Tongue-Tie: A complex issue requiring careful assessment

ByLondon Speech and Feeding September 27, 2024September 29, 2024

Tongue-tie, or ankyloglossia, is a condition where the lingual frenulum, the thin piece of tissue that connects the underside of the tongue to the floor of the mouth, is too short or tight. Tongue-tie is quite common in babies and is often not detected after birth. Tongue-tie can lead to a difficult start with breast feeding as it makes it very difficult for the baby to latch effectively.

In my clinical experience as a feeding therapist, I have seen many babies who were not able to latch well due to the frenulum being tight. In many cases an experienced feeding speech therapist/lactation consultant can really make a difference and help a new mum to latch the baby even though the tongue is tethered to the floor of the baby’s mouth. In some cases the frenulum can be divided and once this has been done, in some cases, feeding improves immediately or soon after the division. But this is not always the case. I have seen several babies who have had as many as four tongue-tie divisions and feeding was still difficult.

It is important to say that while tongue-tie can sometimes impact speech and feeding, it’s important to note that it’s not always the root cause of these difficulties. In recent years, there has been a surge of interest in tongue-tie division surgeries, with some cases being unnecessary. It’s crucial to understand the complexities of tongue-tie and the role of speech therapy in addressing related challenges.

The impact of tongue-tie on speech and feeding

When tongue-tie is severe, it can interfere with the tongue’s ability to move freely, affecting speech production and swallowing. Some common speech and feeding difficulties associated with tongue-tie include:

Feeding difficulties: Challenges with sucking, chewing, and swallowing.
Drooling: Excessive drooling due to difficulty controlling saliva.
Speech problems: Difficulty producing certain sounds, such as /l/, /r/, /t/, /s/ and /d/.

The importance of comprehensive assessment

Before considering any surgical intervention for tongue-tie, it’s essential to undergo a thorough evaluation by a qualified speech-language therapist (SLT). An SLT can assess the severity of the tongue-tie, its impact on speech and feeding, and determine if surgery is necessary.

Functional assessment: The SLT will assess the tongue’s range of motion, its impact on speech sounds, and the child’s overall oral motor skills.
Feeding evaluation: The SLT will observe the child’s feeding patterns and identify any difficulties related to tongue-tie.
Differential diagnosis: The SLT will rule out other potential causes of speech and feeding difficulties, such as apraxia of speech, dysarthria, or sensory processing disorders.

The role of speech therapy

Even in cases where tongue-tie is present, speech therapy can often be highly effective in addressing speech and feeding difficulties. Here’s how speech therapy can help:

Articulation therapy: Targeting specific speech sounds that may be affected by tongue-tie.
Childhood Apraxia of Speech (CAS): if the diagnosis by the SLT has shown that in fact the child has motor planning difficulties then there are very specific and effective treatment programmes that help with this and can make a real difference over time.
Feeding therapy: Strategies to improve swallowing, chewing, and oral-motor skills.
Sensory integration: Addressing underlying sensory processing issues that may contribute to feeding difficulties.

London Speech and Feeding Case Study: The importance of comprehensive assessment

One of my clients was initially diagnosed with tongue-tie and recommended for surgery at the age of eight years old. His speech had been perceived by parents and teachers as ‘mumbled and unclear’.

However, after a thorough evaluation, I was able to determine that the child’s primary issue was apraxia of speech, a neurological disorder that affects motor planning for speech. Parents decided to wait with surgery and trust my judgment and we proceeded with weekly intensive speech therapy to address motor planning difficulties around tricky sounds and words. I am delighted to say that the child’s speech has improved significantly, demonstrating the importance of comprehensive assessment and individualised treatment. He is no longer seen as a candidate for an operation, which would have been traumatic for him at his age and, as it turned out, entirely unnecessary.

Below is a short video clip of my working on the /l/ sound with this child.

Using the Gingo Puppet from GingoTalk

Conclusion

Tongue-tie is a complex issue that requires careful evaluation and individualised treatment. While surgery may certainly be necessary in some cases, it’s essential to consider the potential benefits and risks. Speech therapy can be a highly effective approach for addressing speech and feeding difficulties associated with tongue-tie, even in cases where surgery is still required. By working with a qualified speech-language therapist, parents can ensure that their child receives the best possible care and support.

