One of my students started our virtual Occupational Therapy (OT) session in tears. He became overwhelmed in his science class that took place right before our session. We started with 2 minutes of silence with a timer which helped to de-escalate his emotions. He then enjoyed a long hug with his mom and said “I have an idea!” He suggested that he get what we called pillow “squishes”.
After 10 minutes squishes and a few minutes under a weighted blanket he was drawing and then writing. At the end of the session, he interrupted me before I closed our meeting. His voice was still shaky from the crying earlier. He said, “Thank you for helping me.”
What was great about what this student did was that he knew what would help his body feel better. This is called self-regulation. Self-regulation is the ability to manage your internal state (physical and emotional) to match the demands of your environment.
Experiences like the one I had with my student illustrate the importance of the sense of touch and how it is connected to self-regulation. Touch is within the umbrella term of the somatosensory system. This system tells us about pain, temperature, pressure, vibration, and body position (4).
We do lots of things to self-regulate using the system of touch and you may not consciously be aware of those things, such as:
– Playing with your hair
– Rubbing a piece of clothing
– Stretching your body
– Wringing your hands
– Chewing on a pencil or your lip
Of this system, the sense of proprioception allows us to feel muscle stretch and body position. This happens because there are nerve endings in the layers of our skin and at ends of our muscles and tendons that detect stretch and pressure. These nerves communicate to the network of nerves and eventually to our brain.
To access the sense of proprioception and improve self-regulation consider starting with deep pressure touch (DPT). This type of touch is applied with increased pressure. Examples include gentle squeezes, compressions and hugs.
Deep pressure touch is a commonly used sensory tool for OTs. This touch releases serotonin, dopamine and oxytocin [1] [3]. Deep pressure touch is also one of the most tolerable ways to access a child’s nervous system (more on that in our next blogs).
Deep pressure touch releases oxytocin, a hormone that decreases cortisol (stress hormone) levels. Other benefits include a more regular pulse and increased skin temperature [1].
Serotonin and dopamine have short and long-term effects on mood regulation, movement and impulse control. These two, in addition to oxytocin, are released in techniques like massage that involve “low to moderate pressure” touch. [2] These hormones help our children’s nervous systems feel better overall.
Although this is often the aim of deep pressure touch, it can be noted that the result of deep pressure touch is not always a calm state, though it may assist with difficult behaviors.
A systematic review looked at 14 studies of various sensory interventions, including tactile (touch), vestibular (movement) and proprioceptive-based techniques. They found that “Tactile-based interventions such as massage therapy were the most promising intervention in reducing behavioral problems.” [6]
From my clinical experience, using touch and pressure increases body awareness in space and makes it easier for children to self-regulate.
For someone starting off with deep pressure touch techniques at home, it is good to know that the most tolerable kind of touch is self-directed. This means that the child is using their own movements to control the intensity of the input.
For example, having a child crash into something or hug a pillow. Pillows do not move and are more predictable, so even if a child is in a state of distress or doesn’t enjoy hugs from others, these activities are a great introduction to deep pressure touch on the child’s own terms.
Deep Pressure Touch Home activities:
Pillow Crash
– Make a BIG pile of pillows on the floor or bed. Put them on a yoga mat if you’re on a hardwood floor to prevent the pillows from sliding away. Just moving heavy pillows, like couch pillows, is already giving deep pressure touch input.
– Have a child “crash” or jump on to the pile.
– Count the number of times they have left to help them know when to transition. For example, say 10 more crashes and count with them to help with ending the activity
Pillow hugs
– Get a big pillow such as a couch cushion. I used my dog’s bed.
– Have a child hug it while lying on their back.
– One game to play is “Don’t let go”. They lie on their back and grip a big pillow tightly with their arms and legs wrapped around it. You (dramatically) try to pull it away from them. I usually cheer the child on, “Don’t let go!!!” Important: Make sure you are not dragging your child around on carpet to protect the child’s skin. Instead dragging the pillow, give it and the child tugs while you stand in one place.
This game also has other benefits – core strengthening and Moro reflex integration which will also help with postural endurance for sitting and staying out of survival modes of fight and flight.
The Pillow or Ball Squish
– They lie on the carpeted ground/couch/yoga mat (something soft).
– Use a big yoga ball or big pillow to SLOWLY press on their lower legs. Right at the start, check in with the child about the pressure intensity.
– As you roll the ball up their limbs, be gentle around knees. Keep checking in around pressure and where to “squish”.
– Go lightly over their chest, if they do request the squish over their torso.
– You can have them cover their face, if they do want you to roll the ball over their head.
Hand Hugs
For children that actively enjoy deep pressure touch, they may like it applied with your hands. This is also a great activity when on the go.
· This is easily performed when a child is lying down on their back or belly. Use both hands to push slowly on their limbs (arms and legs) into whatever surface they are lying on.
