Washing and Bathing

Bath time can be very emotional for children with sensory processing difficulties. They may feel frightened because they do not feel secure sitting or moving around in the bath. They may not like the sound or the feel of water, interpreting these sensations as alarming or threatening; they may find it difficult to sit still in the confined space of the bath. Personal care activities often involve multiple stimuli being delivered at once which can be overwhelming for the tactile system and may lead to a fight or flight response.

Scheduling bath times at a certain time of day can be helpful so that it is predictable for your child, e.g. making it part of their bed-time routine, and making it quick but not rushed. Develop a predictable routine for washing your child so that they are aware of what order it happens in, you could use visual prompts or pictures to help your child to know what is going to happen next.

You could try using toys to distract your child and treats to motivate them on completion of the task. Offer your child the choice of a bath or shower. Use a bath rail if your child is frightened getting in or out of the bath.

Movement Tools- If your child seeks sensory input, allow them to jump or run around prior to bath time.

If your child in over-responsive to sensory input or has a postural disorder, try washing them in a sink or baby bath (if they are small enough), as they this may make them feel more secure. A shower may also make them feel more secure because there are fewer changes in body position.

Use a bathmat, towel or bath seat in the bottom of the bath so that your child is less likely to slip around.

Children that are uncomfortable changing the position of their head may not lie down in the bath to have their hair rinsed; try a handheld shower or cover their eyes with a face cloth and use a jug to pour water over their hair.

Dry your child in front of a mirror and name body parts to increase your child’s ‘body map’.

Muscle Tools- Offer a variety of containers so that your child can pour water from one into another.

Touch Tools- Try to be aware of the temperature of water your child prefers. Water that is warm to the touch is the best temperature, let your child test to ensure they are comfortable.

Use firm pressure downward on your child’s shoulders whilst bathing them as this would be calming to your child.

Massage your child with a facecloth, bath mitt or your hands using firm, constant pressure prior to and during bath time, depending on what your child will tolerate. Use pressure and downward strokes.

Place a warm, wet, heavy towel over your child’s shoulders whilst he is having a bath and keep pouring water over him/her to help him/her feeling warm and safe.

Use buddle bath if your child is not sensitive to this.

Hide toys in the bubbles for younger children to find, or offer play with soap, bath paints or bath crayons if your child with tolerate them.

Use the shower sprayer for rinsing, allowing your child to rinse themselves.

Offer bath toys/fidget toys to play with in the bath if your child seeks sensory input.

Use the shower sprayer for rinsing, allowing your child to rinse themselves.

Offer bath toys/fidget toys to play with in the bath if your child seeks sensory input.

Use heavy towels for drying; use firm constant pressure. Wrap your child in a large towel and pretend that is it a hot dog roll and that he/she is a ‘hot dog’. Offer and maintain firm control with your hands to give him/her ‘ketchup’ and ‘mustard’!

If your child is over sensitive to touch, use a smaller towel which you can direct more easily. Use a firm pressure.

Ear Tools- Read stories about bath time to allow your child to talk about what they do and do not like about bath time.  If the sound of the running water bothers them, fill the bath before you taken them into the bathroom.  Tell your child where you are going to wash him/her to prepare them.  Use earplugs to minimise noise and water going into the ear.  Play calming music.  Sing songs with your child.

Eye Tools- Allow your child to look into a mirror whilst in the bath to increase predictability.  Use pictures/visual aids to help your child to understand the task and the predictability.  Dim the bathroom lights, particularly of your child is over responsive to sensory input.  Use a visual timer so that your child knows how long it is until the task is finished.

Nose Tools- Use calming scents or unscented soaps if your child is oversensitive to smells.  Allow your child to help choose bubble bath, soap, and shampoo by sniffing it before you buy it.

Mouth Tools- Let your child use straws to blow bubbles in the bath, making sure they do not swallow the water.  Be careful to ensure that your child does not eat the soap.

