COVID-19 and How It May Impact Our Sensory Systems

COVID-19 and How It May Impact Our Sensory Systems

“COVID-19” is a novel virus, from the Coronavirus family, that was discovered in December 2019. It has since become a global pandemic.

In recent weeks, we – our children included – have seen the ripple effects. As of today, a national state of emergency in America has been declared and “Stay at Home” orders have been initiated, leading to school and store closures, discontinuation of sports activities, and more.

Fortunately, we understand how to decrease the risk of infection. More information on prevention can be found through the Centers for Disease Control and Prevention and World Health Organization websites here:

This article provides insight on how this pandemic may affect our children’s sensory systems and strategies to address this topic with them.

We have 8 senses in our bodies: vision, hearing, taste, smell, touch, proprioception, vestibular, and interoception. Lifestyle changes related to COVID-19 may affect these senses, and lead to dysregulation in our children. Dysregulation can look like distractibility, meltdowns, anxiousness, aggression, or fatigue.

How to Speak with Your Child about Coronavirus

In general, we can decrease dysregulation by listening to our children’s concerns and having age-appropriate discussions regarding these changes. We can provide validation (i.e. “It can be scary to see people in gloves and masks for the first time”), remain present, and provide comfort by stating facts (i.e. “Many people are working hard and doing their best to stop people from getting sick” or “We can avoid getting sick by taking healthy steps like washing our hands”). We can answer their questions in a simple and clear manner (i.e. “A lot of people are sick right now, so we have to stay home from school until they feel better”).

Below are examples of how specific sensory systems may be affected by the lifestyle changes related to COVID-19. Some of the examples may apply to your child, some may not. Every child is unique. Each category can be further analyzed and tailored to your child specifically with occupational therapy services. The purpose of this article is to promote awareness of these factors, as it can influence our overall well-being during this time.


Possible Changes

  • Long lines to buy groceries
  • Empty shelves at the stores
  • “Social distancing” of at least 6 feet when interacting
  • Parents and caregivers are now home
  • New weekly morning routines
  • Emergency items and extra food at home
  • Signs on the store windows saying they are closed
  • Signs reminding others to maintain social distance
  • Signs stating new store hours
  • Buildings removing furniture or items to reduce items to clean
  • People in protective equipment (i.e. gloves, masks, gowns)
  • People discussing COVID-19

Potential Strategies

  • Create a visual schedule to maintain mutual expectations
  • Routines can promote comfort and security because expectations are being met.
  • Verbally discuss these visual changes with language they understand.
  • Create story books by drawing out these changes to promote understanding. Examples can be found here –
  • Create a visually calming space (i.e. blank walls or with pictures of loved ones, their favorite characters, etc.) where a child can retreat to if they become visually overwhelmed.
  • Point out kindness when they see it take place within the community.·
  • Visually model appropriate ways to cough or sneeze (i.e. into the insides of their elbows) and effectively wash hands.


Possible changes

  • Hearing more worry in our tone of voice.
  • Increased volume in the house because more people are home.
  • If parents are working from home, they may have difficulty adjusting to the expectation of quietness around a workspace.

Potential Strategies

  • Calming music
  • What is “calming” to them?
  • Do they enjoy music with lyrics or without lyrics?
  • What instruments do they prefer to listen to?
  • The volume and the pace of the music also matters.
  • No auditory background at all
  • Nature sounds
  • Lullabies
  • Storytelling (i.e. reading books with them)
  • Metronome
  • Make note of what sounds may increase dysregulation
  • Create a quiet space
  • Use a timer to designate quiet time
  • Priming them before quiet time – i.e. “Mom has to talk with her work in 10 minutes. We need to stay quiet, so she can hear.”


Possible Changes

  • Many restaurants have limited their services to take-out only
  • Grocery stores may run low on certain foods, which may lead to missing out on favorite foods or having a limited selection of what is offered at home

Potential Strategies

  • Create a visual aid by taking a blank sheet of paper with a vertical line down the middle of the page. On the left side of the line, write “Have” and on the right side of the line write “Need”. Write a list of their favorite food items under the appropriate heading. Feel free to use pictures, as well.
  • Create a menu, so meal expectations are clear (this may be a fun activity to work on together!).
  • Ask them what food they would like for a better understanding of what foods may bring them comfort (portioning and nutrition education can promote a healthy balance). The key is to make food and mealtime fun and enjoyable, especially during this time.
  • If access to food is limited, please contact local agencies or reach out to school districts, as some have offered continued lunch services for their students. Proper nutrition is imperative for your family’s health at this time.


Possible Changes

  • Frequent use of cleaning agents exposes us to more chemical scents, which can overwhelm our sense of smell. Children who are sensitive to smells may not outwardly verbalize their discomfort, so it is important to be aware of this in order to recognize their discomfort and make appropriate changes.

Potential Strategies

  • Change the environment.
  • Open doors and windows, as long as it’s safe.
  • Clean before you leave the area in order to give the scent time to dissipate.
  • Inform your children before cleaning, so they know what to expect.
  • Spend time playing outside for fresh air, while maintaining precautions.


