Inclusion - Supporting… Theo

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Practitioners observed that two-year-old Theo was babbling and sounded as if he was talking underwater when he joined Paint Pots Nursery in Sholing, Southampton.

Around a third of the children attending the 60-place nursery have speech and language difficulties, so staff are used to supporting children and working with specialist agencies.

A speech and language link worker attends the nursery, which is based in a deprived area, every week to run targeted groups and work with individual children. The nursery’s practitioners also address speech and language issues with children who are not formally diagnosed but are not meeting their milestones.

Commonly these speech and language issues are linked to:

• Shyness: refusing to speak to adults at nursery but speaking one-to-one with their peers.
• English as an additional language (EAL): children whose parents do not speak English, so they require additional support to learn the language.
• Deprivation: children who hear limited words at home, leading to a reduced vocabulary.
• Bridging the gap: those needing intensive support to catch up with their peers.
• Dummies: problems with speech sound issues linked to frequent dummy use.

OBSERVING THEO’S DEVELOPMENT

Theo started accessing a funded two-year-old place at Paint Pots in May 2017 and will be starting school in September. He attends the nursery during term time for three hours a day, five days a week.

During his first settling-in session, his mother, a single parent, noted that he did not use as many words as his older brother did at that stage, but said she was not concerned because he was making sounds and babbling. Practitioners decided to observe his development and bring his two-year check forward so that he could be properly assessed.

‘Theo’s key worker noted that he would attempt to say words but did not respond to instructions very well, so the initial concern was that he was not hearing properly,’ says nursery manager Reagan Grainger.

‘She also noted that he was using a dummy so she had a discreet chat to his mum about his dummy use, and she agreed that he didn’t need it. Remarkably she just took the dummy away and put it in his bag. Often children need to be slowly weaned off their dummies but Theo is very car-orientated and toy cars were used to easily distract him from using his dummy.’ (See box).

Theo’s key worker continued to monitor his speech and language. Contrary to first impressions, she observed that Theo did not have problems with hearing or comprehension, although he would often pretend to be oblivious when asked to do tasks.

She also noted that, despite stopping using a dummy, he had a lot of saliva in his mouth, which made him sound as if he was ‘talking under water’, and that the limited words he used were pronounced in a way consistent with his tongue being held down.

‘His mum was very tuned in to him but didn’t always have a lot of time to converse with him at home, and his brother, who is four years older, had got into the habit of talking for him,’ says Ms Grainger. ‘She admitted to “babying” her youngest child and that she thought his babbling was cute rather than a possible problem.’

These issues were raised at his two-year-old check and staff suggested that Theo should have a speech and language referral, which his mum was happy to do. Ms Grainger says they refer children as soon as they can so any problems can start being addressed before they begin school. Theo was seen after ten weeks, when he was two years and eight months old.

‘He was found to be making mainly consonant sounds rather than vowels and his mouth was not moving as expected, probably because of lack of oral motor skills,’ recalls Ms Grainger. ‘His assessment found he didn’t have a diagnosable condition but that additional speech and language support was advisable.’

The link worker suggested strategies to use with Theo during nursery time. These included:

Oral motor activities to encourage him to move his tongue and mouth more and exercise his oral muscles, such as:

• using a straw to blow a Malteser through a maze (with the chocolate as a reward at the end)
• blowing up a balloon to encourage his use of lip placement
• putting jam on his top lip and encouraging him to lick it off.

Aural activities to help Theo to listen for and distinguish individual sounds from background noise, including:

• sound walks with his friends in the local woodland where they were tasked to listen for and pick out sounds, such as bird song
• sound hunts in the nursery with the challenge to locate a ringing phone or musical toy.

Theo’s key worker introduced these strategies when he was not engaged in play. She also continues to hold ten-minute key group time every day – with three other children when he was a toddler and seven others now that he is in the pre-school room. During this time his key worker can hear Theo’s speech in a smaller, controlled area while he engages in shared activities, such as floor puzzles.

The key worker shares the strategies with Theo’s mum so she can support him at home, and she also gives advice on other ways that his speech and language development can be supported.

‘Theo had his own unique words that he would use, such as “baba” for brother. We encouraged his mum to acknowledge that she understood what he was saying but also model using the correct word so that he could use it,’ says Ms Grainger.

MODELLING LANGUAGE

Theo’s progress continued to be tracked by his key person and monitored by the speech and language link worker, who would see him at nursery around every four months. They were both happy with his progress. When he moved into the pre-school room at three years old, he started attending specific groups to help support his speech and language development, including a music and movement group, and also one to help address his behaviour issues – such as saying no to requests, running away and problems with boundaries.

His mum was also invited to attend stay-and-play sessions at the nursery. ‘We hold these sessions so that parents can see what their children are doing in the nursery, but it’s also good for them to observe staff interacting with the children,’ explains Ms Grainger. ‘It’s good for parents to see examples of how staff are managing behaviour rather than feeling preached at.’

Theo’s speech and language was assessed again at 41 months and found to be much clearer, but there was concern about the amount of words he was using, specifically a lack of verbs.

‘His link worker made it a target for him to expand on phrases so we carefully modelled language to him. For example, if Theo said “I have a car”, we’d comment, “Oh yes, you have a red car.” We’d also give commentary on what he was doing, such as “You jumped and ran with your friend”,’ says Ms Grainger.

JOINING IN WITH SUPERHERO PLAY

Now, although Theo’s speech and language is still slightly behind – he is classed as ‘developing’ for the 40- to 60-month age band, rather than ‘secure’ – staff are confident that he will cope well with the transition to school in September. The speech and language link worker has been in touch with his school and made them aware of the support he has been receiving.

‘Physiological problems are not always something that we can fix but we’re surprised how quickly he’s progressed,’ says Ms Grainger. ‘It was a lovely surprise when he started to use full words. His mum has been very supportive and she is now hearing full sentences at home and says that life is much easier because there is less frustration when he struggles to be understood.

‘I watch him with his friends and he can communicate with them. He’ll join in superhero games and be given a character. I’m not worried about how he’ll manage at school, he’ll just make friends and be Theo.’

Dummy use

Health professionals advise against using dummies with children aged over 12 months old.

Prolonged use of dummies can result in problems including:

• speech and language delay
• middle ear infections
• stomach upsets
• mouth breathing
• misaligned teeth.

At Paint Pots Nurseries practitioners quietly speak to parents about their child’s dummy use, explain the disadvantages and advise them on how to wean their child off their dummy. Tips include:

• Gradually reducing dummy time, such as restricting use to bedtime and removing it from their mouth when they are talking.
• Using distraction when they want their dummy and praise when they have not used it.
• Reading picture books on giving up dummies.
• Swapping the dummy for another comforter, such as a soft toy.
• Giving the dummy away to the ‘dummy fairy’ or ‘Father Christmas’.
• Agreeing a date to stop using their dummy.

FURTHER INFORMATION

• Paint Pots Nurseries, www.paintpotsnursery.co.uk
• The Communication Trust, www.thecommunicationtrust.org.uk/early-years
• ICAN, https://www.ican.org.uk