Stage 2 NLA

ByLondon Speech and Feeding
| |
Image by Freepik

Last time we asked: is our child ready tp move to Stage 2 NLA (Natural Language Acquisition stage 2) and we looked at how we can know. Now we know: he/she is ready, they are mixing and matching those scripts quite liberally! Hurrah!

So for example we hear phrases like:

  • ‘let’s go’+ ‘downstairs’
  • ‘it’s’ + ‘downstairs’
  • ‘I see it’ + ‘downstairs‘
  • ‘I want to’ + ‘shoes downstairs’ (I want to put my shoes on downstairs)

To recap, it’s important to listen out to a variety of contexts because if we only hear the single version of a gestalt —this is so great, hurrah!— but that’s not yet Stage 2.

What we can now do on a daily basis to help and support at this time:

1. We need to offer more ‘mix and match’ phrases to help our child establish this new way of communicating.

Good phrases:

  • It’s … raining / cooking / eating / washing / brushing
  • That’s … great / cool / amazing / wow / so good
  • Let’s … see / look / go / run / chase
  • How’bout … some food / playing / I’ll chase / sleeping / we read a book
  • I see a … bird / large car / fire engine
  • I wanna … have a biscuit / have a book / have a snuggle
  • We’re … going out / going home / going in the car / going upstairs

Here in my video clip of train play I use:

  • Let’s go
  • It’s going up the hill
  • It’s coming down
  • Ooops it falls!
  • It’s stopping
  • Let’s put on another parcel
  • Ready steady go
  • Off we go
  • It’s come off!
  • Let’s fix it
  • I can do it
  • I don’t need help

You can offer these gestalts either with an AAC as you can see me do in the video clip or you can just verbally offer these.

2. Watch out for Pronoun confusion or reversal:

Gestalt kids repeat gestalts, so we don’t want to create ‘pronoun reversal’.

Instead model from a:

  • first person perspective: ‘I’ / ‘Our’ / ‘Us’
  • joint perspective: ‘We’ / ‘Let’s’ or a
  • neutral perspective: ‘It’

You can turn almost any sentence into a good language model once you get used to it. And you can avoid ‘you’ and ‘your’ at the same time!

So instead of saying, ‘Do you want to go to the park?’

You could say:

  • We wanna go to the park?
  • Let’s go out?
  • Shall we go out / to the park?

3. Start providing ‘variation’ in your language modelling:

Instead of just modelling something one way, start thinking about offering a pattern in a couple of other ways, in a couple of different situations, then several ways in several different situations.

Example: once you hear your child saying: ‘it’s raining’ and you know it’s a mitigation, because you don’t often say ‘it’s raining’, or haven’t said it in a while and you know your child says other ‘it’s’ phrases.

Repeat: ‘it’s raining!’

Then: ‘it’s’ + ‘raining hard’ / ‘it’s wet out there’ / ‘It’s’ + ‘raining lot’s’.

Then later think of other combinations for ‘it’s’ + ‘something’:

  • (rice) ‘It’s’ + ‘cooking’
  • (water/tap) ‘It’s’ + ‘running’
  • (radio) ‘It’s’ + ‘singing
  • (dog) ‘It’s’ + ‘peeing’ / ‘it’s’ + ‘running’ / ‘it’s’ + ‘jumping’

In my train video clip:

  • Let’s go
  • It’s going
  • Let’s make it go
  • Ready steady go
  • Oops its gone

4. Use natural intonation that shows you really mean what you’re saying.

You can be animated or try for musical if your child prefers that / doesn’t mind you singing —they might not like it if their hearing is pitch perfect and your singing is off key…—

  • ‘I’m’ + ‘trying to find you!’ (animated, goofy face)
  • ‘I’m’ +’ getting tired!’ (exaggerated stretch and yawn)
  • ‘I’m’ + ‘catching up with you!’ (animated goofy)
  • ‘I’m’ + ‘gonna get you!’ (animated goofy)
  • ‘I’m’ + ‘sad right now’ (exaggerated face and tone of voice)

5. USE SILENCE!

Important, I might not have said this before but we need to hold back sometimes (hard I know) and not constantly offer models. Let our child sit in a bit of silence with us there just observing and waiting for their own offers. This is a very important point. Silence is golden sometimes. Try it out. I am not talking about the silence that comes with a person scrolling on their phone though, we do need to be present and receptive.

