Sensory processing at home

Play is an essential part of a child’s development, it helps them learn, grow and understand the world around them. Children are naturally drawn to sensory play and everything they experience is processed and understood through their senses. Through sensory exploration which involves looking at things, picking them up, tasting them and shaking them to make noise, children learn from the world around them.

Using play to improve sensory processing

It is important that children have opportunities to actively use their senses as they explore the world around them. Sensory information is passed from the body to the brain though the central nervous system and a series of physical responses are initiated. Thus sensory play is vital for brain development and is a device through which children learn how to integrate and process sensory information. It reinforces the neural pathways important for more complex learning tasks, language development, social interactions, gross motor skills and all types of future learning.

It is always important to meet a child at their developmental level rather than what might be perceived as age appropriate play and behaviours.
 

Carrying out self-hygiene tasks

Self (personal) care involves self-hygiene tasks such as bathing or showering, brushing our teeth, hair and nail care. For children who have sensory processing difficulties, these tasks can present with huge sensory inputs that they may not be able to manage.

We all have different sensory preferences and interpret information from the environment around us in different ways. Some children find certain types of sensory input more distressing or distracting than others.

The challenges of touch sensitivity

Our tactile or touch system doesn’t just refer to our hands but is also processed through our skin, which has many receptors all over our bodies for all different kinds of sensations. When children are sensitive to touch, they may react negatively to touch input e.g. screaming, crying or hitting back. This is because the nervous system is interpreting the stimulus as potentially harmful or dangerous. In personal care tasks, touch may be through direct contact such as brushing teeth, but can also be the feeling of the fabric of clothing, feeling of running water etc.

Bath and Shower time can provide a variety of sensory experiences that can be fun and can help the bedtime wind down routine. However for a child with sensory sensitivities, this activity can be emotional and anxiety provoking. Children with postural or motor planning difficulties may feel unsecure sitting and moving around the bathtub. An over-responsive child may not like the feel or sound of the water and may even interpret these as alarming or threatening. The result of the above sensory processing difficulties is a child refusing to engage in this self-care task.
It is always helpful to have predictable routines and making bath or shower time part of the daily bedtime wind down routine can help prepare your child for the sensations associated with this.

Ideas to support Bathing and Showering

• If your child struggles with a bath, try a shower or vice-versa. The tactile input from a shower may be more difficult for over-responsive children to cope with and tends to be more alerting so you might want to make this part of the morning routine rather than the wind down bedtime routine.
• Engage in movement and heavy work activities prior to bath or shower time.
• Providing your child with a seat and a non-slip mat if they have difficulties with their posture.
• Have toys that encourage ‘heavy work’ for the muscles whilst in the shower or bath e.g. pouring water from one container to another.
• Allow the child to play with hand toys e.g. squeeze toys, sponges and other bath toys that they have to squeeze.
• Use a straw to blow bubbles in the bath. Be careful they don’t drink the bath water though.
• Use firm, maintained touch pressure through the shoulders during bath or shower time.
• Use a wet towel over your child’s shoulders whilst taking a bath.
• Using firm, maintained touch pressure, massage your child with a flannel, bath mitt or your hands before and/or during bath time.
• Use firm, maintained touch pressure when drying your child.
• Wrap your child in a bath towel after bath or shower time and pretend they are a ‘hotdog’. You can then offer firm, maintained pressure with your hands to put on the ‘ketchup’ and ‘mustard’.
• Use visuals to support your child’s understanding of the bath or shower steps.
• Tell your child where you are going to wash so they are ready for your actions.
• If the sound of water running bothers your child, fill the bath without them in the room.
• Sing bath time songs. Slow, rhythmical music is most calming.
• Use earplugs to minimise bath or shower noises and also prevent water going in their ears.
• Use a visual timer or a sand timer to help the child know the end point of the activity.
• Use calming scents or unscented soaps e.g. lavender.

Brushing teeth is an essential part of our oral hygiene routine however this can be a difficult task for a child with sensory sensitivities. Touch receptors are very important for survival and are abundant in the face making this touch system even more sensitive that the rest of the body. If a child is over-responsive to touch, this can result in poor tolerance for anything in or around the mouth and consequently make tooth brushing very difficult.

It is recommended that children receive assistance to brush their teeth until they are 7 years old as before then, they haven’t developed the motor coordination required to reach and brush all their teeth appropriately.