Possible Changes

  • Social distancing is a new social norm for how we go about greeting others and our expectations of personal space. As with adults, this can be awkward for children to navigate.
  • Avoiding touching their face, especially their nose, eyes, and mouth may take some time to get used to.
  • With all of the sanitizing, the textures of surfaces, door handles, toys, furniture, and even the dryness of their hands may change.
  • Surfaces and items may feel wet from cleaning or they may feel grainy when the sanitizing agents dry.
  • Items may need to be replaced due to being worn down.
  • Clothing or bedding textures may feel different due to the frequency of washing.
  • These changes may contribute to our children’s emotional state, especially if it is unexpected or if they forget.

Potential Strategies

  • Inform your children before cleaning so they know what to expect.
  • Incorporate your child in the cleaning routines, as long as it is safe.
  • Have the child pull the laundry basket.
  • Use visuals to demonstrate appropriate social distancing by placing a sheet of paper on the floor to mark 6 feet, then have the child stand on one paper and another person stands on the other.

Hand hygiene deserves its own category. This is something your child will be doing more often. The effective way to wash hands is wet hands with warm water, lather soap on all areas of the hands (including between fingers, under fingernails, above the wrists, and to the front and backs of the hands) for at least 20 seconds, rinse under warm water, use a towel to turn off the faucet, dry hands completely, and toss the used towel without using hands to open any garbage lids.

In this sequence, a wide range of touch is involved.

  • Consider the temperature of the water
  • Consider the type of soap you can use (i.e. foam, beaded)
  • Consider the water pressure
  • Consider the texture of the towel
  • Consider the height of the sink, as this affects their ability to reach all items, which affects their frustration tolerance during this activity
  • Model the task for them


The vestibular sense refers to detecting balance and movement through a structure in your inner ear.

Possible Changes

  • More idle time
  • Fewer opportunities for movement

Potential Strategies

  • Swing
  • “Red Light, Green Light”
  • Bike
  • Walk
  • Jog
  • Skip
  • Run
  • Sit-Ups
  • Jumping Jacks
  • Sit N’ Spin
  • Scooter
  • “Eye Spy” while pointing out objects on the ground, in the sky, to the sides of he child
  • “Pin the Tail on the Donkey” *involve the blindfold and spinning component
  • Tumble
  • Cartwheel
  • “Easter Egg Hunts” around the yard
  • DANCE!


The interoception sense is defined as sensing what is happening inside our bodies.

Possible Changes

  • Stress-related changes affect their bodily function, such as hunger, heart rate, breathing, or pain

Potential Strategies

  • Model mindfulness using age-appropriate language
  • “I feel thirsty after our walk, I will drink some water.”
  • “My leg hurts from sitting for too long, I am going to stretch.”


The proprioception sense refers to understanding where your body is in space through receptors in your joints.

Possible Changes

  • Decreased time running on the playground
  • Decreased time on playground equipment (i.e. monkey bars)
  • No longer walking to school with a backpack on
  • No recess may mean fewer contact sports (i.e. basketball, handball, dodgeball, tetherball)

Potential Strategies

  • Safely push or pull heavy objects, such as large pillows
  • Crawl through pillow forts
  • Jump rope
  • Hopscotch
  • Draw with chalk on the ground while in a tabletop position
  • Squat and tip-toe while drawing on posters on the wall
  • Squeeze sponges while helping to wash the car
  • Squeeze lemons to make lemonade
  • Climb upstairs
  • Run uphill
  • Play with PlayDoh
  • Knead slime
  • Supervised baths
  • Weighted blankets
  • Napping in tucked in sheets

It is important to maintain precautions in all activities in order to ensure health and safety at all times. Consult with your pediatrician or your occupational therapist, if you have any questions regarding the above information.

If you made it this far in the article, that is telling of how much you care – and caring at this time is important. We hope this article provides insight for your overall health, too. Breathe, and remember to take care of your mind and body. Make time for your well-being and keep in mind that we are still in it together.

Wishing you all good health and peace at this time!


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Centers for Disease Control and Prevention. (2018, October 15). Center for preparedness and response: Books.

Centers for Disease Control and Prevention. (2020, March 12). Coronavirus disease 2019 (COVID-1): Checklist for teachers and parents.

Centers for Disease Control and Prevention. (2020, March 23). Coronavirus disease 2019 (COVID-1): Frequently asked questions.

Centers for Disease Control and Prevention. (2020, March 18). Coronavirus disease 2019 (COVID-): Protect yourself.

Centers for Disease Control and Prevention. (2019). Personal needs: Emergency supplies kit basics.

Children’s Hospital of Orange County (2020, March 6). 7 ways to help kids cope with coronavirus (COVID-19) anxiety.

Children’s Hospital of Orange County (2020, March 2). Hand-washing 101.

Nicholson, T., Williams, D., Carpenter, K., & Kallitsounaki, A. (2019). Interoception is impaired in children, but not adults, with Autism Spectrum

Disorder. Journal of autism and developmental disorders49(9), 3625–3637.

Official California State Government Website. (2020). California coronavirus:

COVID-19 response toolkit.

World Health Organization. (2020, March 9). Q&A on coronaviruses (COVID-19).

Going on a road trip this winter break?

If your family is like my family, this is the time of the year we like to be spontaneous, get in the car, and drive around to explore our beautiful country!

