Speech and Language Therapy - Children (Richmond)

Speech and language support during COVID-19

We would like to reassure you that we are doing everything we can to continue to deliver a service to families within the constraints of the current circumstances. 

Families will be advised of the procedures as part of the process of being booked into an appointment. 

PPE is worn for all sessions both in school and in clinic in-line with trust guidance.

For any further queries or clarification regarding the service we are delivering, please contact the service on 020 8891 8150.


What is speech and language therapy?

SLT photo.jpgSpeech and language therapy provides services for children and young people (aged 0 – 19 years) in the borough of Richmond who are having difficulties with the development of their speech, language, communication and feeding.

We work closely with parents and relevant professionals to enhance and assist the development of all areas of the child/young person’s speech, language and communication and feeding. We will also suggest and model strategies that can be reinforced throughout the day.

We offer assessment and input in the areas of:

  • Attention and listening
  • Understanding spoken/signed language
  • Communicating using sentences and vocabulary appropriate for the person’s age
  • Augmentative Alternative Communication (AAC)
  • Using speech sounds appropriate for the person’s age
  • Social interaction and play
  • Stammering
  • Voice production
  • Feeding and swallowing, including sensory behavioural difficulties 

As well as providing assessment and input to children with speech, language and communication needs (SLCN), we also provide:

  • Training and support for families and other people involved in the care of children and young people with speech, language and communication needs
  • Training for professionals who work with children and young people with communication needs. These are delivered in a variety of settings including schools, early year’s settings, and children’s centres.  We also contribute to the local council’s workforce development training programme
  • Support in the community to prevent or reduce communication difficulties from developing

Our service also participates in research and development and student therapist training. 

Advice, Early Help and Prevention

Telephone advice line

The advice line is a quick way to access our service for advice/information on speech, language and communication development for parents of children who are registered with a Richmond GP. It provides the opportunity for parents to ask a qualified speech and language therapist questions about their child’s communication or feeding.

No referral is necessary although the therapist may feel, following discussion with you, that a referral into the service is indicated.

Call 020 8614 5333 and leave a message for a therapist to call you back. Current wait times to expect a call back are approximately 2 weeks.

Professionals can also access general advice, but for information relating to a specific child parental consent must be obtained.  

Supported Stay and Play sessions for under 5s

Specific Stay and Play sessions running in your local children’s centre will include your local NHS speech and language therapist or assistant. The speech and language therapy team will be available to answer your questions on your child’s speech, language and communication skills development.  They will also be working closely with the stay and play team to give you tips on how to support your child learn to talk during play and everyday activities.  

Session times and locations

Assessment and Intervention

Early Years Service

Speech and language therapists from the Early Years Team work with children with a range of speech, language and communication difficulties.

Our approach focusses on assessing each child’s individual needs and working together with parents and key adults in order to introduce strategies to support the child’s speech, language and communication skills development.

Sessions may be delivered as 1:1 or group input based on each child’s individual needs and include bespoke training to parents/carers.

In addition, the team offers a consultation service to early years setting practitioners as well as a range of training modules as part of the brough’s workforce development programme. To book onto training courses, visit Richmond Council's website.

Mainstream Schools service

Therapists provide a consultative service to mainstream primary and secondary schools within the London Borough of Richmond for children with an Education and Health Care Plan (EHCP).

The team provides ongoing assessment and monitoring of children’s speech, language and communication needs delivering input as recommended in their EHCP.

They work closely with teaching staff to offer advice, identify targets and strategies and model activities so that these can be integrated and embedded into the curriculum.

Whole school and small group training is offered as necessary in discussion with the school SENCo. The school's allocated therapist is also able to offer consultative advice and support in school for children who do not have an EHCP and whose parents have consented. 

Parents who have concerns about their school-aged child's speech, language and communication needs should discuss this with the school's Special Educational Needs Co-ordinator (SENCo) in the first instance. 

Special Schools Service 

Therapists provide a speech and language therapy service to Strathmore and Clarendon schools, two of the boroughs specialist education settings. 

The team provides ongoing input based on the children’s speech, language and communication needs delivering input as recommended in their EHCP.

They work closely with teaching staff to offer advice, identify targets and strategies and model activities so that these can be integrated and embedded into the curriculum.

Whole school and small group training is offered as necessary in discussion with the school leadership team. 

Clinic service

School-aged children and young people who present with a stammer or speech sound disorder come under the care of the clinic service and are offered assessment and follow-up sessions according to their presenting need.

Input may be in the form of advice; 1:1 or group sessions and focuses on working with the key adults around the child in order to embed supportive strategies.   

Feeding service

For children aged 0 – 19 years with dysphagia (chewing or swallowing difficulties) or sensory behavioural feeding difficulties.

The feeding team offer assessment, advice and monitoring according to each child/young person’s individual needs and in collaboration with parents.

We also work closely with key adults and other health professionals as part of the multi-disciplinary team caring for the child or young person.

Contact us

The team is based at Teddington Health and Social Care Centre. We see children in schools and clinics across the London Borough of Richmond Upon Thames.

Address:

Speech and Language Therapy Department
Teddington Health & Social Care Centre
18 Queens Road
Teddington
TW11 0LR 

Email:

hrch.slta@nhs.net

Telephone numbers

  • Richmond Speech and Language Therapy Telephone advice line:
    020 8973 3512  

  • Richmond Speech and Language Therapy enquiries: 
    020 8614 5333

  • General enquiries / administration hub:
    020 8614 5333

  • Children's SLT services manager - Claire Schneider:
    020 8614 5331                                  

Opening times:

Clinics operate during office hours and there is an answer phone to leave a message.

Our admin hub team are available to take calls and enquires from parents and professional and are involved in booking initial appointments which is generally done by phone wherever possible.

Our speech and language therapists work across different clinics and settings in Richmond so are not in the same place all the time.  

Staff will get back to you as soon as possible. However due to day to day commitments and some staff working part time it may not be possible to get back to you immediately. Every effort is made to get back to you within 48 hours. 

Frequently asked questions

Where can I park?

Teddington Health and Social Care Centre
18 Queens Road
Teddington
TW11 0LR

  • Free parking for visitors for up to 4 hours. Visitors must get a free ticket from the machine and display in car. Free road parking is also available on Queen’s Road just outside Teddington Health and Social Care Centre. 

