Consider positioning in class. Some children find it easier to focus at the front near the teacher; others prefer to sit at the back where they can see everything, which reduces anxiety.

Reduce background noise, including turning off unused electrical equipment.

Have clear class rules about not talking when the teacher is talking, or during quiet work.

Gain attention before giving whole class instructions or information.

Be aware that emotional dysregulation will significantly affect listening and processing ability. Take a non-verbal approach at such times.

Use visual supports to cue into the current task. This may include gestures, symbols or drawings visible to the whole class.

Consider including movement in tasks to support attention and focus.

Provide opportunities for movement prior to listening tasks and consider adaptations such as wobble cushions.

Consider use of interoception curriculum to support body awareness and self-regulation.

Use short simple sentences and simple words.

Pause before responding to slow the pace of the interaction and to give extra processing time.

Repeat information if necessary - repeat exactly to avoid confusion.

Give plenty of processing time before expecting a response.

Chunk information into smaller pieces. Let children complete each step before giving the next.

Ask for repetition of your message to check it has been processed.

Check understanding after giving instructions - ask children to tell you what they think they have to do.

Use visuals such as objects, photos, symbols, gesture, signing or demonstration to show what you mean. E.g.

• hand gestures, such as a rising or falling hand gesture to show 'higher' / 'taller' vs 'lower' / 'shorter'

• symbols to illustrate key concepts or vocab

• demonstration of a practical task

• photos showing each step of a practical task.

Pre-teach next term's technical / specialist vocabulary for topics like science, history or geography, so children are familiar with it when it arises in class. Send home simple vocab sheets/ glossaries for study during half-term holidays.

Model language throughout the day by giving a running commentary during a range of activities.

Model language which is individualised and meaningful.

Model a variety of communicative intents (not just requests), such as protesting, shared joy, commenting, self-advocacy. E.g. 'that's not nice', 'we did it!', 'this is fun'.

'Scaffold' - to help children giving longer narratives, feedback to them what you have understood so far in a clear form and use cues to prompt more information. e.g. 'So, you were in the dining hall, and you got your meal and then...?'

Talk about the sounds and meanings of words to build vocabulary knowledge. E.g. What sound does it start with? What does it look like? What is it used for? Where do we find it?

For written narratives, use story boards to support narrative structure, with context (where, who etc) prompts at the top, or paragraph structure systems (e.g. PEEL).

Be aware of common misconceptions around bilingual learning: Myth-busting: Bilingualism / English as an additional language

Use expressive language supports to support English development.

Ensure appropriate cultural representation in the classroom (including access to relevant books and videos).

Teach some useful classroom phrases in English to support getting needs met (for example, ‘Where’s the…?’, 'Can I go to the toilet?' etc.)

Learn and use in class some words and phrases from the home language (e.g. greetings and ‘thank you’).

Model a variety of question types. This will show the different functions of language.

Give a running commentary on what you are doing to give models of English.

Model back attempts at words using the adult pronunciation.

Talk about sounds in words during all lessons, not just during phonics. E.g. 'There's a dog. That starts with /d/'

Clap, tap or drum the syllables in words - this is particularly useful when pre-teaching upcoming specialist / technical topic vocab which is often multi-syllabic.

Use rhymes/songs and play with rhyming words.

Do not correct errors if the sound has not yet been learned or targeted in therapy - this will cause frustration.

In daily conversation, focus on the content of the message rather than the pronunciation.

Use no-blame prompts for clearer speech, e.g. "My ears aren't working very fast today. Can you say it slower please?", "It's noisy in here, I didn't hear you. Can you say it louder please?"

Pick a phonics word or words of the week and encourage use of target sounds each time this word is used in class.

For bilingual children, use the universal strategies both in English and also in home language if possible (e.g. through a bilingual staff member).

For gestalt language learners, use a natural language modelling approach to support learning gestalts which they can break down to mix and match in future. E.g. 'let's play', 'that's noisy', 'I love it!'

