As speech pathologists, we will often ask about eating and how a child behaves at mealtimes. This can give us a lot of information about what they are doing with their mouths, their routines and their sensory preferences.

One of the most frequent responses that I get is “Oh, he is eating pretty well, except he hates his veggies”. Even as adults, we often aren’t consuming as many vegetables as we need, and we also have preferences about which ones go in our mouths. So how can we act as role models to encourage more vegetable consumption? There are in fact many steps to eating that don’t involve chewing and swallowing. Beginning with increased exposure and normalising vegetables can be the start to a more nutritious and diverse palate. Here are some tips to helping kids love veggies:

PEELING – Peeling vegetables and creating snakes, eels or noodles from the peels can encourage interaction with new vegetables as well as fine motor skills. Websites such as https://kiddiesfoodkutter.com.au sell kid-safe utensils for worry- free food play. Alternatively, they could hold the vegetable still with a fork and peel with the other hand. Soft vegetables such as zucchini are easier and safer to begin with. Once this is achieved, you could suggest peeling with teeth!

BLENDING – Blending fruits and vegetables together can be very entertaining to watch as the colours swirl and mix. You may let your child choose their favourite fruits and one new vegetable to blend together. There should be no pressure to taste the smoothie, but it may spark curiosity about how the flavours could change once mixed.

STAMPS – Vegetables such as potatoes, beetroots and other root vegetables make great stamps if you’re willing to do some carving. However, there are many vegetables that create beautiful patterns when cut in a certain way. Encourage your child to choose and experiment with cutting and stamping to create an artwork or wrapping paper.

The idea is not to pressure with tastes and bites, but to encourage sensory exploration and investigate the different properties of vegetables. The aim is for your child to be able to talk about food positively and to feel encouraged to try vegetables on their own terms.

Written by Joanne Tran, Speech Pathologist.

Learning To “Do”

“Fine motor skills” is a term for something we all do all the time…use our hands. Being able to use their hands means more to your child than simply being able to pick things up and put them down. The fine motor skills your child develops in their first year will enable them to interact with their world… to create, to explore, and to “do” all kinds of things. By the time they are two or three years old, they will be grasping crayons and markers to scribble, holding the handles of a push toy or riding toy, and learning to grip and release a ball in their earliest games of “catch.” To use their hands, your baby will have to develop hand-eye coordination and also the ability to reach, grasp, hold, and manipulate things.

• By the time most infants are about five months old, they are able to judge whether an object is within their reach.
• At six months, most babies’ fingers will still act as one. When they grasp something, it is with a full-handed raking motion.
• During the second half of the first year, your child will begin to show a preference for one hand over the other. They will gradually learn to move their fingers and thumbs individually, and will begin using their fingers more and more to explore things…from the faces of parents and family to any accessible electrical outlet! Gradually they will learn to use their thumb and forefinger to pick up small objects. Achieving this ‘pincer grasp’ is probably the most significant milestone in small motor skill development. Your child will begin to use their index finger to point at objects in order to get your attention and “tell” you something without using words.
• By about nine months, many children can guide their hands smoothly to an object after glancing at it only briefly. At about this age, many children also learn to transfer an object from one hand to the other.

Increasingly complex “doing”

It’s interesting to observe the progression babies make in learning to manipulate objects. First, they simply hold it, then they rotate it in their hands, then they shake it. They will learn to hold an object with one hand before they are able to hold it with two. Gradually, they are able to make the objects they hold part of a deliberate plan as they experiment with stacking blocks, or fitting a toy into a shape box.

By twelve months…

Most toddlers are able to adjust their fingers and thumbs into positions that are appropriate to the size and the shape of the object they are trying to grasp. As a toddler’s reaching and grasping skills become better coordinated and more precise, they are able to achieve independence in many ways; drinking from a cup, eating with a spoon, picking up small bits of food from their highchair table, taking small snack foods out of a container, and learning to put on, and take off, some or all of their clothes.

If you have any questions about your child’s development of their fine motor skills, an occupational therapist can assess whether your child’s current fine motor development requires any early intervention to ensure that they are able to continue to develop their skills to their best of their ability.

Written by Alannah Santomartino, Occupational Therapist.

Gosh, it can be pretty tricky for children to wait for their turn, especially when they are doing something that is so fun and exciting!

Below is a great flipcard strategy I use during my sessions to help my clients learn to wait. Young children are still developing their sense of time. They need help to understand how long “soon”, “5 seconds” or “in a minute” really is without having to read a clock.