Sheen Lane Health Centre
Sheen Lane
London
SW14 8LP

  • Pay & Display parking

Centre House
68 Sheen Lane
London
SW14 8LP

  • Pay & Display parking

Ham Clinic
Ashburnham Road
Ham
Surrey
TW10 7NF

  • Free parking available on site for visitors and free road parking nearby.

Whitton Corner Health and Social Care Centre
Percy Road
Twickenham
TW2 6JL

  • Free parking available on site for visitors and free road parking nearby.

Can I bring siblings?

Siblings are welcome to attend appointments. However, if it is possible to arrange childcare this can make the session easier for parents to talk to the therapist without distractions.  

Can I communicate by email with the therapist?

Yes, email communication is possible. Parental consent for sharing programmes and documents via email is required. 

Interested in a career in Speech and Language Therapy?

We are happy to offer shadowing opportunities for those interested in a career in speech and language therapy. For more information please email hrch.slta@nhs.net

Testimonials

  • ‘You are such an inspiration and your positivity and excellent modelling to all staff will stay with me.' 
    Richmond School
  • ‘Thanks Vanessa. You have been wonderful to work with, in all my various roles! Very good luck with keeping it all running. You and your team do amazing work.’  Achieving for Children
  • ‘I wanted to thank you for the session that you delivered to our STEPS team. It was fantastic and you covered everything that we could have asked for. The training and ideas have already been very useful and I have already been trying some of the ideas and techniques when visiting a couple of my families.'
    Community Nursery Nurse

Who can refer?

  • We have an open referral system to our clinic service for advice concerning the speech, language and communication and feeding development of children and young people aged 0-19 years via our telephone advice line on: 020 8614 5333

  • School aged children with language and communication needs should be referred by their school Special Educational Needs Co-ordinator (SENCo).

School starters - 2022/23 academic year

For professionals wishing to refer a child for assessment who will be starting school in Sept 22 please refer to our service by Friday 27 May 2022

Any referrals received after this date, parents will receive phone consultation only.

Referral Criteria

Referrals will be accepted by the service  for pre-school and school aged children according to the following criteria.

  • Referrals to our clinic service will be accepted for pre-school children if the child has a Richmond GP. 
  • School-aged children whose primary difficulty is stammering and/or significant persisting speech sound difficulties, and who have a Richmond GP, can also access our clinic service.
  • Children and young people whose primary difficulty is language or social communication can be referred via the School SENCo if they attend a state-funded Richmond school and have a Richmond or Kingston address. This includes children with Education, Health and Care Plans ( EHCP).
  • Consent needs to be obtained from parents or caregiver prior to submitting the referral

All referrals should be made using the referral form linked below.

If you are unsure whether to refer or would like advice before referring please contact our Telephone Advice Line on 020 8614 5333.

Please return the referral form to:

Email: hrch.childrens-therapies@nhs.net 

or

Post: Children's Therapy Services Admin Hub
Teddington Health & Social Care Centre
18 Queens Road
Teddington
TW11 0LR

Resources for Parents and Professionals

Please explore the links below for resources, advice and videos to help you support children and young people with speech, language and communication or feeding needs.

This section aims to give you tips and ideas for helping your young child’s speech, language and communication development at home. 

Emotional regulation

Emotional regulation is something we all need to learn effectively and maintain our wellbeing. Your child will be developing these skills and at this time may have particular difficulties regulating their emotions as they are outside of their usual routine.

Young children with speech, language and communication difficulties can have challenges identifying and expressing their emotions using language.

Zones of Regulation by Leah Kuyper’s uses a colour coded system to support students with this.

Zones of Regulation Explained

An advice sheet explaining The Zones of Regulation

Video resource

A video tutorial on Zones of Regulation 

Zones of Regulation Board

This Zones of Regulation Board can be used to show and remind your child of the different zones and the emotions that belong to them

Emotions Choice Board

These emotion cards can be used to support children to identify how they are feeling

Inside Out Zones of Regulation

The Zones of Regulation with Disney’s ‘Inside Out’ Characters

Zones Tools

These cut out ‘Tools’ cards can be used to support students to identify ways they can re-regulate and get into the Green Zone.

Language

Children with language difficulties can find it hard to understand instructions, express wants and needs to others, and use communication to play and interact with peers.

We have gathered together a selection of handouts with information, suggestions and tips for supporting children’s language in the home environment:

Talk about talking - an introductory talk for parents/carers

This video contains information about how language and communication develops, as well as tips and strategies for you to try with your child if you are concerned they are not developing their language and communication skills as you would expect compared to other children you know.

4Ss

This leaflet gives advice on 4 simple language-enhancing strategies you can integrate into your daily routines and communication with your child.

Special time

This leaflet gives advice on special time. Special time is a time for you and your child to engage in 1:1 distraction-free play to support with your child’s language development.

Strategies to support language and communication development

This leaflet gives a range of different activities you can try with your young child to facilitate their communication development. 

Early Imitation Skills

One of the most important ways that young children learn is through imitation of those around them.   This sheet gives you ideas of ways to explore imitation with your child.

Help me to communicate ‘before words’

This leaflet gives advice on how to support your child’s communication before they are using words.

Help me to communicate ‘with single words and phrases’

This leaflet gives advice on how to help your young child when they are starting to talk (e.g. labelling objects) and to extend these into sentences so that they can express what they want and how they  feel with other people.

Help me to communicate ‘with longer sentences’

This leaflet gives advice on how you help your young child when they are able to use sentences but need some help starting and joining in with conversations, listening and responding to others, coping with changes and managing emotions.

Developing language through play

These advice sheets give you top tips on how to develop your child’s language skills through play.

Increasing commenting

Making comments rather than asking lots of questions supports language development. This link will take you to a video with ideas on how to increase commenting

Tiny Happy People

The BBC have launched a website for families with young children – there are lots of activities on there that support language development grouped by age range – have a look and we’re sure you’ll find something new and fun to try at home. They also have an Instagram page you can follow: @bbctinyhappypeople

Aided Language Displays

Single page displays with core vocabulary for specific activities for students who have difficulty expressing their wants and needs using language:

Splingo’s Language Universe App – app for iPhone and iPad. 

This app costs about £5 and has fun engaging games for children to follow instructions from 1-4 key words.

