When we are asked to list our senses we usually are able to recall the most familiar ones: touch (tactile perception), taste (oral perception), smell (olfactory perception), vision (visual perception) and hearing (auditory perception) but did you know there are two others?
Vestibular: sensory information received from our middle ear that is related to movement and balance.
Proprioceptive: sensory information we receive from our muscles, joints and ligaments.
The seven senses work together to help us understand and move within our environment.
This article explores the role of our senses, ways to assist their input and integration and what are some of the signs if our child may have difficulty processing them (sensory dysfunction or sensory processing disorder).
Our sensory system provides the foundation for all forms of learning. Our sensory system not only gives us information needed for visual perception, motor planning and body awareness, but provides the essential building blocks required for achieving academic learning, emotional security and social confidence.
Integration of the sensory system, whereby the sensory system is well organized and responding efficiently is integral to developing: self confidence, self control, academic learning, abstract thought and reasoning, the ability to concentrate, the ability to organize and the capacity to effectively interact with the environment.
Neonatal care (Neurodevelopmental care)
The knowledge and understanding of the development of the sensory systems in the foetus, neonate, and infant have progressed and grown extensively in the past twenty to thirty years. This has been aresult of the advances in technology for study of brain development and the sensory systems specifically. While the basic physical structure of the sensory receptors (i.e. eyes, ears etc.) develops early in gestation, most of the neurosensory development occurs in the last sixteen to twenty weeks.
The neurological processes are not accelerated by preterm birth. Preterm birth accelerates the maturation of the kidney, gastrointestinal, lung and cardiovascular function but does not alter the sequence or timing of neurodevelopment.
The stresses and the environment of the Newborn Intensive Care Unit (NICU) play a major role in the altered neurodevelopment observed in preterm infants. The brain development in the foetus, neonate, and infant includes not just sensory systems but motor systems, social/emotional systems, and the cognitive systems. These systems are connected and integrated during development. The development of the brain, both structure and function, is shaped by the influence of four major factors or processes including:
- genetic make up of the infant
- internal brain activity and sleep
- external experiences and stimulation of the sensory organs
- the physical, chemical, sensory, and social/emotional environments.
It is essential that the environment of the foetus, neonate, infant be adapted and managed to provide for the healthy early brain development. This requires both a developmentally, supportive environment and developmentally appropriate care practices.
Sensory regulation in NICU
How sensory stimulation may be regulated in NICU & SCU
Use of appropriate tactile stimulation
Gentle hands, infant massage and kangaroo care. The skin is the earliest sensory system to become functional. The preterm infant skin is a sensory surface for the infant and a psychological and perceptual interface with caregivers and parents
Provide early exposure to mother’s scent
Evidence suggests that infants may have discriminatory olfactory sense by 27-28 weeks gestation. After birth, the NICU environment provides the newborn with some of their earliest postnatal chemosensory exposures, and this may be influential in shaping subsequent chemosensory responses. Studies have shown that biologically meaningful odors such as amniotic fluid, colostrum and breast milk are soothing to infants particularly when obtained from the infant’s own mother. Introducing mother’s scent may prove beneficial to preterm as well as term infants in the NICU environment by eliciting a suckling reflex and reducing crying
Minimize infant’s exposure to noxious odors
Unpleasant or noxious odors may result in detrimental responses such as diminished respiratory rate, periodic apnea and increased heart rate.
Minimize ambient noise level around the infant’s environment
There is concern that excessive noise levels in the NICU may negatively impact infants because of the increased risk for hearing loss and disruption of sleep. Infant ear muffs may also help dampen noisy ventilaors, pumps and monitors. Encouraging staff and visitors to lower their voices, especially when the incubator doors are open may also assist.
Avoid exposure of the infant to direct ambient lighting
Direct ambient light has a negative effect on the develop ent of the preterm infant’s visual neural architecture and early exposure to direct light may adversely affect the development of other neurosensory systems. Eye shields, isolette / cot covers and dimming lights are some strategies that can assist.
