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

ByLondon Speech and Feeding
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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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  • Submucous cleft palate: What is it and how does it impact on speech?

    ByLondon Speech and Feeding
    Submucous cleft palate: What is it and how does it impact on speech?

    What exactly is a submucous cleft palate?

    A submucous cleft palate (SMCP) is much less obvious than its counterparts, cleft of lip and/or palate, and can profoundly impact a child’s speech development. It leads to often extreme hyper nasal speech and difficulty with producing many sounds (/K/ /G/ /T/ /D/ /P/ /B/ /S/ /Z/ /F/ /V/).

    In short, the muscles and bone of the soft palate, and sometimes the hard palate, do not fuse completely during foetal development and the mucous membrane that lines the roof of the mouth remains intact, effectively camouflaging the underlying muscular and bony deficit.

    So, while the surface of the palate appears normal, the essential muscle and functions responsible for sealing off the nasal cavity from the oral cavity during speech are compromised. This cleft (or lack of muscle) can be seen as a bluish midline discoloration of the soft palate, often a bifid (split) uvula, and at times a notch in the posterior border of the hard palate can be felt upon palpation. However, these signs aren’t always present or easily discernible, contributing to the difficulty arriving at a diagnosis.

    Diagnosing a submucous cleft palate is often akin to searching for a needle in a haystack, especially for the untrained eye. Unlike overt clefts that are visually apparent at birth, an SMCP can go undiagnosed for years, sometimes well into childhood or even adolescence. Paediatricians and even ENT surgeons have been known to miss it during routine checks due to the intact mucosal lining. Parents might notice their child’s speech sounds ‘different’ or ‘nasal’ but struggle to pinpoint the cause. Children might undergo extensive speech therapy without a proper diagnosis, as the underlying structural issue continues to hinder progress.

    My experience as a speech therapist in private practice:

    Over my years of practice, I have encountered several children presenting with persistent hyper-nasal speech and significant difficulties producing plosive and fricative sounds.

    It has been incredibly rewarding, though at times challenging, to successfully diagnose SMCP in a number of these children. My approach often involves:

    • a meticulous oral motor examination,
    • careful listening for the specific qualities of hypernasality,
    • and a deep understanding of the physiological requirements for clear speech sound production.

    When I suspect an SMCP, I refer these children to Great Ormond Street Hospital where a fantastic multidisciplinary team, typically including ENT surgeons and a specialist speech-language therapist can conduct more definitive assessments. These assessments often involve instrumental analyses such as videofluoroscopy or nasoendoscopy, which provide objective measures of velopharyngeal function and visual confirmation of the anatomical deficit.

    The path to resolution: surgery, therapy, and successful outcomes

    Surgery

    The journey for these children, once diagnosed, often involves surgical intervention. It’s not uncommon for children with SMCP to undergo multiple operations to achieve optimal velopharyngeal closure. These procedures aim to reconstruct or augment the velopharyngeal mechanism, enabling it to effectively separate the oral and nasal cavities during speech. The specific surgical approach depends on the individual child’s anatomy and the severity of the velopharyngeal insufficiency. It’s a testament to the skill of these specialised surgeons that such intricate repairs can be performed with remarkable success.

    Speech therapy

    Following surgery these children embark on the crucial phase of speech therapy. While surgery addresses the structural problem, speech therapy helps a child learn to utilise their newly improved anatomy. It involves intensive work on developing oral airflow, establishing correct articulatory placement, and reducing learned compensatory strategies that have developed due to the original structural deficit. It is immensely gratifying to witness the transformation. Children who once struggled to produce basic sounds, whose speech was difficult to understand, gradually develop clear speech.

    Next steps?

    If you’re a parent concerned about your child’s speech and feeding, you’re not alone. The journey can feel confusing, but professional guidance can make all the difference. Never hesitate to have a second opinion when you have that niggling feeling that there is something that has not yet been explored. At London Speech and Feeding I specialise in being thorough and thinking outside the box.

    I am here to provide the support you need. Reach out to schedule a consultation and take the first step towards helping your child communicate and thrive.

    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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    Support your child’s communication using books: OI FROG

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    Sonja's top recommendation: Oi Frog, written by Kes Gray and Jim Field. An exciting book for children to enhance their speech, language and communication.
    Oi Frog by Kes Gray and Jim Field

    Book corner with Oi Frog! by Kes Gray and Jim Field.

    Books are an engaging way to support your child’s communication development. Even if your little one dislikes reading in the traditional sense. They will become immersed in this adventure, without realising they are taking in language and developing vital communication skills. This is one of my favourite series for children.