Please feel free to contact me.

Sonja McGeachie

Early Intervention Speech and Language Therapist

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

The London Speech and Feeding Practice

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

Autism Therapy · Neurodiversity · Speech and Language Therapy

The power of imitation in supporting children with autism
ByLondon Speech and Feeding May 19, 2025May 16, 2025
Image by Freepik

Imitation, the act of mirroring someone else’s actions, gestures, sounds, or words, is a fundamental skill that plays a crucial role in human development. It’s how babies learn to wave ‘bye-bye’, how toddlers pick up new words, and how children acquire social skills. But for children with autism imitation can be a significant challenge and understanding why it’s important and how to foster it becomes a key focus for parents, educators, and speech and language therapists.

Why is imitation important?

Imitation is a building block for a wide range of developmental skills:
- Social interaction: Imitation is the foundation of social reciprocity. When a child imitates, he or she is engaging in a shared experience, connecting with another person, and learning to take turns in social exchanges.
- Communication development: Imitation is closely linked to language acquisition. Children often imitate sounds and words before they can produce them independently. Imitation also helps them understand the meaning of gestures and facial expressions, which are vital for nonverbal communication.
- Cognitive development: Imitation plays a role in problem-solving, learning new skills, and understanding cause and effect. By imitating actions, children explore their environment and learn how things work.
- Emotional development: Imitation helps children understand and share emotions. When a child imitates a smile, he or she may begin to understand the feeling of happiness.
Imitation challenges in autism

Many children with autism face challenges with imitation, which can affect their development in these key areas. These challenges can manifest in different ways:
- Difficulty imitating motor actions: Children with autism may struggle to imitate simple motor movements, such as clapping hands, waving, or playing ‘peek-a-boo’.
- Limited vocal imitation: Imitating sounds, words, and phrases can be difficult for some children with autism, which can impact their speech development.
- Challenges with social imitation: Imitating social cues, such as facial expressions, gestures, and body language, can be particularly challenging for children with autism, affecting their ability to engage in social interactions.
Why do children with autism struggle with imitation?

The exact reasons for imitation difficulties in autism are complex and not fully understood. However, several factors may contribute:
- Neurological differences: Research suggests that differences in brain structure and function, particularly in areas involved in social perception and motor control, may play a role.
- Sensory processing differences: Some children with autism may have sensory differences that make it difficult to attend to and process the movements or sounds they are expected to imitate.
- Attention and motivation: Challenges with attention, focus, and social motivation can also affect a child’s ability to engage in imitation.
How to foster imitation in children with autism

Fortunately, imitation skills can be developed and improved through targeted interventions and strategies. Here are some approaches that I use in my practice as a speech and language therapist working with autistic children and their families:
- Create a playful and engaging environment: Children are more likely to imitate when they are having fun and feel motivated. I use toys, games, and activities that the child enjoys.
- Start with simple imitation: Begin by imitating simple motor movements that the child is already capable of and gradually introduce more complex actions.
- Imitate the child first: As the Hanen Program emphasises, imitating the child’s actions, sounds, and words can encourage him or her to interact and communicate more.
- Use visual supports: Visual aids, such as pictures, photos or videos, can help children with autism understand what is expected of them and make imitation easier.
- Break down complex actions: Divide complex actions into smaller, more manageable steps. For example, to teach a child to brush their teeth, break it down into steps like ‘pick up toothbrush’, ‘put toothpaste on brush’, and ‘move brush on teeth’.
- Reinforce imitation attempts: Provide positive reinforcement, such as praise, smiles, or preferred activities, when the child attempts to imitate, even if the imitation is not perfect.
- Integrate imitation into daily routines: Incorporate imitation into everyday activities, such as imitating sounds during playtime, imitating gestures during songs, or imitating actions during self-care routines.
The role of speech therapy

Speech-language therapists play a crucial role in helping children with autism develop imitation skills, particularly in the areas of vocal and verbal imitation. As part of my therapeutic role, I offer the following:
- Assessing a child’s imitation abilities.
- Developing individualised therapy plans to target specific imitation goals.
- Using a variety of techniques to encourage vocal imitation.
- Working with parents and caregivers to provide strategies and support for promoting imitation at home.
Summary

Imitation is a fundamental skill that is essential for social, communication, cognitive, and emotional development. While children with autism may face challenges with imitation, it is a skill that can be developed and improved with targeted interventions and support. By understanding the importance of imitation and using effective strategies to foster it, parents, educators, and therapists can make a significant difference in the lives of children with autism, helping them to connect with others, learn new skills, and reach their full potential.

