Motor Skills

Sensory Diet
Nutrition for your sensory system
by Shahnoor Dharamsi MS, OTR/L and Nicole Golante OTR/L

In the summer edition of Kids Enabled, occupational therapist Linda Stephens discussed sensory integration deficits. Once sensory difficulties are identified, as well as how they affect a child’s life, many activities can be prescribed to help get him organized to better participate in school and play tasks.

A “sensory diet,” constructed by occupational therapist Patricia Wilbarger, is a set of sensory activities. Usually prescribed by an occupational therapist, the activities are incorporated into a child’s daily routines. Its purpose is to help the child become more focused, adaptable and skillful.

A sensory diet includes a combination of alerting, organizing and calming activities. The sensory plan typically targets a child’s ability to engage and participate in everyday activities, such as maintaining attention to a task, playing appropriately with others, participating in selfcare tasks, transitioning from task to task or tolerating new textures of food. The Out-of-Sync Child, by Carol Stock Kranowitz, contains various strategies that parents can do with their children to help them attend to and complete tasks.

Alerting activities benefit the underresponsive child who needs a boost to stay organized and focused. These include:

• crunching foods such as dry cereal, chips, crackers, nuts, carrots or apples,
• playing with cold water,
• listening to fast, loud music, and
• bouncing on a therapy ball or beach ball or jumping on a trampoline.

Organizing activities help regulate a child’s responses. They include:

• chewing chewy foods (i.e. granola bars, dried fruit or gum),
• pushing or pulling heavy loads, and
• getting into the upside-down position.

Calming activities help the oversensitive child respond more appropriately to sensory stimulation. They include:

• sucking a pacifier, hard candy or frozen fruit bar,
• pushing against walls with the hands and back, and
• rocking, swaying or swinging slowly.

Various types of activities can be used in sensory diets to increase the child’s ability to complete tasks. The following are a list of activities that can be used in each sensory area:

Tactile

Children who are hypersensitive to touch and are touched unexpectedly might react by hitting or punching. Conversely, children under aroused by touch might not react at all. Activities can be used to encourage processing of tactile system such as:

• Rub a dub dub: Encourage children to rub a variety of textures on their skin. Offer different kinds of soap (shaving cream, lotion soap, etc.) and differently textured scrubbers (loofa sponges, plastic brushes, etc.).
• Finger painting: (shaving cream jell-o and sand) If a child craves it, let him wallow in it! If he shuns it, encourage him to stick a finger or two into the goop, but don’t force him if he’s uncomfortable.

Auditory

When children are hypersensitive to sound, they might hold their ears with their hands if noises, such as vacuum cleaners or the toilet flushing, are too loud. If children are underaroused, their name being called might not even register. Activities to encourage more appropriate auditory processing are:

• Teaching children to play a musical instrument.
• Talking a child through loud
  noises that might be scary.

Teaching a Motor Task An example of teaching a child with sensory difficulties and difficulties with motor coordination how to catch a ball: 1. Break down the activity into steps. This helps the child plan and sequence the movement required to accomplish the task. 2. Start by starting out with a big beach ball as bigger balls are easier to catch. 3. Demonstrate if possible. Visual cues help the child plan and execute the task. 4. Provide verbal directions for each step. Give one di­rection at a time. 5. You can also physically guide the child through each step.

Vestibular

When children are hypersensitive to vestibular (movement) input, they might be overly fearful of heights or vomit after a short car ride. If children are underaroused, they tend to seek a lot of movement to get their arousal level “up.” Activities to encourage more appropriate vestibular processing are:

• Sliding: Try a variety of positions including sitting up, lying down, frontwards, backwards, holding on to the sides, not holding on, with legs straddling the sides, etc.
• Swinging: Encourage (never force!) the child to swing. Gentle, linear movement is calming.
• Jumping on a trampoline: A kid-sized trampoline with a handle is a good option.

Proprioception

When children have difficulties with their proprioceptive system, they can be clumsy and have poor body awareness. They might often roughhouse inappropriately with their peers. Activities to encourage more appropriate proprioceptive processing are:

• Pillow crashing: Jumping into a pile of cushions or bean bags.
• Pushing and pulling: Pushing a vacuum cleaner or comforter. Heavy work has powerful calming and organizing effects on the nervous system.

Visual

When children have problems with their visual system, copying homework from the chalkboard,
for example, can be a challenging task. A child who has an over-aroused nervous system might be overly sensitive to lights, for example, while a child who has an underaroused nervous system might not respond easily to visual stimulation. Activities to help with visual processing include:

• Flashlight games: Focus your light on the wall or ceiling and ask the child to meet your spot with his light. Have him follow the path of your light as you move it across the wall. Trace shapes and ask the child to name them.
• Preferential Seating: Sit the child at the front of a classroom where there are fewer visual distractions.

Sample Sensory Diet MORNING  - Use a vibrating toothbrush  - Crab walk (Lie on your back, push up your tummy, and walk backwards and forwards on your hands and feet) to breakfast DURING SCHOOL  - Carry extra books in back pack  - Climb playground equipment AFTER SCHOOL  - Play outside for 20 minutes before starting homework. Lots of pushing and pulling.  - Eat crunchy foods as snacks BEDTIME  - Take a warm bath  - Listen to calming music while being wrapped in tight blanket

Smell

When a child is oversensitive to smells, they often begin to gag or begin to cry at the scent of certain foods. When children are underaroused, they might not even register smells. Activities to try are:

• Explore scents: Lavender, vanilla and rose are generally calming. Peppermint and lemon are usually alerting.
• Play smelling games: Have him close his eyes and try to identify different smells.

Motor Coordination

When children have motor coordination challenges, they may have difficulties with complex tasks like skipping, pedaling a bike and playing team sports such as soccer or baseball. Activities that can help include:

• Obstacle courses: Use tunnels, balance beams, boards, stepping stones, steps, ladders, monkey bars, stepping in shoe boxes, etc. for a fun activity.
• Animal walks: Encourage the child to walk like a bear, crab, turtle, snake, duck, frog, kangaroo, rabbit, elephant, gorilla, horse or other animal.

If you notice that your child continues to have difficulty in the area of sensory processing, discuss your concerns with your pediatrician and request a referral for an occupational therapy evaluation. A sensory diet may be suggested to enhance your child’s ability to reach his optimal potential in his daily life.

Shahnoor Dharmsi MS, OTR/L and Nicole Golante OTR/L work together at an Atlanta outpatient pediatric practice. Shahnoor can be reached at shahnoor02@yahoo.com and Nicole can be reached at ngolante@yahoo.com.