Environment

The restrictions on social and structured activities outside of your home are likely to change your own and your young child’s routine for the short while. We want to support you to set up an environment within your home which facilitates your child’s communication development.

A Communication Friendly Environment at Home

This advice sheet gives top tips on how create a structured, predictable and low distraction learning environment.

Everyday routines

Everyday routines are great opportunities for your child to learn language and concepts. This sheet gives you ideas on how to support your child’s learning of language through functional activities.

Creating the opportunity to communicate

This sheet gives you ideas on how to create communication opportunities and optimise your child’s motivation to interact.

Now/Next Boards

Now/Next Boards is a simple and visual way to implement structure and predictability throughout your child’s day. Now/Next boards support children’s attention and listening skills. 

Visual timetables

Visual timetables are another way of supporting your child’s focus on the tasks at hand and supporting their understanding of the routine. You can cut out the ‘Daily Routine Symbols’ and place these onto the ‘Visual Timetable Template’. This can be used beyond learning tasks, for example, to support your child with their morning routine. 

Special Time

This leaflet gives advice on special time. Special time is a time for you and your child to engage in 1:1 distraction-free play to support with your child’s language development.

Tips and resources for early communication development in babies

Communication starts developing even before your baby is born, so it is never too early to focus on communication. This section gives ideas on how to support your baby’s communication development between the ages of 0 – 18 months. Our ‘babbling babies’ resources below each give examples of how the same activity to support your child’s communication development can be adapted for 0-6 months, 6-12 months and 12-18 months.

Talk about talking - Getting ready for school

This video is specifically designed for parents of children with language and communication difficulties who will be starting in Reception year in September. It contains information about how language and communication develops, skills needed to access Reception year as well as tips and strategies for you to try with your child if you are concerned they are not school ready in terms of their language and communication skills.

Talk about talking - Getting ready for school

Please note: if your child has been referred to the service since 28th May 2022 and is a school starter in September 2022, your child’s input will be different to that stated at the start of the video. You will be able to access a phone consultation with a speech and language therapist once you’ve watched the presentation who will explain the service relevant to your child. 

Starting primary school is an important transition for children and young people with SEND and their families. Our transition pathway, which describes our role in the process is here:

Starting school

This section will provide you with resources to support your school aged child's speech, language and communication skills. 

Emotional regulation

Emotional regulation is something we all require in order to learn effectively and maintain our wellbeing. Your child may have difficulties regulating their emotions outside of their usual routine, there are ways you can support your child to identify and regulate their emotions at home:

Label the emotion
“I think you might be feeling frustrated because this task Maths is difficult”

Empathise
“I feel annoyed too when I find something difficult.

Validate
“It’s OK to be frustrated”

Set Limits – If needed
“It upsets me when you push your work on the floor, because it means we need to print it out again”

Problem Solve
“Maybe we can try another activity, and come back to this when you feel calmer”

Children with speech, language and communication difficulties can have challenges identifying and expressing their emotions using language. Zones of Regulation by Leah Kuyper’s uses a colour coded system to support students with this. 

Zones of Regulation Explained

An advice sheet explaining The Zones of Regulation

Video resource

A video tutorial on Zones of Regulation 

Zones of Regulation Board

This Zones of Regulation Board can be used to show and remind your child of the different zones and the emotions that belong to them

Emotions Choice Board

These emotion cards can be used to support children to identify how they are feeling

Inside Out Zones of Regulation

The Zones of Regulation with Disney’s ‘Inside Out’ Characters

Language

Children with language difficulties can find it hard to follow spoken instructions, express their ideas clearly to others and keep up with the pace of interactions with others. This means that daily tasks can take longer for children with language difficulties and they can find learning challenging.

The handouts below contain information, suggestions and tips for supporting children’s language in the home environment:

Creating a Supportive Language Environment

This advice sheet gives parents advice on how to support their child’s receptive (understanding) and expressive language at home. 

Aided Language Displays

Single page displays with core vocabulary for specific activities for students who have difficulty expressing their wants and needs using language:

Colourful Semantics Programme

Colourful Semantics by Alison Bryan is a colour coded visual approach which supports student’s understanding and expression of ‘wh-’ words (‘who’, ‘what doing’, ‘what’, ‘where’). This handout created by ‘London Speech Therapy’ will show you how to navigate through this programme.

Vocabulary Book

Encourage your child to identify key words they are learning about in their lessons and to fill out the word maps. The word maps reinforce students understanding of the meaning and sound of the word. 

Find the link between these words

These cut out cards can be used as a game to exercise your child’s ability to link words by their underlying meanings. This is an important skill for word learning. 

Story Planner

This Story Planner resource supports students to identify key information in a story and sequence this to create or recall a narrative.

Inferencing skills

This resource can be used to develop student’s inferencing skills (forming links between meanings which are not obvious). 

Environment

At school your child will be used to a predictable, structured and sociable environment. With students learning in different ways (e.g. google classroom), and parents potentially working from home, we want to support you to set up an environment which facilitates your child’s communication and learning. 

Advice: Setting up the learning environment

This advice sheet gives top tips on how create a structured, predictable and low distraction learning environment.

Advice: Creating interaction opportunities at home

At school, your child will be used to a highly sociable environment where they mix with their peers and have opportunities throughout the day to interact. It is important to continue to create opportunities for your child to socialise. Please see top tips for how to create simple interaction opportunities within the home environment

Interaction Activities by STEM Learning

Please see ideas for more interaction activities by STEM Learning.

Now/Next Boards

Now/Next Boards is a simple and visual way to implement structure and predictability throughout your child’s day. Now/Next boards support children’s attention and listening skills. 

Visual Timetables

Visual timetables are another way of supporting your child’s focus on the tasks at hand and supporting their understanding of the routine. You can cut out the ‘Daily Routine Symbols’ and place these onto the ‘Visual Timetable Template’. This can be used beyond learning tasks, for example, to support your child with their morning routine. 

Task Planner

Task planners encourage students to break down task demands into smaller steps. This is particularly useful for students who have difficulty processing, retaining and understanding lengthy instructions

Space Reward chart

Identify a behaviour you want to reinforce, e.g. completing a non-preferred activity, requesting help etc. Then agree on a suitable motivator for your child. You can adapt this space chart to fit in with your child’s motivators. When you observe your child carrying out the behaviour you want to see, show them by ticking a star.  

