can be invaluable, there are several techniques you can try at home to support your child’s eating development:

    • Create a positive mealtime environment: Make mealtimes enjoyable and stress-free by avoiding distractions, limiting screen time, and creating a calm atmosphere.
    • Create regular mealtimes and mealtime routines: Introduce set ways of announcing meal times, including songs or short nursery rhymes, try and involve your child with table setting, even just carrying their spoon to the table and putting the beaker next to the plate and ensure that meal time finishes after about 30 minutes, again with a set routine so that the child always knows: this is how we do it in our home, now I am finished and meal time is over.
    • Introduce new foods gradually: Start with small amounts and gradually increase exposure. This can help reduce anxiety and make new foods less overwhelming.
    • Model healthy eating: Show your child how to enjoy a variety of foods by eating a balanced diet yourself.
    • Avoid forcing food: Allow your child to choose and explore foods at their own pace. Forcing them to eat can create negative associations with food.

    Seek professional help

    If you’re concerned about your child’s eating habits, consult with a feeding therapist. We can provide guidance and support.

    Remember, feeding therapy is a collaborative process between parents, caregivers, and professionals. With patience, understanding, and the right strategies, you can help your child develop healthy eating habits and enjoy meals.

    Would you like to know more about specific techniques or have any other questions about feeding therapy?

    Please feel free to contact me.

    Sonja McGeachie

    Early Intervention Speech and Language Therapist

    Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

    The London Speech and Feeding Practice


    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

    1
  • · ·

    Why ‘Prosody’ Matters in Childhood Apraxia of Speech (CAS)

    Prosody refers to the ‘music’ of speech — the rhythm, pitch, stress, and volume that convey meaning and emotion beyond the literal words themselves. Think about a monotone statement like ‘Really?’ compared to one with a rising inflection, expressing genuine curiosity.

    When I work with children on producing speech sound sequences, we focus on mastering individual sounds and then putting them together into target words. A crucial element that can significantly impact a child’s speech production is ‘prosody’.

    In CAS, where the difficulty lies in planning and executing the motor movements for speech, prosody can be a powerful tool for producing clearer words and phrases.

    Here’s why working on prosody is an essential tool in CAS speech therapy:

    1.  It aids Motor Learning:

    Apraxia of Speech means that the planning and execution of speech movements are impaired. When we use exaggerated intonation or stress patterns while modelling words, we are providing additional prosodic variation and, therefore, additional auditory cues. These cues often help my student to carry out the correct motor movements for a word or syllable sequence.

    For instance, I might say ‘ball’ with a high-pitched emphasis on the ‘b’ sound. This auditory cue might be more effective in guiding the child’s tongue placement than simply repeating the word without variation.

    In this little video clip I get my student to say the word ‘snuggle’ (since we were working on that particular sound sequence: snuggle, snout, snore and sneeze) with a high voice and then a lower voice ‘like a bear’ — again it provides that extra auditory cue, but, in addition, the fun aspect also helps to take away the intense focus on a tricky movement pattern.

    By now the new pathways have been laid through repeated practice and now automaticity takes over and without too much effort my student can suddenly produce a motor pattern. It’s magical when it happens and gives me such a thrill.

    2. It makes speech more engaging and natural sounding:

    Children with CAS often sound robotic or flat due to challenges with prosodic elements. By incorporating variations in pitch, volume, and rhythm during therapy, we can help achieve a more natural flow of speech

    3. It makes it easier to express our emotions:

    Children with CAS often struggle to express themselves emotionally; partly through the difficulty of producing clear words — period, but also in addition due to the difficulties or absence of musicality and rhythm in their speech.

    Therefore, it is so important to incorporate activities focused on practising different emotions with varied intonation patterns. This can really empower our students to put emotions into their words.

    Good words to practise are fun words like ‘Wow!’ or ‘Yeiih’ or power words and phrases like ‘No!’ or ‘Gimme that’ etc.

    Making Therapy Fun and Engaging:

    Speech therapy for CAS doesn’t have to be all drills and exercises (though to be fair sometimes we can’t quite get round to making each and every word huge fun though we try…).