Use word networks (KS1 example, KS2 example) to pre-teach curriculum vocabulary and strengthen word knowledge.

Keep a word bank of targeted words and revisit them on a regular basis.

Use Colourful Semantics to support sentence building. Ask specific questions to encourage more specific information (e.g. Which room were you in? Who was there? What happened next?)

Some children may benefit from functional interventions from the Wellcomm Primary Big Book of Ideas

Be aware that emotional dysregulation and/or sensory overload will impact on children's ability to manage demand.

Watch children's responses to learn preferences and responses to preferred/non-preferred experiences. This will help you recognise emotional dysregulation and overload.

Use statements rather than questions or instructions. E.g. 'It's time for...' (rather than 'Can you ...' or 'Please ...').

Give choices. E.g. 'we need to do x and y, which shall we do first?'

Give as much control as possible over task choices, content and format.

Be flexible in your approach to task demands. Does it really have to be this task, does it really have to be completed this way?

Use play or game-based approaches to work wherever possible.

Watch for subtle signals of overload and when needed give support to take a break.

Use structured worksheets (including sentence starters, gap filling, multiple choice questions or box-filling), rather than free-flow writing, open answer or essay style questions.

Give explicit, specific written learning objectives to state what needs to be achieved.

Give explicit and specific instructions for each step of a task.

Avoid any ambiguous or vague language. Use specific and explicit words to support literal comprehension.

Clearly explain idioms in meaningful contexts as they arise.

Use directions rather than questions. E.g. 'Time for...' (rather than 'Can you...?')

Give further explanations to ensure full understanding.

Focus on building skills rather than reducing unwanted behaviours. Make a 'can do' list rather than a 'can't do' list.

Use appropriate and affirming language to talk about Autism: How to talk and write about autism.

Prepare for changes. Explain what is happening and why.

Use countdown timers to develop waiting and prediction skills and support transition to the next activity.

Use photos to support prediction of the next activity and develop symbolic understanding skills (e.g. a picture of nursery before setting off for nursery)

Use Now-Next boards (example here: Now Next Visual Aid) to support and develop prediction, waiting or transition skills.

Be aware that:

• everyone occasionally does things like:

  • Repeating sounds or words, e.g. "My name is J-J-J-J-John".

  • Stretching or prolonging sounds, e.g. "Can you read me a ssssssstory?".

  • Having a silent block where a sound gets stuck, e.g. "---------Can I have…".

• Some people do this much more often, and we call this stammering. Stammering may affect how people communicate and this may cause distress.

• Many children also experience periods of non-fluency while they are developing language. This may include hesitations, pauses, fillers ('erm', 'what do you call it' etc). This is not the same as stammering.

• Stammering and non-fluency can be affected by demand and capacity. Demands placed on children's speech and language processing system can easily exceed their processing capacity. Support includes reducing demands and increasing capacity.

Ask fewer questions - especially unnecessary or 'test' questions.

Use comments rather than questions. E.g. say 'I wonder what you had for lunch' instead of 'What did you have for lunch?'

Slow your own talking and add pauses, to slow the pace of the interaction.

Do not say "slow down", "speak properly", "stop stammering" or "start again". This increases demand and awareness of the stammer.

Focus on what the child said, rather than how they said it.

Allow plenty of time for talking. Wait and listen to the whole message. Avoid interrupting or finishing the message for them.

When listening to stammered or non-fluent speech, try not to show any tension. Keep calm body language and maintain natural eye contact, to prompt a calm, relaxed approach to talking.

Support emotional regulation, avoiding where possible over-excitement or upset, to support a calm, relaxed approach to talking.

Normalise making mistakes for the whole class. Remind children that everybody finds things difficult sometimes, especially when still learning, and that this is ok.

Talk about activities you find easy and activities you find hard to show that it's ok to find some things difficult.