You will see this works wonders!

Do get in touch if you would like some in-person or on-line 1:1 support with this. It can be overwhelming to figure it all out alone.

You can also check my friend’s lovely handmade jewelry on her website.

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

Similar Posts

  • · ·

    Chaining: A powerful tool for phonological development

    ByLondon Speech and Feeding

    Understanding chaining

    Chaining is a therapeutic technique I like to use in my speech therapy work with children who have Childhood Apraxia of Speech (CAS) or phonological speech sound difficulties. It helps to break down a complex target behaviour into smaller, more manageable steps. By systematically teaching and reinforcing each step, I can help my students achieve their communication goals.

    There are two types of chaining: Forward and backward chaining

    Today I am going to show and talk about backward chaining. This technique involves starting with the last step and working backward to the first. This approach can be particularly effective for children with persistent speech sound difficulties where combining consonants into clusters, such as /BL/ or /FR/ or /SHR/ is very difficult.

    Backward chaining allows my student to experience immediate success and build his confidence.

    In my video I show you how I applied backward chaining to the words ‘Shriek’, ‘Shrub’, ‘Shrimp’ etc

    My student struggles with both the /SH/ and the /R/ sounds and we have been working on both sounds for some weeks now. He has mild Childhood Apraxia of Speech and he has difficulties with coordinating his tongue movements, breathing and using his jaw effectively to make words. His sound repertoire has grown a lot since we started working together last year. Today in this session I show you how we pulled both the sound /SH/ together with /REEK/ to make ‘SHRIEK’. I love using the pictures and therapy materials from Adventures in Speech Pathology.

    This is also part of the Complexity approach which I will explain in a separate blog post.

    • Step 1 (not shown in the video): I explain what the word means; I find that when my student understands what a word means he is much better at saying it. It increases his confidence and motivation to say a word that he knows the meaning of. Often this student does not tell me that he does not know what a word means, so I always remind myself to check that out first.
    • Step 2 (not shown in the video): We do a little rhyming game and think about what any one word rhymes with: ‘Shriek’ – ‘meek’, ‘weak’, ‘seek’.
    • Step 3: I show my student that there are two parts to this word /reek/ and the sound /SH/.
    • Step 3: We practise the easier part: /reek/ /reek/ /reek/.
    • Step 4: We add the /SH/ sound and pull it together to make our target word ‘Shriek’.

    /REEK/ /REEK/ /REEK/ + /SH/ = ‘SHRIEK’
    /RUB/ /RUB/ /RUB/ + /SH/ = ‘SHRUB’
    /RUG/ /RUG/ /RUG/ + /SH/ = ‘SHRUG’

    By breaking down the word into smaller, manageable steps, my student can focus on each syllable individually, get that right and then gradually build up to the full word. This approach can help to reduce frustration and increase motivation.

    Forward chaining

    Forward chaining is the same process but in reverse: we start with the front sound or syllable and work forward towards the next/last part of the word:

    /SH/ + /REEK/ = ‘SHRIEK’
    /SH/ + /RUB/ = ‘SHRUB’
    /SH/ + /RUG/ = ‘SHRUG’

    Benefits of chaining

    • Increased motivation: By starting with the last step, my student experiences success, which boosts his motivation to continue trying to say the word and trying other words.
    • Reduced frustration: Breaking down the target behaviour into smaller steps can make the task less overwhelming, reducing frustration and anxiety.
    • Improved confidence: As the little learner masters each of the step, his confidence and self-esteem increases. Again, this leads to increased motivation.
    • Faster learning: By focusing on the final step first, and practising lots of chaining (forward and backward), a student can quickly learn to generalise to other words.

    Backward chaining (and forward chaining) is a really great tool for teaching complex speech sounds and words to children with phonological disorders.

    Watch out for my next blog which is all about the complexity approach in Phonology.

    Do get in touch if your child has a speech sound disorder, I would love to help.

    Any questions or need help with supporting your little one’s language please contact me via my contact form, or you could also check out www.hanen.org for advice and lots of inspiration.

