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Total communication

By Lara Franks, Care Support Worker

Across the UK, one in ten children struggle to speak and understand language. A lack of knowledge and resources means that many children and young people with expressive and understanding difficulties are left feeling frustrated that they can’t communicate their needs.

As a children’s hospice, we care for a variety of children and young people of differing ages, abilities, and communication skills. Some children may be visually or hearing impaired, have limited movement, or are unable to express themselves.

It’s important to us that we continuously develop our communication skills, both verbal and non-verbal so that we can effectively communicate with all our children and young people. This ensures that they have independence, can make their own choices, and have open, clear lines of communication.

Here are some simple tools that we have adopted that you can follow to make communication more accessible.

To effectively communicate, we must realise that we are all different in the way we perceive the world and use this understanding as a guide to our communication with others

- Tom Robbins

Create a communication-friendly environment

A communication-friendly environment is one that supports children’s language and communication skills. By using objects, pictures, and symbols to describe key features of the environment in a way children and young people understand. We all use visual prompts daily – think about road signs, laundry symbols, and maps; this is a similar approach!

Abstract concepts, such as time, can be difficult for children and young people to understand. Visual prompts can really help overcome this obstacle. For example, we’ve started using a sand timer or a stopwatch to help explain to a child that when the sand reaches one side of the timer, or the timer goes off, this activity is over, and we will move on to the next thing.

Visual prompts enable children and young people to make their own choices. When the timer goes off, for example, we will show them ‘what next?’, and use symbols to reinforce the transition of moving on to another activity. We also have visual prompts on all doors at Chestnut Tree House, so when the door is closed and you can’t see what’s inside, children and young people who may not understand what’s in the room by its name or past experiences can make their own choice if they want to go in or not.

Creating a routine

Having a routine is a good way to settle anxiety and increase a sense of control and order. Especially for those with speech and language difficulties, a clear routine means that children and young people will be aware of what will happen next and will allow them to feel more comfortable in communicating freely without worrying about last-minute changes.

Our fantastic Activities Team always have lots of fun activities planned for children and young people, so we’ve created a ‘what’s happening board’ which shows what activities are on and when, but also which staff members are in, using symbols and pictures – we’ve also done this for the food menu. This board helps children and young people make their own choices as they have more of an understanding and are in an environment where they are enabled and encouraged to make their own choices.

Reduce language

Depending on each child’s needs, we may have to change the way we speak to ensure that they understand. For example, if we give too many thoughts and ideas in one sentence, this can leave an individual feeling confused and overwhelmed.

Breaking down instructions can help children focus on one instruction at a time. So, ‘put your coat on’, then ‘zip it up’, then ‘go in the garden’, is a lot easier to comprehend than all instructions given at once.

Questions vs comments

How many times a day do we ask or answer questions? A lot! Questions help us understand what’s happening, make choices, explain our feelings, and learn. But for children with communication difficulties, this can often be overwhelming as they may not understand the question or how to answer. Instead, only ask questions when you need to, for example when you need to know an answer and you’re talking to a child who is confident with their vocabulary. When you can, try to turn questions into comments, such as when a child is drawing, instead of asking ‘what are you doing?’, comment, ‘You’re painting a red flower’. This technique removes the pressure for children to speak and gives them a model they can copy if they want to.

Using technology

Modern technology is having an impact on how we communicate. In our computer room, we have an Eye Gaze machine – a piece of equipment that works by tracking the movement of the user’s eye, meaning that all children, whatever their abilities, will have access to the power of technology. This state-of-the-art piece of technology gives children and young people independence and the ability to create something on their own.


Makaton is the one visual we have access to 24/7. Makaton is based on British Sign Language, but signs are always used alongside speech. Using signs can help people who have difficulty expressing themselves and symbols (for example on picture cards) help those unable to sign. We are always developing our Makaton skills.

Signing while speaking has been shown to encourage the development of communication and language skills. It can reduce frustrations and help you to understand your child’s needs and wants.

Makaton is flexible and can be used at any level appropriate to the individual’s needs. It promotes an inclusive environment. If you want to learn about Makaton, visit the Makaton website, where there are a wide range of free resources available.

These are just some of the techniques we use to communicate at Chestnut Tree House. Each child and young person has different needs and abilities, so we are continuously learning and developing new techniques to make sure we can communicate as best as we possibly can. By communicating effectively, we can involve everyone and empower children and young people to make their own choices when they are with us.

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