Rethinking the PECS Approach

ByLondon Speech and Feeding
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I want to talk about some concerns of SLTs, parents and increasingly autistic adults who explain to us how this communication method did not really work so well and why.

What is PECS in a nutshell:

PECS (Picture Exchange Communication System) is based on the idea of exchanging pictures in return for desired items. For more advanced users, it is used to communicate different functions such as emotions, comments, negations using the exchange of a sentence strip. It was founded on the principles of Applied Behavioural Analysis (ABA).

How does that look in practice?

In my experience, having been trained in the approach myself, the overall aim is eventually for the child to spontaneously go and get their picture book (PECS book), open it, look through a range of pages to select the correct picture of what they want to have or say, then go and find their communication partner, and finally place that picture onto the communication partner’s outstretched palm to be rewarded with an item or with a response of some sort. Or the child selects a range of pictures to create a little sentence, such as: ‘the blue fish swims in the sea’, ‘the red bird flies in the sky’ or ‘I see a red bird’ for example. This can be part of a structured table top activity.

The system follows a series of phases, starting from simple picture exchanges to eventually construction of sentences using symbols. PECS’s aim is to promote communication initiation and reduce frustration for those who struggle with speech.

So far so good one might say, why not? Before I go into the various concerns, I would want to add my own working experience with PECS, and whilst it is my opinion, I would say I have NEVER seen a working PECS book being used spontaneously!

My experience

I have seen attempts of stages 1 and 2 done quite well, in schools, and where people knew that I was coming in “to have a look at how PECS is working with child X”. Yes, in those instances an effort was made of course to try and show me how it worked. I must add that have never been very impressed. I cannot recall it used for any other items than: biscuits/quavers/crisps/ raisins and bubbles/puzzle pieces or spinners.

If we want to see a child trained to exchange for these items in a structured setting, i.e., the child sits at a little table with the adult sitting opposite enticing the child with one or other item, then yes that can be done successfully. I have seen children exchange 25 pictures with a crisp on it, for said crisp and they might have asked for another 25 of those crisps given half the chance. Yes. Good. But. I have yet to see a child go to their PECS book and go through all the motions that I mentioned above to get a crisp. In school they don’t need to: they know that crisps are only available when the PECS book is being practised. Otherwise, let’s be honest, it’s fruit at 10.30 am!

So, they don’t get a spontaneous opportunity to ask for highly motivating items as that is not how school works, is it? ‘SIR! Can I have a crisp?’ At 10.02am, in the middle of maths? Didn’t think so… So in reality this does not get practised in my experience.

A few concerns in no particular order:

Limited Generalisation

One issue often raised is the limited generalisation of skills learned through PECS. The structured nature of the program may result in a child only being able to communicate effectively within the specific contexts where they were taught to use the system (as I suggest above: crisps: yes, please let’s do the PECS for it). This limitation can pose challenges when trying to apply communication skills in new or unstructured/spontaneous situations.

Lack of Spontaneity

Critics suggest that PECS can sometimes lead to scripted and less spontaneous communication. This is also what I have observed. Since the method is designed to follow a structured progression, there is a concern that individuals might struggle to initiate communication outside of the established framework, potentially hindering their ability to engage in more natural interactions.

Narrow range of communication functions being practised

While PECS is quite successful in focusing on requesting and naming items, there are many other important communication functions, such as expressing emotions, asking questions, giving opinions or greetings for instance. We can argue that a communication core board where we have a whole range of different core words available lends itself much better to practising a range of communicative functions.

The Pictures are movable

They are attached to the book via Velcro. They are constantly being picked and exchanged and then returned to the book. This means that the pictures tend to be always in different places. This goes against the motor planning that takes place when one is learning a new skill: imagine you want to learn to touch type and the letters always move and are at different places? How can you be quick about finding a letter? You can never get to “automatic” with this type of approach.

