The sensory system, which is a part of our central nervous system, allows us to interpret and respond to information around and within us. The way we process sensory input informs our responses, from how we move and communicate our needs to how we attend to our world. At birth our sensory system is still in development. While most babies are able to take in information from their environment, the processing of this sensory information varies based on maturity, individual ability and previous experiences.
Based on individual sensory experiences in the medically supportive NICU, some babies may have differences in the way they process sensory information (ex:sights, sounds, touch, movement, tastes and smells). Sensory processing differences can be related to individual factors, such as gestational age at birth and medical history, as well as specific sensory experiences in the NICU. Preterm or medically fragile infants often have difficulty integrating the amount and type of sensory stimuli in the NICU, which can place them at higher risk for sensory processing challenges.
What can I do to support my baby?
Observe and respond. Watching how your baby responds to different experiences will help you learn their cues, including signs of engagement and stress. This simple act is key in supporting your child's sensory development as it helps you know how to proceed and builds on your relationship by responding to your baby's needs. When your baby indicates they enjoy a type of sensory input, such as your touch, they will let you know. Behavioral responses may include making noises, such as cooing, gazing in your eyes, moving in excitement or perhaps relaxing their body. Maybe that same sensory input could be overwhelming. Possibly the touch is too light and your baby would prefer a deeper stroke. Maybe your baby is over-stimulated and just needs to be held in that moment. Common signs of stress include, closing eyes or turning head away to avoid eye contact, arm pushing away or blocking, arching, fussing, crying, subtle changes in color (slightly pale, red, or splotchy) or increased rate of breathing. All babies at some point show signs of stress, it's their way of communicating. Responding by changing the sensory input, stopping it or merely giving your baby a break and trying again later may be all that's needed.
Pushing a sensory experience that causes stress may likely reinforce that stress reaction, while altering the experience may allow for improved processing. For example, if you have a baby who cries with every bath, changing your approach may improve their ability to process this highly sensory experience. Perhaps it’s the feel of the water, or the temperature. Maybe your baby is startled by the sound of the water or the difference in gravity of the fluid environment. Keying in to what is causing your baby stress by altering the variables can improve their tolerance.
Pay close attention to the timing and sequence of interactions or routines. Your baby may have learned ways to protect themselves from unpleasant experiences in the NICU and they could have different ways of regulating their arousal states and attention. Identifying and interpreting your baby’s cues and engaging in therapeutic play activities when they are in a regulated state (alert, visually attentive, calm) makes all the difference in the way they are able to interpret and respond to sensory input. When fussy, tired, or showing signs of disengagement it’s likely your baby needs a break from the stimulation.
Specific sensory strategies are dependent on your child’s age, stage of development, and individual sensory processing abilities. See Pathways for general activities to incorporate in your routine to support sensory skills within the first year. Here are some additional sensory strategies to support your child...
There is a good deal of research that supports the benefits of skin to skin care (aka: Kangaroo Care). The smell of your body, the sound of your heart and voice, the feel of your skin against theirs, the experience of your movement -all support temperature and state regulation while reducing stress. Infant massage is another great tool with many benefits, including improving regulation, sleep, digestion, reducing stress hormones and more. There are a number of local (if you are in the Portland area) as well as online infant massage trainings available for parents and caregivers.
If your baby spent an extended period in the NICU their opportunities for movement were likely limited, either due to medically essential equipment, immature neurologic and motor systems or less frequent opportunities to be held and rocked. Most babies tolerate slow rhythmic movements, especially when provided with deep input from a swaddle blanket or when held in your arms. Especially starting out, your baby will likely tolerate movement when held by you more than rocked in a swing or bounced in a seat. Start slow and your watch your baby’s reactions to know when they want more (smiling, cooing, eye contact) or when enough is enough (stress signals).
Leaving the sounds of the NICU (constant alarms, monitors, swooshing doors, pagers) can be a big shift. Once you are home, your baby may benefit from a white noise machine for sleep, which can also act as a sound cue for sleep. Continue to talk to, sing, read and respond to your baby’s sounds. This is important for language development. Watch for signs of engagement (smiling, cooing, babbling) or signs of needing a break (turning away or closing eyes).
If your baby was born prematurely they have likely been monitored for a condition called Retinopathy of Prematurity, or “ROP”. When babies are full term they can see about 8-12 inches away and are able to see high contrast colors, such as black, white and red more easily. Positioning your face about a foot from theirs will allow them to see you best. In the first year, babies are going through a tremendous amount of brain growth and can get easily over-stimulated, especially with a system that is still in development at birth, like the visual system. There will be times when your baby is able to visually attend to stimulation better than others. Your baby will be most interested in your face following birth, though may also enjoy looking at high contrast toys or mobiles. As with all other sensory stimuli, watch your baby for cues of engagement or over-stimulation.
When to Seek Help
Here are some potential indicators your baby may be having difficulty processing types of sensory information. This is not a comprehensive list and many babies will demonstrate one or more of these characteristics over the course of their development. Trust your instincts and if any of the below indicators persist or if you have concerns based on behavior not listed, seek support from an occupational therapist.
Your baby spent an extended time in the NICU
Sleep is problematic for your baby (getting to sleep or staying asleep)
Your baby has strong reactions to sensory stimuli such as sounds, lights, touch, or movement
Your baby has difficulty with feeding (bottle, breast or solids)
Your baby does not explore objects, such and hands or toys with their mouths or may gag frequently
Your baby startles very easily, even beyond 4 months (corrected age)
Your baby has delays in their motor development
Daily routines such as diaper changes, clothing changes, bathing and other care activities cause intense reactions
Your baby has muscles that seem stiff or floppy, or a mix of both.
Your baby may frequently cry and have difficulty being consoled
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Learn More about Sarah Reppenhagen, OTR/L