Value all children's voices, focussing on functional communication, whether they stammer or not

Use an Inclusive Communication approach: accept and make space for all forms of communication, including speech, symbols, signing, objects, gestures, pointing and eye contact.

Use signs and/or natural gestures alongside your speech throughout the day, with all pupils. For example:

• pointing to a person, item or place you are referring to

• using a rising or falling hand to illustrate ideas such as 'taller/higher' vs 'shorter/lower'.

• using wide vs narrow hands and expansive vs hunched body language to illustrate 'big' vs 'small'.

Treat all communication as meaningful, even if you don't think it is. For example, at snack time, give banana if this is 'chosen', even if you know the child doesn't like bananas. This helps to develop an understanding of meaning.

Do not insist on use of communication board/ book/ symbol system if the message is communicated a different way. Accept speech, signs or gestures too.

Do not ask for repetition of children's message (unless you didn't understand it).

Give food/drink in a calm, quiet environment as far as possible.

Consider positioning - most children need to be stable and upright with head in the midline as far as possible. Sitting with their back to the back of their chair, feet flat on the floor and hips, knees and ankles at right angles helps maintain core stability for eating and drinking.

Use positioning supports if needed. Consider chair height, or use a small footstool. Ensure chairs have stable backs. Ensure chair is close to the table to help provide support in front. A cushion may help with back support.

Avoid teated bottles and non-spill (one-way) valve beakers. Instead, use an open cup, an adapted cup (e.g. Doidy, flexi or nosey cup) or free-flow spouted beaker to help development of drinking skills.

Be aware of the difference between choking and gagging:

• Choking is silent. The airway is completely blocked and no air (or noise) can get through. This can result in the skin going blue. Please see this page for advice: First aid for a child who is choking | British Red Cross. If a child often chokes while eating solid foods, this may indicate a swallowing difficulty - seek advice from the SLT service.

• Gagging is usually noisy. It is a normal reflex as children learn to chew and swallow solid foods. They may make retching sounds. This page describes what gagging looks like and has a useful video: Choking and gagging on food - Start for Life - NHS (www.nhs.uk). Gagging is not harmful, and on its own does not need SLT service support.

Be aware of common misconceptions about bilingual learning: Children learning more than one language.

Use expressive language strategies in the home language.

Adults should use their strongest / most natural language when talking to the child.

Do not switch to using English at home when the child starts school or nursery. School will give enough exposure to help full learning of English.

Where possible use a range of languages at home. Hearing more than one language helps language development. It also helps children to communicate with relatives and maintain their cultural identify. 

Use video or phone calls to connect with family and friends in the home country. Encourage use of home language during these calls.

Visit cultural events in the community together. Talk about them using the home language.

See universal and targeted strategies.

Spend 5 minutes of one-to-one 'special time' together each day, where the child chooses what to play with or talk about. Let the child lead, with the adult responding in a relaxed way.

Keep regular bedtimes and mealtimes. Feeling tired or hungry reduces processing capacity and can affect speech.

Encourage other preferred activities, especially non-speaking activities, such as art/craft, physical activities, and play. Give plenty of praise about these activities to support wider self-esteem.

Talking openly abut stammering in a sensitive way helps to manage feelings about it and encourage confidence in communication skills.

When talking about the child's speech or stammering, avoid value-judgement words like 'bad/worse/good/better'. Instead use neutral words like 'more/less'.

If the child is aware of their stammer, ask them what they find helpful - and implement it.

Be mindful of situations where there may be a feeling of increased pressure or demand. Encourage the child to talk to someone if they are feeling worried or nervous before a higher-demand situation.

Encourage participation in group/class activities. Wait for the child to volunteer rather than selecting them on the spot.

Give options of different ways of participating in more demanding activities. E.g. could they pre-record a speech instead of performing it live. Give support to help prepare for situations.