Communication is not taught via behavioural means

Only if you say “banana” in the way that I dictate that you should will you get a piece of banana. Who does that? Nobody. Typically, child points to the counter where there is a banana and says: ‘ba’ or ‘ana’ and mother/carer will look over there and say ‘oh banana! You want a banana? Ok there you go have a piece.’ Or something like it. Mother will not say: ‘SAY BANANA or else you won’t get it.’ Child hears mum saying ‘Banana’ each time and with time will point and say ‘banana’ or ‘I want-a-nana’ or something. This is how communication is learned: through the adult modelling it cheerfully all day long and the child hearing it and then gradually copying it.

One other gripe I personally have but I am reliably informed by all my parents that they share this about PECS:

IT IS SO LABOUR INTENSIVE!

There are 10, 50, 100’s of little pictures that first of all need laminating… then velcroing, then finding and replacing. As I said above, it’s a constant moveable feast for one, but also you LOSE them. Yep. You want to find the picture for “trampoline”. ‘Where is it? I saw it yesterday… We had it outside when we practised you asking for the trampoline. I am sure we put it back? Where is it??? Ok. We need to print off a new one.’

It is also labour intensive for the first stage where you need to have TWO adults to ease the exchange (pick up and release of picture into the communication partner’s hand). Who has two adults available for what can be weeks until the child is able to pick up and release by themselves?

YEP. So it’s really not for me you can tell! I much prefer Core boards (see my previous post on using one) or electronic speech generating AAC devices like GRID, or LAMP or TOUCHCHAT. These are all great to use and there is good support out there for introducing these.

Finding a Balance

While the concerns surrounding the PECS approach are valid, it’s fair to note that the method also has some merits. There is anecdotal evidence of many individuals who have successfully improved their communication skills and quality of life through PECS. But, finding a balance between using PECS as a stepping stone and ensuring the development of more comprehensive and SPONTANEOUS communication is key.

As educators and therapists, we need to extend the focus beyond requesting and labelling by incorporating symbols that represent emotions, actions, and more complex ideas. This expansion encourages a broader range of communication functions. When the time is right, gradually transitioning from PECS to more advanced communication methods such as Core boards or electronic AAC tools and speech-generating devices is the way forward.

We want to value all communication equally and our approach ought to be playful and child-led and to focus on intrinsic motivation instead of extrinsic rewards and reinforcers.

If you have any questions or if you are looking for a therapist who endorses play-based and child-led therapy approaches, please do reach out.

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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    A helpful addition in my toolbox for lisp correction

    ByLondon Speech and Feeding

    Meet the MUPPY – a vestibular orthodontic plate

    I have become very well versed in Lisp Correction because so many children come to me with this problem! And I absolutely love lisp correction and Articulation Therapy! Please take a look at my blog on tips and tricks for correcting a lisp.

    The MUPPY

    Over the years I have created my unique style of remediating an Interdental Lisp and as part of my treatment I sometimes use an Orthodontic Tool, called the ‘MUPPY’, which I purchase directly from Germany. I first discovered it some years ago when working with a child with Down Syndrome. Back then I was searching for additional support with my student’s jaw grading and mouth closure difficulties and that’s when I first came across this little tool as recommended by one of my colleagues, a specialist orthodontist in Germany.

    I was a bit sceptical at first but I have used it now many times for three years on a variety of clients with varying degrees of lisps. I find it really helps together and in addition to all my other techniques which are language and motor based.

    How do I use it?

    The MUPPY is a custom-made mouth plate that gently repositions the tongue, encouraging correct tongue placement for clearer speech. It sits comfortably between the lips and teeth; a thin wire sits right behind the teeth, inside the oral cavity.

    The plate I like to use for lisp correction has a pearl in the middle. As soon as it is in situ the tongue starts fishing for the pearl and thereby keeps on moving up towards the correct place on the hard palate, just behind the front teeth. This is the place where the tongue tip needs to be for all the alveolar sounds our students find so hard to make.

    How does this help reduce a lisp?

