Category Archives: Sensory Integration

Sensory Integration, Assessments, intensive blocks of treatment, children with sensory processing disorder, Autism / ASD, DCD / dyspraxia, ADD / ADHD, Down’s syndrome, sensory diets / lifestyle.

Meltdowns – Sensory NOT Behaviour

Children have an inherent desire to please. They don’t intend to be naughty or mean.

I work with many children who are punished at school for acting out or being ‘naughty’ however their ‘behaviour’ is actually in response to sensory overload. It’s important to put on our detective hats for these children to determine the cause of their behaviour and how we can help the child be more comfortable with their bodies and environment. An Occupational therapist trained in sensory integration can help.

For children with sensory processing disorder, the demands of school can be over stimulating resulting in a meltdown.  During this time, their nervous system enters a fight-or flight response as a protective measure.  Noises can be too loud, lights too bright, classrooms too busy with ‘decorations,’ kids sit too close, it’s hard to sit still, and large spaces such as gyms or playgrounds are overwhelming.  Dealing with this all day long often results in a meltdown either at school or by the time the child gets in the car or home.

Check out this wonderful diagram on Facebook’s Autism Discussion Page describes ‘Stress Overload at School.

So, how can children be helped?

During a meltdown, find a quiet retreat where the chid can calm down.  This may be a corner of the house or class with pillows, fidgets, or a beanbag.  It could even be under the teacher’s desk.  Do not treat it as behaviour!  Here are some ideas of quiet spaces.

To pre-empt a meltdown, try:
-Providing breaks for movement and proprioceptive inputs during the day.  Have your OT help figure our what works for the child.
-Help the child identify when they start to feel overstimulated.  What is the trigger? Touch, sound, novel activity, going to the cafeteria?
-Teach the child how to label their emotions so they can verbalise when they feel stressed.
-Provide forewarning when possible to prevent anxiety or stress (eg. Review schedule in morning.)
-Good sleep and nutrition (another subject in itself)

Here is a brilliant handout to share with teachers and professionals about sensory overload and meltdowns.
http://asensorylife.com/how-to-handle-a-meltdown-in-the-classroom.html

This article helps explain children, stress and learning. http://movingsmartblog.blogspot.co.uk/2011/02/understanding-children-stress.html?spref=tw

Therapeutic Benefits of Babywearing

 

I’ve an 8-month old baby with sensory processing difficulties and who has had a bit of a rough start from a traumatic birth.  Babywearing has been a huge part of our lives as he struggles to tolerate any seating devices especially strollers and car seats.  We started with a ring sling when he was home from the hospital, then a hop tei (a modified mei tai Asian carrier), and now as he is older, we also use a more supportive Ergo carrier. It’s our favourite therapeutic, ahem “fun, ” activity. 🙂

 

I have found many therapeutic benefits to babywearing and often recommend it to parents for these reasons:

 

SENSORY:

 

1) Deep pressure input, warmth, and comforting smell of parent are calming and organizing. This is particularly helpful for babies who are sensitive to touch, movement, or sounds, who have had long NICU / SCBU stays, or who need support settling into the big, outside world.
2) Boundaries of the carrier give body input and awareness for comfort and motor skills development such as babies with low tone, sensory motor difficulties, or prematurity.
3) Vestibular / movement input – the gentle bouncing, rocking and swaying motions provide movement input which is again soothing but also helps stimulate tone for balance and coordination and make sense of one’s body. The vestibular system is also strongly connected to the visual, auditory, and emotional centres of the brain. Movement helps kids focus, learn, and coordinate both sides of their bodies.
4) Powerful way to bond after a traumatic birth and from personal experience, so fun to interact with baby wherever you go.
You can see how it can either help decrease sensory overload for sensitive babies or provide extra input to babies who need more sensory information.  By integrating, touch, body and movement input, we are helping develop multi-sensory processing.
MOTOR:

 

1) Encourages flexed  positioning – oftentimes babies with traumatic births, brain bleeds, prematurity, low tone, or sensory processing disorder assume an extended posture due to tightness, arching their back or sensory overload.  Heathy, full-term babies are in a flexed curled-up position from the womb. Extension is a red flag. Slings and carriers can be used to help encourage this flexed position.  Have your occupational or physical therapist help with positioning.
2) For positioning, remember it is important to face inwards and assume a squatt position. See this article:

http://blog.ergobaby.com/2012/02/facing-inward-or-outward-the-physiological-aspects/

