Transcript of this week's interview with Christie Kiley, a pediatric occupational therapist and prolific blogger. Our discussion focuses on Christie's background as both an occupational therapist (OT) and a mother of two, as well as some really helpful definitions and tips about sensory processing, also known as sensory integration - for all children, including those with sensory processing difficulties.
Today, I have a very special guest, Christie Kiley, pediatric occupational therapist and creator of MamaOT, or www.mamaot.com, one of my own go-to blogs for activities and information about infant and toddler development. Christie, I’m so happy to have you on Strength In Words, welcome!
Christie: Thank you! Thank you for having me.
Ayelet: Why don’t you give us just a little bit of background about what your focus has been as an occupational therapist… and, I think you bring sort of a unique perspective because you started practicing in your field right around when you became a mother.
Christie: Yeah, sure. So I graduated from OT school, took the boards, I was 7 ½ or 8 months pregnant when I took my board exams, had my first little baby a couple of weeks after that, did kind of a traditional maternity leave for three months, and then started my first job as an OT when he was 3 months and 1-day old. So… I was very sleep-deprived and I was a new therapist, I was a new mom, I would not recommend starting both those things at the same time! Yeah… I tend to do things kind of non-traditional ways, so it works for me!
So I started out in my first job working in pediatrics (I became an OT because I wanted to be in pediatrics, that’s always what I wanted to do)… so my first job – I would say my caseload was about 80% in-home with birth to three and 20% in the clinic with toddlers and preschoolers and school-aged kids. So that’s how I got started. And as I was learning to become a mom and an early intervention OT at the same time, it was really interesting being able to apply what I was learning as a mom into my work as an OT and what I was learning as an early intervention OT into my time with my baby. But then also, I was only working 3 days a week, so I was with him the majority of the week – while playing with him at home, I tend to be kind of a creative and resourceful person, and I would find things that were fun for him to do. I had several babies on my caseload and I was able to apply that in a therapeutic manner to the babies I was working with, and that seemed to go over really well. So that was the perfect combination and crossover at that point.
Once I started to get my feet under me, my little boy was about 6 or 7 months old, and I was sharing this information with people I was working with, I was sharing things on Facebook, and I was like, “man, I need to get this information out to new people – like, every new parent needs to know about these things!” These tips and these tricks that come from an OT perspective, but are, like, “mom-tested!” Yeah! And they actually work! People really need to know about it! You get all your problems solved! Not really, not all of them…
Ayelet: A lot of really good information!
Christie: Yeah, and I think a lot of the families I worked with appreciated the fact that this was my true, real honest perspective. They all knew that I had a newborn also, and so that helped build rapport and trust… but, they were able to understand, “I’m actually going through this with you and actually trying this, and I’m learning about these things with you," but I have a different perspective that I’m able to share to determine whether it’s actually a good thing or a bad thing or a gimmick.
Ayelet: Because of your OT training.
Christie: Exactly. Even though I was new. It’s still just a different perspective than what your typical new parent would have. Not that I had all the answers as a new parent! You know, I’ve made my own mistakes! And so, it just kind of made sense, you know, oh, I need to start a blog, this is what I need to do! The first real post that I published was “Seven Tips for Tummy Time” for making it less miserable, and to this day, 4 ½ years later, it’s still one of my top ten posts – because it’s a real problem that people experience and they want help with it! And the information in that post has helped real people, and they share it. And that’s awesome. That was the whole point.
Ayelet: Yes! So can you give our listeners some basic information about the role of an occupational therapist who works with infants and toddlers. Because, I think in general, a lot of people have difficulty understanding the term “Occupational Therapist” and they can’t imagine what an OT does with a baby, right? A baby’s occupation is to be a baby. So, what is an OT in the early years?