    A lisp results mainly from incorrect tongue placement during sound production – though at times atypical dentition also contributes to the problem. Specifically, an interdental lisp occurs when the tongue protrudes between the teeth during the production of sounds like /S/ and /Z/. The tongue is often described by parents as ‘thrusting forward’ but I find that is rarely the case. Most often the tongue simply protrudes forward, which is different to tongue thrusting, a more forceful and involuntary movement. Most often I see a habitual tongue protrusion not only for /S/ and /Z/ but also for /T/, /D/, /L/ and /N/. Often /SH/ and ZH/ are also affected.

    To visualise this:

    1. A correct /S/ sound looks like this: The tongue tip is raised and touches the alveolar ridge (the bony, slightly uneven ridge behind the upper teeth). The sides of the tongue touch the upper molars.
    2. Interdental lisp: The tongue tip protrudes between the front teeth, creating a /TH/ sound.
    3. Lateral lisp: Here the mechanics of the tongue are different. But using the MUPPY can help here too. To visualise a lateral lisp, the sides of the tongue are not raised high enough, allowing air to escape over the sides. This results in a ‘slushy’ or ‘wet’ sound.

    Understanding the specific type of lisp is crucial for targeted therapy and successful correction.

    The Vestibular Plate (Muppy) HELPS to guide the tongue towards the right place from where we shape the NEW SOUND.

    Methods

    Most important to my articulation work re lisping are the motor- and language-based techniques I use, as broadly described below:

    • A thorough oral examination, tongue movements, lip closure, dentition, jaw grading, breath coordination, cheek tonicity, palatal form
    • Discussion on awareness and motivation of child to work on their speech
    • Contrasting sounds at the beginning and end of words: sing vs thing / sink vs think / mess vs mesh etc to raise awareness that it matters what sounds we use in speech and that just one sound can change the meaning of a word completely
    • Mirror work, pulling faces, moving our tongue voluntarily
    • Exploring the oral cavity and thinking about all the parts of the tongue and the palate
    • Finding the alveolar ridge and placing the tongue there at rest
    • Then working towards a good baseline of the other alveolar sounds: /T/ /D/ /L/ /N/ and from there we work towards our NEW /S/ SOUND.

    I use a variety of picture clues depending on what is most meaningful for my student:

    The child likes a train set, I use the TIRED TRAIN SOUND.

    The child knows about bike or car tyres, I use the FLAT TYRE SOUND.

    With a student who loves a balloon I might use the FLAT BALLOON SOUND.

    And we work our way from correct tongue placement to these long /SSSSSSSSS/ sounds with the help of these visual cues, but also gestural and hand cues such as Jane Passy’s Cued Articulation sound for /S/.

    I really love helping children correct their speech sound, be it an articulatory difficulty like the lisp or a phonological difficulty such as ‘fronting’ or ‘gliding’ and I also love working with motor-based speech difficulties we see in Childhood Apraxia of Speech. Feel invited to get in touch if your child needs help in these areas.

    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

  • Quick Overview Of How To Implement Those Early Hanen Speech And Language Strategies

    ByLondon Speech and Feeding
    Quick Overview Of How To Implement Those Early Hanen Speech And Language Strategies

    First up try and get down at eye level or Face-to-Face with your child

    Try to sit so that your child can see you easily, i. e. your child does not have to look up to make eye contact with you. We call that Face to Face: try and sit opposite your child. This makes it easier for you to see facial expressions and therefore pick up nonverbal /pre-verbal communication. Now you can connect and share the moment with your child.

    OWL (Observe, Wait and Listen)

    Never skip this step as it prepares us for what happens next !

    Observe

    First, try and simply watch your child quietly and listen and observe what he/she says or does; you need to know what your little one is interested in. For example with this toy (pictured below) we could observe that your child loves the actual spinning of the marble, perhaps more than that noisy click-clacking down the run. Or perhaps he loves collecting the marble at the end and feeling it in his hand.

    You could start off with showing once how the marble goes down and say:“ look it goes round and round !” Then hold back and observe, without speaking, so that your child has time to explore the toy.

    Wait

    Just sit and avoid telling or showing your child what he or she could do with the toy. This gives your child an opportunity to explore and experiment.