Do get in touch via my contact form if you have any question or need help with supporting your little one.

Sonja McGeachie

Highly Specialist Speech and Language Therapist

Owner of 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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Speech and Language Therapy

One activity, endless opportunities for speech and language therapy targets
ByLondon Speech and Feeding May 19, 2026May 18, 2026
Communication does not happen in neat little boxes. In Speech and Language Therapy we often use one great activity to target multiple areas of speech and or language development all at once.

Children are trying to:
- understand language
- build sentences
- organise their thoughts
- pronounce sounds
- remember words
- use grammar
- follow social interaction
- communicate meaning…
all at the same time.

This short therapy clip is a little example of that.

Within one playful interaction, we naturally work on:
- grammar
- sentence expansion
- pronouns
- speech sound errors
- modelling
- visual cueing
- turn-taking
- confidence in communication
And, importantly, the child remains engaged, relaxed, and successful throughout.

Using language activities to refine speech sound targets

We all learn language through:
- shared attention
- play
- repetition
- connection
- modelling
- responsive interaction
As a Speech and Language Therapist I am constantly thinking and considering how to bring in all the targets a child is working on. The reason for that is that often we do not have a full therapy hour to work leisurely and calmly on various targets! Many children have short attention focus and ‘go off the boil’ quickly and often suddenly. Therefore, I always feel a sense of ‘make hay whilst the sun shines’ and pack it all in whilst the going is good. So then we can afford five minutes of trampolining in between activities to help the child regulate themselves without losing valuable speech therapy opportunities or time.
- How can I expand this sentence?
- How can I model better grammar?
- Can I gently shape the pronunciation here?
- Should I recast that phrase?
- Is this the right moment to pause and encourage a longer utterance?
- How can I keep communication flowing while still targeting goals?
These decisions happen continuously during therapy.

Building longer sentences naturally

In this clip, one of the key areas we are targeting is sentence expansion through Colourful Semantics, which is a particularly useful and researched approach, developed by UK Speech and Language Therapist Alison Bryan in 1997 to support children with speech and language difficulties.

Colourful Semantics is a visual, colour-coded therapy approach that helps children break down, understand, and construct sentences by assigning specific colours to thematic roles (e.g., Who, What Doing, What).

Many children with language delay use reduced language for example: they might say:
- ‘dog’ instead of ‘the dog is running fast’
- ‘eatin a dinner’ instead of we are eating our dinner
- ‘baby shhh’ instead of ‘the baby is sleeping’.
Using the Colourful Semantics Framework helps create a solid baseline from which to work and with which to construct basic good sentences using WHO is DOING WHAT and WHERE.

We are building language upward gently and positively.

This technique is incredibly powerful because children learn language through hearing it used meaningfully over and over again.

Supporting pronouns through real conversation

Pronouns can be surprisingly difficult for many children.

Words such as:
- he
- she
- him
- her
- they
require children to understand perspective, grammar, and sentence structure all at once. Using pictures and basing the activity on the Colourful Semantics Model I can shape pronouns repeatedly as part of the overall activity.

Books, pictures, and play scenes are fantastic for this because they create endless opportunities for meaningful repetition.

Again, this may look simple from the outside.

But underneath it is highly intentional clinical work.

Listening for speech sound errors at the same time

While supporting grammar and language, I am also constantly listening to the child’s speech production.

In this short interaction, I respond to speech sound errors as they arise.

Sometimes I:
- model the correct production
- emphasise a sound slightly
- use visual cues
- slow the word down
- add gesture or sign support
- encourage another attempt.
And sometimes I intentionally let the error go in order to protect confidence and maintain communication flow.

That balance is incredibly important.

Children need support. But they also need to feel successful communicating.

The child simply experiences this as warm, responsive interaction.

But underneath it is detailed clinical reasoning.

