We all know about “the five senses”. They are smell (olfactory), taste (gustatory), touch (tactile), sight (visual), and hearing (auditory). Did you know that there are at least three more that we know of? These are proprioception, vestiular and interoception.
Basically, sensory integration is the way our brain and body work together with each of these senses. For a clear and more thorough description check out here: http://www.sensory-processing-disorder.com/what-is-sensory-integration.html
When a family contacts me with concerns about breastfeeding, sensory issues are not always the first thing I think of, but I keep them in the back of my mind while in conversation. For breastfeeding to be harmonious, mom and baby are a team. There needs to be involvement with baby’s physician as well as an occupational therapist for the correct diagnosis. Mother’s and baby’s health are both evaluated. Tongue tie and palate issues, low supply, oversupply or fast milk ejection reflex, allergies, reflux or other health issues that may mirror sensory issues around feeding, need to be ruled out first.
When I think about my personal journey with breastfeeding three children, I think about how naïve I was at first and how that actually worked out in our family’s favor. When nursing A, she would nurse sometimes for 45 minutes…long, leisurely nursing sessions that I now know were related to her low muscle tone. Had I then read some of the false claims that babies take “x amount of time” to nurse, I would have tried to make her fit that mold and perhaps created worse issues. She was my squirmy, wiggle worm that needed to either be worn in a sling or let loose to roll around the room. She startled easily to sounds and was particular about clothing and foods. Her sensitivity has made her into a wonderfully, empathetic young girl. Thankfully, when ordering some nursing clothing, I discovered The Baby Book by Bill and Martha Sears and was encouraged to follow her and our other children’s lead. The book also gave me a good idea of what was normal/typical infant development and what was not… this education and other resources helped me start the process of learning about sensory integration. Later, during the first 3 to 4 months of S’s life, I held him in my arms so often that even my most “attachment parent friendly” friends teased me about never putting him down. Yet, he needed that deep pressure hold to feel secure and we had to work out different nursing positions that helped him figure things out (in S’s case this was vertical). He cried so often, even in our arms and needed dark and quiet by mid-afternoon as I learned his cues. It was an exhausting time. and a lot of our learning was trial and error. As we started to offer solids, he would turn away. Following his lead, he chose to feed himself at 10 months. As he progressed into his toddler and preschool years we continued to see his intensity and learned how to help him with his feelings and to appreciate his passion. You can read part of Z’s journey here.
In order for breastfeeding to work on the infant or child’s end, all their senses must integrate or blend together well. This is not always the case for a myriad of reasons. First, lets look at what it takes for the baby to breastfeed well… to feel the sensations in their mouth, smell the mother’s skin, taste her milk, see and hear her, but there really is more to it than this! Page 239 -240 of the chapter entitled The Role of Sensory Integration and Sensory Processing in Breastfeeding in the book Supporting Sucking Skills in Breastfeeding Infants by Catherine Watson Genna, IBCLC explains this process in good detail.
“Intact sensation and sensory processing are important for breastfeeding. The infant must be able to tolerate touch and movement through space to be positioned at breast, and must be able to respond to touch and smell cues from the breast to orient to the nipple, gape appropriately, and grasp a sufficient amount of breast tissue to transfer milk. The infant must modulate muscle tone appropriately, and maintain sufficient arousal to facilitate the work of feeding. The infant needs to respond to the tactile and proprioceptive input of the soft breast in the mouth and use this information to cup and groove the tongue to form a teat and stabilize it in the mouth. Sequential activation of small bundles of the genioglossus (muscle which runs from chin to tongue) and the transverse intrinsic tongue muscles are required for wavelike movements of the tongue. The posterior half of the tongue must depress to pull milk from the breast while the soft palate seals the mouth from behind, and the cheek and lip muscles must have sufficient tone to resist the intraoral negative pressure. Tactile and kinesthetic sensory registration and fine control of tongue, velar (soft palate), and the pharyngeal muscles is necessary for coordination of swallowing and breathing. “
So, what does a sensory integration issue look like in an infant? A baby “over-responds to sensory stimulation, he may react intensely to normal touch by arching away or screaming when put down. Or a baby may be usually unresponsive. A baby may over-respond to some senses and under-respond to others.” Page 127 Breastfeeding Answers Made Simple by Nancy Mohrbacher, IBCLC, FILCA. There seems to be a continuum of symptoms from one extreme to the other and these symptoms can affect tactile, auditory, visual, vestibular, etc. each in different ways. Some babies cry a lot more than others…and some seem to cry all the time or have long periods of inconsolable crying, even when in arms and all else seems alright. Some babies hold their heads up super early and seem tense and stiff while others look too placid and “rag doll” like. They may not just cry at diaper changes but scream their heads off. On the other hand, they may not seem to notice even if their pants are wet or feel uncomfortable at all. They may be wiggly all the time and not really settle even in arms… a typical infant snuggles in. As they grow into toddlers most babies try to put things in their mouths but babies with sensory issues may either gag while eating or even prefer spicy or inedible things. They may be intolerant of certain sounds or smells or oblivious to them.
