Teletherapy With Toddlers: Does It Really Work for Speech Therapy?

A Guide for SLP Students, Clinicians, and Parents

Teletherapy with a two-year-old? I've watched the doubt cross people's faces — clinicians and parents both. How do you possibly hold a toddler's attention through a screen when you can't always hold it across a living room in person? Fair question. Here's my answer, after doing this for real: it works. Not by accident, and not with every trick you'd use in person — but it works, when you build it right plus with the right partnership of parents and caregivers it works so well.

At the Pepperdine University MS in Speech-Language Pathology (SLP) program, we train our graduate students to understand that technology isn't a barrier to speech therapy; rather, it's a bridge to empowering families.

Does Teletherapy Work?

Yes, teletherapy works. The therapy is the coached interaction happening in that room, on the child's side of the camera. The mistake is thinking the screen is the therapy. It isn't. The SLP's job on a teletherapy call isn't to entertain a toddler through a monitor. It's to coach the person sitting right next to them. Once you make that shift, the whole process of teletherapy stops feeling so difficult and you can start making real progress.

How to Set Up a Toddler Teletherapy Session for Success

Most of whether a toddler session works is decided before you ever say hello.

• Clear the field.

  Ask the caregiver to reduce distractions — TV off, busy toys put away, siblings occupied if you can swing it or have them as part of the session not the distraction.

• Gather materials first.

  Have the caregiver pull together a few of the child's own favorite toys ahead of time, on their side. Their bear beats anything I could hold up to my camera.

• Fix the camera.

  Position it so I can see the child move, not just a close-up of a forehead. Toddlers are whole-body communicators.

• Prime the caregiver.

  Before we start, the parent needs to know they're not an audience member. They're my hands in the room — and we'll get to why that matters.

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Strategies for Keeping a Toddler Engaged on Screen

This is the part people always want, so here's what actually moves the needle:

• Keep it short and high-energy.

  Think bursts, not marathons. A toddler's attention comes in waves — ride them.

• Use movement and songs.

  Get them up. Sing, bounce, do the motions. Stillness is the enemy of a two-year-old's attention.

• Use their toys, on their side.

  Follow the child's lead into what they already love.

• Build anticipation.

  Pause games — "ready… set…" and wait — pull a toddler in harder than any animation. The pause is the hook.

• Go big.

  Your face and voice have to work overtime through a screen. Exaggerate everything — surprise, delight, the countdown. Your "big" teletherapy voice is a real tool.

• Follow the child, not the plan.

  If they wander to the window, the window is now the lesson. Flexibility isn't giving up control; it's how you keep it.

The Caregiver as the Co-Therapist: A Real-World Example

Here's the whole game: the caregiver isn't watching the session. They are the session. I model a strategy, then I hand it off — and the parent runs it while I coach in real time. If the parent slides into passive watching, engagement dies. If they stay in it, the child gets a therapist in the room all week, not just the half hour I'm on the call.

Let me give you a real one. I was on a call once, coaching a mom through a new language activity, when her little boy climbed clear up the front of the refrigerator behind her — and that right there is the thing we're all afraid of with toddlers: the second we're distracted, up they go. Instead of panicking, I used it. I coached his mom to put words to what he was already doing — "go up," "come down" — and because climbing was his whole world, we moved the game over to the couch, where a tumble isn't so scary. Before long that little boy was saying "go up" and "go down" for everything — himself, the bugs in the yard, his big brother — and from those two little phrases, we started stacking on more words and growing his vocabulary right along with him.

That's teletherapy working. Not despite the chaos — through it.

Troubleshooting Guide: When Teletherapy Sessions Go Sideways (Because It Will)

1. The child wanders off.

   Let them, for a beat, then follow into whatever they went to. Bring the language to them.

2. A meltdown hits.

   Stop pushing. Coach the caregiver through co-regulation first; the lesson can wait ninety seconds.

3. The tech glitches.

   Have a low-tech backup and don't let it rattle you — the parent takes their cue from your calm.

4. The caregiver takes over too much, or too little.

   Name their role gently and keep handing it back: "You try the next one — I'll jump in if you need me."

What Does Successful Digital Engagement Actually Look Like?

Engagement on a screen doesn't look like a toddler sitting still and gazing at you. It looks like movement, noise, a parent laughing, a kid climbing something they shouldn't. That's not the session falling apart. A lot of the time, that's the session working.

One more thought for any students reading this: teletherapy isn't a watered-down version of "real" therapy, and it isn't going away. It's a tool — and a tool is only as good as the clinician holding it. In Pepperdine University's School of Speech-Language Pathology, we prepare our master's students to treat technology as an asset rather than something to fear, so that when they meet a real caseload — a toddler on a screen, a caregiver in the next room — they already know how to make the connection work.

About the Author

Dr. Danielle Waldrep Rich, Ph.D., CCC-SLP, is Associate Dean of the School of Speech-Language Pathology at Pepperdine University, with nearly thirty years of clinical experience across early intervention, the NICU, acute care, and private practice. Her work centers on neurodiversity-affirming, culturally responsive care.