Let’s talk about tongues!
You may have heard of tongue tie before, formally known as ankyloglossia. With around 4-11 percent of new babies being affected by tongue tie (NHS 2017), many parents will have had some experience of it or know someone who has.
What is tongue tie?
Tongue tie occurs when the strip of skin that connects the tongue to the floor of the mouth (frenulum) is too short. There are no known causes for tongue tie. Normally newborn babies will be checked for this upon entering the world. If you lift the tip of your tongue up to the roof of your mouth you will be able see this strip of skin underneath. Now, if this strip of skin was a little bit shorter, it would impact upon the movement of your tongue. For babies with tongue tie, they may not be able to stick their tongue out passed their lower lip or move it from side to side or up and down.
Why are we talking about tongue tie?
We use our tongues to speak, suck, chew, swallow, eat, drink and clear our mouths of food.
As Speech and Language Therapists are trained to recognise any abnormalities within the mouth, we are equipped to identify tongue tie. Having up to date and evidenced based information on tongue tie can help to allay concerns and dispel many myths. As tongue tie is quite common, you may find there is a lot of easily accessible information. When searching the internet for information, always check that the guidance is coming from a reliable source. Some advice may come from friends and family. Keep in mind that tongue tie will affect people differently. Information will also come from your health visitor, midwife or doctor. It is important to remember that whilst tongue tie is very common, the consequences for the individual are not generic and no two experiences will be the same.
So, what do I need to know about tongue tie?
Tongue tie causes restricted movement of the tongue and this may make latching on and feeding troublesome for some young babies (NCT)- Some babies with tongue tie will have no problem with feeding at all. If you think that your baby has tongue tie but are not experiencing any difficulties with feeding, you do not need to take any action. Sometimes tongue tie can be harder to spot, especially if it is posterior (at the back of the mouth), it may therefore go undetected. if you are concerned your child may have tongue tie and it is causing feeding challenges, contact your health visitor or midwife for guidance.
For some children with tongue tie, eating may be a messy business. When we eat, our tongues work hard to collect and push the food from around our gums, teeth and lips to the back of the mouth, so we can swallow it. For some, the restricted motion of the tongue may make this mouth clearing troublesome and parents may find they are having to assist e.g. wiping around the child’s lips after eating a yoghurt.
As a result, food may stay in the mouth and in between the teeth for long periods of time and could impact upon dental health and oral hygiene (Caroline Bowen 2015)
As well as potentially causing feeding issues, some professionals believe that tongue tie can cause difficulties with producing speech sounds. This is widely debated, and the evidence concludes that there is no direct link between tongue tie and speech challenges.
“There is virtually no evidence in the literature to establish a definite causal relationship between ankyloglossia and speech disorders. In fact, there is very little in the literature that addresses ankyloglossia and speech at all. This is probably because a causal relationship is not what is typically seen clinically. (Kummer 2005)
The impact that tongue tie has upon speech is therefore a contentious issue. Some professionals may document that the restricted range of motion of the tongue is having an impact upon a child’s ability to make particular speech sounds. Generally, however, it is thought that speech is rarely affected. Inaccurate articulation of sounds may be more apparent when a child or adult with tongue tie speaks quickly (Caroline Bowen 2015).
The most likely sounds to be affected are below:
- ‘t’,d ’n, l,s,z’ as these all require that the speaker raise the tongue tip to the top of the mouth.
One reason for limited reports of tongue tie impacting upon speech may therefore be due to the way in which the tongue learns to compensate for reduced movement. For example, with t,d,n, whilst many people will raise their tongue tip to make these sounds, they can also be made using the main body of the tongue. L,s,z may be made by pointing the tongue tip down rather than up.).
Treating tongue tie
Treatment will depend upon the severity of tongue tie and to what extent it is affecting feeding or speech. For many, tongue tie will be asymptomatic and no treatment will be required (NICE 2005)
If you are worried that tongue tie is causing your child to struggle with eating of speaking, contact your health visitor, GP or speech and language therapist. If treatment is warranted, then the short frenulum can be cut. This procedure is done following a full assessment and may be carried out under general anaesthetic.
4 Fun tongue facts! 1. The saying ‘the cat has got your tongue’ is thought to have originated from the English Navy. Apparently, they had a whip called the ‘cat-o-nine-tails’. A whipping with this tool is thought to have been so painful that one couldn’t speak for some time afterwards. Hence the phrase ‘Has the cat got your tongue’. 2. On average, we have around ten thousand taste buds. 3. In Tibet, sticking out your tongue is considered a greeting (Don’t tell your kids!) 4. Contrary to popular belief, our tongues do not have four different taste zones for sour, sweet, salty and bitter! We can in fact sense these tastes all over the tongue.
