and language development for the Progress Check at Age Two, with the
example of a child hindered by her need of a dummy.
Ava, the youngest of four children, was admitted to the nursery aged two years and two months. No concerns were raised at the initial discussion and there was no professional involvement with the family. Her siblings were all quite a lot older, with a gap of ten years between Ava and the next-youngest child. The key person noticed that throughout the visit, Ava had a dummy in her mouth and did not communicate verbally, mainly nodding or shaking her head or pointing when she wanted to make herself understood.
Ava also had a dummy in her mouth throughout the induction period. Her key person spoke to Ava's mother about the reasons for having a nursery policy on dummies, and explained to her how staff would gradually and sensitively wean Ava off her dummy.
We know from research that dummies can have a huge impact on a child's language development. The World Health Organization (1989) reported a positive correlation between dummy use and increased incidence of the middle-ear infection otitis media.
Boshart (2001) found sucking on a dummy could cause problems in articulation, and Van Norman (2001) found that children trying to talk with a dummy in their mouths may not talk at all or have vocalisations that are distorted. The sucking action tends to cause an increase in saliva production, which in turn can cause dribbling, often leading to sore lips and chin.
Parting Ava from her dummy was very easy. After her induction, she settled quickly and was delighted to be among other children and in an exciting and stimulating environment. However, it was observed by staff that her speech and language were quite delayed.
SLUSHY SOUNDS
Ava's understanding and listening and attention skills were progressing normally; her problems were around expressive language and articulation.
She mainly used gesture to make her needs known, and when she did speak she tended to make slushy 'S' sounds, where the air escaped from the sides of her mouth rather than the front, and sounds from the back of the mouth instead of the front (for example, using a 'K' sound instead of a 'T'). This made Ava difficult to understand and, in turn, frustrated when she could not express herself.
The key person invited Ava's mother to a meeting to talk about Ava's speech difficulties. Although Ava was managing very well in nursery without a dummy, she was still insisting on it at home and throwing tantrums whenever her mother tried to take it away.
The key person suggested mum begin to persuade Ava to part with her dummy for short periods of time; to show her where she had put it and returning it as soon as the activity was over. The number of periods should be extended gradually and eventually limited just to going to sleep. The dummy should be taken away once Ava was asleep and moved out of reach so that it wasn't there for her to put back into her mouth as soon as she woke.
During the discussion it became clear that Ava's siblings and parents all guessed and responded to what she needed from her gestures, thereby discouraging her from making herself understood verbally. Ava's mother agreed that she and the family would encourage her to talk more and, if she had the dummy in her mouth, ask her to remove it before trying to communicate her wishes. Mum was quite happy for the nursery to refer Ava to a speech therapist for assessment to rule out any fundamental problems.
The nursery already used Makaton as an additional means of communication with all the children. It is very important if a child is using signs and symbols that everyone in contact with them has knowledge of the system and understands some key signs, so the key person invited Ava's parents and siblings to a basic training session. She explained that having an additional means of communication would help to solve some of Ava's frustration at not being understood.
BOOKS AND RHYMES
The nursery continued to implement good practice based on the guidelines from The Communication Trust. These ideas were shared with Ava's mother, who was able to carry them out at home, and the nursery lent her some of Ava's favourite books and resources. The ideas included:
- Share books together; interactive books with flaps and different textures are great.
- Wait for toddlers to initiate talking - don't feel that you have to fill the silences.
- Repeat and expand on what children say. If a child says 'car', you can say 'mummy's car', 'blue car', etc. This shows children how words can be put together.
- Playing with children, taking their lead and building their language and thinking helps them learn and grow - young children really benefit from this approach.
- Finger rhymes and action songs help toddlers with the rhythms of language and make talking and listening fun.
Ava was observed in the nursery by the speech and language therapist. She noted that Ava's expressive language was delayed and, in her feedback to Ava's mother and key person, discussed what strategies were being implemented at the nursery and at home. She advised that these should be continued and would be reassessed in six months to see how effective they had been.
By the time of Ava's Progress Check at Age Two, she had been weaned off the dummy except for going to sleep. Her parents and siblings were regularly using ten basic Makaton signs (for example, sleep, eat, drink, hungry, toilet, wash and wait) to help Ava express her needs while her language was developing.
Home and nursery had worked hard together to develop Ava's skills, independence and confidence in using language. When the speech and language therapist assessed Ava a few weeks before the progress check was carried out, everyone was delighted that Ava was meeting her developmental outcome goals.