This is why effective therapy is never about simply owning resources or downloading activities online.

The real skill lies in:
- how the therapist uses the activity
- how they adapt moment by moment
- how they analyse communication in real time
- how they shape interaction to maximise learning opportunities.
One activity. Endless opportunities.

A single book, picture scene, or playful interaction can provide opportunities to support:
- speech sounds
- language development
- grammar
- vocabulary
- attention
- confidence
- social communication
- emotional connection.
The magic is not in the activity itself.

The magic is in how a therapist uses it.

Because excellent speech therapy is never ‘just playing’.

It is careful, responsive, evidence-based intervention woven seamlessly into joyful interaction.

Contact me avia 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

Bryan A (1997) Colourful semantics. In: Chiat S, Law J, and Marshall J (eds) Language disorders in children and adults: psycholinguistic approaches to therapy. London: Whurr, 143–61.

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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Autism Therapy · Neurodiversity · Speech and Language Therapy

Chaining: A powerful tool for phonological development
ByLondon Speech and Feeding November 18, 2024November 13, 2024
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.

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Autism Therapy · Feeding · Neurodiversity · Speech and Language Therapy · Top tips

Managing mealtime sensory overload at holiday gatherings: Supporting children with allergies and feeding differences
ByLondon Speech and Feeding December 17, 2025December 16, 2025
Holiday meals are meant to be joyful and something we all look forward to. But for many children and their families, these occasions can be overwhelming and be the cause of dread and worry. The combination of new smells, unfamiliar foods, loud environments, social expectations, and allergy anxieties can quickly turn what should be a festive time into a stressful one.

For parents of children with sensory processing differences, selective eating challenges, or food allergies, holiday gatherings often require careful planning and a big dose of tolerance and compassion. The good news is that with awareness and a few gentle strategies, you can support your child to feel safe, regulated, and included during festive meals without pressure, tears, or discomfort.

Let’s explore how to make holiday mealtimes calmer, safer, and more connected this season.

🎄 Why holiday meals feel so overwhelming

Holiday gatherings usually combine several sensory triggers all at once:
- Noisy, chaotic rooms
- Strong smells from a mix of foods we don’t normally cook
- Multiple conversations happening at once
- Bright lights, Christmas décor, flickering candles
- Unfamiliar foods with unexpected textures
- Expectations to ‘try everything’ or ‘enjoy it’s sooo good!’
- New environments, seating arrangements, or routines
For children with sensory sensitivities, this can feel like a tidal wave of input. Research shows that children who are sensory-sensitive often have heightened responses to smell, taste, and texture, which may lead to avoidance or distress at mealtimes (Cermak, Curtin, & Bandini, 2010).

Add food allergies into the picture and anxiety increases even further for both children and parents. A 2020 study by DunnGalvin et al. found that children with food allergies experience significantly higher stress in shared eating environments, especially when food preparation or contamination risk is hard to control.

So, if your child becomes tearful, shuts down, or refuses to sit at the festive table, it isn’t ‘bad behaviour.’ It’s sensory overload, heightened vigilance, or discomfort communicating through their body.

🌟 Preparing your child for a calmer festive meal

Preparation is especially important for sensory-sensitive or allergy-aware children. Here’s how to set them up for success:

1. Offer predictability through previewing

Before the event, show your child pictures of:
- where you’re going
- who will be there
- the types of foods that might be served
- where they might sit
A visual schedule or social story can help reduce anxiety and give your child a sense of control.

2. Pack safe foods without apology

If your child has allergies or selective eating, bring:
- ‘Safe foods’ you know they will eat
- Backup snacks
- A separate (their own) plate, if needed
- Emergency medication
Announce clear, firm boundaries such as:

‘Ok people, these are Jamie’s safe foods — we’ll stick with these today.’ This will help relatives understand without pressure or judgement.

3. Choose seating that supports sensory regulation

If possible, seat your child:
- at the end of the table
- near a familiar adult
- away from the kitchen (strong smells)
- away from noise clusters
- give them their favourite toy or fidget whilst waiting
Let them take breaks when needed. This isn’t ‘rude,’ it’s self-regulation.

🍽️ Supporting children during the meal

1. Focus on connection, not consumption

The holidays are not the time to expand your child’s food range. Keeping mealtimes low-pressure actually supports long-term progress.

