Speech prompts and strategies I use in Speech Sound Therapy

ByLondon Speech and Feeding
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This particular student has a mild motor planning difficulty and six weeks ago he came to me with a very strong lisp. In addition to the lisp he is struggling to produce a number of sounds, SH and L on its own and all the clusters (FL/BL/KL/PL) but also CH together with some vowel difficulties.

The prompts are a mix partially from the DTTC (Dynamic Temporal and Tactile Cueing) model by Dr Edythe Strand as well as phonological models I have learned over the years, and some of them are my own.

Visual/picture prompts and Images

Here I use the ‘Flat Tyre’ Sound, to offer as an image for a new S sound and the ‘Tick Tock’ Sound for a new image of the T sound. Both cards are from the Bjorem Speech Sound Deck, which I love and use almost daily.

Gestural Cues

I like to use all the ‘cued articulation’ hand cues by Jane Passy for consonants and fricatives. Here we use our fingers and hand to illustrate what our tongue does, and we also show whether a sound is voiced or voiceless. When I use one finger it is voiceless (k/f/s/p) and when I use two fingers for the same cue it means that the voice needs to be turned on: (g/v/z/b/n/m). For vowels I like to use Pam Marshalla’s cue system.

Simultaneous production

We say the word together.

Direct imitation

I say the word and my student copies me directly.

Imitation after a delay

I say the word and then after a little wait my student says the word.

Spontaneous production

My student has now learned to say the word by him/herself.

Offering feedback

It sounds like… I just heard… I didn’t hear the first sound there? Can you try again?

Letting the student reflect

By just shaking my head or by looking quizzical so that my student realises something didn’t quite go right.

Postitive reinforcement

‘Yes that was it, do it again, nice one…’

Cognitive reframing

This is a technique where we identify different semantic cues and metaphors or imagery cues, so instead of teaching or focusing on a sound we try out viewing each syllable from a different point of view.

For example: ‘yellow’. I have had great success with this one: we start with just saying ‘yeah yeah yeah’. I might make a little joke and say something like ‘imagine your mum says tidy your bedroom, what do you say or what do you think?’ Answer: ‘yeah yeah yeah’. Then we practice ‘low’ together, I might blow some bubbles high and low and we talk about ‘low’. And then we put ‘Yeah’ and ‘Low’ together and now we have YELLOW!! It might at first still sound a bit odd, like ‘yea-low’ but we soon shape that up and have the real word.

Each student is different and having a great rapport is crucial to our success.

Then a little game break after some 7–10 or so repetitions and always trying to finish on a positive note.

What game breaks do I use:

Very quick ones! Students can post something, place a counter in a game, take out a Jenga block from the tower, pop in a counter for ‘connect 4’, stick a sword into the Pop the Pirate barrel or add a couple of Lego blocks to something they are building.

I hope this is helpful, please contact me for any questions.

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

    ByLondon Speech and Feeding

    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.

    1
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    There is more than one way to model communication: Using speech prompts, signs, and AAC together in therapy

    ByLondon Speech and Feeding

    One of the most important things I have learned as a paediatric speech and language therapist is this:

    Children do not all learn communication in the same way.

    Some children learn best through listening.
    Some need visual support.
    Some need movement and gesture.
    Some benefit from symbols or technology.
    And many children need multiple supports together before communication truly starts to develop.

    That is why flexible, responsive therapy matters so much.

    In this short therapy clip, I model just two simple words:
    ‘Go’ and ‘Up’.

    But underneath those tiny moments is a combination of therapeutic strategies:

    • speech sound prompting
    • visual cueing
    • Makaton signing
    • AAC (Augmentative and Alternative Communication) modelling
    • repetition
    • motor planning support
    • language modelling
    • total communication principles.

    Communication is bigger than speech alone

    One of the biggest misconceptions about speech therapy is the idea that communication only ‘counts’ if a child says the word verbally.

    In reality, communication comes in many forms:

    • speech
    • gesture
    • facial expression
    • signing
    • pointing
    • symbols
    • body language
    • AAC.