    Increase fun and interaction

    These books are made for fun and excitement! It may seem silly putting on different voices for different characters, but this is one way in which you can engage your child. Why not try to use different intonation patterns (e.g., you may use a deep voice for the dog, and a higher pitch for the cat)? Make your story interactive: you could ‘rawww’ like a lion and see who can make the loudest noise. Make noises to encourage interaction (e.g., when scratching his chin, make a squeaky sound!). You could also relate the experience back to your child (e.g., ‘can you scratch your chin?’).

    Time to talk

    Talk about what you can see on the front cover (e.g., There’s a frog on a log, how funny!) You could also ask your child to choose the rhyming words on a page in the book. Can your child tell you what rhymes with certain words (e.g., can you guess what a parrot sits on?)? Make use of every page. You could comment on your favourite frog and see if your child can talk about their favourite. You can support them by giving them an example (“my favourite frog is the one swimming backwards because he looks funny”). Then you could use this scaffold to support their answer. Your favourite is [________________] because [_________________]

    If your child is reluctant to use language, the use of commenting can take the pressure of them (“look at all those frogs” or “he’s climbing up the stool”) is a powerful way in which you (as parents) can take the pressure off your child. A top tip I like to give is to make sure you pause regularly, which creates opportunities for your child to use language.

    This book uses a subject-verb-object sentence structure (e.g., ‘hares sit on chairs’) which allows your child to hear a good model of a sentence. You could also talk about things in the book that belong in a certain category (e.g., animals, food) or begin with a specific sound. See if your child will name any more.

    Reap the reward of repetitive language

    Oi Frog uses repetitive rhyming language and puts emphasis on these words. This is important because the more your child hears a word, the more likely they are to remember, understand and use it in the correct context.

    Emotions matter

    Talk about how the animals feel and why they may feel this emotion (e.g., the cat’s feeling annoyed because…, Lions sit on irons, how does the lion feel?). Reasons can be difficult for children with communication difficulties. Support them by giving an example or by giving them an option (e.g., “does the lion feel happy or sad? I think the lion feels sad because he’s burnt his bottom on the iron! It’s too hot!”)

    A collection of books
    OI Books

    Why not read similar stories? I highly recommend OI CAT, OI DOG and OI DUCK-BILLED PLATYPUS.

    Need support for your child’s communication? Contact me here.

    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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    Discover more about Verbal Dyspraxia

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    What is Verbal Dyspraxia?

    Apraxia or dyspraxia is a difficulty in motor planning, which sometimes can be seen in both gross and fine motor skills, as well as speech. Gross motor refers to difficulties in coordinating the whole body (e.g., bumping into things frequently, often falling over hurting themselves or others through being “clumsy” or unsteady). Fine motor movements refer to smaller, more precise movements (e.g., difficulties doing anything with their hands such as holding a spoon or pen).

    Verbal dyspraxia

    In Dyspraxia of Speech, instead of seeing a coordinated smooth way of talking, we see the articulators (tongue, lips, cheeks) and voice coordinating very smoothly. The voice can be very quiet or very loud. Muscle tone can be weaker at times. Speech sounds are very unintelligible, with a flat voice that can sound forced. It may be that the timings of verbalisation appear random and that children can say a certain word once and never again. This is often what we hear from parents.

    It is interesting to note that many of our autistic clients are either non-speaking or are reluctant speakers. Sometimes they say a word once and then never again. Others say lots of words but the words are very hard to make out. Did you know that about 40% of autistic people have verbal dyspraxia? (Richard, 1997). Because the problem is one of motor planning, not of automatic motor execution, once a plan has become automatic, it is easier to get back to it and this is why we often see repetitive patterns that can be called ‘stims’ (Marge Blanc, 2004).

    How can Speech and Language Therapy help?

    Children with verbal dyspraxia can make great progress!

    We provide frequent and appropriate speech movement opportunities and with time and the right support, children will move forward and begin to speak more fluently and with greater intelligibility. It is important to know this can take time.

    We provide Oral Motor Therapy using a variety of approaches to practise breathing, vocalising on the outbreath, and sequencing our speech movements.

    We design carefully tailored programmes focusing on words that have a lot of power (e.g., NO, GO, UP, IN, OUT, LET’S GO, STOP).

    We offer shared enjoyment, and laughter. This helps a child find their voice. Other ways of finding our voices include singing or humming, or even yelling/shouting!

    The most difficult phase of verbal dyspraxia is initiation, that is to start talking, to start producing a word. Frequent “automatic” repetition supports children with initiation because it removes the element of “thinking to start”. I often ask a child to repeat a word 5-10 times (with rewards at the end. A little game works well). You can see that with repetition the act of initiating is taken out of the equation as you are “on a roll “as it were.

