My Child

My Child..

• doesn't talk very much

  My child doesn't talk very much
  
  Children need to hear words lots and lots of times before they attempt to say them.

  There are many ways we can help children to start talking:
  

  Name things that he or she shows interest in and repeat that word several times in different ways, e.g. ‘car’, ‘big car’, ‘car is driving!’.

  Try to reduce the amount of questions that you ask and use comments instead, for example, instead of saying ‘what’s that?’ say ‘look, a bus!’.

  It is important to remember not to put too much pressure on your child to talk. Children will usually talk when they are able to and they are not just being lazy. 

  If you have concerns regarding your child’s spoken language development see our 'Activities, Ideas and Info' section. We also suggest you discuss your concerns with your health visitor or the staff at your child’s setting/school, who may have helpful suggestions.  

  If you feel that you would like an assessment of your child's speech and language, please visit our 'How to refer' section.

• can't hear

  My child can't hear
  
  If your child often does not respond to you when you call their name or needs the volume of the television to be turned up loud it may be that they have some difficulties with their hearing.
  
  There are two types of hearing loss:
  Sensori-neural
  Sensori-neural hearing loss is caused by damage to the hair cells or nerves that detect sound waves. This type of hearing loss is quite rare and will usually be picked up when baby’s hearing is checked just after they are born.
  Conductive
  Conductive hearing loss is caused by a physical problem, such as a blockage of the ear canal. An example of this is glue ear.
  It is fairly common for children to suffer from glue ear at least once before they are four years old but it can occur at any age. Glue ear affects hearing and even a slight loss can affect a child’s speech development. Glue ear can resolve naturally or it may need treatment. 
  

  If you have concerns that your child may have difficulties with their hearing, contact your Health Visitor or GP and they can refer your child for a hearing test.  If your child is seen by a speech and language therapist they can also make a referral for you. The Community Paediatric Audiology Service provides hearing assessment and advice for children for whom there is concern about hearing.

   

  For information on supporting speech and language development, see our leaflet 'Making Hearing Easier for Babies and Young Children'. 

  We also have a leaflet for parents about the speech and language service for children with a hearing impairment or who are deaf. 

• doesn't listen

  My child doesn't listen
  
  Many young children have a short attention span and find it difficult to listen to and follow instructions. Children need to develop their ability to listen as they get older.
  
  If you feel that your child does not listen to you it could be because s/he has not understood what has been said or s/he has difficulties with  hearing or it may be that his or her attention and listening skills are not yet developed enough.
  
  To help your child to listen to what you are saying use the following strategies:

  • get your child’s attention by calling their name before you give an instruction
  • present information in short chunks to allow your child time to process it
  • support your child’s learning as visually as possible, e.g. show him/her what to do rather than just saying it
  • use a lot of repetition when explaining ideas or tasks to your child
  • encourage your child to repeat things back to you to ensure that he/she has understood.

  If you have concerns regarding your child’s language development see our 'Activities, Ideas and Info' section. We also suggest you discuss your concerns with your health visitor or the staff at your child’s setting/school, who may have helpful suggestions.  

  If you feel that you would like an assessment of your child's speech and language, please visit our 'How to refer' section.

  
  

• doesn't understand

  
  My child doesn't understand

  Understanding language involves understanding what individual words mean, understanding sentences and understanding abstract language such as how some words or sayings have more than one meaning.  Children can have difficulties in one or several areas of understanding language.  To help to support your child’s understanding, match your language to the language that s/he uses.  If your child uses three words in a sentence, you use three words.  To help to develop  understanding, add a word.  
  
  If you have concerns regarding your child’s understanding of spoken language see our ‘Developing Understanding’section. Discuss your concerns with your health visitor or the staff at your child’s setting/school who may also have helpful suggestions.  If you would like an assessment of your child's speech and language we would be happy to see you.

   

  If your child is a pre-schooler please come along to one of our drop-in sessions.  If your child is at school you can ask his or her teacher to refer to us (see our 'referral' section for details).

   

  Alternatively, you could visit your local children’s centre and find out when the speech and language therapist is next in so you can chat to her. 

