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Sensory Integration Problems in Preemies

By Lindsey Biel, co-author of Raising a Sensory Smart Child

Mickey is a 18-month-old who was born at 29 weeks, weighing 2 lbs., 12 oz.. He’s getting early intervention for developmental delays in gross motor and fine motor skills, visual perceptual skills, and speech-language skills. He’s come a long way already. But what concerns his parents most is that Mickey doesn’t like to be cuddled, cries inconsolably whenever they change his diaper, and never, ever seems to sit still. He’s on the go from the minute he wakes up, running on his tippy toes from toy to toy, crashing into the sofa, banging into the wall, and leaving a mess wherever he goes. He’s a whirlwind of activity all day long, and his parents are simply exhausted.

What is going on with Mickey? He shows signs of sensory integration issues.

What is Sensory Integration?

All of us learn about and comprehend the world through our senses. We see things, we hear things, we touch things, we experience gravity, and we use our bodies to move around in it. All of the sensory input from the environment and from inside our bodies works together seamlessly so we know what's going on and what to do.

Sensory integration is something most of us do automatically. Usually, sensory input registers well, gets processed in the central nervous system and then hooks up seamlessly with all of the other senses. This lets us think and behave appropriately in response to what's going on.

Kids with sensory integration (SI) dysfunction experience the world differently. They don't take in and use sensory information the same way. Their central nervous system responds to sensory input differently, so they're not always getting an accurate, reliable picture of their bodies and the environment.

Think of sensory integration like an orchestra. You need the woodwinds section, the strings section, the percussion, the piano to all be in tune, playing in key at the right volume, all perfectly coordinated with each other. With SI dysfunction, the conductor isn't controlling the music well. Different sections in the orchestra are out of tune and out of sync so it doesn't sound right.

For a child with severe sensory issues, walking into the supermarket can feel like walking into a rock and roll concert. Such a child may be able to see and hear the fluorescent lighting flicker, a squeaky shopping cart may sound like thunder, the meat department may smell like a garbage dump, and navigating the aisles and other shoppers may feel like being on a bumper car ride. What seems normal to us can easily overwhelm a child with sensory problems.

Common Signs of Sensory Integration Dysfunction

• Out of proportion reactions: over or undersensitivity to touch, sounds, sights,
movement, tastes, or smells
• Problems with vestibular (movement) and proprioceptive senses (body awareness)
• Bothered by particular clothing fabrics, labels, waistbands, etc.
• Avoids or excessively craves intense movement — slides, swings, bouncing, jumping
• Resists grooming activities such as brushing teeth and washing hair
• Avoids foods most children enjoy
• Gets dizzy easily-or never at all
• Seems clumsy or careless
• Often “tunes out” or “acts up”
• Poor attention and focus
• Uncomfortable in group settings
• Very high or very low pain threshold
• Squints, blinks, or rubs eyes frequently (may have an undiagnosed vision problem)

What causes sensory integration problems?

Sensory problems result from neurological differences, and new research is being done to confirm this. It’s a difference in how the brain and nervous system are wired. Sensory problems are quite often seen in children born prematurely (especially the smallest and the youngest), those adopted from overseas, children who have experienced birth trauma or prolonged hospitalization, and those exposed to heavy metals. Sensory problems are a common symptom of other diagnoses including autism, attention deficit disorders, Down Syndrome, fragile X, anxiety and depression and others. A child may have such a disorder AND SI dysfunction. A child can just have sensory problems and nothing else. It’s estimated that there’s one child with sensory issues in every regular classroom, and somewhere between 50-80% of children have some degree of sensory problems in a classoom of children with autism spectrum disorders.

Why preemies are at increased risk for sensory integration problems?

In the womb, a baby spends her time curled up, cozy and warm in the dark, listening to her mother’s heartbeat and muted sounds from the outside world. Meanwhile, her nervous system is developing at astonishing speed, forming thousands upon thousands of essential nerve cell connections. When a baby is born prematurely, her immature, disorganized nervous system isn’t ready to handle all of the sensory messages bombarding her.

Most NICUs do their best to minimize overstimulation, but the inevitable beeping and buzzing equipment, room lighting, and busy atmosphere can agitate sensitive preemies. The NICU primary care team—including neonatal nurses, occupational and physical therapists—work with parents to facilitate development. Usually, moms and dads are sent home with warnings to look out for signs of sensory issues and developmental delays in their babies.

Each baby is, of course, totally unique, but in general preemies tend to:

• be highly sensitive to noise, light, touch, and movement—even beyond the second birthday
• retain startle reflexes longer than usual
• have muscles that tend to be either stiff or floppy, or a mix of both. (Abnormal muscle tone in preemies often resolves itself by 12-18 months.)
• be very distractible and highly active—or extremely quiet and sleep more than expected
• have increased risk for vision problems
• often develop oral defensiveness because of negative oral experiences with feeding tubes, respirators and suctioning. This can interfere with feeding, as can abnormal muscle tone inside the mouth

Most of sensory-based difficulties resolve as the baby’s nervous system matures, especially given informed parents like Mickey’s. They worked closely with an occupational therapist who helped them to understand and meet his sensory needs while avoiding sensory overload, e.g, the best ways to position him in his crib and for feedings, how to caress him with firm rather than light touch, how intensely to rock him, and so on).

The Good New: There is help for sensory integration problems!

With appropriate interventions and time, most children develop needed central nervous system connections and sensory input starts getting more familiar and more comfortable. Not always, but most of the time, children can overcome their sensory problems, especially with parents who develop their own "sensory smarts."

If you are concerned about whether your child has sensory integration issues, the first step is to get an evaluation from a qualified health care professional. This may be a developmental pediatrician or an occupational therapist who has special training and experience in this area. If your child is under age 3, you can get a multidisciplinary evaluation through your state's Early Intervention program (see www.sensorysmarts.com for a link to your state's EI program). If your child is over age 3, you can request an occupational therapy evaluation from your school district. You also have the option of hiring an OT privately, which may be covered by your health insurance.

Parenting a child with sensory issues takes a lot more creativity and willingness to do things differently. Traditional parenting methods often don’t work. Expecting a child to “get over it” and go ahead and tolerate something intolerable just isn’t going to work.

Lindsey Biel, OTR/L, co-author of Raising A Sensory Smart Child, provided this original article. For more information on sensory integration issues, practical solutions, finding professional help, advocating with schools, and more, pick up a copy of her book, Raising A Sensory Smart Child: The Definitive Handbook for Helping Your Child with Sensory Integration Issues. You can visit her site at www.sensorysmarts.com.

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