    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

  • One book, dozens of therapy opportunities: What speech therapy really looks like

    ByLondon Speech and Feeding

    As speech and language therapists, some of the most effective moments in therapy don’t come from flashcards, worksheets, or even drilling sounds (though to be fair I do drill quite a lot too! needs must…😊).

    By and large they happen in natural interaction — during shared attention, laughter, storytelling, and connection.

    This short video clip captures that.

    In under two minutes, while simply reading a book together with a three-year-old child, we naturally work on:

    • Speech sounds
    • Vowel production
    • Early phonological patterns
    • Motor planning
    • Signing and total communication
    • Visual cueing
    • Repetition and practice
    • Confidence building
    • And engagement through play

    To many people, it may just look like ‘reading a book’.

    But underneath that moment are years of specialist training, clinical decision-making, preparation, and therapeutic skill.

    Therapy hidden inside play

    One of the most important parts of paediatric speech therapy is knowing how to embed targets into meaningful interaction.

    Books are one of my favourite therapy tools! Why: because as speech therapists we need to prepare for our child and our sessions. And having a book gives me the structure to know beforehand what kind of sounds or words might be coming up. Then I can be prepared for providing extra support for them. As you can see in this clip, I had the sound cards just there because I had anticipated what might be coming up!

    A single story can provide opportunities for:

    • Speech sound practice
    • Vocabulary development
    • Sentence building
    • Turn-taking
    • Symbolic understanding
    • Attention and listening
    • Gesture and signing
    • Motor speech cueing
    • And social communication

    In this clip, I follow my little one’s interests while carefully weaving in her individual therapy targets.

    It looks relaxed and spontaneous — and it is — but it is also highly intentional.

    Catching opportunities in the moment

    One lovely example in the clip is when she says ‘yes’.

    She is now starting to say the final /S/ sound, so I immediately model and draw attention to it using the ‘snake sound’ visual cue, giving her positive feedback that she can now also try using this sound at the start of words.

    My gently shaping the word ‘yeSSSS.’ gives her:

    • Auditory feedback
    • Visual support
    • And an achievable opportunity to try again

    A few seconds later, we naturally practise it again.

    That’s responsive therapy.

    Speech therapists are constantly listening, analysing, adapting, and deciding:

    • When should I model?
    • When should I pause?
    • When should I repeat?
    • When should I let it go?
    • How can I keep confidence high while still targeting speech?

    These decisions happen in seconds.

    Working on speech without ‘stopping the play’

    Another moment in the clip focuses on the word ‘out’, where the vowel sound is one of her speech targets.

    Then we move into practising the word ‘open’, a word she has previously found difficult.

    Within this one word, we can support:

    • Sequencing
    • Motor planning
    • Lip shape
    • Vowel production
    • And speech sound accuracy

    We also briefly practise the /K/ sound — a sound produced at the back of the mouth which can be particularly tricky to produce.

    Instead of explaining it verbally (which is often too abstract for young children), I use:

    • Visual demonstration
    • Exaggerated mouth movements
    • Gesture/sign support
    • And playful modelling

    Children learn through seeing, hearing, doing, and experiencing.

    That is why Speech Therapists use multiple layers of cueing simultaneously.

    Why I use signs alongside speech

    Throughout the clip, I also use signs such as ‘book’ and ‘pig’.

    Using signs does not stop children talking.

    In fact, for many children, signs:

    • Reduce frustration
    • Support understanding
    • Increase participation
    • Reinforce vocabulary
    • And help bridge the gap while speech is developing

    Communication always comes first.

    Speech is only one part of communication.

    When children feel successful communicating, they are far more likely to keep trying.

    The skill behind ‘natural’ therapy

    One thing I often hear from parents is:

    ‘You make it look so easy.’

    That is actually one of the biggest compliments a therapist can receive. (Though we also often feel we need to justify our very existence with these thoughts because we don’t just play/just read but we know it can look like that!) 😊 this is the reason for this blog…

    High-quality paediatric therapy should feel warm, playful, responsive, and natural.