Here are some activities we do, and items we take along with us, to keep us all sane, and our kids screen-freeless (meaning, they will spend less time on electronics):

  • A Drawing Kit – attach some sheets of plain paper to a clipboard and put some crayons in a box (or attach them with strings to the clipboard). Encourage your child to draw pictures of what they see outside their window, what they see inside the car, what they think the next place you’ll stop looks like, what you’ll eat for lunch, etc. I also add stencils, stamps, and stickers to the box, to prolong the engagement in this activity.
  • Reusable Sticker Pads – stickers are always fun, especially if you can use the over and over again! Scene sticker pads are very engaging and provide the opportunity to promote fine motor and visual-motor skills, as well as language skills. Let your child set the scenes and spur their imagination!
  • Painting/Coloring Books with Water Drawing Pen – these mess-free books come with a magic pen that can be refilled with water to color the pictures in the book. Once the pages dry, the pictures can be painted again, reducing the consumption of papers!
  • A Snack Box – I get a multi-compartment container (like a beads storage box) and a variety of kid-friendly and mostly healthy snacks. Each one of my kiddos gets to pack their favorite snacks to bring along. I try to choose snacks that don’t need to be refrigerated and that are low in sugar, but I will have a couple of candy options. Some ideas: pretzels (rods, PB filled, twisted, yogurt dipped, etc.) crackers (regular or filled with cheese/PB), dried fruits and/or freeze-dried fruits, Cheeto Puffs, fig bars, mini cookies, gummy bears, M&M’s, lollipops (I always prefer Trader Joe’S organic lollipops), goldfish, and animal crackers. Although it can sometimes get messy, and the car might look like a little trash can, the kids love it and they are less likely to complain that they are hungry!
  • Mini LEGO Box – my son and younger daughter love to build with Legos! I use a simple pencil box, attach a lego base plate to the top lid (I use double-sided adhesive, and fill up the box with a variety of their LEGO pieces). This is often a favorite, and I love that they use their imagination and enhance their fine motor, and bilateral hand use skills!
  • A Fidget Box – another favorite is the fidget boxes I pack. I make 3 different ones, so the kids get to rotate them. Some ideas for items include: squeeze balls (there are so many different types, so I put a different one in each box), Wiki Stix (fun to stick on the windows… just make sure they don’t block the driver’s view), stretchy strings, snake cubes, flippy chains, mesh and marble toys, mini fidget spinner, puzzle balls, etc.
  • Books – if your child doesn’t get car sick reading in the car, books can always help the time pass faster. For my little one, I bring more interactive books or busy books (the ones with the fasteners or little parts that Velcro), to keep her engaged.
  • Card Games – Go Fish, Lazy 8, Old Maid, and even regular playing cards are always a hit!
  • Magna Doodle – this one is a lifesaver! I actually keep it in the car even for short rides! My little one has been using it in the car since she could hold the pen and scribble. Now, she loves copying road signs and street names, or letters to us who sit in the front. My older kiddos love to play tic-tac-toe or hang-man on it… so I bring 2 boards.
  • When all else fails, put a movie on or bring out the electronics

Have a safe drive and enjoy this wonderful family time! 🚙

Tactile Defensiveness: Some People Are More Sensitive

In addition to the important role of our touch (or tactile) system previously discussed under tactile perception, another critical aspect of this sense is its protective function.

Our tactile sense alerts us when something is sharp, hot, cold, or in some other way may present a danger. We learn to “notice” those things which may represent harm or danger and respond by moving away from them. For some individuals, however, the aspect of the touch system which distinguishes between potentially harmful and harmless “messages” does not work normally. Occasionally we see children who have an underactive sense of touch.

These children do not seem to feel pain as much as others and often seem unaware of tactile sensations that should be noticeable. More common, however, is a condition of inconsistent responsiveness or hypersensitivity to touch. Dr. A. Jean Ayres was the first to describe this condition as “tactile defensiveness.” An individual with hypersensitivity to touch or tactile defensiveness appears to overreact to a sensation that most people might not particularly notice, or at least are not bothered by.

Common signs of tactile defensiveness include: sensitivity to certain types of clothes or fabrics; preference or aversion to foods which seems most related to the texture of the food (e.g. avoidance of smooth and creamy foods or irritation in response to crunchy or lumpy foods); avoidance of touching substances such as finger paint or mud, or of getting one’s hands messy; avoidance of walking barefoot on particular surfaces such as sand or grass; a greater than normal resistance to having teeth brushed, hair combed or face washed; and/or a tendency to prefer to touch rather than be touched, especially when the touch is unexpected.

Because we do not usually think much about our sense of touch or realize that some people are more “sensitive” than others, many of these behaviors are often attributed to personality, emotional make-up, or behavioral tendencies. However, enough cases of tactile defensiveness have been documented for us to be confident that this is truly a neurologically-based condition which can create a great deal of discomfort and even turmoil for the individuals who experience it and their families.

Our sense of touch is closely tied to our emotions. Perceiving frequent discomfort through this sensory system is likely to make an individual demonstrate emotionally potent reactions. Thus, children who experience this condition are often described as irritable, withdrawn, weepy, angry, etc. It’s difficult to pay attention if a person is thinking about how his clothes feel, or how much it bothered him when someone brushed against his skin while he was standing in line. Individuals who have this condition can cope with it better at some times than they are able at other times.

Stresses such as fatigue, illness, anxiety and even hunger often make defensive reactions more severe. Therapy aimed at reducing tactile defensiveness attempts to gradually elicit more regulated reactions to various tactile sensations. The goal is to normalize the way the nervous system registers and interprets touch information and to develop productive coping strategies for understanding and living with increased sensitivity.