Christie: So, when you think of occupational therapy, you’re thinking of the term “occupation,” which can be interpreted as a job, or what you do for work. And so you think of, well, what are the jobs of daily living that a baby has to do? Or a toddler has to do? Sometimes they involve developmental milestones, sometimes they involve family support and family interaction, so we think of things like being able to participate in play at an appropriate or functional way. We think about being able to participate in feeding and mealtime. Sleeping is an important occupation for everyone, but especially babies, because it supports so much of their growth and development. So, things like that. One important occupation of a baby is to be able to interact with other people socially. We don’t target the speech and language development like a speech and language therapist would, but we support it more from an occupation and participation sort of way with promoting interaction, bringing in those motor skills and the sensory component and the social skills all sort of together so they can participate in social interactions throughout the day. So, you think, what are the jobs of daily living for a baby? Play time, feeding time, sleeping time, social interaction – those sorts of things.
Ayelet: So, I think you sort of hit on this, but what parts of a young child’s development fall under the scope – as you said, sleeping, playing, and the positioning to be able to play and engage with, say, play objects. So you mentioned a little bit about the ability to experience things sensorially, or from a sensory perspective, and I think one of the terms that gets used so often these days, and especially in relation to the role of an occupational therapist, whether that’s early intervention or school aged children, is the term “sensory processing” or “sensory integration.” I think our listeners would be really interested to have your explanation really about what that term means from a theoretical and practical standpoint.
Christie: One way I like to explain “sensory processing” that parents seem to appreciate is – we constantly have sensory input coming at us from our environment, and then also sensory input that occurs within our body. And so we have to take sensory information that occurs from outside of our body and inside of our body and be able to make sense of it, so that we can use it to participate in our daily activities.
So, sensory information coming from the outside. So we have the auditory information, we have smells, we have taste, we have vision. And then we have what we can feel through our skin, the tactile sense. Those are sort of classic senses that we think about that we learn about as kids. And the two that come from inside of our body, vestibular, being a fancy word for balance and motion, located in our inner ear, and then proprioception, which is that sense of body awareness, what our limbs are doing in relation to each other, in order to be able to navigate through our environment. Those seven senses are typically the 7 that we’re talking about as occupational therapists when we’re talking about sensory processing. So during our day to day, we have to be able to take in information from all of those different channels and organize it, make sense of it so that we can use it. Examples would include knowing how much force to use when you’re opening the refrigerator – you have to be able to see it, feel it with your skin, feel it with your muscles, know how far you are away from it, and then appropriately pull it open. We open the refrigerator maybe a dozen times a day or more, and it’s such a basic thing, but you don’t realize how much sensory integration or sensory processing has to go into that simple act in order to successfully operate the refrigerator.
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Ayelet: What might the difficulty with sensory integration or processing look like in an infant or toddler?
Christie: So, for a baby, if their nervous system is having a hard time processing the sensory information coming from the environment or from their body, they may be overly sensitive to touch, so they may be the type of baby that doesn’t like to be held by strangers – even held by mom – they might not like to be bounced to be soothed, or rocked to be soothed because they’re too sensitive to movement. They may be extremely sensitive to light, and so they cry and fuss whenever the lights are turned on or if they’re taken outside, or if the windows are open. Those would be more like “sensitivities” to sensory input. One way that you can think about that the way that sensory processing is divided up is that some sensory channels may have a tendency to over-respond, so they might be very sensitive to or avoidant of certain types of sensory input. Then, you might have other sensory channels that might be sensory under-responsive, so they might need more input in order to really feel secure or to really activate what’s needed to respond to the environment. And then you have your “sensory seekers” who actively seek out because they need more of that input to really feel regulated and secure. So if we go back to the example of the baby, you may have a baby who’s under-responsive to tactile input maybe on their skin or even in their mouth, and so that might affect, let’s say, their ability to develop feeding skills – because if they’re under-responsive from a sensory perspective in their mouth, they are not going to be able to as skillfully sense what’s going on in their mouth when they’re trying to deal with a nipple they’re drinking from or trying to learn to bite from a cracker, or even learning to drink from a cup. So that would be an under-responsive example.
So you have babies that might appear more sensitive to certain types of input, you have babies that might appear to seek out or be under responsive to other types of input, and it can be complicated to determine whether something truly is a sensory challenge for a little one because each sensory system can respond in its own way. You can have one system, like your tactile system, that’s over-responsive or too sensitive, while you may have another system that is under-responsive or seeking, like with auditory. So they don’t want to be touched, but they love those loud noises, they love the sound of the toy, you know, making the noise over and over and over, they want to hit that button over and over… so it’s not always clear cut as to whether a child’s challenge in the first year is really due to sensory issues.
