The Tactile System and your child’s behaviour- Undersensitivity

Continuing our series of posts on the tactile system….

In our last post we talked about how an over-sensitivity to touch might show up in your child’s behaviour.  This time, we are looking at signs that may indicate that your child is under-sensitive (hyposensitive) to touch.

A difficulty in sensory processing may be apparent in a child’s motor skills, and/or in their emotional and behavioural responses.  There are many areas in which tactile difficulties might show up.  Because my posts are more feeding-oriented in origin, I’ll focus a little more on signs you might see in that area.  Sensory processing is very complicated, so no one post or list will ever quite capture your child.  That is why a good quality assessment of sensory processing is important.  As we’ve discussed previously, a child with a general pattern of under-sensitivity may react passively (not acting to address their needs), or actively (seeking out sensation to meet their needs).

Under-sensitivity:

  • Poor awareness of food in the mouth- poor oral skills, poor chewing skills, gagging (there are lots of physical reasons why children might show these too)
  • Cramming food into their mouth
  • May enjoy very highly flavoured foods, or tend to like highly textured food (like crunchy things)
  • Unaware of food on their face or left in their mouth
  • May drool with little awareness
  • Poor awareness of being dirty
  • Low pain awareness
  • Seems unaware of temperature
  • May seek out tactile experiences- e.g. rubbing their face against the carpet, mouthing excessively
  • May have a poor sense of personal space
  • May eat non-food items

If your child is showing these signs, they might benefit from working with a Speech and Language Therapist with the appropriate sensory training, and/or an appropriately trained Occupational Therapist.

Coming up- Look out for posts on practical ideas to support your child who is under- or over- sensitive to touch.

Posts from Find the Key Speech Therapy are intended for information.  They are not inetnded to, and cannot, take the place of advice from an appropriately qualified Speech and Language Therapist who knows your child.  Find the Key Speech Therapy does not take responsibility for the use of any advice without appropriate professional guidance. 

The Tactile System and Your Child’s Behaviour- Oversensitivity

So, in my last post I explained a little about how the tactile system is structured.

How do differences in the way your child processes touch sensation show up in their behaviour?

Your child’s sensory processing tendency may be towards over-sensitivity to touch (also called hyper-sensitivity), or towards under-sensitivity (hypo-sensitivity).  This post is about hypersensitivity.  A difficulty in sensory processing may be apparent in a child’s motor skills, and/or in their emotional and behavioural responses.  There are many areas in which tactile difficulties might show up.  Because my posts are more feeding-oriented in origin, I’ll focus a little more on signs you might see in that area, this list is in no way exhaustive.

Over-sensitivity:

  • May eat a restricted diet, and especially restrictive with regards to food texture.  Often ‘stuck’ on smooth foods.  Especially finds lumpy textures difficult.
  • Dislikes having their hands messy.  If they will get their hands messy, may ask to have their hands wiped quickly or frequently.
  • If they will join in with messy play, may only use the very tips of their fingers to explore.
  • May not mouth toys.
  • May be distracted by the visual appearance of foods- focussed on packaging, eating only particular brands, rejecting foods if they are presented differently, rejecting foods if sauce has touched them, or if foods have touched each other on the plate.
  • May be distracted by, or controlling about clothing textures- e.g. labels, long sleeves, seams.
  • May dislike having their shoes and socks off, or exploring with their feet, e.g. walking on sand or grass
  • May dislike having hands/face/hair/teeth brushed/washed etc.
  • May reject foods based on temperature
  • May react excessively to everyday events like being brushed up against
  • May exhibit responses to the above that you would consider out of all proportion- distress, anxiety, anger, silliness, controlling behaviour
  • May have poor fine motor, oral-motor and/or gross motor skills
  • Fearful or rejecting of being touched/hugged

If your child is showing these signs, they might benefit from working with a Speech and Language Therapist with the appropriate sensory training, and/or an appropriately trained Occupational Therapist.

Look out for posts about supporting children with over-sensitive tactile systems with their feeding, coming up soon.

Posts from Find the Key Speech Therapy are intended for information.  They are not inetnded to, and cannot, take the place of advice from an appropriately qualified Speech and Language Therapist who knows your child.  Find the Key Speech Therapy does not take responsibility for the use of any advice without appropriate professional guidance. 

 

The Touch Processing System

This article will be looking at the touch processing system in a bit of detail.  If you’re anything like me, you like to know why something works before you’ll do it.  So this introduction to the touch system will give the background to future articles that will talk a bit more about practical strategies to support your child with difficulties with touch (tactile) processing.

I think that knowing a bit about how the brain processes touch helps Families to be more independent of their Professionals in choosing the right strategies for them.  With the right knowledge, you’ll understand why a strategy might work, and how to adapt it.

Your tactile system has receptors that take in touch information through the skin.  It’s the largest sensory system in the body, and so if you have difficulty with processing touch, it has the potential to effect lots of different areas of development.  I’m going to mainly talk about children who have emotional over-reactions to touch (and therefore food too).

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The touch system has two branches, the discriminative and the protective parts.