What You Can Do To Help

The following are ways you may be able to help your child or other members of your family who seem to display tactile defensiveness:

  • Light, ticklish touch is usually the most irritating. When you touch your child, attempt to use firm and constant pressure, versus light touch. You may be able to help your child avoid the irritation of light touch by asking the teacher if your child can stand at the front or back of lines or at the end of a reading circle at school rather than in the middle.
  • Firm, consistent-pressure tends to override tactile irritation. This is why we naturally rub something that hurts and it is probably how hugging developed.
  • Firm massage, pressure (as in wrapping: the arms or legs with a stretchy material such as an ace bandage) and gently “sandwiching” the child between cushions may be helpful.
  • Pay attention to which types of clothing, play substances or social situations (e.g. walking through a crowded mall) seem to elicit negative reactions from your child. Until the problem is alleviated, try to avoid irritating situations (e.g. let your child wear all cotton clothes if this is what she prefers).
  • Avoid power struggles over this unless safety or some other critical issue is involved. It is easy to think that the child with tactile defensiveness is trying to manipulate you or purposefully make your life difficult. Believe him when he tries to tell you something hurts. There is a good chance that it does.

Note: any sudden or significant change in behavior should always be checked. Children with issues around sleep, digestion, allergies and other medically based conditions might show increased irritability, including tactile sensitivity. Be sure that other possible conditions are considered and fully evaluated before assuming that these behaviors are sensory in nature.

Tactile Defensiveness: Some People Are Mote Sensitive© is part of a series of “Parent Pages” on the topic of sensory integration written by Zoe Mailloux, OTD, OTR/L, FAOTA. May be reprinted for educational purposes with full title and copyright information included.

Explore The Sense Of Touch

The sense of touch (or tactile sensory perception) is one of our most important senses. It begins to develop very early during pregnancy and becomes quite active long before a baby is born. Like the other senses that play an important role in sensory integration, it usually goes about doing its job without us noticing very much. Yet it is very important for allowing us to perform many skills and to feel comfortable and at ease in many situations.

Babies learn a lot about the world through the sense of touch. When they go through the stage of picking up and putting everything in their mouths they are using their sense of touch to find out about shape, size, and texture. This is how they first learn about the difference between things like round and square, big and little, rough and smooth, etc. If the sense of touch is not very specific, that is, it doesn’t provide clear, consistent information, then it may be more difficult to understand these types of differences visually or cognitively. The hands, feet, and mouth are the most sensitive areas of our bodies because they have many more cells which detect and respond to touch. We depend on information from our touch system to help us perform many skills.

Touch as Feedback

Think about how hard it is to do anything with gloves on. Your muscles still work the same way, but you have reduced “feedback” from your sense of touch. Think now of all the intricate tasks done by using your sense of touch, without looking — finding a dime in the bottom of a pocket, buttoning a button on the back of a shirt, cracking a sunflower seed and removing the seed with your tongue — all day long, one after the other, we rely on our sense of touch to perform everyday tasks without giving it a second thought. How would you do these things if your sense of touch did not help very much? How much longer would it take you to do things if you had to stop and look at everything, or if you had to think about everything, you were going to do with your hands. This happens to many children who are not able to rely on their sense of touch. It can be frustrating and confusing.

Try These Touch Activities

If a child has poor or inconsistent touch perception, one aim of therapy is to help this function to work more efficiently. We might use many different therapeutic activities to work on this. Here are some things you can do at home to help a child whose sense of touch is less than optimal, or who might benefit from enhanced touch feedback:

  • Play hide and find games with objects hidden in dried beans or rice. Choose objects with which your child is familiar, and see if he can identify objects by touch alone. If your child is not verbal, have her match simple shapes (Example: place a coin, a block and a ball on the table. Say, “When you find one of these, show it to me.”
  • Play games where you ask the child to describe an object being felt without looking at it. You can keep the ideas simple, such as “round” “cold” or “wet” or more complex, such as a “long, smooth, pointed object.”
  • Have objects with different textures available for play and help your child discriminate between soft and hard, rough and scratchy, bumpy and smooth, etc. Talk about these differences and see if your child can distinguish them through touch.
  • Have your child identify shapes (or letters and numbers if your child is at this level) that are drawn on their back or on their hands. You can play this game in the bathtub and draw through soap foam or shaving cream so they can see the shape after they have tried to guess.
  • Have your child draw simple lines, shapes, letters or numbers with their fingers in substances such as sand, play-doh, soap foam, pudding, etc. The extra sensation may help them get the idea of the shape or letter.
  • Think about ways to involve novel tactile experiences during play and daily activities. For example, crawling through tunnels, climbing over cushions or rolling in blankets/cloths of various textures; adding shaving cream to a small pool “slip and slide”; making fun cooking activities that involve forming dough with the hands; adding cloths, sponges, loofas and scrubs to bath time; getting “buried” in the sand at the beach, etc.

These are just a few ideas. Try to think about your own sense of touch and incorporate tactile discrimination games and tactile activities into your child’s play in a fun and non-stressful way.

Explore The Sense of Touch© is part of a series of “Parent Pages” on the topic of sensory integration written by Zoe Mailloux, OTD, OTR/L, FAOTA. May be reprinted for educational purposes with full title and copyright information included.

Visual Perception – What Do We See Through The Mind’s Eye?