3) Alternative to tummy time – many babies struggle wit tummy time for varied reasons. Baby carrying can be a gentle step towards tummy time by holding your baby against you.
4) Upright positioning can be more comfortable for babies with reflux, gutt, or respiratory problems.
Resources:

 

UK Sling Libraries
Visit a sling library to try different carriers and find what suits you and your baby.

http://www.ukslinglibraries.co.uk/

Babywearing International

http://babywearinginternational.org/

Homemade Sensory Equipment

 

**Disclaimer:  All content on this website is my professional opinion and for your information only.  It is by no means a substitute for medical or individualized input from an Occupational Therapist. 

I often encourage parents to use what they have at home for sensory input activities and obstacle courses.   There are many inexpensive items that may be used.  Here are some of my favourites.  Pease obtain input from your  OT of how to use these to help your child. Supervision is necessary for safety.

 

1)  Therapy Ball for trunk exercises, ball massages, throwing and catching games, or cross pattern brain gym activities.

 

2) Sofa Cushions and Pillows can be used as stepping stones, piles to jump and crash onto, or to crawl over for babies to older children.  For example, here are some fun stepping stones made from scrap cardboard. http://wendyjanelle.blogspot.co.uk/2010/05/sensory-steps.html

 

3) Crash Pads for gross motor or sensory input, or as part of a quiet, calming space.  You can make a crash pad by filling a duvet or quilt cover with pillows, blankets or scrap pieces of foam.  Use it to relax in, do homework or read a book, crawl or roll over, walk and climb over to improve balance, or hide objects under.

 

4) Boxes have endless potential. We know babies rather play with a box than toys. 🙂 Use different sizes for climbing in and out of. Open the box flaps to become a tunnel to crawl through.  Lay on a box and use it as a sled. Prop a huge moving box against a sofa and voila, you have a slide. A tight box filled with pillows can be used as a calming spot. For little ones, fill a box with balls or other textures for a sensory bin. Boxes can be used in lots of fun ways as an addition to your sensory tables.
Sand and Water Tables Blog

http://tomsensori.blogspot.co.uk/

Pre school play link

http://pre-schoolplay.blogspot.co.uk/2012/01/sensory-table-cover.html

 

5) Mattress or an air mattress can be used to jump on, crawl over, or prop up against the bed or sofa for a slide or a mountain to climb up.

 

6) Blanket swings for smaller, lighter children.

 

7) Step ladder for climbing practice to develop strength, bilateral coordination and motor planning.

 

8) Suspended Balls – You can either tie a string to a beach ball or place a tennis ball in panty hose and then hang it for lots of fun target practice.

 

9) Tires – Save those old car tires at your next car service. They can be used to sit or stand on, walk around or to step in and out of.

 

10) Plank of Wood as a balance beam. Alternatively fold a bath towel or blanket in the shape of a balance beam or put long strips of masking tape or string on the ground to walk on.

http://movingsmartblog.blogspot.co.uk/2011/08/smart-steps-walk-line.html

 

Have a look at these 2 blog posts for lovely ideas:

http://wecandoallthings.blogspot.co.uk/2012/07/parents-guide-to-diy-therapy-equipment.html

http://www.thegoodneighborhood.com/2012/06/20/a-place-of-joy-pulling-off-a-pop-up-playground-on-buffalos-east-side/

 

For those of you with carpentry and DIY skills, here are some projects I also hope to make…..well, some day. 🙂

 

Woven Wrap Hammock Swing (All you need is a wrap and a coffee table or bunk bed)
Tire Rocker

http://barefootnparadise.blogspot.co.uk/2011/10/tire-rocker-and-see-saw.html

http://www.crumbbums.com/?p=1934

 

Balance Beam

 

Balance Board

Movement = Increased Attention and Learning

I chose to become a pediatric Occupational Therapist because I’ve always loved kids but also, I can’t sit still.  I think best when I’m moving and doodling. I think doodling is a word? 🙂 Like kids, I struggle to sit still for long, let alone sit still and learn. I love when research shows that children who get more physical activity actually do better in schools.