Use visual timetables to make joint decisions with the child about tasks to be completed, with the pictures/symbols.

Reduce processing overload by having an adult complete the less important parts of a task. This frees up the child's resources to focus on the most important learning aspect. E.g. could an adult get the equipment out, write the name and date, or find the right page in the book?

Support the child to use non-verbal means to ask for help, rather than having to use language. Keep this discreet to reduce feelings of stigma. E.g. placing a ruler on the table, or turning to the last page of the exercise book and pointing to a list of pre-printed 'help' messages. Actively watch to see when help might be needed.

Check whether hearing loss (e.g. caused by glue ear) could be affecting speech sound development. Treatment of any underlying hearing loss can help speech sound development.

Point out items in the environment that start with current target sounds.

Use a mirror to give visual feedback of lip/tongue position when practising specific sounds.

When practising a new sound, do actions alongside the sound to provide visual and kinaesthetic support.

Break longer words into chunks and practise each syllable separately.

When generalising a newly learned sound into daily use, feedback errors to prompt self-correction e.g. 'Is it a tat?' Give a forced choice if needed, e.g. 'Is it a tat or a cat?'

STAMMA (British Stammering Association) 

Dedicated to creating a world where people who stammer are able to fulfil their potential and enjoy respect and consideration

Action for Stammering Children

UK charity for children and young people who stammer, their families, and the communities who support them. We provide advice and information, champion research, and campaign for policy and societal change.

National Autistic Society (NAS)

The UK's leading charity for people on the autism spectrum and their families, providing support, guidance and advice, as well as campaigning for improved rights, services and opportunities to help create a society that works for autistic people.

Derby & Derbyshire - Emotional Health & Wellbeing 

Support for wider needs related to neurodiversity. Click on the Neurodiversity tab.

Derby / Southern Derbyshire Neuro-developmental assessments (Autism & ADHD) 

Neurodevelopmental assessments for children in Derby and southern Derbyshire.

Northern Derbyshire Neuro-developmental assessments (Autism & ADHD)

Neurodevelopmental assessments for children in northern Derbyshire.

RADLD | Raising Awareness of Developmental Language Disorder

Resources explaining what DLD is, the impact it can have, how to get help and how to raise awareness.

Speech and Language UK

Charity whose mission is that no child should be left out or left behind because of a difficulty speaking or understanding. Their vision is a world where all children have the communication skills they need to fulfil their potential

Afasic

Supports and provides information for families with children and young adults who have Speech Language and Communication Needs (SLCN) with a focus on Developmental Language Disorder (DLD).

DLD and me

Organisation aiming to raise awareness about developmental language disorder (DLD) and to offer support and resources for parents, teachers and individuals impacted by DLD.

The Hanen Centre | Speech and Language Development for Children

A company selling resources and training for parents and professionals around communication development. Site contains some free advice.

RADLD | Raising Awareness of Developmental Language Disorder

Charity with resources explaining what DLD is, the impact it can have, how to get help and how to raise awareness.

Speech and Language UK

Charity whose mission is that no child should be left out or left behind because of a difficulty speaking or understanding. Their vision is a world where all children have the communication skills they need to fulfil their potential

Afasic

Charity supporting and provides information for families with children and young adults who have Speech Language and Communication Needs (SLCN) with a focus on Developmental Language Disorder (DLD).

DLD and me

Charity aiming to raise awareness about developmental language disorder (DLD) and to offer support and resources for parents, teachers and individuals impacted by DLD.

The Hanen Centre | Speech and Language Development for Children

A company selling resources and training for parents and professionals around communication development. Site contains some free advice.

Children with no other learning needs or a spiky profile: if their speech sounds are below expectations for their chronological age.

Children with global developmental delay or wider learning disabilities: if their speech sounds are below expectations for their overall developmental stage. Make sure you consider wider developmental stage. rather then chronological age when considering speech sounds.

If you have done a SpeechLink screen which indicates discussion with an SLT is needed.