Here are some strategies that can help your child understand how long a turn will be:

• Timers – A sand timer can be used with very short turns. When all the sand falls to the bottom your child will know it is his turn. You can set a kitchen timer for a few seconds or minutes. When the buzzer sounds it is time for your child’s turn.
• Counting – Count out loud or use your fingers. If your child can count, encourage him to join in. For example, “One…two…three… It’s Adam’s turn!”
• Music – Play or sing a short song for your child. When the song is over, it will be his turn. You can also recite a short nursery rhyme.
• Quiet Activity – Children who often become restless or impatient while waiting for others may be directed to do a quiet activity on their own such as looking at a book.
• ‘Fidget’ Toy – Your child can play with a small toy or piece of clay while waiting for his turn. This is a helpful way to keep your child busy when you need to wait.

Communicating Turns

Try to emphasize the word “turn” during daily routines at home. For example, “Sally is riding the bike. Next, it will be David’s turn.” Your child will soon understand that a turn means he has to wait until another person is finished using or doing something before he can use or do the same thing.

Use a combination of speech, gestures, and pictures to help your child learn to use the following expressions:

• “My turn” Pointing to his chest.

Pointing to the “my turn” picture in his communication book.

Practise saying the words.

• “Your turn” Pointing to or gently touching the hand of the other person.

Passing a toy to the other person.

Pointing to the “your turn” picture in his communication book.

Practise saying the words.

• Flip Card – You can create a special card to help your child during turn taking. Take a cue card, or small piece of construction paper and glue your child’s picture to one side. On the other side, glue a picture of the person he is taking turns with. You can show whose turn it is by placing the card on the table. For example, Johnny’s picture is on one side of the card and Jessica’s picture is on the other. When Johnny’s turn is finished, he flips the card over so Jessica can see her picture and know it is her turn.

Written by Didem Karademir, Speech Pathologist.

Vocal nodules are benign (non-cancerous) growths that form on the vocal folds. Our vocal folds are tissue with a delicate lining that vibrate in the air stream to produce voice. Sometimes, when we speak or sing incorrectly for prolonged periods of time, the lining can swell. Over time, this swelling becomes firmer, until it is a nodule.

All children strain their voice every now and then: calling out while playing with their friends, imitating animals or cartoon characters while pretend playing and screaming when upset about something. This usually does not do any harm to the vocal cords.

However constant screaming, excessive crying or using the voice in an unnatural way for a prolonged period of time could lead to misuse of the vocal cords. This can lead to your child’s voice sounding hoarse or breathy for a long period of time. A child with chronic hoarseness will usually be referred to an Ear Nose and Throat (ENT) specialist for a thorough examination.

A speech therapist can help by teaching the child better vocal hygiene and ways to preserve and use his/her voice better over time. If you have questions about vocal nodules or think your child may have them, please contact your ENT and speech therapist for further evaluation.

Written by Tasneem Abdul Samad, Speech Pathologist.

Many times, I am asked by parents about the impact of pacifier use on the development of speech and language in young children.

According to research, there are benefits of using a pacifier. Some of these include

• Pacifiers may help your baby fall asleep
• Pacifiers may ease discomfort during flights by relieving ear pain caused by changes in air pressure
• Pacifiers are disposable
• Pacifiers may soothe your baby

Oral health and dentition

One of the primary concerns related to pacifier usage is the potential for dental problems. One study, in 2006, found that pacifier use does not significantly impact the arrangement of teeth if its use is stopped by 2 to 3 years of age. However, pacifier use beyond 3 years of age, particularly beyond age 5 years, was found to lead to greater problems with teeth. This can have a negative impact on speech and language learning.

Anterior open bite, a dental concern related to prolonged use of pacifiers

Posterior crossbite, a dental concern related to prolonged use of pacifiers

Speech (pronunciation) development

Different studies examining the relationship between pacifier use and speech (pronunciation) of children found different results. One study found no impact on speech of children with prolonged pacifier use. However, in 2009, another study found that use of a pacifier for 3 or more years may lead to problems with speech development in young children.

Pacifiers can sometimes cause the child’s tongue to push between the teeth, as shown in the picture above, and inhibit the child from being successfully able to produce the /s/ and /z/ sounds. This speech development delay in these sounds can then cause the child to form a lisp when producing words.

If your child has a pacifier in his/her mouth for most of the time, this may reduce his/her opportunities for babbling (“gaga” “dada” “a-ga”) and imitation of sounds and words. Engaging in conversations may also be limited as the sounds that are made around the pacifier may not come out as clear.

When should my child stop using a pacifier?

According to BabyCenter Editorial Team, 2016, the best time to limit the pacifier is at 18 months of age.

