Sensory processing

My child needs glasses. Now what?

Jan 31, 2017 by Hélène Serfontein Leave a Comment

It is a shock to find out that one’s small child can’t see properly. I somehow thought because they are still small their eyes should be very good. Well, actually I didn’t give it much thought at all. Until it happened.

The trouble is, children don’t know what things should look like. Or, if their vision deteriorated gradually, they forget. So they DO NOT COMPLAIN of bad eyesight. They might blink a lot. (Which, incidentally, also might point to a vitamin A deficiency or uptake problem). They may sit too close to the TV. They may develop a squint. They may become less attentive of their environment. They may stop paying attention in school. Their art work may not be the best – which sometimes it isn’t in any case. They may seem bored or unmotivated. In children depression can look like boredom. And it surely is depressing when one can’t see. They may seem anxious and unsure. They may suddenly fall down a lot or become car sick. And parents may very well overlook all these subtleties. Teachers too.

So well done if you realized your child has a vision problem. That was some great parenting right there! And if you are looking around for more help, even better. This is the list I wish I had. If someone could sit me down in the very beginning and say, “Listen, here’s what you do:…,” we would have had a much easier time. But when everything turns out ok, luckily we tend to forget a lot of those pesky little details. Remember that the whole body is one unit. Vision is a function of every single part of a child. This will hopefully demonstrate that. So here is my two cents’ worth:

STEP 1: Have your child’s eyes tested. Find the best ophthalmologist or optometrist by reputation. It is very very difficult to get a child into their ideal glasses prescription. And they may refuse to wear it, because of the big change it creates. Work with the professionals to find the prescription that your child can tolerate initially. It can be adapted once they get used to it.

STEP 2: While you are waiting for your eye appointment, start looking at frames. The optometrist’s is a good place to go. They should be small enough so the lenses don’t have to be too thick. And very sturdy for playing and rough housing in. Get your kid excited about these glasses – even though you are still struggling with the idea.

STEP 3: Get support. Yes, it helps to see you are not alone. And to ask all those many many questions. Two wonderfully useful Facebook groups are: Little Four Eyes and: Vision Therapy Parents Unite. Vision therapy is an option in some countries.

STEP 4: Have a developmental occupational therapy assessment. If your child could not see properly for however long, they are sure to need a little bit of developmental input. The occupational therapist will look at things like vestibular and proprioception or tactile issues. They will also test for gross and fine motor delays. These skills are the foundation for school skills later on. Visual-motor perception and motor planning is greatly affected by faulty vision.

STEP 5: Young children with vision problems often have retained primitive reflexes. These reflexes create movement patterns in babies before they do conscious, controlled movements. When the higher postural reflexes start taking over as babies mature, the primitive reflexes disappear. They may reappear as a result of physical stress (like lack of vision). Or they may have been retained because of lack of tummy time and movement opportunities as a baby. To check, look at a photo of your smiling child. If they have wide, staring eyes even when smiling, they may have a raging retained Moro reflex. Some paediatric physiotherapists, occupational therapists and behavioural optometrists address these reflexes and help integrate them. It is a long term process that requires dedication and daily effort, but it pays off big time. Retained reflexes interfere with vision development, gross and fine motor skills, hand-eye coordination and general school performance.

STEP 6: Inform your child’s teacher. Getting glasses is a transition. This child might have a hard time adjusting and coping. Kindness and gentle encouragement is needed. Keep the expectations at a minimum for a while and everyone will be happy.

STEP 7: This one should actually be the cornerstone of every step. Lots of love for this brave child. Patience, love, acceptance. Your child is going to be facing hard changes. Lots of challenges. They need you on their team. Loving them, cheering for every little step forward, carrying them sometimes. Your job as a parent is to know when your child needs a break.

STEP 8: Limit screen time. Too much screen time interferes with developmental movement opportunities of body and eyes.

STEP 9: Get moving, get active, get outside. Studies have shown outdoor activity has a positive impact on vision development. Work those core muscles. Head control and core stability has an effect on eye convergence. Very important for children with amblyopia (lazy eye). Ball sports are lovely and fun for improving eye tracking.

STEP 10: Nutrition. Certain foods can boost vision development. Zinc and Vitamin A deficiencies especially impact vision development negatively.

