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All you need to know about glue ear in babies and toddlers

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All you need to know about glue ear in babies and toddlers

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Glue ear is a build-up of sticky fluid in the middle part of the ear which can make it hard for your child to hear. It's really common in toddlers and preschoolers: according to the National Deaf Children's Society it affects eight out of 10 children .

It usually clears up on its own, but for some children, glue ear comes back again and again. "Because it causes mild hearing loss each time, this can cause problems with speech and language development", explains Alys. "If they're not hearing certain sounds this might make it hard for them to learn new words and sounds."

The symptoms of glue ear in children

There are a few different signs your child may have glue ear, says Alys. These include:

Temporary hearing problems

"This is a really obvious sign", says Alys. "If you're talking to your child and they are facing the other way, they might not hear you at all.

"Babies normally turn their heads when they hear a sound or voice. If they're not doing this, it might be because of glue ear."

They seem more tired or frustrated than usual

"It's tiring not being able to hear", says Alys.

Your child might be frustrated or not be able to concentrate on chatting or stories.

"They might choose activities where they don't have to talk or listen too much. Or they might not want to join in with an activity and choose to play on their own instead."

Earache or pain in their ears

Not all children with glue ear will have pain, but some will. They may also have a ringing or buzzing sound in their ears. Glue ear can be in one ear or both.

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All you need to know about glue ear in babies and toddlers

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Glue ear is a build-up of sticky fluid in the middle part of the ear which can make it hard for your child to hear. It usually clears up on its own, but for some children, glue ear comes back again and again.

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Children's ENT - What is glue ear and how is it treated?

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The Northern Care Alliance provides a range of nationally accredited audiology services for children and adults living in Bury, Heywood, Middleton and Rochdale (HMR) and Oldham. Our experienced and knowledgeable NHS professionals help with hearing and balance assessment, along with support and rehabilitation for conditions such as tinnitus. We offer digital hearing aid fitting and any ongoing care people need.

What causes balance problems?

There are nerves running from the balance organ in the inner ear to the balance control centre in the brain along with various other inputs from the body. When all these inputs co-ordinate, balance is maintained. If there is a difference in these inputs, it is possible to experience a sensation of unsteadiness, dizziness or vertigo.

What can be done to help?

In the vast majority of cases, the symptoms do improve with time as the brain learns to cope with the changes that have taken place. However, depending on your symptoms, you may benefit from rehabilitation exercises or the Epley manoeuvre.

Bury and Heywood, Middleton and Rochdale Audiology have an Adult Balance service. A GP referral is required to access this service.

What can I expect to happen at the appointment?

Your appointment will last about one hour. You will usually be asked to complete a questionnaire prior to your arrival, which you will need to bring to your first appointment. During your appointment we will ask you about your dizziness and other relevant medical history. We may also assess your hearing and/or balance ability and you will have an opportunity to ask any questions throughout the consultation. You may bring one other person to the appointment with you and it is advisable not to drive immediately after the tests as you may feel a little unsteady.

What tests will be done?

If you have not been assessed previously, you will have a range of tests which the practitioner will explain to you. This may include tests of hearing, eye movements, balance assessment and tests for dizziness in certain positions. All these tests will help the practitioner identify any ear related causes for your dizziness.

Treatment
Rehabilitation exercises
If the brain fails to naturally recover from an episode of dizziness, simple exercises can be given which aim to improve your symptoms. These exercises may initially make your dizziness seem slightly worse, but if you continue with them your dizziness symptoms may gradually improve. If exercises are appropriate the practitioner will arrange a programme that is tailored to your particular problem.
The Epley manoeuvre
Sometimes dizziness can be experienced when moving in certain positions, such as when looking up or down, lying down or rolling over in bed. This is benign paroxysmal positional vertigo (BPPV) This is caused by loose particles triggering the sense organ in the inner part of the ear. If this is the cause of your dizziness, a simple but effective manoeuvre of the head undertaken by the practitioner can correct the problem.
What happens next?
The practitioner will discuss any test results with you and the options you have. Depending on your results we may recommend further investigations. We do not undertake any treatment or arrange ongoing management without your informed consent.

The practitioner who referred you to the service will be informed of the outcome of your appointment.

Exercises for Dizziness

The following exercises can help you to improve your balance and reduce symptoms of dizziness associated with movement. The exercises may initially make your symptoms seem slightly worse, but if you continue with the exercises your dizziness can gradually improve over time.

Benefit is usually achieved over a period of one to three months, providing the exercises are done correctly.

It is essential that you ensure the environment you are exercising in is safe. Make sure the area is clear and that there are no sharp edges or objects which could cause harm. For standing exercise's, stand in a corner of the room and if you feel safer ask someone to stand in front of you or place a high back chair in front of you.

The exercises that the Audiologist recommends for you are listed in the booklet they have given you. Videos of these exercises are also available below. Repeat each exercise 3-4 times a day for up to 1 minute each. It is important you practice them every day. Gradually increase the speed and time you do each exercise to improve.

Exercise 1 Eye movement - Left and Right

Exercise 1 Eye movement - Up and Down

Exercise 2 Eye movement - Left and Right

Exercise 2 Eye movement - Up and Down

Exercise 3 Eye movement - Left and Right

Exercise 3 Eye movement - Up and Down

Exercise 4 Eye movement - Left and Right

Exercise 4 Eye movement - Up and Down

Exercise 5 Eye movement - Left and Right

Exercise 5 Eye movement - Up and Down

Exercise 6 Tightrope

Exercise 7 Tightrope 2

Exercise 8 Standing on one leg

Exercise 9 Tracing the alphabet

Exercise 11 Sitting down exercise

Exercise 12 Ball exercise

Exercise 13 Turning exercise

Exercise 14 Thai Chi Exercise

Exercise 15 Brandt Daroff

Exercise 16 - Epley right

Exercise 16 - Epley left

Exercise 17 - BBQ roll right

Exercise 17 - BBQ roll left

The videos below provide practical demonstrations of the basics of hearing aid maintenance.

Changing the battery

Tube change - open fit

Tube change - ear mould

Tube cleaning - open fit

Cleaning the ear mould

Putting the aid on - open fit

Putting the aid on - ear mould

Removing your hearing aid

Virtual fitting packs

11 million people in the UK are living with a degree of hearing loss. It is estimated that this figure is going to rise over the next 20 years. There are many causes of hearing loss but the good news is that there is help and options available to you.

How do I know if I have a hearing loss?

Do you want the TV turned louder than other people? Are you missing parts of speech when out socialising or where there is a lot of background noise? Do you struggle to hear the teacher in the classroom? Do you often have to ask people to repeat themselves or completely get the wrong message? Is it hard for you to tell what the words are in the song or even cannot understand what they are saying when you turn the volume up on the radio or TV? Do you find that you are withdrawing from parties, stopped going out for a meal or to the cinema? If you have answered yes to any of these things then it is possible that you have some degree of hearing loss.

Getting help if you have a hearing loss

It is important to get your ears tested so you can find out if you have a hearing loss and what your options are to manage it.

Speak to your doctor and tell them your concerns. Your doctor will check your ears first and then make a referral to the Audiology department for tests to be performed. You should be able to get an appointment within 2 weeks at the Audiology department. You may be given a choice of where you want to have your Audiology Assessment. You can discuss these options with your GP.

If you are under 16 years old you do not need to speak to your doctor first. Your parent or your carer can contact your local Audiology department and make an appointment for some tests to be carried out.

What will happen at my hearing test?

You will be asked some questions by the Audiologist (the person who will be testing your ears). Some questions will be sent to you on a form that comes with you appointment letter. Please take time to answer any questions before your appointment and also write down questions that you would like to ask your audiologist.

First, the Audiologist will look into your ears. Next the Audiologist will instruct you on how to do a hearing test. You have to listen very carefully for the sounds, which will be played through some headphones that you will be wearing. The Audiologist will record your results on a chart known as an Audiogram.

After the test has been completed the Audiologist will discuss the results with you. They will also discuss treatment options and onward referrals if necessary. Onward referrals may include being referred for a scan or to see an ENT consultant. If you have chosen hearing aids as part of your treatment plan, the Audiologist will arrange for the aids to be fitted. Usually the hearing aids will be fitted within 2-3 weeks.

The following videos present some personal views from patients on their experience with the Audiology service and the benefits that being fitted with a hearing aid has brought them.

Newborn Hearing Screening Programme

The NHS newborn hearing screening programme (NHSP) aims to identify moderate, severe and profound deafness and hearing impairment in newborn babies. Early identification of hearing impairment gives children a better chance of developing speech and language skills, and of making the most of social and emotional interaction from an early age.

