Touchy, Feely

It’s the season of love! Everyone shows their love in different ways such as a hug or a kiss. However as Valentine’s Day rolls around the corner, it’s important to remember not everyone will be struck by cupid’s arrow. Some children have difficulty tolerating sensations such as touch that we often associate with this month of love. This aversion to touch sensations is called tactile defensiveness and may present in a child in a variety of ways. 

Our tactile system helps us learn more about the world around us and also serves as a protective system to alert us when touch sensations are dangerous. Children who have tactile defensiveness have trouble processing touch sensations which can lead to an over reaction of their nervous system. They may find everyday touch to be uncomfortable or lead to a fight or flight response (Chu, 1999). 

Ways tactile defensiveness may present in a child: 

  • Avoidance of certain clothing textures
  • Avoidance of having messy hands or engaging in messy play (shaving cream, fingerpaints, sand, etc)
  • Avoidance of being close to other people or children: May not like to stand in lines or be in crowded spaces
  • Avoidance of being picked up, hugged, or cuddled
  • Avoidance of activities of daily living (showering/bathing, finger nail cutting, teeth brushing, hair brushing, diaper changing, washing face)
  • Rub or scratch skin after being touched

If you have noticed your child has difficulty with any of the following, you are not alone and can rely on your occupational therapist to provide customized recommendations to best suit your child’s needs. Below are a list of general recommendations you can use to help your child better process tactile sensations.

Strategies to help your child with tactile defensiveness:

Provide deep pressure:

  • Give your child tight bear hugs or place hands firmly on shoulders or head
  • Ask permission or alert your child before providing these hugs or tactile input

Change environment:

  • Provide enough space for your child when in a crowded area
  • Give them a designated space for sitting with a bunch of children
  • Organize the waiting line to have your child stand first or last or shorten the amount of time they need to be in line
  • Prepare a calming area of your house to allow your child to have time to process sensory meltdowns

Adapt their wardrobe:

  • Find fabrics your child can tolerate such as soft cottons or athletic fabrics
  • Buy tagless clothing
  • Wash new clothing before wearing it to decrease stiffness of fabrics

Participate in heavy work activities that are calming and organizing to the body:

  • Encourage child to carry groceries, participate in chores such as vacuuming or moving laundry baskets
  • Play push/pull activities or jumping games
  • Walk like an animal

We all express our love in different ways, so it is important to be mindful of the cues children provide us. Children learn best through play. As parents, you can create routines to allow opportunities for children to participate in these activities and encourage small steps. Move at your child’s pace and applaud them for small successes they make towards tolerating touch. 

By Katherine Danella, OTD, OTR/L

Reference:

Chu, S. (1999). Tactile defensiveness: Information for parents and professionals. Dyspraxia foundation.

https://dyspraxiafoundation.org.uk/wp-content/uploads/2013/10/Tactile_Defensiveness.pdf

Feeding the Picky Eater 

Eating is a very complex and sometimes challenging task for some of our friends with sensory processing challenges. The looks, smells, textures, and tastes of foods can sometimes be very overwhelming for these kiddos. When it comes to meal times which include foods not on their, sometimes minimal, list of preferred foods, these overwhelming feelings can result in big behaviors or even shutting down completely.  Below are some simple strategies to encourage your child to explore new foods at mealtimes while taking the pressure and stress out of the situation. 

Setting up the Environment 

How and where the child is sitting during mealtimes can be the first consideration in allowing for the greatest success at mealtime. Giving children the appropriate postural support while sitting at the table allows them to focus more on the food presented and less on having to use their muscles to sit. It is ideal to position your child so that they are seated with their hips, knees, and ankles all bent at a 90-degree angle with their feet resting on something. If your child’s feet can not reach the ground while sitting in the chair, try putting a box or stool under their feet to give them something to rest their feet on. If the dining room chair is too deep for them to keep their hips and knees at 90-degrees, try putting a pillow behind their back to help them maintain that upright position. Another key aspect of setting up the optimal environment for mealtimes is to turn off screens. When screens are not present, this allows kids to engage with the foods with all of their senses, building new sensory pathways and flexibility in order to support engaging with more foods in the future. 

Increasing Engagement with Foods 

There are a few different ways to increase your child’s engagement with novel and different foods. If your child has a really limited diet and only eats a few foods, one way to modify their foods and increase engagement is to change the shape or color of their preferred foods. Get your kids involved in changing the color by allowing them to add a drop or two of food coloring or allow them to change the shape of their foods by using a cookie cutter. Another way to increase engagement around food is to talk about the food during mealtime. Talk about the shape of the foods, the color of the foods, the smell of the foods, how they feel about the foods, etc. Talking about the sensory aspects of the foods can support the foundational sensory pathways that support adding new foods to their diet. Serving foods family-style and allowing your child to scoop the amount of food they want on their plate is another way to increase engagement with foods during meal time. 