WHAT TO ASSESS: COMMUNICATION AND LANGUAGE
The Early Years Outcomes 2013 document sets out what you should be observing a child doing in communication and language between 22 and 36 months if they are developing typically for their age.
Listening & Attention
- Listens with interest to the noises adults make when they read stories.
- Recognises and responds to many familiar sounds. For example, turning to a knock on the door, looking at or going to the door.
- Shows interest in play with sounds, songs and rhymes.
- Single-channelled attention: shifts to a different task if attention fully obtained; using child's name helps focus.
Understanding
- Identifies action words by pointing to the right picture. For example, 'Who's jumping?'
- Understands more complex sentences. For example, 'Put your toys away and then we'll read a book.'
- Understands 'who', 'what', 'where' in simple questions. For example, 'Who's that? What's that? Where is ...?'
- Developing understanding of simple concepts. For example, big/little.
Speaking
- Uses language as a powerful means of widening contacts and sharing feelings, experiences and thoughts.
- Holds a conversation, jumping from topic to topic.
- Learns new words very rapidly and is able to use them in communicating.
- Uses gestures, sometimes with limited talk, e.g. reaches toward toy, saying 'I have it'.
- Uses a variety of questions. For example, 'What ..., Where ..., Who ...'.
- Uses simple sentences. For example, 'Mummy gonna work.'
- Beginning to use word endings. For example, 'going', 'cats'.
In order to monitor whether a child's speech and language are developing normally, it may be useful to refer to the ECAT Speech and Language Progress Monitoring guidelines.
The Attentive Communicator
By 18 months:
- Interested in music and singing.
- Easily distracted by noises or other people talking.
- Understanding of single words in context is developing. For example, 'cup', 'milk' and 'daddy'.
- The child can understand more words than they can say.
- Progresses from using babble and around ten single words, although these will often not be very clear.
- Likes being with familiar adult and watching them.
- Developing the ability to follow an adult's body language, including pointing and gesture.
The Innovative Communicator
By 24 months:
- Starting to focus on an activity of their choice, although finds it difficult to be directed by an adult.
- Using the child's name helps them to attend to what the adults says. For example, 'Ben, drink juice'; 'Aysha, coat on'.
- By 24 months, understands simple instructions. For example, 'Get mummy's shoes'; 'Put your bricks away'; 'Tell dad tea's ready.'
- Using up to 50 words, and is beginning to put two to three words together.
- Frequently asks simple questions. For example, 'Where's my drink?', 'What's that?' (near two years of age).
- Uses speech sounds 'P', 'B', 'M' and 'W'.
- Gradually able to engage in 'pretend' play with toys.
- Frustrated when unable to make themselves understood.
The Developing Communicator
By 3 years:
- Beginning to listen to talk with interest; but easily distracted.
- Listens to 'talk' addressed to self, but finds it difficult if prompts are not provided. For example, use of name, 'stop and listen'.
- Developing understanding of simple concepts including in/on/under, and big/little.
- Understands simple 'who' and 'what' and 'where' questions, but not 'why'.
- Uses up to 300 different words including descriptive language, space, function. Can link four to five words together.
- May stutter or stammer when thinking what to say.
- Finds it difficult to say some speech sounds: 'L', 'R', 'W', 'Y', 'F', 'th', 'S', 'sh', 'ch', 'dz', 'J'.
- Holds a conversation but jumps from topic to topic.
- Interested in others' play and will join in.
- Expresses emotions towards adults and peers, using words and actions.
MORE INFORMATION
- Boshart, C (2001) The Pacifier: Making the Decision, Speech Dynamics
- The Communication Trust: Early Years, www.thecommunicationtrust.org.uk/early-years
- Foundation Years: Every Child a Talker Child Monitoring Tool, www.foundationyears.org.uk/2011/10/every-child-a-talker-child-monitoring-tool/
- Edgington, M (2004) The Foundation Stage Teacher in Action: Teaching 3, 4 and 5 year olds, SAGE Publications
- Whitehead, M (2009) Supporting Language and Literacy Development in the Early Years, Open University Press
- National Strategies (2008) Inclusion Development Programme Supporting children with speech, language and communication needs: Guidance for practitioners in the Early Years Foundation Stage, DfE
- Van Norman, R (2001) Why we can't afford to ignore prolonged digit sucking. Contemporary Pediatrics, 18(6), 61-81
- The Wave Trust (2013) Conception to age 2 - the age of opportunity. Addendum to the Government's vision for the Foundation Years: 'Supporting Families in the Foundation Years'.
Sue Chambers is a senior associate at London Early Years Foundation
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