    This is particularly true for children with:

    • developmental language disorder (DLD)
    • autism
    • motor speech difficulties
    • childhood apraxia of speech (CAS)
    • phonological difficulties
    • global developmental delay
    • complex communication needs.

    These children often need communication to be presented through multiple pathways at once.

    That is where total communication approaches become so powerful.

    This is important to know: this does not confuse children. In fact, for many children, it does the opposite. It creates clarity.

    Careful sound prompting helps bridge that gap.

    Research and clinical experience consistently show that signs often support spoken language development rather than hinder it.

    Research suggests that learning signs alongside spoken language does not hinder speech development and may support overall language acquisition, communication confidence, and vocabulary growth in many children.

    For many children, signs actually help speech emerge because they:

    • reduce communication pressure
    • build confidence
    • strengthen understanding of words.

    A child who can successfully communicate is far more likely to keep attempting interaction.

    The power of AAC and LAMP Words for Life

    In the clip, I also model language using an electronic AAC system: LAMP Words for Life.

    AAC stands for Augmentative and Alternative Communication.

    AAC includes any tool that supports communication beyond speech alone, including:

    • picture systems
    • symbol boards
    • communication books
    • speech-generating devices.

    LAMP Words for Life is one of my favourite AAC systems because it focuses on consistent motor patterns and meaningful language development. Because communication is not about achieving perfection. It is about connection.

    And when children are given multiple ways to express themselves, they often become more confident, more engaged, and more willing to interact with the world around them.

    That is the true power of total communication therapy.

    Contact me via my contact form if you would like me to work with your child.

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Reference

    Pontecorvo, Elana & Higgins, Michael & Mora, Joshua & Lieberman, Amy & Pyers, Jennie & Caselli, Naomi. (2023). Learning a Sign Language Does Not Hinder Acquisition of a Spoken Language. Journal of Speech, Language, and Hearing Research. 66. 1291-1308. DOI 10.1044/2022_JSLHR-22-00505.

    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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  • ·

    How can I incorporate AAC into my speech therapy sessions?

    ByLondon Speech and Feeding

    Many parents are surprised when I bring AAC into a session, especially if they’ve come to see me primarily for speech sound work.

    They might wonder: ‘If we’re working on pronunciation, why are we using a communication device?’

    The simple answer is this: speech therapy is about communication first, and speech sounds second. Supporting a child’s ability to express themselves clearly and confidently is always the priority, and AAC can be a powerful tool alongside spoken speech.

    What do we mean by AAC?

    AAC stands for Augmentative and Alternative Communication.

    This can include:

    • A speech-generating device (such as LAMP Words for Life or GRID as I used in the photo below)
    • A communication app on a tablet
    • A symbol board or communication book
    • Gestures, signs, or visual supports

    AAC does not replace speech. Instead, it supports language development, reduces frustration, and builds communication success while speech skills are developing.

    Pretend Play using Speech and AAC in my clinic room

    But I mainly work on speech sounds… So how does AAC fit?

    Most of the children I see are working on:

    • Articulation difficulties
    • Phonological delay
    • Motor planning challenges (including apraxia/dyspraxia)
    • Unclear speech affecting confidence

    For these children, AAC isn’t a separate therapy. It’s simply woven naturally into what we are already doing.

    If a child brings their device to sessions, I actively include it. If they don’t yet use AAC but could benefit from visual or symbolic support, I may introduce simple options within activities.

    Using AAC to support speech practice

    Let’s say we are working on early speech targets like: ‘GO’.

    We might practise:

    • Saying the word verbally
    • Listening for the target sound
    • Using play (TOY TRAIN GOING ROUND A TRACK)

    Now we can extend this using AAC.

    On the device or communication board, we might model: ‘LET’S GO’ or ‘IT’s GOING up the hill’.

    This allows the child to:

    • Practise their speech sound target
    • Build a simple sentence
    • Experience successful communication even if speech is not fully clear yet

    All responses are valid and supported.

    AAC helps children communicate more than they can say

    Many children can understand and think in longer phrases than they can physically say.