The programme offers all parents in England the opportunity to have their baby's hearing tested shortly after birth.

The incidence of significant permanent congenital hearing impairment (PCHI) is about 1 in 1,000 live births in most developed countries although this may be 3-4 times higher in certain communities or parts of the UK.

The most common reason for PCHI is loss of hair cells in the inner ear but it is sometimes due to malformation of the middle ear ossicles (small bones that transmit vibrations of the ear drum) or the ear canal (tube from the outer to the inner ear). If the hearing loss is due to a problem within the inner ear (sensory), or occasionally due to abnormalities in the hearing nerve (neural), the term sensorineural hearing loss is used. Hearing loss due to a problem within the middle ear or the outer ear is called a conductive hearing loss while a combination of sensorineural and conductive hearing loss is called a mixed loss.

In the event that your baby is referred to Audiology following a referral from the new-born hearing screening programme please use the link below offering advice and information regarding your visit to the Audiology department.

Your baby's visit to the audiology clinic: information for parents click here.

Leaflet is available in other languages:
https://www.gov.uk/government/publications/newborn-hearing-screening-first-visit-to-the-audiology-clinic

Paediatric hearing aids

Following your child's hearing assessment, if you decide to trial a hearing aid(s) a hearing aid fitting appointment will be booked and will last for 90 minutes.

We also work closely with the Sensory Support Service for Hearing Impaired Children. The service is provided by Teachers of the Hearing Impaired who either visit you and your child in your home or at school. They provide advice about hearing aids, communicating and playing with your child, advice about school and support in school for your child and teachers. If you agree we can refer your child to this service.

Vision and Hearing Impairment/Deaf Education Service - Hearing Impairment | The Bury Directory

Your child may also be offered investigations into the cause of the hearing loss Deafness causes before birth | Deafness in childhood (ndcs.org.uk)

All NHS hearing aids are available free of charge. All of the hearing aids we fit in the Audiology department are digital and come in a range of colours.

Hearing aids consist of a hearing aid that sits behind your child's ear and a mould which is made for the shape of their ear. The mould is made of soft material and takes about a week to make. They can be made in different colours and with designs or logos, such as football team logos or cartoon characters.

Open fit hearing aids consist of a hearing aid that sits behind your child's ear and a soft plastic dome and thin tube that goes into your ear canal. This type of hearing aid is best suited to older children as there are small parts involved and who have a mild-to-moderate hearing loss. The benefit of this hearing aid is that it is more discrete and does not require an ear mould to be made.

At the fitting appointment the hearing aid(s) will be programmed for your child's hearing loss and for the size and shape of their ears.

Usually we carry out Real Ear Measurements (to check the hearing aid performance in the ear). These measurements are used to program the hearing aids and involve placing a slim rubber tube in your child's ear for a moment.

We will then make sure that the hearing aids are not too loud and perform some tests to see how well your child is able to hear different words or speech sounds when wearing the hearing aid(s).

We will explain the different controls of the hearing aid(s), how to change the batteries, how to keep them clean and give information about our repairs services. We will show you how to correctly put the hearing aid(s) into your child's ear and take it out again. The audiologist will answer any questions that you might have about the hearing aid. They will organise a review appointment to see how you and your child are getting on with the hearing aid(s).

Batteries and consumables can be requested through our click and post service. Click and Post Service (northerncarealliance.nhs.uk)

Children will be seen regularly in clinic for a hearing assessment to see how your child is managing and address any concerns or issues.

For hearing aid repairs an appointment can be made by contacting us on 01706 674 913 or NESaudiology@nca.nhs.uk
Hearing aids repairs can be by appointment or we offer a drop off and collect service.
Children will transition to the adult service aged 16. qs_transition_from_paediatric_to_adult_audiology_2011.pdf (ndcs.org.uk)

Useful links
National Deaf Children's Society | supporting deaf children (ndcs.org.uk) How to use Oticon ON app | Bluetooth® hearing aids | Oticon How to pair your hearing aid with a mobile phone (oticon.co.uk) How to use an FM system in a classroom (oticon.co.uk) How to use computer and tablet with your hearing aids (oticon.co.uk) Watch TV (oticon.co.uk) How to listen to music and audio with your hearing aids (oticon.co.uk)

What is tinnitus?

Tinnitus is the term for the sensation of hearing a sound in the absence of any external sound. Symptoms of tinnitus are you may hear different types of sound, for example, ringing, whooshing or humming or buzzing in the ear. These can be continuous or they can come and go. The tinnitus might seem like it's in one ear or both, in the middle of the head or even be difficult to pinpoint. Some people may think the noise is coming from outside and hunt for it until they discover it's actually inside them!

Occasionally people have tinnitus that has a musical quality and can seem like a familiar tune or song. This generally occurs in older people who have a hearing loss and a strong musical interest. This type of tinnitus is known as musical tinnitus or musical hallucination.

Who gets tinnitus?

Tinnitus is very common and is reported in all age groups, even young children. About 30% of people will experience tinnitus at some point in their lives but the number of people who live with persistent tinnitus is approximately 13% (over 1 in 8). Tinnitus is more common in people who have hearing loss or other ear problems, but it can also be found in people with normal hearing.

The experience of tinnitus is different for different people. Most people find that they are able to continue their normal day-to-day activities. However, a small percentage of people with tinnitus report it as severely affecting them.

What causes tinnitus?

Whilst we do not know the exact answer to what causes tinnitus, we know that it is not a disease or an illness. It is generally agreed that tinnitus results from some type of change, either mental or physical, not necessarily related to hearing.

When we hear, sound travels into the ear and then the hearing nerves take the signals to the brain. The brain is then responsible for putting it all together and making sense of the sound. Because the ears don't know what's important and what's not, they send a lot of information to the brain. This is too much information for us to process, so the brain filters out a lot of unnecessary 'activity' and background sound, such as clocks ticking or traffic noise.

If there is a change in the system, for example, a hearing loss or ear infection, the amount of information being sent to the brain changes. The brain then responds to this change in levels by trying to get more information from the ear, and the extra information you may get is the sound we call tinnitus. The tinnitus is therefore actually brain activity and not the ear itself! It is generally accepted that it isn't only a change in the ear that can result in tinnitus, but it could be due to a change in our stress levels, for example, with tinnitus being noticed after periods of significant stress, a change in life circumstances or general wellbeing.

People often say that they are aware of noises in the ears when they have a cold, an ear infection or wax blocking the ear. Sometimes people become aware of tinnitus following a really stressful event and once they're aware of it, seem to notice it more and more, but this usually fades once these things have passed. However, some people continue to notice the tinnitus, for example after an infection has cleared up.

Fortunately, tinnitus is rarely an indication of a serious disorder and a doctor will be able to check this for you.

What should I do?

The first person to talk to is your GP. You may need to be referred to an Ear, Nose and Throat (ENT) Surgeon or an Audiovestibular Physician, who will rule out any medical factors, assess your hearing and probably give you some information about what tinnitus is and how best to manage it. Some hospitals have hearing therapists or specially trained audiologists who are available to offer more support if you need it.

The most important thing to do is to keep doing the things you enjoy. If you start living your life differently to accommodate the tinnitus, it's just going to seem more of a problem. You may need to do things differently, for example reading with some background music on, but it's important that you do them nonetheless.
It does improve
When you first experience tinnitus, you may naturally be worried and very aware of this new sound. We constantly monitor our bodies and if anything changes, we become aware of the changes. Hearing tinnitus for the first time can be quite frightening if you think it means that something is wrong with you, or that it might change your life. It's a new sensation and you need to give yourself time to adapt.

Most people find that their tinnitus does seem to settle down after this initial period, even without doing anything in particular. You might hear this being referred to as habituation. It's a bit like walking into a room with a noisy fan or air conditioner. Initially, it seems really loud and then after a while, you stop noticing it as much. Tinnitus can often be much the same - initially, it's more noticeable but you gradually notice it less than you did. The first time you realise it's in the background is a great moment - it confirms that there are times when it's less noticeable, which means you should be able to keep doing the things that you enjoy doing.

Things that can help
Talking to someone
People around you may not understand what tinnitus is and how it might affect you, so might not be able to give you the type of support you need. It can be really helpful to talk to someone who has experience of tinnitus.

Meeting people who have been through the same things you are going through right now can be very helpful. There are Tinnitus Support Groups around the country. Not only can you pick up tips from others, but you can gain (and give) support simply by sharing your story with people who understand because they've been there themselves.

The BTA offers a confidential tinnitus helpline.You can call us for support, and we may also be able to point you in the right direction for local support groups.
Relaxation
It is quite common to feel anxious and afraid when you first experience tinnitus. By relaxing more, you may be able to feel less stressed and so notice your tinnitus less. Learning to relax is probably one of the most useful things you can do to help yourself.