    I aim to make all my sessions fun and have intrinsic rewards built into the speech practice where possible.

    Home practice tips:

    Therapy shouldn’t exist in a bubble. Working on prosody during sessions is crucial, but it’s equally important to integrate these skills into everyday interactions. Parents and caregivers can model appropriate prosody during playtime, story time, or even simple conversations. This consistent reinforcement helps our children to generalise their newfound skills and use them naturally in their daily lives.

    • Sing songs and rhymes: Songs naturally incorporate variations in pitch and rhythm. Singing familiar songs and creating silly rhymes can be a delightful way to practise prosody.
    • Use puppets and toys: Assign different voices and personalities to puppets or toys. This encourages children to experiment with pitch and volume to differentiate characters.
    • Read aloud with enthusiasm: Model expressive reading, varying your voice for different characters and emphasising key words. This makes reading time engaging and helps children understand the power of prosody.

    Please feel free to contact me if your child has speech sound difficulties. It is my passion. I love supporting children with apraxia.

    Sonja McGeachie

    Early Intervention Speech and Language Therapist

    Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

    The London Speech and Feeding Practice


    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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  • · ·

    Understanding phonological processes in 3–7-year-olds: What’s typical and when to seek help

    As a speech and language therapist, one of the most common questions I hear from parents is:

    ‘They can talk, but their speech still sounds immature. Is this normal?’

    Many children between the ages of three and seven use speech patterns that make their words sound different from adult speech. These patterns are known as phonological processes, and for younger children, they are a normal part of speech development.

    However, when these processes persist beyond the expected age, they can start to affect clarity, confidence and learning, especially once children enter school.

    This blog will help you understand:

    • what phonological processes are
    • which patterns are typical at different ages
    • and when it might be time to seek speech therapy support

    What are phonological processes?

    Phonological processes are patterns of sound simplification that children use while their speech system is developing.

    Instead of learning each sound one by one, children initially organise sounds into patterns that make speech easier to produce. This is a normal and efficient strategy for a developing brain.

    For example:

    • saying ‘tar’ instead of ‘car’
    • saying ‘poon’ instead of ‘spoon’
    • saying ‘bud’ instead of ‘bus’

    These are not ‘bad habits’. They are part of how speech develops.

    The key question is how long these patterns last.

    Common phonological processes (and when they usually disappear)

    Below are some of the most common processes parents notice in 3–7-year-olds.

    1. Final consonant deletion

    Leaving off the last sound in a word

    • ‘ca’ for cat, ‘da’ for dog
    • Typically resolved by 3–3½ years

    2. Fronting

    Replacing back sounds (k, g) with front sounds (t, d)

    • ‘tar’ for car, ‘do’ for go
    • Typically resolved by 3½–4 years

    3. Cluster reduction

    Omitting one sound in a consonant cluster

    • ‘poon’ for spoon, ‘top’ for stop
    • Typically resolves by 4–5 years (some clusters slightly later)

    4. Gliding

    Replacing /R/ or /L/ with /W/ or /Y/

    • ‘wabbit’ for rabbit, ‘yion’ for lion
    • Can be typical up to 5–6 years

    5. Weak syllable deletion

    Leaving out unstressed syllables

    • ‘nana’ for banana
    • Usually resolved by 4 years

    If these patterns continue past the expected age, speech can remain difficult to understand particularly for unfamiliar listeners such as teachers, peers, and also Auntie Karen or grandparents who visit once in a while.

    Why phonological processes matter in school-age children

    By the time children reach reception and Year 1, speech clarity becomes increasingly important.

    Persistent phonological difficulties can affect:

    • being understood by teachers and peers
    • phonics and early reading
    • spelling
    • confidence in speaking
    • willingness to participate in class

    Some children become aware that they ‘sound different’ and may speak less, avoid longer words, or become frustrated when misunderstood.

    What’s the difference between a delay and a disorder?

    This is an important distinction.