Dressing

Performing self-care tasks involves a series of complex processes, such as sequencing, motor planning and body awareness. Other areas also have to be considered: adequate attention levels are required if the activity is to be achieved and sensitivities to tactile experiences have to be overcome, e.g. from clothing etc.

Dressing can be a complex process and children need to be able to master a number of skills. These include:

• Motor Skills: where a child needs to be able to move their limbs and body in a full range of movements requiring muscle strength and flexibility at their joints.
• Coordination: where a child needs to be able to create co-ordinated movements, using one arm and both arms. A child also needs the control of hand movements that require fine motor skills, such as fastening buttons.
• Balance: being able to maintain their balance whilst changing posture/ position both with eyes open and shut
• Fine motor skills: being able to reach, grasp and release objects in order to complete tasks such as buttoning or holding the item of clothing.
• Perception: having an understanding of various sizes and shapes of buttons and also knowing the size of arm holes.
• Stereognosis: being able to feel their way without relying on sight such as finding arm holes with a jumper over their head or fastening buttons behind at the back.
• Body schema: being able to tell right from left and the difference between arms and legs.

Sensory suggestions:

• Sensitivity to fabrics is often one of the first sensory issues that a parent notices. There may be particular fabrics that the child just can’t tolerate. A child who is sensitive to tactile input may be feeling their sock seams or shirt cuffs all day long.
• Some children are more comfortable in loose clothing or if they wear tight clothing beneath their other clothes, like school uniform for example. Sports/ cycling shorts (such as the all-cotton ones from www.sensory comfort.com), tights, ‘too small’ T-shirts, sports vests and so on. A hooded sweatshirt/ hoodie provides great input when the child pulls the hood up, sticks their fists in the pockets, and pushes downward, tightening the fabric.
• Buy softer fabrics: cotton, fleece, and flannel. Avoid items made of polyester blends, which can become uncomfortably rough.
• If your child can only tolerate well washed clothing, wash new clothes multiple times.
• Consider using laundry products without added perfume or dye. Fabric softener may or may not be helpful; it does make clothing softer but the strong scent may bother some children.
• Before your child gets dressed after a bath or shower, rub in a moisturiser while their skin is still damp. This is especially important in winter, when skin tends to get dry and itchy.
• Use comfortable clothes; consider the type of fabric and length of sleeves. Experiment with different weights of clothing, as well as different fabrics. One child might prefer loose heavy clothing while another might prefer lightweight, stretchy clothing.
• If the child cannot tolerate labels, cut them out. Look out for typical clothing irritants: elastic at the wrist or ankles, scratchy backings on appliques or patches that rub against the skin, tight collars, or waistbands that don’t have cloth covering the elastic.
• If the child cannot tolerate seams, undergarments can be worn to reduce friction.
• Try washing and drying clothes in unscented products.
• Dressing can be done in front of a mirror so as to provide visual cues to assist with sequencing, motor planning and body awareness.
• Be aware of other visual or auditory noises in the room which may be off-putting.

Wearing Glasses

• Try ultralight, flexible glasses. These weigh far less than regular glasses and can be twisted and bent without breaking.
• Try an elastic strap to hold glasses on. The extra pressure against the head might be comforting to the child as well.
• Some children will pull glasses off when the frames get a little bent. So check to see if they are still in shape or need adjusting.

Hats, gloves, and mittens

• Massage your child’s head and hands before she puts on a hat or mittens.
• A tighter or looser hat, gloves, or mittens might be more tolerable for your child, try snug glove liners beneath mittens.
• Look for fleece hats, gloves, and mittens, which are less scratchy than acrylic and wool.
• A tactile sensitive child might need a hood or hat to protect them from the uncomfortable feeling of even a small amount of rain or snow falling on their head.
• Some children can tolerate a hood better than they can tolerate a hat.