Of the sensory systems that we discuss when we talk about sensory integration, visual perception (along with auditory perception) is one of the most familiar and commonly understood. Visual perception refers to the meaning that our brains give to the information that we see. For example, if you look at the following design it may appear only as a series of lines with no real meaning:

IVY - Upside Down

The lines spell the word “Ivy” upside down. Now the lines have a meaning when you look at them. An optometrist checks our eyes to ensure they are working well to see the world around us. Visual perception allows us to make sense out of what we see. Good visual perception is obviously needed to read, write, use scissors and draw. We also need visual perception to keep from bumping into things, to direct a ball toward a goalpost on a soccer field and to follow a map to a desired destination. There are many functions related to visual perception. Figure-ground perception refers to the ability to see something that is part of a bigger or confusing picture. For example, finding a roll of tape in a drawer or identifying your child while he is climbing on the play equipment at the park requires figure-ground perception. Mental imaging is another aspect of visual perception. We use this skill to figure out how to arrange furniture in a room (sometimes we need a few attempts!) or planning to put paper in a printer so the letterhead comes out correctly. Eye-hand coordination is also a part of visual perception. We need this skill to coordinate the actions we use to serve a tennis ball, to tie our shoes (at least when we are first learning) and to pull a lever at the right time on a pinball machine. It is easy to see how problems in visual perception can create many hardships in the classroom, on the playground and at home.

Therapists concerned with sensory integration usually think of visual perception as an “end product” of good tactile, proprioceptive and vestibular sensory processing. In other words, these basic systems must work well for a higher-level system, like visual perception to develop. This is why a child’s therapist may select therapeutic activities that do not, at first, seem obviously related to the concerns at home or school. For example, a child who has trouble learning to write may have problems with his vestibular sense which makes it difficult to coordinate his eye movements when his head is moving. He may have poor proprioception which makes it difficult to judge how hard to push on the pencil or how to position himself correctly in the chair. Poor tactile perception may interfere with his ability to hold a pencil properly. Therefore, therapists often work first on these foundational skills to help higher-level skills, like visual perception, come along more easily.

What You Can Do To Help

The following are some ideas that can be used to help the visual perception systems develop and function optimally:

  • Encourage your child to build things-with blocks, couch cushions, cardboard or plastic boxes- or any other found materials. You can help your child to develop visual perception by both making structures for your child to copy and also to have your child make his own creations (ones that you might try to copy to add to the fun).
  • Make puzzles, mazes and other visual games that are at the right developmental level for your child available and easy to access. You may need to start with simple ones if this is an area in which your child might need some help.
  • Books and games such as “Where’s Waldo” and “I Spy” can be helpful for developing figure-ground perception. You can also ask your child to “spot” signs, cars or other landmarks while on walks or driving in the car.
  • Parents often know how important it is to read to their children and to provide visually appealing toys and designs in their rooms. Finding ways to help your child interact with these important visual elements such as stopping to point to objects in a book or to trace designs on the wall will make the visual experiences more meaningful and long-lasting. Active participation always trumps passive input!
  • Practice “drawing” shapes and objects in various tactile media, such as sand, finger paint, shaving cream, etc. The touch and visual systems develop closely with one another and feeling the shape, size, and texture of something will reinforce the visual concept as well.
  • Similarly, matching shapes or objects felt in the hands with pictures of objects will further reinforce the co-development of tactile and visual perception.
  • Simple and fun eye-hand coordination games such as tossing, catching and batting with balls or other objects will support depth perception and smooth eye movements in conjunction with visual perception and motor skills.
  • With increased access to computer and handheld games, some children will spend a lot of time watching screens. While many of these games and apps can be engrossing for a child, those that involve some problem solving and physical interaction (such as the on-screen games that involve activities like bowling or tennis) will be most supportive of your child’s overall development.
  • Be aware of too much visual stimulation-too many visual distractions in a bedroom or study area can be distracting for a child who is sensitive to visual stimuli or who has trouble discriminating one thing from another visually. If your child seems especially sensitive to sunlight, to certain colors or contrasts of colors, or to particular shapes, consider ways you can reduce the irritation by removing these sensory features of a situation. Helping your child to understand that he may be more sensitive than others to these experiences may also help him to cope more effectively.

Visual Perception – What Do We See Through The Mind’s Eye?© is part of a series of “Parent Pages” on the topic of sensory integration written by Zoe Mailloux, OTD, OTR/L, FAOTA. May be reprinted for educational purposes with full title and copyright information included.

Discover Proprioception: A “Hidden” Sense

Most children learn that we have five senses: sight, sound, taste, touch, and smell.

However, there are other very important senses not included on this list.

Awareness of our body position or “proprioception” is one of these. Because we do not usually teach children about this sense or think about how much we all use it, most people are not aware of it. This creates an additional challenge when the sense is not working well. If we’re not even aware of it, it’s hard to understand problems related to it. Just as our eyes and ears send information about what we see and hear to the brain, parts of our muscles and joints sense the position of our body and send these messages to the brain as well. We depend on this information to know exactly where our body parts are and to plan our movements. When our proprioceptive sense works well, we make continual, automatic adjustments in our positions. This sense helps us to stay and to move into optimal positions for everyday activities such as sitting in a chair to do paperwork; holding utensils such as a pen or a fork in the right way; judging how to maneuver through an aisle so that we don’t run into or knock down things; knowing how far to stand away from people so we’re not too close or too far; planning how much pressure to exert so we don’t break a pencil lead or a toy; and changing actions that were not successful, such as the throw of a ball that was off target or a dive that turned into a belly flop.

