So what about Children who are fussy about having their hair cut?

So what about Children who are Fussy about having their Hair Cut??!!

Are haircuts traumatic for your child? Some children object vehemently about going for a haircut even with the most sensitive and gentle of hairdressers. It is likely that these children are hypersensitive to light touch input. They are often referred to as being “tactile defensive”. 

Some children who are hypersensitive to touch are uncomfortable with wearing certain textures of clothing, and they may refuse to wear hats. They also usually avoid fancy-dress parties. This is because they feel more comfortable when wearing softer textures of clothing, and clothing which is particularly comforting to wear. 
They may also fuss about having their nails trimmed or about having their faces washed or creamed with sunscreen. 

They might also experience sensory sensitivities in other senses as well. They may be sensitive to loud sounds, or they might have trouble gauging how much noise they are making, resulting in them being very loud indeed! A sensitivity to smells which other people perhaps don’t even notice would not find offensive or uncomfortable, is also often noted.

When a child’s sensitivity to various kinds of sensory input becomes intolerable or overwhelming to them, it can result in meltdowns and in poor behaviour. It can also disrupt eating and sleep patterns. If you a concerned that your child’s extreme sensory preferences may be causing him or her undue stress, you would do well to check in with an Occupational Therapist who is trained and experienced in Sensory Integration. The solutions are often easier than you would imagine, and could impact significantly on your child’s development. 


Babies Need Movement

A young baby’s vestibular system, which integrates movement input from the body, needs movement in order to mature.

A young baby’s vestibular system, which integrates movement input from the body, needs movement in order to mature.

“Wearing” your new baby in a papoose or baby sling, allows your baby to experience movement as you move. He will also feel secure since he is held close to you, and is less likely to be fearful of movement if he is carried in this way. As you bend over to reach for things, he too will experience the pull of gravity as his little head becomes orientated in different ways. The baby who is left to lie or sit, rather than being carried, does not experience nearly as much movement input.

It is also wise to read your baby’s cues, – some babies do not like to be moved much. Be sensitive to this, and gradually encourage more movement, but always do so gently and respectfully if your baby appears more sensitive to movement.

Car seats and baby carry seats are useful to move baby about when you go visiting. They should however not be used for more than a short while – a few times a day – as they restrict movement far too much. The rest of the time, your baby should be positioned lying on his tummy, on his back or his side on the floor, so that he can move his arms and legs freely. With this freedom of movement, he can also begin to learn to roll.

Once your little one learns to roll, you can leave him on his tummy and he will find his own way to roll over to whatever position he prefers.

Sensory Modulation

These notes have been drawn up for parents or teachers who may wish to understand more about sensory modulation.

These notes have been drawn up for parents or teachers who may wish to understand more about sensory modulation. They are intended to explain the different types of sensory defensiveness, particularly tactile and auditory defensiveness, which are features commonly seen, and to assist parents and teachers in gaining a better understanding of sensory modulation. 

Aggression or overreaction in children is sometimes a feature of a condition known as “sensory defensiveness”. The child may have a tendency to react negatively and emotionally (often aggressively) to touch sensations as well as to other sensory input. They perceive touch which most people would regard as inconsequential, as threatening. The reaction may occur only under certain conditions, and might not always occur. Generally, the child’s sensory defensiveness is worse when he is stressed. 

Most people only react negatively to touch sensations which are particularly offensive or which are alerting, such as a fly crawling on their arm. The child who is tactile defensive is inclined to over-react to many ordinary touch sensations, and may react in a negative or emotional manner. Certain touch sensations cause major “disruptions” in his nervous system and cause negative emotions and behaviours. Whereas most people are not aware of the tactile sensations from their clothing touching their bodies or from other irrelevant stimuli, the tactile defensive child’s nervous system is not able to filter and exclude unnecessary sensory information, and the child remains aware of such sensations. He is unable to inhibit the perception of irrelevant sensations and cannot prevent his nervous system from responding to them. He is likely to be distractible, as he cannot attend only to the relevant sensory input. His discomfort may also make him want to move around a lot.

What are the typical features of the tactile defensive child? 

