One of the easiest and most beneficial ways to provide a dose of organizing and regulating sensory input "prone on elbows", also known as tummy time!  This is a developmental position first encouraged for infants and should be encouraged throughout life...even as adults.  Let me explain why....

First of all "prone on elbows" is when one is on their belly on a flat and firm surface like the floor, and propped up on the elbows (pictured above), supporting the upper body and neck/head with the use of the shoulder girdle and back muscles (not resting the chin on the hands or the floor).  When in this position the neck is in extension which activates the brain stem, and this is very regulating for the nervous system.  It also promotes prone extension which is one of the two most important developmental patterns for sensory integration.  Another great benefit is this facilitates shoulder girdle strength and stability which is essential for fine motor and visual motor development.  And one other therapeutic benefit is ocular motor development.  So you simply can't go wrong with tummy time! You want to encourage it often throughout the day and for any length of time...some children can only stay in true prone on elbows for a minute or two...then take a little break resting the head and shoulders on the floor, and prop back up again.

Here are some great activity suggestions for incorporating tummy time into the day for your child and for yourself!  I would suggest doing this with your child, as it really encourages and promotes more participation, and as I mentioned earlier...it is great for all of our nervous systems!

• Play games or do puzzles
  
• Coloring, drawing, or reading a book
  
• Doing homework
  
• Allowing students in the classroom to be prone on elbows to help with attention to a lesson.
  
• Have the entire group of children do this at circle time at school!
• And even though I do not promote screen time...at least make the most of it and have your  child watch TV or play video games prone on elbows.
  
• Swinging on a platform swing or in a hammock, or draped over a BOSU ball.

Pillow caves and squish boxes...these are two ideas I came up with using household items since over the years, recommending expensive items from the therapy catalogs just wasn't feasible for most families.  And me myself being a deep rooted "always want to get a good deal and clearance shopper", it was very fulfilling to me to come up with an idea that worked and was inexpensive!  I did name the "pillow cave", but the squish box was already named in the therapy catalogs.  You indeed can buy a fancy and cute squish box if you feel like it, they are out there. :-)  Alright...back to business....

A sensory retreat, which I recommend many times in "Understanding Your Child's Sensory Signals" and in "Your Essential Guide to Understanding Sensory Processing Disorder", is a crucial component of a sensory home program and as a sensory tool for our sensory kiddos.  
Here are some sensory benefits of the pillow cave and/or the squish box....

• Assists in self-regulation and helping a child in "fight or flight" or recovering from a meltdown.
• A great place for much needed proprioception and full body deep pressure.
• A safe place to be removed from overwhelming sensory stimuli such as sound, light, touch, and movement.
• Can be used for helping with sleep.
• The pillow cave can also be used as a great landing pad for jumps from a mini-trampoline, BOSU ball, or other fun surfaces.
• The squish box is also very portable and can be used at school as a sensory retreat or also at circle time!
• *More information on the importance of a sensory retreat can be found here on my blog listed under "Fight or Flight" or "Meltdowns".

                                                 HOW TO MAKE A PILLOW CAVE

MATERIALS NEEDED:
1. A twin size duvet cover (not any bigger) or two twin sheets sewn together leaving one of the short ends open.
2.  Lots of throw pillows, blankets, stuffed animals, etc
 
The key to making the pillow cave is to be sure it is STUFFED, you then simply fluff it up in the corner of a room and your sensory kiddo can climb in it, on top of it and get cozy in it like a nest, they can go under it for some deep pressure and weight, or it can be used as a landing pad!  It is also fun to add some sensory tools inside (for when it is not being jumped on) such as a flashlight, oral sensory tools, a vibrating pillow or toy, fidget toys, etc.  (Or a dog) hehe

                                                    HOW TO MAKE A SQUISH BOX
MATERIALS NEEDED:
1. A plastic tote or laundry basket
2. Pillows and blankets

The key to the squish box is the "squish" factor.  But you also want it cozy and comfortable.  You want your child to squish into the box with their body in full flexion (body tucked in a ball) for the maximum benefit. Full body flexion is very calming and regulating for the nervous system.  You can also add a weighted blanket or lap pad as well.

 The winter months can often be very difficult for sensory kiddos due to the increased amount of time spent indoors, and decreased amount of time outdoors.  Typically this is due to the shift of sensory input from an increase of visual and auditory input and a decrease of the essential and crucial types of sensory information….vestibular, proprioceptive, and tactile input.    Winter time often goes hand in hand with more sensory meltdowns, more sensory dysregulation, and more overall stress in the home.  There are many factors that come along with winter which contribute to this winter, sensory slippery slope....