The discriminative system helps us with precision information.  We need it to explore our food and toys, and develop good manipulation skills with our hands for things like writing, turning the pages of a book, or doing a puzzle.

kids-girl-pencil-drawing-159823

The discriminative system carries a few different types of information, that you might not think of as being part of the touch system:

  • Discriminative info like texture
  • Deep touch pressure
  • Vibration
  • Proprioception (more about this in another post)

The protective system is designed to keep us safe on a much more basic level.  It is the system that will make you jump when an insect lands on you, make you shiver when there is a sudden cold draught, or think about running away if someone brushes against you in a dark alley.

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The protective system carries information about a few things too:

  • Light touch
  • Pain
  • Temperature

The protective system, unlike the discriminative system, sends branches out to the parts of the brain that make us switch focus and be alert, and react by running away, putting up a fight, or freezing.  All useful things in the right situation.

But sometimes children (and adults) have an overactive protective system, and/or an underactive discriminative system.  So they are triggering strong protective behaviours in response to touch sensations that would not bother the rest of us.  For example, getting food onto their hands or into their mouth can trigger genuine fear and anxiety.  Eating foods of a certain temperature might be an issue.

Luckily for us, our brain isn’t very good at processing information from both parts of the tactile system at the same time.  If you want to see this in action, then next time you bang a knee (generating a pain signal, processed in the protective system), then rub it (deep pressure, processed in the discriminative system), and it won’t hurt so much.

We can use this trick of fate in therapy activities and strategies for your child by:

  • Supporting their discriminative skills in our choice of activity
  • Using deep touch pressure such as massage
  • Using toys that vibrate (but not if they only have light vibration or the brain thinks it is light touch)
  • Doing activities that get us moving our muscles (proprioception)

So, we might build more opportunities to use the discriminative pathway into a child’s day, and especially before we ask them to push themselves to do something difficult in their feeding, like messy play.

Have you got any examples of touch activities that your child finds difficult?  Maybe they make more sense now that you know more about the way the brain processes touch?  As usual, post your comments and questions!

Posts from Find the Key Speech Therapy are intended for information.  They are not intended to, and cannot take the place of advice from an appropriately qualified Speech and Language Therapist who knows your child.  Find the Key Speech Therapy does not take responsibility for the use of any advice without appropriate professional guidance. 

Towels, your feeding chair hack

“A towel, The Hitchhiker’s Guide to the Galaxy says, is about the most massively useful thing an interstellar hitchhiker can have.”  Douglas Adams, The Hitchhiker’s Guide to the Galaxy

Who am I to disagree with Douglas Adams?  Towels, in feeding, as in the wider Galaxy, are a tremendously useful thing.

Is your baby finding this weaning thing tricky?  Maybe they’re developmentally delayed? Physically small?  Have they got low muscle tone (hypotonia)?

We talked about the importance of sitting as a developmental skill for eating in a previous post. But getting the seating right can help your child a lot too.

Look at your lovingly selected expensive baby seat.  Now look at your baby in it, and see if any of the following might apply:

  • Are they in midline? If your baby is slumping to one side or the other, they are not in a good position to concentrate on their mouth.  Try padding out one or both sides of the seat with towels or cushions to give them more support.
  • Are they sat up?  This is not a trick question.  Your baby might look upright, but they are often really quite far back in their chair.  They might be having to lean forward to get at their food, using valuable energy to do so, which they could be using developing new oral skills.  Try adjusting the seat position if possible, bringing the tray backwards if possible so it’s not so far away, or padding behind them with towels.
  • Is the tray somewhere up in their armpits?  Does using their arms require them to have their shoulders up around their ears?  This is not making the business of developing self-feeding skills any easier.  Try putting towels/a cushion under your baby, or bringing the tray down if you can.
  • Are they on the move over the meal?  If you child is slipping down in their chair over the meal, they are going to be finding it hard work.  If padding out with towels doesn’t work, then try putting a non-slip mat or piece of Dycem or similar (https://dycem-ns.com/) under them.
  • Where are their legs?  If your child’s legs are sticking out unsupported, they might be making more effort than they need to stay stable.  As a general rule, having your feet on something will help.

For children with higher or mixed tone, or problem reflux in conjunction with physical delays, not sitting at all for meals might be a solution.  A standing frame will sometimes be more helpful.

Seating will always be part of any feeding assessment.  Ask your Physiotherapist, Speech Therapist and Occupational Therapist about your child’s seating.

Posts from Find the Key Speech Therapy are intended for information.  They are not intended to, and cannot, take the place of advice from an appropriately qualified Speech and Language Therapist who knows your child.  Find the Key Speech Therapy does not take responsibility for the use of any advice without appropriate professional guidance. 

 

‘Bite and Dissolve’ finger foods- your Speech and Language Therapist’s favourite weapon of oral progression

In my last post, we talked a bit about developmental readiness for weaning, espcially in the context of developmental delays and disabilities.

We’re going to expand today on the subject of finger foods, something that feeding-specialist Speech and Language Therapists talk about all the time!