“Sucking on Sour Candies, Pickles or Lemon Pieces. Sour tastes help bring facial muscles and eyes into a more focused (aimed inward) state, called convergence. Sucking helps to bring the facial muscles, including eye muscles, into a convergent posture…After sucking on a sour food or piece of candy, encourage the child to attempt a near-vision task that was difficult for him previously, and see what happens!” – Quote courtesy of the book Eyegames: Easy and fun visual exercises by Lois Hickman and Rebecca E. Hutchins.

STEP 11: Sagging arches in the feet may affect vision development. Arch support is directly linked to eye convergence. The lumbrical muscles in the feet are responsible for arch support. They work in synergy with all the postural muscles. For children older than five with flat feet orthotics can be investigated. The physiotherapist can recommend a good orthotist to custom make these. Lumbrical exercises for feet are easy. It has been suggested that toe walking may improve the arch support in flat feet. Invest in good shoes that keep little feet more optimally aligned.

STEP 12: Reawaken the senses. You know how some people feel like they don’t hear/connect well without their glasses on? Same goes double for children. Not being able to see well does not sharpen the other senses. Rather it dulls them. With muted senses a child’s world becomes small. And they do less of the very activities that would have helped them. Practicing mindfulness on nature walks is a lovely way to help a child with visual neglect to reconnect. This could be a walk around the garden. Smells in particular raise a child’s level of awareness. Probably because the olfactory and limbic system, where emotions are seated, are enmeshed. Vestibular input helps restore proper eye movements, so running, rolling, swinging.

Enjoy this special time of rediscovering sight with your child.

The princess and the pea

Mar 20, 2016 by Hélène Serfontein Leave a Comment

I grew up with a number of sensory quirks, which seemed to run in the extended family. These goings on were duly noted and mostly disregarded. I recognise similar traits in my little daughter. Quite the sensory circus over at our house sometimes.

These sensory traits meant that having my hair combed was screaming agony. It meant waiting outside the house when my brothers were eating stinky fish in the kitchen. It meant bearing the discomfort of scratchy seams of clothing that felt like it had a wooden sticks sewn into the sides. It meant gagging from smells and refusing to go into places because of it.

Some of you will understand. The people who have to smooth down the creases in the fitted sheet in order to sleep know what I’m talking about. The ones who wake up in the dead of night from clocks ticking or blinds rattling in the wind. I get how the princess could not sleep with a pea under the mattresses. Honestly. Who could sleep in those conditions?

Without the proper sensory filters too much input comes through. Or: The body and brain does not know how to tone down sensory input or integrate it properly. This has huge emotional impact. Imagine walking through a minefield of sensory input. Any step can create an explosion of overwhelming sensation. Emotional volatility is bound to ensue. Anxiety is a given. Irrational fears are not uncommon. Food of course, is a big issue. Smelly things? No way. Funny textures? Keep away.

Today these things are classified on the continuum of sensory processing. On the one end are the people who get freaked out by sensory input. Overstimulated and affected. Where everything is too much: Too loud, too smelly, too heavy a pressure, too bright. On the other end are the people craving sensory input. The sensory seekers who need more input than is the norm, to make sense of their environment. On this end of the continuum there are also the people who seem more oblivious to sensory input. Visual neglect and other sensory neglect sometimes go together (where one sense can be therapeutically used to wake up the others). These people are more shut off from their environment, and often become ‘locked in’ emotionally. In the middle of the continuum is the happy medium where sensory input is accurately perceived and properly interpreted. Here the sensory feedback correctly guides motor planning, movement and emotional responses.

Depending on a myriad of things, sensory processing issues can become less intense eventually. Sensory input can become better integrated. Sensory sensitivities and the need for more sensory input can become better modulated. How? What is helpful?

Vestibular input. The vestibular system provides sensory feedback about a child’s head in space. It is vital for postural control. Insecure postural control causes so much anxiety. When the body can’t orient itself properly with changes in position – chaos may ensue.

Core muscle control. A stable core provides a stable background for movement. A strong core ensures grounded, strong, purposeful movements. Read more here.