Ideas to support Brushing Teeth

• Talk about your teeth and their roles e.g. front teeth are for biting, back teeth are big for chewing and our canines are for ripping.
• Engage in movement and heavy work activities prior to tooth brushing.
• Try massaging your child’s face prior to tooth brushing with firm and maintained touch pressure as tolerated by the child.
• Use a shoulder wrap or weighted animal toy on the child’s shoulders whilst brushing teeth.
• Allow the child to sit down during tooth brushing to remove the added postural expectation of standing up. They could even sit on your lap for added deep pressure touch during the activity.
• Soft bristles may be easier to handle than hard bristles. But discuss this with your child as to what their preference is.
• Some children may enjoy the feel of a vibrating tooth brush and this can assist a child with poor motor skills as the motor planning is decreased. But some children may not tolerate the vibration.
• Have a mirror in front of the child so they can see where they are brushing.
• Warm water is more calming than icy cold water. 
• Use tooth brushing songs, a timer or a sand timer to help the child know the end point of the activity.
• Use background noise or music to override the brushing sounds if your child is sensitive to sound.
• For the child who is sensitive to the taste of mint toothpaste, there are a variety of other natural flavours or mild mint toothpastes.
• Encourage your child to chew on chew toys or a wet flannel to help calm their touch system prior to tooth brushing.
• You could try brushing teeth during bath or shower time if they enjoy this activity.
• Brush your teeth together. Modelling behaviours to our children is wonderful in helping them learn.

The head is particularly sensitive to touch, which can make hair washing, brushing and cutting an uncomfortable and sometimes distressing experience for some children. For a child over-responsive to vestibular inputs, moving their head out of vertical can be very distressing; making hair brushing, cutting or rinsing difficult. Some children may struggle to screen out touch sensations and as a result the feeling of hair on their necks is distressing. They may interpret the feeling of water on their head, a hair brush on their scalp, or scissors near their neck as dangerous.

Ideas to support Hair Care

• Use a visual timer to help the child know the end point of the activity.
• Engage in movement and heavy work activities prior to or during hair care tasks.
• Ensure your child is seating with their feet on the floor to support feelings of safety and grounding.
• Place a pillow behind the child for them to push back against during hair cutting.
• Consider alternative sitting positions for haircuts e.g. sitting on a bean bag, on a therapy ball, in a supportive chair or on your knee.
• Use a spray bottle instead of head tilting to wet the hair for hair care.
• Use a snug cap, beanie or sweatband for 15 minutes prior to hair care to provide firm, maintained touch pressure that can be calming.
• Try a lycra/neoprene vest or wrap your child firmly in a blanket or lycra during hair care.
• Massage their head and use downward pressure on the shoulders before, during and after hair care.
• Use a weighted lap bag or shoulder wrap during hair care.
• Use a wet towel on your child’s shoulders during hair washing.
• Use a handheld showerhead or cup to rinse and minimise water on your child’s face.
• Try washing hair using a wet flannel.
• Experiment with a variety of hairbrushes to find one that works for your child. 
• Detangler spray can be helpful to help with tangles.
• Offer hand fidgets or mouth chews before and during hair care.
• If appropriate offer your child a lolly, chewy foods or chewing gum.
• Try hair cutting hair at home or at a home salon. 
• Cut hair in the bath so that the hair can be rinsed off immediately. 
• Check with your child if they prefer scissors or the clippers to cut their hair. Show them the scissors and clippers and let them feel each safely.
• Have a mirror in front of the child so they can see what is going on during hair care.
• Use soft, calming or unscented shampoos and conditioners.
• Offer swim goggles, a washcloth or a water visor to keep the water out of their eyes
• Use ear plugs to minimize sounds and water in their ears.
• Use tear free or no rinse shampoo to keep soap out of their eyes.
• Minimise sound if your child is sensitive to it or play slow, rhythmical, calming music during hair care.
• Dim the lights if the child is over sensitive to sensory inputs.
• Tell your child what you are going to do and give definitive time limits for tasks e.g. 5 cuts or brushes and end the task at that point even if the job isn’t complete.

Some children may not tolerate nail clipping because they interpret the touch sensations as uncomfortable or even painful. Like the face and head, our hands have increased touch receptors and nail cutting involves touch, pressure, sound and vision sensations. 