Develop practices that preserve and promote infant sleep within the NICU
Sleep is important to the neurodevelopment and growth of the infant, and disruption of normal sleep cycles may be detrimental. In utero, the majority of the foetus’ time is spent sleeping, most often rapid eye movement sleep. Individualized care, with increased awareness of infant sleep states, may increase total sleep time as well as optimizing the environment to support sleep. Cluster care – grouping activities such as taking vital signs, line and linen changes also enable the baby to rest longer and more regularly.
Promoting sensory development
Promoting Sensory Development in Children: Infants, Toddlers, and Preschoolers
Sensory Development in Infants (from term onwards)
Your baby has been able to hear since before there due date, and is likely to recognise your voice. From 32 weeks gestation parent’s should be encouraged talk to their child. Simply talking to your baby about anything will help to imprint language on his developing mind. While there is debate over the benefits of playing classical music for babies, certainly quiet music may soothe and comfort baby. Lullabies have survived years of parenting because they calm and reassure both infant and parent. The gentle rhythm of music can mimic the heartbeat sounds your baby has heard so long in utero and will help prepare him for language development.
Babies love to look at faces, whether yours or representations of them. Keep a picture book of faces on the changing table for your baby to study as you change him. Bright, contrasting designs like black and white graphics will stimulate his vision, particularly when he is still in the newborn stage of seeing stark contrast versus detail. As your baby is able to hold objects, offer him a variety of textures to touch. Fuzzy blankets or bumpy teething toys will help his fine motor skills and keep him interested. Your baby will discover that anything he can hold can go straight to his mouth, and as he begins to teethe, he will appreciate raised textures and cool teething rings.
Sensory Development in Toddlers
Toddlers seem to be natural musicians. Banging on pots and pans, singing loudly, and stomping on the floor all bring that wonderful sense of “I did it!” to your developing toddler. Remember the classics from your childhood and some new songs from the many rock-bands-urnedchildren’s- bands, and be prepared to sing or play them over and over. Toddlers love repetition, So don’t be surprised if you can’t get “Five Green Speckled Frogs” out of your head for days on end. Picture books are terrific ways to stimulate your toddler’s visual senses. Keep on hand a revolving stack of picture books with bright, interesting designs, and your toddler will gravitate toward studying their pages.
“Modelling clay, Play-Doh, and finger paints, while potentially messy, are wonderful avenues of discovery for your toddler. The various textures will encourage his fine motor development and help prepare him for handwriting”
Sensory Development in Preschoolers
Preschoolers thrive on sensory stimulation. At this age, they’re ready to make differentiations between sounds, experimenting with their own voices and making imaginative play a daily routine. Watch as your preschooler plays with puppets or figures, and you’re sure to find he assigns different voices to different characters. Encourage your child to listen to various birdcalls, for instance, and talk about how genres of music sound different and use different instruments. Your child’s artistic talents are growing, too, and painting and drawing are excellent ways to let your preschooler experiment with light, composition, and color. Keep crayons and markers and non-toxic paints on hand, and he’ll naturally produce visual art masterpieces you’ll want to showcase around your house. Allow your preschooler to experiment with textures and sensations, too. Sandboxes, mudpies, or lacing cards and simple sewing projects will help him to differentiate between textures and develop his tactile senses.
Everyday Items Foster Sensory Development
Since humans incorporate vision, hearing, and touching in everyday life, you don’t need any special or technical items to develop these senses in your child. Take a look at and listen to your everyday life. The birdfeeder, the sunset, and the feel of dirt in the springtime are all perfect opportunities to engage your child’s senses, and will remind you to take a moment to enjoy these things as well.
‘sensory play is crucial in assisting a child to achieve sensory integration’
This is one of the important foundations upon which children develop good movement skills. Children organise the sensations they feel (sensory input) into an internal picture of their body (body image). This awareness enables them to understand their bodies better, including a perception of: what their body parts are, the dimensions of their bodies, including size and weight, what shapes their bodies can make and how they fit into the different spaces in the world around them and what movements their bodies can do. (Sloan & Kemp (2004)
Three senses in particularly important in this area: Tactile (touch sense) Vestibular (balance sense) Proprioceptive (position sense).