A really easy way to relax is to find somewhere peaceful and just slow your breathing down (feel free to have some sound on in the background). You can take a few slow deep breaths and pay full attention to the feeling of the breath entering your body, filling your lungs and leaving your body. When we use deep breathing to relax, we feel calmer and more able to manage the tinnitus, and often don't notice it as much!
Using a hearing aid
Loss of hearing is often an unnoticeable and gradual process, and many people are surprised when they are told that they have a hearing loss. If you have hearing loss, using hearing aids can be helpful for tinnitus because they are restoring what you can't otherwise hear.
Using sound
Tinnitus is usually more noticeable in a quiet environment. It's a bit like candles on a birthday cake - in the lights, the candles aren't very bright but if you turn the lights off, the candles seem much brighter. With tinnitus, when there is other sound, it doesn't seem that loud, but when you turn all the other sound off, the tinnitus seems much more noticeable.

A lot of people have found that u sing background sound helps them - this can be a radio, music, or using natural sounds. People are really good at figuring out ways of making things better for themselves and you might already be aware that you generally don't notice the tinnitus as much when there is background noise. By using sound at other times, you're just using other ways of doing what you already know to be helpful.
Addressing sleep problems
People who live with tinnitus might have difficulty falling asleep or staying asleep. In order to sleep well, our bodies and our minds need to be relaxed. Worrying about the tinnitus, or worrying about how much sleep you're getting (or missing out on), is unhelpful and will only make it more difficult to sleep. Most people with tinnitus sleep well and their tinnitus is no different from those who do not sleep well. People who have tinnitus and sleep poorly tend to worry more at night than people with tinnitus who sleep well. Working through problems during waking hours is better than in the middle of the night when you have nothing else to occupy you.

It helps to make use of relaxation techniques to prepare the body for sleep. Once your body and mind are relaxed, sleep will come a bit easier.

Having some soft sound in the bedroom can help some people with tinnitus sleep better. The type of sound you use is up to you - as long as it is pleasant or neutral.
Professional support
If you are referred to a specialist tinnitus clinic, and your tinnitus is particularly troublesome, you will be introduced to more formal or structured ways of managing tinnitus. Most centres use a combination of approaches. You may come across some terms before, or hear them when you get there, and it helps to have some understanding of what these terms are.
Cognitive Behavioural Therapy (CBT)
This is one psychological approach that can be useful in managing tinnitus. The idea is that when you became aware of your tinnitus, you responded to it negatively. For example, you may have thought there was something seriously wrong with your hearing (a belief) and this led to you being anxious (an emotion), and you then tried to feel better, for example by avoiding silence (a behaviour). Some beliefs and behaviours are helpful and that's great - keep doing them! But some beliefs and/or behaviours are unhelpful and CBT helps you to recognise them, and then you work together with the clinician (usually a psychologist, audiologist or hearing therapist) to find different ways of responding to the tinnitus so it becomes less bothersome.
Mindfulness
This is a meditation technique that is used frequently for pain management, and more recently for tinnitus. The idea is that we tend to resist unpleasant sensations (eg hearing tinnitus). If we stop resisting and allow the unpleasant sensation, this alters our awareness to include more sensations. We start to notice that sensations become less dominant once our attention moves away from them and focuses on a different part of the body. All of this can change in a moment, simply by changing our awareness. If we use mindfulness effectively, we can create some space from the tinnitus and in that space, we can decide how we're going to respond to it. It's a wonderful way of achieving 'peace and quiet'.
Tinnitus Retraining Therapy (TRT)
This is a very structured approach to managing tinnitus. Basically, TRT assumes that the tinnitus has been prioritised as an important signal. TRT uses sounds at a particular level to try to reduce the priority of the tinnitus so that you no longer hear it. It is based on the idea that we can get used to sounds, e.g. the sound of the fridge or air conditioner, so we can also get used to this sound of tinnitus. The process of getting used to the tinnitus sound is called habituation. TRT uses sound generators and counselling to attempt to retrain how the brain processes sound so that you habituate to the tinnitus. Most people working in the tinnitus field will use elements of TRT but the strict method is not frequently used because there is limited evidence for its effectiveness.
Take care of your hearing
Frequent, prolonged exposure to loud noise increases the risk of getting tinnitus, or of making it worse, so take care to avoid very loud sounds, or protect your ears against them. Wear proper ear protectors (not cotton wool) when hammering metal, using power tools or when you are near any noisy motors. Ear protection is also important if you watch live music or play in a band or orchestra. Ear protection should not be used if ordinary, everyday sounds are uncomfortable (this may be hyperacusis or oversensitivity to sound). If earplugs are worn for blocking out such sounds, it can actually make hyperacusis worse.

Hyperacusis

Hyperacusis is an increased sensitivity to sound. If you find that everyday or ordinary sounds are uncomfortable, you may have hyperacusis. Whilst it might seem natural to want to block out as much sound as possible, avoiding sound can actually make hyperacusis worse. Talk to your GP about this and ask for a referral to either an ENT Surgeon or Audiovestibular Physician who will be able to suggest management options - often, using sound (in a very controlled way) can improve hyperacusis.

More information

Having information about tinnitus can be very helpful. A lot of people start off looking online and while there is some fantastic information available on the internet, there is also a lot of very unhelpful information. An easy way to ensure what you are reading is appropriately written and produced is to check that the Information Standard has been adhered to - all our information complies with the Information Standard.

(British Tinnitus Association 2020, https://www.tinnitus.org.uk/all-about-tinnitus)

Aetiology - The cause of a condition (e.g. cause of the hearing loss).

Aided soundfield testing - A hearing test performed to check how well a person hears sounds of different frequencies when wearing hearing aids.

Auditory Brainstem Response (ABR) - This hearing test measures whether sound is being sent from the cochlea through the auditory (hearing) nerve to the brain. Three small sensors and a set of headphones will be placed on the child's head. For an accurate result, the child must be very still and quiet throughout the test.

Conductive deafness - When sound cannot pass efficiently through the outer ear and middle ear to the cochlea and auditory nerve.

Decibel (dB) - The unit used to measure the intensity or loudness of sound. Frequency - Most sounds are made up of different frequencies. Frequency is often thought of as the pitch of the sound. For example, on a piano keyboard, the keys to the left play low frequency (or low pitch) notes, and the keys to the right play high frequency (or high pitch) notes.

Hearing aid - Hearing aids amplify sound. Modern hearing aids process sound using digital technology.
Inserts - A type of headphone that inserts into the ear to present sounds during a hearing test.

McCormick toy test - A hearing test used in which the child must discriminate between similar speech sounds in words.

Middle ear - The middle ear is made up of the ear drum which vibrates because of sound waves, and three tiny bones known as the ossicles which pass on these vibrations to the inner ear.

Otoacoustic emissions (OAE) - This hearing test is commonly used as part of the screening tests carried out on babies shortly after birth. It tests the cochlea response. A small earpiece is placed in the child's ear and a clicking sound is played. If the cochlea is working properly, the earpiece will pick up the response and it is recorded on a computer.

Phoenix - Automated version of the McCormick Toy Test.

Pure Tone Audiometry (PTA) - Behavioural test which actively involves children from the age of three years. Sounds are played through headphones or earphones placed inside the child's ear to test each ear separately. Younger children might be shown how to move a toy each time they hear a sound and older children might be asked to respond to sounds by saying "yes" or pressing a button.

Radio aid - A radio aid consists of a transmitter (used by the person who is talking) and a receiver (used by the deaf child/adult). A microphone picks up the speaker's voice.The sounds are then transmitted by radio waves to the receiver.

Sensorineural deafness - This is a permanent hearing loss. The inner ear isn't working properly, so the cochlea or hearing nerve don't work as they should.

Soundfield Performance Test - Behavioural test where sounds are played through speakers to test the child's overall hearing rather than each ear separately. Children are shown how to move a toy each time they hear a sound.

Tympanometry - Tympanometry is not a test of hearing; it is used to check how well the moving parts of the middle ear are working If the eardrum is not moving freely, there is likely to be some fluid or another problem with the middle ear.

Visual Response Audiometry (VRA) - This can test the full range of hearing but does not give specific information about each ear. An audiometer plays sounds of different frequencies and loudness through speakers. When the child hears the sound, they will turn their head when a visual "reward" is activated, such as a toy lighting up.
Glossary of hearing aid-related terms
Datalogging - A program on the hearing aid that monitors how much the hearing aid is being worn.

DSL version 5 - Prescription that the hearing aid is set to.