Written by Carolyn Fox, Children’s Speech and Language Therapist
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YouTube – teaching through video in less than 5 minute ‘bites’!
Video is the perfect medium to teach parents and education staff signs to use with children to help their communication development. Many of the signs we use to help can be found on YouTube:
Makaton Their YouTube channel has videos of their signs of the week to keep your skills fresh (see ‘signing’ blog post for more information about using signs to support language development)
Cued articulation is often used with children with speech sound difficulties. If your child is using this in therapy sessions, you might like to look up the signs on YouTube to remind yourself how to make them. Jane Passy explains about Cued Articulation here
Songs and Rhymes
Toddlers and pre-school children will get the most out of the videos when you watch and join in with them. YouTube is a huge library of action songs and videos, so if your child comes home from nursery singing ‘dingle dangle scarecrow’ you can learn how to join in with them here.
Singing hands sing and sign lots of popular nursery rhymes and songs if you need inspiration for a new song to share with your child visit them.
Our article ‘make time to rhyme and sing’ has tips on how you can make the most of rhyme time to boost your child’s communication skills.
Think back to the way you first learnt the alphabet, or the colours of the rainbow – does a song or a rhyme pop into your head? Calvert (2009) found that songs improved adults and children’s memory of content presented in a song compared to when the information was spoken. Videos that are engaging to children may make them more likely to want to hear the content again and again (helping them to learn it), and you can find a number of YouTube videos with songs or rhymes about anything your child may need to practice, such as…
Check out this video on opposites
And this one!
The same study also found that it is important to check your child’s understanding of information learnt through song, and talk about it together in different activities and situations, so if you learn about opposites using those songs, you could then practice sorting toy animals into big vs small animals, or talk about big and small when you are sorting out the washing.
Young children practicing a sound might benefit from these videos from Ring Card phonics (plus they give adults some handy examples of words beginning with target sounds they can then use in games):
Songs that have lots of your child’s target sound can also be good to listen to, for example if your child is learning the ‘f’ sound then this ‘fee fi fo fum’ song from Jack and the Beanstalk would be good listening practice! http://www.songsforteaching.com/speechtherapy/ has more examples of songs you could look up on YouTube containing a whole range of different speech sounds.
Pixar, Disney, and a few of the other animation companies have produced ‘shorts’ which are beautifully animated, often wordless video stories. These are great for working on language and social communication targets with school-aged children. Two of my favourites are:
Mouse for Sale
These can be used in a whole range of ways:
- Pause the story and guess what might happen next
- Your child could provide a ‘voiceover’ to the story, or dialogue for the characters
- The characters are full of personality, so provide a good opportunity to practice descriptive language when describing the characters
- Talk about the emotions in the story
- Suggest an alternative ending for the story
- Summarise the ‘moral’ of the story
YouTube has cartoons and stories designed to teach children desired social behaviours, either explicitly:
Keep your hands to yourself
Or through suggestion:
‘My no no no day’, teaching that some days you might feel tired, sad and grumpy, but the next day you might feel better again!
YouTube is a massive resources, and these examples just skim the surface. Please share with us via social media and tag us @Iris_Speaks with the hashtag #YTSLT your top YouTube videos for developing communication skills. Remember, your child will get the most out of any videos when you join in watching with them, and talk about the videos together.
Please check all external content, including YouTube videos, before using these with your child. Whilst these videos were approved at the time of writing this post, content on YouTube and links may change. Inclusion in this blog does not imply endorsement of the creator or poster of the videos. YouTube contains adds prior to videos which may not be suitable for your child to watch.
Written by Alys Mathers, Speech and Language Therapist
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What is sign language?
We all use sign language. We nod our heads in agreement or shake them in disagreement, we wave hello and wave goodbye, sign thanks to kind drivers that let us go and refrain from signing anything to those who don’t! When we visit a country where we don’t know the spoken language, we rely on signs to communicate, remain courteous or order from a menu.
Many of us already use lots of signs with our children. We may have signs for animals, different foods and so on. Using signs, supports every day conversations and for our children it can act as an important bridge towards developing more spoken words.
All languages, whether Mandarin, English, Korean, French or British Sign Language use symbols to represent the world around us. There are different types of sign and symbol systems. The ones you may have heard of or have seen in schools are:
- Makaton – is a language programme that uses symbols alongside sign language to represent key words with nearly 40 years of evidence backed research on it’s effectiveness in encouraging speech and communication skills. It’s used by over 100,000 people across the UK. Many schools use this to help hearing children develop spoken language. When using Makaton, the signer speaks alongside signing. This encourages the development of spoken language. Often once spoken language develops or increases the signs naturally fade out.