If speech is not following the typical developmental pattern: Speech sounds - typical development

Children do not usually need SLT support if:

• they are following the typical developmental pattern but more slowly because of a wider developmental delay.

• they have small differences in pronunciation that are not affecting their functional communication (e.g. a lisp, or using /w/ for /r/).

• they have a temporary hearing loss due to glue ear - speech sounds usually catch up within 3 - 12 months after glue ear is resolved.

• they have dentition issues (missing or misaligned teeth/jaw) affecting speech. SLT cannot resolve these speech sound issues.

See universal and targeted strategies.

Turn off the TV or other screens when the child is not actively watching or playing video games. Do not have TV or other screens on in the background while child is talking, reading, or playing.

Have clear rules about taking turns for talking / only one person talking at once.

Play board games to develop skills in waiting your turn and watching other players.

See universal and targeted strategies.

Help child to pre-learn specific technical vocab for next term's topics in the holidays before it arises in class.

Discuss current learning topics at home, to revisit key vocabulary and ideas.

See universal and targeted strategies.

Comment on what the child is doing, seeing etc, instead of asking them questions. Children need to hear language in order to learn it - they do not learn language easily from trying to answer questions.

If appropriate, and if bilingual staff are available, use the targeted level individual supports/ interventions for expressive language, as well as working on any language targets, in the home language too.

This includes word networks (KS1 example, KS2 example) and Colourful Semantics if appropriate.

Pair the child with a peer who is a confident English speaker to support development of English.

Help children practise talking in pairs and small groups before speaking in front of the class.

See universal and targeted strategies.

Children with difficulties occurring in both English and the child's home language: follow guidance for relevant area of need (understanding, expressive language, speech).

Children do not usually need SLT support if

• difficulties are in English only.

Children with no other learning needs or a spiky profile: if their expressive language is below the expectation for their chronological age.

Children with global developmental delay or wider learning disabilities: if their expressive language is below the expectation for their overall developmental stage. Ensure you consider the wider developmental stage and not chronological age when considering expressive language.

Children with Down Syndrome: if their expressive language is not as expected for the usual development of language in Down Syndrome (see p7).

See here for more detailed descriptors of age-related expectations: 4-5 years, 5-7 years, 7-11 years.

If you have done an Infant LanguageLink or Junior LanguageLink screen which indicates SLT discussion is needed.

Children who are English-speaking only: if they have disordered word order, large vocabulary gaps or difficulties retrieving words.

Children do not usually need SLT support if:

• they are gestalt language learners with the above strategies are in place.

The SLT service cannot manage attention and listening on its own, however the service can support these needs where they co-occur with and impact on or are impacted by speech, language and communication needs.

Some children do not understand that whole class instructions also include them. When gaining the class's attention, add the child's name before giving whole class instructions.

Say the child's name and watch for signs of attention, before giving individual instructions / asking individual questions.

Do not rely on eye contact as a sign of listening/attention. Some children cannot give direct eye contact. They may still be listening and attending (e.g. using their peripheral vision).

Some children cannot listen and look at the same time. Accept averted gaze if this helps them to process what you are saying.

For children who can use eye contact, get into their line of sight to help them look at you if needed.

Consider a quiet distraction-free environment for specific academic tasks.

For students with no prior SLT service support for their stammer, or with a new stammer: Always refer straight to the SLT service, as early support is key. You do not need to discuss stammering referrals with the service first.

Students who have had prior SLT service support for their stammer: if the student is worried or frustrated by their communication, or if they are struggling to communicate or participate effectively.

Make sure you answer the stammering questions on the referral form, so we the service give the right help sooner.

If in doubt, contact the SLT service to discuss.

See universal and targeted strategies.

See universal and targeted strategies.

Use visual aids to show how much work is needed, e.g. markers on the page to show where to write to, word counts, markers to show which questions to answer etc.