• More time spent indoors, which usually means less vestibular, proprioceptive, and tactile input
• Less time outdoors where all of the sensory power sensations can be found.
• Less time spent out in the sunshine
• Shorter days with less daylight

Although it does take some work and effort, it is possible to get through the winter months without a sensory decline! Probably the very biggest key and factor is to limit screen time and replace it with sensory activities!  This includes, TV, computer, video games, and handheld devices...Your child should AT LEAST be getting the same amount or more of powerful sensory enriched activities, as they do screen time. Here are some ideas....

Shoveling, Digging a Snow Cave, & Sledding!

Excellent proprioception, great for all ages! Even 5 minutes of these activities can have an hour of benefit for the brain!  It gets your kiddo outside and will promote self-regulation and is calming for the nervous system.  

An Indoor Swing and additional Vestibular Input
This is crucial for sensory kiddos all year round...it will just likely get much more use in the winter.    Install from a single point suspension for various planes of movement. There are also tension rods that can be used in door frames if you are unable to drill into the ceiling.  If your child is small, swinging in a blanket with an adult holding the blanket at each end.  Vestibular input is essential.  Other options if a swing is not feasible: hippity hop ball, BOSU ball, therapy ball, indoor trampoline, scooter board, etc.  

I think it is quite possible the word "meltdown" is the most frequently used term and struggle for parents of sensory kiddos.  A meltdown can be referred to a child who is kicking and screaming and biting or spitting...or a child who simply can't stop crying....or a child reacting to a situation in a disruptive and aggressive manner...or simply losing all emotional control. 

As a sensory OT I think the biggest missing puzzle piece is in understanding WHY a child has a meltdown.  Most parents, teachers, caregivers, etc simply have not been taught why the sensory child has a meltdown and how to help them. Unfortunately meltdowns often fall into the behavior category in our society. Yet in my professional opinion, there is a very very small percentage of meltdowns which warrant being considered behavioral, especially with our sensory kiddos!  IMPORTANT SENSORY CONCEPT:  Children inherently want to please, they do not want to misbehave or get in trouble.  I think this concept is SO very important to remember when talking about meltdowns. The meltdown is often misunderstood for attention seeking or spoiled behavior or simply the child trying to get what they want out of the situation.  This may be true in a few cases, but with our sensory kiddos it is often much more deep rooted than that.  Here are some of the most common reasons a sensory child may have a meltdown....

• Sensory overload
  
• Dysregulation and the inability to maintain self-regulation and a ready  state
  
• "Fight or flight" response to sensory overload yet mistaken for a meltdown
  
• The inability to cope with a new or challenging situation
• Inability to communicate wants and needs
• Difficulty with transitions
  
• Lack of sleep or over tired
• Lack of proper nutrition or too much of the wrong food
• Change in routine

                                     HOW TO HELP!
I truly believe most meltdowns trigger a "fight or flight" reaction for the child's brain, especially with sensory kiddos. Therefore the meltdown lasts longer and is difficult to manage.  Here are my three recommendations...
#1  Do not treat the meltdown as behavior.
#2  Try to determine if there is a sensory trigger or lack of essential sensory input  (too much screen time).
#3  Follow the steps below in regards to "fight or flight".

                                “Fight or Flight” Response
            Understanding and Addressing the Sympathetic Nervous System

Research shows that children with sensory processing disorder and sensory processing differences have a greater tendency to switch from the PNS (parasympathetic nervous system) to the SNS (sympathetic nervous system) based on an adverse stimuli or an environment with new or a great amount of sensory stimuli. 

Parasympathetic nervous system: This is where our nervous remains most of the time and when we are at “ready state” for learning, social interaction, and alert and awake. 

Sympathetic nervous system: The state of “fight or flight”.  This part of our nervous system is intended for safety and the ability to react to a perceived dangerous situation.

Why do we See our Sensory Kids in “Fight or Flight”?

Children with sensory defensiveness or sensory over-responsivity perceive their environment as dangerous and painful based on how they process sensory information.  Therefore their nervous system switches to the SNS and displays a “fight or flight” response.  A child who has a difficult time processing and modulating sensory input can also have the tendency to switch to “fight or flight”.  And almost all sensory kiddos have a difficult time with self-regulation, in turn, a greater risk for “fight or flight” episodes.