- British Sign Language – is an official language used amongst the deaf community. Unlike Makaton, it has its own grammar rules. It is not commonly used alongside the spoken word.
- Sign Supported English (SSE) – Follows English language grammatical structures. Putting sentences together is therefore much more intuitive for English speakers as opposed to learning another set of grammatical rules. Although the grammar rules are different from BSL, SSE uses the BSL signs. Many schools use this to support language learning for deaf and hearing children.
- Paget Gorman (PGSS) – is a signed alongside speech and used in the UK, Ireland and Australia. Like the other sign systems, it supports learning for all children and especially those who struggle with language or following directions in the classroom.
There are other types of sign language too such as American Sign, Australian sign language…every single country has a different sign language – there is no universal sign language and even from region to region it can vary in dialect.
Will using sign language impact on my child’s ability to speak words?
This is a common concern, however, for children who are going to be verbal, learning sign language does not hinder their potential. Think of a baby who has not yet developed language. Caregivers use gesture regularly from the day babies are born. We wave hello and goodbye to them before they know these words, we may even have gestures for key words in songs. Some parents teach their babies ‘baby sign’ so they can start communicating using their hands before their language develops. In normal circumstances these babies then go on to develop language, the gestures/signs merely support this journey.
Using sign can benefit children whether or not they have a speech and language delay.
Supports learning in the classroom
Signing or gesture helps all children in the classroom and particularly those who struggle understanding verbal language. It can aid their ability to follow directions and is instrumental in reducing anxiety and increasing participation. Think about being in the foreign country again and interacting with locals to get directions back to your hotel. By following the hand gestures of the locals, you can safely make your way. Yay for sign!
When a word is heard and seen, children tend to recall the word more easily, leading to better vocabularies. Providing a sign for the word gives them another hook to hang the meaning on to.
‘Language and imagery are inseparable’ (David Mcneill 2005)
Gestures and signs are visual aids. If we understand gestures to be interlinked with speaking, then sign language is just a more structured way to elaborate on these gestures. Creating strong images for words is immensely useful for little language learners. Using gesture or signs with speech also slows down the pace of your speech – making it easier for little ears and brains to digest and process information.
Signing supports children who are struggling to develop language
Signs can bridge the gap between having no meaningful communication and speaking. For children who are finding it hard to use words, signing can reduce frustrations, increase participation and learning and increase communication confidence. For some children, using sign successfully can lead to the development of verbal communication.
It is thought that learning sign language may boost cognition by as much as 50 percent! (John Medina 2010)
Vocabulary development comes on leaps and bounds when little fingers master fine motor control. Signing is a good way to support this!
From around 9 months of age, typically developing children can start to learn language using sign. ‘Baby Sign’ has become very popular in recent years. Parents who wish to can attend sign classes with their baby and start communicating with them before verbal language develops.
If we view sign language as an extension of verbal language rather than something separate from it, we start to see it as an integral part of the language learning process. Signing can make activities like singing songs, requesting objects and naming things in the environment much more interesting, engaging and fun!
Video copyright The Makaton Charity
Check out the Makaton sign for lamb above! To see more Makaton signs if you’ve got an iPad check out the MyChoicePad app
Visit https://singinghands.co.uk/ for fun Makaton classes, sessions and resources.
Singing Hands also have some fantastic videos of popular nursery rhymes using Makaton signs that you can watch with your child
Check out this week’s Makaton Sign of the Week! https://wetalkmakaton.org/
Written by Carolyn Fox, Children’s Speech and Language Therapist
Iris Speaks – Access the UK’s best Speech and Language Therapists from anywhere in the world 7 days a week. Online and at home. Book an initial consultation.
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New Year good communication habits
Amongst consuming an abundance of food, opening presents, returning some of them (!) and watching Christmas movie after Christmas movie, this time of year often keeps us occupied in one other way; thinking about our new years resolutions.
In fact it’s hard to get through the last and first month of the year without someone asking you what you are going to change.
Plunging in to the new year with a whole list of things to change can be disheartening and often unrealistic! Not to mention; change can be hard and sometimes change can take a long time.
Food for thought
At this time of year we can quite literally have enough on our plates to even contemplate piling them up higher. Hats off to you if you did shed that half a stone or visit your in laws more. If you can do it then go for it. But let’s face it, we are already doing so may things well, why not focus on what we are already getting right and perhaps fine tune and increase the frequency?
This sounds more like a recipe for success. Don’t you agree?
Resolve to reflect
So when it comes to supporting communication, you probably know of and are no doubt using some great strategies. You may have picked these up on our previous blogs. Sometimes all we need is a little reminder .
