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'How to help the child who stammers'. Referral information for health visitors and other professionals

What is stammering?

  • Stammering or stuttering is characterised by unusually frequent repeating or prolonging of sounds or words. The child may struggle to speak which can lead to anxiety, distress or reluctance to speak.
  • 5% of children under 5 years will experience some stammering. Four out of five will naturally grow out of it but one out of five will need therapy intervention.
  • Onset is usually between 2-5 years but can be earlier or later.
  • Boys are four times more likely to stammer than girls.
  • It varies in severity over time.
  • It varies in different situations. It is more likely when the child is spontaneous, so professionals may not hear stammering.

Why early referral?

Early referral is desirable because:

  • Speech and Language Therapy (SLT) needs to evaluate the risk of persistent stammering. If the child seems low risk they will monitor progress, if high risk they will intervene.
  • Provides support for parents and carers.
  • Intervention close to onset takes less therapy time and can prevent later psychological difficulties.
  • Empowers parents and other key workers.

When to refer

  • Referral can be made when there is concern about the child's speech, which may be close to, or within weeks of onset.

How to refer

  • Health Visitors and teachers can refer directly to SLT service.
  • Contact local SLT department or www.nhs.uk. Many departments have an open referral system and will accept a referral directly from parents /carers. Most SLTs will discuss parents' concerns with them and then action a referral if this seems appropriate.
  • Parents can ask their GP for a referral.
  • The British Stammering Association provide contact details for NHS and private SLTs.

What does a therapist do?

  • There are specialist SLTs who provide a range of early intervention approaches, some that work indirectly (change communication within the environment), and some that work directly with the child's speech.
  • Intervention may also address confidence and self esteem, areas which can be undermined by stammering.
  • SLTs work with carers, preschool staff and teachers to look at factors which may be significant in the child's life.
  • SLTs work closely with parents and carers to give them knowledge and skills to help their child.

Helping children under five

Our Pre-school projects have led to a significant increase in appropriate referrals for children under 5, have helped speech and language therapy departments develop their services to pre-school children who stammer, and have spread knowledge of existing models of good practice.


Risk factors

The following factors have been shown to be characteristic of those children at greater risk of developing a persistent stammer.

If you observe a child who has dysfluent speech, or if a parent reports hearing this, and one or more of the following factors are present:

  • a family history of stammering or speech or language problems
  • the child is finding learning to talk difficult in any way
  • the child shows signs of being frustrated or in any way upset by his speaking
  • the child is struggling when talking
  • the child is in a dual language situation and is stammering in his first language
  • parental concern or uneasiness
  • the child's general behaviour is causing concern

then an immediate referral to a speech and language therapist should be made.