Working with toddlers online is a different skill from working with older children online, and a different skill from working with toddlers in person. Therapists trained primarily in clinic-based work sometimes assume online doesn't suit this age group. The honest experience of therapists who've made the shift is more nuanced. Toddler telehealth can work very well, but the approach has to change.
This article shares practical strategies developed through working with under-5s online.
Key takeaways
Toddler online therapy is fundamentally about parent coaching, not direct child therapy
Sessions should be shorter and more focused than typical adult or school-age online sessions
The therapist's role shifts toward observation, modelling, and feedback
Home environment becomes an asset, not a limitation
The skills carry over to daily life more directly than clinic-based work
The fundamental shift in approach
In a clinic, a therapist with a toddler typically:
Engages the child directly with toys and activities
Models target language during play
Coaches the parent at the start or end of sessions
Sends home activities for practice between sessions
Online with a toddler, the dynamic flips:
The parent engages the child directly
The therapist coaches the parent in real-time
The therapist models strategies briefly when relevant
Practice happens continuously in daily life, not just in sessions
This shift requires therapists to let go of the urge to "deliver therapy" themselves and lean into a coaching role. For some this feels like less control; for others it feels liberating.
Pre-session setup
Before the session, brief the parent on:
A quiet space with minimal distractions
2-3 of the child's favourite toys to hand
The child fed and rested (mid-morning often works best)
Camera positioned so you can see both parent and child interacting
Parent ready to be the active player, not a bystander
A 5-minute setup call before the first session helps avoid technical disasters during the actual session.
Session structure that works
A typical 30-45 minute toddler session might look like:
Minutes 0-5: Quick parent check-in
How has the week gone?
What did they notice with last session's strategies?
What's the focus for today?
Minutes 5-25: Coached interaction
Parent plays with child, you observe
You comment briefly with strategies in real-time ("try waiting a bit longer there")
Child does or doesn't engage with the camera, both are fine
You step in to model occasionally if needed
Minutes 25-35: Discussion and planning
Reflect on what worked and what didn't
Identify 1-2 strategies to focus on this week
Plan how it'll fit into the family's routine
Minutes 35-45: Buffer and admin
Wrap-up notes
Schedule next session
Send any resources
For under-3s, even 30 minutes is often enough (both child and parent run out of fuel quickly).
What "coaching" actually looks like
Effective real-time coaching during online sessions sounds like:
"Notice how he just looked at you, that's a moment to wait and see if he says something"
"Try saying the word once and then waiting"
"He's interested in the train. Can you describe what's happening with the train?"
"Lovely. That's exactly the kind of expansion we talked about"
Less effective coaching:
Long explanations during the interaction (parent gets distracted)
Theoretical points without immediate application
Critical feedback in front of the child
Over-controlling ("now say this... now do that")
The skill is being directive enough to teach, but unobtrusive enough that the parent-child interaction stays natural.
Engaging the child directly when needed
Sometimes you do want to engage the toddler directly through the screen. Strategies that work:
Big, simple visuals. Hold a single toy up to the camera. Avoid cluttered backgrounds.
Slow, exaggerated language. Sing-song intonation, key words emphasised.
Wait expectantly. Children often look back at the screen when something happens or pauses.
Mirror their actions. If they wave, wave back. If they bring a toy to the camera, comment on it.
Don't compete with the parent. If the child's engaging with the parent, don't pull their attention to you.
Some children love the screen. Others ignore it entirely. Both are fine. The therapy is happening through the parent in either case.
Common challenges and responses
"My child runs away from the camera." This is fine. Have the parent describe what the child is doing, or follow them with the camera if practical. The session continues.
"My child won't engage with the toys you suggest." Then use what they do engage with. The strategies are about how to interact, not what to interact with.
"My child is having a tantrum." Pause the session. Reschedule if needed. Toddlers are toddlers. A bad day doesn't mean therapy isn't working.
"My child only does sessions in front of the TV." Politely insist on a TV-off environment. The interaction quality won't be there with TV on, and you won't be able to assess accurately.
"My partner does the bedtime routine and the morning rush, and they're not on the call." This is a common challenge. Strategies for the absent parent can be:
Recorded sessions (with consent)
Brief follow-up videos summarising key points
Including both parents on alternate sessions if schedules allow
Adapting standard programmes
Many evidence-based parent-coaching programmes adapt well to telehealth:
Hanen It Takes Two to Talk: Designed for parent coaching, translates directly online
Hanen More Than Words: Works well online with adapted modules
Lidcombe Programme (older toddlers and preschoolers): Strong telehealth evidence base
Routines-based intervention: Particularly suited to telehealth — uses the actual home routines
What you'll learn that surprises you
Therapists who shift to working with toddlers online often report:
Parents become more confident than in clinic-based work because they're doing the actual interaction
Generalisation to daily life happens faster
Family insights you don't get in a clinic. You see the kitchen, the toys, the siblings, the dog
Some children engage better online than they did in clinic, paradoxically
You also see things that are harder to address. Chaotic home environments, parental mental health, sibling dynamics. These aren't your job to solve, but they affect the work.
The bottom line
Working with toddlers online isn't about replicating clinic-based therapy through a screen. It's a different model, built around coaching the parent in their natural environment. Done well, it can produce excellent outcomes, often better than clinic-based work because the strategies generalise immediately.
For SLTs new to this approach, the learning curve is real but manageable. After 10-20 sessions, most therapists find their rhythm and stop missing the clinic.
References
Source
https://www.hanen.org/This article is based on current peer-reviewed research and clinical guidelines. It is intended for informational purposes and does not replace professional clinical advice.