    But underneath that natural interaction is:

    • Clinical knowledge
    • Phonological analysis
    • Motor speech understanding
    • Language development expertise
    • Sensory awareness
    • Relationship-building
    • And careful session planning

    Before this session even began, I already knew:

    • Which speech patterns to target
    • Which words would likely appear in the book
    • What visual cues might help
    • Which signs to model
    • And how to adapt depending on the child’s responses

    That preparation allows therapy to stay child-led without losing therapeutic focus.

    Following the child while leading the therapy

    The best therapy is rarely rigid.

    Children do not learn communication through pressure or endless correction. They learn through interaction.

    That is exactly what this short clip demonstrates.

    One book.
    One conversation.
    Hundreds of tiny therapeutic decisions.

    And all within a joyful moment shared together.

    Because good speech therapy should never feel like hard work for a child.

    It should feel like connection, confidence, success — and fun.

    If you’re concerned about your child’s speech and language or wondering whether they might benefit from speech therapy, feel free to get in touch.

    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
  • ·

    Cued Articulation – using hand gestures to show how a sound is made

    ByLondon Speech and Feeding
    Watch how cued articulation can transform your child’s speech and language skills!

    Cued Articulation involves using specific handshapes and placement cues to guide the speaker’s articulators, such as the tongue, lips, and teeth, to produce accurate sounds. It was originally conceptualised by Jane Passy, a speech-language pathologist. But it is important to know that we can, and often do, also use other speech cues which help our student visualise what they need to do. In other words, we can mix and match our cue pictures depending on what works best with each student.

    In the beginning of my speech therapy practice I would stick religiously to Jane Passy’s method but over the years I have learned and used many different visual hand cues which all have worked with individual students.

    It is important to remember that this is not an exact science, rather than an art! The art is to find the key to each individual student’s understanding and inspire motivation to try out a sound which they find hard to do.

    As an example, the hand signs used by Caroline Bowen’s method, an Australian Speech-Language Pathologist, are quite different to Jane Passy’s signs but they can equally work very well. Caroline Bowen’s visual for the /r/ sound is the ‘rowdy rooster’ — a crazed rooster on a motorbike — and the hand signal is that of revving up the motor bike engine with both hands whilst trying out the /r/ sound! I have a good handful of students who really loved this rooster image and were able to eventually produce a good /r/ using this cue.

    So, it is horses for courses with many things, and visual images and hand cues are no exception!

    Sound picture cards:

    Again, there are a host to choose from and I tend to collect a number of different images for each sound I want to practise with my student. As an example, below are a couple of different examples I use for the sound /p/:

    The Nuffield Programme suggests to use this popper card, which works well with a student who knows these poppers and perhaps has one on their trousers.

    As an alternative, and especially for younger students, I like using the Popper Pig Card – which I also have in my room so I can quickly show how it pops. Or we can have a popping game in between saying the /p/ sound at times. (The popper card is great as I can use the real toy to help with conveying the /p/ sound as it pops.)

    Each card has its own merit and I choose the right card for the individual student.

    How I use cued articulation and the visuals in Speech Therapy

    1. Cueing and practice: I introduce the appropriate card and handshapes for the targeted sounds. We then practise producing the sounds.
    2. Reinforcement and feedback: Positive reinforcement encourages progress and builds confidence.
    3. Fading out the cues: Once my student is able to say the sound more easily, we can gradually fade out the speech cues.

    Benefits and effectiveness

    Using Cued Articulation and Speech Image Cards has been shown to be effective in improving speech production for individuals with various speech and language disorders, including:

    • Articulation disorders: Difficulty producing specific sounds accurately.
    • Apraxia of speech: A motor planning disorder that affects the ability to sequence and coordinate movements involved in speech.
    • Phonology disorders or delays: Confusion and delays in how sounds are organised in categories to convey meaning, errors in sound patterns, for example front sounds are produced at the back, or long sounds are produced as stops.
    • Stuttering: A fluency disorder characterised by interruptions in speech, such as repetitions and prolongations.

    Tips for parents and student speech therapists

    Parents can play a crucial role in supporting the implementation of cued articulation at home and in therapy sessions. Here are some tips:

    • Collaborate with your SLT: Good feedback and communication with the Speech and Language Therapist creates consistency and progress..
    • Practise Regularly: Encourage consistent practice of cued articulation at home to reinforce learning.
    • Use Visual Aids: Use the same visuals that your therapist uses in the speech clinic to help your child at home with recall and practice.