    • A phonological delay means a child is following the normal pattern of development, just more slowly.
    • A phonological disorder means the child is using atypical patterns, or continuing age-expected patterns well beyond when they should have resolved.

    A speech and language assessment helps identify:

    • which processes are present
    • how many are affecting speech
    • how consistent the errors are
    • and whether intervention is needed

    Signs it may be time to seek speech therapy

    You may want to seek professional advice if your child:

    • is 3½ years or older and still hard to understand
    • is understood well by family but not by others
    • becomes frustrated or avoids talking
    • has difficulty with phonics or spelling
    • uses several phonological processes at once
    • has not made progress despite time and encouragement

    Early support does not mean something is ‘wrong’. It simply helps speech development move forward more efficiently.Research consistently shows that unresolved phonological processes beyond the expected age can impact intelligibility, literacy and confidence (Dodd, 2014; Bowen, 2015).

    How speech therapy helps phonological development

    Phonological therapy is not about drilling individual sounds endlessly.

    Instead, therapy focuses on:

    • helping children recognise sound patterns
    • building awareness of contrasts (e.g. ‘tar’ vs ‘car’)
    • practising speech in meaningful, playful ways
    • supporting generalisation so progress carries into everyday speech

    For school-aged children, therapy is usually structured, motivating and highly targeted and progress can be very encouraging.

    A final reassurance

    Many children with phonological difficulties go on to develop clear, confident speech with the right support.

    If you’re unsure whether your child’s speech is ‘just a phase’ or something that needs attention, a professional assessment can give clarity and peace of mind.

    If you’d like support or advice, please contact me and I can help guide the next steps.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Research references


    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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  • · · ·

    Why open cup drinking and good sitting matter for your toddler

    When your baby reaches around 12 months, there is a lot going on developmentally. They are learning to walk, communicate, feed themselves and become increasingly independent. One small but important milestone that can sometimes get overlooked is learning to drink from an open cup.

    Many toddlers continue to have milk from a bottle well beyond their first birthday, and parents are often understandably reluctant to take it away. The bottle may be familiar, comforting and convenient, particularly at bedtime.

    But moving towards an open cup is not simply about changing the way your child drinks. It is part of their development of oral-motor skills, feeding independence and mealtime development.

    And there is another piece of the puzzle that is often overlooked: how your toddler is sitting while they eat and drink.

    The way the body is supported can make a real difference to what the mouth is able to do.

    Why introduce an open cup from around 12 months?

    Babies can begin learning to drink from an open cup much earlier than many parents realise. By around 12 months, most children should be given regular opportunities to practise drinking from an open cup alongside other suitable drinking vessels.

    An open cup encourages your toddler to learn a different pattern of drinking from the sucking pattern they have used with a bottle.

    With an open cup, your child needs to:

    • lean towards the cup and control its position
    • grade how much liquid enters the mouth
    • use their lips to help control the liquid
    • coordinate breathing and swallowing
    • develop increasingly mature tongue and jaw movements
    • learn to take a drink without relying on a teat or nipple.

    These are useful skills for developing efficient eating and drinking.

    This doesn’t mean that a toddler who still has a bottle at 14 or 18 months has somehow ‘missed their chance’. Children develop at different rates, and there is always an opportunity to work towards new skills.

    However, if a bottle remains the main or only way a child drinks for a long time, there can be fewer opportunities to practise these more mature drinking skills.

    What are the pitfalls of staying with a bottle for too long?

    The occasional bottle is not the issue. The concern is when a toddler continues to rely heavily on a bottle and therefore has little reason or opportunity to develop other drinking skills.

    A bottle encourages a sucking pattern which is appropriate for infancy. As children mature, we want to see increasing use of their lips, tongue, jaw and facial muscles in more sophisticated ways.

    Long-term bottle use can also make the transition to an open cup more difficult simply because the child has become very accustomed to the bottle.

    There can also be practical considerations around dental health, particularly when milk is offered frequently throughout the day or overnight.