    Once a child starts to find their voice, we will be able to hear them talk lot… And if we give them credit and presume that what they are saying has meaning, we will find in time that their words become clearer and more intelligible. If we listen carefully, we can detect real words and phrases.

    For more tips and support, please get in touch!

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

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    Understanding Angelman Syndrome: A guide for parents

    ByLondon Speech and Feeding

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

    What are the key characteristics of Angelman Syndrome?

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

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

    The role of Speech and Language Therapy

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

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

    The importance of a multidisciplinary approach

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

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

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

    Conclusion

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

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

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

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

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

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    Let’s live and breathe AAC

    ByLondon Speech and Feeding

    We all have the right and want to express thoughts, feelings, and needs. For non-speaking or minimally speaking children, finding an avenue to communicate effectively can be a challenging journey. Parents are often at a loss as to where to start. Sometimes a little bit of Makaton signing has been used here and there but we mostly find that gradually signing fades as parents feel that it just doesn’t seem to get copied and used by the children.

    They live and breathe their system

    This is where we need to pick up the pieces and start again: because all successful families where children start using their boards or their electronic AAC (Augmentative and Alternative Communication) systems do this one thing: THEY LIVE AND BREATHE THEIR SYSTEM.

    • They have boards in every single room of the house;
    • They have a board in the car, attached to the side of car door so their child can point to it as they need to;
    • They have a smaller board in their handbag/rucksack when out and about;
    • They have a board for shopping and attach it to the shopping trolley;
    • They are never ever without their board.

    Because they realise that a child should never be without their mouths to speak, should never be without a means to speak. They use their own board to model and the child has always access to their board to model back or to just look.

    This is where success begins

    Success begins at consistent and joyful use of the board/AAC system throughout the entire day. If we think about it, doesn’t it make sense? Of course, it does! We talk to our child for the first two years of their life continuously wherever we are and our child is continuously encouraged to use their mouths for talking in all situations.

    Same goes for Signing: Makaton or any other sign system is a very powerful means to aid communication and I certainly advocate and use it in practice. Though much like words, signs are very elusive and temporary—as soon as the sign has been made it is gone and no longer present. Same with words of course. This can be difficult for people who need longer to process information.

    The beauty of symbols or photographs is that they are permanent: they don’t vanish, they stay and with the core board they stay in the same place! This is very reassuring. We can learn where a symbol is and we can be assured that it will still be there the next time we look at the board.

    AAC core board

    Here is a picture of a core board:

    AAC board

    You can download this and other boards for free on the Saltillo Word Power website.

    It has 48 cells and we can see the most frequently used core words on here, words that we use 80% of the day when talking with our non-speaking/minimally speaking children, younger children and children with cognitive delay. We keep our sentences short and we say phrases pertaining to their daily lives;

    • Let’s GET your toy
    • PUT it here, PUT it away, PUT it IN
    • Let’s READ a book
    • UP you get
    • WANT some MORE?
    • That’s GOOD isn’t it?
    • Let’s OPEN the box and LOOK

    And so on… All these phrases can be aided with the above board. Your child will learn OVER TIME and OVER CONTINUOUS USE where GET/PUT/MORE/WANT/IN—where these symbols are. For children who are slow to process this is so helpful, to have a visual representation of what has just been said. It aids understanding in the first place. Gradually as a child starts to copy they will point to powerful symbols themselves and if they want to speak they can also speak of course:

    A child might point to WANT + MORE and then say with their mouths: BANANA!

    Board examples

    Here are some other boards I have made specifically for daily situations and preferences of some of my students. Here is one for toileting:

    AAC toileting board

    And another one:

    These boards incorporate high-frequency and versatile words, enabling us to make little sentences.

    Building Language and Literacy Skills

    AAC Core Boards are not just tools for immediate communication. They also play a pivotal role in language and literacy development. By using these boards, non-speaking children engage with words and symbols, reinforcing their understanding of language structure and grammar.

    Over time they naturally absorb language patterns, laying the foundation for improved literacy skills.

    Customisation for Individual Needs

    Every non-speaking child is unique, and their communication needs can vary significantly. AAC Core Boards are designed with this diversity in mind. The boards can be adapted to include specific vocabulary relevant to the child’s daily life, interests, and activities. This personalisation ensures that the AAC Core Board is a true reflection of the child’s personality and needs, making communication more engaging and effective.