Traffic Light System

Support your child to check their own levels of understanding of a task by regularly identifying what ‘traffic light’ colour they are. Agree with your child before they start their learning for the day what to do if they need help.

Starting secondary school and leaving school to progress to education, training or employment at 16 or 18 are important transition points for children and young people with SEND and their families. Achieving for Children provides help and support with the process of Preparing for Adulthood as part of their local offer. You can find out more here:

Achieving for Children 

If your child has an EHCP their link therapist will work with school staff to support them through these points of transition.  Our transition pathways, which describe our role in the process are here:

Starting Secondary School 

Post 16

Post 18 

This section contains specific information for children and young people with social communication difficulties or a diagnosis of Autism Spectrum Disorder.

Please also look at the sections which correspond with your child’s age above for more information on how to support your child’s emotional regulation, create a structured a predictable environment and support their language skills. 

Resources

People Games

When trying to build interaction routines with your child, you can try ‘people games.’

Now/Next Boards

Now/Next Boards is a simple and visual way to implement structure and predictability throughout your child’s day.

Visual timetables

Visual timetables are another way of supporting your child’s focus on the tasks at hand and supporting their understanding of the routine. 

ASD tools App – app for iPhone and iPad

This app costs £3.99 and consists of first/then boards, visual schedules/choice boards, timers and rewards. 

Attention Autism

To build attention play ‘attention bucket’ games and extend to stage 2 ‘Attention Autism’ by Gina Davies

National Autistic Society    

The National Autistic Society has a wealth of information and support on their website including a Parent to Parent helpline

www.autism.org.uk  

Social Thinking 

Social Thinking by Michelle Garcia Winner is an approach for students who have solid language skills, but require support with their social communication. The approach provides students, their families and professionals with a shared vocabulary and frameworks in which to make sense of our own and others’ thoughts, feelings, and intentions in context.

www.socialthinking.com   

Parents often ask how they should respond if their child stammers.  

  • When your child is talking show them you are listening and interested in what they are saying by nodding, waiting and giving them time.
     
  • Avoid interrupting your child to finish their sentence or tell them to take a breath or slow down as this can add increased pressure for the child (although it is not intended!) 
     
  • Parents are often worried about whether to comment on the stammer and may fear that making this will make it worse. If you child is having a particularly hard time it is okay to acknowledge this in a neutral and supportive way, e.g. “Oh that was a bit tricky wasn’t it! Well done, you got there in the end!"

    There is no need to give it a label, but showing the child that it is fine to mention it may help them to feel better about it.  If your child is not bothered then no need to mention it and just keep on listening, interacting and talking! 
     
  • Set up special 1:1 times with your child (you may need to do this with all your children)  on a regular basis (at least 3x a week) and allow your child to choose the toy/game/activity and take the lead in the play. Make sure it is a time when you relaxed and not in a rush.    These 1:1 special times can be a nice way to have calm, quality interaction with reduced pressure. 
     
  • You can play games as a family to help with taking turns in conversation and everyone to listening to the ‘speaker’.  You can make up stories together or talk about your favourite things. Please see attached ‘The Microphone Game’ sheet from the Michael Palin Centre.
     
  • We know that slowing our talking down and pausing can help all of us to plan what we want to say, choose words we want to use and support our fluency and ability to communicate our message clearly.  Avoid telling your child to slow down, and instead, model slow talking and pausing in your own speech.  
     
  • Support your child’ confidence and self-esteem by focussing on what your child doing well, giving praise and celebrating their successes. 
     
  • Supporting your child to get enough sleep, eating a good meal, establishing a routine and slowing down their ‘pace of life’ can indirectly support their fluency. 

Tips for talking to your child

Please see top tips for talking with your pre-school child from ‘The Stuttering Foundation’:

Michael Palin Centre

Specialist centre for stammering - click on the parent advice section for further advice:

www.whittington.nhs.uk

Information and Advice for Parents

Please see Information and Advice Sheet for parents by the Michael Palin Centre

The Listening Game and The Microphone Game

These games are great ways to encourage your child to implement strategies to support their talking

Important information: If at any time your child has difficulty breathing, in any way, regardless of whether you think this is related to Covid-19 or not, you should contact NHS 111 or if an emergency, call 999.  It is likely that a Paramedic would be sent to your home to advise on next steps i.e. either to go to A&E or you will be given further advice / strategies at home by the Paramedic or a home-visiting medic.  

SLT Feeding Team

Speech and Language Therapists (SLT) are experts in the anatomy, physiology and psychology behind the skills required for all aspects of eating and drinking. We provide assessments and support for those experiencing difficulties with eating, drinking or swallowing. When the ‘mechanics’ of eating, drinking or swallowing go wrong – this is known as dysphagia.

What is Dysphagia?

This is where a person may have difficulty with:

  • keeping food or fluid inside their mouth
  • moving food and drink around their mouth
  • chewing 
  • the act of swallowing

What are the risks?

When swallowing, the food or fluid should go down the food pipe (also known as the oesophagus); however, it may go down the ‘wrong way’ resulting in coughing or choking. This means the food or drink has entered the airway. If this occurs regularly, then it could signify a risk of aspiration (food or fluid entering the lungs) and could potentially lead to a chest infection or aspiration pneumonia.  

A person who has difficulty feeding and or maintaining a healthy weight, may require enteral feeding such as tube feeding i.e: Nasogastric tube (NGT) or Percutaneous Endoscopic Gastrostomy (PEG). This would only be recommended after other strategies have been trialled and always as part of a discussion with Parents, SLT, Dietitian and Consultant Paediatrician.

Resources

Recommendations for Dysphagia

This sheet provides recommendations for children with dysphagia (chewing / swallowing difficulties)

Cough & Symptom Diary

Please complete this diary if you have concerns about your child’s feeding and share the information with your speech and language therapist

Advice sheets

These advice sheets give information on how to support your child to move on to different textures of food:

Pacing strategies

This advice sheet gives you information on how to pace food and fluids slowly to support your child

IDDSI Information

The IDDSI framework has been developed to introduce standardised and consistent terminology internationally for modified diet and thickened fluids and to provide clear descriptions of these textures. 

IDDSI framework

The International Dysphagia Diet Standardisation Initiative (IDDSI) outlines the different consistencies for food and drink.  