How can I get my child to stop using a pacifier?

• Limit the time you allow your child to use a pacifier. For example, only for sleep time and comfort. Refrain from taking the pacifier out of the cot.
• For older children, involve your child in the decision to stop using it. For example, give them choices of throwing it away, putting it away or leaving it under the pillow for the ‘tooth fairy’
• Mark your child’s progress with a reward chart
• Praise your child when they have given up the pacifier. For example, “I am so proud of you. You are growing up”
• When you first take away the pacifier, you will probably need to soothe your child in other ways. For example, rocking, gentle swinging motion, soft singing and gentle massage are some ways you can help ease your child’s discomfort. For older children, blankets or stuffed animal could provide the comfort

If you feel that your child’s speech or language has been affected by the use of a pacifier or you would like some further information, please feel free to contact us at any time.

Written by Didem Karademir, Speech Pathologist.

Often parents think about learning to talk in the stages of crying, babbling and then words.  However, there are many steps to learning to use speech and language functionally. Below I’ve listed important skills that a child must develop before being able communicate in a functional way.

1. Joint Attention: This is your child’s ability to understand that he or she and at least one other person can pay attention to the same object.

Signs of Joint attention: Your child is able to follow eye gazing, pointing, or other gestures from another person (a communication partner) which leads to both paying attention to the same object.

2. Shared Enjoyment: This is your child’s ability to share an event or feeling with another person.

Signs of Shared Enjoyment: Your child looks at you or tells you to look at what’s happening. For example, you and your child are throwing balls into a hoop. Your child gets the ball in and looks at you with a smile to confirm you also saw their achievement.

                                  Intent – baby is pointing to request an adult to look (Hemera, 2013)

1. Intent: This is your child’s ability to purposefully use different forms of communication (verbal or non-verbal) to send their messages to other people.

Signs of Intent: Your child uses verbal (e.g. saying “look”, “watch”, “come here”, etc.) or non-verbal cues (e.g. pointing, gestures, etc.) to communicate clear messages to others about their wants and needs.

2. Persistence: This is your child’s ability to continue attempting to communicate with someone else when their message has not been received yet. This shows that your child is aware of whether or not their message is reaching their communication partners.

Signs of Persistence: For example, your child is calling out to you. If you don’t turn around and acknowledge they called you, your child attempts to gain your attention by poking you and repeats what they were trying to say until they know you received their message.

                      Social Referencing – baby is checking whether its okay to climb (Coleman, 2016).

1. Social Referencing: This is your child’s ability to use cues and messages from the people around them to help guide how to act appropriately in the current situation.                                                Signs of Social Referencing: For example, your child looks to you to see if it is ok to open the door. Your child should be aware of any cues you are giving off (such as a scared facial expression or shaking your head).

You can start to look at what pre-linguistic skills your child is displaying and which ones you can work on together. If you would more advice in this area, feel free to speak to one of our speech pathologists.

Written by Joanne Tran, Speech Pathologist.

Do family members or teachers frequently report that they have difficulties understanding your child? Does your child frequently mispronounce words? Your child may need ‘speech therapy’.

What is the different between speech and language?

• Language is a person’s ability to understand and use a range of words correctly and put them into a sentence to communicate. A child who has difficulties with language may say “I duck want” or may not know what ‘duck’ means

• Speech is a person’s ability to use the correct sounds in words. A child who has difficulties with speech may say “I want du guck”

What should I do if I think my child has a difficulty with their speech sounds (pronunciation)?

• Make an appointment with a speech pathologist for a ‘speech assessment’
• The speech pathologist will assess your child’s speech using one of the many speech assessments available. This will involve showing your child a range of pictures and writing down their pronunciation
• The speech pathologist will then analyse the results and let you know if the errors are typical for a child of their age OR if they need a block of speech therapy

Is there anything else I need to know before we start speech therapy?

• In order for your child to be suitable for speech therapy they will need to be able to sit down and follow an adult led tasks for 5 minutes. If this is difficult for your child, the therapist may recommend that you delay therapy
• The therapist may ask you to see an audiologist to ensure that your child’s difficulties with sounds aren’t due to an underlying hearing difficulty

What will speech therapy involve?

• Your speech pathologist will select at least 1 sound for you to work on
• They will provide training and advice so you are able to carry out speech therapy at home
• This is usually for 5- minutes daily with your child carrying out listening work and then practising the selected sound

If you have any questions or concerns about your child’s speech, call us today and have a chat about whether there is any way we can help you!

Written by Philippa Brown, Speech Pathologist.