    For many toddlers, the bottle has also become associated with comfort, sleep or emotional regulation. This can make giving it up feel like a very big change for the whole family.

    So rather than thinking, ‘The bottle has to disappear tomorrow’, think:

    ‘How can I gradually increase opportunities for open-cup drinking?’

    Offer the open cup regularly at meals. Let your toddler experiment. Expect spills. Keep the amount of liquid small initially and provide plenty of encouragement.

    Learning to drink is a skill. And skills need practice.

    But what has sitting got to do with drinking?

    Quite a lot!

    When we think about feeding, we naturally tend to focus on the mouth. We watch what the tongue is doing, whether a child chews, whether they cough or gag and what foods they accept.

    But feeding is a whole-body activity.

    Your child needs a stable body position before they can use their mouth efficiently.

    Think about trying to drink from a cup while sitting on a wobbly stool with your feet dangling in the air. You would probably find it much easier if your body was well supported.

    The same principle applies to toddlers.

    Tripp Trapp® Chair

    A well-designed highchair such as a Tripp Trapp chair can provide a stable base when it is correctly adjusted for the individual child. Ideally, your toddler should have:

    • hips well supported
    • knees comfortably bent
    • feet resting firmly on a footplate
    • a stable pelvis and trunk
    • the table or tray at an appropriate height

    This gives your child a solid foundation from which to move.

    And that matters because stability in the body supports movement and control in the mouth.

    Feet supported = better feeding?

    I sometimes hear parents say, ‘He doesn’t need the footrest don’t worry about it (as I crouch down with my Allenn key to adjust the Tripp Trapp chair) but I always explain it is very important to have his feet supported. Dangling legs can make it much harder to maintain a stable sitting position.

    When the feet are supported, your toddler can push gently through their feet and stabilise their pelvis and trunk. This can help them maintain a more organised position while eating and drinking.

    They can then devote more attention to the job in front of them:

    looking, reaching, grasping, chewing, swallowing and drinking.

    This is particularly important for toddlers who are developing their chewing skills or who find mealtimes physically demanding.

    A stable body supports a busy mouth

    Eating involves an extraordinary amount of coordination.

    Your toddler is managing food in their hands, bringing it to their mouth, biting, chewing, moving food around with their tongue, forming a bolus and swallowing,  often while simultaneously looking around, communicating and interacting with you.

    Drinking from an open cup adds another layer of coordination.

    Good postural support doesn’t teach a child to drink from a cup, but it can give them a much better physical foundation from which to practise the skill.

    This is why, when I assess a toddler’s feeding, I don’t just look inside the mouth.

    I also look at how the child is positioned.

    Making open-cup drinking part of everyday life

    You don’t need a complicated programme.

    At meals, offer a small amount of water in an open cup. You can help your toddler hold the cup initially, tipping it gently towards their lips and allowing them to control the drinking as much as possible.

    Some mess is completely normal!

    You might also use a small, lightweight open cup that is easy for little hands to manage.

    And remember that the goal is not to make every drink perfect. The goal is to give your child regular, positive opportunities to practise.

    If your toddler is struggling with drinking, frequently coughing or choking, refusing cups, relying heavily on a bottle, or experiencing difficulties with chewing and eating, it is worth seeking professional advice from a Speech and Language Therapist with expertise in paediatric feeding.

    The bigger picture

    Open-cup drinking and good sitting are not two unrelated developmental skills.

    They are part of the same picture.

    A stable body provides a foundation for skilled movement. Skilled movement supports feeding. And feeding skills develop through practice and opportunity.

    So as your toddler approaches and moves beyond their first birthday, think beyond simply asking, ‘How much milk are they drinking?’

    Think about how they are drinking, how they are sitting, and what opportunities they have to develop the skills they will need as they grow.

    And if you have a little one sitting beautifully at the table in a well-supported Tripp Trapp chair, remember: you’re not just creating a comfortable seat.

    You’re creating a stable foundation for eating, drinking, learning and growing.

    Do get in touch with me. I would love to hear from you and help your little one develop good sitting and drinking habits.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.


    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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