– Some kids like gentle pressure to their heads applied on their forehead. To do this, place one hand on the back of their head and the other on the forehead.
– The key word is SLOW. Start soft. I usually say it is like “pressing into a bag of marshmallows”. This is to make sure you don’t overdo it as it may take a while for a child’s body to register the pressure. Even if kids may ask for more pressure, you should consider increasing it very slowly.
– Hold it for a count of 7-10 seconds and ask how it feels.
– You can tell that they like it if they are smiling or have their eyes closed with a blissful look on their face.
– I find that taking a deep breath helps me connect to myself first before working on others. If your child prefers a faster pace that is also ok! Just ask. Eventually, the longer you hold the pressure the better as their system get more time to register the sensory input and start to build stronger.
· To do this technique while a child is sitting you can use the table/desk they are sitting at.
– (see picture) use both hands to slowly press their forearms onto the table.
-Keep hands soft and forming to the shape of the arm.
– On the legs you can use two hands to wrap around the calves to start.
-Moving closer to the core, they can push the child’s lower thighs into the chair. Pressure can also be applied at the outer hips with two hands.
– Leverage your body weight instead of squeezing with your hands. It will feel better for everyone.
*You can hold for fewer seconds but the longer you do it the more their nervous system can register where you are for body awareness.
Word of caution: no child or sensory system is the same. When considering introducing something new to your child, explain what you will do before doing it. Check in frequently to make sure it feels good to them. Stop if it doesn’t. And HAVE FUN!
These techniques are not a “cure all” to difficult behaviors. You will need to adjust the intensity of pressure and duration. Increased frequency of deep pressure touch will build body awareness over time. Some kids will need many sessions of self-directed deep pressure touch before they will feel safe enough to allow someone else apply pressure touch to them. TIP: You can have them switch roles and do these activities on an adult so they can get the pressure from pushing.
Once you get going with these, remember that most kids enjoy novelty so you can make your own games. Think in themes like space, under water, dinosaurs, etc. For example, the pillow can be a big dinosaur egg that the child must guard against other dinosaurs trying to steal it.
I can’t emphasize enough how important it is to consistently keep giving your child opportunities to get this kind of touch. Recently, one parent told me how her child used to need over 30 minutes to recover from a meltdown and now needs less than 10 minutes. Another parent has noticed her child is no longer hurting himself, tripping bumping into things. In the above cases, the parents used deep pressure touch techniques on a daily basis. The kids were also receiving reflex integration which is a topic for another blog series.
This blog has many fun ideas for “heavy work” or activities that give deep pressure. My favorite go-to-technique is hand hugs.
Also studies on mice have shown that touch applied with a hand instead of a tool, such as a brush, increases immune factors in the body. [7] This said, brushing is still a great tool that we will cover in our next blogs.
The stand-alone activities mentioned in this blog post are akin to sensory “snacks” and if you want a combination of activities that are a part of a “sensory diet,” you can talk with an occupational therapist about how to create one. Other types of touch and more sensory activities will be covered in the next few blogs.
Thanks for reading!
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References
1) Field T, Hernandez-Reif M, Diego M, Schanberg S, and Kuhn C. Cortisol Decreases and Serotonin and Dopamine Increase Following Massage Therapy. 2005. Int J Neurosci 115(10):1397-413.
2) Jacobs K.M. (2011) Somatosensory System. In: Kreutzer J.S., DeLuca J., Caplan B. (eds) Encyclopedia of Clinical Neuropsychology. Springer, New York, NY. https://doi.org/10.1007/978-0-387-79948-3_359
3) Uvnäs-Moberg K, Handlin L, Petersson M. Self-soothing behaviors with particular reference to oxytocin release induced by non-noxious sensory stimulation. Front Psychol. 2015;5:1529. Published 2015 Jan 12. doi:10.3389/fpsyg.2014.01529
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4290532/#B151
4) (2005) Discriminative General Senses, Crude Touch, and Proprioception. In: The Human Nervous System. Humana Press. https://doi.org/10.1007/978-1-59259-730-7_10
5) Bestbier, L., & Williams, T. I. (2017). The Immediate Effects of Deep Pressure on Young People with Autism and Severe Intellectual Difficulties: Demonstrating Individual Differences. Occupational therapy international, 2017, 7534972. https://doi.org/10.1155/2017/7534972
6) Wan Yunus, F., Liu, K. P., Bissett, M., & Penkala, S. (2015). Sensory-Based Intervention for Children with Behavioral Problems: A Systematic Review. Journal of autism and developmental disorders, 45(11), 3565–3579. https://doi.org/10.1007/s10803-015-2503-9
7) Major, B., Rattazzi, L., Brod, S. et al. (2015) Massage-like stroking boosts the immune system in mice. Sci Rep 5, 10913. https://doi.org/10.1038/srep1091