Keeping Me Well - Cardiff and Vale University Hospital

My child is having difficulties with interaction and play

Communication involves more than simply saying words. To develop functional communication skills a child

  • needs something to communicate about (e.g. wanting/not wanting something, showing you something, etc.)
  • a means of communicating this and
  • most especially someone to communicate with.
lady playing hide and seek with baby - copyright Children's Speech and Language Therapy, Cardiff and Vale

This latter skill involves the ability to socially interact and use communication for a social and communicative purpose, rather than for instance, a child climbing to get things for themselves, pulling people by the arms/hands or perhaps naming letters/number/shapes with no communicative purpose.

Children learn to interact from the moment they are born. They learn about facial expression, words, events and gestures. Babies learn that crying provides comfort or food and as they grow and develop they learn more about social interaction through play.

Play is the single most important activity for the under-fives; it is the ‘work’ of your child. It is how they learn about themselves, the world around them, and their place in it. Through play, your child develops their physical, learning and social skills such as taking turns, sharing and compromising.

As with other areas of development, not all children develop interaction and play skills at the same rate. This may be influenced by many things such as opportunity, interests and motivations or perhaps because this is something your child might need support with.

You may find some of the questions below are things that you have thought about, if so please take a moment to look at some of the suggestions.


This is probably one of the most frequent observations made by parents and it is not uncommon for busy under 5’s not to respond to their name. However, if you have noticed that your child does not respond to other sounds/noises and have any concerns regarding their hearing, please contact your child’s Health Visitor to discuss whether a referral for a hearing assessment is worth consideration.

If, however, your child notices when you perhaps open a favourite packet of crisps/sweets, you may not be concerned about their hearing so much as their lack of response to their name.

When young children are busy they can find it hard to change their attention from what they are doing to you, and this may be in keeping with your child’s age and development. Please have a look at our leaflets for further information and ideas.

Some children are aware of their name but not yet aware that the calling of their name requires them to look at you. In order to look at you, your child will want something worthwhile for them, perhaps a tickle, hug, kiss or treat.

It may be worthwhile to consider if you are in front of your child when you call them so looking towards you is simple. If you call your child’s name over and over they may be used to this and used to not looking.

You could try calling your child’s name once and as you do so gently touch their face/arm to physically prompt looking towards you.

You could find something your child likes and instead of calling their name, use the object to attract their attention (perhaps shake the object, tap your fingers on it) when your child turns towards the noise reward with a smile/hug/tickle (whatever your child likes) so that your child is rewarded for interacting with you.

See the information and suggestions above regarding children who do not always respond when their name is called.

Your child may be listening when you speak but may not understand what they are being asked to do.

Try to make sure you use simple and consistent language when you talk to your child such as words they could use if they repeated you e.g. ‘look’, ‘come’, ‘go’, ‘stop’, ‘more’.

If your child is busy playing they may ignore what you say, try to make any comments you make relevant to what your child is interested in.

Use a simple activity (such as blowing bubbles or building blocks to knock over), consider what are the important words you need to use (more/again, block/brick/Duplo) and what is the important interaction skill.

Most play in the under 5’s involves sharing and turn taking. Rather than anticipating and providing what your child wants, create a turn simply by waiting for your child to look towards you when they want more of something or want you to perform an action e.g. blow a bubble, give a tickle, lift them up to swing, etc.

See the BBC’s Tiny Happy People website for ideas on developing sharing, turn taking and waiting for ‘go’ such as:

Independence is an important skill and it is always good to encourage this in children. However, if your child can, for instance open gates and cupboards to access food/drink themselves, or climb to reach objects, then this may be reducing their opportunities to interact with you and to realise that interacting with others is important.

