My son was only about 3 months old when I noticed he had a hard time calming his body down. Admittedly, we had stopped swaddling too soon (rookie parent mistake), but I still had a feeling there was more going on.
He could only fall asleep when being held, and he needed his feet touching the bottom of his crib to stay asleep on his own. When we tried putting him down to fall asleep, he would thrash his head side-to-side, scratch his face, and suck wildly on his fist. He just couldn’t settle. I remember saying to my mom in exasperation, “I wish they made a weighted sleep sack! I know it’s what he needs!”
Helping kids with special needs
Pediatric occupational therapy is a field that has gained increased attention over the past few years. (Well, I get fewer blank stares when I tell people what I do for a living, at least!) The increase in developmental diagnoses, such as autism, has led more families to seek out specialized services and products for their children with special needs.
As a pediatric occupational therapist, my job is to help a child fully participate in all aspects of daily life, including self-help skills, play skills, and developing routines (including sleep!). A major cornerstone of my practice involves looking at a child’s sensory-processing skills.
Sensory processing is defined as the neurological process by which a person organizes sensations from their body and the environment to effectively participate in daily life (Ayres, 1972). In simpler terms, how does a person process the information in their environment? Are there any challenges as a result of the way they process this information?
Occupational therapists are trained to analyze a child’s sensory system and identify any areas of dysfunction. For example, a child with an auditory processing disorder may not be able to focus in a crowded classroom. A child with a high need for movement input may spin themselves in circles until they become overstimulated.
One of the most important, yet least discussed, sensory systems is the proprioceptive system. The proprioceptive system is the body’s ability to sense its location, movements, and actions. It tells us where our body is in space.
Kids with dysfunction in their proprioceptive system often appear clumsy, constantly lean against things, and enjoy crashing their body into things. They can appear very “rough and tumble” since their body is constantly trying to get more feedback from the environment. These kids often have a hard time “settling,” or getting enough input to feel calm and relaxed.
When I see a child with proprioceptive challenges, I immediately recommend activities and products with heavy work (think: carrying a heavy backpack) or deep pressure (think: a massage) components.
Heavy work and deep pressure modulate the central nervous system, and this helps the body process sensory information (Grandin, 1992, McClure and Holtz-Yotz 1991). Once the body is calmed and modulated, the child feels more “grounded” with a lowered state of arousal. Sounds ideal for bedtime, right?
I think it’s important to pause here and state that every child processes sensory information in their own way. We expect kids to react differently to the textures, sights, or sounds, but it’s when a child’s sensory response inhibits their ability to participate in daily life that it becomes an issue.
Sensory dysfunction can happen in any child, and it is not indicative of any other disability or dysfunction. I see sensory processing disorders in otherwise typical kids all the time. In fact, many of my clients aren’t referred until there has been a major change in their environment, such as starting kindergarten.
Helping our kids
As parents, we all get used to our kids’ quirks, likes, and dislikes. We may be modifying the environment to help their sensory processing without even realizing it, such as dimming the lights at mealtime or using a sound machine for bed.
However, a child with special health needs does not have that kind of control in a school environment, and that’s when sensory processing challenges can become much more obvious. They may appear as behavior issues, a developmental delay or learning disabilities, and they may affect reading, writing, speech and language and children’s learning overall.
In this case, it’s always a good idea to consider educational evaluations or a meeting with a special education teacher. The answer might be an individualized educational program or some other individualized educational plan.
While I have many neurotypical kids with sensory issues, I also see a large number of clients with clinical diagnoses of autism spectrum disorder, ADHD, and anxiety. There are always accompanying sensory processing challenges with these clients which has been heavily documented (Baranek, David, Poe, Stone, and Watson, 2006). There is also emerging evidence to suggest that proprioceptive processing, in particular, is very impacted with these diagnoses (Glazebrook, Gonzalez, Hansen, & Elliott, 2009).
One study examined kids with special needs such as autism spectrum disorder and ADHD, and they discovered these kids experience more sensory over responsivity and anxiety as compared to typical children (Lane, Reynolds, and Dumenci, 2012). In short, we would expect kids with autism, ADHD, and anxiety to have difficulty with their sensory processing.
What you can do
So, what should parents, caregivers and families of children with these issues do?
Sensory processing can be an overwhelming topic because there’s so much variation between kids. It’s also something a lot of people have never heard of until there’s a concern.
The best advice is to talk to your pediatrician. They will (hopefully) recommend an occupational therapy consultation. However, this requires special evaulations, which may be challenging, especially in the age of Covid. Luckily, there are other things you can do in the meantime.
I always recommend that parents with a special needs kid add some proprioceptive input into their child’s day. Proprioceptive input is good for all kids because it helps them develop body awareness and motor planning skills, too.
Some of my favorite types of special activities to do with my little one include: Pushing a heavy laundry basket around the house, jumping into couch cushions placed on the floor, and doing simple yoga poses. I also encourage parents to have a bedtime routine that includes a bath (when possible) and a lotion massage.
One of the most common items I recommend to parents is a weighted blanket.
When I first started my career almost 10 years ago, the only weighted blankets on the market were made by therapy companies. They were expensive, scratchy, and lacked any cute design. However, parents swore by them. They said their kids fell asleep more quickly and stayed asleep longer. I’ve even had kids carry the blanket throughout the day because they need that constant input.
I first spotted the Dreamland Baby sleep sack while shopping at a cute boutique in my hometown. It was actually a prototype for the boutique owners to try out before deciding if they wanted to carry the product. When they asked if I’d like to test it for them, I jumped at the chance. And, wouldn’t you know it, that additional weight was exactly what my son needed to settle down so he could fall asleep. Thanks, science!
While he’ll never win a gold medal for his sleeping skills, the weighted sleep sack helped him fall asleep more independently which was a huge win for us.
Overall, there’s no “magic bullet” to deal with a child with special sensory challenges, but I’m always grateful to find products I can suggest to my families. Plus, Dreamland Baby recently released a weighted blanket that I can recommend for older children as well. (A good rule of thumb is a weighted item should never be more than 10% of your child’s body weight.)
Parenting can be difficult and overwhelming, especially if you have a special needs child, so I’m all about tips and tricks to make daily life run a little smoother. I think bedtime can be a challenge for so many families, and I’m excited to have another product to add to my tool kit!
This guest post was written by Kaitlin Hughes, MOT, OTR/L, an Occupational Therapist Licensed and Registered in Chicago, Illinois. Follow her on Instagram.