IDDSI handouts

The International Dysphagia Diet Standardisation Initiative (IDDSI). This refers to the different descriptions for food / drink. Your SLT may recommend a modified diet if your child is having difficulty with a particular texture and also a particular ‘level’ of fluid may be required to minimise any risk of aspiration.  Your SLT would have given you specific advice for which level to follow.

Sensory-Behavioural Feeding Difficulties 

Sensory Behavioural Feeding Difficulties are when a person has an aversion to eating or drinking. This may be based on the sensory properties of food or can be caused by a negative feeding experience such as prolonged tube feeding. 

What is Fussy-Picky Eating?

Fussy picky eating can be part of normal development, and this is known as neophobia.  Each child is different, some may grow out of neophobia and for some children this may be lifelong.

What is Sensory-Behavioural Feeding Difficulties?

Some children demonstrate significant reluctance to trying new foods. They may avoid wet sticky foods like sauces on pasta and prefer only dry, crunchy consistencies such as bread sticks or they may prefer foods presented in the same way at each meal (known as food jagging). This may result in a very limited diet.  

What is Avoidant Restrictive Food Intake Disorder (ARFID)?

ARFID is a significant and extreme sensory-behavioural feeding difficulty. As described in the DSM-V (Diagnostic and Statistical Manual of Mental Disorders-V, 2013), it includes:

An eating or feeding disturbance (e.g. lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) shown by persistent failure to meet nutritional or energy needs with one or more of the following:

  • Significant weight loss (not always the case)
  • Significant nutritional deficiency 
  • Dependence on enteral feeding/oral nutritional supplements
  • Marked interference with psychosocial function. 

It does not occur exclusively during the course of anorexia nervosa or bulimia nervosa and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced. It is not attributed to a co-existing medical condition or disorder. 

It is important to remember that the child is not being stubborn or difficult about food, but are experiencing a fear or anxiety around food.

Please remember:

It is important that you try not to worry. You really are not alone in this as so many children develop a degree of fussy-picky eating. Try and follow the professional guidance outlined below and if you are concerned that they are losing weight or are unusually lethargic, contact your GP as a referral to a dietitian may be required.

Your Sensory-Behavioural Feeding Journey

Please explore the image below to see how we can support you and your child on your sensory-behavioural feeding journey.

FwF Roadmap.PNGStrategies for Home and Education

Away From Meal Times:

  • Encourage them to have fun with food by: 
    • Food preparation e.g. cutting vegetables for the family dinner with no pressure to eat
    • Helping with food shopping and putting shopping away
    • Making a shopping list. 
  • Messy Food Play - this helps the desensitisation process as they are not expected to eat during this activity.

During Meal Times:

  • Keep to regular meal and snack times. This helps to regulate the appetite.
  • Try to eat as a family whenever possible, even if it is just once per week. This allows your child to see what and how you are eating
  • Do not force-feed your child. This sets up a negative situation for both of you. We want eating to be a positive experience. 
  • Try to serve the meal at the dining table, rather than plate up in the kitchen, so they can see the whole meal.
  • Encourage your child to serve the food to others at the dining table. This is a desensitisation approach and enables them to interact with food from a slight distance.
  • Try to offer multi-vitamins each day. These may be available from your Health Visitor or Children's Centre.
  • Try to offer preferred foods that are already 'fortified'. This means that they will get some extra nutrients in their diet.

Resources

"Food Refusers course for parents" video

To help parents understand fussy-picky eating and sensory-behavioural feeding difficulties and provide further strategies. 

Sensory Play Toolkit

The fun way to help avoidant, picky or fussy eaters.

Food Diary

To help you identify which foods your child mainly eats.  It can also help to highlight which food groups may be missing from their diet.

Love it-Like it-Learning it Meal Planner

This is to help you meal plan and identify which foods to offer to try and expand their diet.

32 Steps to Eating

This demonstrates the different steps we all need to take before we will eat something

Matching Fun with Food

Another approach to encouraging your child to try something.

Schools and ARFID

A leaflet on advice for schools.

NHS Fussy Eaters

Advice with links to understanding challenging behaviours as well as meal planners.

ARFID Awareness UK

This is specifically for children with significant sensory-behavioural feeding difficulties or who may have ARFID.  However, it has a number of resources for all those with challenging eating / limited diets.

www.arfidawarenessuk.org

Infant & Toddler Forum

This has a range of advice sheets on fussy-picky eating and although aimed at younger children, would benefit school-age children also.

Tiny Tastes

This is a reward based programme to help children try different foods.

weightconcern.org.uk

Speech sound screening tool

Click the text above to access our speech sound screening tool. 

Resources

Helping your child’s speech sounds

This is an advice leaflet containing strategies to support your child’s speech sound development.

Making music listening activities 

This is an advice leaflet containing a range of listening activities which will benefit your child’s speech sound development. This is aimed at younger children.

Developing listening skills for speech

This is an advice leaflet containing a range of listening activities related to making music to support your child’s speech sound development This is aimed at older children.

Referred families

You may have been advised to complete the All About Sounds Course by your Speech and Language Therapist, if this is the case please access the All About Sounds Movie and Dragonfly Sessions below:

All About Sounds movie

Click on this link to launch a video with information on how speech sounds develop as well as tips and strategies for you to try with your child if you are concerned their speech is not as you would expect compared to other children you know. 

Dragonfly Sessions

Please find here guidance on activities to try with your child to support their speech sound development once you’ve listened to and watched the All about sounds powerpoint presentation with narration

Session 1

There are 5 videos for this session. Please watch all 5 and try out the activities with your child. We advise you practise these activities with your child little and often (e.g. 5 minutes at least 3 times a week) for a few weeks before moving onto session 2. 

Session 2

There are 4 videos for this session. Please watch all 4 and try out the activities with your child. Once you have watched both sessions, you can practise the activities from both sessions with your child little and often. You will start to notice changes in your child’s speech over the next few months.

Some of the changes will be very subtle so listen out for them – remember to praise any attempt your child makes to change the way s/he is pronouncing words. 

Our service works closely with parents, early year’s practitioners and teachers to encourage families to best support multi language development. 

The Royal College of Speech and Language Therapists (RCSLT) recognises that bilingualism in children and adults is an advantage. Using more than one language is something that should be celebrated, promoted and supported. Bilingualism stimulates brain development and helps children learn because they can think about their ideas in two (or more) languages.  