    Feel free to contact me if you need help with your child.

    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

  • Getting down on their level: Why face-to-face play is a speech therapy superpower

    ByLondon Speech and Feeding

    As parents, we spend a massive portion of our days multi-tasking. We are talking to our toddlers while washing dishes, shouting encouraging words from across the living room while folding laundry, or answering their questions from a few feet above them while walking through the supermarket. It is a completely natural dynamic, after all, the adult world happens up here, and their world happens down there.

    But when it comes to actively boosting your child’s speech and language development, one of the simplest, most profound changes you can make costs absolutely nothing and requires no special training.

    It is simply this: Get down on the floor, sit cross-legged, and get face-to-face.

    At London Speech and Feeding I call this physical positioning ‘face to face’. It is also one of the major ‘Hanen Programme’ Strategies. It completely reshapes how your child interacts with you, transforms how they process language, and turns ordinary playtime into an instant communication opportunity.

    Our mouth is the magic: Visual cueing and speech imitation

    When a child is learning to talk, they aren’t just listening to the sounds you make; they are watching how you make them.

    Speech is an incredibly complex motor skill. To say a single word, the brain must coordinate the lips, tongue, teeth, jaw, and vocal cords in a fraction of a second. When you speak to your child from a standing or even a seated chair position while they are on the floor, your mouth is entirely out of their direct line of sight. They miss the visual roadmap of speech.

    When you sit right in front of them at eye level:

    • They see mouth shapes: They can see how your lips round for an /OO/ sound, how your teeth touch your lip for an /F/ sound, or how wide your mouth opens for an /AH/.
    • They read facial expressions: Emotions give context to words. Seeing your eyes widen with excitement or your eyebrows lift in surprise helps them map meaning onto the vocabulary you are using.
    • They mimic naturally: By putting your face directly in your child’s field of vision, you make it infinitely easier for her or him to try and copy your oral movements.

    If you are working on a specific word like ‘pop’ while blowing bubbles or ‘more’ during snack time getting your face just a foot or two away from your child gives her or him the front-row seat she or he needs to learn the mechanics of that word.

    Unlocking joint attention: The foundation of all languages

    Before a child can say their first words, they need to master a milestone called joint attention.

    What is joint attention?

    It is the magic moment when a child looks at an object (like a toy train), looks up at you to share their excitement, and then looks back at the object. It is a three-way loop of shared experience.

    Without joint attention, communication cannot thrive. If a child is entirely hyper-focused on a toy and ignoring your presence, or if you are commenting on a book they aren’t looking at, true communication isn’t happening.

    When you get down on the floor on a play mat, you naturally insert yourself into their bubble. You aren’t a distant narrator anymore; you are a co-player. Being at their level makes it incredibly easy for their eyes to flick from the toy straight to your face. This shared gaze is the exact moment language takes root. It signals to the child, ‘We are experiencing this together, and this thing we are doing has a name.’

    The ‘wait and see’ technique

    Once you are down on the floor, the temptation is often to take over by pointing at everything, asking a million questions like ‘What’s that?’, ‘Is that a blue train?’, or somehow driving the play.

    Instead, the most powerful thing you can do at eye level is to practise the ‘Wait and See’ technique.

    In the video clip you can see this exact dynamic in action. Look at how I am sitting cross-legged on the mat, at eye level with the toddler. Notice how my hands are on the toy container, but my eyes are locked on the child. I am not forcing the interaction; instead, I am waiting.

    Here is how you can use this strategy at home:

    1. Set the stage: Get down on their level with a high-interest toy that requires help (like a wind-up toy, bubbles, or a tight-lidded box with toys inside).
    2. Create anticipation: Hold the object near your face or place your hands on it, but don’t open or activate it right away.
    3. Lean in and wait: Lean slightly forward, open your eyes wide, adopt an expectant facial expression, and completely pause. Count to five or ten in your head. Do not say anything.
    4. Capture the gaze: Wait for the exact moment your child looks up from the toy to meet your eyes, as if to say, ‘Well? Are you going to open it?’
    5. Reward the eye contact: The instant they make eye contact, deliver the language reward! Model a simple, functional word like ‘Open!’, ‘Go!’, or ‘Look!’ as you immediately do the action.

