Keeping Me Well - Cardiff and Vale University Hospital

Useful ideas and strategies to help my child

The Children’s Speech and Language Therapy Service is here to help you support your child’s speech, language and communication skills. Our dysphagia team can offer advice and support regarding your child’s feeding and swallowing skills.

A boy with health-related icons around him

Our therapists know that parents and careers are the best people to support children’s speech, language and communication skills. You understand your child the best; you know:

  • what they like or dislike,
  • what motivates them, and
  • how they are currently communicating with you and others around them.

Children’s speech, language and communication skills develop at different ages. There can be a lot of variation in when children develop these skills. A good language and communication learning environment can support these areas.

This short video called “What role do parents play in early language development?”, produced by the Hanen Centre, gives some ideas on how you can help in everyday activities.

The approach of integrating activities into everyday things at home is also relevant for all children with speech, language, and/or communication difficulties.

We have several therapists trained in this approach (Hanen) in our service, however if your child needs support we will always discuss with you the different options and approaches available to see which would help you and your child the most.

Please click on the area below that best describes your child or the area you would like more information on. 

Frequently Asked Questions

Which children do Children's Speech and Language Therapists work with?

There can be many reasons why a child may be referred to the Speech and Language Therapy department. These can include:

‘Language’ refers to words, meanings of words and how words are linked together. Language skills include the understanding of words/sentences, and saying words/sentences. 

Different elements of language (for example, pronouns, different verb tenses, plurals) develop at different ages. Some children may not have fully developed language skills but they are still able to get their meaning across to the listeners.

‘Speech’ refers to the different speech sounds in words, for example consonant sounds (such as ‘p’, ‘m’, ‘sh’, ‘f’, ‘ch’ and ‘g’ sounds) and vowel sounds (such as ‘ah’, ‘ee’, ‘oo’). When there are two consonant sounds together (for example ‘sn’, ‘bl’, ‘tr’) these are known as consonant clusters. Different speech sounds develop at different ages. It is normal for young children to change or miss out some sounds in their talking. Some children may also simplify words by missing out syllables in longer words (for example, they may say ‘caterpillar’ as ‘capillar’). 

For most children these sounds continue to develop and resolve in time, however some children may need some support to help them say and use the speech sounds.

‘Social communication’ refers to how we interact with other people around us. This can include taking turns in conversations, giving the right amount of information when talking, using communication for a range of reasons (for example, to request, to respond, to comment, to refuse, to ask).

Some children may have speech, language, communication or feeding difficulties associated with, or as a result of other medical conditions, for example, cerebral palsy, autism, cleft lip and/or palate, hearing impairments.

Children who have other medical or genetic needs may or may not need support from the Children’s Speech and Language Therapy Service. The support and advice provided is given on an individual basis for the child and family and not just because of other medical needs or diagnoses.

You may hear the term stuttering as well as stammering. These two words mean exactly the same thing. We tend to talk about stammering in the UK while elsewhere it is called stuttering.

A stammering ‘moment’ means that there is a break in flow when speaking. You then hear or see different automatic individual reactions to this ‘moment’. The stammering moment will affect people differently inside (their thoughts and feelings) and with their behaviour (i.e. their willingness to speak).

A person who stammers may:

  • repeat whole words, e.g. “and-and-and then I left”
  • repeat single sounds or syllables, e.g. “c-c-come h-h-here mu-mu-mummy”
  • prolong or stretch sounds, e.g. “sssssssometimes I go out”
  • block, where the mouth is in position, but no sound comes out

Please see the section ‘My child seems to be stammering when they talk’ for further information about stammering.

Selective Mutism is classified as an anxiety disorder relating to communication.

Children may have Selective Mutism if they are able to speak and communicate freely in at least one setting (often home) but do not speak in other specific social situations (for example nursery/school).

Selective Mutism is different to shyness.

Please see the section ‘My child is able to talk but does not talk in some places (e.g. nursery/school)’ for further information about Selective Mutism.

When young children talk, their vocal cords vibrate together about 300 times a second. This vibration occurs using air from the lungs and small muscle adjustments in the voice box. If the vibration is forced or strained then the vocal cords can become sore and red.

If the voice is not rested, or it has been strained or used for a long time, it becomes difficult for the redness and swelling to settle down. The sound of the voice may also change because of this.

