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.

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, 'Need the toilet', ‘Where’s the…?’)

Learn and use in class some simple 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 provide models of English.

Link speech sound awareness with phonics curriculum.

But, be aware that the phonics curriculum does not always correspond with typical speech sound development. Children may not be developmentally ready to work on certain sounds.

Talk about sounds in words during everyday activities, 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 topic vocab which is often multi-syllabic.

Use rhymes/songs and play with rhyming words.

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.

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.

Model symbolic noises (moo, brrm brrm etc) in context.

Label items and actions and model useful phrases during play or daily routines e.g. car, running, more, finished.

Model the same words/phrases repeatedly in context.

Offer fixed choices (e.g. 'juice or milk?'), then model the word for the chosen item.

Sing familiar action songs slowly. Leave out the words at the ends of lines to encourage joining in.

Exaggerate key words in a sentence to help children focus on them.

Model language which is individualised and meaningful.

Model language with 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'.

See universal and targeted strategies.

Children need to hear language in order to learn it - they do not learn language easily from trying to answer questions:

• Label items instead of asking the child what it is.

• Label their actions instead of asking them what they are doing.

Model language in a naturalistic way, instead of asking the child to copy your words.

Interpret non-verbal communication and offer a model from the child's point of view or a share point of view e.g. if they reach for a biscuit say "let's get a biscuit".

Model back language attempts using the adult form.

Add to language attempts, e.g. add a verb or an adjective to a noun e.g. Child: 'Dog!', Adult 'Big dog!'.

Use 'ready... steady...' and pause to prompt addition of 'go'. This may be a look, reach, sound or word.

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

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!'

For bilingual children, use these strategies in English, but also in home language if possible (e.g. through a bilingual staff member).

See universal and targeted strategies.

See universal and targeted strategies.

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

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

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 a simple visual timetable to show the class the broad schedule for the morning or afternoon (e.g. painting, snack, home corner, carpet time, home time).

In free-flow areas have clear zones to help children understand what happens in which area e.g. water play area, home corner, reading corner.

Try colour-coding each zone and key items in that zone so children know what belongs where.

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

Keep motivating items in sight, but out of reach (only if safe to do so). This creates a reason to communicate.

Miss out important items from everyday routines (e.g. give a yoghurt but no spoon) or give an incorrect item (e.g. a fork instead of a spoon) to create reasons to communicate.

Support interactive play in natural quiet play situations with other children, offering gentle support for interaction and sharing. Begin taking turns with dual resources first e.g. both children have cars to put down the ramp, before sharing materials e.g. one car to share.

Prepare for changes. Explain what is happening and why.

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

Use photos or objects of reference 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 children say, rather than how they say 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 the class 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: How to stop a child from choking - NHS (www.nhs.uk). 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.

See universal and targeted strategies.

See universal and targeted strategies.

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 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.

Be face to face at the same level to support easier interaction. If a face to face approach causes withdrawal, try slightly to the side or at a distance first.

Play people games e.g. tickles, peekaboo, rough and tumble play.

Pause frequently, watching for any responses to what you have said/done or to prompt a request for more.

Play alongside. Follow the lead in play and engage with current activities of interest. Try to add in a new idea to the play (e.g. a different vehicle if playing cars).

Target interaction through frequent short Intensive Interaction sessions.

Copy sounds and actions to encourage shared attention and early turn-taking awareness.

If child naturally uses eye contact, hold motivating items at eye level to encourage shared attention. NB do not force eye-contact on children - some children cannot process eye contact or find it threatening.

Offer choices between a strongly motivating and a non-motivating/irrelevant object to develop choice-making skills.

Be a helper - pass items one at a time to take part in harder to join in activities, e.g. cars for the car ramp, pieces for the inset puzzle. This creates an opportunity for requesting the next item. Pause briefly to provide this opportunity but don't demand it.

Pause a motivating activity and wait expectantly for an indication that more is wanted.  Model the word or sign, then continue with the activity. Repeat the cycle several times.

Use expressive visual systems to encourage the sending of a message. This could be single symbols on lanyards, choice boards, communication boards. Model without expectation.

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.

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'.

Be mindful of situations where there may be a feeling of increased pressure or demand.

Give options of different ways of participating in more demanding activities. E.g. painting a picture of what they did on holiday, instead of telling a story verbally.

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.

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.

Gently model back attempts at words using the adult pronunciation, but do not directly correct errors.

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?'

Use a mirror to give visual feedback for practising specific sounds.

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

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

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.

Speechlink

Company who market software to help schools identify and manage speech sound needs.

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.

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 simple board or group games to develop skills in waiting your turn and watching other players.

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.

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.

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.

Deliver Attention Autism sessions at least once a week to develop attention skills.

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: 0-6 months, 6-12 months, 12-18 months, 18-24 months, 2-3 years, 3-4 years.

If you have done a Little Link screen which indicates SLT discussion is needed.

If you have done a Wellcomm Early Years screen which gives red indicators.

If use of the Derbyshire Every Child a Talker (ACAT) assessment tool indicates expressive language below the expectation for the child's developmental stage or diagnosis.

Children who are English-speaking only: if they are not saying any words at all by age 3 (but have age-appropriate understanding and other skills).

Children do not usually need SLT support if:

• they are gestalt language learners with the above strategies 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.

Always refer children who stammer to the SLT service, as early support is key. You do not need to discuss stammering referrals with the service first.

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

See universal and targeted strategies.

Use simple visual timetables help the child into the current activity and what is next.

Use Now-Next boards (example here: Now Next Visual Aid) to cue the child into the current activity and to reassure them that they will get to do a fun activity afterwards.

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

If use of the Derbyshire Every Child a Talker (ACAT) assessment tool indicates social communication below the expectation for the child's developmental stage or diagnosis.

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: 0-6 months, 6-12 months, 12-18 months, 18-24 months, 2-3 years, 3-4 years.

If you have done a Little Link screen which has advised discussion with an SLT.

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

If use of the Derbyshire Every Child a Talker (ACAT) assessment tool indicates understanding below the expectation for the child's developmental stage or diagnosis.

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.

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.

SLTs are not able to manage demand avoidance on its own, however we can support these needs where they co-occur with and impact on or are impacted by speech, language and communication needs.

SLTs are not able to manage planning and organisation on its own, however we can support these needs where they co-occur with and impact on or are impacted by speech, language and communication needs.

SLTs are not able to manage prediction and transition on its own, however we 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.