Ideas to support Nail Cutting

• Dim the lights and minimise background noise if the child is over sensitive. You can play a nail cutting song or slow, rhythmical, calming music.
• Engage in movement and heavy work activities prior to nail cutting. In particular activities that involved weight bearing through the hands e.g. Animal walks, hanging or climbing tasks, pushing and pulling activities.
• Involving your child in the task of nail clipping and being clear with the expectations of the task can help children cope with this difficult task.
• Massage your child’s hands/feet before nail cutting and in between nail clips.
• Use firm, maintained pressure when holding your child’s finger to cut the nail.
• Allow your child to sit on your knee or in another comfortable but supportive position for nail cutting.
• Allow you child to choose which order nails are cut in and how many finger nails are to be cut. Then stop a this number and agree another time to do some more.
• Use a weighted lap bag, shoulder wrap or blanket during nail cutting.
• Cut nails in the bath or just after whilst the nails are softer.
• Try filing your child’s nails if this is more comfortable.
• Allowing your child to chew or suck on something during nail cutting.
• Allowing your child to play with a hand fidget in the other hand during nail cutting e.g. putty or a stress ball to squeeze.

Dressing involves many sensory challenges for children who have sensitive (over responsive) touch systems. Tags, seams and clothing textures can be irritating and even perceived as painful to children whose touch system is over responsive. Sensory challenges also exist for children who have difficulties with motor planning and/or postural difficulties. Children who have under-responsive tactile systems often don’t notice when their clothes are twisted or their shoes are on the wrong feet because they just don’t ‘feel’ it. Dressing tasks involve complex motor planning to complete together with attention to the task. Children generally learn to undress before they learn to dress themselves independently. 

Ideas to support Dressing

• Allow your child to chew or suck on something safe during dressing tasks.
• Place clothing out ahead of time
• Engage in movement and heavy work activities prior to dressing.
• Break down the activity into steps with clear verbal or visual instructions. 
• Give the child time to practice and learn each step – repetition is essential for mastering skills.
• Backward or forward chaining can be helpful. That is the child completes the last or the first step in the activity and once mastered, gradually increases the steps they are doing.
• Talk about each step and encourage your child to talk you through each step as they are doing it.
• Sing the steps to dressing and undressing in a predictable order.
• Identify a clear marker for the back and front of clothing e.g. draw an X on the back.
• Try socks with a coloured toe and heal to help children orient socks correctly.
• Sit down with feet on the floor or sit on the floor to complete dressing tasks.
• Try firm, maintained touch pressure over the whole body or a massage prior to dressing.
• Involve your child in shopping for clothes so they can choose clothes based on their ‘sensory preferences’.
• Respect clothing preferences. Bold, strong coloured clothing patterns may make your over-responsive child feel nauseous or dizzy.
• Allow your child to choose sleeve and trouser length.
• Pre- wash clothing prior to wearing if your child is sensitive to fabric textures.
• Remove tags completely or buy tagless clothing.
• Try lycra or calming bike shorts or vests under clothing. E.g. Jett proof or Calming clothing.
• Wear socks inside out if your child is sensitive to the seams. Seamless socks and other clothing are available.
• Try bumpy or gel insoles or shoe stickers to help put shoes on the correct feet.
• Reduce visual distractions or get dressed in a small space to minimise distractions during the task.
• Use unscented washing detergents if your child is sensitive to smells.

We need to receive and understand sensory information from our internal body systems to know when we need to go to the toilet. This signal relies on Interoception and sensory information from the bowel and bladder, this is much subtler than from other muscles of the body, which can make recognising the urge difficult for some children. Signs a child might be ready to try toilet training are being dry for hours at a time or fussing when their nappy is wet or messy. In children who are under responsive or have poor body awareness, it is not unusual for them to experience delays with toilet training.

Ideas to support Toilet Training

• Ensure the child feels safe and secure on the potty or toilet. That is their feet are flat on the floor or a foot rest and they have a handle to hold onto if needed. A child sized toilet seat (padded or not) can be helpful to make the child feel safe and secure.
• Allow your child to practice and have patience. As with any new skills this will take time to learn so don’t expect your child to master it straight away.
• Engage in movement and heavy work activities prior to toileting if sitting still for any length of time is difficult for your child
• Encourage crash-bang type play to support body awareness development
• For a child who is under responsive, try wearing pants under their nappy to intensify the feeling of being wet or dirty. 
• Ensure your child is able to get their clothes off in time. Looser fitting clothing will be easier to remove in a hurry.
• Play relaxing music in the toilet to help the child relax or use ear plugs/defenders if they are sensitive to sounds. 
• Turn off extractor fans, putting toilet paper in the water prior to going and flushing after the lid is closed can be helpful if your child is sensitive to sounds. You may even have to wait until the child has left before flushing.
• Read stories together about going to the toilet.
• Use a visual story with the steps to going to the toilet.
• Use soft toilet paper or washable toilet wipes as these can be gentler for over responsive children.
• Dim the lighting if your child is sensitive to lights.
• If your child is sensitive to smells, allow them to hold a pleasant smell to their nose when using the toilet. 
• Include sitting on the toilet as part of your daily routine e.g. when the child gets up in the morning and/or as part of the evening wind down routine.