In fact, the research is clear: pressuring children to eat decreases acceptance and increases refusal (Galloway et al., 2006).

So instead of ‘Just try it!’ try:
- ‘You don’t have to eat it, you can look at it.’
- ‘You’re in charge of what goes in your mouth.’
- ‘You can keep your safe foods on your plate.’
2. Protect your child’s allergy safety

Holiday meals often include:
- cross-contamination risks
- shared utensils
- buffets
- homemade dishes without ingredient lists
Use gentle but firm scripts:
- ‘Because of Ellie’s allergies, we’ll keep her plate separate.’
- ‘We’ll serve her food ourselves to make sure she stays safe.’
Confidence in your boundary helps others respect it.

3. Manage sensory load in real time

Offer:
- headphones
- a small chew or fidget toy
- a designated ‘calm corner’
- time outside for fresh air
- a predictable signal for breaks (e.g., a hand squeeze or card)
Remember, sensory regulation is healthcare, not ‘giving in.’

4. Model calm eating

Children learn most from watching.

Slow, happy bites and relaxed facial expressions tell the nervous system: ‘This environment is safe’.

💛 What to say to well-meaning relatives

Families often have big feelings about food. You can prepare nice phrases like:
- ‘We’re focusing on helping him feel safe around food today.’
- ‘She has allergies, so we’re sticking to our plan.’
- ‘We’re avoiding pressure because it helps him eat better long term.’
- ‘We’re celebrating together, eating is not the goal today.’
Setting expectations ahead of time can reduce awkward moments later.

🎁 The bigger picture: It’s about safety, not ‘picky eating’

Children with allergies, sensory differences, or feeding challenges aren’t trying to be difficult. They are trying to stay safe, regulated, and comfortable.

Your calm presence, gentle boundaries, and preparation create the conditions for a holiday that feels peaceful, not pressured.

Sonja McGeachie

Highly Specialist Speech and Language Therapist

Owner of 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.

📚Research References

Cermak, S. A., Curtin, C., & Bandini, L. G. (2010). Food selectivity and sensory sensitivity in children with autism spectrum disorders. Journal of the American Dietetic Association, 110(2), 238–246.

DunnGalvin, A. et al. (2020). APPEAL-2: A pan-European qualitative study to explore the burden of peanut-allergic children, teenagers and their caregivers. Clinical & Experimental Allergy, 50(11), 1238–1248.

Galloway, A. T., Fiorito, L. M., Francis, L. A., & Birch, L. L. (2006). ‘Finish your soup!’ Counterproductive effects of pressuring children to eat on intake and affect. Appetite, 46(3), 318–323.

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Speech and Language Therapy · Top tips

Four struggles parents face when out and about with children with speech, language, and communication difficulties
ByLondon Speech and Feeding January 27, 2023February 10, 2023

Hug

You (as parents) often describe yourselves as being under constant pressure and stress when looking after your children and young people with Special Educational Needs and Disabilities (SEND). You may find going out to do the simplest of tasks a challenge. And you will try to avoid social situations out of fear and anxiety. One of the most important factors to you is having like-minded people who understand your position as a parent with a young person with additional needs. Let’s look at some of the challenges you face and how I can support you and your family.

1. Challenging behaviour and going out to the shops

When your child displays challenging behaviour and won’t go into a shop without buying a toy that they insist on having, it can be tough on your family. You see people around you staring as you try to manage the situation. They do not understand the pressures you face, or that the simplest of tasks are a huge challenge.

I can support you by giving strategies to use when out and about. I know that using visuals is important for your child. They may not understand or take in language when they are in a heightened state of anxiety or feeling overwhelmed. You could print pictures of the places you’re going to and put them on an easily accessible chain. Then you could use that chain when out and about at the shops. You may want to introduce a visual timetable at home. That way your child or young person understands where they are going. This may lessen their anxiety and subsequent behaviour.

2. Your child is not able to communicate their needs to an unfamiliar communication partner

When your child has difficulty communicating to an unfamiliar person it can be hard to manage. You feel yourself explaining your situation repeatedly. I can provide your child with individualised strategies or communication aids which support your child to communicate with both familiar and unfamiliar communication partners. We’ll work together to find which communication methods work in different situations and how your child will use these to help their independence.