It may be worthwhile to consider whether there are any opportunities to encourage your child to interact with you for these things. You may need to move things out of your child’s reach to make them less accessible in order to create opportunities for your child to try to communicate with you. For instance, if you see your child climbing/opening doors and know what they are searching for, can you reach it first? If so you can follow the suggestions for face watching (please refer to our Face Watching leaflet) – offer the item to your child, as they reach for or looks at it, move it towards your face. Wait for your child to look towards your face (it doesn’t have to be eye contact, just looking at your face/head area).


You could also offer your child a choice of two objects. Our video ‘Offering Choices’ shows how you can use choices in everyday activities.

See the section above for ideas on creating opportunities to interact with your child, using ‘face watching’ and using your child’s interest in an object to have a reason to interact with you.

When your child pulls you to something they want this is a positive sign, it shows they want something and see you as the person who can help.

To increase their experience of interacting with you, not just your arm/hand, you may find the following helpful:

    • as your child pulls your arm/hand, bend down to your child’s level and hold your arm/hand near your face so that your child is looking towards you.
    • try saying a consistent word e.g. ‘help’, ‘go’ or ‘come’ (as this is what your child wants you to do). If you do this each time you do this, your child may start to copy you.
    • when you reach what your child wants (you may need to hold them up to look and reach towards what they exactly want) instead of just giving your child the item, create a reason for your child to interact with you and make a choice. Our video ‘Offering Choices’ shows how you can use choices in everyday activities

It will be encouraging to know that your child can say words and that they have a good memory.

Children often learn to repeat patterns/routine words such as counting and the alphabet as they hear these often (perhaps on App’s or electronic toys) and/or you have spent time showing and teaching your child concepts such as colours, shapes and pictures in books. However, your child may not yet have learnt to associate these words to a communication function/purpose.

Instead of teaching more words/concepts you can use your child’s strengths for memory and learning patterns/routines, to develop their use of words for communication.

Try to use consistent words for things your child typically wants/needs – if you use lots of words (e.g. for ‘drink’ – cup, pop, bottle, juice, drink, milk etc.) or phrases (what do you want, do you want this, here you go, etc.) then your child won’t learn a consistent rule of what to say.

If you give your child what they want when they lead you to it, or they get it themselves, they won’t have a chance to socially interact with you, to make a choice or to hear a consistent word.

If your child likes letters/numbers/colours/shapes/animals etc., instead of letting them play alone with the toy or naming these when you ask what it is, create an opportunity to interact and communicate. For instance, you could put puzzle pieces for a puzzle board in a box, and silently offer one to your child, hold the piece near your face to encourage your child to interact by looking towards you, pause. If they say nothing, you can name the item as you give it to them (e.g. ‘four’) and encourage your child to start naming what you offer. Your child will be learning to name an item to ask for it.

Instead of asking your child a question such as ‘what’s this?’ for instance, when looking at a book, shape sorter, magnetic letters etc., build in a comment e.g. ‘look, sheep’, ‘look, duck’, and encourage them to do likewise. If your child copies you, acknowledge the comment e.g. ‘wow, look, sheep’

From around 18 months old children start to realise that they can make choices. This is often when tantrums begin and can range from not wanting to go to bed, to not wanting a food they have previously eaten. This stage, often referred to as ‘the terrible two’s’ can actually start earlier than this and last a lot longer. As young children do not have well developed communication skills, even children who are talking will typically use behaviour to show that they are not happy/do not agree with you. However, for some children the cause of the behaviour may not be as obvious or might be very rigid and extend across many aspects of the child’s day. This can be tiring and worrying.

If you have concerns please talk to your Health Visitor as they may be able to offer reassurance, suggest strategies or give information about parent programmes.

You may find it helpful to use objects for daily routines so your child understands their day see Objects of Reference leaflet.

Objects or pictures may be easier for your child to understand. They last longer than words and are more predictable because they always look the same. They can be used to help your child understand what is going to happen next. Start with one item, then try two (e.g. ‘first brush teeth then story’). You can build this up gradually to help them understand what is going to happen throughout the day.

Pictures can also help your child communicate with you. Find or draw pictures of the things your child would ask for. Encourage them to give you the picture before you give them the item.