Picking a couple of things and making them a habit is key. Take a few minutes to think about what you already do successfully, that could be optimized with a revisit. Write these down or tell someone about them. For some more inspiration, look at the list below:
6 New Year Communication Habits
- Reduce questions and increasing comments. This is a great one for taking the pressure away from child to talk. Comment on the world around you, books or simply on the task at hand e.g. “ you are building a really big colourful tower”
- Wait ten seconds for a response. This seems like a really long time but you will be surprised!
- Model back correct language. This not only demonstrates to your child that you were listening to them, but provides a good language model for them to copy. E.g child: ‘Put the presents down the tree!’. Adult: ‘ yes let’s put the presents at the bottom of the tree”
- Acknowledge the message rather than its accuracy. When your child has made and error but you understand what they have said, continue the communication exchange and respond appropriately. This will ensure that communication remains motivating and that your child doesn’t become frustrated and give up.
- Reduce background distractions. Take time where you can and focus on just the conversation. Turn off the TV and put the phone in silent.
- Provide feedback– comment on what you are pleased with e.g. ‘ I really like it when you use your words/ talk in sentences/remember your ‘p’ sound). Be sure to tell your child why e.g “ it helps me to understand/,it lets me know what you want” . This might also work for other things too e.g. “ I like it when you clean your room, it makes it look so pretty,”
Try using your useful strategies a few times a day or in a set 15 minute focused time. Think about where you would like to start. How often can you focus on using communication support strategies?. Can you focus every day at a particular time? Perhaps during breakfast or bath time? Maybe it suits your lifestyle better to put 15 minutes aside for this daily or perhaps focusing on it at the weekend is a good place to start?
Reflections rather than resolutions
Wherever you start, think about what has worked well for you and your family over the last year? What things have you already started doing that you can fine tune and perfect?
So enjoy those fully loaded plates of food, unwrapping gifts and watching the old traditional movies. And from all of us here at Iris Speaks, enjoy reflecting!
Written by Carolyn Fox, Children’s Speech and Language Therapist
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It is not an easy task for a small child to understand their emotions. That is why we love this book ‘The colour monster’ by Anna Llenas. The story of this cute little creature’s day aims to help our own little monsters raise their emotional awareness and make facing their feelings just that little bit less of a monstrous task!
Why get emotional about it?
Understanding our own emotions and the emotions of others is called Theory of Mind (ToM). With research highlighting links between ToM and language skills, it has become a hot topic within speech and language therapy. ToM starts to develop quite early on and can be encouraged by talking to our children about their emotions and the emotions of others. From around 4 years of age children might start to develop skills in thinking about how another person feels. Using books at this stage can be lots of fun and help them on their way to understanding emotions.
The colour monster
We meet the colour monster at the start of a day that is threatening to be rather confusing for him. This baffled little monster is in a bit of a frenzy over his feelings.
His emotions are cleverly depicted by colours. This little stumped soul is bemused and wearing all his emotions (colours) at the same time. The colours are intertwined and swirled together in a jumbled-up mess. Picture your child’s face and hands after a painting session. It is quite clear that this little guy needs a bit of help and along comes a trusted friend to lead the way.
She takes each colour, one by one and talks it through with the troubled guy.
Whilst giving the feelings a name, she explains what the feeling might make you want to do e.g. “anger can make you want to stomp”, thus helping children to recognize and identity with the different feelings. This could act as a great prompt to get your child to talk about what anger or another emotion makes them want to do.
This clued up companion goes on to say what you can do when you feel a certain way. When addressing fear, she says “If you are scared, tell me why and we will through the forest together”. Thinking about why we feel a certain way and what we can do about it can be a little tricky. With the monster sharing his emotions first and leading the way, we can then go on to attempt the same dialogue with our children.
What started out as a daunting day, turns in to a vibrant and educational journey for the colour monster. Together with the little girl they have organized his emotions and they are no longer tangled up. His world is much clearer.
For little ones and adults who enjoyed the movie Inside Out, this book is a must!!
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Carrying over the colour of your emotions!
The colour monster book provides a lovely fun read with lots of talking points. You can try some of the below:
- Guess how the colour monster feels. As you look at each page see if you and your child can remember how the colour monster is feeling by looking at the colour.
- As you go through the story ask your child when they have felt sad/happy/ etc.
- What does it make them want to do?
- Are they the same or different from the colour monster?
- What about other people? Together can you think of how other people in the family feel and how they show it? What colour are their emotions?
- Together can you think of other emotions that the colour monster might have but has not shared in this story? What colour might they be?