Since proprioception helps us with such basic functions, a problem in this system can cause a great deal of trouble. Often, an individual has to pay attention to things that should happen automatically. He may also have to use vision to compensate and “figure out” how to make adjustments. This can take a lot of energy. A child with these difficulties may feel clumsy, frustrated and even fearful in some situations.

For example, it may be very scary to walk downstairs if you’re not sure where your feet are. The proprioceptive system is activated through push/pull type activities, jumping, and activities that involve weight and deep pressure. This kind of sensation is often calming and may be helpful to a child who becomes easily disorganized.

Help Your Child Be More Aware Of Body Position

The following are some examples of proprioceptive-type activities. They may be useful in helping children be more aware of body position and become more calm and organized:

  • Have children help with “heavy work” activities like carrying in the groceries, carrying the laundry basket, pulling bags of leaves, taking out garbage cans and pulling weeds.
  • Play “backpacking” by placing bags of beans or rice in a child-size backpack. Pretend to be climbing mountains and jumping off rocks at the park or in the backyard.
  • Make a “sandwich” out of your child between the couch cushions. Gently add pressure as you pretend to put on “pickles”, “cheese”, ”lettuce”, etc.
  • Have the child close his eyes and “feel” where his legs, hands, arms, etc. are. Ask if they are up or down. See if the child can get into different positions without looking, such as rolling into a ball, touching his nose, making a circle with his arms, making an “X” with arms and legs, etc.
  • Some children will especially enjoy the sensation of holding onto a bar and feeling the stretch of hanging and swinging their body from it. A pull-up bar installed in a doorway can be a simple way to offer this activity to a child at home.
  • Give the child extra proprioceptive input when he is learning a new skill. For example, wearing a light-weight cuff when a child is trying to throw a ball may give a little extra feedback about the position of his arm. Other examples include practicing letters, shapes or numbers by making them in clay or another firm mixture; placing your hands on his hips or shoulders and providing gentle pressure when the child is learning a new motor skill such as climbing upstairs or skating; and moving the child through an action and providing gentle resistance to his movements so he can “feel” it more easily.
  • Provide gentle but firm massage if your child enjoys this. Try rubbing arms and legs to help wake him up, applying gentle pressure to his shoulders and head to calm him down, or massage his hands before he tries a difficult fine motor task

These are just a few ideas. Use common sense and don’t apply too much pressure or ask a child to push, carry or pull something that’s too heavy. Experiment and find out what seems to help your child the most.

Discover Proprioception: A “Hidden” Sense© is part of a series of “Parent Pages” on the topic of sensory integration written by Zoe Mailloux, OTD, OTR/L, FAOTA. May be reprinted for educational purposes with full title and copyright information included.

The Vestibular System: Why Is It So Critical?

Of all the sensory systems that we talk about in sensory integration theory and treatment, the one that may be the most basic, yet the hardest to understand is the vestibular sense. This sensory system develops just a few weeks after conception and plays a very important role in a child‘s early development. It was also probably one of the most important senses for our evolutionary ancestors. However, the vestibular sense is not familiar to many people.

Children do not learn about it when they learn about the basic sensory systems and if adults know about this system, they may only be aware that it has something to do with balance. Understanding more about the vestibular system will be helpful to a better understanding of the types of problems children may have as well as the methods we use to address these problems.

As we all know, there are portions of our eyes and ears which “take in” sights and sounds and send that information to our brain. The parts of the vestibular sense which “take in” information to be sent to our brain are located in the inner ear. One part is a set of fluid-filled canals which respond to movement and change of direction. The other part is a sac-like structure which responds to change of head position and gravitational pull. The information about movement and head position that comes in through these structures is sent to many different parts of the brain. This is one of the main reasons we are so concerned about this sensory system–it has so many different functions which are important to our ability to do so many things.

One important function of the vestibular system allows us to coordinate our eye movements with our head movements. This occurs in activities such as copying from a blackboard (looking up and then back down at our work), turning our head to watch a moving object (as in watching a ball move across a soccer field), and even sometimes in looking across a page to read. These functions of the vestibular system probably help to explain why several studies have shown that up to half of all children with learning disorders show signs of vestibular dysfunction.

The vestibular system is also important for helping us to develop and maintain normal muscle tone. Tone is not the same as muscle strength, but it does allow us to hold our body in position and to maintain positions. The vestibular system is especially important in helping us to keep our heads up. Many children with vestibular problems slouch at their desks, hold their heads up with their hands and generally seem to have low endurance.

Balance and equilibrium are also very influenced by the vestibular system. In addition, our ability to coordinate both sides of our body together (as is needed in riding a bicycle or cutting with scissors) also require good vestibular function. Finally, some aspects o flanguage seem closely related to the way in which the vestibular system processes information.

Considering all of these very basic and important functions, it is not difficult to see how a vestibular problem can create a very real yet often invisible problem.