Use mind maps to organise information and story boards to structure narratives or sequence events.

Do not expect or coach children to use neurotypical behaviours. Do not teach compliance. This causes masking and can lead to trauma and mental health difficulties.

Use Comic Strip Conversations during short one-to-one interactions to build awareness of own and others' thoughts and feelings and to think about social situations.

Use Social Stories (TM) during short one to one sessions to support navigation of social situations.

Use externalised social thinking. In real-life situations or while watching films or TV programme, talk about others' emotions aloud. e.g. 'I think Jack is sad because he can't go to the party. His mouth is turned down and he looks like he's about to cry.'

Be social detectives - after using externalised social thinking, try to predict what the person might do or say next. Think of sensible or silly things, and talk about which is which.

Work on emotional literacy. Start with interoception and body awareness. Then move on to simple emotions, labelling them as experienced in real-life situations. Talk about how the body feels and looks during each emotion.

Use Lego Therapy during group sessions with 3 children to develop collaboration skills. These sessions can also be used to model language without expectation and play alongside each other, experiencing enjoyment of a shared interest.

Older children (KS2): read the SLT Service's Social Communication Toolkit.

Autistic children whose differences in social communication are over and above what is expected with autism.

Children experiencing significant frustration or distress around social communication.

Children do not usually need SLT support if:

• They communicate as expected with their autism diagnosis. Although neuro-divergent children may communicate and interact differently to neurotypical children, this is not always a problem and they may not always need SLT support.

Children with no other learning needs or a spiky profile: if their understanding of language is below the expectation for their chronological age.

Children with global developmental delay or wider learning disabilities: if their understanding of language is below the expectation for their overall developmental stage. Ensure you consider the wider developmental stage and not chronological age when considering understanding of language.

Children with Down Syndrome: if their understanding of language is not as expected for the usual development of language in Down Syndrome (see p7).

See here for more detailed descriptors of age-related expectations: 4-5 years, 5-7 years, 7-11 years.

If you have done an Infant LanguageLink or Junior LanguageLink screen which has advised discussion with an SLT.

If you have done a Wellcomm Primary screen which gives red indicators for the child.

Children do not usually need SLT support if:

• they are following the typical developmental pattern but more slowly due to a wider developmental delay.

Model use of any communication boards / books / devices throughout the day - this is the most important thing you can do to develop use of AAC systems.

Focus on modelling the most widely used ('core') words, such as "help", "something different", "want", "stop", "more", "finished". These words should always be in the same place on each page of the book, to help with finding them.

Remember to model comments (e.g. "funny!", "I like it", "I don't like it") as well as requests.

Add to signing or symbol use attempts, for example, adding a verb or an adjective to a noun. E.g. if child signs / points to symbol for 'dog', adult signs / points to 'big dog'.

Respond to all communication attempts by modelling the spoken language to match the signs / symbols.

Where available and safe, give what has been requested, especially in the early weeks, to encourage use of AAC.

If the requested item/activity is not available, acknowledge the request then explain it is unavailable (e.g. "no swimming today", "Grandma's tomorrow" etc). With communication boards and books, briefly place a red cross over the symbol to visually reinforce this. Never remove symbols just because the item is not available.

Never use the board/ book for behaviour management. Never remove it as punishment or give it as a reward. It must be accessible at all times, as if it were spoken language.

See universal and targeted strategies.

See universal and targeted strategies.

Children with an electronic AAC device provided by the NHS Electronic Assistive Technology Service (EATS) regional hub (Lincoln): EATS usually provide oversight and technical management of the device (including repair/replacement).

The NHS SLT service provides any initial training or content modifications needed to support use of an EATS-provided electronic device in school and at home.

Communication Matters

A charity that exists to support people who use Augmentative and Alternative Communication (AAC) in their basic human right to communicate, be included and heard in an equitable society.

Widgit

A company selling resources to support use of symbols. Some free resources available.

