The Drive-Thru Carwash, What's Not To Like?

My two children love to go through the car wash after I fill up my car tank with gas. What's not to like about the drive-thru car wash anyways? The car gets sprayed with water, soaped up, and "blow dried" before you leave the tunnel. Well, it is quite the sensory rich experience, because the car is moving while all of these noisy machines are coming at you!

Although my typically developing kids think it is fun, I can see why a child with sensory over-responsiveness, poor motor planning (AKA dyspraxia), and/or anxiety would not think it is fun. If lots of noise, sights, movement, and smells tend to be over-whelming to a child, then the car wash is not the place to go for entertainment!

This gets me thinking, how many common daily or week events would be over-whelming to these children. Well, just to name a few: going to the grocery store, taking a bath including washing hair, mealtime (preparation and eating), singing at church, going to the local park, and playing with other children. Then, there's always the events that tend to happen on a monthly or quarterly basis: birthday or holiday parties, haircuts, zoo, and going to the movie theater. How fun would life be, if these things created more anxiety?

Children who over-respond to sensory input to the point where it interferes with functioning in life events, could benefit from occupational therapy services. Children who have difficulties with motor planning and learning new activities or with transitions could often benefit from occupational therapy as well; these kids tend to be clumsy and may need physical therapy, and may also have a speech delay requiring speech therapy.

One thing that is beneficial to do at home for these children is to make routines predictable. This helps them to feel in control because they know the order of events. But we all know that the unexpected can happen, so the best thing to do is be calm and provide calming sensory input (see www.sense-ablebaby.com ). Realize that the child gets upset and reacts the way he does because of the "fight, flight, or fright" response. If attending occupational therapy treatment, ask the therapist for a home program and ideas on how to handle tough situations. This is especially the case if the child has been diagnosed with sensory processing disorder (AKA sensory integration dysfunction).

Well, I'm off to go cook a new recipe- not a predictable experience. And I'm doing this after I attended a sporting event, took my child to a roller rink with her friend, and cleaned up my son's vomit...none of which are predictable experiences! Wow, and it's not even 5 pm yet!

Washing a Kid's Hair Who Has Tactile Sensitivity

My two young kids absolutely love bath time. When they hear Daddy start the water, they dash upstairs to crawl in. They have fun during bath time for many reasons: playing with one another, splashing, playing with bath toys, singing & laughing. My 15 month old son could care less if the water is poured over his head in order to rinse out the shampoo. My daughter on the other hand, acts as if she is dying if any water touches her face. I have her wear a cloth over her eyes and tilt her head back to minimize the damage. If I am washing her hair, all goes well because I am careful to not get any water on her face. When Dad rinses the shampoo, she puts up more of a fight because he typically gets water in her eyes. My child doesn't have sensory processing disorder (SPD) or an extreme tactile sensitivity that I know of, but she is still sensitive to getting water on her face. Once she is upset about the water in her face while bathing, she is over it within 10 seconds after it has stopped. But unfortunately for a lot of the families I work with, once their toddler or young child with SPD or tactile sensitivity becomes upset, it is meltdown city, and then the child is so upset that he can't fall asleep for well over an hour.

While applying shampoo to the child's (with SPD or tactile sensitivity) head, it is a good idea for the adult to put the shampoo in their own palm before applying it to the child's head. The trickle of shampoo over the child's head may be aversive whereas the deeper touch of a palm full of shampoo isn't as aversive, usually. When rubbing in the shampoo, use firm massage strokes. If using organic shampoo without lauryl sulfate, the shampoo may not create suds, therefore suds can't fall into the child's eyes. To minimize water in the face while rinsing shampoo from the sensitive child's hair, try the following tips:

• Have them tilt their head backwards as you rinse the shampoo out



• Have them put a dry washcloth over their eyes as if it is a blindfold. It can catch any stray sprinkles of water



• Use a sun visor to catch any water that would fall down the child's face



• Use a Lil' Rinser (R). They have a website; I purchased one at Target (R). I have only used it a few times, and if put on properly, it helped minimize water in the eyes even if the head isn't tilted back



• Only wash a young kid's hair up to 2 times per week unless they are extra dirty. Since they do not produce as much oil (pre-puberty) as an adult does, they don't need their hair washed as often.