Playing more games where your child takes turns will help them to share, take turns and follow the lead of an adult see the BBC’s Tiny Happy People Site:

The internet can be a wonderful tool providing instant information about things we are curious about and sometimes about things we have not thought about. If, for instance you look up something simple like ‘headache’ you may find pages and pages of information ranging from medication, natural cures, advice to check your eye sight and information that may sound more alarming such as the cause of your headache. When this happens for something we have knowledge about we know when we should and should not be concerned. When it is something you know less about and concerns your child you will naturally worry.

Much documented information related to Autism that you might read about can also describe behaviours that many children might do, but this does not necessarily mean it is cause for concern. For instance children often line up toys as part of typical play development.

Your Heath Visitor can give you advice regarding your child’s development skills and if they have any things they want further information about they may refer you to a Paediatrician.

If you feel the need to explore this more please explore the National Autistic Society web page (opens a new window) .

Try the suggested activities and links on this page related to interaction and play to see if these make a difference to how your child interacts and plays.

Try not to worry and enjoy playing and interacting with your child.


Children’s play develops through different stages according to their age, but different children will find some stages of play more appealing than others. Not all children of a certain age like certain toys. If your child finds play challenging they will not necessarily progress with play just by providing a different toy.

You may find some of the questions below are things that you have thought about, if so please take a moment to look at some of the suggestions.

Some children find it challenging to ‘play’ or occupy their time in the same way that a child of a similar age might do. Your child may like to explore by putting objects in their mouth. Creating sensory play bags will help these children learn by touching, looking, listening and perhaps smelling, rather than just putting items in their mouth. Please have a look at our Sensory Play Leaflet for more ideas.

Some children like to hold toys/objects. Providing a basket/box/bag to put toys in will enable your child to know where their toys are and free up their arms/hands to play with other items. If they like to collect objects/toys perhaps you could take turns to put these in/out of a bag/box.

Some children are fascinated by turning things on/off (taps, light switches), throwing objects or opening closing/things. This is the start of cause and effect play, that is, if I do something, something will happen.

You could explore the Tiny Happy People site for more ideas on cause and effect play for instance:

Some children prefer to repeat physical actions over and over such as building blocks to knock down or running circuits of your room. See if they will let you join in – how do they respond if you copy them? Take a turn? Can you introduce waiting for ‘go’ for the actions (see the video links above for some more ideas).

If your child likes numbers/letters/shapes they may like to complete puzzles/shape sorters – these are ideal for taking turns. Our Posting Tube leaflet can give more ideas.

You could also watch the Tiny Happy People video My turn, your turn. (opens a new window)

Technology can be really appealing to children especially children who learn visually. Although there can be many positives to these devices they cannot replace learning through doing and finding out in the real world. Time on a device is also usually time alone rather than time interacting. Our leaflet on Turn screen time into ‘you and me’ time can give advice on how to use devices with your child.

Provided a child is safe, it is important for them to learn how to occupy themselves for short periods and not always need an adult to play. However, as children learn play by copying and interacting with others, it is also important that that they are happy/accept an adult and/or child playing with them too.

A younger child is more likely to accept play from an adult and it is typical for children of 2 years and 3 years old to play alongside others and need adult help to share with other children.

Some children may just need an adult to remind them of the ‘rules’. Some children, however, find play with others, even Mum and Dad, challenging. For these children you may need to consider the following:

  • Turn off the television and put away other toys. It will be hard to engage your child if you have to compete with other stimuli.
  • Play can happen anywhere, outside, as well as indoors.
  • You do not have to sit to play and learn.
  • Limit how many toys are available – if your child always pulls out all the toys in the toy box but plays with nothing, only make a few items available, they are more likely to engage with one thing if there are less options.
  • Repetition may be boring to you, but it’s not to your child. Children learn by repeating play patterns.
  • Play near your child rather than trying necessarily to play with them.
  • Don’t call them or ask questions.
  • Let your child determine the pace of play. The best way to teach a new skill is to show your child how something works, then step back and give them a chance to try.
  • Don’t force or prolong play. When your child is tired of an activity, it’s time to move on.
  • Playing with your child should be fun and is a great way to find out what is important to them. Play alongside your child with the same or similar materials. You, as the ‘friend’ must be flexible. If your child does not copy you, you must copy them.
  • Begin with fun activities that your child will find fun and at their level of play. For example,
    • throwing a balloon or feathers into the air,
    • rolling a ball/car/train along the floor, down a slope or a tube,
    • blowing bubbles,
    • posting milk bottle tops in a bucket,
    • Peek a boo games with a blanket.
  • Take turns with your child. Use very short games where turns are changed quickly. For example, push the toy car towards your child, then pull the toy car towards you. They will have something to watch even though it’s not their turn.

Some children find it challenging to ‘play’ or occupy their time in the same way that a child of a similar age might do. Some children show ‘clever’ skills with knowledge of the alphabet/numbers/shapes etc. but are not always as able to use these skills with a range of play activities. Some children find it reassuring to repeat patterns of play and can be very upset if Mum/Dad join in or try to alter this.

The early stages of play involve finding out through sensory experiences, physical play, cause and effect and construction. These areas of play are ideal for repetition.

The next stages of play involve the ability to relate items and events together and to pretend. For some children this is challenging, there are no set rules and nothing ‘happens’ – for instance if you throw a ball it may make a noise, bounce, light up, roll, knock over something else, if you throw a doll it may make a noise but little else. Your child may prefer sensory/physical/cause and effect play as it makes them happy.

For other children play with prediction is preferred – for example, the yellow button always says the same thing, the alphabet is always the alphabet, numbers are always in same sequence. They prefer play when they understand what to do and what the rules are.

To help your child you may need to begin very gradually, if for instance your child likes sensory play with water they will not be ready for pretend play. However, all these play stages will be enhanced if your child is happy to take turns, share, wait for ‘go’ and accept other variations within the play.

For more ideas on sensory play:
Our Sensory Play leaflet gives ideas and includes links to videos on the Tiny Happy People website.

For more ideas on taking turns:

For more ideas on cause and effect play and waiting for ‘go’:

Remember, there is no right or wrong way to play and there are not necessarily any results to show at the end. Your child should be able to play in their own way.

Your aim is to encourage more variety in your child’s play so new experiences and learning are made possible.

What should I do if I'm worried?

Think about how your child is communicating now. Does this impact your child or family? What would you like to change about your child's skills?

Have a look at the advice and strategies on this page to give you ideas on how to support your child's language and communication skills. Try these strategies at home for two or three months to give you and your child time to get used to using them.

After you have tried the advice and activities for a couple of months and you are still worried about your child's play and development...

Has your child started full-time school?


If your child is preschool age (not yet started full time school) and you live within the Cardiff and Vale area please contact our service on 029 2183 6585 to request further assistance.


If you live within the Cardiff and Vale area please contact our service on 029 2183 6585 to request further assistance.


Please discuss your concerns with your child's teacher (or the ALNCo at school). Schools may be able to provide some additional support to help your child. If you and the school continue to be concerned about your child's interaction skills, we recommend the school makes the referral to our service as they can include information about how their interaction skills are impacting on their learning.


Please discuss your concerns with your child's teacher (or the ALNCo at school). Schools may be able to provide some additional support to help your child. If you and the school continue to be concerned about your child's interaction skills, we recommend the school makes the referral to our service as they can include information about how their interaction skills are impacting on their learning.

Keeping Me Well - Cardiff and Vale University Hospital

Help us improve Keeping Me Well!

We’re currently working to improve the Keeping Me Well website. If you’d like to help us make this site a better, more helpful experience for you, please take a few minutes to let us know what improvements you’d like to see.

Skip to content