Part 1: The Visual, Auditory and Tactile Senses

As a new parent to an 9-month old boy, I busy myself reading child development books and checking online resources, to assure myself that he is meeting his developmental milestones each month. While we are playing and having fun, I am assessing his emerging gross and fine motor skills, listening to his burgeoning language, and marveling at his cognitive gains. As an Occupational Therapist (OT), I have been encouraged to see that the books and online articles often reference the sensory skills that are developing in our babies; skills which continue to develop in children until their early teenage years. In this entry, I will discuss ways to support your child’s visual, auditory and tactile skills from an OT perspective. These are ideas that are easy to implement at home, and which can be enjoyed by children who are typically developing as well as assist those who are experiencing delays.

VISUAL SYSTEM

Definition: Our visual system allows us both to see and to interpret what we see. Developmentally, it is important for recognizing people, shapes, colors, and eventually letters and numbers. Socially, it helps us to read body language and facial expressions. For example, we must use our vision to guide our movement through the world safely and effectively.

Infants: Provide the baby with high contrast black and white images, bright colors (especially red and yellow), simple geometric designs, mirrors, and slow-moving mobiles. One of baby’s favorite things to look at is the human face (especially mom and dad). Books with pictures of faces are often interesting to babies and will stimulate their vision. As your baby grows, you can help their vision mature by presenting slowly moving items so that they have to track the item as it moves throughout their field of vision (first try horizontal movements, then vertical, then circular).

Preschool: Help your child learn shapes, colors, and begin letter and number recognition through activities like puzzles, blocks, and books. Children gain valuable “practice” with their visual system through activities such as rolling a ball, stacking blocks, pointing to pictures in a book, coloring and cutting with scissors.

School age: Higher-level visual skills are developing at this age, including figure-ground, visual discrimination, and visual memory. Hidden picture books (figure-ground), matching worksheets (discrimination), and games like Memory are all great for this age group. In addition to the school tasks of reading and writing, children can work on their eye-hand coordination at this age through mazes, connect-the-dots, and word searches.
For more information about the development of vision, visit the website of the American Optometric Association. It provides great information about what changes occur at each age and stage and development: http://www.aoa.org/x9419.xml

AUDITORY SYSTEM

Definition: We use our auditory system (or sense of hearing) to identify both the quality and location of sounds in our environment. For example, our auditory sense alerts us so that we turn our heads when a car is approaching.

Infants: A baby is born with a very well-developed sense of hearing. Your baby can recognize (and prefers) the sound of parent’s voices. Talking to your baby is one of the best ways to help your baby’s auditory system develop. This can include your own singing, too! As young as one month, babies can remember sounds, such as a repeated lullaby. Parents should also talk to their babies as they go through their day, narrating what you are doing is a great way to introduce language. Babies respond to repetition, and to high frequency sounds (which is why many prefer female voices). As your baby begins to make her own sounds, repeat them back to her as this lays the foundation for the turn-taking of spoken language. Music, of course, is another strong auditory input that babies enjoy. This can be anything from classical music, to nursery rhymes and songs, to any music that mom and dad like! You can help your baby refine her sense of hearing by having her find (localize) a moving sound (slowly move a rattle or noisy toy). As your baby grows, introduce the following auditory/language concepts during play: animal sounds, names of colors, and counting (fingers, toes, blocks, etc.)

Preschool: Continue to explore music through playing simple instruments, learning finger songs, and singing. Playing with puppets and using different voices (high, low, silly, etc.) is a fun activity, and it also engages the child in pretend play. Have your child point to pictures in a book as you read it. Listen for and identify sounds in the environment (“that’s a car horn”, “hear the birds chirping”, etc.). Work on giving one-step, then two-step directions. As always, continue to talk to your child during your daily routines and continue to read books.

School age: At this age, you can help your child continually improve their auditory skills by giving him three- and four-step directions. Addressing the concept of voice volume may be an issue as children enter school, where they are asked to be quiet for long stretches of the day. Instead of expecting children to understand the term “inside voice”, a visual aid may be helpful. You can make a simple chart with the following information: 0 = silent, 1 = whisper, 2 = talking, 3 = yelling. Act out each volume with your child. Then, explain the rules of your home regarding when it’s OK to use each (i.e., yelling may be OK during play, or during an emergency; a whisper should be used at nighttime, etc.) One final piece of OT advice regarding school-age children and auditory input relates to that dreaded word…homework. My advice is to know how your child responds to noises and be aware how this impacts his/her focus during homework. Some children will require a quiet work space, away from distractions such as radio, TV, siblings, phone calls, or even a parent cooking dinner. However, other children thrive on “background noise” to help them. These kids may do well working at the kitchen table, or wearing headphones with music playing as they work.