It certainly takes creativity and flexibility on a teachers part to cater to each students  sensory preferences and what helps them learn.  Some kids need to move, others need to fidget or doodle, and some may need to chew. This improves the child’s processing, attention, memory and overall ability to learn.
 

 

Movement Breaks for the Classroom:
-Run /jog on spot, march, spin, do jumping jacks.
-Infinity Walk
-Yoga moves in chair or while standing
-Brain gym activities
-Pass out materials or tidy up
-Use a move ‘n sit cushion
-Sit on a balance ball
-Stand at the table instead
-Lay on floor to do work

 

Here are some fun ‘Brain Breaks’ for teachers to combine movement and learning:
 
 

 

Fidgets are also helpful for processing and learning.  Teachers can provide students with rules to safely use fidgets.  Items used could be:  ponytail bands, paper clips, Velcro under the table, key chain on trouser loops, stretchy bracelets, pencil toppers, koosh balls, balloons filled with flour or rice, or simply an eraser.  Consider the child’s sensory preferences when choosing a fidget and change it for variety.  Some children need feet fidgets. My friend Ida Zelaya from Sensory Street, Inc. suggested rolling cut-up pool noodles with the feet. Perhaps even having a beanbag to use with the feet.
 
 

 

Proprioceptive input, heavy work, can be calming and organizing.  The easiest way is by running an errand or doing chores involving heavy lifting, pushing or pulling.  A popular strategy is to tie theraband to the chair legs to stretch with legs or squeezing a stress ball.
 
 

 

Here are 3 wonderful articles to share with your teacher or school:
 
 
 

 

Due to every child having their own sensory and learning preferences, it’s important to have an Occupational Therapist advise on strategies, frequency and intensity of sensory input to help under various circumstances. Ultimately, the goal is for the child to learn this for themselves. 🙂

Integrated Listening Systems therapy at ot4kids

I use Integrated Listening Systems (iLS) Therapy to improve children’s sensory processing, motor skills development, auditory processing, attention and regulation.

I have found that iLS and Occupational Therapy together make a good pair and help children progress faster.  It is also effective as part of a home program for many children.

iLS is unique in providing bone conduction in the headphones.  This is highly beneficial as it offers additional vestibular (movement) input to the child working on a neurophysiological level.

WHAT IS iLS?

iLS is built upon the techniques and theories developed by Alfred Tomatis, M.D., and has been refined by Dr. Ron Minson over many years.  It is based upon the theory of neuroplasticity, strengthening and creating neuronal maps that support sensory processing, movement, attention and learning.  iLS is a sound-based multi-sensory program that combines movement, visual and auditory input.

HOW DOES iLS WORK?

Classical music has been digitally manipulated to specific frequencies and vibrations that stimulate various parts of the brain to improve the neurological foundation for sensory integration.

Music is delivered via a portable iPod through specially designed headphones with bone conduction (a small transducer).  The bone conduction unit is inside the top of the headphones and provides specific vestibular and auditory stimulation.

In my practice, after I assess a child I determine whether iLS will benefit their program.  We then create an individualized listening program along with sensory, movement, visual and auditory exercises based on the child’s goals.  Generally, the program is administered approximately 3-5 times a week for 30-60 minutes.  For the first 15-20 minutes, the child participates in their home program exercises and for the remainder of the program, they either relax or complete fun projects.  I either use iLS during the child’s treatment sessions or offer units for rental for intensive home programs.

iLS HELPS:

Sensory processing, body and spatial awareness, motor skills coordination

Motor Planning, sequencing

Attention and following directions

Auditory Processing, sound sensitivity

Visual Motor Skills

Self-esteem

Sensory regulation, calming, sleep

iLS can be used for children who have various diagnoses including:

Sensory Processing Disorder

Autism, Asperger’s syndrome

Dyspraxia

Learning difficulties

ADD / ADHD

Neurodevelopmental delays

 

FURTHER iLS RESOURCES-

Research and case studies:

http://www.integratedlistening.com/research-science/

Free parent webinars:

http://www.integratedlistening.com/training/ils-webinars/

Online videos and talks by Dr. Ron Minson about iLS:

http://www.blogtalkradio.com/thecoffeeklatch/2011/10/24/dr-ron-minson–ils

http://www.autismsocialnetwork.org/community/72-ils/videos/video/46-ron-minson-md-a-edward-hallowell-md-qhow-integrated-listening-systems-ils-worksq

http://www.worldtalkradio.com/worldtalkradio/vepisode.aspx?aid=55628

Study by the Spiral Foundation regarding the effectiveness of home-based iLS therapy:

http://on.fb.me/S8eUjJ

How iLS influences sensory processing

http://www.integratedlistening.com/how-ils-influences-sensory-processing/

Parents’ account of using iLS and music therapy with their child:

http://www.autismsupportnetwork.com/news/feeding-hungry-brain-music-autism-2321452