This can be a bit of a complex topic, because, whilst the principles are the same, our advice might be a little different if your child has complex medical or developmental needs, compared to children with more typical developmental progress.

So, if you have a child with complex needs and you’re not sure, be sure to check with your own Speech and Language Therapist.

Baby-lead weaning is a big topic, and I’m not going to wade into it here, except to say that I do think it has got everyone feeling a bit differently about finger foods, and I think that overall, that is a good thing.

Adults tends to assume that there is a nice logical progression that goes smooth foods- lumpy foods-finger foods.  In reality, when we ask children to learn to chew (one of the major oral-motor tasks of weaning), lumpy foods can give them mixed signals.  They come on a spoon, great!  I know what to do with these, I suck them.  My tongue goes back and forth and – aargh, what is that lump, and why has it made me gag?

Dealing with lumpier foods is actually a really complex skill, you have to deal with the thinner smoother component by sucking, and sift out the lumps and deal with them by chewing.

When we give children finger foods, they can learn so many skills:

  • Hand-eye co-ordination
  • Fine motor skills
  • Self-feeding (spoons are hard!)
  • Biting skills (important for jaw skills, and therefore speech development)
  • Tongue skills (moving foods from side to side)

In general, when it comes to teaching oral skill development, a finger food has many advantages over lumpier purees.

There is lots of good advice out there for good finger foods for children with typical development.  (Try https://www.nhs.uk/start4life/choosing-first-foods).  Don’t forget that your Health Visitor may have lots of good advice and resources too.

But maybe your child is higher risk for introducing finger foods because of medical or developmental issues?  Maybe they have gagged a lot in the past?  Maybe you or they are feeling anxious about finger foods?

Speech and Language Therapist’s go-to foods in these circumstances are ‘bite and dissolve’ finger foods.  These are foods which will help your child along by dissolving on contact with saliva.  This helps them practise skills, but reduces the risk of choking and gagging whilst they learn.  What they are not is great all-round sources of nutrition.  They are often relatively low calorie too, not great news if your child is struggling to gain weight.  So if these things are a concern, your Speech and Language Therapist will run the recommendation past your Dietitian (I’ve never known one say ‘no’, yet!).

Some examples of bite and dissolve foods (not advertising here, there are lots of these about these days, these are just the ones that come up a lot in consultations):

  • Wotsits
  • The Organix range of crisps that includes carrot sticks and sweetcorn rings
  • Pombear crisps
  • Heinz biscotti

If in doubt, buy some and see how long they take to dissolve in your mouth.  Some take longer than others. Rice cakes, whilst they feel like they should fit in this category, are not bite and dissolve. Remember also that they need to be big enough for your little one to hold and bite through too, an important skill. When we give small children tiny cut-up pieces, we’re actually making it harder for them to gain control of these with their tongue.

Does your child have any favourite bite and dissolve foods?  Spread the news below.  And don’t forget that if you have anything you’d like to read about here, let me know in the comments below.

Posts from ‘Find the Key Speech Therapy’ are intended for information.  They are not intended to, and cannot take the place of advice from an appropriately qualified Speech and Language Therapist who knows your child and their circumstances.  ‘Find the Key Speech Therapy’ does not take responsibility for the use of any advice without appropriate professional guidance.

 

 

 

 

Your mouth is connected to your hip bone (sort of)

Have you got a child with developmental delays?  Are you struggling with their weaning?  Maybe they got onto purees ok, but they are gagging on lumps and finger foods? 

When your child takes puree from a spoon, they can use a similar backwards-forwards sucking tongue pattern to the one they use when they take milk from the bottle or breast.

But dealing with solids or lumpy purees is a much more complex task.  Your jaw needs to go up and down (to bite through things, and get those teeth mashing food), and your tongue needs to go side to side (to move the food to your teeth in the first place).

Your child needs some good underlying skills to accomplish this complicated task!  If your child can’t sit yet, they won’t be stable enough in their core to do sophisticated things with their jaw, lips, or tongue.

When you give your child lumps, but they don’t have the underlying skills, they’ve got no choice but to suck on them.  The forwards-backward tongue motion pushes the lumps forwards and out of their mouth, or backwards where they might stimulate a gag.

So if you want your child to progress with their mouth skills, you need to pay attention to their sitting.  They don’t need to be completely stable, but a good sign is if they can sit in play, and use their arms and hands to interact with toys at the same time.

Whether they sit at 6 months, 2 years or way beyond this, the same principle will apply, and you’re not likely to be able to progress their skills safely (eating textures they are not ready for will put them at risk of choking and having foods enter their lungs- aspiration).

Some of our young people with physical disability will need chairs or other equipment to gain enough stability to work on their mouth skills.  There will be more posts on children with more complex physical disability to come.

Look out also for posts on small changes you can make to your child’s seating to help their oral skills, and the kinds of foods that are likely to help them to progress.

Posts from ‘Find the Key Speech Therapy’ are intended for information.  They are not intended to, and cannot take the place of advice from an appropriately qualified Speech and Language Therapist who knows your child and their circumstances. ‘Find the Key Speech Therapy’ does not take responsibility for the use of any advice without appropriate professional guidance.