    Listen

    Listen to what your child says, or look at your child’s non-verbal communication without interrupting. Your child will now feel and know that you are really present and that what they have to say is important. It’s best to avoid questions like, “What are you doing or “What’s this?” as that might be a lot of pressure when they don’t know what to say about that yet.

    Respond immediately by showing interest

    Once you have all the information from OWLing you can respond in the right way, for example: if she catches the marble at the end of the run and looks up with a smile or a sound you could respond with: you’ve got it! One marble in your hand! Nice playing!

    Now how to join in the play:

    First you can copy what your child is doing

    If your child puts the first marble at the top of the run you can take a turn and do exactly the same once his marble is done. Ideally you might have another marble run, perhaps a similar one, it does not have to be exactly the same! Once your child has put the first marble in you can do the exact same with your own marble on your run. Your child is likely to look at what you are doing and you might well see a smile on their face or perhaps she might say: look at mine!

    Next you can build on that

    You can respond with simple comments like: “Wow! Yes I am looking at yours now! It’s spinning on the red one lots! I love the noise!” Now wait once more to see what your child says or does.

    To summarise

    We are signalling to our child that we are really interested in what they are doing and saying so we can “collect” our child, i.e. bring him/her back into a joint interaction.

    Important

    We want to try and not direct our child but respond with interest and fun! This creates a lovely stage for interaction and joint play! And this leads in turn to practising conversation and ever more opportunities for great speech and language skills to emerge.

    Great activities we use in Speech and Language Therapy:

    • Any cause and effect toys like this Marble Run
    • Creative activities, such as mark making with crayons
    • Train tracks (building and running the trains)

    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.

  • · ·

    Explore how to improve communication skills for a Gestalt Language Processor

    ByLondon Speech and Feeding

    Let’s break it down into steps to make these complicated words easier to understand. Once you have a deeper understanding, you will then be able to support your child or young person develop their communication skills in the best way as a Gestalt Language Processor. Remember not every child will be a Gestalt Language Processor; if your child uses echolalia and/or has a diagnosis of autism then your child’s way of processing language is most likely different to the classic way children typically learn language.

    Let’s start with understanding what each of these words “Gestalt Language Processors” mean.

    Gestalt: “the way a thing has been placed or put together”

    Language: “a system of human communication”

    Processors: “responds to and processes basic instruction”

    So, let’s put those meanings together. “Gestalt Language Processors are children who process early language in strings of sounds or chunks.” They tend not to process single words.

    It is important to understand this way of processing communication because between 75-90% of children with Autistic Spectrum Conditions process language in this way (Blanc, 2012). We know that it’s important for young people to have their voice heard and to be able to express themselves. So, it’s vital that they move from echolalia to self-generated communication to be able to do this. This means that our children’s communication partners play a vital role in supporting their child’s language. We can support our children by modelling phrases until the child has learnt the process themselves.

    Speech Therpaist in London

    Let’s explore an example together

    X (who is a gestalt language processor) and his family love to feed the ducks in their spare time; this is an activity that takes place regularly. Let’s look at how you, as the adults, could support X in his communication. Look at the phrases that are used. They are meaningful to the activity with repetition used throughout.

    Top tip: You could think of an activity you and your child or young person take part in on a regular basis and brainstorm some key phrases that you could use.

    Need a boost in confidence to support your child’s gestalt language processing?

    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.

    6
  • · · ·

    Following your child’s lead: A playful path to AAC success

    ByLondon Speech and Feeding

    Unlocking playtime: A guide to child-led learning

    Does your child struggle to focus on toys or activities? Do they dart away as soon as you approach? You’re not alone!

    The key to unlocking your child’s potential lies in following their lead. Let them guide the play session, and watch their engagement and focus soar.

    Why Child-Led Play Works:

    • Empowerment: Children feel in control, sparking their curiosity and motivation.
    • Focused attention: They’ll stay engaged with activities for longer periods.
    • Reduced frustration: By stepping back and observing, you eliminate the pressure and stress that often comes with directed play.