Tips on introducing headphones to a sensitive child:

http://polaristherapy.com/2012/07/07/introducing-headphones-to-the-tactile-and-auditory-sensitive-child/

Write On!

I commonly get referrals for children with handwriting difficulties between 5-7 years old.

There are so many factors to consider when assessing a child who struggles with handwriting. Here are just a few:
1.  Core strength – Can the child sit upright long enough to do writing in class? Do they tire easily? How do they manage with gross motor and physical activities at recess or P.E.?
A child must have a strong core to sit in their seat and to support their arms for writing.

2.  Shoulder stability and arm strength – Imagine the shoulder to be like a hinge to hold a frame. It must be strong to support what hangs off it (i.e. the hand). Chances are if the shoulders are weak or unstable, it can’t support the hands.  This causes the child to tire easily and have poor grasp on their writing utensil.

3.  Visual motor and perceptual skills – Does the child use the muscles of their eyes to visually track objects? Do both eyes work well together? Does the child spatially organise parts to draw a picture such as a house or a person? This is necessary on a finer level to form letters.

4.  Fine motor skills – Are the child’s thumb and fingers strong enough to grasp and coordinate the pencil? Do they have isolated control of fingers or use their whole hand to manipulate their writing utensil?

5.  Body and spatial awareness – Is the child aware of front/back, right/left, top/bottom on their own bodies, when given directions, or to draw and write?  These skills are first developed with gross motor skills, on the playground, when building forts from sofa cushions and dining room chairs, playing with blocks and then forming letters.

6.  Balance, midline crossing and bilateral integration – Can the child balance in their chair or when sitting on the floor at circle time? Oftentimes a child may slump over the table or have difficulty sitting still at circle time due to core weakness and poor balance.  Have they developed a hand dominance? To do this the child must comfortably be able to turn their body and cross midline without losing their balance? And lastly, do they use both hands to play, get dressed, open / close bags, cut, or hold the paper while writing.

7.  Motor planning and sequencing – Can the child follow a sequence, problem-solve, do a multi-step task?
http://www.apraxia-kids.org/site/apps/nlnet/content3.aspx?c=chKMI0PIIsE&b=788449&ct=464199

8.  Attention, auditory processing, and more.

Could we help these kids earlier before starting school? ABSOLUTELY!
Here are some difficulties children who struggle with handwriting often have when younger:

-Disliked tummy time
-Short or no crawling period
-Described as ‘lazy’ and lacking desire to move
-Delayed infant milestones
-Cautious with movement and climbing activities

-Avoided manipulative or constructive play (blocks, Legos)

-Difficulty with hand actions to nursery rhymes

Handwriting is very complicated.  There are early red flags and children do benefit most from receiving therapy input early.  It’s never too early or too late, however earlier the better.  If children have the chance for early intervention, they can focus their energies at school on attention, learning, and playing with friends.

ot4kids has an office!

I’m so excited to tell you that ot4kids now has its own office space in Southfields, southwest London.

Funnily when I first moved to London a few years ago, somebody mentioned that they worked in Southfields. I think I probably scrunched my nose as I had no idea where or what Southfields was. And now I’m working here. 🙂

At first I wasn’t sure what to call this practice.  When I was in California, we’d use the term ‘Sensory Integration Clinic’  and in New York City, ‘sensory gym’.  Either way, I’ve always wanted a practice that is in a home so that it’s comfortable, a natural environment, and parents can replicate what we do in a treatment session using what they have at home.  I will have specialized therapy equipment however I will also use what’s naturally available in one’s home. I hope this will be a cozy practice where kids can have fun, grow and reach their best potential.