Earmould/mould - An earmould is the part of the hearing aid that fits into the ear.

Feedback - When sound leaks out from the ear mould and causes whistling.

Linear - Loud sounds are amplified the same as quiet sounds.

RECD - A measurement performed that takes into account that size and shape of your child's ear when setting the hearing aid.

Soundrecover - A setting that helps make high frequency sounds more audible. Whistleblock technology - Hearing aid setting that reduces feedback.

Wide Dynamic Range Compression (WDRC) - Sounds are amplified by different amounts depending on how loud they are to start off with. Quiet sounds are amplified more while loud sounds are not amplified as much.

Adults can be referred by a GP or an ENT Consultant. Children can be referred by a range of health professionals and parental referral is also accepted.

Contact details

Address:

Radcliffe Primary Care Centre - Church Street West, Radcliffe M26 2SP
By appointment only. Monday to Friday between 8am - 6pm. Free parking available.

Tottington Health Centre - Wesley Street, Tottington BL8 4AD.
By appointment only, available Monday to Fri 8am-6pm. Free parking. Short walk to bus services.
The Traveline journey planner website can help you to plan your route using public transport.

Townside Primary Care Centre - Knowsley St Bury BL9 0SN. Townside Primary Care Centre - Google Maps
By appointment only, Monday to Friday 8am-6pm. Q Park pay parking available adjacent to centre.

Fairfield General Hospital - Rochdale Old Road, Bury BL9 7TD. Paid parking available. Short walk to bus services.

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The Northern Care Alliance provides a range of nationally accredited audiology services for children and adults living in Bury, Heywood, Middleton and Rochdale (HMR) and Oldham. Our experienced and knowledgeable NHS professionals help with hearing and balance assessment, along with support and rehabilitation for conditions such as tinnitus.

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NEW-A guide to screen time for children under 5-printable infographic.

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I was a bit scared when we found out we were having a baby, obviously happy, but a bit scared and in the beginning I was a bit clueless. The child development part is my favourite bit, but there's things in there, like things about mental health, that I didn't know about and that I didn't know you needed to know about.

Ross, 22

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Developed with the NHS, DadPad gives new dads and dads-to-be the knowledge and skills needed to gain confidence and give their baby the best start in life.

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What is Speech and Language Therapy?

Speech and Language Therapy (SLT) is a specialist service that can help support your child's speech, language and communication development, or feeding and swallowing needs, by working with you as their parents or guardian.

SLT does not provide an instant fix for a child's difficulty, but helps to find ways of supporting development and positive change. We will provide you with activities and strategies to do at home in between appointments.

SLT is more successful when these are carried out regularly with an adult at home or in school. We offer specialist information and advice to give you the skills and confidence to successfully support your child's needs for the future.

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Paediatric Speech and Language Therapy :: Northern Care Alliance

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Bury Paediatric Speech and Language Therapy can help to support your child's speech, language and communication development, working with you as their parent or guardian.

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Tiny Happy People is here to help you develop your child's language skills. Explore our simple activities and play ideas and find out about babies and toddlers' amazing early development.

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Children’s language development and parenting advice - BBC Tiny Happy People

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A chatty child is a happy child, so Tiny Happy People is here to help you develop your child’s communication skills through simple interaction and play.

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***NEW-Bury Early Years Integrated Speech and Language Pathway Guidance

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***NEW-Bury Early Years Integrated Speech and Language Pathway Guidance

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Find out all about the Speech, Language and Communication support available in Bury

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Talking and listening to your baby helps build their communication skills from the very start. Discover our new Little Moments Together Cards perfect for helping you chat to your 0 to 2 year old throughout the day.

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Bury Vision and hearing Impairment/Deaf Education Service

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Bury Vision and hearing Impairment/Deaf Education Service

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Better Health Start for Life – Little Moments You Tube Videos

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Better Health Start for Life – Little Moments You Tube Videos

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Little Moments Together- Helping your child to talk

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Little Moments Together- Helping your child to talk

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Talking and listening to your baby helps build their communication skills from the very start. Discover our new Little Moments Together Cards perfect for helping you chat to your 0 to 2 year old throughout the day.

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Talking to your child when you are out and about

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Talking to your child when you are out and about

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Make the most of everyday opportunities to chat with your baby or toddler, especially while you are out and about. It will help them learn new words and develop their communication skills.

Use our walk and talk trail to chat to your baby or child. Here you'll discover tips, activities and prompts to have exciting new conversations. Download the trail here. Scroll down for translated versions of the trail.

Watch the video below to see a dad talking with his daughter about what they see and hear on their journey to the park. He mimics the sounds of what he sees and hears, and encourages his daughter to join in too.

How will the trail help my baby or toddler to start talking?

Both the trail and activities on this page will support you to introduce new words to your baby or child. This will help them begin talking and communicating. If you child is already very chatty, the trail will help them develop their vocabulary.

The first five years of a child's life have a big impact. The development that happens helps improve their future learning, happiness and wellbeing. You can encourage this development by finding as many opportunities as you can to talk and listen to them, and introduce new things.

The walk and talk trail will help you get started.

What if English isn't my first language?

It's important to talk to your baby or child in your home language. Translated copies of the walk and talk trail can be downloaded below:

We like reading together. Are there any books based on chatting and exploring outside?

Sharing a book together is a great way to introduce your children to new words and develop their imagination. There's lots of great books about the outdoors you can read together, to inspire you to spend outside. Check out our booklist for suggestions. If you don't have these books at home, visit your local library to borrow a copy and see what other outdoor stories you can find.

Remember, you don't always need to read the words in books. Looking at and talking about picture books is a great way to encourage your child to enjoy stories.

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Talking to your child when you're out and about

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Walking near your home can be a good chance to get your child speaking about the things they see and hear around them.

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Supporting the Neurodiverse Child Padlet of Resources

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Supporting the Neurodiverse Child Padlet of Resources

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Speech and Language UK- Myth busting Dummies

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Speech and Language UK- Myth busting Dummies

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Speech and Language UK: Changing young lives

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There is a lot of confusing advice about whether to use dummies or not. In the past, professional advice has been to avoid excessive dummy use and not let children talk with a dummy in as this could cause speech sound difficulties. But is there any evidence that this is true?

Myth: Using a dummy will cause my child to develop speech difficulties

There is some evidence to suggest that frequent dummy use in the daytime may affect young children's speech sound development. It would suggest that having something in their mouths will make babies and toddlers less likely to babble and experiment with sounds, both of which are important for the development of speech. However, current evidence suggests that any speech sound errors associated with dummy use do clear up as children get older. Also, lots of children will have speech difficulties due to other reasons that are completely unrelated to dummy-use.

Dummies can be useful in settling young babies and encouraging strong sucking patterns, especially in premature babies, but their specific usefulness declines after a developmental age of about six months. Some studies have suggested that using a dummy lowers the risk of Sudden Infant Death syndrome, although more research is needed to confirm this.

There are a few suggested disadvantages of dummy use. These include:

Stopping breast-feeding early - however research in this area is undecided

Increased risk of middle ear infections (otitis media/glue ear)

Increased risk of dental problems and crooked teeth if used beyond age three

Dipping your baby's dummy into anything sweet is very likely to cause tooth decay.

So, what now?
Your baby, your choice! As a parent/carer you need to be armed with the facts to decide what's best for you and your family. Being aware of the potential risks and benefits will help you to make this decision. If you do decide to use a dummy, it's a good idea to restrict dummy use to night-time where possible and to decide on an appropriate age to wean your baby off the dummy.

What is the best way to reduce dummy use?

There is useful advice and tips on reducing dummy use here.

Interested in reading more? Check out some of the articles we referenced when putting this blog together:
Does the duration and frequency of dummy (pacifier) use affect the development of speech? - Strutt - 2021 - International Journal of Language & Communication Disorders - Wiley Online Library Dummies not to blame for common speech disorder in kids - The University of Sydney

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There is a lot of confusing advice about whether to use dummies or not. In the past, professional advice has been to avoid excessive dummy use and not let children talk with a dummy in as this could cause speech sound difficulties. But is there any evidence that this is true?

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Twinkle boost- Support classes available for you and your child

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Twinkle boost- Support classes available for you and your child

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Our classes Twinkleboost sessions provide an opportunity to enjoy fairytale-themed classes with your baby and support their language development. 1. Twinkleboost Communication Classes In our Award-Winning classes, our skilled Speech...

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Words for Life-Activities for 12-24 months

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Words for Life-Activities for 12-24 months

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Chat, learn and play with your toddler to improve their early literacy skills and improve their confidence in communicating. Support your 1 to 2-year-old in reaching their literacy milestones. By the age of 2, many children can say around 50 words. Words for Life provide activities, songs, games and nursery rhymes to help you practise English language reading and speaking skills at home.

