Using Makaton and Objects of Reference in Children’s Hospice Settings: Supporting Connection and Comfort

Communication is so much more than words. For children with life-limiting or complex medical conditions, spoken language may not always be possible — but connection, comfort and understanding can still flourish through meaningful communication strategies.

During a recent training session I delivered at a local children's hospice, staff there shared how a lot of the children visiting use objects of reference, we discussed and explored how Makaton can be used to support a total communication environment.

One powerful approach in children’s hospice settings is combining The Makaton communication programme with objects of reference. This pairing can make a profound difference to how a child experiences their world and how those around them can support, include and reassure them.

What Are Makaton and Objects of Reference?

Makaton is a communication programme that uses speech, ,signs and symbols to support understanding and expression. It can be adapted to suit each individual child’s abilities and needs.

Objects of reference are real items or parts of items used to represent a person, place, activity or concept. For example, a towel might be used to represent “bath time” or a musical toy to signal “music session.” It is important that the objects used are individual to the person you are supporting.

When used together, they offer multi-sensory communication — combining visual, tactile, and auditory input to help a child make sense of their surroundings and what is happening next.

Why This Approach Works So Well in Hospice Settings

Children’s hospices are unique environments where sensitivity, predictability, and emotional security are essential. For many children receiving palliative or complex care, understanding spoken language alone can be overwhelming or not accessible.

The benefits of using Makaton and objects of reference together include:

1. Reducing Anxiety Through Predictability

Hospice settings can involve many changes — new people, unfamiliar equipment, or different routines. Consistent use of Makaton signs and familiar objects helps children anticipate what’s coming, reducing uncertainty and emotional distress.

2. Building Trusting Relationships

When staff, volunteers and family members use the same communication methods, children learn that their needs and preferences will be understood. This fosters a sense of safety and belonging.

3. Encouraging Participation and Choice

Even small gestures — like signing “music” and offering a shaker or “bath” with a towel — can give a child the opportunity to show preference, communicate “yes” or “no,” and engage actively in their care and daily life.

4. Supporting Emotional Expression

Many children in hospice settings may not be able to express feelings through words. Using Makaton signs for emotions (e.g. happy, sad, finished, more) alongside tangible objects helps them express themselves, maintaining dignity and agency.

5. Supporting Families and Teams to Communicate Consistently

By adopting shared communication tools, everyone involved — families, nurses, therapists, volunteers — can work together, ensuring the child experiences consistency and understanding at all times.

Practical Examples in Hospice Care

• Transitioning between activities: Showing and sharing of a familiar object to prepare for moving into different spaces or activities.

• Preparing for medical procedures: Presenting a stethoscope and signing “doctor” to give reassurance and prepare the child.

• Signalling comfort and routine: Using a soft blanket and signing “sleep” to indicate rest time.

• Sharing moments of joy: Signing “music” and presenting a bell or tambourine to invite participation in a music session.

  
  

These small steps can have a big impact on how children experience care and connection.

Embedding Communication in the Heart of Care

For Makaton and objects of reference to be truly effective, it’s important that everyone in the child’s world uses them consistently. This may involve staff training, creating visual resources, and encouraging families to contribute ideas for the objects that hold the most meaning for their child.

When communication is embedded in daily routines — not as an “extra,” but as a core part of care — it can transform how children and families experience hospice life.

A Compassionate Call to Action

Every child deserves to be understood, included and valued, whatever their communication abilities. By combining Makaton with objects of reference, children’s hospice teams can create calm, predictable environments that help children feel safe and connected.

👐 Communication is care. By making it accessible, we create meaningful moments that last.

If you’d like to learn more about introducing Makaton in your children’s hospice or care setting, specialist training and support are available to help your team confidently embed these approaches in practice. The Makaton Charity now have a full range of Makaton for... courses that are designed to support learning Makaton specific to your role and setting.

To find out more about Makaton, please click HERE or visit the Makaton Charity website www.makaton.org

Get in touch for further details alimakatontutor@gmail.com

📚 References

1. The Makaton Charity. (n.d.). What is Makaton? from https://www.makaton.org

2. Acorns Children’s Hospice. (2023). Makaton at Acorns: Giving every child a voice. https://www.acorns.org.uk/news/makaton-at-acorns

3. Sense. (n.d.). Objects of Reference. from https://www.sense.org.uk/information-and-advice/ways-of-communicating/objects-of-reference

4. Sheffield Children’s NHS Foundation Trust. (n.d.). Visual Support: Objects of Reference. https://library.sheffieldchildrens.nhs.uk/visual-support-objects-of-reference

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