  My child doesn't understand

  Understanding language involves understanding what individual words mean, understanding sentences and understanding abstract language such as how some words or sayings have more than one meaning.  Children can have difficulties in one or several areas of understanding language.  To help to support your child’s understanding, match your language to the language that s/he uses.  If your child uses three words in a sentence, you use three words.  To help to develop  understanding, add a word.  
  
  If you have concerns regarding your child’s understanding of spoken language see our ‘Developing Understanding’section. Discuss your concerns with your health visitor or the staff at your child’s setting/school who may also have helpful suggestions.  If you would like an assessment of your child's speech and language we would be happy to see you.

   

  If your child is a pre-schooler please come along to one of our drop-in sessions.  If your child is at school you can ask his or her teacher to refer to us (see our 'referral' section for details).

   

  Alternatively, you could visit your local children’s centre and find out when the speech and language therapist is next in so you can chat to her. 

  My child doesn't understand

  Understanding language involves understanding what individual words mean, understanding sentences and understanding abstract language such as how some words or sayings have more than one meaning.  Children can have difficulties in one or several areas of understanding language.  To help to support your child’s understanding, match your language to the language that s/he uses.  If your child uses three words in a sentence, you use three words.  To help to develop  understanding, add a word.  
  
  If you have concerns regarding your child’s understanding of spoken language see our ‘Developing Understanding’section. Discuss your concerns with your health visitor or the staff at your child’s setting/school who may also have helpful suggestions.  If you would like an assessment of your child's speech and language we would be happy to see you.

   

  If your child is a pre-schooler please come along to one of our drop-in sessions.  If your child is at school you can ask his or her teacher to refer to us (see our 'referral' section for details).

   

  Alternatively, you could visit your local children’s centre and find out when the speech and language therapist is next in so you can chat to her. 

  My child doesn't understand

  Children may have difficulty:

  • knowing what individual words mean
  • understanding sentences and following instructions
  • understanding abstract language such as how some words or sayings have more than one meaning.
    

  To help support your child’s understanding, match your language to the language that s/he uses e.g. if your child typically uses three words in a sentence, you use three words.

  To help to develop understanding, add a word to what your child says e.g. if they say "dog", you say "yes, dog eating".

   

  If you have concerns regarding your child’s language development see our 'Activities, Ideas and Info' section. We also suggest you discuss your concerns with your health visitor or the staff at your child’s setting/school, who may have helpful suggestions.  

  If you feel that you would like an assessment of your child's speech and language, please visit our 'How to refer'section.

• can't speak clearly

  My child can't speak clearly
  
  When children learn to talk they also have to learn to use speech sounds. For most children this will occur naturally and they will not need any help, however, some children may need some support to help them on their way.
  
  Many children will go through stages where their speech is difficult to understand. Some children get stuck at certain stages, where typical speech sound development may be taking a bit longer. This is called delayed speech sound development. Some children’s speech does not follow the typical pattern of development. This is called disordered speech development. Children in both of these categories may require speech and language therapy to help them to develop their sounds.  
  

  There are ways that you can help your child with their speech sounds at home:

  • hold objects close to your face when naming them, so they can see the way you are making sounds. Sitting face-to-face will help with this.
  • accept your child's attempts and model back, rather than asking them to correct i.e. child says 'tat', (meaning cat), you model back 'yes cat'.

  
  

  If you have concerns regarding your child’s speech, see our 'Activities, Ideas and Info' section. We also suggest you discuss your concerns with your health visitor or the staff at your child’s setting/school, who may have helpful suggestions.  

  If you feel that you would like an assessment of your child's speech and language, please visit our 'How to refer' section.
  

   

• has a tongue tie

  My child has a tongue tie
  

  What is a tongue-tie?

  Underneath your tongue is a small fold of tissue that limits the movements of your tongue. Everyone has one of these and it is called a frenulum. The term ‘tongue-tie’ indicates that the frenulum is unusually short and tight. This can lead to reduced movement in the tongue. The tongue tip may appear blunt, forked or have a heartshaped appearance.

  Observations:
  A person with a tongue-tie may not be able to:
  -  Stick out their tongue beyond their lower teeth
  -  Get their tongue to reach the top of their mouth, called the alveolar ridge (the hard part just behind your upper front teeth). The tongue comes into contact with this part of your mouth for some speech sounds.