I’m also looking forward to start some BABY groups for parents and babies who are:

  • at-risk due to having prematurity or a traumatic birth
  • have medical diagnoses such as Down’s syndrome
  • have developmental delay or aren’t reaching their developmental milestones
Groups will be hands-on, targeted to a child’s needs, and kept very small so parents and babies can get the most benefit.   Feel free to contact me at munira@ot4kids.co.uk to sign-up or for further details.
I will put up photos as soon as settled in. Stay tuned. 🙂
All the Best! Munira

SPD and Gifted Children

We know that at least 1 in 20 children have sensory processing disorder (SPD).  Research has also shown that 35% of gifted and talented children have features of SPD.  This is even more than the general population.  Most of these children have the most common subtype of SPD called Sensory Modulation Disorder (over-responsively, under-responsively, sensory seeking) and some also have dyspraxia.

I think that this is a huge deal and should be taken more seriously.  I work with many children who are so bright and intelligent, yet they struggle to cope with day-to-day activities such as tactile experiences, changes in routine, being in louder or busier environments, socialising with siblings or peers, or moving about the playground and playing physical games.  Simply, their cognitive skills are beyond their age however their emotional regulation and sensory processing are well below their age.  This mismatch can make it really frustrating for them.  Also, because these kids are so bright and look okay from the exterior, parents are often told that they’re reading into it and their concerns aren’t taken seriously by professionals and teachers.

If unrecognised, sensory processing difficulties amongst gifted kids can negatively impact upon their social and emotional development which carries over into adulthood.  It also causes difficulties in motor and cognitive abilities.

Being that 1/3 of gifted kids are found to have SPD, it would be wonderful if gifted and talented programs would screen their kids for SPD and teachers would be armed with supports and strategies to help their students.

Imagine, if this population were given the right sensory tools and strategies to help them be more comfortable with their bodies, environment and others, they would soar. Occupational therapists, parents, teachers, and the students must work together to support gifted students and make sure they can reach their fullest potential.

For more on the topic, look at this research in more detail as well as this website called Smart Kids with Learning Disabilities.

Check out the library of the Sensory Processing Disorder Foundation for more on this important research as well as other articles.

 

 

 

Follow Your Gut, part 2.

Mums and dads know their child best! They are their child’s biggest advocate.  In a recent post I had written to ‘Follow Your Mummy Gut’ or Daddy Gut.

Sadly, in my practice I’m often told by parents that they just knew ‘something wasn’t right’ from early on however their concerns were dismissed by their doctors, health visitors or even family members. They were often told to wait and see, let him / her (child) be a kid, or they’ll grow out of it. So, what can you do as a parent if you’re in this situation?

This article offers some great suggestions to parents including:

1) Get a second opinion
2) Keep a record of behaviours via either a log, journal, photos, or even videos
3) Research – nowadays the internet is full of resources and it can at times be overwhelming, however there are some fantastic parent groups out there with other parents who are in your same shoes
4) Don’t stop, keep asking questions and get a referral for a specialist
5) I’d like to add that if you have concerns with development, behaviour, learning, social-emotional skills, sensory processing or motor milestones, have your child assessed by an Occupational Therapist experienced in these areas right away. They can assess your child’s development, let you know how it is impacting on their functional skills and start working on these areas now versus later. It’s never to early to get help.

Sensory Processing – Early Warning Signs for Babies

In my practice I work with many children with sensory processing difficulties that are identified during their school years.  These children may struggle with concentrating in class, coping with transitions or changes, or playing with peers.  They can be clumsy, have difficulty holding a pencil or writing, awkward with their movements, or be either withdrawn or aggressive.  Oftentimes, they are very bright and as a result, their sensory processing difficulties are misunderstood.  Usually, warning signs were present as babies however parents were told to ‘wait and see,’ ‘your child will grow out of it’ or that their child is misbehaving.

Early signs of sensory processing difficulties I have seen amongst babies include:

  • Hates tummy time, prefers to sit or stand
  • Plays while sitting still versus moving around and exploring their environment
  • Tend to get ‘stuck’ with their movements, delayed milestones (e.g. rolling, crawling, clapping hands, waving)
  • Cautious with movement, dislike being laid down or moved
  • Fussy or irritable babies, cry easily sometimes for no known reason
  • Not a ‘cuddly’ baby, resists being held
  • Struggle to settle down or going to sleep
  • Difficulty with nursing, transitioning to other textures
  • Startles easily to loud sounds, distracted, avoids eye contact
  • Very easy going, described as a ‘lazy baby’, don’t know they’re in the room

These difficulties indicate that a child’s central nervous system is struggling to process sensory information.  It is a neurological problem that can impact on their movements and development, learning, and social-emotional skills.