The tactile (or touch sense)
Receives input through the sensory receptors in our skin. It gives children information about how things feel including pressure, temperature, pain, and movement of the hairs on the skin. If this sense is not regulated properly the child may be over or under sensitive to touch stimulation. A child who is over sensitive may avoid touching certain textures such as finger paint or shaving cream. A child who is under sensitive may seem to have a higher pain tolerance or be constantly seeking touch stimulation. Ideas to incorporate tactile input: massage, walking bare foot, obstacle courses through tight tunnels, making mud pies, playing with goo, sand and water play, playdough, identifying different textures without looking, blindfold games,
The vestibular (or gravity/balance sense)
This sense provides information from the receptors in our inner ear. It makes us aware of our body position in relation to the earth and helps us balance and orient ourselves and assists us to resist the pull of gravity. A child with who has an under active vestibular sense may constantly seek vigorous activities such as spinning, rocking, swinging to try and stimulate this sense. A child who is overly sensitive may be excessively anxious about moving, heights or balancing. A child with poor control of this sense may also experience motion sickness. Activity ideas: swinging, rolling, jumping, spinning, rocking and balancing games.
The proprioceptive (or body awareness sense)
Our muscles, joints and ligament receptors provide children with information about how their body and limbs are moving without having to use their eyes to see what they are doing. A poorly regulated proprioceptive sense may cause children to appear clumsy in their movements as they have difficulty knowing where their body is moving in space. Activities involving pushing, pulling and weight bearing give the body good proprioceptive input. Tug of war, animal walks on the ground weight bearing on hands and feet, carrying something heavy are ways to stimulate this sense.
Is the ability to return the body to a stable position when it has been tipped off its centre of gravity. Static balance is the ability to maintain equilibrium while we are still or in a static posture Dynamic balance is maintaining stability while we are moving (running, hopping, riding a bike). The sensory information that we use to keep our balance comes from our visual and vestibular systems.
Motor Planning and Co-ordination
Motor planning is the ability of a child to organise, plan and perform a motor activity. It is part of learning any new physical activity. Motor planning is dependent on good body awareness and good motor sequencing.
Sensory development for five to eight year olds
Research has shown that a critical time for sensory development is between the ages of 5 and 8 years, the above website is aimed at this age group. It provides information about the importance of the different senses in childhood learning and provides activities that will help to stimulate sensory development.
What is sensory processing disorder (SPD)? Bonnie Arnwine (2005)
SPD causes individual’s bodies to misinterpret the sensory information received from the surrounding environment. One or more of their senses may over or under react to sensory information. Because their sense are not working together properly, people with SPD have difficult responding effectively to their environment
The over reactive or hyper reactive response
People who are over reactive to sensory stimulation may respond to certain harmless sensations as if they are dangerous or painful. They may: avoid letting people touch them, become agitated if a peer accidentally bumps them, scream during hair washing or brushing, gag on or avoid certain textures of food, scream or cover their ears if they hear a vacuum clearer or dog barking and fear ordinary movement activities like swings, slides or ramps.
The under reactive or hypo reactive response
People who are under reactive to sensory information need higher levels of stimulation in order to respond to their environment. They may seek intense stimulation or shy away from sensory stimulation. They may: seem immune to pain, not noticing cuts, bruises or other injuries, chew on inedible objects, such as their clothing, toys or objects they find on the ground, bump or crash into things, tire easily and avoid contact with others
A combination of responses
Some people may be hyper-reactive to certain sensory information and hypo reactive to other types of sensory information. SPD is a complex condition and is usually assessed by a knowledgeable professional. Once a child is assessed, symptoms and behaviors related to SPD will be defined and a sensory diet may be prescribed to address the dysfunction. A Sensory Diet is a variety of sensory experiences designed to help the child properly interpret his or her environment.