Shoes, shoelaces and boots

Feet are one of the most sensitive parts of the body, especially the soles, so it’s no surprise that a lot of children are very particular about socks and footwear. Some are uncomfortable being barefoot, and some insist on having something on their feet at all times in order to gain more information about the environment and where their body is. Others have trouble adjusting to a new pair of shoes, which can be a real problem as feet grow and seasons change. Also, tying shoelaces is a complex task that requires more advanced, fine motor, visual-perceptual skills, and proprioceptive processing skills.

• Desensitise your child’s feet before trying on shoes. When you go to the shoe shop, bring along seamless socks that your child tolerates well.
• Try slippers or moccasins, or canvas shoes, which are breathable.
• Investigate whether very tight, thin socks or really thick socks or seamless socks make shoes more comfortable.
• Many older children prefer high top trainers that provide some ankle support.

Toileting

Toileting, like eating, is an extremely sensory experience. Many children find that bathrooms and toilets are upsetting or scary.

They may have difficulties in understanding the sensations experienced by their own body and knowing how to react to them.

It is useful to look at the different sensory experiences a child has and try to analyse and understand which aspects are causing difficulty. This helps in appreciating a child’s perception and difficulties, and to create an environment where the child feels more relaxed, secure and comfortable.

For further information, please visit:
https://eric.org.uk/sensory-needs-and-toileting/

See “Bladder & Bowel/Continence Issues” section for more information

Eating and drinking

There are several reasons why children with sensory processing difficulties have challenges with eating. Eating requires postural stability to maintain sitting, whilst having the motor co-ordination and sensory processing to manipulate and eat the food put into the mouth.

Taste, smell and texture

If the child is over-responsive to smell, this can also affect their taste. Most taste perception is dependent on the perception and interpretation of smell sensations which go right from the nose to the part of the brain involved with emotions and motivation. This explains why eating can be such an emotional roller coaster for some children with sensory processing difficulties.

Sensory sensitivities can also affect the child’s ability to cope with different food textures and tastes.

Sensing hunger and fullness

We rely on Interoception to sense when we are hungry and to identify when we are full. Eating is a learnt behaviour and it is important to understand a child’s feeding history in order to support eating difficulties.

A child may have had reflux, a surgery or an unpleasant experience when starting solid foods that may now be impacting on their association with food and pain or unpleasant feelings and emotions.

Food jags

‘Food Jags’ is a term used for a habit where children eat the same food, prepared the same way every day or at every meal. The problem with food jags is that a child can eventually get burned out on these foods and they are typically permanently lost from that child’s food range.

Ideas to support Eating

Encourage active play and movement activities before sitting at the table for a meal. Incorporating proprioceptive activities ( heavy muscle activities and push and pull games) will be calming and organising before a meal time.

Set up good pre and post mealtime routines e.g. setting the table, washing hands, 5 minute warning and a clean-up routine involving scraping scraps into the bin.

Eat together at the dinner table. This encourages social interactions, social modelling and exposure to different foods. Children are more likely to eat a new food if an adult is eating the same food versus just present or eating a different food.

Use a plain placemat to define the child’s food space. This is then a portable cue that can be transferred to anywhere you go.

If needed, allow your child movement breaks during mealtimes or allow them to sit on an air cushion e.g. move-n-sit, disc-o-sit cushion or ball chair.

Ensure your child is feeling supported. If their feet are not supported on the ground, they may feel postural insecurity, so a foot step can help.

Place a heavy lap bag on your child’s knee during mealtimes.

Use a non-slip mat under their plate to hold it still.

Offer ‘family meals’ with a buffet style set up on the table for everyone to serve themselves.

Involve the child in meal preparations to increase their exposure to foods.

Find other times to play with food outside of mealtimes in a different spot to where the child normally eats. e.g. puddings or jelly.

Ensure the child has a face cloth during mealtimes to wipe their hands and face straight away if they are over sensitive to touch.

