This study investigates the perception of the strengths and challenges that face city centre preschool teachers and preschool learners in the acquisition of English as medium of instruction and to use the results to explore the role of speech-language therapists in this context. A descriptive survey, incorporating a quantitative data collection method, was selected as the research design and a questionnaire was developed as a survey instrument. The findings identified the strengths as including the creative communication strategies employed by the pre-schoolers and the innovative techniques of the teachers. Perceived challenges include a cultural and linguistic mismatch between teachers and learners and communication barriers that cause emotional and behavioural problems in classrooms. The study suggests that speech-language therapists need to consider and employ service delivery models instead of traditional models with the preschool teachers.