  Will it affect my child’s speech?

  A tongue-tie does not usually impair speech. Even those whose frenulum is attached very close to the tongue tip under the tongue can have normal sounding speech.

  Some individuals may have imprecise articulation, especially when talking quickly.

  Children may find some sounds more difficult.

  Tongue-tie and feeding difficulties

  A child with a tongue-tie may have difficulties with feeding as a baby; they may also find it difficult to clear food from inside and or outside of their mouth.

  Please speak to your GP, health visitor or a lactation consultant if you are concerned about a tongue-tie and feeding, including if you are finding breastfeeding difficult. They will be able to check for a tongue-tie and, if appropriate, a referral for a simple surgical procedure can be made at the earliest possible age.

  You could also ask your child's dentist about oral hygiene implications at a check-up appointment.

  Tongue-tie and speech sound difficulties

  There is no evidence to suggest that tongue-tie is related to delayed onset of speech or language, despite common parental concern.

  However, you can speak to a speech and language therapist if you are concerned about speech sound difficulties.

  Surgical intervention for tongue-tie

  Not every tongue-tie requires surgery. Doctors often look into the range of movements of the tongue. They may look at the two points of attachment of the frenulum. They may also discuss the child's speech development.

  Some tongue-ties may break or loosen without any intervention. Others may need surgery to increase mobility of the tongue. Cutting a tongue-tie for a breastfed baby can dramatically improve ease of feeding and lessen pain for the mother
  

  My child has a tongue tie

  A tongue tie is cause by an unusually short frenulum which is the bit of skin which connects the bottom of the tongue to the floor of the mouth.  Most people can go through life with a tongue tie without experiencing any difficulties but it may cause problems for others.  

  
  

  A baby with a tongue tie may experiences difficulties breast feeding which may cause problems with gaining weight and sleep deprivation.  

  
  

  A child with a tongue tie may experience difficulties chewing solid foods and gagging.  They may also experience difficulties with their speech sound development although this is not a major cause of speech difficulties.

  
  

  If you are concerned that your child has a tongue tie contact your GP or Health Visitor for some advice.

  
  

• dribbles

  Why might children dribble?

  • Reduced control of the oral muscles e.g. poor lip closure
  • Reduced sensory awareness of the face and mouth
  • Poor head positioning
  • Developmental delay (saliva control is usually established by between 15 months and 3 years in typically developing children)
  • Open mouth breathing due to breathing problems and enlarged tonsils/ adenoids etc.
  • Reflux

  What can help?

  • Reduced control of the oral muscles e.g. poor lip closure
  • Improve positioning. Supporting child’s head to be upright and mid line 
  • Develop the concepts wet/dry, open/close. Relate to his/her lips and chin 
  • Wipe your child’s face with 1-3 firm dabs (if you wipe quickly you will stimulate your child to produce more saliva)
  • For younger children it may be useful to encourage mouth closure by giving support under their chin 
  • Encourage your child to take responsibility for wiping his/her own face. Provide tissues to use when necessary. A more discreet option is for your child to wear a scarf/bandana or a towelling wristband to use for dabbing throughout the day
  • Agree on a discreet gesture or sign as a reminder to dab or wipe
  • Medical investigations may be required for reflux and mouth breathing If you have any concerns regarding excess dribbling do not hesitate to contact your GP or health visitor. 

• stammers

  My child stammers
  
  Learning to talk, like learning to walk, is never completely smooth and does not happen straight away. Young children often stop, pause, start again and stumble over words when they are learning to talk.

  Between the ages of 2 and 5 years, it is normal for a child to repeat words and phrases and hesitate with “um”s and “er”s when he is sorting out what to say next.

  However about 5% of children stammer for a time when they are learning to talk. Many find it easier to talk fluently as they get older. Others continue to find talking difficult and often get stuck.

  The words “stammering” and “stuttering” are the same thing; it may also be referred to as dysfluency.

  Websites that you may find informative include:
  stamma.org (The British Stammering Association)
  The Michael Palin Centre for Stammering

  For further help and support from a speech and language therapist, please visit our 'How to refer' section.