He might prefer a long sleeved shirt to keep his arms covered, or he may want to keep a sweater on even when he is warm. He may complain that the labels on the back of his shirt are scratchy, or may refuse to wear certain items of clothing as he finds their texture uncomfortable. Some children may refuse to wear shoes, while others will refuse to walk barefoot. He may avoid getting his hands dirty, and may as a result dislike playing with finger paint or mud. Walking barefoot on grass or sand may elicit a negative response. He often reacts rebelliously to having his face or hair washed, may refuse to have the dentist work in his mouth, or may object to having his nails cut.

The tactile defensive child may experience considerable difficulty when faced with a regular classroom setting. There are lots of other children who brush past him, and who inadvertently touch him. Even the threat of impending uncomfortable touch (for example, the thought of having to stand in line while the school is addressed at assemblies) may be disturbing to this child. He finds it difficult to concentrate and to apply himself to the task at hand. He may however find it easier to concentrate and to apply himself when he is alone at home, as he is probably exposed to considerably less sensory input in this setting. At home, his family are more aware of his “idiosyncrasies” and do not put as much pressure on him as his peers and teachers might at school. 

He is likely to dislike being close to other people and may avoid crowds. This child is often perceived as being a naughty or badly disciplined. It will however be seen that he displays aggressive behaviour only when provoked by touch situations which he finds threatening, for example, “ring time” in nursery school. A serious emotional problem could however result over a period of time, as this little child tends to be perceived as being the disruptive child. He may then be labelled as naughty, and in turn may begin to behave in a manner which fits his label, and which meets the expectations of others around him!

On the other hand however, he may try rather to avoid threatening touch situations, presenting as a loner who refuses to go to birthday parties, and who does not enjoy boisterous “rough play”.

Certain children present with a sensory hypersensitivity not only with regard to the sensation of touch, but also with regard to other sensory systems. As explained before, the child may be unable to filter sensory input and therefore responds not only to the significant sensory input, but also to the irrelevant input. He may be over sensitive to sounds. This may cause him to talk very loudly and incessantly when he is exposed to a great deal of background noise. In this manner, he attempts to control the amount of noise input which he receives. (If I’m doing all the talking, I can make enough noise to block out all the other noises which offend me). He may even be fearful of certain sounds, for e.g., the sound of power tools or of the vacuum cleaner.

Certain children are also very sensitive to odours in the world around them. They will often embarrassingly remark on offensive smells and will behave in a manner which indicates just how much that particular smell offends them. Similarly, excessive visual input, such as bright lights, or strong fluorescent light overwhelms them. Sometimes, the child who has difficulty modulating visual input may avoid eye contact. He may then rely more on his peripheral vision and may even feel threatened when he is forced to make eye contact. 

When one considers just how much unnecessary information this child has to attend to, and is unable to simply switch his attention off to, it makes sense that he should be so restless and should have such difficulty in assuming a calm disposition. A good concentration ability demands such great effort on his part, that it is something which he can only achieve for very short periods of time, if at all. It also explains why it is that he can manage to cope with tasks requiring concentration, when he is alone at home.

The sensorily “dormant” child

Sometimes, a child may appear to be dormant or “switched off” to sensory input. They often appear not to have registered sensory input as they do not show any reaction to the input. Often parents will have the child’s hearing tested as they are certain that he does not hear properly. The results of the hearing test often show normal if not above average hearing ability, with the child responding to all the frequencies appropriately. 

Sometimes, the reason for this apparent lack of arousal is in fact that the child is under-aroused, and therefore does not respond to sensory input with an alert and discriminating response. 

More often however, the sensory history provided by the child’s parent will show that he is not “switched off to everything”. He may in fact show signs of being overwhelmed by certain types of sensory input. The parents may also recall that when he was younger, he in fact had difficulty in tolerating certain kinds of input. This group of children are seen as being so over-sensitive to certain types of sensory input, that they are unable to tolerate it and they then move into sensory overload , and sensory shutdown. 