Proper proprioceptive feedback. This is the body’s sense of position and movement. Movements can be executed with the correct amount of force/effort when you have a good sense of where your joints are. These first three aspects are great confidence builders. When your body responds the way it should, or the way you want it to… just wow.

Primitive reflex inhibition. With a retained Fear Paralysis Reflex, children are overly sensitive to sensory stimuli. The Moro Reflex over-stimulates the sympathetic nervous system, causing continuous fight or flight response. Read more here.

Tactile stimulation helps infants to integrate sensory experiences. It stimulates healthy proprioceptive feedback. Read more here.

Down regulation of emotional states. Story time, calming music, sensory water or sand play, deep breathing, yoga and mindfulness helps to calm and soothe.

Magnesium supplementation. Magnesium deficiency causes hyperirritability. Deficiency can mimic stimming behaviours in children. Stimming is viewed as a protective response to sensory overload, or too much stimuli. Never supplement without consulting your healthcare practitioner.

Rhythmic Movement Therapy (RMT) for integrating the emotional brain (which is so connected with smells) and prefrontal cortex (conscious reasoning). RMT helps inhibit primitive reflexes and helps to establish conscious control over emotional reactions to stimuli, by establishing brain connections.

Massage over the vagus nerve. The vagus nerve is meant to bring balance between the sympathetic and parasympathetic nervous systems. To override anxiety so to speak. This nerve is connected with vision, speech, heart rate, stomach, bowel functioning and more.

Attachment parenting. Having a calm dependable primary carer to help make sense of sensory turmoil. Lots of loving support, hugs and touch. Hold your child’s hand every time they need it. They will decide when they are ready to let go.

Olfactory stimulation. Smells have powerful sensory and emotional connotations. Smells can reawaken the senses in children with sensory neglect. Essential oils are very useful.

Limit screen time. Enough said.

Sand & Glitter would like to thank Caitlin Truman-Baker from ctbdesign for this truly inspired blog post cover image.

WITH THANKS FOR INTERESTING LINKS

What does the Vagus Nerve do?

Massage technique for Vagus Nerve

The power of smell

How smells affect the senses and a host of other cognitive processes

The power of Touch

Jan 6, 2016 by Hélène Serfontein Leave a Comment

Long time ago, babies were born into their mothers’ welcoming arms. The babies could not walk or talk, so the mothers carried them around and responded to their needs as they arose. The babies thrived and gradually grew to increasing physical and emotional independence. They received touch, were rocked by the mothers’ movements and were exposed to sensory stimuli in a safe and nurturing environment, thereby learning to integrate their sensory experiences in a healthy way.

Then the wheel was invented and it started to turn. Faster and faster until mothers were stressed and busy. Babies were increasingly left to their own devices. Babies could make less sense of the loud, bright, scary world without someone to snuggle against. And strollers and baby seats rendered them unable to roll, reach and move. The babies craved their mothers’ touch.

One day, scientists discovered that babies’ brains needed touch to develop optimally. That the babies needed to move to wire their brains properly. That the babies needed to be held and loved, so they could make sense of the sensory chaos of their new world and adjust their emotional responses accordingly. The scientists told the mothers all of this. The mothers cried and picked up their children. They held them close and ran away from the busyness of their lives. They played and became attuned to each others’ needs again. And everyone lived happily ever after. The end? Not hardly.

More true is the story of the modern child. Developmental delay, sensory processing disorder, vestibular disorder, developmental coordination disorder, attachment disorder. And my personal nemesis: Disorder of the natural order, as created by technology.

What if we were all to hold and stroke our children for 10 extra minutes a day? Apparently it would lessen their reflux as babies. An extra 20 minutes? It would seemingly help them score higher on developmental assessments. And improve motor skill learning. Wow. Getting the urge to hug your child yet?

Animal studies have shown that sensory deprivation in youngsters may lead to attentional deficits in later life; however, it was demonstrated that these deficits could be undone to a large degree by tactile stimulation with a paintbrush. Sounds like a fun game: “Let’s see if you can ‘paint’ your little sister blue, without her laughing or squirming.”