• is learning two or more languages

  My child is learning two languages
  
  Why bring your child up bilingually ?

  • They can communicate with the people in their extended family and within their community
  • They can feel secure in their cultural identity and sense of belonging
  • It helps their learning because they can think about ideas in both languages
  • It helps them think more flexibly and creatively
  • There may be economic advantages later on in you child’s life.

  Points to remember 

  • Learning more than one language is a common and normal childhood experience 
  • No one language is more difficult to learn than another
  • There is no evidence that bilingualism will make it harder for children with delay to speak.

  What is the best way to bring children up bilingually?

  Children develop speech and language skills from listening to and interacting with their parents. It is very important that parents use the language that they know best and the one that they feel most comfortable in.

  Remember to be consistent with the language you use when speaking to your child. It will help him to distinguish between the different languages. If a child is secure in his first language then he will learn English quickly when he starts to have experiences outside of his home.

  What if my child’s speech and language is delayed?

  If you are concerned your child’s language development is delayed in their first language, find out how to contact a speech and language therapist through our 'How to refer' section. The therapist will advise you on ways to promote speech and language development in the home language.
  

• has special needs

  My child has special needs
  
  Speech and Language Therapists work with children who have a wide ranging variety of special needs with associated speech, language and communication difficulties, such as global developmental delay, Cerebral Palsy, Downs Syndrome and Autistic Spectrum Conditions.

  If your child is of pre-school age and has difficulties in a range of areas e.g. mobility, eating, interaction, please discuss with your health visitor the completion of an Early Help Assessment, as your child may benefit from the co-ordination of referrals and services provided by Early Support. For children in school, referral to speech and language therapy is via the school link therapist.

  Speech and language therapists work with parents and early years settings to ensure that the best communication strategies and interventions are in place to enable progress with communication to be made.

  Speech and language therapists may also contribute to an Education, Health and Care assessment to ensure that your child's needs are understood and appropriate provision detailed on an Education, Health and Care Plan (EHCP).
  
  Once your child has made the transition into school the  Speech and Language Therapists may work with the school to support the development of speech, language and communication skills . Therapy may involve some or all of the following:

  • training and advice for parents and school staff, for example Makaton parent workshops; using visuals to support communication; developing the effective use of alternative methods of communication.
  • Working with other education and health professionals such as Occupational Therapy and the Visual Impairment Service Teachers. 
  • assessment of your child’s communication ability through observations of the child in different environments, discussions with key adults as well as formal and informal speech and language assessments.
  • recommendations to improve the child’s communication environment, for example ensuring there is a Total Communication approach being used consistently across all settings;
  • working directly with the child to develop their speech, language and communication skills. This may include the use of Alternative and Augmentative Communication (AAC) 

  When  a child’s speech, language and communication needs are being appropriately supported by the setting or  school the child will have their care closed by the Speech and Language Therapy service. A new individually planned episode of care will be opened when further specialist support is needed.

• needs speech and language therapy

  My child needs speech and language therapy
  

  If you have concerns about your child, please look at the information on these pages for answers to common questions and tips and ideas for supporting communication.
  
  We also suggest you discuss your concerns with your health visitor or the staff at your child’s setting/school, who may have helpful suggestions.  

  If you still feel that you would like an assessment of your child's speech and language, please visit our 'How to refer' section.

  
  

• won't talk

  My child won't talk

  Some children will not speak in pre-school or school even though they chatter away happily in the home setting.  This is often referred to as selective mutism. You may also hear this referred to as reluctant speakers.

  Selective mutism is an anxiety disorder in which a person who is normally capable of speech cannot speak in specific situations or to specific people. Selective mutism usually co-exists with shyness or social anxiety. There is good information on the SMIRA website about this and how to help http://www.selectivemutism.org.uk/information/information-for-parents/

  Whilst we signpost parents and settings to advice about supporting children with selective mutism, we do not actively treat this. The best support is from sensitive and informed carers in the setting who are with the child every day and who are following the advice on the website.

  Where there are also communication difficulties at home, the role of the speech and language therapist is to assess for any other underlying communication disorder.