To learn more about how your child’s hearing develops from in utero throughout childhood; visit the home of the American Speech-Language and Hearing Association: http://www.asha.org/public/

TACTILE SYSTEM

Definition: This is our sense of touch, which plays an important role in a child’s motor and social development. The tactile system provides information about the shape, size, and texture of objects. This information helps us to understand our surroundings, manipulate objects, and use tools proficiently. For example, you are using your tactile system when you reach into your pocket and find a quarter among several coins.

Infants: Touch helps promote parent-child attachment by giving your baby a sense of safety, security and love. Developing awareness of the nature and quality of a variety of tactile input also gives infant valuable information about the world around them, thus aiding their cognitive and fine/gross motor skills. Offer infants a variety of safe textures to explore (plastic or wooden toys, stuffed animals, soft blankets, “crinkly” toys, feely books, tactile mats, and tactile balls). Give her an infant massage (with or without lotion). Lightly rub her feet and clap her hands together. Expose her to different textures and sensations, such as a vibrating toy, a soft cloth, a feather, a scratchy piece of sandpaper or bumpy ball. Be sure to tell her what the textures are as you show them to her. Allow for some “naked time” every day, so that your child can feel textures on her arms, legs, back and belly. (If you are daring, you can go without a diaper for a while!) Also, be sure to have some supervised “tummy time” every day, so that your baby does not become too sensitive on her stomach (This position is necessary in order to prepare for crawling and develop upper body stability and strength).

Preschool: One activity preschoolers often enjoy is a sensory table (or at home, you can make a “sensory bin”). Fill a large plastic bin with a mixture of dried rice and beans, then you can hide small toys or “treasures”, puzzle pieces, or simply cups and spoons for empty-fill. Other fun suggestions include: modeling clay, Play-Doh, and finger paints. Don’t be afraid to let them get messy! They are working on developing their tactile awareness, as well as the small hand muscles needed for later activities such as handwriting. Finally, taking a nature walk to pick up and explore various outdoor items (leaves, rocks, petals, dirt, etc.) is a great way to enjoy a nice day, while promoting this important sense.

School age: The sense of touch is highly developed in this age. A few ways to challenge your older child to use and perfect this sense are: draw letters on his back with your finger and have him guess, fill a cloth bag with common objects and have him identify things (one at a time) without looking in the bag. Activities such as arts and crafts, stringing beads, and lacing cards can help children continually improved their tactile skills.

The neurological process that interprets sensations from the body and its environment is called Sensory Integration. The brain’s ability to process sensory information makes it possible to use the body effectively within any given environment.

The quick screening checklist below will help you assess your child’s sensory development. If you answer “yes” to one or more of these questions, your child may be experiencing difficulties with sensory integration:
• Was your child unusually fussy, difficult to console, or easily startled as an infant?
• Is your child over-sensitive to stimulation? Does he/she over-react to touch, taste, sounds, or odors?
• Does your child strongly dislike baths, haircuts, or nail cutting (screaming, crying, “melting down”)?
• Does your child use too much force when handling objects, coloring, writing, or interacting with siblings or pets?
• Does your child seem to have weak muscles? Does she tire easily? Does she prefer to lean on people or slump in a chair?
• Was your baby slow to roll over, creep, sit, stand, or walk, or to achieve other motor milestones?
• Is your child clumsy? (Does she fall frequently, bump into furniture or people, and have trouble judging position of body in relation to surrounding space).
• Does your child have difficulty following instructions or sequencing the steps for an activity?
• Does your child avoid playground activities, physical education class, and/or sports?
• Does he/she not enjoy age-appropriate motor activities such as jumping, swinging, climbing, drawing, cutting, assembling puzzles, or writing?

For further information on Sensory Integration and for children diagnosed (or suspected) of a Sensory Processing Disorder:

http://www.sensory-processing-disorder.com/index.html
http://www.spdfoundation.net/index.html
http://www.otawatertown.com/

Check out Kids Health website for further information on the development of senses, as well as other great information: http://kidshealth.org/parent/growth/index.html#cat166

If your child is experiencing difficulty with any of these areas of development, please contact your pediatrician and/or an Occupational Therapist to assess if there is an underlying problem. Children develop at their own pace, with a wide range of normal regarding skill acquisition. If he/she has difficulty in several areas of sensory development, it may indicate a Sensory Integration Dysfunction.

Stay tuned for Part Two of this discussion, which will address the ‘hidden’ senses that are developing in your child.

Lynn-Marie Herlihy is an Occupational Therapist in private practice in Park Slope, Brooklyn. She has over 12 years experience treating children from birth to school-age, with a variety of sensory and motor deficits, developmental delays, and learning issues. You can also visit her website at www.BrooklynOT.com.

Infant and toddler nutrition is a complicated subject and complexity leads to communication breakdowns. One common miscommunication occurs between parents and pediatricians. The pediatrician gives your child clean bill of health. Great! Yet, your child never eats vegetables and prefers white bread to whole grain or just eats 4 or 5 foods. That cherished goal of a perfect diet is dashed not only by the child but, in addition, the physician is not that concerned. You may be mystified, frustrated or even angry, but the physician sees that the child is eating enough based on the growth chart, even though your child may be technically underweight. That physician judges that the child’s height and weight are adequate, the skin, hair and lips look fine, the child is energetic. In clinical short hand, the doctor looks at appearance, height and iron. If your child is consistently getting taller, despite difficulties, enough protein, carbohydrates and fats are entering your child. An iron sufficient child is getting enough iron, a marker nutrient, and the proteins and vitamins that go into hemoglobin production and hence enough of everything.

The focus on carbohydrates, fats and proteins is macronutrient nutrition, the most level of nutrition because macronutrients represent basic needs and calories. From the point of view of macronutrient nutrition, the vitamins, minerals and other important micronutrients, such as antioxidants, fiber and essential fatty acids, take care of themselves because they are in common foods. Macronutrients are measured in grams. When parents focus on nutrition, they tend to worry about macronutrients, eating enough, and micronutrients, eating well. Micronutrients are measured in milli- and micrograms. A milligram is one thousandth the size of a green Monopoly house. Other nutrients such as Vitamins A and D are measured in International Units, a measure of potency but still a small amount.

Parents naturally want to provide a complete diet. The combination of facts and feelings is almost too powerful to resist, not to mention, the power that comes from being older and bigger. The parent’s desire, however, may be different from the child’s once the food is on the plate.

Different desires create the second communication breakdown. The previously fine mealtimes disappear when the parent’s desire to nurture meets the child’s desire for independence. While parents worry about micro and macro nutrients, your toddler is looking for you to acknowledge a different need that could be called developmental or life cycle nutrition. In developmental nutrition, food satisfies hunger and the desire to develop mastery. The differing goals between parent and child are behind most feeding problems. The natural parenting desire to provide macro and micronutrients gets separated from the child’s desire to self feed. The breakdown is not unlike your nutrition disconnect with your pediatrician. Different ideas of nutrition can collide. Just ask Dean Ornish and Dr. Atkins.

The infant’s desire to feed his or herself kicks in at around 6 months. That desire to develop can manifest in refusing baby food or by pushing the spoon away. Your exploring child has figured out that you are not eating pureed carrots but something else, something far more interesting and you are feeding yourself. Your baby who cannot walk or crawl is beginning to separate and the drive for independence often occurs first at mealtime. Standard developmental milestone guides say that children can use a cup at around 6 months, finger feed around 7 or 8 months and use a spoon sometime after that. That’s great if your child follows along. Educated parents look to that kind of guide as a ruler, but your child is the best guide. Guides do not take into account that some children quickly copy older children or favorite adults sooner than anticipated, especially if your relationship is great. Even when a developmental delay clouds the picture, children who refuse to be fed by others are exhibiting standard behaviors known to people who help parents who are just struggling too much at mealtimes. If your child is giving you a hard time, your child probably thinks you are giving him or her a hard time.

When mealtimes collapse into struggles, arents may feel alone, rejected or forced to engage in dramatic actions when their child does not eat. Such feelings of parents are universal, as are the problems. The World Health Organization (WHO) has taken up the task of helping parents feed their children because feeding struggles are worldwide. Visit the WHO website http://www.who.int/childgrowth/training/en/ to find the latest recommended practices. For WHO, after 6 months the best guide on feeding your child is your child. Just pay attention to the trinity of feeding practices: the cup, finger foods and the spoon. Your child will let you know how they want to eat, fingers, spoons or even let y ou feed them if there is no fights and lots of smiles. If your cultural preference is for eating by hand feeding or chopsticks, your child has already figured that out, too. Once you begin to experience refusals and too many games at the table it is time to help your child develop new skills. Then you will have smiles. If mealtimes are not pleasant for you, they are certainly not engaging for your child. If you cannot make mealtimes more productive, speak to a professional who knows about feeding behavior and nutrition.

Richard is a Registered Dietitian offering nutritional services for children between 6 months and 5 years of age. His interests are feeding problems in typical and atypically developing children experiencing pickiness, refusals, failure to thrive or other weight gain concerns. His work is based using developmental, play and family strategies to address eating problems in families with young children and children with developmental delays. He is currently researching a method to help parents wean their children off the bottle. He can be reached at: richard@brooklynlearning.com and by phone at 917-232-5373. www.brooklynlearning.com