If your child has a persistent hoarse, rough or croaky voice, we advise that you see your doctor who may then make a referral to Ear Nose and Throat (ENT) to find out about any underlying cause.

Please see the section ‘My child’s voice sounds rough or croaky (hoarse voice)’ for further information about voice difficulties.

It is very common for all children, particularly toddlers, to go through a stage of being less interested in food and to be fussier about the foods that they will eat.

Please see the section ‘My child is very fussy with their eating’ for some advice and top tips.

We strongly advise you to contact the Speech and Language Therapy department urgently if you think your child is:

  • Regularly coughing and choking on food or drinks
  • Having noisy or wet sounding breathing after eating or drinking
  • Showing signs of lips or facial colour changing or eye tearing when feeding
  • Having regular chest infections and is needing antibiotics for their chest frequently
  • Under 6 months and is refusing bottle feeds persistently
  • Under 6 months and you are concerned about their weight

If you live within the Cardiff and Vale area, please contact our service on 029 2183 6585.

Children may have difficulties in more than one of these areas.  Not all children who have difficulties in these areas need support from the Speech and Language Therapy Service. 

If you have any concerns about your child’s skills, please look at the advice under the relevant ‘My child is…’ sections above.

The Children’s Speech and Language Therapy Service has an open referral policy which means that anyone who has a concern can contact our service for advice.

The referrals are triaged in order to decide who the best Therapist is in our service to carry out an initial assessment.

An initial telephone appointment is offered (in some cases a face-to-face appointment is required) to the parent/main caregiver to collect any necessary background information, listen to your opinion and observations with regards to your child’s current skills, and discuss any impact or concerns there may be.

Before the initial appointment it will be useful for you to think about your child’s current communication and/or feeding skills and what help you would like.

During the initial appointment we will discuss with you who may be the best people to help. This may be us, or when we have understood a little bit more about the problem, you may decide that another organisation may be able to offer you more help.

At the end of the initial appointment, we will hopefully have a shared understanding of the problem, so you can make a decision about what to do next to help. We will discuss whether your child/family/the education setting needs further advice and support from our service.

  • You may feel you are able to work on your child’s communication yourself with support, for example, leaflets or websites to read
  • You may feel you do not need further support, as the advice you have been given in the initial appointment is sufficient. However, if new concerns arise in the future you can always contact us for further advice.
  • The Therapist may provide some advice and/or activities for you to do at home. We may speak to you again to hear how you got on.
  • Another group or agency is identified who maybe better placed to work with you and your child
  • We agree that a particular intervention from us is appropriate. Some children may need short blocks of Speech and Language Therapy in order to get new skills into place but these are rarely ongoing and long term. If we are going to be working with you we will help you to set goals for the work we are going to do together.

We offer

  • telephone appointments. These are appointments with the parents/carers to discuss with you your child’s progress, what is currently working well for you, and to offer suggestions as to how to adapt the activities you are currently doing at home.
    video appointments. These are appointments with you and your child; the therapist may have a specific activity to carry out during the
  • video appointment or they may ask you to set up an activity at home.
  • face-to-face appointments in clinic, nursery or school. If there is further information that is needed that cannot be gathered through a telephone or video appointment, then we may suggest a face-to-face appointment for you and your child to come to one of our clinics, or we may arrange a nursery/school visit.
  • parents group sessions (video groups or face-to-face groups) to help parents understand how language or speech develops, and how you can help your child.
  • advice to nursery or school settings on how they can support your child throughout the day is sometimes more appropriate than direct therapy with one of our team.

Don’t worry if you feel that your child is shy or may not respond in the appointments, we are used to working with a wide range of children.

We understand that parents are the most important people in a child’s life, therefore a lot of our work is giving parents advice and suggestions of activities you can do at home with your child.

You may be given activities to do with your child at home to support their development. These activities are an important part of their Speech and Language Therapy intervention.

Children are discharged when it is felt that further input from the Speech and Language Therapy service will not benefit your child at that particular time. If circumstances then change in the future, further advice can be requested again.

What is a tongue-tie?

A tongue tie (ankyloglossia) is where the strip of skin connecting the tongue to the bottom of the mouth is shorter than usual.