• Get tear-free shampoo and/or shampoo with natural/organic ingredients; this way the shampoo won't be as harmful



• Wash the kid's hair earlier in the day or before supper, not at bedtime. This way if he is upset about it, it won't delay his ability to fall asleep. Many kids with SPD have a hard time winding down to fall asleep on any evening much less on an evening when they became upset



• Consider showers. The deep pressure of water coming from a shower head may be less aversive than water trickling from the faucet or a cup used to rinse out shampoo



• If you are concerned that the your young child may have sensory processing disorder but you are not sure, go to http://www.spdfoundation.net/ for information on kids and http://www.sense-ablebaby.com/ for information on babies.

Humpty Dumpty Had a Great Fall

Why are some kids so clumsy? They fall often or bump into things...accidents waiting to happen! Well of course, each child is different. Some possible reasons are listed below and may require intervention from a physcian, therapist, or other healthcare practitioner:

• Ear infections or vertigo. The balance receptors are in the inner ear, and any disturbance with the ear can hinder balancing abilities
• Orthopedic impairments: whether it be pigeon-toed, bow-legged, tippy toe walkers, flat or pronated feet, or other differences, it could be the bones out of alignment for whatever reason including muscle tone, joint laxity, or muscle weakness. Also, kids who tend to "w-sit" often have hips that turn in and pronated feet (collapse at the arch and turn in)
• Sensory processing: vestibular (sense of motion and balance), tactile (sense of touch), vision, and proprioceptive (body-in-space awareness) senses contribute to balance, and if there is a problem in one of these senses, the child may fall often or bump into things
• Needing glasses for visual acuity
• Cross-eyed (AKA strabismus)
• Shoes: lack of wearing them or poor fitting shoes can hinder balance skills
• Environment: maybe the room set-up is too "busy" and hard for the child to maneuver without falling.
• Strength and tone: some kids are "floppy" and/or have low endurance
• Hyper-activity or autistic spectrum disorder (ASD): these kids may be extra busy, therefore use momentum as they zoom around the room, so fall often. This is even the case for a child with advanced gross motor skills who can climb the staircase as a baby, but when not on an apparatus (swingset, stairs, slide, etc), he falls

Obstacle Courses

One of my favorite things to play with my daughter and the older toddlers that I work with as an O.T. is "obstacle course". My daughter likes to set up a few movement activities in a sequence in the living room, and then maneuver through the obstacles while I time her with my stop-watch. I like this activity because it is good for strength, coordination, balance, praxis, sensory processing, and cognition. The activities we often include within the obstacle course at home are: crab-walking, fabric tunnel, exercise ball with handle (AKA hippity hop), hula-hoop, dining room chairs, and large pillows. Sometimes I challenge her more by having her crawl backwards through the tunnel, jump into the hula hoop with both feet as it is laying on the floor and then hop out of it on one foot, slither under the chair, and bounce on the ball while circling a piece of furniture. She gets the biggest kick out of this!



When I am in a client's home I just search through the play room, toy box, and other areas to find objects that are in the environment that could be included within an obstacle course. Below are some common things within homes that could be used:

• Place mats: place 2-3 in a row and have the child jump from one to the next
• Blankets and chairs: create a tunnel to crawl through by draping a blanket over 2 chairs
• Large pillows or couch cushions: pile a bunch of pillows together and have the child climb over them, slither under them, log roll or forward roll over them
• Coffee or end tables: slither under them like a snake or walk around them forward or backwards
• Exercise ball: roll, bounce (on bottom, standing, back, or belly), carry over head, "crash" into it
• Heavy quilts: take a "magic carpet" ride by being pulled on it or pulling sibling on it as they sit or lay down
• Laundry basket: the child can push it while it is inverted, or sit in it and be pushed or spun
• Balled up socks: toss balled up socks into a box or large plastic bowl
• Stairs: walk up or down them, "booty bounce" as the child bumps down as he sits on his bottom
• Common toys kids have: trampoline, rocking horse, tricycle or other ride-on toy, tunnel, tent
• Activities to incorporate: marching, jumping, hopping, running, walking or jumping backwards, rolling, bear crawl, crab walk, army crawl, galloping, spinning, donkey kicks

Part Two: Sensory Strategies for Adapting the Environment for Young Children with Sensory processing problems/ SPD

Well, I'll now begin the second part to my blog on helping young children with sensory processing problems or who have a diagnosis of SPD (Sensory Processing Disorder) by making adaptations to the environment. Part One was blogged on July 20, 2009.