Presentation of New Foods

When presenting new foods to your child, first take all pressure out of eating it. Provide choices to your child about how they want to interact with the new food. For example, “Do you want the food on your plate or on the napkin next to your plate?” Giving your child options in how they engage with the new foods allows them to feel a little more in control in a situation where their sensory systems often feel out of control. Also, when presenting new foods, encourage your child to play with them. Can your child drive the green bean like a car or make their cracker smash the pea? What about, sneeze the piece of chicken off their head or draw a mustache with the soup? Encouraging play with foods allows the child to experience these foods and exposes their sensory systems to the various sights, textures, and smells of these foods without the pressure of actually eating the novel or non-preferred food. 

Feeding these kiddos with sensory processing challenges can definitely be tricky for all involved. By setting up the environment for success, making small changes to their preferred foods and getting them to engage with foods in novel ways you can support them in growing their food repertoire and hopefully make mealtimes less stressful for everyone.

By Erin Christensen, OTR/L

My child was just diagnosed with autism spectrum disorder… Now what?

Step 1: Take a deep breath!

Learning that your child has been diagnosed with Autism Spectrum Disorder, or ASD,
can understandably flood parents and caregivers with a range of overwhelming emotions.
It’s easy to feel trapped or condemned by a label. When the “what ifs” start to invade,
remember that this new information does not change who your child is or who you
already know them to be. It is simply an identification of a root cause for various
symptoms and the first step to helping your child reach their full potential.

Step 2: Free your child (and yourself) from expectations

Following a diagnosis of ASD, it is common for parents and caregivers to experience a
period of mourning for “normality” and feelings of uneasiness when thinking about the
future. However, the new diagnosis is not a predictor of the future, let alone a sentence to
a life of failure or unhappiness. Taking one day at a time and celebrating any progress,
no matter how small, is key in cultivating both acceptance and a sense of hope.

Step 3: Advocate for your child

With a new diagnosis comes a plethora of recommendations from medical and school
professionals. Always remember, though these recommendations are backed by research
and have been proven to help, you have the final say in your child’s treatment. Though
30 hours of therapy per week might be recommended, you may feel that is too much. Go
with your instinct! Your child’s team of professionals will work with you to ensure the
best possible treatment to match your child’s individual needs.

Step 4: Find community

No one has to face the journey alone! Consider joining a virtual or in-person support
group for parents and caregivers of children with Autism, or an online forum. Sometimes
well-meaning family and friends can misunderstand and unintentionally cause more pain,
so it can be important to connect with people who do understand. Autism Society San Diego offers both support groups for parents/caregivers and fun events for the entire family. Military families can take advantage of the Exceptional Family Member Program
(EFMP) for a range of family support. When in doubt, meetup.com is a great place to
start!

Step 5: Take care of yourself!

Self-care is often placed on the backburner when caring for a child who has an ASD
diagnosis. However, burn-out is not only emotionally draining for you, but is also
unhelpful for your child. It’s important to seek Respite Care services if you don’t have a
friend or family member to babysit while you take time for yourself to recharge. In
addition, pick your battles with your child. Rome wasn’t built in a day, so anticipating
immediate results and/or perfection can contribute to high stress levels.

Checklist, in no particular order:

  • Developmental evaluation (medical) through your doctor or San Diego Regional Center. It is important to get a medical diagnosis, not just an educational label
    through the school district. This is not the same as a formal diagnosis.
  • Speech therapy (medical/outpatient)
  • Occupational therapy (medical/outpatient)
  • Behavioral therapy (e.g., ABA) (in home or in facility)
  • Apply for school services at age 2 and 10 months to begin at age 3. This will determine eligibility for services through the school district such as, speech
    therapy, occupational therapy, and behavioral therapy. Your child can receive these therapies in both the medical and school setting, as medical and educational
    services are autonomous from one another.

Written by: Kat Winger, MS CCC-SLP

What is Pediatric Occupational Therapy and how would I know if my child would benefit?

Occupation refers to functional tasks or activities that bring meaning to your life. And our children’s main activity is PLAY. Did you know that kids play to learn and that play requires motor, sensory processing, cognitive, and social skills? All these skills work together for learning. However, when the necessary skills for play are observably difficult, it can make grasping new competencies challenging for kids.