I think a really common one that we’ll see in toddlers a lot, too, is that tactile defensiveness. They don’t like to touch things that feel messy, they get irritated by clothing tags, they avoid participating in “typical” early childhood activities that are great for their development like running around barefoot on the grass, like playing with play dough, like finger painting… and so that’s one is pretty commonly seen that we’ll get referrals for is those kids with more of a tactile defensiveness in those toddler years.
Ayelet: What are some of the reasons why a child might have difficulty with sensory processing – I realize that’s a giant question – but, some of them?
Christie: Yeah… that’s a really big question. You know, at this point in the research, there hasn’t been anything nailed down like, you know, a certain chromosome or marker in the genetic code or anything like that. It does, just based on our observation and some still-developing research, there does seem to be some sort of genetic or hereditary component. Family members often are more likely to have challenges with that sensory processing as compared to someone who doesn’t have that in their family tree, but, like I said, at this point, it hasn’t been really nailed down as to whether there’s something specific that causes it. I mean, there are so many theories about what could contribute to that. And certainly we know from sensory deprivation environments like orphanages where kids are kept in a crib their whole first three years or even their first year and they’re not exposed to the world – sensory deprivation can definitely contribute to that, and there’s been a lot of research in that area. But yeah, it’s tricky. It’s all based on the nervous system’s ability to process and integrate that sensory information, and as to what specifically causes it, I don’t know that we know that yet.
Ayelet: I think a lot of parents and caregivers would love to know whether a child who is exhibiting issues with sensory integration or tactile defensiveness, like you said, whether that’s always a part of a larger issue? Does that mean that the child has autism, for instance, does that mean that the child is going to have issues with learning down the line? Can you give us some insight about what this might imply?
Christie: Sure. In the last couple years, there’s been some really interesting, groundbreaking research from the University of California, San Francisco (UCSF). They’ve been doing neuro-imaging studies to get a better understanding of whether sensory processing disorder is something that can occur on its own, or whether it’s something that always has to occur with other diagnoses like Autism or Fragile X Syndrome or things like that. The research is really interesting. They really are finding that true sensory processing disorder looks different in the brain than the way that kids with Autism process sensory information or the way that kids with ADHD process sensory information. So, that’s kind of the long answer. The short answer would be: just because your child’s demonstrating sensory symptoms doesn’t necessarily mean that they also have Autism or some other big scary diagnosis.
Ayelet: And, obviously, like you said, an occupational therapist who works with young children is someone who might work with a child with sensory issues. So, what are some of your, say, top 3 sensory activities that you might do with any child, and/or with a child with sensory processing issues?
Christie: We talk about the big three sensory systems, being: the vestibular system (that balance and motion system), the proprioceptive system (the input to the muscles and the joints), and the tactile system. I would say the first main sensory type of activity that is great for all kids is what’s we would call “heavy work,” and that’s that proprioceptive system. So you think of, literally, heavy work. Moving and pushing things that are heavy – anything that’s going to give some nice heavy input into those muscles and joints. So, it can be helping to move chairs out from under the kitchen table so you can sweep, helping to push the laundry basket down the hallway to and from the laundry room, it can be, if it’s an older child, helping to mow the lawn or rake the leaves… those are all boring chores, but any play activities, too, that involve heavy work – crawling through a tunnel, crawling through like a cave of pillows that the parent is kind of “nicely” pushing down on them, hanging at the bars on the park. And so that’s often one of the first go-to’s, because heavy work tends to be very regulating and organizing for kids, especially kids that maybe have a lot of energy, or maybe who have other true sensory processing challenges. So that’s that heavy work and proprioceptive system.
I would say the second one would be movement – you know, vestibular. Movement for some kids can be very alerting and disorganizing. So that’s why I wouldn’t typically recommend it just to any parent first, because if I don’t know how sensitive their kid is to movement, I’m not going to just go and tell them to spin their kid on the swing at the park! But, you know, swinging at the park, riding a bike, jumping on a trampoline – those are all great, typical vestibular activities. For a kiddo who has some vestibular challenges, the parent would need to work closely with the OT to make sure that they’re providing the right type and amount and duration of vestibular input. But movement is how kids learn – it’s how they grow, it’s how they develop. So, that’s a big one.