Sensory processing affects children’s abilities to use cutlery or their fingers to place the food into their mouth. It can also affect their ability to chew and swallow foods. Additionally, sensory processing influences children’s tolerance of different foods textures and tastes.

There are several reasons why children with sensory processing difficulties have challenges with eating. Eating requires postural stability to maintain sitting, whilst having the motor co-ordination and sensory processing to manipulate and eat the food put into the mouth.

Taste, smell and texture

If the child is over-responsive to smell, this can also affect their taste. Most taste perception is dependent on the perception and interpretation of smell sensations which go right from the nose to the part of the brain involved with emotions and motivation. This explains why eating can be such an emotional roller coaster for some children with sensory processing difficulties.

Sensory sensitivities can also affect the child’s ability to cope with different food textures and tastes.

Sensing hunger and fullness

We rely on Interoception to sense when we are hungry and to identify when we are full. Eating is a learnt behaviour and it is important to understand a child’s feeding history in order to support eating difficulties.

A child may have had reflux, a surgery or an unpleasant experience when starting solid foods that may now be impacting on their association with food and pain or unpleasant feelings and emotions.

Food jags

‘Food Jags’ is a term used for a habit where children eat the same food, prepared the same way every day or at every meal. The problem with food jags is that a child can eventually get burned out on these foods and they are typically permanently lost from that child’s food range.

Ideas to support Eating

• Minimise visual and auditory distractions during meal times.
• Encourage active play and movement activities before sitting at the table for a meal.
• Set up good pre and post mealtime routines e.g. setting the table, washing hands, 5 minute warning and a clean-up routine involving scraping scraps into the bin.
• Eat together at the dinner table. This encourages social interactions, social modelling and exposure to different foods. Children are more likely to eat a new food if an adult is eating the same food versus just present or eating a different food.
• Use a plain placemat to define the child’s food space. This is then a portable cue that can be transferred to anywhere you go.
• If needed, allow your child movement breaks during mealtimes or allow them to sit on an air cushion e.g. move-n-sit, disc-o-sit cushion or ball chair.
• Ensure your child is feeling supported. If their feet are not supported on the ground, they may feel postural insecurity, so a foot step can help.
• Place a heavy lap bag on your child’s knee during mealtimes.
• Use a non-slip mat under their plate to hold it still.
• Offer ‘family meals’ with a buffet style set up on the table for everyone to serve themselves.
• Involve the child in meal preparations to increase their exposure to foods.
• Find other times to play with food outside of mealtimes in a different spot to where the child normally eats. e.g. puddings or jelly. 
• Ensure the child has a face cloth during mealtimes to wipe their hands and face straight away if they are over sensitive to touch.

Children’s sleep can be greatly affected by their emotional experiences that happened during the day. Children with sensory processing difficulties often find it hard to relax into a sleep state.

Research has discovered a significant link between sleep behaviours/patterns and the way a child experiences sensory stimuli or sensations.

For some children, the bedtime routine leading up to bedtime can be so dysregulating that it impacts the quality of sleep they achieve. Whilst for another child, their day is so overstimulating that settling and falling asleep can be difficult. Sometimes the overstimulation from the day is so exhausting that the child may fall asleep when they get home and this then disrupts their night time sleep.

Sensitivity and sleep difficulties

Children who are sensitive to sight, touch, movement, and sound can experience more difficulties with sleep. Sensory modulation difficulties can impact on self-regulation because these children don’t yet have the strategies to do this independently and thus require additional co-regulation, adaptive strategies, and use of external sensory inputs to support sleep.

As well as sensory modulation difficulties impacting on sleep, we also rely on our Interoception to sense that we are tired. Common difficulties with sleep include:

• Taking a long time to settle or a long time to fall asleep.
• Requiring someone present in the room, next to the bed, or lying in bed in order to fall asleep.
• Restlessness during the night or frequent changing of positions.
• Getting up or waking up at night on a regular basis.
• Inconsistent sleep patterns e.g. sleeps 6 hours one night and 10 hours the next night.
• Showing signs of being excessively tired during the day or falls asleep during the day.