Here’s a nice article that discusses the early warning signs of Sensory Processing Disorder amongst infants.

Due to the plasticity of a young child’s brain, there is hope and good potential for progress and improvement with Early Intervention.  If you are concerned about these early warning signs, seek advice from an Occupational Therapist who specializes in working with infants and younger children, particularly those with sensory processing difficulties.  It is never too early or never too late to get help.

Look here for links and books about sensory processing.

Follow your Mommy Gut!

I recently watched Holly Robinson Peete share her family’s story about their son who has Autism. Her story sounds so much like the stories of families I work with. I loved what she had to say as it applies to families and children with all types of special needs, not just Autism.

Follow your “mommy gut!” Nobody knows your child like you do.

As health professionals and therapists, we should be listening carefully to what parents are saying as they know their child best and in effect, are telling us their child’s diagnosis. Early Intervention is key.

Check out the video:

Homemade Occupational Therapy Toys

Isn’t it amazing that kids often love to play with what’s simply laying around the house versus a fancy toy?  I often find that babies and toddlers prefer to play with a cardboard box or kitchen towel roll instead of the flashing, music-making, popping-up toy.   🙂

I love homemade toys for two reasons:

1)    Recycle, Reuse, Renew!  It’s great for the environment.  Save those kitchen towel rolls, cardboard boxes, and empty water bottles to make fun toys or do interesting crafts.

2)    For children with sensory and motor impairments, it’s oftentimes easier to make a toy that is just right for their motor abilities and coordination.  For example, if a child who has limited fine motor skills, you can use larger objects such as making a giant pegboard with water bottles.   To add a sensory component, make a textured board with different sponges, fabrics and materials. Using objects found at home, you can make a toy that’s just the right size, shape, or texture to suit a child’s motor, sensory and cognitive skills.

A couple of my favourite resources for homemade toy ideas are:

1)   http://ohiodeafblind.org/assets/files/files/milestone_packets/0_2/hold_everything.pdf

Personal favourites are the ball board, curler board and eggs in a can.

2)    The Recycling Occupational Therapist – Check out her Facebook page or YouTube videos for ideas for homemade toys.

Go buy some stick-back Velcro, magnetic tape, and start saving those cardboard boxes and empty plastic bottles.  Have fun!

Treating the Cause, Not the Diagnosis

Lilly, a baby gorilla, gets Occupational Therapy! Trainers noticed she had a weak grasp for climbing and self-feeding, her left side lagged behind, and she struggled to latch on while nursing. Medical experts found nothing. Disney switched their emphasis from diagnosis to quality of life.

I found this to be such a great story with good reminders for health professionals and parents:
1) Paying attention to normal developmental milestones is very important. If concerned that a child is struggling to meet milestones, it’s important to get an evaluation.
2) The earlier we detect a problem, the sooner we can help and the easier to correct or minimize. Early Intervention is critical.
3) Treating the cause not the diagnosis – I treat many children who have no diagnosis. We identify the child’s strengths and areas of difficulty, and then determine why are those areas a challenge. For example, a child may have a weak grip for many reasons. Perhaps they have weak core strength and can’t hold themselves up. Are their shoulders loose or stiff causing them to have difficulty lifting their arms to reach? Or does the child lack sensation of their body parts related to each other? Do they have limited eye-hand coordination so that tasks requiring a precise grasp and dexterity are challenging? Labels don’t matter— As Occupational Therapists, we assess the cause of actual areas of difficulty versus the diagnosis.

It’s fantastic that Lilly’s caretakers follow through with her home programs twice a day and are encouraged by her good progress. Hooray!

Sensory Processing and Babies

1 in 20 children have sensory processing difficulties!   Clearly, this is very common and impacts on childrens’ behaviour, motor skills development, learning and confidence.

As an Occupational Therapist, I specialize in treating infants and younger children.  I’m often asked ‘what can you do with a baby’ or how do you know a baby has sensory processing difficulties?

