On a Friday afternoon, the Clinic for High Risk Babies at the University of Pretoria’s (UP) Hatfield Campus is abuzz with the sounds of babies and toddlers.
During scheduled sessions, staff and students of the Department of Speech-Language Pathology and Audiology provide targeted early intervention to young children who are hampered in their ability to speak or communicate, and offer support and relevant coaching to their families or caregivers.
The clinic has been running since 1990. This year, 18 children aged 1 to 5 are attending weekly sessions. Some struggle with dysfluency (commonly known as stuttering), while others were born with craniofacial disorders such as a cleft lip or a cleft palate, dysphagia (swallowing and eating difficulties) or autism spectrum disorders.
In the past, children born with Down syndrome or cerebral palsy have also been helped.
Thobeka Mary Sithole has been bringing her 5-year-old son Yaya to the Clinic since June 2023. She says she has since learnt that communication comes in many forms. Yaya, who is on the autism spectrum, has already made admirable progress and is able to communicate with his family “in his own way”, she adds. This has led to fewer meltdowns borne from frustration.
Sithole gratefully notes he has started saying a few words during the intervention sessions, or echoes ones used by the two final-year students assigned to him.
“I’ve been taught different ways to prevent meltdowns, such as deeply rubbing his hands in the mornings,” says Sithole, who adds that learning such techniques has made parenthood somewhat easier. “I’m thankful for the advice I’ve received – from how to potty train him to how he can feed himself – and for advice on how to get him placed at a good school... Our daily life isn’t complete without the clinic.”
Her sentiments are echoed by Chiedza Maswa, mother of 5-year-old Jayden, who first visited the Clinic when he was around three-and-a-half years old. Although he still only says single words such as “up”, “down” or “shake”, she knows that these are providing necessary “small beginnings” that are improving his general well-being and will help him later in life.
“The support I have received is tremendous. The results were magical. Today I am a proud mother,” says Maswa, who adds that she feels much more confident about trying new activities at home involving her son.
“Communication gives people quality of life and helps them connect with the world,” explains clinic head and senior lecturer Dr Esedra Krüger, who also coordinates the Speech-Language Pathology programme in UP’s Department of Speech-Language Pathology and Audiology.
“Our mission is to help young children to communicate better, by supporting their families or other primary caregivers to walk the path with them. The clinic is increasingly moving towards a caregiver-centred approach, through which we provide as much support as possible to the adults taking care of a specific child.”
Children potentially in need of early communication intervention are first thoroughly assessed by Krüger and Dr Renata Eccles, who is also a Senior Lecturer in the Department of Speech-Language Pathology and Audiology.
“Working with children with communication difficulties is complex, and therefore it is important to do so within a multidisciplinary team,” says Eccles. “The right support starts with the right diagnosis, but this can take time.”
Every year each “littlie” (as clinic staff and students often refer to their young visitors) is assigned to two specific fourth-year students, who meet with them and their parents or primary caregiver at an appointed hour for weekly intervention sessions. All students are carefully supervised by Krüger and Eccles.
All clinic staff recognise the value of walking families through a diagnosis and allowing them, throughout the intervention process, to talk about the sometimes overwhelming challenges they face while rising their children.
The clinic runs on a special fee structure. Most children will only attend it until pre-primary age. Both experts stress the importance of primary caregivers being involved in the weekly sessions, as they are the constant throughout the children’s lives, and not necessarily the speech-language therapists they see.
“It is therefore important that an adult champions and supports a child, and puts the strategies provided into practice at home. Parents or the primary caregivers know a child best. They spend far more time with our ‘littlies’ than we ever can. They will know which of the strategies we suggest might work or not, given personal circumstance and personalities,” Krüger explains.
The clinic’s increasingly caregiver-centred approach was further enhanced during the Covid-19 pandemic, when tele-intervention sessions only involving adults were put in place after restrictions were placed on in-person attendance. Staff have since successfully continued some tele-intervention sessions with parents living further afield. They have also started training teachers working in early childhood development centres (ECDs).
Eccles believes boundaries should constantly be pushed – and backed up by active research. Earlier this year she co-authored a paper in the South African Journal of Communication Disorders on caregivers’ perspectives on the value of using early developmental tele-assessments in challenging circumstances.
Krüger highlights that the clinic not only provides a valuable platform for the community outreach work that UP staff and students are committed to, but also an important job shadowing and training ground for students in the department, from their first year onwards. Under careful supervision, fourth-year students are able to put into practice what they have learnt in their module on early communication intervention.
“It gives us real-world insight and valuable experience in applying therapy models that are particularly effective in early communication intervention,” says current fourth-year student Gabriela Lange.
Kabuba Masule and Palesa Molongoana, fourth-year students who have supported Yaya this year, are heartened by positive feedback from his family.
“He used to never want to leave his safe space. Now he never wants to leave the therapy sessions!” they say.