Ideas to support healthy sleep routines

• Be conscious about fabric preferences when purchasing bed sheets and pyjamas.
• Try to ensure your child engages in lots of movement and heavy work activities during the day, but at least one hour before bed switch to quiet play.
• Create a consistent bedtime routine. Completing a routine before bed is a great way to help the mind and body prepare for sleep. It may take some time to figure out what works best for you, your family, and your child. Experimentation, creativity, and flexibility are important in this process and once you figure out a routine that works, stick to it!
• If your child is sensitive to visual inputs, try to avoid bright screens (TV, computer, phone, iPad). Especially in the 1-2 hours right before bedtime. Blue light is alerting and can have a negative impact on melatonin production.
• Relax in a quiet space before heading to bed with dim lighting and decreased sensory inputs e.g. visual and auditory stimulation.
• Choose a relaxing activity like reading, drawing, jigsaw puzzle, word/number games (Sudoku, crossword or word search), cards, or knitting as a wind down activity.
• Play soft, rhythmical music or white noise.
• Wrap body tightly in a blanket or sit under a weighted blanket.
• Take a warm shower or bath. Try calming scents such as lavender in the bath or a diffuser.
• Meditate or do light yoga.
• Dim the lights and close the curtains/blinds prior to the child entering the room. Use block out blinds to help filter out any additional light that might be keeping them awake.
• A bed tent may help block out visual distractions if your child is visually sensitive.
• Having a tight hug or play the ‘steam roller’ game (roll an exercise ball firmly over your child’s back while they lie on a carpeted floor or mat).
• Rhythmic motion such as gently rock in a rocking chair can be calming. 
• Offer the child a teddy with your perfume/cologne on it or a piece of your clothing with your scent on to help with separation.
• Deep breathing or sucking may help the body feel more calm and ready for sleep; for example, blow up a balloon several times, drink room temperature water through a straw, or suck on a sugarless mint.
• Tightly tuck the bed sheets/blanket in to provide firm, maintained deep touch pressure, or try a lycra compression sheet. Ensure your child is able to get out if they need to.
• Offer heavy body pillows, duvets or weighted soft toys. Again, ensure your child is able to get out if they need to.

Home is usually a child’s ‘safe space’ so it is not uncommon for them to let go and meltdown the day’s difficulties when they get into this space. This can make unpicking behaviours even more difficult as they may be reacting to something that has happened earlier in the day.

Self-regulation

Self-regulation involves monitoring and controlling feelings, emotions and behaviour. It requires the ability to pay attention to relevant stimuli but block out irrelevant stimuli, as well as controlling impulses and persisting with the task at hand. Therefore, effective processing of sensory information from the world around us is crucial to regulation and daily functioning. The area of the brain called the limbic system is involved in processing sensations, as well as emotional regulation.

Emotional regulation difficulties

Emotional regulation is the ability to present a levelled emotional response when exposed to highly stimulating situations. This skill is essential for maintaining emotional well-being which creates the foundation for healthy behaviours. Therefore, it makes sense that children who experience difficulties with self-regulation and modulation of sensory input can also present with emotional regulation difficulties.

Watch this video to learn more about emotional regulation.

The fight, flight or freeze response

Our fight, flight, freeze response is triggered when our body responds to something it has perceived as harmful or as a threat to our survival. This triggers us to fight (hit out), flight (run away) or freeze (like a ‘deer in the headlights’). Problems arise when our brain perceives something as harmful or a threat but it isn’t and this is what we commonly see with children who are experiencing sensory processing and emotional regulation difficulties.

Ideas to support Emotional Regulation

• Learning to calm one’s physical body is a vital aspect of regulating emotions and sensory stimulation. It is important for children to learn calming and relaxing strategies to help them when feeling overwhelmed. 
  • Deep breathing activities.
  • Going for a walk or other physical exercise.
  • Having a quiet, calm down space for the child to retreat to. You can have heavy items or fidget toys in this space to support a calming feeling.
    • Activities involving blowing e.g. blowing out a pretend candle, blowing up a balloon, blowing bubbles through a straw, straw blow ‘football’ (scrunched up paper) or having a drink through a straw.
    • Yoga

‘The Zones of Regulation’ is a handy tool to explore with children. It links visuals, colours and emotions to body feelings. It helps identify sensory ‘tools’ to support successful engagement and highlights how our zone or feelings can impact on others.

Providing regular proprioceptive input and heavy work activities during the day to support body awareness and modulation.

Identifying emotions and helping the child label these when they are feeling them e.g. ‘I can see that is making you feel a little frustrated. What can we do to help you calm down and we can do the job together’ or ‘I can see you are going into the yellow zone, what can we do to help you get back into the green zone’.