What Parents Can Do To Help. The following are some ideas that can be used to help the vestibular system develop and function normally:

  • Movement experiences are very important to the developing child. Be sure to make time for activities like swinging, sliding, riding the merry-go-rounds at the park, etc. Encourage active, child-propelled movements rather than passive movement (e.g. never spin, twirl, or swing a child excessively or for prescribed lengths of time-this is sometimes recommended by individuals who quote, but do not understand, Ayres‘ theories).
  • Experiment to see if your child has an easier time sitting up or doing her paperwork after physical activity (especially swinging or other movement activity). The vestibular system often has a fairly immediate effect on the nervous system, and for some children, these activities can make desk type work much easier.
  • Encourage activities in which the child lies on his stomach and holds his head up. Try playing with Legos in this position, or have him throw objects at a target while lying on his stomach on a swing.
  • Encourage “bilateral” or two sided activities such as jumping rope, swimming, biking, rowing, paddling, etc. Too much swinging or spinning can have negative effects (overactivity, lethargy, changes in heart rate and breathing, etc.) Some children cannot pace themselves very well and have reactions sometime after the activity. Discuss these activities with your therapist and plan appropriately for your child.

THE VESTIBULAR SYSTEM: WHY IS IT SO CRITICAL? is part of a series of “Parent Pages” on the topic of sensory integration written by Zoe Mailloux, OTD, OTR/L, FAOTA.

How Sensory Processing Disorders May Affect Kids

Sensory Processing Disorders may affect kids in multiple ways. In the following post, we explain the 2 additional senses related to body awareness and balance/spatial orientation.

Many are already familiar with the five senses:

Sensory Processing - child legos
  • Taste
  • Sight
  • Touch
  • Smell
  • Sound

Did you know there are two more senses? These two additional senses refer to body awareness (proprioception), and balance/spatial orientation (vestibular sense).


Proprioception is the ability to sense where your body is in space, and the ability to safely maneuver around your physical environment. For example, we can tell when our arm is raised above our head without looking at it because of our sense of proprioception.

Vestibular Sense

Vestibular Sense helps control balance, eye movement, and spatial orientation. It helps you stay stable and upright.

Sensory Processing Disorder

Children with Sensory Processing Disorders have trouble organizing information received from the senses. That is, they can be oversensitive to input, undersensitive to input, or both.

These issues can make it hard for children to succeed in school. For example, a child who is undersensitive to the sound of a school bell may take longer to transition to the next class simply because they were not alerted by the initial sound of the bell. A child who is oversensitive to the sounds of peers laughing or talking loudly during recess may be observed to cover their ears because they are overwhelmed with the auditory input.

There are many other ways sensory-motor difficulties can be observed. The following examples may be suggestive of difficulty with sensory integration.

Undersensitive Children

Children who are undersensitive to sensory processing input may seek out more sensory stimulation, which may look like:

  • Constantly touching people or feeling different textures
  • Personal space issues
  • High pain tolerance
  • Unable to sit still/are fidgety
  • Love jumping, bumping and crashing activities
  • Enjoy deep pressure
  • Crave fast, spinning, and/or intense movement

Some behaviors might look like hyperactivity or Attention-Deficit/Hyperactivity Disorder (ADHD) when many of these behaviors are sensory seeking. It is important to speak with your medical team for more information.

Oversensitive Children

Children who are oversensitive to sensory processing input may avoid sensory stimulation, which may look like:

  • Unable to tolerate loud noises
  • Refuse to wear clothing/find tags and labels irritating/clothes feel too tight
  • Easily distracted by background noises
  • Fearful of playground equipment
  • Clumsy and bump into people
  • Have extreme meltdowns when overwhelmed

Medication and Treatment

There is currently no medication available to treat sensory processing issues.

However, occupational therapists engage children in specific, purposeful physical activities that are designed to regulate their sensory input, so they may participate in their daily activities and navigate their environment more efficiently.

An occupational therapist who is trained in the Ayres Sensory Integration approach identifies the child’s sensory preferences, assists the child in becoming aware of what their body seeks and avoids (self-awareness is key!), and provides meaningful activities that are the “just-right fit” to help regulate their sensory needs so they may go about their days more smoothly.

The sensory system is a realm of the human body that can be overlooked because we do not necessarily constantly and consciously think about it (much like how we take breathing or the beat of our heart for granted).

However, our senses affect how we go about our days and how we interpret our days. Think about it: if we are in an environment with consistent auditory and visual stimulation for hours, we may go home feeling drained and ready to relax.

We may not consciously think about it, but our brains are constantly processing, registering, and putting together the sensory input we provide it. What we surround ourselves with and what we do matters.

Once understood it can be fun learning about how we can modify our environment or activities to set us up for success for the day.

What is Sensory Processing Disorder?

To describe what Sensory Processing Disorder (SPD) is, we need to first look at what the terms Sensory Integration and Sensory Processing mean.

What is Sensory Integration?

Sensory Integration (SI) is a normal, neurological, developmental process which begins in the womb and continues throughout ones’ life. It is the process by which the brain receives information from the direct five senses (vision, hearing, movement, touch, taste), and interprets it so we can respond in an appropriate, effective, and meaningful way.

What is Sensory Processing?

Sensory Processing (SP) is the process by which our brain takes in sensory input, organizes it and interprets this information for use.

What is Sensory Integration Dysfunction?

Sensory Integration Dysfunction is difficulty with sensory integration. SID was first studied in-depth by Anna Jean Ayers who described SI as the ability to organize sensory information for use by the brain.

The more current diagnostic study uses the Sensory Processing Disorder (SPD) term. SPD is a condition where sensory integration is not adequately processed in order to provide appropriate responses to the demands of the environment.