    How to Implement Child-Led Play:

    1. Prepare the environment: Set out a limited selection of engaging toys.
    2. Observe and wait: Sit back, watch, and listen to your child’s interests.
    3. Embrace the moment: Resist the urge to direct or question; simply enjoy the process.

    Remember: This simple approach can transform playtime and support your child’s development. Give it a try for a week and see the difference!

    #OWLing #hanenmorethanwords

    Observe, Wait, Listen. It’s a powerful formula for unlocking your child’s potential.

    You will likely see:

    • Your child will stay put with any toy for longer whilst you are near them.
    • Your child will tolerate you being nearby and he/she won’t move away.
    • Your child will start giving you brief glances of enjoyment, or perhaps they will hand things to you, or they might take your hand and lead it to something that needs opening etc.
    • In other words, you will see that there suddenly is JOINT PLAY. Yes, granted it may not be according to your adult agenda, but there will be more togetherness than there was before. And this is the START of communication and social engagement.

    USE Core words and a coreboard — to help your child understand the power of words

    Core words are the building blocks of communication. Try using a coreboard like the one below, they are versatile and can be used in countless ways. By modelling these words naturally during play, you expose your child to their meaning and function in context. This approach is far more effective than isolated drill and practice, more powerful than flashcards!

    Using AAC coreboard
    Photo by lemonlenz

    A Winning Combination

    Combining child-led play and AAC modelling creates a magic effect. To summarise:

    • Increased engagement: When you follow your child’s lead, they are more likely to be engaged and receptive to learning. This creates optimal conditions for introducing AAC core words.
    • Natural learning: By modelling AAC core words in the context of play, you help your child understand their meaning and purpose naturally. This fosters generalisation and spontaneous use.
    • Building relationships: Shared play experiences strengthen the bond between you and your child. This trust and connection are essential for successful communication.
    • Reduced pressure: Modelling AAC core words without expectation removes the pressure to produce language. This allows your child to explore communication at their own pace.
    • Expanded vocabulary: As your child becomes more comfortable with AAC, they will begin to incorporate core words into their own communication. This leads to vocabulary growth and increased independence.

    Practical Tips

    • Observe and respond: Pay close attention to your child’s interests and actions. Respond to their cues with enthusiasm and support.
    • Keep it simple: Start with a few core words and gradually introduce new ones as your child’s skills develop.
    • Be patient: Language learning takes time. Celebrate small successes and avoid frustration.
    • Have fun: Remember, play is supposed to be enjoyable for both you and your child. Relax and have fun together!

    Example:

    Photo by lemonlenz

    Let’s say your child is playing with a pop-up toy like you see me do in the above photograph. Here, I followed my child’s lead by waiting to see what she wanted to do with the toy. You are now OWLING! (Observe Wait and Listen)

    Once I noticed that there was repetitive opening of the flaps going on I then pointed to OPEN and MORE on the board, as I said: ‘let’s OPEN this one’ / let’s see MORE animals’ / ‘MORE cow! it says moo!’ ‘OPEN another one’ and so on.

    Important to know, we are not expecting our child to respond verbally or with AAC, but we are providing language input and demonstrating how these words can be used with enthusiasm.

    Naturally in time your child will look at the board and at your pointing and they will eventually want to copy you!

    By incorporating these strategies into your daily interactions, you can create a supportive environment that fosters language development and communication growth.  If you would like more guidance please get in touch and book in for a consultation, some individual therapy and/ or some parent coaching.

    I look forward to supporting you. Please contact me and let’s see how.

    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
  • · ·

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

    ByLondon Speech and Feeding
    Conquering the ‘slushy’ /S/: Your guide to treating lateral lisps

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

    What is a lateral lisp?

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

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

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

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

    Why is it tricky to treat?

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

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

    My success with children aged six years and over

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

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

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

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

    The recipe for success: Little and often

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

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

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

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

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    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

    ByLondon Speech and Feeding
    Image by gpointstudio on Freepik

    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.

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