What Does “Fight or Flight” Look Like?
There are many different manifestations of “fight or flight” but some common responses may be:

• Hitting, kicking, biting, spitting, pushing (especially while standing in line or in new challenging/overwhelming situations or activities)
• Trying to run or escape from the situation
• Trying to hide under something like a desk, table, or chair 
• Burying themselves in a teacher’s arms, avoiding all eye contact, or trying to curl up in a ball on the floor or at their desk
  
• Covering ears or eyes
• Crying or screaming
• Hiding in the closet, under couch cushions, or under covers in bed
• Shutting down completely and not speaking or responding
  
• Even falling asleep unexpectedly

What Do You Do?  How to Respond...

#1   Do NOT treat it from a behavioral stand point; your efforts will be fruitless. The brain is not responding in a cortical manor (thinking, judgment, and reasoning), it has shifted to brainstem level during a “fight or flight” episode.  I think this is the most important concept to grasp.
#2  Remove the child from the adverse stimuli and decrease sensory stimuli to a minimum.

#3  Provide a “sensory retreat” for the child, such as a play tent loaded with pillows with other calming sensory tools (soft music, vibration, chewy/oral sensory tool, weighted blanket, noise cancelling headphones, calming fidget toy)

#4  Allow for the child to come out of the sensory retreat on their own terms. Their nervous system will know when it is ready.

#5 Do not try to talk the child through it, calm, bargain, or rationalize. This in itself can be overwhelming and the child’s brain is not ready for that type of interaction yet.

As we all look forward to the excitement of Christmas morning and time spent with family and friends,  as well as the overall holiday atmosphere in the home...please take a moment to step back and think about how you can help the sensory kiddos in your life.  It may not be your own child, but a niece/nephew, a grandchild, or a friend's busy little toddler.  The multi-sensory challenges and social expectations which go hand in hand with the holidays can be completely overwhelming for a sensory kiddo.  Episodes of "fight or flight" or sensory overload are bound to happen UNLESS you are sensory prepared!  

Here are some helpful sensory tips....

• Create a sensory retreat, even if you are travelling or will be outside of the home at a friend or relative's house, create a safe place for the child to retreat to if sensory overload occurs.  A cozy, dark area with sensory tools is ideal.
  
• Provide deep pressure touch to arms and legs as needed throughout the day, and lots of bear hugs! 
  
• Keep in mind that 10-15 minutes at the holiday dinner table will likely be the maximum amount of time the child can handle.  A kid friendly side table with a ball chair as the seat would be best.
  
• Keep in mind that asking the child to try new foods during an already challenging sensory experience may be out of the question.  The child's nervous system is already stressed.
•  Prior to the group situation, prepare the child’s nervous system with a 15-minute movement and heavy/hard work activity.
• Provide sensory tools such as earplugs, headphones, compression clothing, a fidget toy, weighted blanket, vibrating pillow, or an oral sensory tool...depending on the child's sensory needs. And be sure to bring these along wherever you may go!
•  Do not push the child to the limit. If he/she is showing signs of over-stimulation, allow the child to take a break in a less stimulating room, preferably a sensory retreat.
•  Do not insist on eye contact or verbal communication.  Let it happen naturally.  This will be especially challenging in a group situation, with people the child perhaps does not see on a regular basis.

Sleep issues are a HUGE topic of frustration and concern for parents of sensory kiddos.  From the child requiring extensive help in falling asleep, to staying asleep, to the 2am "play time", and the morning grumpy pants.   

Sleep effects the whole darn family...possibly the sibling who shares a room, or even in a separate room and of course at least one parent.  We ALL need sleep, so when our little precious sensory kiddo isn't sleeping, it affects the whole family.  And the biggest problem is the snowball effect.  When any of us do not get enough sleep it impacts mood, behavior, and self-regulation overall.  And then as always, the results are magnified for a sensory kiddo. And for the parent of the child, this state of dysregulation (irritability, mood swings, impatience, etc)  from lack of sleep impacts that child's state of regulation as well.  It's a double whammy.