Studies have illustrated the existence of only 62 pathways linking 13 brain areas in the somatosensory/motor system, compared to the 187 pathways linking 32 brain areas for vision. This would mean the brain would easily revert to visual input in the absence of touch and would use vision to try and interpret touch. It seems that tactile stimulation improves the brain’s perception of touch, but also expands the area of brain associated with the body part that was touched, creating more skilled and precise movement. And this is why occupational therapists love to brush children. Makes me want to brush the whole family immediately, including the dog.

The power of touch is highly underrated and truly astounding.

INTERESTING RESEARCH

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2865952/

http://cercor.oxfordjournals.org/content/early/2013/08/22/cercor.bht230.full

http://www.theassc.org/files/assc/psyche_vol_16_no_1/7_Gallace_A_SO%20EDITEDpaged30-67.pdf

Retained Primitive Reflexes

Dec 7, 2015 by Hélène Serfontein 2 Comments

What are primitive reflexes?
Movement stimulates brain connections. Neonatal reflexes are present in the womb and the early stages of life and occur in a specific sequence to wire the brain for optimal sensory and motor function. These primitive responses originate in the brain stem and cause automatic, repetitive movements. Babies were designed to do reflex movement patterns until more sophisticated neural connections start to form. These allow babies to have conscious control over their movements. The reflex is triggered by a specific internal or environmental stimulus, and always cause the same response. The knee-jerk reflex in adults is an example of a healthy adult reflex pattern.

The primitive reflexes are systematically integrated and replaced by the higher postural reflexes, starting with head control. A developmental sequence is triggered where postural control, gross motor function, balance and coordination and sensory integration are perfectly orchestrated.

What happens if something goes awry in this harmonious sequence? Where do things go wrong? And how does it affect development? What would interfere with this process of primitive reflex integration?

To begin: The primitive reflexes are integrated once they have served their purpose and before children turn one. If a certain reflex is retained for some reason, it keeps creating uncontrolled reflexive movement patterns, which interfere with more age-appropriate postural control and skilled movements.

Causes of retained primitive reflexes
The birth process is a key factor: Traumatic birth or caesarean section, breech or induced birth may all cause retained reflexes.
Injuries or trauma, lack of tummy time, too little healthy developmental opportunity for movement, chronic ear infections, chronic stress, environmental toxins and neurodevelopmental toxins like heavy metals (mercury) may lead to non-integration of primitive reflexes.
Reflexes that were completely integrated may reappear at any stage of life due to any of the reasons above.

What causes primitive reflexes to integrate?
Movement. Babies do stereotypical movements when starting to reach, grasp, roll or be more upright. These movements, when repeated enough times, create new brain connections to replace the primitive pre-programmed brain stem reflex loops. The new connections override the old. But the primitive connections remain dormant. If something causes harm to the brain control centre at any stage of life, it will revert back to the default primitive reflexive patterns of movement.

It is important for babies to spend time on the floor, and on their tummies. Inhibition of free movements by using strollers, bouncers and baby seats, or time spent in front of the TV may interfere with the natural order.

Retained reflexes in children and adults can be integrated through therapy. Neuroplasticity is the brain’s ability to reorganise and establish different neural connections through intervention. Rhythmic movement training is a therapy method where rhythmic movements are used to establish connections between the three main brain areas: The prefrontal cortex (the control centre), the midbrain or emotional brain and the cerebellum (balance, coordination and muscle tone). It also connects other areas of control like speech and vision. The rhythmic movements are used to inhibit primitive reflexes. Other therapies all include specific sequences of repetitive developmental movements to integrate reflexes. Slight isometric pressure techniques can be combined with inhibition movements to compound the effect.

What effects do retained primitive reflexes have?
The more skilled, higher patterns of learning and development are affected by retained reflexes. The postural reflexes and balance and righting reactions are disturbed. Without these higher brain automatic responses children expend a lot of energy trying to stay upright. Incomplete integration of reflexes may contribute to developmental delay, feeding and eating challenges and learning challenges. Speech and vision development may be influenced. Potty training takes much longer when children have retained reflexes. Emotional self-regulation becomes much more difficult under these conditions, causing anxiety or behavioural issues. When the primitive reflexes are not inhibited, they interfere with normal organisation and functioning of the nervous system in very specific ways. The type of interference depends on which reflex is retained. The sooner a primitive reflex is integrated, the better.

