Mealtimes and communication

Also called Eating and drinking communication, Communication at the table

Mealtimes happen three times a day and are full of choices. That makes them the best communication lesson in the house, if the person has the words.

What it is

Mealtime communication is choosing what to eat and drink, saying more, saying finished, saying too hot, saying I don't like that, and taking part in the talk around the table. It happens several times every day, it is naturally motivating, and it involves real choices with immediate results. For a person learning to use AAC there is no better classroom.

It is also where a person who cannot communicate is most likely to be fed what somebody else decided, at somebody else's pace.

Who it can help

Anyone who uses AAC, at any age, and especially early communicators for whom mealtimes are the first place needs and wants become real. Families, care staff and school lunchtime supervisors, who are the partners at the table. People with eating and drinking difficulties, who need to be able to say that something is wrong quickly.

It is not about the swallowing itself. Difficulty swallowing, dysphagia, is assessed by a speech and language therapist and needs its own plan; this entry is about the words.

How it works

The words come first: the food and drink vocabulary for what this person actually eats, plus the core words that do the work: more, finished, different, don't like, help, hot, cold, yum, yuck. A small choice board with two or three real options, offered with the real food in view, is where most people start. See offering choices.

Pace is the second half. A person being fed cannot be rushed and cannot talk with a spoon in their mouth. The partner offers, waits, watches for the answer, and stops when the person says stop. A refused mouthful is communication and gets the same respect as a spoken no; see saying no.

And mealtimes are social. A person whose device is put away "so it does not get food on it" is cut out of the conversation three times a day. A wipe-clean cover or a paper board at the table solves that.

Getting started

This week, offer a real choice at every meal, using the words on the person's system: this or that, shown and named. Wait for the answer. Then give what they chose, even if it was the wrong one, so that the choice was real.

Add the person's ten favourite foods and drinks to the board, and the core words more, finished and don't like, and model them while you eat.

Keep the device or a paper board at the table. If the person is fed by someone else, agree a stop signal and write it down for anyone else who helps.

Where to get help

The speech and language therapy team covers both communication and eating and drinking, and the GP or school can refer; see referring to speech and language therapy. Royal College of Speech and Language Therapists explains what the service does. Mencap covers mealtime choice and dignity for people with a learning disability. Alzheimer's Society covers eating and drinking with dementia.