Songs and rhymes

All children like songs and nursery rhymes, even small babies.

Read Songs and rhymes now

Minibeast exploration

Minibeasts Exploration - a range of bug related activities

Read Minibeast exploration now

Early Years books to support numbers and counting

We have put together our top six mathematical story books for you to share with your child.

Read Early Years books to support numbers and counting now

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Fun ways to boost your child's literacy skills.

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Words for Life-Activities for 6-12 months

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Words for Life-Activities for 6-12 months

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The best way to help your baby develop their language and literacy skills between 6 and 12-months-old is through songs, nursery rhymes and talking to them. Talking to your baby will help them to learn new words and sounds, which will help to build their confidence when it comes to making noises and speaking their first words. Words for Life provide a range of activities for your baby to help work on their early milestones before starting nursery.

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Fun ways to boost your child's literacy skills.

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Words for Life-Activities for 0-6 months

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Words for Life-Activities for 0-6 months

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Fun ways to boost your child’s literacy skills.

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Reading can make us laugh, cry, stir-up emotions to make us think differently or help us to walk in someone else's shoes. Being able to read can help our children unlock the magic of books and develop a lifelong love of reading. Nurturing reading skills is important to set the foundations for a child's early language, thinking and writing ability. That's why we're working hard, with the help of our partner Chase, to develop a love of reading through the Chase Rewarding Futures school libraries programme. Find out more about Chase's commitment to improving childhood literacy skills.

Top tips for reading with your little ones

While you can't force a love of reading, reading for fun is something you can nurture and encourage. One of the most effective ways to do this is by making time to read together. These video clips have been put together to support you and your child in sharing in some book love at home or wherever you find the time and space to get comfortable with a good story.

Sharing in the book love - reading with your child

Reading a book offers so many benefits for children and adults alike. It can make us laugh, it can thrill us and it can even make us cry. Reading can help us find out more about the world and connect our lives with the lives of others. But what about reading for pleasure? Why does reading for pleasure really matter? Watch our video which explains why reading for pleasure is so important and find some top tips on how to encourage a love of books with your child.

Bringing stories to life - reading aloud to your child

Discover how to bring stories to life and learn tips on how to get the most out of reading aloud to your child. Martin from the National Literacy Trust has six helpful tips to get you started.

In this video, Martin mentions some useful websites to have a look at when you have a moment to help you in your reading for pleasure journey with your child:

Let's get chatty - talking about books with your child

Let's talk about books! Join Lucy from the National Literacy Trust as she shares tips on how to inject more fun and enjoyment into your child's reading experience. Lucy explains why 'booktalk' matters and four great ways to get started.

In this video, Lucy mentions some useful websites which will help you in your reading for pleasure journey:

Lovemybooks.co.uk offers a great selection of titles for all ages, together with suggested activities for book-based fun.

Empathy Lab provide expertly curated lists, focused on titles that offer the chance to explore a vast range of social situations filled with well-drawn characters.

We're going on a book hunt - finding the right book

Watch our next video to explore ways to support your child on their reading for pleasure journey. Martin from the National Literacy Trust shares top tips on how to find the right book for your child.

You can find our list of recommended websites and additional information: National Literacy Trust guide to finding recommended reads.

Building on the love of books - Follow-up activities based on reading

It's time to build on the love of books by going beyond the books. Discover some creative ways for you and your child to get the most out of reading.

Make it memorable - the importance of empathy

In the final part of our series of videos exploring the power and importance of reading for pleasure, let's look at how reading can help build empathy.

Why reading for fun matters

Our research shows that reading for pleasure plays a very important role in developing keen, confident readers. Let's show you why it's important:

Sound good? We think so. Never underestimate the powerful contribution you can make by putting the fun back into reading. Enjoy making precious reading memories together.

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Get more from reading with your child with the help of these videos designed to put the fun back into reading.

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Goldilocks and the 3 Bears Activity Pack

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Goldilocks and the 3 Bears Activity Pack

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Bury Council Early Years Team- Universal FREE sessions

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Bury Council Early Years Team- Universal FREE sessions

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FREE SERVICE-Talk to a Speech and Language Therapist-Speech and Language UK

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FREE SERVICE-Talk to a Speech and Language Therapist-Speech and Language UK

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Speech and Language UK: Changing young lives

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Enquiry service

Our free enquiry service is a confidential phone call with an experienced speech and language therapist. During the 30-minute call, you will be given the opportunity to talk through your concerns and questions regarding your child's development.

Our speech and language therapists will be able to provide you with information on typical development, as well as advice on how to support your child's skills. They will also be able to signpost you to other services.

Following the call, you will receive an email summary with tips, techniques and signposting to other helpful services.
Please note that we open booking slots monthly. This service does not include meeting and assessing children. The speech and language therapist cannot give specific advice on topics such as diagnosis or the provision the child is receiving, but will aim to signpost to services and organisations that can help further.

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An enquiry service for parents or carers and practitioners to discuss concerns they have about a child. A series of webinars designed to give parents the tools they need to support their child.

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Here you can find lots of lovely interactive books to read online or watch with signing.

There are classic children's stories that we think you and your family will love, including Hairy Maclary from Donaldson's Dairy by Lynley Dodd to Owl Babies by Martin Waddell and Patrick Benson, along with newer favourites such as Chris Haughton's Oh No, George! and Everybunny Dance! by Ellie Sandall.
Our storybooks and games are free to use, however some older devices aren't able to support them. You can also watch our Storytime playlist on YouTube read by the likes of Ore Oduba, Adam Buxton, Fearne Cotton and many more.
We also have lots of free online games for children to enjoy. Whether you're after number games, puzzle games, colouring or interactive storybooks, there are lots of fun activities to try!

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Stories for kids online and fun games to play

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Find kids' books to read online for free, including classic children's stories like Hairy Maclary and Owl Babies, and play our fun online games - from number games to colouring.

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There are all sorts of reasons babies might be crying, so you could try and meet these needs without resorting to the dummy.

Equally, sometimes babies will cry and cry and a dummy might be a way of helping you cope with it. But before reaching for the dummy, see if there's another way of soothing them.

2. Try giving them an alternative comforting object.

This could be a favourite soft toy.

As they get older, try praising them and giving them stickers as a reward for not reaching for their dummy.

3. Set limits and stick to them to gradually wean them off.

Limit dummy use to key times like bedtime or when they're ill.

Be consistent and be strong - there may be tricky moments, but it will pass.

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When should babies lose the dummy and how do I wean baby off it?

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There are all sorts of reasons babies might be crying, so you could try and meet these needs without resorting to the dummy. Equally, sometimes babies will cry and cry and a dummy might be a way of helping you cope with it. But before reaching for the dummy, see if there's another way of soothing them.

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Renewing library items, finding a library, search our catalogue, joining a library, and other services available.

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We are a free service providing information for parents, carers, children and young people and those working with families in Bury.

We are the main contact for updating and searching information for Children and Families on The Bury Directory, where we have information for children and young people aged 0-19 ranging from searching for Childcare Provision to a section for Teenagers.

There is a section for disabled young people up to the age of 25 in our SEND Local Offer Bury Channel which offers information on support services, activities and places of interest.

We also have information on activities for children and families such as guides and scouts and community activities in our Leisure and recreation section. There is even a section on Sports.

There is also a section dedicated to Information for Childcare Providers, which has information relating to various services available to providers in the Bury area.
Unable to find the childcare you need
If you are still unable to find the childcare you need our Brokerage Service may be able to help.

This service is for parents and carers who:

have exhausted the normal routes of finding childcare and are still unable to find childcare which meets their needs

need extra support to understand the options available to them, this may be because of individual child's circumstances such as a disability or special educational needs

need childcare as an emergency/short notice

are unable to find a free early learning or childcare place for their child.

For brokerage enquiries to find childcare, please complete the enquiry form below
Family Information Service Enquiry Form

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Family Information Service (FIS) | The Bury Directory

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We are a free service providing information for parents, carers, children and young people and those working with families in Bury. We are the main contact for updating and searching information for Children and Families on The Bury Directory, where we have information for children and young people aged 0-19 ranging from searching for Childcare Provision to a section for Teenagers.

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Learning to Talk-Guidance for parents- NHS-Better Health Start for Life

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Learning to Talk-Guidance for parents- NHS-Better Health Start for Life

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Chat, play, read!