And then, tactile, that third one. Just being able to explore and be exposed to experiences! Like I said earlier, whether it’s running barefoot on the grass, or playing in the sandbox, or playing with a bucket of beans, all those are great tactile experiences that actually can also help develop the fine motor system, the fine motor development. As you get more fine motor input into those hands, then the skin on your hands starts to learn to differentiate and discriminate, “oh that one feels soft, ooh that one feels hard, oh that one’s kind of cold – I should hold that crayon on that side instead of this side because this part is slippery.” You know, things like that. Again, that’s the long answer. The short answer is the heavy work, the movement, and the tactile experiences.
Ayelet: That’s great, because I think when we think about “sensory play,” most of the go-to understanding of that is beans or water play or something. But it’s really nice to hear you talk about the other two areas, which are such important areas of sensory processing. That’s awesome. Thank you. Do you have any tips for parents that you would like to share about looking at sensory processing and giving sensory-type experiences with infants and toddlers?
Christie: Yeah! One of my main tips for parents is always that we can embed or incorporate so much therapeutic value into the day to day activities that we do each and every day. And that’s like, the meat and potatoes of occupational therapy, is that we’re helping people do the job of living, and there’s so much therapeutic value in the things that we just do in our regular day-to-day, it’s just all about having the right perspective or the right lens to really see it that way, and then to really turn things into even more therapeutic value. So, I was talking about chores earlier, and from an OT perspective, that’s such a good way to build core strength and upper body strength and to get some heavy work input. And as a parent you’re thinking, “oh, well they’re just helping me with the chores,” but they’re also getting all those therapeutic things. So there’s so many ways to build in sensory development and motor development into the day to day. Especially within early childhood – because that’s really what the early years are all about is that sensory and motor exploration and development. So my encouragement is always to think, “well, what are the things that you’re doing day to day?” Are you going to the grocery store? Ok, well then have your kiddo hold the basket and they can carry some of the things to get some more heavy work if that’s the type of input they need. Are you going on a walk with your family after dinner? Ok, well, have them pull the wagon, things like that. Do you give them a bath? Ok, give them two cups – they can scoop and they can pour from cup to cup, and now they’re working on their bilateral coordination. Oh, you’re going to go rake the leaves in the backyard? Ok, you can have them use the rake or scoop up and pick up the leaves and put them into the bag. Those are just a few examples, but if you really think about what you do during the day, there are so many opportunities to work on development, just in the day to day.
I have a post on my site, “40 Heavy Work Activities For Kids,” and so many of them are chore and day-to-day related! Yeah, you can come up with creative and fun things to do, but, that’s kind of a lot of work! You know? And who’s going to memorize a list of 20 fun play activities for heavy work? But you just think about what you do during your day, and then involve your child. And then you’re building that relationship, you’re building their independence, and so many other factors that are such an important part of their development.
Ayelet: That’s great. I think our listeners really appreciate the “make it simple approach” really, versus feeling really overwhelmed by all those amazing suggestions on Pinterest! So thank you so much, Christie, that’s wonderful. I’ll direct my listeners, also to that post on this week’s podcast page for this episode.
Christie is a mama to two precious kiddos and a pediatric occupational therapist (OT) to many. Her mission with Mama OT is to encourage, educate, and empower those who care for children by sharing helpful insights and fun activities. You can learn more about Christie and the story of how she became an OT on her blog. Or follow along on Facebook, Twitter, Pinterest, or Instagram for even more tips, tricks, and behind-the-scenes fun!
STAR Institute: https://www.spdstar.org/
UCSF 1st study investigating biological basis for SPD (2013): https://www.ucsf.edu/news/2013/07/107316/breakthrough-study-reveals-biological-basis-sensory-processing-disorders-kidsi
UCSF 2nd study on SPD (2016): https://www.ucsf.edu/news/2016/01/401461/brains-wiring-connected-sensory-processing-disorder
UCSF sensory research website: http://anp.ucsf.edu/overview/spd