Sensory Integration Problems in Preemies Lindsey Biel
Sensory problems are quite often seen in children born prematurely (especially the smallest and the youngest), those adopted from overseas, children who have experienced birth trauma or prolonged hospitalization, and those exposed to heavy metals. Sensory problems are a common symptom of other diagnoses including autism, attention deficit disorders, down syndrome, anxiety, depression and others. A child may have such a disorder AND SPD. A child can just have sensory problems and nothing else.
Why could prem children be at increased risk for sensory integration problems?
In the womb, a baby spends her time curled up, cozy and warm in the dark, listening to her mother’s heartbeat and muted sounds from the outside world. Meanwhile, her nervous system is developing at astonishing speed, forming thousands upon thousands of essential nerve cell connections. When a baby is born prematurely, her immature, disorganized nervous system isn’t ready to handle all of the sensory messages bombarding her. Most NICUs do their best to minimise over stimulation, but the inevitable beeping and buzzing equipment, room lighting, and busy atmosphere can agitate sensitive prems. Each baby is, of course, totally unique, but in general prems tend to:
- be highly sensitive to noise, light, touch, and movement, even beyond the second birthday
- retain startle reflexes longer than usual
- have muscles that tend to be either stiff or floppy, or a mix of both.
- be very distractible and highly active, or extremely quiet and sleep more than expected
- have increased risk for vision problems
- often develop oral defensiveness because of negative oral experiences with feeding tubes, respirators and suctioning. This can interfere with feeding, as can abnormal muscle tone inside the mouth Most of the sensory based difficulties resolve as the baby’s nervous system matures.
Where to get assistance if you are concerned if your child has sensory integration issues.
The first step is to get an evaluation from a qualified health care professional. This may be a developmental Paediatrician or a paediatric allied health therapist such as an Occupational Therapist or Physiotherapist who has special training and experience in this area.
Allied Health Public ServicesSome free or low-cost public services are available. These may be offered from your local public hospital outpatient department or local Community Health Centre. There may be long waiting lists, especially in rural areas. Children who qualify for Early Childhood Intervention may also be able to access relevant allied health professionals through this service.
Allied Health Private Services Enhanced Primary Care Scheme
Children with certain complex and chronic conditions can obtain a Medicare rebate of $45.95 per consultation with a private allied health professional, provided that the treatment is part of a patient care plan drawn up by a GP. However, the rebate is available for a total of no more than five consultations in a year and this limit covers all allied health professionals. So if you claim for two sessions with a physiotherapist, you can claim for only three further sessions with a different type of allied health professional, such as a dietician. A chronic medical condition is one that has been (or is likely to be) present for six months or longer. It includes conditions such as asthma, musculoskeletal conditions and stroke. Patients have complex care needs if they need ongoing care from a multidisciplinary team consisting of their GP and at least two (2) other health care providers
Eligible allied health professionals include:
Aboriginal Health Worker, Audiologist, Chiropractor, Diabetes Educator, Dietician, Exercise Physiologist, Mental Health Worker, Occupational Therapist, Osteopath, Physiotherapist, Podiatrist, Psychologist, and Speech Pathologist
Information about allied health services for a child with autism or any other pervasive developmental disorder is available at www.health.gov.au
Patients who have private health insurance will need to decide whether to use Medicare or their private health insurance to pay for these services. Private health insurance ancillary cover cannot be used to ‘top up’ the rebate.
Private Health Insurance
As well, if you have private health insurance, most funds offer rebates. Rebate levels vary but are generally much less than the cost of the consultation and there are limits on the total amount that can be claimed in a year
Sensory Processing checklist
Below is a link to a sensory processing disorder checklist. The purpose of this checklist is to help parents and professionals who interact with children become educated about particular signs of sensory processing dysfunction.
It is not to be used as the absolute diagnostic criteria for labelling children with sensory processing disorder, but as a guide to speak with your doctor or therapist so you can clearly explain why you think your child may need help.
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