Complex Needs and Dysphagia Pathway

Complex Needs and Dysphagia

This pathway covers children from birth to age 16 and is divided into two routes – “Complex Communication Needs” and “Dysphagia”.  Some children in this pathway will receive packages of care from both routes.

Complex communication needs

Learning language is a complex skill that involves attention, listening, social skills, understanding, word and sound knowledge and muscle coordination.  Children may experience difficulties in any of these areas.  Children with more complex needs may have additional medical diagnoses such as Down syndrome, epilepsy or learning difficulties which affect how their language and communication skills develop.

What difficulties with language development may look like?

Children may have difficulties:

  • Concentrating on activities
  • Listening and responding to others
  • Interacting with others
  • Understanding what is said to them and following instructions
  • Using a range of words or using any words at all
  • Using sentences at an appropriate level to express themselves
  • Speaking clearly

How may a Speech and Language Therapist help parents/carers to develop their skills to support their child?

Our Speech and Language Therapy team supports and promotes children’s communication and language development from birth to age 16. We assess, diagnose, and develop programmes of care, including training of the wider workforce and parents/carers to improve outcomes for children with language difficulties.

We currently offer the following packages of care:

  1. Initial assessment: this may be at home, in a clinic, or virtually (telephone or video call)
  2. How to play and talk more – a webinar which provides information on communication and strategies that parents/carers can use with their early years child to support the development of their communication skills.
  3. Makaton signing for babies training – this course (offered virtual or face-to-face) teaches parents of early years children around 100 useful Makaton signs that can be used with very young children, alongside presentations on how Makaton signing can support communication development. This package of care is not currently available to early years children attending a NARP
  4. Review appointments – depending on the age of your child, these may be offered at a local clinic, at home or in your child’s educational setting. 

    Early years children: If your child also receives services from other specialists such as Portage, a Teacher of the Deaf or Teacher for Visual Impairment, we try to carry out reviews jointly with them where possible. 
    Early years children in a NARP (Nursery with Additional Resourced Provision): Children who are attending Godwin and Valence NARP’s are seen at nursery by SLT’s working in the Complex Needs Pathway. The SLT’s also liaise with parents by telephone or video call so that strategies can be modelled.
    School age children at Riverside Bridge Special School: We have SLT’s working closely with the class teams at Riverside Bridge Special School, reviewing children for their Annual Reviews, and providing targets and recommendations for staff and parents 
    School age children in Additional Resourced Provisions (ARP’s): We have SLT’s working closely with the class teams at:
    1. Warren secondary ARP
    2. Dagenham Park secondary ARP
    3. St Peter’s primary ARP
    4. Richard Alibon primary ARP
    5. Dorothy Barley primary ARP
    6. Warren secondary ARP
  5. Modelling sessions – a block of sessions where specific strategies or activities are modelled so that parents/carers and/or education staff can continue these in their setting.

What is Dysphagia?

Dysphagia is the medical term for ‘swallowing difficulty’ and describes eating and drinking disorders in children and adults which may include problems positioning the food in the mouth and in oral movements, including sucking, chewing and the process of swallowing.

How may a Speech and Language Therapist help parents/carers to develop their skills to support their child?

The overall aims of the speech and language therapist working with an individual with dysphagia include:

  • Detailed and accurate assessment (there may be multiple assessments over time). leading to accurate diagnosis of dysphagia which may assist with the differential medical diagnosis.
  • Ensuring safety (reducing or preventing aspiration) with regards to swallowing function.
  • Balancing these factors with quality of life and considering the individual and family preferences and beliefs.
  • Working with other members of the team, particularly dieticians, to optimise nutrition and hydration.
  • Interventions including positioning, pacing, equipment changes and programmes to support development of oral motor skills.

For Dysphagia we currently offer the following packages of care:

  1. Urgent initial appointment (2 weeks) for infants under 6 months or infants, children and young people referred with complex dysphagia. This may be carrie out virtually or face to face depending on individual need. Initial assessment will be followed up with reviews/intervention package depending on individual need.
  2. Standard initial appointment (6 weeks) for infants, children and young people experiencing swallow difficulty. This may be carried out virtually or face to face depending on individual need. Initial assessment will be followed up with reviews / intervention package depending on individual need.
  3. Joint clinic appointments with Speech and language therapist and dietitian for infants, children and young people weaning from enteral feeding or oral nutrition supplements.
  4. Behavioural feeding package of care for children and young people experiencing restricted diet or picky eating in the absence of any physical cause or concerns about swallow safety. We accept referrals for children who are accepting less than 10 foods. This package consists of our food explorers pack and feeding factsheet and the offer of a 3-month review session (virtual) after working through the pack.

We also hold feeding ‘drop in’ sessions – these virtual sessions happen every 2 months and can be accessed by parents / carers / other professionals without an open referral to the feeding team.

How do you refer to the Complex Needs and Dysphagia team?

We accept referrals from parents/carers, health professionals (such as Health Visitors and GP), and other professionals (such as nursery staff or portage workers). For dysphagia referrals please let us know whether you are concerned about chest health / swallow safety / oral motor skills or for the behavioural package of care let us know how many foods the child accepts.

Complex communication needs: What can you do at home in the meantime?

You can visit to see how your baby or child is getting on with their speech, language, and communication development.

The following websites provide simple activities and games that you can carry out with your child to develop their speech, language, and communication skills:

You can visit your local children’s centre that provide a range of groups that are aimed at supporting parents/carers in developing their child’s communication skills. Families can find out about Play and Communication services at their local children’s centre at:

Many of our children with more complex needs benefit from visual communication to help them understand and express themselves.  Start with words that you use often (for example, drink, food/eat, sleep, ball, car, book, more).  You can find out more about Makaton signing from the following websites: