• Hannah OT

Why 'Stop touching' is not always easy to follow

Today I will explain why some children just seem to touch everything, whereas others seem to flinch at even the slightest brush past.

The tactile system is the first sense to develop, and develops inside the womb. It is central to our understanding of the world around us as through receptors in the skin throughout the body, it enables us to interpret hugs, the clothes we wear, the surface we are walking on, the food we eat and what we are drinking. Through receptors in the skin our tactile system processes sensations like pressure, texture, vibration, movement, temperature and pain. Due to its close ties to the proprioceptive and vestibular systems our tactile system is closely related to visual discrimination, motor planning, body awareness and emotional security. In addition, it is the tactile sense that informs many daily activities such as how we get dressed, feeling for items in draws/ bags, wash, supports grasp, and protects us from harming ourselves (temperature and pain reception).

Firstly, let me define the difference between light and deep touch. Light touch is very often unpredictable and can be anxiety provoking - think about that unexpected brush past when you were least expecting it and how it made you jump; or how light strokes can be ticklish and unpleasant. Deep/ firm touch is more often than not calming - it is rhythmical, predictable, familiar and longer in duration - a massage, a familiar hug, the feel of your favourite jacket or scarf or the hand of your loved one.

Like when describing seekers of proprioception and vestibular input, often children are a little bit of a mixture - this is especially true with the tactile sense, primarily because of the close ties to the other senses. In addition, just like I mentioned in my vestibular blog, it may not be as simple as your child struggles to modulate (receiving the 'just right' level of input), they may also have low registration. These children may not actively seek tactile input, but may have some similarities with seekers, such as being unaware of being touched by others, and not noticing that they are dirty. Where they differ is that they will probably not have any decisive preferences - not really be aware of the feel of clothing or particularly dislike hair brushing or be too bothered by rough play. These children will, however, still benefit from more tactile input to alert them, support successful movement panning and ensure they have all the information that they need to be successful in daily tasks e.g. being aware of their body, being aware of the tactile feel of fastenings for dressing, or being able to be aware of the feel of food/dirt on their face etc.

Children who are seekers: ,

  • Seem to touch everything

  • Love to be messy

  • Enjoy tight well fitting clothes

  • May be unaware of being touched by others

  • Often have a high pain threshold

  • Enjoy the feel of vibrations

  • Often dislikes hair brushing, washing or drying

  • May mouth objects (in an older child this could be pen, hair or pencil sucking)

  • Often enjoy engaging in rough play

Children who are avoiders:

  • Avoid certain textures or clothing

  • Avoids or dislikes messy play

  • Can becomes distressed by certain clothing such as tight pants, seams in socks, and new textures

  • Dislikes getting face/hands washed

  • Avoids hugs or physical contact

  • Fearful of large crowds

  • Anxious or over excited at light touch

  • Extremely ticklish

  • May refuse to walk bare foot

  • May dislike hair brushing, washing or drying

  • May dislike being barefoot

  • Can be picky eaters

Is messy play important?

Surely if a child doesn't like messy play it is not important, after all children have their preferences. Although potentially your child may just prefer to be clean and that is fine, if they are becoming excessively anxious or indeed are one of the many picky eaters then tackling messy play avoidance through gradual exposure may be necessary and even fun! This is because messy play is directly related to food texture preferences - the messy play and fun with food hierarchy mirror each other in their challenges from dry-wet. It is believed that through fun with food and messy play activities children learn to tolerate different textures and therefore become more experimental with different food types. The steps to eating approach can be found:

The above shows you how to lay out your expectations around supporting your child to expand their food choices, and also asserts the small wins like getting your child to tolerate tomato on their pizza - it has been a long battle, but my daughter will not at least take off the fresh tomatoes on a pizza at a restaurant, rather than freak out and refuse to eat the whole thing!

The below hierarchies demonstrate where to start in terms of challenge:

Beginning a daily fun with food/ messy play is a great addition to your day, particularly during this time of isolation, but there are other things that can really support your seekers and avoiders at this time!

Children who are clearly seekers and or low responders will benefit from tactile breaks (short bursts of tactile activity) throughout the day. Tactile avoiders, particularly those who are anxious or struggling to be in close proximity with their siblings will benefit from more movement breaks, sensory circuits and gradual and controlled exposure to tactile activities.

Another contentious sibling pairing which can be difficult to manage in these times, but through use of the cup exercise (discussed in an earlier post) you may be able to encourage some empathy and understanding between siblings.

Ideas for tactile breaks:

1) Material key ring - cut squares of different materials, some rough and some soft, hole punch them and put them on a key ring. This can also be used throughout the day as part of a sensory diet (hear more about this in a post later today!).

2) Feely bag/ box - with lots of different items in - you can also isolate one thing and ask your child to guess what it is through using touch alone.

3) Messy play breaks throughout the day.

4) Playing games like 'blind mans buff' where you can cover a child's eyes and they have to feel around the room to find someone.

5) Sand play - I have introduced this for supporting letter formation, but all things are possible! I would particularly recommend kinetic sand at this time as it is less messy and easier to contain, but even small amounts of sand can produce just as much fun:

6) Magic rings - cheap and cheerful from Amazon and make a great playtime exercise for the young and older child:

7) Theraputty/ playdough - theraputty is particularly useful as it is really hard and stretchy so supports proprioception seeking behaviour too.

Check in later today for more information on sensory diets and how they can be used to structure your days at home.

Hannah OT:-)

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