Children who may meet the criteria for provision of an electronic AAC device from the Electronic Assistive Technology Service (EATS). This includes:

• having a severe and complex communication difficulty associated with a range of physical cognitive, learning or sensory deficits,

  AND

• a clear discrepancy between their level of understanding and their ability to speak.

The SLT service will manage appropriate referrals onto EATS, including any local assessment needed, and support implementation of a device locally.

Children will not usually meet the EATS criteria if:

• Their understanding of language is at a similar level to their spoken language.

• They are not an intentional communicator / do not understand the purpose of an aid.

• They do not understand cause and effect.

If the child often shows signs of aspiration during or just after eating or drinking:

• coughing

• choking

• colour change

• arching the back

• sweating

• eye watering

• 'gurgly' voice

• noisy or 'wet' upper airway sounds before, during or after feeding

• increased rate and work of breathing

• apnoea (a pause in breathing)

• change in state and/or level of alertness for example: sudden drowsiness or irritability

• or any other change in presentation.

If the child is losing weight or not putting weight on as expected.

If the child is getting repeated bacterial chest infections (treated with antibiotics). This can be a sign that aspiration is happening regularly.

• NB viral chest infections (which are not treated with antibiotics), such as those caused by colds or flu, are not a sign of eating or drinking difficulties.

The SLT service cannot accept referrals for:

• Children who have eating/drinking needs that are purely sensory, behavioural or emotional, including aversion related to sensory preferences, such as not tolerating certain tastes or textures (for example liking purees but not liking lumpy foods). Please seek advice from the health visitor in the first instance.

• Children with Avoidant Restrictive Food Intake Disorder (ARFID). Please seek advice from the child's GP, who can refer to relevant support services.

• Children where the main concern relates to gastro-oesophageal reflux (GOR) and/or a cow’s milk protein intolerance. Please talk to the GP or paediatrician.

• Children who are only gagging, with no signs of aspiration and no other difficulties.

Understanding of language is usually most effectively supported via classroom strategies rather than direct interventions.

However, if you have the Wellcomm Primary Big Book of Ideas, some children may benefit from some of the activities to support understanding.

Agree a clear system for child to show when they have not understood your message. E.g. a learned phrase ('I don't understand') or a visual system like a coloured card on the table.

The SLT service cannot manage demand avoidance on its own, however the service can support these needs where they co-occur with and impact on or are impacted by speech, language and communication needs.

The SLT service cannot manage planning and organisation on its own, however the service can support these needs where they co-occur with and impact on or are impacted by speech, language and communication needs.

The SLT service cannot manage prediction and transition on its own, however the service can support these needs where they co-occur with and impact on or are impacted by speech, language and communication needs.

Children with specific gross motor needs (e.g. cerebral palsy or low muscle tone): always seek advice from the physiotherapist about equipment to support positioning (e.g. seating systems, orthoses etc).

Children with specific fine motor needs: seek advice from the occupational therapist about specific equipment to support feeding, such as modified cutlery etc.

Children with dysphagia: avoid straws as these can shoot fluid to the back of the throat and increase risk of aspiration (food or fluid entering the airway).

For children with dysphagia, stop offering food/drink immediately if you see any signs of aspiration (food/fluid entering the airway):

• coughing

• choking

• colour change

• arching the back

• sweating

• eye watering

• 'gurgly' voice

• noisy or 'wet' upper airway sounds before, during or after feeding

• increased rate and work of breathing

• apnoea

• change in state and/or level of alertness for example: sudden drowsiness or irritability

• or any other change in presentation.

See universal and targeted strategies.

Derby City Council's Ethnic Minority Achievement Team (EMAT) provide support to Derby City schools for issues with English as an Additional Language.

The BBC's Tiny Happy People site has lots of advice for supporting bilingual children: Tiny Happy People - Bilingual babies and speaking multiple languages at home.