Please also look at the sections which correspond with your child’s age above for more information on how to support your child’s speech, language and communication skills.

Bilingualism key points

  • Bilingualism does not cause or contribute to a speech, language or communication disorder
  • Only you can teach your child your native tongue, you must be the one using this language around them
  • Parents should use their strongest language with their child, this helps to build a good language foundation and the second language can then map on top 
  • Speaking more than one language comes naturally to babies, whose brains are wired for all language, you can speak a range of languages to your child from birth 
  • At a very young age a child learns to tell the differences between the languages used around them 
  • If your child is mixing languages in a sentence (known as code-switching) this is a strength it shows that your child has a good knowledge of multiple languages 
  • It is important to identify who speaks which language to your child – try to be consistent with this, your child will learn to associate who to speak which language to
  • If you are confident in speaking your home language and English you can speak both languages to your child. It may help to allocate times or places to speak certain languages e.g. speaking one language at home and one language in the community or speaking one language when you are alone and one language when your partner or other friends/family are present
  • Try to use both languages in a range of environments and activities so your child learns the range of vocabulary they need  - it may help to find a community group for your home language
  • English as an additional language (EAL) Key Points: 
  • If you are not confident in speaking English please use your native language at home, your child will be exposed to English at nursery and school - it is much more important that your child has a good foundation language for English to map onto 
  • When your child is learning a new language it is common for them to go through a ‘silent period’. This is where they are taking in and understanding the new language around them before they begin to use it in their talking
  • Visual materials may help a child learning English as an additional language in their nursery or education setting. They will be able to apply their knowledge from their home language to the visuals being used e.g. photos or symbols 
  • Playing with other children and participating in a wide range of activities that encourage communication is the best way to support a child’s bilingual development 

When to refer

We refer children to our service under the same criteria for bilingual and monolingual children 
If there is a delay in your child’s first language and they are making limited progress with secondary languages it is worth seeking further advice.

You can contact our telephone advice line on 020 8614 5333.

Advice sheets

Biligualism - English as an additional language (ICAN factsheet)

This advice sheet is from the ICAN charity for children’s communication. It provides further information on frequently asked questions regarding bilingualism. This advice is suitable for early years and school aged children. 

Supporting bilingual children in early years settings (ICAN factsheet)

This advice sheet is from the ICAN charity for children’s communication. It provides further information on how to support children in early years settings learning multiple languages. This advice is suitable for early years foundation stage children (up to 5 years). 

Teaching your home language - top tips for parents (National Literacy Trust)

This advice sheet is from the National Literacy Trust for supporting early language development. It provides further tips on good communication techniques to support your child’s language development in your home language. This advice is suitable for early years foundation stage children (up to 5 years). 

Useful websites

National Literary Trust

Bilingual resources for early years children in a range of languages 

More information and advice sheets for bilingualism in the early years 

ICAN Communication Charity

Resources from the ICAN communication charity - click on the 'resources for speakers of other languages' drop down menu. You will then find their 'Talk Together' booklet for babies and toddlers in a range of languages. 

ICAN parent resources

This section contains specific information for children and young people with any degree of hearing impairment.

Our service works closely with other members of the multidisciplinary team including Audiology and teachers of the deaf to support the needs of your children.

Research supports early help and prevention for children with hearing impairment and therefore the Richmond service offers an early help and prevention service for a child identified with a permanent hearing loss who has been referred into the service prior to any communication delay being identified.

Please also look at the sections which correspond with your child’s age above for more information on how to support your child’s language skills and their emotional regulation skills as well as their speech sound pronunciation.

Glue ear

Glue ear is a very common childhood illness; it can affect one in five pre-school children at any one time. It results in a temporary fluctuating hearing loss.

How my child’s communication may be affected

  • Attention and listening – may not respond to their name, may demonstrate difficulties maintaining attention.
  • Social interaction – may begin to stop playing with others and prefer to play alone, may demonstrate a change in behaviour
  • Receptive language (understanding) – may not follow instructions or respond to questions you ask. 
  • Expressive language (talking) – may have a delay in their talking e.g. how many words they have compared to other children their age; may say ‘what?’ to you a lot of the time. 
  • Speech (pronunciation) – may have difficulties hearing particular speech sounds, which can impact upon how the child learns to use the sound and therefore the clarity of their speech. 

Parental strategies for glue ear

  • Get down to your child’s level and get eye contact with your child before speaking to them.
  • Reduce background noise as much as possible (e.g. radios, TV, washing machine).
  • Make their teacher is aware of your concerns and ask for them to sit at the front.
  • Make sure you have their attention before speaking to them, by saying their name and touching them if necessary.
  • Use gesture alongside language and encourage them to do the same.
  • Slow your talking down rather than speak louder.
  • If your child is struggling, use a shorter sentence. Repeat the main point again to make sure they have heard it.
  • Ask your child to repeat back an instruction to check that they have heard it properly.
  • Support verbal information with visuals e.g. gesture, Makaton, pictures
  • See speech sound section for specific listening/speech based activities. 

Resources

Glue ear guide NDCS

This resource was produced by the National Deaf Children’s Society. It outlines more details about glue ear for parents.

Permanent hearing impairment

Babies and toddlers

It is important to notice communication attempts from your baby, these may be subtle (e.g. kicking legs), and then be sure to respond to these communication attempts. It may be useful to keep a record of how your child is trying to communicate with you.

Help my baby communicate advice sheet

This advice sheet gives a range of strategies to support your baby’s communication development. 

How is my baby communicating monitoring sheet

Use this resource to track how your baby is communicating with you, it may not be verbally. You can also track what this is in response to and therefore what your baby is motivated by.

University of Sheffield videos

This series of YouTube videos explore how babies learn to communicate as well as communication tips for supporting babies and toddlers with a hearing impairment.

Children

For older children with a hearing impairment, it is important to continue to consider environmental adjustments, especially minimising background noise, and also the communication partner’s communication style with the child.

Parents and school staff need to be aware of the impact of listening effort on a child with a hearing impairment.

It is also important for school staff to encourage and praise self-advocacy when a child has a hearing impairment, for example, the child informing staff that they did not hear something, the child informing staff that their hearing aid is not working. 