Occupational therapy addresses all the skills needed for play. It works on strength, coordination, and control to support their movement. OT also helps with sensory processing difficulties by identifying the way your toddler receives or responds to sensory input and teaching fun ways for you to support your child. And finally, Occupational Therapy promotes executive function skills building on motor, attention, and regulation foundations for learning.

Though play can look different and vary from child to child, there are general toddler development skill ranges necessary for learning to happen. When these are not progressing or missing, they can inhibit engaging in and learning through play.

The development of sensory processing and motor skills begins immediately at birth. The brain is where all the magic happens. Newborns take in sensations, but their body is unable to organize them—their reflexes are neurological responses to stimulation, including the senses of light, sound, touch, or pressure input such as stroking and vestibular sensory input with sudden movement.

The sensory processing and motor skill development looks random and clumsy at first with the baby’s initial kicking of their legs or trying to find their mouth with their hand. As they continue to be exposed to the sensation and repeat the movement, it becomes more purposeful.

Babies are holding, pulling, pushing, and dropping toys as they learn about cause and effect. More and more skills work together to explore and learn through play.

For your toddler, the years from 1 to 3 are very busy. They are essential years of curiosity, trial and error, and learning about what they can do. At age one, toddlers are very active. Give them a container, and everything comes out; maybe a few things go back inside. Set something on the table, and they pull up to see if they can get it. They make sounds and babble and may tug on your heart with Ma Ma or Da Da words!

Toddlers are in a transition of building more independence. During the terrible twos, a stage that everyone stresses about, they continue to learn about their environment, manipulate things, and communicate their experiences. Their development takes all the work that the baby’s brain and body did and uses it in play to build confidence, control movement, and explore new sensations. Toddlers experience big emotions. They must learn about these feelings and how their body responds to them. How we react and support them is important.

They also learn to transition from one activity to another, even when they don’t want to.
For example, two-year-olds usually can stack a few blocks, string a few large beads on a shoelace, feed themselves with a spoon, drink from an open cup or a straw, remove/pull on clothing, brush teeth, help wash their body at bath time, jump, run, and walk up and down a few steps. They can also throw a small ball toward a target, help clean up, and put toys away. Though the terrible twos try on parents and toddlers, they don’t last long. And both parents and kids learn a great deal!

As we strive to develop more patience during these times, our toddlers are growing far more in their quest for independence. Two-year-olds should be able to attend and learn a new play activity for 4-6 minutes. Some research even suggests that this age group should be able to focus on a task for 10 minutes.

Though many toddlers can sit and play for extended periods of time with preferred toys or activities they have initiated themselves, a better learning opportunity is to give them a new task to work on to develop manipulation skills like using a tool to scoop, fill a container, feed themselves with a spoon or fork, stack or build with blocks, lace beads on a string, or roll a ball back and forth.

Notice how your child works through activities. When development is not smooth, there will be clues in how your child moves, plays, speaks, or acts. See if you observe any of these challenges:

  • unable to manipulate toys in play, they continue to dump, empty containers, or throw them around the room
  • difficulty using tools to scoop, squeeze, hammer, draw
  • unable to demonstrate repetitive play activities. May run around, only roll the car back and forth
  • moves between many play activities quickly, not engaging in any of them
  • requiring or demanding your attention and unable to initiate or engage in play by themselves for short periods
  • difficulty imitating actions in movement, imitating mouth or tongue movements, silly faces, or being unable to throw a ball at a target. Difficulty moving from sitting to moving under structures, crawling through a tunnel
  • unable or very clumsy with jumping, climbing, moving between different level surfaces, climbing ladder to slide
  • unable to take turns in play activities such as rolling ball back to you, stacking blocks
  • seems fixated on the television, tablet, or phone and unable to engage with other toys in play
  • difficulty putting things together such as connecting blocks, lacing, and beads
  • unable to tolerate play on a swing, on a slide
  • unable to play near or with other children
  • unable to tolerate tactile messy play or engagement with media like play-doh, finger paint, or shaving cream
  • difficulty removing pull on clothing from dress-up activities

Play is one of the most significant areas that can provide clues about your toddler’s development. As we’ve outlined, there is so much growth happening during this time. If you see your child struggling in any of the areas we mentioned, occupational therapy can help develop and strengthen the skills needed for learning.

Occupational therapists are experienced experts and can help identify the areas inhibiting your child’s primary occupation and introduce fun activities for successful skill development.

Children are tiny individual humans with varied interests and gifts. We embrace and work together with parents to help children reach their greatest potential.

Come in and check us out in April for Occupational Therapy month!

Author: Pamela Vasiloff, OT

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