A lisp usually refers to a person having difficulty placing the tongue in the correct position to produce the /s/ and /z/ sound.

Types of lisps

Interdental lisp

The child protrudes the tongue and places it between the teeth when making the /s/ or /z/ sound. For instance “saw” would sound like “thaw”.

Lateral lisp

Air flows laterally over the sides of the tongue instead of “along” the centre of the tongue when making the /s/ or /z/ sound. In this type of lisp, the sound is often described as sounding “slushy”.

Is this age appropriate for my child?

/s/ or /z/ production is mastered by age 4-5 years. If your child is producing an interdental lisp and he/she is younger than 4 ½ years old, then this sound might emerge with maturation. However it is recommended that you seek support from a speech pathologist, especially if your child is older than 5 years of age.

If your child is producing a lateral lisp, then a speech pathologist should be consulted without delay as this is often not considered as something children will ‘grow out of’.

How can speech pathologist help with the lisp?

Speech Pathologist would assess your child and be able to tell you if your child has a lisp, and, if so, the type of lisp it is. The speech pathologist will show your child the correct tongue position and teach your child to produce /s/ and /z/ in isolation, phrases, and sentences.

The speech pathologist will guide you through the various steps and provide you with home practice to ensure the therapy is successful.

Written by Tasneem Abdul Samad, Speech Pathologist.

Socials stories are a tool that can assist any child with managing a situation, task or event. Social stories are a simple, visual way to guiding the child with what to do in a fun and supportive way.

Focus on one specific thing you are trying to change

Try to focus on one particular area that you are wanting to focus on changing, instead of including many different issues all in one social story.

Incorporate the positive in the story

Social stories are meant to be positive, motivating and include what your child is doing well. Focusing purely on the negatives may only deter your child from changing their current behavioural patterns.

Investigate what is causing the behaviour

Try to determine what is the exact cause of the issue. Break down elements of the situation, task or event to find out what is essential to include in your social story. Ask yourself the following questions when playing detective:

• What is going well at home or at school?
• What are my child’s strengths?
• What might be interfering with my child’s ability to participate in play, eating, dressing, learning, ect?
• Is it sensory or is it behavioural, or both? (A sensory preference can turn into a behavioural response to input or vice versa)
• What is the behaviour communicating?
• What sensory input is my child seeking or avoiding?
• Does the behaviour need to change?
• What is a more appropriate replacement/substitution that still meets his/her need?

Keep it simple

When writing your social story aim for only one to two sentences per page and include relevant visuals to support the written content of the story. For younger children write in first person, and for older children write in third person.

There are three types of sentences in social stories:

• Descriptive sentences: provide an overview of a situation event or task, and answer “w” questions your child may have – Who?, What?, Where?, When?, Why?
• Perspective sentences: describes what is happening for all involved, including their thoughts, feelings and emotions.
• Directive sentences: highlight what the desired and expected behaviour is in a positive way

If you have trialled lots of other strategies with your child you may want to give writing a social story a go. Remember to always review your social story before implementing it with your child.

At DSKC, we use social stories daily and tailor make them for our clients. Feel free to give us a call if you would like to find out more.

Written by Alannah Santomartino, Occupational Therapist.

This is such an effective strategy that I use during my sessions with clients!

The First-then schedules are some of the simplest types of schedules that I use with clients during speech therapy sessions. A first-then schedule will tell the client what activities will occur and in what sequence

First-then schedule are important for children because they:

• Help address the child’s difficulty with memory and organisation of time
• Assist children with language comprehension problems to understand what is expected of them
• Lessen the anxiety level of children with autism, and reduce the possible occurrence of challenging behaviours. The schedule provides structure for the child to predict events. For example, puzzle is coming up soon…. but only after playdoh)
• Assist children in transitioning independently between activities by telling/showing them what is happening next. Schedules can be used in all environments, including gym, classroom, home, Sunday School, speech therapy/OT sessions

How do I teach it and use it?

• Decide what you want your child to complete first (goes in the ‘first’ box). Place the reward item or activity in the ‘next’ box. Your child can have the reward item/activity immediately after the ‘first’ task is done.
• Put the visuals on the board – this could be photos, drawings, written words- that presents the activities.

Present board to the child with short instruction. Try to use least amount of words as possible. For example, ‘John, first playdoh, then puzzle’.

When the ‘first’ task is completed, refer back to the board and immediately provide the preferred, reinforcing item/activity. For example, ‘All done playdoh, now puzzle’.

Below you will find first-then schedule template that you can use with your child. Print and have a go with different pictures!

Written by Didem Karademir, Speech Pathologist.