Minimise visual and auditory distractions during meal times.

https://sensoryprocessinghub.humber.nhs.uk/home-eating/

ARFID is when someone avoids certain foods, limits how much they eat or does both.

One reason for ARFID is that they might be very sensitive to the taste, texture, smell, or appearance of certain types of food, or only able to eat foods at a certain temperature. This can lead to sensory-based avoidance or restriction of intake.

PICA (Eating Inedible Objects)

Pica refers to eating objects that are inedible such as stones, coins,  shampoo, clothing and cigarette butts. Children may eat one specific inedible object, or lots of different ones.  Pica can be associated with mineral deficiencies, particularly iron and zinc. A general health check should be conducted by the individual’s GP. Tests to rule out iron and zinc deficiencies should be considered.

One of the potential causes is a need for sensory feedback.  Are the textures, tastes, smells or sights of the inedible objects a child eats similar or unique in some way? They may have learned that chewing, tasting or eating particular inedible objects give them enjoyable or unusual texture/taste/smell. For example, sand or gravel are very crunchy and toothpaste has a strong flavour.

If pica is motivated by sensory feedback (e.g., the smell, colour or texture of the object) then a strategy may include giving the child items that provide the same type of sensory feedback without being harmful. The alternative would need to give the child as strong a sensation, so it is important to be creative when finding safe alternatives to offer the child. Once an effective alternative has been identified this could be scheduled in as an activity for certain times of the day to reduce the impact on the child’s daily routine.

PICA information is provided by The Challenging Behaviour Foundation. To view the leaflet visit: https://www.challengingbehaviour.org.uk/learning-disability-assets/07picaandpolydipsia.pdf

For more information see the eating and drinking section

Play

Sensory information gives us feedback about the environment and ourselves enabling us to make sense of what is happening and respond accordingly.

Sensory play can get messy, to contain it visually define the area by using a mat, tuff spot tray, container, empty paddling pool or even the bath. Here are some suggestions for sensory play, keep in mind that some young people will seek, and some will avoid, and this can be different on different days!

Sensory play suggestions

Create your own mini mud kitchen and offer different textures, rough, smooth, hard, rough, prickly, soft, cold, dough, slime, flour wet, warm, cold. Add equipment such as pots, pans, funnels and cutlery and try mixing them together and add water or paint. Some young people will like to use their hands and feet, or you can paint it on them using your hands or a brush. Some smells can be off putting and others relaxing, try adding a safe to use essential oil or cooking essence. Other activities such a baking, vacuuming, sweeping, washing the car or windows and gardening may appeal to some. Encourage the young person to help prepare and tidy away the activity as this can promote daily living and organisational skills.

Play England has an extensive list of resources: 
www.playengland.org.uk/resource/nature-play-activity-recipes/

Make a sensory room, safe space or den. Use a tent, put a blanket over a table or use a corner of the room. Add lights, torches, lava lamps or projectors, music, instruments, nature sounds or headphones to escape noise. Add cushions and blankets, things to squeeze and touch, books and catalogues.

Some young people enjoy designing, building, drawing, mazes, ‘Where’s Wally’ and optical illusions. These can be satisfying and calming. Provide opportunities to swing and jump, roll up in a rug or cocoon in a blanket or climb into a big box.

Difficulties with Sensory Play

Some children may become fixated on the feel of sand or love to watch it running through their fingers. Some will be strongly drawn to the sight and sound of running water. Others can be distressed by the feel of sand on their skin or the noise of running water.

If children have a fascination for sensory play, allow them some time to explore in their own way. Try to limit this solitary play though by using a timer and consider using this type of play as a reinforcer or reward.

With children who are reluctant to join in sensory play activities, gradually introduce some structured joint play with sensory materials. Use a sequence of very small steps so that, over time, the child will start to become less resistant to the sensory material.