    Collaboration between AAC Core Boards and Speech Therapy

    While AAC Core Boards are an incredible tool, they are only used effectively by the non-speaking child when the board is used BY ALL COMMUNICATION PARTNERS around the child.

    Again, I know I am being repetitive here, but the board needs to be used and modelled by the adults constantly in the first place and for a period of time before we can expect our children to take an interest and use the boards themselves. Think how long it typically takes for a child to learn their first word: around a year! During that time the adults talk constantly to their child without hesitation or expectation! The same goes for introducing this new way of communicating.

    Collaborating with your child’s speech-language therapist (SLT) ensures that your child receives the right guidance in using the AAC system. SLTs can assess your child’s communication abilities, recommend appropriate boards and provide guidance on how to best implement them.

    Conclusion

    For non-speaking children, AAC Core Boards are bridges to their world.

    These boards foster language development, social interaction, and personal expression. AAC Core Boards offer a beacon of hope, helping non-speaking children break through communication barriers and thrive in a world that is waiting to hear their voices. Boards are simple for anyone to use and understand. Have a go! You will be surprised how lovely it is to use a board with ease and once your child sees you do this, you have a chance for your child to start copying you…and express something! HOW ABOUT THAT! I look forward to hearing your stories!

    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

  • What is Speech and Language Therapy (SLT) and what does a Speech Therapist do?

    ByLondon Speech and Feeding
    Kids Speech Therapist London
    What is Speech and Language Therapy (SLT) and what does a Speech Therapist do?

    Speech and language therapists provide treatment, support and care for children and adults who have difficulties with communication, eating, drinking and swallowing. We help children and adults who have problems speaking and communicating.

    How to find the perfect therapist for my child/client:

    There are a huge number of speech and language difficulties, or feeding and swallowing problems that we can help with and the first thing to think about is what age group the person is you are seeking help for. Most SLT’s specialise in a range of disorders and treatments and they often treat specific age ranges. This could be, for instance, very young children up to 3 years, or school aged children, adolescents or just adults. Once you have narrowed it down to age and general area of difficulty you can then go and seek your perfect SLT match.

    Generally it is my view that SLT’s with a narrow area of specialist interest are most likely to help you better if the problem you or your child/adult is having is significant and/or profound. For example, if your child has a very severe stutter/stammer but is otherwise developing fine and has good skills all round, then I would recommend to look for an SLT who only specialises in stammering/stuttering, or has only a small range of other specialist areas related to stammering , such as speech and language delay.

    The reason is that it is a tall order for any professional to stay up to date with latest research, latest clinical developments and training for more than, say, five distinct areas of interest.

    However, a more generalist Speech therapist who has lots of experience in many different areas could be a very good option for your child or adult who has more general speech and language delay in a number of areas, perhaps a global delay or a syndrome which means that their learning is delayed in general. It also means that your child might benefit from a Generalist SLT because they have many more tools in their SLT bag and your child might need a variety of approaches for several areas.

    A good place to start is www.asltip.com which is the Association for Independent Speech and Language Therapists in the UK. Any SLT registered with ASLTIP will also be registered with the HCPC (Health Care Professionals Council), as well as RCSLT (Royal College of Speech and Language Therapists). These two important UK professional regulatory bodies ensure all its members are fully qualified, and are fully up to date with latest developments within their areas of work.

    Here you can enter your post code and look for a therapist near you and you can look for specific problems such as stammering for example and narrow down your search. Most therapists have a website which you can then access too. I would recommend you speak to a few therapists on your list and then go with the person you had the best rapport with. You and the therapist will be spending a lot of time together and you will need to feel that you trust them and that you can relax into the process.

    How I can help you:

    I have 3 main areas of specialism:

    Parent Child Interaction Coaching

    Parent Child Interaction Coaching

    This is an amazing way to help children with the following difficulties:

    • Social Communication Difficulties, Autistic Spectrum Disorders and
    • Speech and Language Delay – for children under the age of 4 years old, this is my preferred way of working because it is so very effective and proven to work. If your child is not developing words or not interacting, has reduced attention and listening and you feel is not progressing or, in fact even regressing, then this way of working is the best. For anyone wanting to read a bit more about the efficacy of this method, below are some research articles. You may also like to check out www.hanen.org which is the mainstay of my work and method when it comes to Parent-Interaction Coaching. You can also look at my latest blog, entitled: Tele-therapy, does it work?