Sensory processing is something most of us don’t think about as it happens naturally, unconsciously, and spontaneously throughout our day.

However, some children’s central nervous system has difficulty accurately perceiving or integrating the information it receives. If this neurological process becomes disrupted somewhere in the loop of intake, organization or output, then normal development and adaptive responses will not be achieved. As a result, learning, physical and emotional development, as well as the behavior may be impacted.

It is this disruption which yields a neurological dysfunction called Sensory Integration Dysfunction/Sensory Processing Disorder.

What Does SPD Look Like?

A child with sensory processing disorder would have an inability to organize sensory information that comes through the senses.

It can affect a child in only one-sense or in multiple senses. A child with SPD might overreact to sensation and find light, sound, contact, or food to be unbearable. It could also cause an individual to not react to stimulation (e.g. not reacting to extreme cold).

Posture and motor skills can be affected in children with impaired sensory processing messages from the muscles and joints. These are the “floppy babies” who worry new parents and the kids who get called “klutz” on the playground. Still, other children exhibit an appetite for sensation that is in perpetual overdrive. These kids often are misdiagnosed – and inappropriately medicated – for ADHD.

Do all children on the Autism spectrum have Sensory Processing Disorder?

It is believed that 95% of children on the Autism spectrum have sensory integration difficulties.

Children on the spectrum typically have a different way of perceiving the environment. This different sensory perception can interfere with the child’s ability to attend, learn, interact with the environment, handle unpredictable situations and develop appropriate peer relationships.

Occupational Therapy utilizes Sensory Integration therapy to help these children manage and master their environment as best as possible.

Can SPD be cured?

SPD can’t be fully cured. However, with OT and related interventions, the symptoms can be lessened.

Research has shown that the nervous system and neural pathways are constantly changing and can be reprogrammed. This coupled with learned behavior and effective strategies help children lead normal and productive lives.

I Think My Child Has SPD. What Should I Do?

If you suspect your child might have SPD, do the following:

  • Try to identify triggers that set off these behaviors with your child
  • Start writing in log behaviors that seem unusual
  • Try to identify what helps soothe your child
  • Try using Red Flags of Sensory Processing Disorder checklist to help organize your thoughts.
  • Schedule an appointment with your pediatrician and discuss your child’s behaviors
  • Ask for a referral to an Occupational Therapist. If you’re in Orange County California, consider contacting our pediatric occupational therapy clinic.
  • Provide sensory input at home using our Sensory Processing activities.

A Week of Sensory and Motor Development Activity Ideas

Sometimes it’s not easy to come up with fresh new fun ideas for sensory and motor development activities. We don’t want to use the same activities over and over because it eventually gets boring for us and the kids.

The following list shows a week of therapeutic activity ideas with common materials that you can do at home.

Click the link for each activity for detailed steps and additional images.

Sensory Salad

Sensory Salad
Sensory Salad

The Sensory Salad activity promotes bilateral hand use, cutting, finger strength, pincer grasp, sensory processing, tactile perception, and also social interaction.

You’ll need a bowl, construction paper, paper plate, pom-poms, scissors, straws, and tongs to complete the activity.

Sunflower Handprint

Hand Flower
Sunflower Handprint

The Sunflower Handprint activity promotes bilateral hand use , cutting, eye-hand coordination, fine motor control, sensory processing, tactile perception, and also visual motor.

You’ll need brown construction paper, green construction paper, glue, markers, scissors, and tempera paint to complete the handprint activity.

Cut the Line

Cut The Line activity
Cut The Line

The Cut the Line activity promotes bilateral hand use and cutting.

You’ll need construction paper or index cards, markers, ruler, scissors, and stickers.

Hand Strengthening Artwork

Hand strength artwork
Hand Strengthening Artwork

The Hand Strengthening Artwork activity promotes crossing midline, eye-hand coordination, finger strength, hand arches/separation, and also visual motor skill.

For this messy activity, you will need paper, paper cup, paper plate, and tempera paint.

The end result is a visually satisfying creation and all ages can participate in this fun activity.

Balance on the Web

Balance on the Web
Balance on the Web

The Balance on the Web activity was designed to promote balance and body awareness. It also enhances core strength, eye-hand coordination, motor planning, and visual perception.

In this activity, the child will promote motor planning skills, as he plans his route on the spider web. In addition, he will strengthen his balance skills and his core, while walking on the web lines and squatting down to pick up objects.

Bean Mosaic

Bean Mosaic
Bean Mosaic

The Bean Mosaic activity promotes distal finger control, eye-hand coordination, fine motor control, finger strength, grasp, finger translation, and many other skills.

When we use small pellets such as beans or small buttons we strengthen finger muscles and promote pincer grasp pattern.

Hang Up a Pattern

Hang Up a Pattern
Hang Up a Pattern

The Hang Up a Pattern activity promotes bilateral hand use, eye-hand coordination, grasp, visual perception, pincer control, and also promoting crossing midline.

It is a simple activity that uses clothespins, hanger, some index cards, and stickers.

Through the use of clothespins and a visual pattern, the child promotes visual perception skills, develops pincer grasp, and practices crossing mid-line by matching patterns on a hanger or writing words using clothespins with character stickers attached.

What else can you do?

If you’re looking for additional OT activity ideas in addition to the “Week of Occupational Therapy Activity Ideas” above, you can search OTPlan by the specific skill to promote or based on the materials you have handy.