Other fun activities
-Draw and colour pictures of how you are feeling today, what colour are you?
– Can you remember what emotions go with what colours? Use different colored tokens, or paper and match the right colours to the word for the emotion.
– create a mood map of the monster’s day by putting different coloured pieces of paper/tokens, or colouring in squares on a piece of paper in order e.g. morning, afternoon, evening.
– Share mood maps of your day. What colour did you feel in the morning, afternoon, evening.
Written by Carolyn Fox, Children’s speech and language therapist
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Lego therapy love
I love it when research finds that something my students love doing is also really beneficial. Lego has been one of my favourite toys since childhood (I loved my pirate island), and a key part of my therapy toolkit since I qualified. But how can I claim Lego and lego therapy is so much more than a bit of fun?
Lego therapy groups are an evidence-based (LeGoff and Sherman 2006 , Owens, Granader, Humphrey and Baron-Cohen 2008), highly motivating and practical way of working on social communication skills. They are enjoyed by children and young people of all ages (although this post will refer to ‘children’ throughout for ease). I have even heard of some corporate away days using similar activities to develop team-work skills! They are also much more reflective of the actual play or social scenarios the child is likely to experience, compared to other social skills group formats.
Lego therapy sessions develop a lot of different skills:
- Team work, as the children have to work together to achieve a completed model
- Accepting your role, and practicing taking different roles within a group
- Listening and following instructions from others, particularly for the supplier and builder roles
- Giving instructions containing a range of vocabulary and language structures, such as adjectives (e.g. the size and colour of pieces) and prepositions (e.g. ‘at the side of the spaceship’, ‘behind the green square’)
- Communicating clearly (e.g. at the right volume and speed, giving enough information), and ensuring the other group members have understood
- Strategies to ‘repair’ a conversation if something goes wrong, such as asking for clarification if you don’t understand an instruction,
- Practical problem solving and flexibility of thought, e.g. what to do if you can’t attach the piece in the way described, or if the piece you need is missing from the box
- Expressing ideas clearly, listening to other’s ideas, and negotiating when building “freestyle”
This is how lego therapy sessions work…
There are normally three group members:
- An engineer (who has the instructions)
- A supplier (who has the bricks)
- A builder (who builds the model!)
Children can swap between the roles within the same session, or keep the same role for the whole session. Children agree to follow the ‘Lego group rules’, such as ‘if you break it you have to fix it or ask for help to fix it’, ‘do not put Lego bricks in your mouth’.
Children start by working together to build small models from instructions (I choose models that can be completed in one session), then can move on to building larger models with instructions over a series of group sessions. You can also have sessions of “freestyle” building where the children have a challenge (e.g. build a car), but no instructions to follow.
An adult is present during the session to help the group run smoothly, but crucially not to solve the children’s social problems for them – instead they just draw the children’s attention to a problem, and help them come up with their own solutions.
Adult: “There’s a bit of a problem here, does anyone know what it is?”
Child: “Sam got the wrong piece out of the box”
Adult: “How could you make sure he gets the right piece?”
Child: “Sam, I need a big red piece”
Adult: “That was a good idea – what did you just do?”
Child: “Said it again”
Adult: “Did Sam get the right piece that time?”
Adult: “Your idea worked! How do you feel now?”
Once the group have identified a good strategy, then this can be practiced in future groups until the children are using the strategy independently. I like to remind the children of useful strategies they have identified and been practicing at the beginning of each session. In this way, the children identify strategies they are happy using, and can start to reflect on the impact of their communication skills on other children.
So Lego therapy groups can be a really powerful way of developing social communication skills. If your child’s school suggests your child joins a Lego therapy group, you can be sure they are doing so much more than just ‘having fun’ (although it is a lot of fun too!). For more information about the benefits of play for children of all ages, see our ‘child’s play’ blog post. Lego can also be used in Speech and Language therapy sessions to help practice a range of other communication skills, such as extending sentence length (e.g. moving from ‘blue brick’, ‘there’ to ‘put the big blue brick on the flat red piece at the front’) or as a motivator in speech work. Lego is truly a versatile and fun therapy tool!
A word of warning
Some schools run ‘Lego clubs’ which are opportunities for children to play with Lego without the structure of a Lego therapy group. They can build whatever they want, on their own or with other children, and usually don’t have instructions to follow. Whilst this can also be useful to help some children learn to play alongside others, this is very different to a Lego therapy group. You may want to check with your school whether they are running a ‘Lego club’ or a ‘Lego therapy group’ if you think Lego therapy is the best option for your child.
Written by Alys Mathers, Speech and Language Therapist and proud owner of a Lego Pirate Island
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