If not inhibited, primitive reflexes can be retained throughout life: A pronounced gag reflex (which is a normal adult reflex), may point to retained reflexes in adults.

Here is a list of some of the neonatal primitive reflexes and their effects:

Fear paralysis reflex (FPR)

The FPR is a withdrawal reflex, established in the second month after conception. The withdrawal reflexes are characterized by rapid withdrawal from stimuli and ‘freezing’ and is a protective response. During a stressful pregnancy, the FPR can cause foetal immobility when triggered, preventing the very movements that would have inhibited the reflex. When the FPR is retained, children and adults have a limited stress tolerance and are overly sensitive to sensory stimuli. They may be extremely sensitive to smells and tastes, as well as vestibular input. The reflex triggers the release of stress hormones. In some children it presents as withdrawal and shyness or seemingly irrational phobias, while others may act out. In adults it can result in panic attacks and social phobias. Children and adults with an active FPR find eye contact stressful, as it may trigger the reflex. The reflex is usually active in autism. The FPR and the Moro reflex go hand in hand. If the FPR is not integrated, both the Moro and Tonic Labyrinthe reflexes stay active.

Moro reflex

This reflex is activated by loud noise or sudden movements, causing baby to throw her arms wide open. It is also referred to as the startle reflex. A baby’s own cry may trigger this reflex. The moro reflex begins to function in utero. If the moro reflex does not integrate within ages 3-6 months, it becomes an uncontrollable overreaction to sudden stimuli, overruling the frontal lobe or higher control centre of the brain. It over-stimulates the sympathetic nervous system, causing continuous fight or flight response. It may cause vision and reading or writing difficulties. When this reflex is integrated through treatment it may cause temporary developmental regression with cranky or demanding behaviour. Both the Moro and FPR cause anxiety and exhaustion.

Rooting reflex

A light stroke to a baby’s cheek or corner of the mouth activates this reflex for feeding. It causes baby to turn her face in that direction, open her mouth and extend her tongue for feeding.
When retained it causes problems with excessive dribbling, speech and articulation, difficulty with chewing and swallowing, gagging and hypersensitivity around the face and lips.

Juvenile sucking reflex

This reflex only starts developing around 32 weeks gestation and becomes fully developed around 36 weeks. Premature babies may have weak feeding ability as a result. Touching the roof of a baby’s mouth stimulates the sucking reflex. Babies push their tongue forward for latching and sucking. When the sucking reflex becomes integrated, the tongue moves more to the back of the mouth for pushing food down the throat.
Problems with this reflex may cause reflux, food texture sensitivities, excessive dribbling, speech and articulation problems.

There is a link between hand and mouth movements in early life (Babkin reflex). If this reflex is not integrated, children tend to stick their tongues out while writing.

Both the rooting and sucking reflexes may be active in picky eaters.

Asymmetrical Tonic Neck Reflex (ATNR)

When a baby turns his head to one side, the arm and leg on that side extend away from the body. Once the reflex is integrated, baby can start to reach and have functional ability around the body midline. To cross the midline with arms or legs is very difficult with retained ATNR. If unintegrated, it creates difficulty with coordinated movement, balance and writing skills. A retained ATNR may interfere with establishing hand dominance. The role in vision development is especially important: The ATNR influences vision tracking, hand-eye coordination and object- and distance perception. Integration is sometimes necessary to improve eye movement for reading (saccades). A very strong retained ATNR may result in scoliosis.

Tonic Labyrinthe Reflex (TLR)

The TLR is important for head control. It involves the vestibular system. It is triggered by forwards and backwards tilting of the head of babies. In infants it helps with development of posture, coordination and the proper head on neck alignment. Head alignment is vital for vision and eye tracking, balance, auditory processing and motor planning.

When unintegrated, children have trouble maintaining good posture in school and paying attention. They fatigue easily. They may have poor spatial awareness, depth perception and difficulty with climbing a rope or hanging from monkey bars.

Neurodevelopment and the presence of retained primitive reflexes are assessed and treated by pediatric occupational and physiotherapists.

WITH THANKS FOR USEFUL LINKS

Comprehensive overview of primitive reflexes

Home tests for primitive reflexes

Yoga poses for primitive reflex inhibition

Mind moves: Moves that mend the mind