    By pausing and waiting at eye level, you create a ‘communication temptation’. The child learns that looking at you and engaging with your face is the key that unlocks the fun.

    Making it a daily habit

    You don’t need to spend hours a day sitting on the floor to see a difference. Start small by dedicating just 10 to 15 minutes of undivided, face-to-face play time each day. Turn off the television, put your phone in another room, get down on their level, and let them lead the play while you focus on being their visual communication partner.

    Whether you’re opening a little toy briefcase, pushing a plastic train along a track, or stacking blocks, remember: your face is the best toy in the room.

    Are you wondering if your toddler’s speech and language milestones are on track? At London Speech and Feeding I love helping families navigate early communication. Feel free to explore my services page and reach out directly to schedule a consultation.

    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
  • ·

    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

    • Could mouth breathing be affecting your child’s speech, sleep and development?

      ByLondon Speech and Feeding
      Could mouth breathing be affecting your child's speech, sleep and development?

      Understanding Orofacial Myofunctional Disorders (OMDs)

      Many parents contact me at London Speech and Feeding because they are worried about their child’s speech. Perhaps their child is difficult to understand, has a persistent lisp, struggles with feeding, snores at night, or always seems to have their mouth open.

      What many families don’t realise is that these concerns may all be connected.

      Increasingly, research and clinical experience are highlighting the important role of Orofacial Myofunctional Health, the way the muscles of the face, mouth, tongue and airway work together to support breathing, eating, sleeping and communication.

      When these muscles are not functioning optimally, children may develop what are known as Orofacial Myofunctional Disorders (OMDs).

      What Is Orofacial Myofunctional Health?

      Orofacial Myofunctional Health refers to the healthy function and coordination of the:

      • lips
      • tongue
      • jaw
      • cheeks
      • facial muscles
      • airway.

      These structures play a vital role in:

      • breathing
      • swallowing
      • chewing
      • speaking
      • facial growth
      • dental development
      • sleep quality.

      When everything is working well, the lips remain gently closed at rest, breathing occurs through the nose, and the tongue rests against the roof of the mouth.

      This seemingly simple posture has a profound influence on how a child’s face, teeth and airway develop.

      What is an Orofacial Myofunctional Disorder?

      An Orofacial Myofunctional Disorder occurs when there is an abnormal pattern of muscle function involving the face, mouth, tongue or airway.

      Children with OMDs may experience difficulties with:

      • speech
      • feeding
      • swallowing
      • sleep
      • breathing
      • dental development
      • facial growth.

      In many cases, these difficulties are linked to chronic mouth breathing.

      Signs your child may have an Orofacial Myofunctional Disorder

      Breathing and sleep signs

      • mouth open at rest
      • mouth breathing during the day
      • snoring
      • noisy breathing
      • restless sleep
      • frequent waking
      • dark circles under the eyes
      • chronic congestion
      • fatigue despite a full night’s sleep.

      Speech signs

      • lisping
      • unclear speech
      • distorted speech sounds
      • difficulty producing certain sounds
      • persistent articulation difficulties
      • reduced speech intelligibility.

      Feeding and swallowing signs

      • picky eating
      • messy eating
      • food remaining in the cheeks
      • gagging easily
      • difficulty chewing
      • long mealtimes
      • tongue thrust swallowing.

      Facial and dental signs

      • narrow palate
      • crowded teeth
      • open bite
      • overbite
      • underbite
      • long face appearance
      • receding chin
      • poor lip seal.

      If several of these signs sound familiar, a comprehensive assessment may be worthwhile.

      Why does mouth breathing matter?

      Many parents assume mouth breathing is simply a habit.

      In reality, mouth breathing is often a symptom that something is preventing efficient nasal breathing.

      Common causes include:

      • enlarged tonsils
      • enlarged adenoids
      • allergies
      • chronic nasal congestion
      • recurrent infections
      • structural airway differences
      • tongue tie
      • prolonged dummy use
      • thumb sucking
      • poor oral posture.

      When nasal breathing becomes difficult, children naturally begin breathing through their mouths.

      Over time, this can affect how the face, jaws and airway develop.

      What does healthy oral posture look like?