As a therapist, I have always wanted to find that cure all for families and the sure ticket to sleep...but unfortunately I do not think that single ticket is out there.  BUT I DO think there can be a combination of tickets which can work...but here's the kicker...those tickets may change on a daily basis.  I am going to list some possible solutions as well as factors which can impact the sleep/wake cycle.  So it is up to you as a parent to consider each factor as well as some trial and error when it comes to what works and what doesn't seem to work.  PLEASE try not to get discouraged if something doesn't work or if an idea might work one night and not the next.  I personally know the struggles and I also feel I do understand the frustration and extreme challenge this can create from 20 years of helping families cope and find solutions to SLEEP.

The ENTIRE day can impact the ability to sleep at night.
Sensory kiddos need an enriched sensory diet every single day...including vestibular, proprioception, and tactile activities.  This is what helps their little nervous systems maintain ready state and self-regulation.  If the child has had more than 1-2 hours of screen time that day (this includes computer, TV, video games, hand held devices) then they were deprived of the important sensory nutrition in which their brain needed.  Now on the other hand, if the child was involved in some type of over-stimulating sensory activity that day this can also impact the ability to sleep (like a big social event or new challenging multi-sensory experience).  It is so important to find that balance!

If a child gets to the point of exhaustion or  "overly tired" it can back fire on the nervous system.
Once again, this requires finding a balance and as the parent knowing when enough is enough for your child. Being aware of the fact that your child can not handle as much social stimulation or partying as perhaps another child.  And not just dragging the child along to social events or play dates which may really be more for the parent.  Sorry...had to say it. 

Nutrition is a HUGE factor!
Proper nutrition throughout the day can significantly impact the ability to sleep at night.  Of course I know this one can be difficult to achieve, especially for our picky sensory kiddos.  But being creative and also aware of everything the child is consuming in a day is possible.  The biggest factors to keep in mind. 1. plenty of protein  2. limit the carbs and sugars  3.  limit the preservatives, additives, and dyes  3. plenty of fruits and vegetables 4. Of course no caffeine for a child and keeping in mind that cocoa and other forms of chocolate have enough caffeine to impact the ability to fall asleep.

Medicine, reflux, and possible sleep apnea need to be considered.
If at all possible, refrain from any medications to help with sleep.  I know this is often recommended by doctors, but with my experience this is not the solution, instead it often leads to side effects and new issues. For a child with SPD, medications further disrupt the processing in the brain.  

Reflux is an issue which can impact the ability to sleep.  This should be discussed and ruled out or addressed with your child's doctor.

If the child snores or seems to make a lot of noise at night, a sleep study should be considered.  I think it is always important to discuss the sleep difficulties with the child's doctor...and bring up or request a sleep study to rule out or to address sleep apnea. 

Before bedtime sensory tools and strategies:
(Keep in mind that this will likely be a trial and error process, unless you strike gold and the first sensory strategy you try is the ticket. )  You can try a combination of these ideas, they are in no way going to over-stimulate your child.  It just may take more than one idea or an alternate idea the next day.

Deep pressure touch to arms and legs, also called hand hugs or squeezes.  

A weighted blanket or heavy quilt folded up to increase weight and pressure. Tight fitting pajamas or compression clothing at bedtime are great too. 

Be sure the room is free of distractions, light, or clutter.  White noise or soft instrumental music is also a great tool.  Sometimes a humidifier works as well.  If possible, have the child sleep in their own space...even creating a nice cozy cave in a big walk in closet or possibly in a play tent filled with pillows and blankets is a great place for sleep.  Canopy beds or the bottom bunk of a bunk bed can be helpful as well, sensory kids like that defined and cozy space factor.

The crucial link of proprioception in regards to attention to task, focus, mood, and behavior is quite often completely overlooked in the classroom.  ALL children need frequent doses of proprioception throughout the day to maintain a ready state for learning and to self-regulate…and children with sensory differences need it that much more.  It is extremely difficult for the nervous system to be over stimulated by proprioception, unlike some of the other senses, so it is safe and beneficial to incorporate it as often as possible throughout the school day.  Proprioception is achieved through “heavy/hard work” to the joints and muscles of the body. Engaging the muscles in a resistive activity is considered heavy/hard work.  This can be achieved through a variety of activities included stretching, marching, wheelbarrow walking, crab walking, hanging from a bar, carrying heavy items, pulling or pushing heavy items, etc.  Using various sensory tools can also provide additional proprioception via deep pressure to the muscles and joints...such as a weighted lap pad, Bear Hug compression vest, Underarmour compression clothing, a squish box, or a pillow cave. A couple of my specialty favorites and kiddo recommended are the Gel E Seat and the Yuk-E heavy medicine balls pictured below.