Here are some tips and activities to help your child develop their speech skills:

use things your child is interested in for play, follow their lead and make sure you're physically at their level while playing

if you notice your child looking or pointing at something, talk to them about it before they lose interest in it

picture books introduce your child to new things they haven't seen yet in real life - ask them to tell you the story, or talk about what the characters might be thinking and feeling

make reading, singing and playing even more fun by using lots of actions and different voices

take turns to make noises or speak - your child will be able to hold longer conversations, so slow down your speech, give them plenty of time to respond and listen carefully to what they have to say

talk to your child in short, simple sentences, as it's easier for them to understand you and have a go at copying when they are ready

try to use the same book or sing the same song, as young children learn a lot from repetition

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Find out how you can help your child with their speech & language development. If you have any concerns, talk to your doctor or health visitor.

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How to help your child's early language skills. 

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How to help your child's early language skills. 

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Department for Education

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Your child's education starts at home long before they enter the classroom. And even when they start nursery or school the home is where a significant amount of their learning happens.

That's why it's really important to build a positive learning environment at home - so parents can bring learning moments into their everyday activities while their child enjoys stimulating and engaging activity.

Creating an environment at home that actively encourages children to develop their language and social skills provides a great foundation for more formal learning.. And developing language skills at a young age is consistently linked with better school attainment and job prospects.

Tracy Jackson, Head of Early Years at the National Literacy Trust, and Dr Kirsten Asmussen, Head of Child Development and Early Intervention Foundation have some top tips on how you can build a great home learning environment and help your child express themselves in their earliest years:
Babies Young Children

Reading with them is a key way to develop a closer connection, encouraging your child's imagination to grow by introducing them to new words. Look at the pages together, talk about the pictures, and follow your child's focus. Try reading to them first, and then, as your child gets older, encourage them to be more involved, first by having them turn the pages, then by discussing the story with them.

Your little one is constantly seeing and experiencing new things, and so things like trips to thesupermarket or the shops provide a whole new world to explore. This is a chance to point new things out and name things. As soon as you notice your child looking or pointing at something, talk about it before their attention moves on to something else - that might be within a couple of seconds for babies - and this can reinforce language skills.

Songs, poems and rhymes are enjoyed by children from a very early age. The repetition, sounds and rhythm help children to predict what's coming next. From as early as one month, sing songs and rhymes to your baby with actions or lots of repetition. Once your child is a few years old, play rhyming games with them - can your child come up with a word that rhymes with "cat"?

Once your baby becomes a toddler, they begin to understand what they can't see - to be able to pretend and think about the future. Make-believe games and conversations about feelings and memories are associated with children's vocabulary development and expressive language use. Play make-believe games together or games which use opposites such as on or off, big or little. Also encourage your child to talk about the future and anticipate events.

Every child is different and there's no one-size-fits-all. What matters most is spending time with your child chatting, playing, and reading. Every little thing you do with them will set them up well as keen little learners for when they start school.

For more information visit ' Start for Life - chat, play, read ' where you can find tips and activities to help support your child's development and find further support in your local area.

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How to help your child's early language skills - top ten tips from the experts

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Your child's education starts at home long before they enter the classroom. And even when they start nursery or school the home is where a significant amount of their learning happens. That's why it's really important to build a positive learning environment at home - so parents can bring learning moments into their everyday activities while their child enjoys stimulating and engaging activity.

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'What to expect when in SLC'-from- Stoke Speaks Out

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'What to expect when in SLC'-from- Stoke Speaks Out

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Communication milestones: what to expect at different ages.

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Selective mutism is an anxiety disorder where a person is unable to speak in certain social situations, such as with classmates at school or to relatives they do not see very often.
It usually starts during childhood and, if left untreated, can persist into adulthood.

A child or adult with selective mutism does not refuse or choose not to speak at certain times, they're literally unable to speak.

The expectation to talk to certain people triggers a freeze response with feelings of anxiety and panic, and talking is impossible.

In time, the person may learn to anticipate the situations that provoke this distressing reaction and do all they can to avoid them.

However, people with selective mutism are able to speak freely to certain people, such as close family and friends, when nobody else is around to trigger the freeze response.

Selective mutism affects about 1 in 140 young children. It's more common in girls and children who have recently migrated from their country of birth.

Signs of selective mutism

Selective mutism can start at any age, but most often starts in early childhood, between age 2 and 4. It's often first noticed when the child starts to interact with people outside their family, such as when they begin nursery or school.

The main warning sign is the marked contrast in the child's ability to engage with different people, characterised by a sudden stillness and frozen facial expression when they're expected to talk to someone who's outside their comfort zone.

They may avoid eye contact and appear:

nervous, uneasy or socially awkward

rude, disinterested or sulky

clingy

shy and withdrawn

stiff, tense or poorly co-ordinated

stubborn or aggressive, having temper tantrums when they get home from school, or getting angry when questioned by parents

More confident children with selective mutism can use gestures to communicate - for example, they may nod for "yes" or shake their head for "no".

But more severely affected children tend to avoid any form of communication - spoken, written or gestured.

Some children may manage to respond with a few words, or they may speak in an altered voice, such as a whisper.

What causes selective mutism

Experts regard selective mutism as a fear ( phobia) of talking to certain people. The cause is not always clear, but it's known to be associated with anxiety.

The child will usually have a tendency to anxiety and have difficulty taking everyday events in their stride.

Find out more about anxiety in children.

Many children become too distressed to speak when separated from their parents and transfer this anxiety to the adults who try to settle them.

If they have a speech and language disorder or hearing problem, it can make speaking even more stressful.

Some children have trouble processing sensory information such as loud noise and jostling from crowds - a condition known as sensory integration dysfunction.

This can make them "shut down" and be unable to speak when overwhelmed in a busy environment. Again, their anxiety can transfer to other people in that environment.

When mutism occurs as a symptom of post-traumatic stress, it follows a very different pattern and the child suddenly stops talking in environments where they previously had no difficulty.

Another misconception is that a child with selective mutism is controlling or manipulative, or has autism. There's no relationship between selective mutism and autism, although a child may have both.

Diagnosing selective mutism

Left untreated, selective mutism can lead to isolation, low self-esteem and social anxiety disorder. It can continue into adolescence and adulthood if not managed.

Diagnosis in children

A child can successfully overcome selective mutism if it's diagnosed at an early age and appropriately managed.

It's important for selective mutism to be recognised early by families and schools so they can work together to reduce a child's anxiety. Staff in early years settings and schools may receive training so they're able to provide appropriate support.

If you suspect your child has selective mutism and help is not available, or there are additional concerns - for example, the child struggles to understand instructions or follow routines - speak to a GP and ask them to refer you to a local specialist service for a formal diagnosis.

You can also contact a speech and language therapy clinic directly. Do not accept the opinion that your child will grow out of it or they are "just shy".

Your GP or local integrated care board (ICB) should be able to give you the telephone number of your nearest NHS speech and language therapy service or another specialist service that can help in your area.

Your child may also need to see a mental health professional or school educational psychologist.

The clinician may initially want to talk to you without your child present, so you can speak freely about any anxieties you have about your child's development or behaviour.

They'll want to find out whether there's a history of anxiety disorders in the family, and whether anything is causing distress, such as a disrupted routine or difficulty learning a second language. They'll also look at behavioural characteristics and take a full medical history.

A person with selective mutism may not be able to speak during their assessment, but the clinician should be prepared for this and be willing to find another way to communicate.

For example, they may encourage a child with selective mutism to communicate through their parents, or suggest that older children or adults write down their responses or use a computer. They may watch the child playing or watch a video of them speaking in a comfortable environment.

Diagnosis in adults

It's possible for adults to overcome selective mutism, although they may continue to experience the psychological and practical effects of spending years without social interaction or not being able to reach their academic or occupational potential.

Adults will ideally be seen by a mental health professional with access to support from a speech and language therapist or another knowledgeable professional.

Diagnosis guidelines

Selective mutism is diagnosed according to specific guidelines. These include observations about the person concerned as outlined:

they do not speak in specific situations, such as during school lessons or when they can be overheard in public

they can speak normally in situations where they feel comfortable, such as when they're alone with parents at home, or in their empty classroom or bedroom

their inability to speak to certain people has lasted for at least 1 month (2 months in a new setting)

their inability to speak interferes with their ability to function in that setting

their inability to speak is not better explained by another behavioural, mental or communication disorder

Associated difficulties

A child with selective mutism will often have other fears and social anxieties, and they may also have additional speech and language difficulties.

They're often wary of doing anything that draws attention to them because they think that by doing so, people will expect them to talk.

For example, a child may not do their best in class after seeing other children being asked to read out good work, or they may be afraid to change their routine in case this provokes comments or questions. Many have a general fear of making mistakes.

