{Professional Insight} Does Your Child Need Occupational Therapy?

September 21, 2015

occupational therapyMost of you reading Hand to Hold and Preemie Babies 101 have personally been through the process of discharge from the NICU and the excitement and nerves to bring the baby home – alone – without the support of the wonderfully supportive and protective NICU nurses. Life, at some point, becomes relatively “normal” (in the sense of your own normal), and you carry on as a new family.

Parents are a child’s best sensory detective.

Your “normal” was different the moment you learned your new infant was not coming home within 3-4 days. Your family has learned to adapt and roll with the punches and has come to expect that nothing is out of the ordinary. Except maybe your “normal” includes that your child may not be processing the information he or she receives from the environment efficiently. This difficulty in processing sensory information may have caused a kink in your family dynamic. You are not alone. I have worked with many parents during their first occupational therapy evaluation with their child and they say things like:

  • “Oh no, we don’t or can’t run errands with our child”
  • “We have not been out to dinner as a family in over a year”
  • “We go to dinner together but what usually happens is my husband takes the child to the quiet car and waits for the rest of the family to finish”
  • “He is just a fussy baby, all the time, I cannot pinpoint what makes him cry”
  • “He is only happy in the bathtub”
  • “We have crying fits that can last hours”
  • “Sometimes her fits get so intense; I have to pull off the road while driving”.

These are just to name a few. Parents who have been through the NICU experience learn to adapt and roll with it, but there is help out there. Occupational therapy can help with many of the above mentioned phrases, and over time, some of these reactions or behaviors can improve. The first step is to start discussing your concerns with your pediatrician, and they can guide you in the right direction.

Just because your child spent time in the NICU does not necessarily mean they will have sensory concerns as an infant, toddler, preschooler or elementary age. It does increase their odds that a child may have sensory concerns. Premature babies leave the womb before they are ready, exposing their nervous system before it is fully developed, causing them to be more likely to develop sensory issues later. I also want to emphasize that everyone has sensory issues… everyone! For example, some do not like to wear shoes that go in between their toes, some do not like “mushy” foods, some like to do mostly sedentary things, while others are always on the go. Some do not like spinning or roller coasters and others cannot get enough and never seem to get dizzy.

A true sensory concern is one that interferes with function. A child needs to function in their natural environment: school, home and community. For example, a child who dislikes “mushy” foods – is that truly a problem? After further discussion with parents, you find the child eats hundreds of other foods, getting all the nutrients they need. Daycare and preschool teacher have no concerns, and the child does great at home as long as you do not serve oatmeal for breakfast. That scenario likely does not warrant a need for intervention. However, the child that eats five foods, is that a problem? Yes, that is interfering with function. What happens if the child tires of one of the five foods and eliminates it from his diet? Then the child will only eat four foods. This does qualify as a need for intervention.

So what are our senses? We learn from a young age that our senses include: taste, smell, sight, ability to hear and touch. There are also two hidden senses, proprioception and vestibular input. Proprioception means information to your muscles and joints. This is our ability to complete activities without looking, for example, walking up steps or driving. It also means to navigate our bodies through our environment and control the amount of force we apply. Vestibular is how our body handles movement, coordination and balance, and coordinating the left and the right sides of the bodies together. All of these senses help to tell us what is happening around us and how to safely navigate our environment. Difficulty with processing sensory information from the environment will look different for every child, but here are some examples that could be noticed in an infant or toddler:

Auditory input– A child may frequently startle with loud or unexpected noises and have difficulty calming himself after. He may cry or fuss due to noises we think are routine: cooking, the noise of a fan, ceiling light, TV, radio, etc. He may make repetitive loud noises over and over, talk at loud volumes on a regular basis, enjoy banging objects together or crashing toys together. Or he may frequently not respond when called.

Propriceptive input– A child may only sleep well with a very tight swaddle, may detest being swaddled at all, or may only calm with firm pats on the back. She may frequently trip over objects or bump into things often.

Vestibular input– A child may become upset with being placed on a changing table, detest movement in the car, only go to sleep by movement in the car, resist tipping head back into the bathtub, or demonstrate a slight delay in milestones such as rolling, sitting unsupported, crawling and walking.

Tactile input – A child may fuss during morning routines, especially getting dressed. He may fuss with shoes or socks or may be selective about clothing, especially pajamas and blankets.

Taste/smell – A child may have difficulty transitioning to solids after breast or bottle feedings or may have continued gagging when attempting new flavors. Some toddlers may be fussy around foods being prepared/cooked, or will not tolerate any new foods on plate, or display sensitivity to temperature or texture of food.

Visual input – A child may have difficulty locating toys, express distress when being in the bright sun, shield her eyes when watching a “busy” TV show, frequently squint, sit too close to the TV, or put her face extremely close to toys.

Remember, one or two of these are not necessarily cause for concern; however, noticing five or more may be a topic to discuss further with your child’s pediatrician. Likely, your pediatrician will recommend a visit with an occupational therapist. You are not alone and it’s worth voicing your concerns.


About Caren Arnold, OTD OTR

caren arnold big sky pediatric therapy austinCaren Arnold is the owner of Big Sky Pediatric Therapy, a clinic in Austin, TX, for children with special needs, offering traditional therapies, occupational, physical and speech therapy, along with progressive music therapy and yoga. She received her Bachelor of Science degree from the University of Tennessee in Exercise Science and her Clinical Doctorate in Occupational Therapy from Belmont University, Nashville. Caren has worked in private practice as well as inpatient and outpatient pediatric hospitals. She specializes in sensory integration, autism spectrum disorders, and dysgraphia. Specialty certifications include: The ALERT program, Interactive Metronome, Debra Beckman’s Oral Motor Skills and Mary Benbow’s foundational hand skills. Caren has also developed a cursive writing protocol, a curriculum for intensive print and cursive handwriting camps, and is skilled in conducting wheelchair and equipment evaluations.