Resources

Strategies for parents of children with a hearing impairment – under 5yo

This advice sheet provides advice for parents with regards to environmental adjustments and communication style with a child with a hearing impairment. Mostly relevant for child under 5 years old. 

Strategies for parents and teachers of children with a hearing impairment

This advice sheet provides advice for parents and teachers with regards to environmental adjustments and communication style with a child with a hearing impairment. Mostly relevant for school-aged children.

Creating good listening conditions for mainstream schools NDCS

This resource was created by NDCS in 2016 to support mainstream teachers in ensuring they have good listening conditions for mainstream schools for children with hearing impairments to ensure they can fully access the curriculum.

Useful websites

National deaf children’s society

This website contains useful information for parents, children and young people and professionals.

Sound foundation for babies and toddlers

This website gives ideas on how to support your child’s early communication through everyday activities.

Tips and resources for Early Years Practitioners

This section is specifically for early years practitioners to support with children who have speech, language or communication needs in their setting. These resources can also be used universally to support all children within the nursery setting with their communication development. 
This section also recommends particular websites that would be relevant to early years practitioners.

What to do if you have concerns about a specific child in your setting

•    If you have concerns about a specific child in your setting, it is important to raise these concerns with the child’s parent in a timely manner. The Communication Trust have created a video on their website that can support you with preparing for this conversation.  The Communication Trust advises that ‘the video is intended to be used as a professional development resource, to enhance confidence and skills in talking with parents about their child’s speech, language and communication development and skills’.

The Communication Trust - A Professional Development Video: Talking to parents

•    You can contact the Richmond speech and language therapy early years setting advice line directly if you would like advice about whether a referral is appropriate – 020 8614 5333.
 

Advice Sheets  
ICAN Factsheet: Supporting Bilingual Children in Early Years Settings  This advice sheet is from the ICAN charity for children’s communication. It provides further information on how to support children in early years settings learning multiple languages. This advice is suitable for early years foundation stage children (up to 5 years). 
The Four S’s Four key tips to help you support all children’s language and communication skills.
Creating the opportunity to communicate  As adults, we often anticipate children’s needs, which reduces their need to communicate.  This advice sheet contains ideas for developing children’s communication skills by creating opportunities through everyday activities.
Reluctant talkers – ABC Handout Some children speak comfortably and confidently at home but when they start at a new setting they are very reluctant to talk and say very little or in some cases nothing at all. This advice sheet provides strategies for helping these children to settle and find their voice early on in their new environment.
Visuals in the nursery handout Visuals in the nursery will benefit all children in the setting. This advice sheet talks about ways photos can be used in your setting to create a more communication-friendly environment. 
Makaton for nurseries Makaton supports children’s understanding and use of language. It does not replace words but when used with words, it is a very powerful tool in supporting early language development. This advice sheet explains Makaton and includes a range of useful Makaton signs to get started with using in your setting.
Bucket time  Sharing joint attention with an adult is a key skill children need to learn in order to develop their language and communication skills and to build readiness for learning.  This advice sheet recommends a short activity that can be run either 1 to 1 or with a small group of children to develop their attention to highly motivating activities.
Play development summary As you are aware, children go through a range of play steps in their development. Play is closely linked with language development as it provides us with a window into the child’s understanding. This advice sheet talks through the stages of play in more detail.
Ways to look at a book There are so many communication skills a child can learn through looking at a book with an adult. This advice sheet talks about ways that looking at a book can support attention and listening, play and interaction, understanding of language, talking and speech sound development. 
Developing listening skills for speech Children can’t say all speech sounds as soon as they start to talk.  Their speech follows a typical developmental pathway, and they develop their skills through listening.  This advice sheets gives tips and ideas to support children to listen and develop their speech sounds.
Help your child’s speech sounds Children can’t say all speech sounds as soon as they start to talk.  Their speech follows a typical developmental pathway.  This advice sheet gives an overview of the order in which children’s speech sounds develop, together with some top tips to help develop children’s speech.
Stammering advice It’s not unusual for young children to have a period of stammering, especially at a time when their language is developing rapidly.  For most children stammering resolves after a short time.  This information sheet gives advice and tips on things you can do to support children who are stammering.

 

Useful websites  
National Literacy Trust

Bilingual resources for early years children in a range of languages 
https://literacytrust.org.uk/early-years/bilingual-quick-tips/ 

 

More information and advice sheets for bilingualism in the early years 
https://literacytrust.org.uk/resources/understanding-bilingualism-early-years/ 

Hungry Little Minds Hungry Little Minds – Simple fun, activities for kids aged 0 – 5 (campaign.gov.uk) – This government website includes a range of activity ideas for different ages and can be shared with parents of children in your setting for providing them with further ideas on how to support their child’s communication development. 
BBC Tiny Happy People Activities for babies, toddlers and children - BBC Tiny Happy People – This website recognises the importance of communication and includes a range of advice and resources to support with communication development. They also have Instagram and Facebook pages that are regularly updated with ideas to try. 
Communication Trust The Communication Trust – This website has a range of resources that are beneficial for early years practitioners including online CPD courses for further developing your skills in speech, language and communication.
Glue ear information from the NDCS National Deaf Children's Society - This website highlights that ‘1 in 5 pre-school children have glue ear at any one time’. It is therefore important to be aware of the signs to look out for so you can help identify children who may need to go for a hearing test. This link explains glue ear, the signs to look out for and how to support a child who has glue ear. 

Useful Links:

Details of Children's Centres within the Richmond Borough

Achieving For Children is a social enterprise company created by the Royal Borough of Kingston upon Thames and the London Borough of Richmond upon Thames to provide their children’s services. On 1 August 2017, the Royal Borough of Windsor and Maidenhead became a co-owner of AfC and they now deliver children’s services across all three boroughs. 

Portage - Portage is a home-visiting educational service for pre-school children with SEND and their families. Portage aims to:

  • Work with families to help them develop a quality of life and experience, for themselves and their young children, in which they can learn together, play together, participate and be included in their community in their own right.

  • Play a part in minimising the disabling barriers that confront young children and their families.

  • Support the national and local development of inclusive services for children. 

Local offer - information on local services and support available for families including children and young people aged 0 - 25 years with special educational needs or disabilities 

Richmond Parent Carer Forum  - The Richmond Parent Carer Forum is a newly formed independent group working to achieve better outcomes for children and young people with any special educational need, additional need or disability in the London Borough of Richmond.

