Though clinical observations as to sensory processing disorders can be made formally and informally in early intervention, formal observations of these abilities in babies include the administration of standardized and non-standardized tests such as the Infant/Toddler Sensory Profile⁶ and the Test of Sensory Functions in Infants.⁷  

Since babies with sensory processing difficulties tend to also have delays in other areas of development, it would be beneficial to administer a comprehensive test. Two of those tests could be the Developmental Assessment of Young Children (DAYC)⁸ and The Hawaii Early Learning Profile (HELP) Strands.⁹

While observing the baby informally, look at how the baby responds to people and things within his environment. Does the baby get easily over-whelmed by visual, auditory or tactile input as he interacts with other people or things? Does the baby have a desire to explore his surroundings or to manipulate toys? Does the baby respond well to the parent's interaction style and volume of voice without being over-stimulated or under-stimulated? Can the baby separate from his parents? How does the baby respond to strangers and familiar people?

Plans of Care
There is no "cookie cutter" answer for sensory intervention. Even if similar answers on questions asked during the interview and scores to test items "matched" for two different babies, it doesn't mean that their plans of care will be identical. They may differ in terms of parents' priorities, family dynamics, cultural backgrounds, daily schedules and available resources.

Also, under the Individuals with Disabilities Education Act (IDEA), parents make the decisions about what goals they want to work on in early intervention. The program is family centered. So a need identified by the clinician may not be a concern to the parents; if this is due to their not understanding the importance of how addressing the problem would improve their child's overall development and functional skills, then re-explaining it to the parents in different terms may be helpful.

Parents and caregivers need to thoroughly understand how the baby responds to various sensations and how they can help their baby throughout the day. That is why it is best to provide intervention in naturally occurring contexts.¹¹ Suggested strategies should not only be imbedded within daily routines but should also be kept simple. This might keep the parents from feeling over-whelmed and increase the chances of carryover.

Strategies might include providing resources on normal development and baby care issues. This would include nutrition needs and feeding skills, reasons for a baby crying, developmental milestones, and how to hold or swaddle the baby.  

Educate the parents on the seven basic senses. Explain sensory processing and the common patterns: sensory sensitivity, sensory avoiding, low registration, and sensory seeking. When parents understand their own and their children's sensory processing patterns, success is seen in participation in life routines.⁴   Teach the parent to read the signals a baby gives off when becoming over-stimulated, hungry, sleepy, or is ready to play. Also, discuss sleep/wake states and self-regulation.

Provide strategies on how to calm a baby with input to the seven basic sensory systems. Since research shows that vestibular-proprioceptive stimulation provided to the baby by the mother can either reduce or stop the infant's crying,¹² this is a good place to start. Sensory strategies may also include adapting the environment or the interaction style of the parent and caregivers.

Provide the parents with ideas from each of the sensory systems on how to "perk up" a baby if he is under-responsive to sensory input or tends to fall asleep while feeding.

Analyze the baby's needs during daily routines. If the baby becomes over-stimulated while getting dressed, provide calming strategies such as playing soothing music in the background, offering a pacifier, or choosing clothing of soft fabrics. If the baby tends to be under-stimulated while eating, provide alerting tips such as offering textured or tart foods, singing and talking at mealtime, and letting the baby "play" with his food.

Provide ideas to promote sensory development during play such as encouraging the baby to put his fingers and toes in his mouth, lying in tummy time, and offering multi-sensory toys such as activity mats, fabric books, and swings.

Parents may want to learn how to massage their babies prior to bedtime, after a diaper change, or during play.

Demonstrate the various techniques you suggest to the parents. Then, watch them and give feedback as necessary. Some techniques may need to be re-demonstrated and discussed at each session.

It is important that once intervention begins, the parent or caregiver be present and actively a part of each therapy session. This ensures that the suggested strategies are thoroughly understood and carried out in the baby's natural environment. Sometimes, if the baby "acts up" around the parents or caregivers, it can be tempting for them to go sit in the lobby when at a therapy clinic or leave to another room when services take place in their home. Eventually, the child will "act up" or cry less, especially if the parents are not seen as rescuers from the therapist and strategies are being carried out when the therapist is gone.

To read the full story from print click here.

References available at www.advanceweb.com/ot or upon request.