Quiet space

Create a quiet space in your home for your child that they can go to when they feel overwhelmed. This could be the corner of a room such as their bedroom or the sitting room. Use a pop-up tent or sheet to create a space where you can put a bean bag or pile of cushions along with soft lighting and some of their favourite toys / books. This could be a chill out space or if you’re a safe crash space if this is what your child needs (providing proprioceptive / deep tactile input to aid self regulation).

Try using calming music or different sounds (such as nature / beach sounds) to see how your child reacts, this can provide some good background sounds to calm their nervous system or help them to block out sounds they are struggling to tolerate / filter out.

Sleep

For some children, the bedtime routine leading up to bedtime can be so dysregulating that it impacts the quality of sleep they achieve. Whilst for another child, their day is so overstimulating that settling and falling asleep can be difficult. Sometimes the overstimulation from the day is so exhausting that the child may fall asleep when they get home and this then disrupts their night time sleep.

Children who are sensitive to sight, touch, movement, and sound can experience more difficulties with sleep. Sensory modulation difficulties can impact on self-regulation because these children don’t yet have the strategies to do this independently and thus require additional co-regulation, adaptive strategies, and use of external sensory inputs to support sleep.

As well as sensory modulation difficulties impacting on sleep, we also rely on our Interoception to sense that we are tired. Common difficulties with sleep include:

• Taking a long time to settle or a long time to fall asleep.
• Requiring someone present in the room, next to the bed, or lying in bed in order to fall asleep.
• Restlessness during the night or frequent changing of positions.
• Getting up or waking up at night on a regular basis.
• Inconsistent sleep patterns e.g. sleeps 6 hours one night and 10 hours the next night.
• Showing signs of being excessively tired during the day or falls asleep during the day.

Ideas to support healthy sleep routines

Try to ensure your child engages in lots of movement and heavy work activities during the day, but at least one hour before bed switch to quiet play.

Create a consistent bedtime routine. Completing a routine before bed is a great way to help the mind and body prepare for sleep. It may take some time to figure out what works best for you, your family, and your child. Experimentation, creativity, and flexibility are important in this process and once you figure out a routine that works, stick to it!

If your child is sensitive to visual inputs, try to avoid bright screens (TV, computer, phone, iPad). Especially in the 1-2 hours right before bedtime. Blue light is alerting and can have a negative impact on melatonin production.

Relax in a quiet space before heading to bed with dim lighting and decreased sensory inputs e.g. visual and auditory stimulation.

Choose a relaxing activity like reading, drawing, jigsaw puzzle, word/number games (Sudoku, crossword or word search), cards, or knitting as a wind down activity.

Play soft, rhythmical music or white noise.

Wrap body tightly in a blanket or sit under a weighted blanket.

Take a warm shower or bath. Try calming scents such as lavender in the bath or a diffuser.

Meditate or do light yoga.

Dim the lights and close the curtains/blinds prior to the child entering the room. Use black out blinds to help filter out any additional light that might be keeping them awake.

A bed tent may help black out visual distractions if your child is visually sensitive.

Having a tight hug or play the ‘steam roller’ game (roll an exercise ball firmly over your child’s back while they lie on a carpeted floor or mat).

Rhythmic motion such as gently rock in a rocking chair can be calming.

Offer the child a teddy with your perfume/cologne on it or a piece of your clothing with your scent on to help with separation.

Deep breathing or sucking may help the body feel more calm and ready for sleep; for example, blow up a balloon several times, drink room temperature water through a straw, or suck on a sugarless mint.

Tightly tuck the bed sheets/blanket in to provide firm, maintained deep touch pressure, or try a Lycra compression sheet. Ensure your child is able to get out if they need to.

Offer heavy body pillows, duvets or weighted soft toys. Again, ensure your child is able to get out if they need to.

Be conscious about fabric preferences when purchasing bed sheets and pyjamas.

Put the mattress on the floor if your child is afraid of heights, place the mattress against a wall rather than in the centre of the room.

https://sensoryprocessinghub.humber.nhs.uk/home-sleep/

For more information, see the Sleep Section