    In brief, what’s so great about Parent Coaching is that it empowers you the parent to help your child in daily life! This is where speech, language and social communication develop typically, in a naturalistic way and environment. Simple steps and strategies are discussed and demonstrated every week and you are encouraged to use these strategies with your child in daily routines: getting dressed, having breakfast, on the school run, whilst out in the park or shopping or simply playing at home or having dinner or bath time. Whatever your family routine happens to be, every strategy I teach you will help create a responsive communication environment; generally, if your child is able to develop speech then they will do so in direct response to your changed interaction style.

    Speech Sound Disorders, Verbal Dyspraxia, Phonology and Articulation

    Speech Sound Disorders, Verbal Dyspraxia, Phonology and Articulation

    I love working with children of all ages on developing their speech sounds. Whether your child has a lisp, or a couple of tricky sounds they simply cannot produce quite right, or perhaps your child is really unintelligible because he/she is having lots of different sound errors, making it really hard to understand them. I typically work on getting “most bang for your buck” , meaning I address the sounds that cause the most problems and, therefore, when they are fixed your child/person’s speech becomes that much clearer fairly quickly.

    Feeding and Swallowing Difficulties

    Feeding and Swallowing Difficulties

    Having worked for over 20 years in NHS Child Development Clinics and Special Needs Schools I trained and worked with feeding and swallowing difficulties early on in my SLT career. I later trained as a Lactation Consultant and so I am well placed helping and support all types of Infant feeding, both breast or bottle, as well as toddler weaning. I aim to ensure that your little one swallows the right kind of foods and drinks for their abilities. I am experienced in managing and supporting children with physical needs and mobility problems, Cerebral Palsy, Down Syndrome or any other type of syndrome or presentation.

    What does a speech therapy session look like?

    All sessions differ slightly depending on the age of the child and the nature of the difficulties.

    However, mostly our sessions look like FUN! After arrival and washing hands we tend to start off with the tricky work straight away whilst our child still has energy and the will to engage. So, for speech work we will focus on the target sounds first: this could be sitting at a table doing work sheets together, playing games using the target sound and really any type of activity that gives us around 70-100 repeats of the target pattern. For example, a child who is working towards saying a ‘K’ at the end of the word I will try and get around 100 productions of words like: pack/sack/lick/ pick/bike/lake and so on.

    Then we often play a fun game where I might try for a ‘rhyming’ activity or other sound awareness type activities, for perhaps 10 minutes and within that time I aim to trial the next sound pattern we need to improve on; I will test which sound your child can do with help from me. During he last 10 minutes we might look at a book, again listening to and producing whatever sound we are working on. If I did not get 100 sounds earlier on in the session I will try and practice them now as part of the story. In total I aim to have about 40-45 minutes of activities, all aimed at the target sound we are working on.

    What does a Coaching session look like?

    During a Parent Coaching Session we meet online for about an hour and we discuss how the week has been for you trying out the strategies. Typically parents start off recalling what went well, what progress was made and what had been more tricky. We work through it all, and then follow on to the next strategies: I will show you examples and demonstrations of each strategy and I will get you to think about how you can use this with your child and in what situation you might use it. I will explain what we are doing and what the purpose is. You might want to write down what you are going to work on for the week. Over the course of about sessions we can cover all the major strategies that are proven to help kickstart spoken language and/or help your child to connect more with you. Through that connection spoken words most often develop.

    Research Papers on the Efficacy of Parent Child Interaction Coaching

    Research Papers on the Efficacy of Parent Child Interaction Coaching

    • The It Takes Two to Talk Program has been shown to be effective in changing how parents interact with their children, and that children’s communication and language skills improve as a result.
    • Baumwell, L.B., Tamis-LeMonda, C.S. & Bornstein, M.H. (1997). Maternal verbal sensitivity and child language comprehension. Infant Behavior and Development, 20(2), 247-258.
    • Beckwith, L. & Cohen, S.E. (1989). Maternal responsiveness with preterm infants and later competency. In M.H. Bornstein (Ed.). Maternal responsiveness: Characteristics and consequences: New directions for child development (pp. 75-87). San Francisco: Jossey Bass.
    • Bronfenbrenner, U. (1974). Is early intervention effective? (Publication No. (CDH) 74-25). Washington, DC: Department of Health, Education, and Welfare, Office of Child Development.
    • Girolametto, L. (1988). Improving the social-conversational skills of developmentally delayed children: An intervention study. Journal of Speech and Hearing Disorders, 53, 156-167.

    Sonja has been a real help for my 5 year old daughter. Due to her support, my daughter is now able to clearly and correctly enunciate ‘th’ ‘f’ and ’s’. She was also helpful in making positional changes to her seating to help her concentrate better and kept her engaged throughout all the lessons which is a feat in itself on zoom!

    Helen, Mother of Catherine Age 5.

    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.