Some signs of a tongue tie can include:

  • Difficulty lifting the tongue up or moving it from side to side
  • Difficulty sticking the tongue out
  • The tongue looks heart shaped when protruding from the mouth

Tongue tie and speech sounds

Many parents and carers are naturally concerned that a tongue tie may cause a child to have difficulty producing speech sounds.

Currently there is no clear evidence that shows that having a tongue tie will cause a child to have speech sound difficulties. This is likely to be because only very small tongue movements are needed to make the sounds need for speech so a child doesn’t needed to be able to put their tongue out or move it from side to side. Therefore it is not recommended that a child will need surgical intervention (snipping of the tongue tie) solely for the purposes of preventing any speech sound problems.

Tongue tie and feeding

A tongue-tie does not necessarily mean that your child will have feeding difficulties.

In newborns some babies manage well, but for others the restrictions in tongue movement mean making an adequate latch for breast feeding difficult. If you feel that this may be a problem, please speak to the midwife/health visitor or breast-feeding specialist for support.

For older children an untreated tongue-tie may not cause any difficulties with feeding as any tightness may resolve naturally as the mouth develops. However, for some children certain foods may be more difficult to manage. If you think that your child is having difficulties with eating because of a tongue-tie, see the GP or your Health Visitor for advice.

In recent years there has been much discussion among many online parenting forums about the concept of posterior tongue-ties and their role in feeding difficulties. As yet there is no evidence to prove any link between posterior tongue-ties and feeding difficulties and the condition is not currently recognized or treated by professionals working within the NHS.

Our ‘Turn screen time into ‘you and me’ time’ advice sheet gives advice on how to use screen time with your child.

Children need to be of a certain level of development to realise that the picture of an item represents the real thing. It is better to use real objects or toys wherever possible in the activities you do at home.

SLTs may recommend the use of pictures for specific speech sound activities, or for expanding vocabulary when children are older and understand that pictures are symbols of real things.

Visit ‘The Truth about Flashcards for Toddlers Who Don’t Yet Talk’ (opens a new window) page, which gives a helpful explanation about the use of flash cards with young children.

Learning to talk and to communicate is a complex process and there is a wide variety of factors that can impact on how a child develops these skills. Some of the factors that can affect speech and language development a include hearing loss, cleft palate, general developmental needs or as part of a medical syndrome or learning difficulty. Other young children may have no other difficulties apart from speech and language needs and there is no obvious cause or reason why for their speech and language difficulties.

Whether there is a contributory cause or factor for your child’s communication needs or not, what we do know is that parents and carers are the most important people when it comes to supporting your child to develop their speech and language skills.

As a parent you are the most important person in your child’s life, you know them best and what makes them ‘tick’ and you spend more time interacting with you child in everyday routines than anyone else. Research shows that when parents use recommended strategies in their daily activities and routines, their child’s language skills improve.

A lisp is when the “s” sound is produced as a “th” sound. This is due to the tongue between or closer to the teeth when saying the sound.

Therapy is based on the impact on a child. When you are only concerned about a lisp in your child’s talking, we may discuss the impact with you and if appropriate we may give advice on adapting tongue placement for the sound, and a programme of activities to follow at home. These children are unlikely to need direct sessions with a therapist to practise the sound.

When children are learning to talk it can sometimes be difficult to know what they are trying to tell us. This can lead to feelings of frustration for both you and your child. Focusing on the ways your child is already communicating can help.

Please have a look at the hints, tips and advice on our website to give you ideas on how you can support your child.

Our ‘Reducing Frustration’ leaflet gives some top tips for how you can help to reduce the frustration for you and your child.

Your child will start letting you know that they are aware that they are going or that their nappy is wet by pointing to it, attempting to remove it, or doing the “I need a wee” dance.

Use the words that you want to use for using the potty/toilet.

You can also introduce signs/gesture and/or pictures. Use the sign and/or show them the symbol when you take them to the toilet or when they indicate they may need the toilet. Over time you can encourage your child to use the sign and/or symbol to indicate that they need to go to the toilet.

The Makaton sign and symbol for ‘toilet’ is shown in the YouTube video:

Further advice is available on the website ERIC (The Children’s Bowel and Bladder Charity) (opens a new window)

If you live in the Cardiff and Vale area and have concerns that are not covered above, please contact our service on 029 2183 6585 to discuss your concerns.

Keeping Me Well - Cardiff and Vale University Hospital

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