Let me start by saying I am a believer in children receiving therapy services at a clinic, but I am also a believer in "home programs". Therapy only occurs a couple of hours per week, but the parents are with the child more of the time and therefore need to learn ways to help the child process sensations more effectively. Therapy helps with the remediation of skills, but that can take awhile. Immediate changes can occur when adapting the environment or altering the way you interact with the child.

Part 1 of this blog gave ideas for children with sensory over-responsiveness and sensory seeking behaviors.

The other categories and ideas are:

• Sensory Discrimination Disorder: this is when it is difficult to detect the qualities of sensations. A problem with auditory processing may be that the child is unsure of what direction a noise came from or can't discriminate if he heard the sound "p" versus "d". A child with a tactile processing problem may not realize he has a wrinkle in his sock or is unsure where he was touched. A child with a vestibular processing problem may get lost in space easily or look clumsy. There are many more symptoms, but these are some basics. Strategies include giving sensory rich opportunities such as those listed for sensory seeking children in Part One. Other ideas include:

Lots of movement as well as mazes and obstacle courses. This is good for visual, proprioceptive, and vestibular processing.

Take the long way when moving between rooms, and march en route.

Lots of tactile experiences such as play-dough, helping to cook, fingerpaint, bath tub toys, and helping to clean (without toxic cleaners).

In order to climb into the carseat, place a stool in the floorboard.

Place a stool or steps at the sink so that everytime the child goes to wash his hands, he is also working on balance.

In the car during rides, play a music CDs with words and listen to read-along story books- the type where you turn the page when you hear the ding or chime sound.

• Sensory Under-Responsiveness: seems slow to respond to sensation or being spoken to, may appear not as intelligent as they are because of slow responses, hypotonia (AKA low muscle tone), fatigues easily.

Once again, offer a sensory rich environment such as blankets/pillows for babies to be in tummy time, swings, rocking horse, ride-on toys, exercise balls, ball pit, mini-trampoline, push-pull toys such as a wagon, and tunnels.

Use lots of movement whether it be through toys or marching, running, "roughhousing", or bouncing on adults lap as this movement "perks" up the child. Often, balance reactions are better after participating in such activities.

During bathtime have the toddler climb into the tub if possible. Offer lots of toys during the bath.

Leave toys lying around the room in various spots, because this is a child that if the house is too tidy, they may not explore. When this is the case, they may get bored and start self-stimming (e.g. rocking back and forth, banging head, flicking fingers in front of eyes, etc.), play with same things in a perseverative way (e.g. blocks must be a tower, can't vere and be a train or house when building), watch too much TV, or just sit there passively.

Give time for the child to respond. He may need a few seconds to decide he wants to play with a toy, move, or answer a question. If he still doesn't respond, he may need a tactile cue such as touching his hand which reminds him to reach for the toy. He may need the toys moved to another location or the room re-arranged. But be patient and don't expect quick changes.

• Dyspraxia and poor motor planning: this is when a child has difficulty with sequencing the steps to an activity or has difficulties executing a task or movement which makes him look clumsy from not knowing where his body is in space. Apraxia is a term used when an adult has lost the ability to motor plan such as after having a stroke (CVA). It is also a term used by speech language pathologists to describe a child who has difficulties with speech and/or oral motor skills due to poor motor planning. These ideas will stick to just the body, from an occupational therapist's (OT) point of view. Adaptations might include:

Set up the room so that things are easily found. Once again, having a home with no toys setting out or in containers high up is not good for this child. Instead put toys in baskets, toy boxes, or low down in invisible containers for easy access to the young child.

Set up the environment for success. These children get frustrated when things become too difficult for him. have the layout of their bedroom be simple to maneuver such as the furniture across the walls and the middle of the room an open space.

Have cabinets or shelves in various rooms with safe items for them to manipulate. For example, have a kitchen cabinet without a safety device on it. Items in it could be plastic or wooden bowls, spatulas, etc.

These children need a certain amount of variety, but start to feel out of control if not having a lot of predictability. So the way you schedule your day should be fairly predictable. For example, after getting dressed and a diaper change then go eat breakfast, then play time, etc. This is why many of these tots do better at good daycares or preschool programs as opposed to when at home. Because at these places, the schedule stays fairly predictable. Although lunch may not be the same food everyday, the child knows that before lunch is circle time and that after lunch it is time for a nap. I don't believe that when at home, it has to be super-structured, just predictable.