Such children appear to have a “dulled” sense of touch and often do not pay attention to auditory input. The child who tends to be “tactile dormant” may have a high pain threshold. He tolerates injections, gashes and grazes far more bravely than would be expected, and does not appear to feel the pain as much as his peers do. He may however feel the need to touch objects more than most children and is forever feeling different textures and touching things. He may particularly enjoy stroking soft fluffy toys. This child’s senses appear to be dulled, although you may think that he presents a confusing picture since you will be aware that he is not unintelligent. It is not always easy to identify such as child as having a problem, since his behaviour is not usually disruptive in any way. He simply presents as an uninvolved child who appears “switched off”. 

Many children may present with a confusing picture where both elements of defensiveness and dormancy are noted. They may be hypersensitive to touch at times, whilst having a dulled sense of touch at other times. This occurs as the child moves from a situation of being aroused to the point where his system “shutsdown” and he presents a “dormant” picture; to a less aroused situation where he reacts to sensory input in a defensive manner. 

These notes present a simplified description of sensory defensiveness and sensory dormancy.

An Occupational Therapist who is qualified in Sensory Integration would be in a position to answer questions on the subject, and would also be able to provide valuable advice on handling such a child with a Sensory Modulation problem both at home and at school. A Sensory Integration therapy programme could assist such a child in overcoming many of the above problems.

Occupational Therapy in Paediatrics

Definition of Occupational Therapy

Occupational Therapists use scientifically chosen meaningful activities to assist diverse clients with a range of problems to maximise their functioning. This empowers them to be as independent as possible and to experience dignity and quality of life at work, at home and at play.

Children are referred to Occupational Therapy, mainly for the following reasons : Gross and Fine motor difficulty (including handwriting difficulties), visual perception difficulties, poor attention and concentration, behaviour difficulties, as well as feeding difficulties or sleep difficulties which have underlying sensory processing difficulties. Babies are referred for sleep and feeding difficulties, developmental delay, including late achievement of all developmental milestones including delayed speech, delayed social development and poor behaviour.

Gross and Fine Motor Coordination difficulties
These difficulties are often on account of lowered muscle tone, which results in poor postural control.
We need good trunk stability or core stability, as well as good shoulder muscle strength and stability, in order to allow for adequate fine motor development. (Think of a crane….). The foundation for good postural control is usually laid down in the first year of life. The baby who does not enjoy being on his tummy unlikely to develop appropriate trunk control and shoulder control…. This might be on account of lowered muscle tone or a movement issue, or it may be on account of sensory processing difficulties. One often sees the beginnings of sensory processing and coordination difficulties in babies…… Midline crossing involves using the hand in the opposite body space. The child who has lowered muscle tone and weak trunk control is likely to M-Sit in an effort to avoid using his weak trunk muscles, – this contributes to further difficulties as he is not likely to develop good trunk rotation. The child who does not develop good rotation patterns is not likely to cross his body midline comfortably.

Sensory processing difficulties often result in poor ability in planning and sequencing movements. The clumsy child, might have reasonable muscle tone, and reasonable postural control, and yet he may have huge difficulty in getting his body to perform more complex sequences of movement. This child might have difficulty in learning new tasks, and might be rather slow in executing most tasks. If he is given the opportunity to practice tasks, he may be able to master them well, but the moment the task is changed slightly, he suddenly has difficulty working out how to compensate for the change. For example, he might be comfortable with throwing and catching a regular sized ball, but the moment the ball size or weight changes, he becomes anxious and uncertain as he does not know how to generalise the components of the movements to the changed situation. This clumsiness, or dyspraxia, often results in serious emotional difficulty for the child, as he always feels inadequate, and uncertain about his ability to act on his world. This difficulty can arise on account of a difficulty in imagining or visualising one’s body moving or executing the movement., or it could be on account of difficulty in anticipating timing and sequencing of the movements. The child is likely to have poor feedback from his body about how he executed the movement. He therefore struggles to work out how to correct his performance and to improve upon his performance when he repeats the actions. We are seeing far more children who have difficulty with planning and with problem solving……

Attention and Concentration Difficulties or Behaviour Difficulties. These difficulties often occur on account of poor sensory processing ability.
The child might be hypersensitive to touch, or tactile defensive, and may find it very difficult to pay attention in an environment where he is exposed to much inadvertent touch input.
He might be hypersensitive to sounds, and might find it very difficult to cope with a high noise level in the classroom.
The child who has a Vestibular processing difficulty may have a higher than usual need for movement. The manner in which his vestibular system processes movement input is unusual and this child might have a high threshold for movement input so that he never sits still. If this tendency is coupled with lowered muscle tone, the child would be inclined to be restless and fidgety simply on account of trying to raise his muscle tone and to relieve tiring muscles.