3. Being overwhelmed

Your child or young person may easily be overwhelmed which may contribute to behaviour changes. I’ll work with your family to understand what the behaviour means, looking at what happened before and what happened afterwards. We’ll not only look at the behaviour but at the environment as well. This can inform how you can support your child or young person in the future, to reduce sensory stimuli (if needed) and for them to feel emotionally regulated.

4. People avoid engaging with you

One of the hardest things as a parent is for others to avoid you. You see them crossing the street because they don’t know what to say to you. All you want is them to accept you, to maintain your identity as a person and not as a SEND parent. I can support you emotionally. I can give you advice on local support networks where you can find other parents in a similar situation.

We know the stresses that being a parent with a child with SEND comes with. Please know I am always here to support you, to find solutions so that when you’re next out and about. Your experience will be a little easier and you’ll feel less isolated.

Improve your child’s communication, confidence, reduce overwhelm and feel supported 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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Speech and Language Therapy

The tricky /R/: Mastering tongue placement for clear speech
ByLondon Speech and Feeding March 5, 2025March 3, 2025
The /R/ sound is notoriously challenging for many children (and even some adults!). It’s one of the most complex sounds in the English language, with various pronunciations depending on its position in a word. If your child is struggling with their /R/s, you’re not alone. As Speech and Language Therapists (SLTs), we frequently work on this sound, and a key component of our therapy is focusing on proper tongue placement.

Why is the /R/ so difficult?

The /R/ sound requires precise coordination of the tongue, jaw, and lips. Unlike sounds like /P/ or /B/ that involve simple lip movements, the /R/ involves intricate tongue movements and tension. There are also different ways to produce the /R/ sound, which adds to the complexity:
- Retroflex /R/: The tongue tip curls up and back towards the roof of the mouth.
- Bunched /R/: The body of the tongue bunches up towards the roof of the mouth, while the tongue tip remains down.
The importance of tongue placement

Regardless of which /R/ variation is being targeted, accurate tongue placement is crucial. Even a slight deviation can result in a distorted or inaccurate sound. That’s why SLTs dedicate significant time to teaching and practising tongue positioning.

Speech therapy techniques: Focusing on the tongue

Here’s a glimpse into how I address /R/ sound difficulties, with a focus on tongue placement:
- Visual aids:
  
  Mirrors: I use a mirror to help children see their tongue movements and make adjustments.
  
  Tongue diagrams and models: These visual tools provide a clear representation of where the tongue should be positioned.
- Tactile cues:
  
  Tongue depressors: These can be used to gently guide the tongue into the correct position.
  
  Food-grade tools: Sometimes, I use flavoured tongue depressors or other tools to provide tactile feedback and increase awareness of tongue placement.
- Auditory discrimination:
  
  I help children distinguish between correct and incorrect /R/ sounds.
  
  I use auditory cues and verbal feedback to reinforce proper pronunciation.
- Exercises and drills:
  
  Tongue strengthening exercises: Strengthening the tongue muscles can improve control and coordination.
  
  Tongue placement drills: We practise positioning the tongue in the desired location and holding it there.
  
  Sound approximation techniques: Sometimes we use other sounds to help approximate the /R/ sound. For example, I use the /L/ sound, to help achieve the correct tongue placement. Once my child has found the /L/ sound it is then a matter of pulling back just slightly to get a good /R/.
- Contextual practice:
  
  Once the child can produce the /R/ sound in isolation, we gradually introduce it into syllables, words, phrases, and sentences.
  
  We also practise the /R/ sound in different contexts, such as at the beginning, middle, and end of words.
Tips for Parents:
- Be patient and supportive: Learning the /R/ sound takes time and practice.
- Practise regularly: Short, frequent practice sessions are more effective than long, infrequent ones.
- Make it fun! Use games, stories, and other engaging activities to keep your child motivated.
- Work with an SLT: A qualified SLT can provide personalised guidance and support.
In conclusion:

The /R/ sound can be challenging, but with targeted speech therapy and a focus on tongue placement, most children can achieve clear and accurate pronunciation.

I hope this blog post is helpful!

Get in touch with me via my contact form if you need support

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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