Meet Ryder from Pathways Awareness’ newest video!  🙂

Ryder’s sensory processing difficulties were noted at FIVE months of age.  He had difficulty lifting his head, hardly moved, tired easily, and was anxious during new situations.  He was overwhelmed by sensory input leading to sensory overload.  Later on, this also impacted on his ability to communicate with peers, play with other children, and keep up with his motor milestones.

With Early Intervention therapies (OT, PT, and SALT) and a home program from very early on, Ryder showed improvements in his coordination, behaviour, confidence and ability to organize and respond to sensory information.  He was able to be in group settings, keep up with peers, multi-task, and have fun with age appropriate activities.  Hooray for Ryder.

Another great video by Pathways Awareness.  I admire their efforts in advocating for early detection and Early Intervention as well as raise awareness about sensory processing.

Sleep Problems and Sensory Regulation for Babies

Whose mood and behaviour isn’t affected by their sleep? We are generally much happier and focused after a good night’s sleep. For some, it takes ages to fall sleep while others zonk out right away. Myself, I can’t exercise before going to bed as I’m too awake. However, I have friends who say exercise helps them sleep faster and deeper.

Many babies I work with, particularly those born prematurely, also have sleep problems. Parents will try any and all strategies to help soothe their baby to sleep. Rocking, nursing, heartbeat sounds, swaddling, bathing before bedtime. Parents themselves are exhausted. Oftentimes, these babies are labeled as ‘colicky’ which technically refers to when a baby has abdominal discomfort however ‘colicky’ now seems to be overused to suggest a ‘fussy’ baby.

***It is critical to rule out gastrointestinal problems, food allergies, reflux, sleep apnea, ear infections, and medical issues.

Sleep is a regulatory process where a baby learns how to change and monitor their arousal level to self-soothe and fall asleep. Babies and young children with sleep difficulties likely have sensory processing or regulation difficulties. A baby who is HYPERsensitive to sensory inputs will have difficulty soothing or regulating themselves to sleep. This baby may not tolerate sucking on their hands to self-soothe or being rocked, and may wake up to the quietest of sounds. They are in sensory overload. On the contrary, a baby who is HYPOsensitive or seeks out sensory inputs may only be able to fall asleep after they’ve been swaddled tightly, bounced up and down, and patted firmly on their back. They need more sensory information to help them regulate their arousal level for sleeping.

When babies are unable to figure out how to soothe themselves they become fussy and irritable, more commonly described as ‘colicky.’ As this article says, there is no such thing as “just” a fussy baby.

A baby needs to regulate their arousal and sensory information for sleep. An OT can help parents sort out what sensory strategies to support sleep. According to Maria Anzalone, an occupational therapist from the States, “either way, they’re (babies are) out of sync.” They need to learn to regulate their arousal, sensations and emotions, and relationships. All of this impacts upon their sleep.

This is not something that parents should feel guilty about!

When a baby has sleep problems, it is important to also consider whether they may have sensory processing or regulation difficulties. An Occupational Therapist who specializes in treating infants can help to determine the baby’s sensory profile, which soothing strategies can help regulation based on the individual child’s needs.

Prematurity Resources

ot4kids is now on FB where I’m sharing information and resources to support families and professionals re: children with developmental delays.  Do come on over. 🙂

I had planned to put up this post for National Premature Awareness Day on 17th November.  Oh dear, it’s already December.

As an Occupational Therapist, I screen, follow-up and treat premature babies due to their risk of developmental delays as a means of prevention and Early Intervention.  This allows me to work closely with parents and provide therapy input early to prevent problems from escalating.

In this post, I wanted to share some of my favourite resources for premature babies. However, please keep in mind that as every premature baby is different and has varied needs, this does not replace the advice provided by their medical professional.  Also, an OT or PT experienced with babies is better able to provide individual advice and support geared toward individual children and families

March of Dimes has an excellent interactive program called “Understand Your Premature Infant” to help others recognize a premature babies’ signals and understand how they respond to their world.

Baby First has a nice article on promoting motor development for babies born prematurely following their NICU stay.  These are general guidelines regarding positioning and recognizing the baby’s cues.

CDC has a developmental chart where you can track a child’s movement, social-emotional, fine motor, cognitive, hearing and visual milestones from 3 months to 5 years of age.  These milestones can offer important clues regarding a child’s development.  Be sure to adjust for a premature baby’s age, however parents should follow their gut, they are the expert on their child.