      Healthy oral posture is surprisingly simple:

      • lips
        • gently closed
      • tongue
        • resting against the roof of the mouth
      • teeth
        • slightly apart
      • breathing
        • through the nose.

      This posture helps guide healthy jaw growth, facial development and airway formation.

      Think of the tongue as a natural orthodontic support system. When it rests in the correct position, it helps shape the upper jaw and supports healthy facial growth.

      The consequences of chronic mouth breathing

      1. Speech difficulties

      Children who breathe through their mouths often have altered tongue posture and reduced oral stability.

      This can contribute to:

      • lisping
      • distorted sounds
      • reduced speech clarity
      • difficulty learning new speech sounds.

      2. Feeding and swallowing difficulties

      A low tongue posture may affect:

      • chewing efficiency
      • swallowing patterns
      • food management
      • oral motor coordination.

      Many children develop a tongue thrust swallow, where the tongue pushes forward instead of moving efficiently during swallowing.

      3. Poor sleep quality

      Mouth breathing can contribute to:

      • snoring
      • restless sleep
      • frequent waking
      • daytime fatigue
      • reduced concentration.

      Poor sleep can have a significant impact on learning, behaviour and emotional regulation.

      4. Changes to facial growth

      Over time, chronic mouth breathing may influence:

      • jaw development
      • facial proportions
      • dental alignment
      • airway size.

      This can result in:

      • narrow palates
      • crowded teeth
      • long facial appearance
      • increased orthodontic needs.

      5. Oral health concerns

      The nose acts as a natural filter and humidifier.

      When children breathe through their mouths:

      • The mouth becomes dry.
      • Saliva protection is reduced.
      • Risk of tooth decay increases.
      • Gum health may be affected.

      Why this matters for speech therapy

      Speech does not develop in isolation.

      The tongue, lips, jaw and airway work together to support clear communication.

      At London Speech and Feeding, we look beyond speech sounds alone.

      A child who presents with:

      • persistent speech difficulties
      • lisping
      • feeding challenges
      • open mouth posture
      • snoring
      • poor sleep

      may benefit from an assessment that explores underlying orofacial myofunctional factors.

      Addressing these foundations can often support more effective progress in speech and feeding therapy.

      How London Speech and Feeding can help

      A comprehensive assessment may include observation of:

      • breathing patterns
      • lip posture
      • tongue posture
      • swallowing function
      • feeding skills
      • speech sound development
      • sleep concerns
      • oral structures.

      Where appropriate, recommendations may include:

      • orofacial myofunctional therapy
      • speech therapy
      • feeding therapy
      • home programmes
      • ENT referral
      • orthodontic referral
      • collaborative multidisciplinary support.

      The good news

      Orofacial Myofunctional Disorders are often highly treatable when identified early.

      Supporting healthy breathing, tongue posture and oral muscle function can positively influence:

      If your child regularly breathes through their mouth, snores, struggles with speech clarity or has feeding difficulties, a specialist assessment may help identify the underlying cause.

      • speech clarity
      • feeding skills
      • sleep quality
      • facial growth
      • dental development
      • overall wellbeing.

      At London Speech and Feeding, we are passionate about looking beyond symptoms and understanding the whole child. Contact me!

      Sometimes the key to clearer speech starts with a simple question:

      ‘Is my child breathing through their nose?’

      Sonja McGeachie

      Highly Specialist Speech and Language Therapist

      Owner of The London Speech and Feeding Practice.

      Frequently Asked Questions

      Can mouth breathing cause speech problems?

      Yes. Mouth breathing can alter tongue posture, lip strength and oral stability, which may contribute to articulation difficulties and lisps.

      Should I be worried if my child snores?

      Regular snoring is not considered normal in children and may indicate airway obstruction or sleep-disordered breathing.

      Can enlarged tonsils affect speech?

      Yes. Enlarged tonsils may affect resonance, tongue positioning, swallowing and breathing patterns.

      What age can children be assessed?

      Children of all ages can be assessed if parents have concerns about speech, feeding, breathing or oral development.

      What is Orofacial Myofunctional Therapy?

      Orofacial Myofunctional Therapy focuses on improving breathing patterns, tongue posture, lip seal and oral muscle function to support overall health and development.

      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