The child who has sensory processing difficulties may find it very difficult to regulate his “arousal” level, so that he tends to be overexcited in situations where he should be calm and quiet.
Children who present with sensory modulation and sensory regulation difficulties often behave inappropriately and may be disruptive in the classroom.

We would offer organising sensory and movement input to assist the child in normalising his reaction to sensory input. The approaches used might include tactile brushing, the use of balls or inflatable cushions in the classroom, deep pressure or heavy resisted activities, the use of weighted waistcoats or weighted lap blankets or sensory fidgets in the classroom. The “sensory diet” needs of each child would be different. An OT experienced in sensory integration could assess the need and offer appropriate therapy.

The child whose autonomic nervous system is primarily in survival mode, might also have dietary issues which need to be considered. We work closely with dieticians to ensure that the child’s blood sugar levels are stable, and that the child is eating a healthy balanced diet with all the necessary minerals vitamins etc.

We work closely with Physiotherapists and we will often see a child briefly, to address sensory regulation or sensory integration difficulties, and then refer them for physiotherapy to address their postural control difficulties. We often find that the child’s fine motor ability improves because you have dealt with the foundation issues in physiotherapy. The child might then come back to OT, and the remaining fine motor or perceptual difficulties are dealt with far more speedily as the child has improved postural control and core stabiliy.
Core stability and good sensory integration are central to good emotional, social and academic development.

The Organising Effect of Deep Pressure Brushing

Deep pressure is one of most effective sensory tools for organizing

Deep pressure is one of most effective sensory tools for organizing the nervous system in children who present with sensory processing difficulties. When a child’s autonomic nervous system is poorly regulated, he may easily over- or under-react to various types of sensory input. For example, he might mis-interpret certain types of touch, and may find some touch input very uncomfortable or even threatening. This might make him avoid that type of input, and his behavior might become disorganized. Loud noises as well as low and high pitched sounds might be experienced as overly alerting for the child and he may find it difficult to maintain his attention and focus in such situations. He could display disorganized and even disruptive behavior.

The impact of deep pressure to the skin and the impact of deep pressure massage, has long been known to have an organizing effect on the autonomic nervous system. This is because the pathways involved in transmitting deep touch pressure input to the nervous system are “organizing” pathways, while those which convey light touch, pain and tickling sensations are more likely to be disorganizing and to have a disruptive effect on the nervous system.

Simply applying deep pressure input by massaging your child with your hands can be very organizing for the child. Using a brush to provide deep pressure to the skin is often hugely beneficial. The brush is used in much the same manner as massage would be applied. It is important to learn from an Occupational Therapist what amount of pressure should be exerted when brushing – for experience, this is the most difficult part of the process for a parent to become skilled at.

Regular brushing 3 to 4 times in a day can be most helpful in addressing sensory processing difficulties in which the child presents with emotional and behavioural difficulties. Continue brushing for a period of at least three weeks in order to facilitate the organizing effect of the deep pressure brushing. For some children, continued brushing over a much longer period of time may be necessary. When brushing your child, use the opportunity to connect emotionally with them as well. The positive effects of spending time connecting emotionally with your child cannot be overstated, and are as important, if not more important than just doing the brushing. Offer deep pressure brushing before tasks and events which you know are likely to unsettle or to disorganize your child, as the organizing effect of the brushing will ease him during difficult times.

This is just a brief and simple discussion of deep pressure tactile brushing. We hope that you find it of value and that you and your child benefit from this simple yet potentially very effective and beneficial approach.