Accidents and urinary infections may result from being unable to ask to use the toilet and holding on for hours at a time. School-aged children may avoid eating and drinking throughout the day so they do not need to excuse themselves.

Children may have difficulty with homework assignments or certain topics because they're unable to ask questions in class.

Teenagers may not develop independence because they're afraid to leave the house unaccompanied. And adults may lack qualifications because they're unable to participate in college life or subsequent interviews.

Treating selective mutism

With appropriate handling and treatment, most children are able to overcome selective mutism. But the older they are when the condition is diagnosed, the longer it will take.

The effectiveness of treatment will depend on:

how long the person has had selective mutism

whether or not they have additional communication or learning difficulties or anxieties

the co-operation of everyone involved with their education and family life

Treatment does not focus on the speaking itself, but reducing the anxiety associated with speaking.

This starts by removing pressure on the person to speak. They should then gradually progress from relaxing in their school, nursery or social setting, to saying single words and sentences to one person, before eventually being able to speak freely to all people in all settings.

The need for individual treatment can be avoided if family and staff in early years settings work together to reduce the child's anxiety by creating a positive environment for them.

This means:

not letting the child know you're anxious

reassuring them that they'll be able to speak when they're ready

concentrating on having fun

praising all efforts the child makes to join in and interact with others, such as passing and taking toys, nodding and pointing

not showing surprise when the child speaks, but responding warmly as you would to any other child

As well as these environmental changes, older children may need individual support to overcome their anxiety.

Cognitive behavioural therapy

Cognitive behavioural therapy (CBT) helps a person focus on how they think about themselves, the world and other people, and how their perception of these things affects their thoughts and feelings. CBT also challenges fears and preconceptions through graded exposure.

Behavioural therapy

Behavioural therapy concentrates on helping combat current difficulties using a gradual step-by-step approach to help conquer fears.

Techniques

There are several techniques based on CBT and behavioural therapy that are useful in treating selective mutism. These can be used at the same time by individuals, family members and school or college staff, possibly under the guidance of a speech and language therapist or psychologist.

Graded exposure

In graded exposure, situations causing the least anxiety are tackled first. With realistic targets and repeated exposure, the anxiety associated with these situations decreases to a manageable level.

Older children and adults are encouraged to work out how much anxiety different situations cause, such as answering the phone or asking a stranger the time.

Stimulus fading

In stimulus fading, the person with selective mutism communicates at ease with someone, such as their parent, when nobody else is present.

Another person is gradually introduced into the situation and, once they're included in talking, the parent withdraws. The new person can introduce more people in the same way.

Shaping

Shaping involves using any technique that enables the person to gradually produce a response that's closer to the desired behaviour.

For example, starting with non-verbal communication, gradually moving to making eye contact, saying short words and then longer sentences and, finally, 2-way conversation.

Positive and negative reinforcement

Positive and negative reinforcement involves responding favourably to all forms of communication and not inadvertently encouraging avoidance and silence.

If the child is under pressure to talk, they'll experience great relief when the moment passes, which will strengthen their belief that talking is a negative experience.

Desensitisation

Desensitisation is a technique that involves reducing the person's sensitivity to other people hearing their voice by sharing voice or video recordings.

For example, email or instant messaging could progress to an exchange of voice recordings or voicemail messages, then more direct communication, such as telephone or Skype conversations.

You could also record your child at home and encourage them to watch or listen to themselves speaking.

Medicine

Medicine is only really appropriate for older children, teenagers and adults whose anxiety has led to depression and other problems.

Medicine should never be prescribed as an alternative to environmental changes and behavioural approaches. Though some health professionals recommend using a combination of medicine and behavioural therapies in adults with selective mutism.

However, antidepressants may be used alongside a treatment programme to decrease anxiety levels, particularly if previous attempts to engage the individual in treatment have failed.

Advice for parents

Do not pressurise or bribe your child to encourage them to speak.

Let your child know you understand they're scared to speak and have difficulty speaking at times. Tell them they can take small steps when they feel ready and reassure them that talking will get easier.

Do not praise your child publicly for speaking because this can cause embarrassment. Wait until you're alone with them and consider a special treat for their achievement.

Reassure your child that non-verbal communication, such as smiling and waving, is fine until they feel better about talking.

Do not avoid parties or family visits, but consider what environmental changes are necessary to make the situation more comfortable for your child.

Ask friends and relatives to give your child time to warm up at his or her own pace and focus on fun activities rather than getting them to talk.

As well as verbal reassurance, give them love, support and patience.

Getting help and support

Teenagers and adults with selective mutism can find information and support at iSpeak and the Facebook group SM SpaceCafe.

The Selective Mutism Information and Research Association (SMiRA) is another good resource for people affected by selective mutism. There's also a SMiRA Facebook page.

The Royal College of Speech and Language Therapists and the Association of Speech and Language Therapists in Independent Practice can help you find professionals in your area with experience in treating selective mutism.

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Find out about selective mutism, an anxiety disorder that prevents people from speaking in certain social situations.

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Speech and Language UK: Changing young lives

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Speech and Language UK: Changing young lives

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Speech and Language UK: A resource library for parents

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Speech and Language UK: A resource library for parents

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We know that each child and situation is different. We also know there are some questions that come up again and again. Our team of speech & language therapists have written the I CAN Help Factsheets, based on our most frequently asked questions from parents, carers and practitioners. Take a look at…

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When children start school they should be able to speak to their new friends in full sentences, ask teachers simple questions and understand what they're told to do. When they have these skills they'll feel more confident and they'll be happier.

But children starting school all across the UK today are unable to do these things.

In England, 1 in 4 children starting primary school are behind with their level of literacy development (language, communication and literacy skills), rising to more than 1 in 3 (42%) in some areas ( Department for Education, 2019 ). The picture is similar in Wales, Scotland and Northern Ireland too.

Language and communication skills unlock literacy, and that's why Tiny Happy People is concentrating on the building blocks of language development.

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Tiny Happy People can help you develop your child's language and communication skills, so they get the best start in life. It's full of activities and things to do with your children to help give them the best start in life.

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Dummy Information Leaflet- Cheshire East Chatters

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Dummy Information Leaflet- Cheshire East Chatters

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GM 10 Tips for Talking- A3 Poster/summary

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GM 10 Tips for Talking- A3 Poster/summary

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Learning to Talk-Information and guidance

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Skip to main content

0 to 6 months

Your baby's eyes and hearing will be checked while you're still in hospital, or within a few weeks after the birth. Your midwife will support you for a week or so after your baby is born. Then your health visitor will take over, your first appointment will be around 10 to 14 days, then at 6 to 8 weeks. You can discuss your baby's development and ask any questions you might have.

Did you know?

Babies start to recognise their mother's voice during pregnancy. Ask your midwife for tips on helping your baby learn to communicate after they're born.

What is my baby learning?

By 4 to 6 months, babies learn to:

recognise their own name

show emotions like excitement, likes and dislikes

start babbling

How can I help my baby learn to talk?

talk to your baby about anything and everything

spend time together face-to-face

see if your baby can copy you when you stick out your tongue or blink your eyes

respond to your baby when they make noises - try saying things like "wow, you can make loud noises!"

sing songs and rhymes with your baby - try songs with actions and lots of repetition, like "round and round the garden"

What can my baby see?

newborn babies can see large shapes and faces when they are near them

at about 1 month, they may be able to briefly hold your gaze

between 4 and 6 months babies start seeing in 3D and can focus on people further away

by 12 months most babies can see clearly

Sign up for emails

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Speaking more than one language

It's important to talk to your child in the language, or languages, you feel most confident speaking.

Children who speak more than one language babble and say their first words in the same way as children learning one language, but some may do it slightly later. It is important not to confuse this slight delay with language difficulties - most children quickly catch up.

Help and advice

Ask your health visiting team for support whenever you need it, they will be able to provide tips and advice.

Remember, children learn to talk at different ages. If you are worried, speak to your health visitor or nursery key worker. Or contact your local speech and language therapy service for advice.

For more ideas on how you can help your child, visit:

Sign up now for our pregnancy, baby and toddler guide

Get personalised emails for trusted NHS advice, videos and tips on your pregnancy week by week, birth and parenthood.
Get weekly emails

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Skip to main content Your baby's eyes and hearing will be checked while you're still in hospital, or within a few weeks after the birth. Your midwife will support you for a week or so after your baby is born.

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Speech and Language UK- FREE Enquiry Service

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Speech and Language UK- FREE Enquiry Service

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The Service is part of Speech and Language UK's Family Support offer. It is designed to give parents or carers and practitioners a chance to discuss questions or concerns about a child’s speech, language and communication development with one of our speech and language therapists. This service is free.