Independent Advice and Support Services  - The organisations offer (mostly free) independent advice and support on all SEND matters including the Assessment, Education, Health and Care Planning processes.

Independent Parental Special Education Advice  - This website has free resources to help families get the right education for children and young people with all kinds of special educational needs and/or disability (SEND).  

Local support groups: 

Small Steps is a charity based in Richmond that run conductive education group classes for pre-school children with physical disabilities.  

Skylarks  is an independent Richmond-upon-Thames based charity that provides activities and therapies for children with disabilities and additional needs. They also support and provide therapies, courses and information for their whole families. 

Kids (Richmond and Kingston SENDIASS) is a free, confidential and impartial service for parents and carers, children and young people (up to 25 years).

Henry's Bleu Moon A local parents and carers support network. Bringing together parents and carers of children with SEND. To connect up parents and carers of children with additional needs and create a support network across Richmond and Kingston.

Please see leaflet for more information

RUILS Family support groups - RUILS are a charity providing support to parents and carers in the Richmond borough. They provide regular coffee drop ins for families with children who have disabilities and/or additional needs on the 4th Tuesday of every month. You can pop in, have a coffee, and meet other families. Ruils staff are on hand to provide answers to any questions you may have.  

National charities and support groups:

I Can - the children's communication charity.  I Can Help is a range of information services that provide help and advice to parents and practitioners about speech, language and communication. It includes a free call-back service with a speech and language therapist,

Talking Point's website is dedicated to speech and language, and ICAN's assessment services

STAMMA the British Stammering Association, is the UK national charity for people who stammer (or stutter) and those that support them. 

Afasic website provides lots of information and supports families in getting the right help for children and young people with SLCN and all related queries.

The Communication Trust is a coalition of over 50 not-for-profit organisations. Working together they support everyone who works with children and young people in England to support their speech, language and communication. 

Charitable funding:

Action for Kids is a charity that helps young people with physical and learning disabilities across the country find greater levels of independence and opportunity through the provision of mobility aids, employability training and family support. 

Always look on the Bright Side of Life Charitable Trust awards grants to make children smile. The trust awards one off grants to children in need for activities/ items (not household)/trips that children’s families are unable to afford. The child must be disadvantaged due to financial circumstances, disability/ill health or other category. 

Boparan Charitable Trust aims to help children and young people up to the age of 18, throughout the UK, who are disadvantaged either through poverty, disability or life-limiting conditions.  

Cash for Kids is Bauer Radio’s network of local charities, which operate across 22 areas around the UK. Our mission is to respond to the needs of children in our communities, and we aspire to enable all children to live life to the full and achieve their individual potential.  

Cauldwell Children offers a range of support to children with disabilities including family support, short breaks equipment, treatment and therapies. You can apply direct and the process is straightforward.

Children Today encourage applicants, usually parents, to come to them for funding and other services on a regular basis as their child’s needs change. Hopefully, this will continue as they grow and develop, gaining more independence and an improving quality of life that is also shared by all those around them. They will continue receiving support until the child reaches the age of 25 years.  

Cerebra is a unique national charity that strives to improve the lives of children with neurological conditions, through research, information and direct, on-going support. 

Dreams Come True is a UK children’s charity. Their mission is to enrich the lives of children and young people with serious and life-limiting conditions across the country by making their dreams come true. Over the last 25 years they have fulfilled dreams for more than 5,000 children and young people as well as their friends, family and carers.  

Family Fund If you are raising a disabled or seriously ill child, the family fund may be able to help with a grant for household items, equipment, sensory toys, a family break or something to help with college for 16/17 year olds. You can apply as a parent carer, or agencies can apply on their behalf.

Happy Days Children's Charity supports families with children aged 3-17 who have learning difficulties, physical or mental disabilities, acute, chronic or life limiting illnesses, been abused or neglected, witnessed domestic violence, been bereaved or act as carers for a parent or a sibling. Eligible applicants can apply for the costs of the following activities: Day trips/theatre trips/theatre workshops and Group Activity Holidays.  ​​​​​​​


Local funders. There are a number of local funders such as Richmond Parish Lands Charity, Hampton Fuel Allotments and Barnes Workhouse Fund that offer grants to individuals and families particularly in relation to fuel grants, white goods and other household equipment and education. For a full list of the local funders.   
 
The Family Holiday Association (FHA) supports families on a low income, that have not been on holiday for the past four years and have at least one child between three and 18 years of age can obtain financial support for a break during 2016 and 2017. The FHA can only accept applications from referring agents (such as a teacher, social worker or health visitor, etc) and not directly from families. The website also has a great resource page which lists other charities and trusts that can support holidays and short breaks.

The Henry Smith Charity (Richmond). People experiencing hardship or distress who live in Richmond, Ham, Petersham or Kew. Applications in writing from referring bodies such as citizen advice and social services.

Tree of Hope is the crowdfunding charity that helps children and young people with a disability or illness by supporting their families to raise the money they need to pay for specialist care that is not freely available through the UK healthcare system.  

Turn2us. A fantastic website that offers help and information for anyone experiencing financial hardship or debt problems, or who is looking for funding to support an individual need within the family such as a short break. It has a grant and benefits search engine which can be tailored to meet your requirements including locality, and a phone helpline that is free to call and gives you access to trained staff who can talk you through your options. The service is available to individuals and organisations acting on their behalf.

Meet the Team

Julie Hale - Divisional Manager 
Tel: 020 8973 3181

Claire Schneider - Clinical Service Manager for Children’s Therapies
Tel: 020 8614 5331

Early Years Team including Clinic, Early Help & Prevention & Feeding service 
Team Leads: Vanessa Gordon & Karen Griffin (Clinic, Early Help & Prevention) and Nicole Murray (Feeding) 
Tel: 020 8614 5333

Mainstream Schools Team
Team Lead: Georgina Brown
Tel: 020 8614 5333

Special Schools and Specialist Resource Provisions Team
Teams Leads: Tess Buckley (Special Schools) & Katie Varney (Specialist Resource Provisions)
Tel: 020 8614 5333

All about us

SLT Team Photo.PNGLearn more about our therapists below.

Ellie

Franky

Georgina

Katie

Laura H

Sunner

Tash

Tess

Vanessa

See where we work

We've made a short video about visiting Ham Clinic, which you can watch with your child.