    For example:

    • A child who verbally says single words may build longer phrases on AAC.
    • A child who struggles to plan speech movements may use AAC to communicate smoothly while still practising verbal attempts.
    • A child who becomes frustrated when misunderstood gains a reliable backup system.

    Rather than slowing speech progress, AAC often:

    • Reduces communication pressure
    • Increases participation in therapy
    • Encourages more attempts at speech
    • Supports language growth

    When children feel understood, they usually become more motivated to try speaking.

    There are no ‘prerequisites’ for AAC

    One of the biggest myths I hear is: ‘My child isn’t ready for AAC yet.’

    In reality, children do not need to:

    • Reach a certain speech level
    • Use pictures first
    • Prove they understand everything
    • Show immediate interest

    Instead, we presume competence and introduce AAC in meaningful, playful ways.

    That means:

    • Modelling words while blowing bubbles
    • Commenting during playdough activities
    • Choosing words during games
    • Building simple phrases in shared reading

    AAC should never feel like extra ‘work’. It’s simply another way to join in communication.

    My goal is always the same: to help each child communicate as clearly, confidently, and successfully as possible, using every helpful tool available.

    If your child uses AAC (or might benefit from it)

     Please feel free to:

    • Bring the device to sessions
    • Show me how your child currently uses it
    • Share advice from school or other therapists

    I am very happy to incorporate AAC into our work together so that speech practice, language development, and real communication all move forward hand-in-hand. Because ultimately, therapy isn’t just about producing perfect sounds. It’s about helping your child be heard and understood.

    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.

      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.

      3
    • ·

      Dynamic assessment – Let’s look beyond the checklist

      ByLondon Speech and Feeding
      Dynamic assessment – Let’s look beyond the checklist

      As a parent, you’re always observing your child, celebrating his or her milestones, and sometimes, wondering if he or she is quite on track. When it comes to speech, language, play, attention, and listening, these early years are a whirlwind of development! It’s natural to seek guidance if you have concerns, and that’s where a truly comprehensive assessment comes in.

      But what exactly does ‘comprehensive’ mean, especially when it goes beyond a typical checklist? You can find any number of check lists online these days but whilst they can give you an overall idea of what a child is typically expected to do at any given age, it can also start leading you into a rabbit hole of anxiety of ‘what-iffery’.

      At The London Speech and Feeding Practice I believe in something far more insightful than a static evaluation: Dynamic Assessment. Think of it as an in-depth, interactive investigation into your child’s unique communication landscape, exploring not just what he or she can do, but how he or she learns and why he or she might be facing challenges. This is so important.

      What makes an assessment ‘dynamic’?

      Imagine trying to understand a child’s personality by just looking at a single photograph. It gives you a glimpse, but it hardly tells the whole story. Traditional, formal assessments, while valuable, can sometimes be like that photograph – a snapshot of skills at one specific moment.

      Dynamic assessment, on the other hand, is a living, breathing process. It’s called ‘dynamic’ because:

      • It’s interactive and responsive: It adapts to your child’s needs in real-time. It’s not about sticking rigidly to a pre-set schedule of tests. Instead, it’s about observing, gently prompting, and providing support to see how your child responds and learns. This allows me to understand his or her learning potential, not just his or her current performance.
      • It’s holistic and multi-faceted: I look at the whole child. We delve deep into not just speech and language, but also his or her play skills (a crucial window into cognitive and social development), attention and listening abilities, and his or her social engagement. These areas are intricately linked, and a delay in one can often impact others.
      • It integrates multiple perspectives: Your insights as a parent are invaluable! Before we even meet, my comprehensive onboarding questionnaire gathers essential background. During the assessment, your feedback, observations, and comments are woven into the fabric of our session. You are the expert on your child, and your voice is central to forming a complete picture.
      Dynamic assessment – Let’s look beyond the checklist

      More than just ‘speech’: A deep dive into development

      You might initially be concerned about your child’s speech sounds, or perhaps his or her ability to form sentences. These are vital areas, but my approach goes much further. I’m keen to understand:

      • The ‘why’ behind the ‘what’: Is a child struggling with language because of difficulties with understanding instructions (receptive language), or with expressing themselves (expressive language)? Are his or her attention skills impacting his or her ability to follow a conversation? Is his or her play demonstrating imaginative thought, or does he or she prefer more structured, repetitive activities? These nuances are critical.
      • Differential diagnosis: This is where the skill of an experienced clinician truly comes into its own. Through dynamic assessment, I can differentiate between a developmental delay (where a child is following a typical progression but at a slower pace) and a disorder (where his or her development is following an atypical pattern). This distinction is vital because it guides the type of support and intervention that will be most effective. Understanding the cause of the delay or disorder is paramount to creating a targeted, impactful therapy plan.

      The art of observation

      While I draw upon evidence-based practice as well as a formal, standardised assessment as well as my extensive clinical knowledge, I also rely heavily on the art of observation. From the moment your child walks into the room, I’m establishing rapport, engaging them in play, and creating a safe, fun environment. It’s through this genuine interaction – often without them even realising they’re being ‘assessed’ – that the most authentic insights emerge.

      This is where the magic happens:

      • Building rapport: A child who feels comfortable and connected will show you so much more of his or her true abilities and personality. I pride myself on creating an atmosphere where children can relax and simply be themselves.
      • Play as a window: Play isn’t just fun; it’s a child’s natural language. It reveals his or her understanding of the world, his or her problem-solving skills, his or her social engagement, and his or her ability to use symbols and language.
      • Skilled interpretation: My years of experience allow me to see beyond surface-level behaviours and interpret the subtle cues that might indicate underlying strengths or challenges. This goes far beyond what any standardised test alone can capture.

      Why choose a clinician who offers dynamic assessment?

      In essence, a dynamic assessment provides a rich, nuanced, and truly personalised understanding of your child. It’s an investment in:

      • Accuracy: Leading to a more precise diagnosis and understanding of his or her unique profile.
      • Tailored support: Enabling the creation of highly individualised therapy goals that truly meet your child where he or she is and gently guide him or her forward.
      • Empowerment: You’ll leave with not just answers, but also practical strategies and a clear path forward, feeling confident and informed.

      If you’re seeking a thorough, empathetic, and truly insightful assessment for your child’s communication development in London, I invite you to get in touch. Let’s work together to unlock your child’s full potential.

      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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    • ·

      Five ways to increase confidence and reduce frustration in children with speech and language and communication difficulties

      ByLondon Speech and Feeding
      An orange speech bubble with a testimonial

      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.

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    • ·

      The great air debate: How different swallowing patterns impact breastfeeding and reflux

      ByLondon Speech and Feeding

      The great air debate

      As a Speech and Language Therapist specialising in infant feeding, I often hear from worried mums describing their breastfed baby’s fussiness. ‘My baby is so burpy and gassy,’ ‘might it be reflux?’ or ‘she just seems uncomfortable after every feed’. While these concerns are incredibly valid and distressing for both baby and mum (and dads!), the underlying cause isn’t always what you might think. Often, the culprit isn’t primarily a digestive issue, but rather a mechanical one: how effectively your baby is managing air during feeding.

      Many parents are told their baby has ‘colic’ or ‘reflux’ and are offered solutions that don’t quite hit the mark because they overlook a fundamental aspect of feeding: the suck-swallow-breathe sequence. Understanding this intricate dance can be the key to unlocking a calmer, happier feeding experience for your baby and you.

      Understanding the suck-swallow-breathe sequence

      Your baby’s mouth, tongue, jaw, and throat muscles work together in a precise rhythm like a beautifully orchestrated symphony. First your baby draws milk, then swallows it, and then takes a breath, all without interruption. This is the ideal suck-swallow-breathe (SSB) sequence.

      When the SSB sequence functions optimally, a baby latches deeply, creates good suction, draws milk, swallows efficiently, and then pauses just long enough to take a gentle breath before the next suck. This smooth, coordinated process minimises the amount of air swallowed.