Premature babies are also at-risk of having sensory processing difficulties due to having an immature nervous system.  Check out Sense-Ablebaby for more information as well as this article on sensory stimulation and premature babies.

Here is an article written by myself regarding ‘red flags’ that can indicate a delay amongst babies and toddlers.

***Premature babies should be screened early on to determine whether there are possible motor, neurological, sensory processing, orthopaedic, or cognitive delays. It is never too early to start therapy input.  Early Intervention is key!

Seating for Children at Home and School

Infants and children must have good posture while laying down, sitting or standing so they have a good foundational base from which to move their arms and manipulate objects as well as attend and learn at school.  If a child has to concentrate on holding up their body, this will take away from their ability to grasp and manipulate objects and concentrate and learn at school.

Therefore, it is critical for babies and children to be well supported at their chairs and tables at home, daycares and schools during feeding, reading, writing and learning tasks.

If a child is unable to maintain good posture while sitting in their chairs at home or school, it’s important to consider whether these difficulties are contributed to by poor balance, body awareness, trunk and upper body strength, or sensory processing difficulties.

Here is a great article which describes how a child should be sitting in their chair, alternate sitting positions, and ideas for movement breaks.  Do share with teachers, family and friends.

October is National Sensory Awareness Month in the US

October is National Sensory Awareness Month created by Kathleen Morris from Sensory Integration Focus.

You can download a free poster of 10 signs and symptoms of SPD from SensoryStreet to raise awareness, thanks to Ida Zelaya.

Do share with doctors, teachers, nursery schools, family and health professionals.  The more people are aware about Sensory Processing, the earlier children can get help they need.

Sensory Processing Disorder (SPD) is a real neurological problem affecting 5 to 13% of children entering school.  With help from an Occupational Therapist trained in Sensory Integration, children with SPD show improvements in attention, learning, movement, socialization, coping and self-esteem.

First Signs-Early detection and intervention for Autism

I often work with parents who are concerned that their baby or child is not making eye contact, struggling to meet their motor and learning milestones, or doesn’t respond to their name.  Oftentimes, the wonder whether the child has Autism.

First Signs is a wonderful organization dedicated to educating parents and professionals about early signs of autism and the importance of Early Intervention.

They have great pages on:

  • Red Flags
  • Hallmark milestones from birth to three years
  • How to share your concerns with your doctor?
  • Screening, Diagnosis, and Treatment

I love how they emphasize that paediatricians should better screen children during routine visits and the importance of partnership between parents and healthcare providers.  Parents know their child best and have a gut instinct when there is a problem.  It’s our job as healthcare providers to listen carefully to what parents are saying and make a proactive action plan. Rather than wait-and-see, let’s act early and make the most of a child’s early years when they are constantly learning and growing.  Let’s use prevention versus trying to remediate a problem later.  It’s never to early and Early Intervention is key.

Plagiocephaly-more than just a flat head?

Sadly, plagiocephaly (flat-head syndrome) is often dismissed as being just a cosmetic issue or one that babies will outgrow.  Finally, studies done at the Children’s Institute in Seattle, Washington, US, show that there may be an association between plagiocephaly and developmental delay.

In this study led by Matthew Speltz, PhD, 472 babies between 4-12 months were screened for cognitive and motor development. Half of these babies had been diagnosed with plagiocephaly from Seattle Childrens Hospital’s Craniofacial Centre and the other half were a “normal” control group.

It was discovered that babies with some degree of plagiocephaly were more likely to perform worse on the Bayley Scales of Infant Development III than the control group.

These findings indicate that there may be an association between plagiocephaly and developmental delay or that children with existing motor problems are at risk of developing flatter heads due to lack of movement.

I find that babies with plagiocephaly often have other underlying problems such as:

  • low muscle tone
  • poor strength and coordination
  • sensory processing, movement sensitivities
  • motor planning
  • organizational skills
  • poor regulation
  • …….and more

Research shows the following babies can be at-risk of developing plagiocephaly:

  • those born prematurely
  • multiple births
  • torticollis (tight neck muscles on one side)
  • developmental delay
  • certain syndromes
  • eye muscle problems.

****Babies with Plagiocephaly should be screened early on to determine whether there are possible motor, cognitive, neurological, orthopaedic, or cognitive delays. Definitely worthwhile catching a problem early!