When you see a dyspraxic child have a meltdown/ tantrum, know that the task may need to be made easier. Break down the activity. For example, if he is upset about trying to feed himself, maybe give some support at the elbow and help him with spearing the food and bringing it to his mouth for that first bite. Then, the next bite give less help. Do this until you are not helping at all. Often, children with dyspraxia just need a little "jumpstart'. This process just described can be either forward or backward chaining, depending if you retreat your help at the beginning or end of the activity.

• Poor postural control:

Although lots of balance activities will help this child to remediate his balance problems, he also needs physical support to be successful until his balance and equilibrium has improved.

Choose a high-chair that offers lots of support for the head and trunk. The wooden high-chairs wthat are often seen at restaurants require that the child have good balance, whereas some of the Graco and Evenflo high-chairs that are store bought can recline and have much more support.

Bumbo chair for the infant who can't play with toys simultaneous to sitting up.

Limit time the baby or young toddler spends in positional devices. 15 minute increments should be the most a young child spends in a bouncer (stand in)/ jumparoo or other devices.

Although some people swear by putting their baby in a walker, I am not a fan. Studies show that infants who use a walker are actually less likely to walk sooner than those who do not use one. This is partly due to the position a child is in in a walker is more forward as opposed to being upright with shoulders over feet for independent walking.

That's it for now!

Now there are numerous more ideas for lil' tots to adapt the environment to improve sensory processing skills. These were just a few I thought of off of the top of my head that tend to work with most young children. However, for some tots, I really have to put on my thinking cap and come up with other ideas.

For "red flags" of sensory processing problems in babies visit http://www.sense-ablebaby.com/ . Although, with babies it is not always so obvious that they have a problem. Sometimes it starts out as just a developmental delay and it later becomes obvious when they are toddlers that their ability to process sensations is not how it should be.

Sensory Strategies for Adapting the Environment to Help Young Children with Sensory Processing Problems / SPD: Part One

Since I work for an early intervention program, I get the opportunity to work in the homes and daycares of many young children under the age of three years. Even though I am providing ways for the child to improve his skills directly, I also provide ideas for altering the environment to help these children. For children with sensory processing problems, we may go through numerous ideas before something works for that child and family...after all intervention should be individualized. But there are some basic ideas that pretty much work for everyone (minus someone here or there). In my blog today, I am going to share a few of those basic ideas.

Sensory processing is the brains ability to detect and respond to sensory input it receives from the body, other people, and the environment. Young children (toddlers and preschoolers) often respond well to adapting the environment in order to help them process sensations better. Below are some categories of sensory processing problems and some possible ways to adapt their surroundings:

1. Over-responsiveness: these children over-respond to sensations by getting upset, avoidance, shut-down, and/or anxiety.
Adaptations include:

• Reduce clutter on the walls and floor: this can over-stimulate these children. Organize the room and remove the excess wall decorations. Put toys in containers and baskets versus scattered all over.
• Go shopping at times that are less crowded versus a chaotic time like Saturday
• Give them plenty of space when they are playing next to another child, this reduces the chances of accidentally getting bumped or hearing noises perceived as annoying
• Don't let them be a loner, this is a sign of being over-whelmed. Pair them up with a calmer child on the playground or a calmer sibling at home

2. Sensory Seeking: these children can't seem to get enough of movement, touch, noise, etc. It is like they are driven by a motor. Adaptations include:

• Make sure they have lots of toys and opportunities for movement: swing set, trampoline, tunnels, bicycles, scooterboards
• Give a variety of opportunities for play during daily routines: bath tub toys while bathing, textured fabric on high chair seat or chair cushions, bag of toys to fidget with during car rides, bag of toys to fidget with while in a cart/stroller for shopping trips, etc.
• Look through catalogs that sell sensory integration products. There are many toys made especially for these children. Look for the words "vestibular" and "proprioception" equipment
• Let them sing songs with motions: "wheels on the bus" or "ring around the rosie" are good choices
• As you play with them, have them pretend to be an animal and set the room up for such. If they are crawling around pretending to be a bear, then add large pillows to the floor or crawl through tunnels. Make believe play is good, especially at home when you don't have the expensive sensory integration equipment that is at therapy clinics

Stay tuned for Part 2 to cover the other categories of SPD/ sensory processing problems. Also check out some ideas for working with babies with sensory processing problems at

http://www.sense-ablebaby.com/

Would finish now, but I am off to go play with my two children on the floor as we pretend to be snakes slithering on our bellies to provide imaginative play and tactile input to our bellies!