      However, for various reasons (it could be a shallow latch, oral motor challenges, an uncoordinated suck, or even an overly fast milk flow) this sequence can get a bit out of sync. Instead of a smooth rhythm, you might see:

      • Suck-suck-swallow-gasp!: Too much air pulled in with the swallow.
      • Rapid, shallow sucking followed by gulping: Inefficient milk transfer and air intake.
      • Clicking noises during feeding: Loss of suction, indicating air entry.
      • Frequent detaching and re-latching: Often to ‘catch a breath’ or because of discomfort.

      Each of these patterns can lead to increased air intake.

      The root cause: Air trapping leading to a gassy breastfed baby

      When a baby swallows too much air during a feed, that air must go somewhere. It builds up in the stomach, causing bloating, discomfort, and often leads to the familiar reflux-like symptoms parents describe: arching, spitting up, burping excessively, or simply appearing distressed.

      It’s a common misconception that all gassiness or reflux symptoms in a breastfed baby are due to something in the mother’s diet or a genuine digestive disorder. While these can be factors, as an SLT, we first look at the mechanics of the feed. If a baby is constantly struggling to maintain a seal, sucking inefficiently, or having to gulp to keep up with flow, he or she is inevitably swallowing air. This air then creates pressure, which can push milk back up (silent reflux) or out (visible reflux).

      Think of it like trying to drink through a straw with a hole in it. You’re sucking, but you’re also pulling in air, making it harder to get the liquid and leaving you with more bubbles in your stomach.

      Why mechanical speech therapy assessment is key

      This is where the distinction between a medical diagnosis (true gastro oesophageal reflux disease or GORD) and a functional feeding challenge becomes critical. A paediatrician will assess for medical causes and may prescribe medication to reduce stomach acid. This can be appropriate for severe cases of GORD.

      However, if the primary issue is air being trapped due to a suboptimal suck-swallow pattern, medication only treats the symptom (acid burning) and not the root cause (air intake). This is precisely where a Speech and Language Therapist specialising in infant feeding comes in.

      My role is to meticulously observe and assess your baby’s oral motor skills, latch, tongue function, and the efficiency of their SSB sequence. I look for subtle signs of inefficiency that contribute to excessive air swallowing.

      • Is the tongue elevating correctly to create suction?
      • Is the jaw stable, or is it excessively moving?
      • Is the latch deep enough to prevent air leaks?
      • Can the baby coordinate suck, swallow, and breathe without gasping?

      By identifying these mechanical challenges, I can then implement targeted strategies to improve feeding efficiency and reduce air intake, often leading to a significant reduction in reflux-like symptoms and overall discomfort.

      Strategies to optimise air management during breastfeeding

      The good news is that many babies can learn to feed more efficiently with the right support. Here are some general strategies we might explore:

      1. Optimise latch and position: A deep, asymmetric latch is crucial. Experiment with different positions that allow for a deeper latch and better head/neck alignment, such as laid-back feeding or upright positions.
      2. Paced feeding (even at the breast): If your milk flow is very fast, consider removing your baby from the breast briefly if you hear excessive gulping or see him or her struggling to breathe. This allows him or her to catch up and manage the flow.
      3. Support the jaw and cheeks: Sometimes, gentle support to the baby’s jaw or cheeks can help them maintain a more stable, efficient suck. I can demonstrate specific techniques for this.
      4. Burping effectively: While burping won’t get rid of all swallowed air, upright burping positions and gentle back rubs can help release some of it.
      5. Pre-feed oral preparation: Gentle oral massage or stretches before a feed can sometimes ‘wake up’ the oral muscles and improve coordination.

      Addressing the ‘Great Air Debate’ isn’t about blaming anyone; it’s about empowering parents with a deeper understanding of their baby’s feeding mechanics. By focusing on the how, not just the what, we can often resolve persistent feeding challenges, reduce discomfort, and make breastfeeding a more joyful, peaceful experience for both you and your little one.

      If you suspect your baby’s gassiness or reflux symptoms are related to how they are managing air during feeds, don’t hesitate to reach out for a specialist assessment.

      Sonja McGeachie

      Highly Specialist Speech and Language Therapist

      Owner of The London Speech and Feeding Practice.

      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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