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Through our Enquiry Service, we are able to offer parents/carers and practitioners a confidential phone call with an experienced speech and language therapist. Our call slots last up to 30 minutes.

During the call, you will have the opportunity to talk through your queries or concerns regarding an individual child's speech, language and communication development. The therapist will be able to provide you with information on typical speech, language and communication development, as well as some advice on how to support the child's skills and signpost to other services as appropriate.

Following the call, the therapist will email you a brief summary of the call with any tips, techniques and links to other services referred to during the call. You will also be emailed a link to an optional feedback survey to tell us what you thought of the service.

This service does not include meeting and assessing children. The speech and language therapist cannot give specific advice on topics such as diagnosis or the provision the child is receiving, but will aim to signpost to services and organisations that can help further.

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Through our Enquiry Service, we are able to offer parents/carers and practitioners a confidential phone call with an experienced speech and language therapist. Our call slots last up to 30 minutes. During the call, you will have the opportunity to talk through your queries or concerns regarding an individual child's speech, language and communication development.

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Guidance

The new Early Help delivery model has been developed through our multiagency Children Trust Partnership, and came into effect on Monday 7 October 2019.

There are 3 new locality Early Help teams based in Bury, Radcliffe and Whitefield and support all five neighbourhoods

The teams are working with children and young people, age 0-19, and their families

The teams are linked to the schools, so that every school in the borough has an Early Help contact

Similar pathways to support are being developed for pre-school children and post-school

The Early Help teams link with partner organisations to ensure a joined up approach

A new Early Help assessment, the Story So Far, replaces the previous Early Help Family Support Plan and is already being successfully used by schools and other agencies

Contact details:
Bury East Locality Team (including Tottington/Ramsbottom)
Telephone Number: 0161 253 5200
Whitefield Locality Team (including Prestwich)
Telephone Number: 0161 253 5077
Radcliffe Locality Team
Telephone Number: 0161 253 7465/7468

Attachments

Guidance / Supporting documents

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The new Early Help delivery model has been developed through our multiagency Children Trust Partnership, and came into effect on Monday 7 October 2019.

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Early Intervention Tool-SLC

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Delayed language skills lead to under-performance later in life, yet many primary school children have unidentified speech and language difficulties. WellComm can help you to turn this around.
Both the Early Years and the Primary toolkits enable you to quickly and easily identify children needing support. They're quick and simple to use (requiring no speech and language expertise), and the traffic light scoring format of the instant reports makes them quick to interpret.

Both toolkits come with an age-appropriate Big Book of Ideas providing a total of over 150 instant, play-based activities so you can take appropriate action straight away. Activities can be used with parents at home too, so that support is provided whether or not a child is referred to a speech and language therapist

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Both the Early Years and the Primary toolkits enable you to quickly and easily identify children needing support.

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Connecting people, communities, and local services throughout Bury.

We care about Bury and our communities and want to empower you and your family to live a happier and healthier life.

We aim to bring together everything you need to live a happier and healthier life in Bury, all in one place. You can find services, information, advice, events, activities, and support that is available for people living within the borough of Bury, including Whitefield, Radcliffe, Prestwich, Tottington and Ramsbottom.

You can find what you are looking for by browsing our main categories, Adult Social Care, Children, Young People & Families, and Health, Wellbeing & Lifestyle, or use our onsite search tool. You can also use the onsite navigation, located at the top of every page to explore other useful sections.

We also have areas of the website dedicated to support unpaid carers, children and families with special educational needs and disabilities, and care leavers living in Bury.

Why not take a look at our What's On in Bury section to find activities and events happening in and around Bury?

Did you know you can list your service or upcoming event with us here on The Bury Directory for free? If you have any questions or require further support, you can contact us today.

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Connecting people, communities, and local services throughout Bury. We care about Bury and our communities and want to empower you and your family to live a happier and healthier life. We aim to bring together everything you need to live a happier and healthier life in Bury, all in one place.

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Available for Looked after Children in Bury

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Dolly Parton's Imagination Library is dedicated to inspiring a love of reading by gifting books free of charge to children from birth to age five, through funding shared by Dolly Parton and local community partners in the United States, Canada, United Kingdom, Australia and Republic of Ireland.

Inspired by her father's inability to read and write Dolly started her Imagination Library in 1995 for the children within her home county. Today, her program spans five countries and gifts over 2 million free books each month to children around the world.

"When I was growing up in the hills of East Tennessee, I knew my dreams would come true. I know there are children in your community with their own dreams. They dream of becoming a doctor or an inventor or a minister. Who knows, maybe there is a little girl whose dream is to be a writer and singer.

The seeds of these dreams are often found in books and the seeds you help plant in your community can grow across the world."

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Dolly Parton's Imagination Library | USA, UK, IE, CA, AU

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Dolly Parton's Imagination Library is a book gifting program that mails free books to children from birth until they begin school in participating areas.

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Speech and Language UK - Check your child's progress in Speech, Language and Communication 

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Speech and Language UK - Check your child's progress in Speech, Language and Communication 

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Our progress checkers will provide short questions you can answer to see how your baby or child is getting on with their speech, language and communication development.

It's based on what we know about how language develops in babies and children. It's not the same as a standardised measure a specialist would carry out but it should give you an idea of how your baby or child is developing and whether you need some support or advice to help you and them.

Choose the right age and answer the questions, at the end, we will let you know how your child is doing and what help is available if you need it.

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Our progress checkers will provide short questions you can answer to see how your baby or child is getting on with their speech, language and communication development. It's based on what we know about how language develops in babies and children.

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Greater Manchester's 10 Tips for Talking-Bury poster.

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Greater Manchester's 10 Tips for Talking-Bury poster.

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GM 10 Tips for Talking poster-Bury version

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Greater Manchester's 10 Tips for Talking in GM's top 10 spoken languages.

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Greater Manchester's 10 Tips for Talking in GM's top 10 spoken languages.

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GM 10 Tips for Talking in other languages

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Bookstart packs - Given to  children in Bury at Birth, and at 9 months old

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Find out about Bookstart, the BookTrust programme that gives free books to every child in England and Wales at two key stages before school, plus free packs for children with additional needs, tips and guidance on reading together, resources and activities, and much more.

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Funded places available for 2,3 and 4 year olds

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Free Early Education and Childcare places can be offered by a variety of providers including school nurseries, private nurseries, pre-school playgroups and childminders as long as they are included in Bury's Directory of EEC Providers for 2, 3 and 4 year olds.

For further information please read the attached documents.

Please Note the EEC Guidance States: Early education funding cannot be claimed by, or spent on, childminders providing childcare for their own child or a related child, even if they are claiming for other children.

You can search for other childcare providers in the Education and Childcare section of The Bury Directory
I am a registered childcare provider, what do I do next?
If you are a registered childcare provider and would like to be included in Bury's Directory of EEC Providers for 2, 3 and 4 Year Olds please email Early Years Funding at the email address below with your details, including your OfSTED URN (registration number).

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Early Education & Childcare (EEC) Information for Registered Childcare Providers | The Bury Directory

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Free Early Education and Childcare places can be offered by a variety of providers including school nurseries, private nurseries, pre-school playgroups and childminders as long as they are included in Bury's Directory of EEC Providers for 2, 3 and 4 year olds. For further information please read the attached documents.

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Statutory Guidance

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Early years foundation stage (EYFS) statutory framework

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The standards that school and childcare providers must meet for the learning, development and care of children from birth to 5.

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Supports you to help your child learn at home

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Chat, play, read!

Here are some tips and activities to help your child develop their speech skills:

use things your child is interested in for play, follow their lead and make sure you're physically at their level while playing

if you notice your child looking or pointing at something, talk to them about it before they lose interest in it

picture books introduce your child to new things they haven't seen yet in real life - ask them to tell you the story, or talk about what the characters might be thinking and feeling

make reading, singing and playing even more fun by using lots of actions and different voices

take turns to make noises or speak - your child will be able to hold longer conversations, so slow down your speech, give them plenty of time to respond and listen carefully to what they have to say

talk to your child in short, simple sentences, as it's easier for them to understand you and have a go at copying when they are ready

try to use the same book or sing the same song, as young children learn a lot from repetition

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Find out how you can help your child with their speech & language development. If you have any concerns, talk to your doctor or health visitor.

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Supports you to help your child learn at home

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Tiny Happy People is here to help you develop your child's language skills. Explore our simple activities and play ideas and find out about babies and toddlers' amazing early development.

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Children’s language development and parenting advice - BBC Tiny Happy People

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A chatty child is a happy child, so Tiny Happy People is here to help you develop your child’s communication skills through simple interaction and play.

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Supports you to help your child learn at home