There is help. There are a few options if you feel your baby or child may have sensory issues. If any of this sounds familiar, a checklist of symptomsfor infants and toddlers is a first place to start. For wonderful information on sensory integration signs for infants see: Breastfeeding and the Sensory World of the Baby Part 1
Bring this information to your child’s doctor for discussion. Then consider finding the right specialists, Occupational Therapist, Speech Pathologists or IBCLC who may be helpful for your situation. Often this can be free or low cost through your medical health insurance or through Early Intervention. Educating yourself on buzz words like “sensory diet” or “oral sensitivities” can be important.
Much of what you try is based on your child’s symptoms. For example, some babies do not like a lot of movement so trying to nurse in a quiet, still place may be a solution. Others need a lot of movement so nursing while sitting on a bouncy ball can work. Some babies do best nursing upright in a sling while others need less restrictive movement and do not like this type of deeper touch. In A‘s case, we discovered laid back breastfeeding far before I heard the term. For S, a dark room was important if he got overstimulated. For Z, pumping and using a bottle was something that helped us find breastfeeding success. You will find what works for you and your child with a bit of patience and in being attendant to them. Try to write down your observations, even if that is just making tally marks for fussy spots or keeping track of things you tried. Sometimes, something that didn’t work one day will work a week later. Great ideas for pieces to the puzzle can be found here: Breastfeeding and the Sensory World of the Baby Part 2
Resources for further information:
You may need to continue to pump and bottle feed or look into using supplemental nursing systems such as the Lact-Aid or Medela SNS or if your child is experiencing severe sucking issues and has other oral anomalies even the Haberman Feeder. Be sure to have an IBCLC on your team in this case.
An interview with OTR/L Lindsey Biel titled Parenting Your Preemie with Sensory Issues. If you have a preemie, you may want to check it out.
Some babies are born “late-preterm” or between 34 and 37 weeks. These babies are often called the “great pretenders” because they seem so similar to babies born closer to 40 weeks gestation but have issues similar to their more premature counterparts http://pediatrics.aappublications.org/content/120/6/1390.full.
Raising a Sensory Smart Child
Sensory Processing Disorder Foundation
SPD Blogger Network
S.I. Focus Magazine
Sensory Processing Disorder
Nipple Shields… Friend or Foe?
Babywearing: The Benefits of Carrying Your Baby in a Sling
The Baby Wearer
CranioSacral Therapy: When Can it Help – Dee Kassing IBCLC
Tactile Defensiveness and Other Sensory Modulation Difficulties
Catherine Watson Genna – Tongue-tie and breastfeeding / Sensory Integration Disorder (July 2005 podcast with La Leche League International)
Attachment Parenting International Respond with Sensitivity
The American Occupational Therapy Association, Inc
Books for parents and supportive adults:
Raising your Sensory Smart Child by Lindsey Biel and Nancy Peske
Supporting Sucking Skills in Breastfeeding Infants by Catherine Watson Genna
The Out of Sync Child by Carol Stock Kranowitz, M.A.
The Out of Sync Child Has Fun by Carol Stock Kranowitx, M.A.
Raising Your Spirited Child by Mary Sheedy Kurcinka
Just Take A Bite: Easy, Effective Answers to Food Aversions and Eating Challenges by Lori A. Ernsperger, PhD and Tania Stegen-Hanson, OT
My Child Won’t Eat! By Carlos Gonzalez
In-Sync Activity Cards by Joye Newman, M.A. and Carol Kranowitz, M.A.
Books for children:
The Goodenoughs Get In Sync: A Story for Kids By Carol Stock Kranowitz
When Does Izzy Cover Her Ears? Dealing With Sensory Overload by Jennifer Veenendall
Squirmy Wormy: How I Learned to Help Myself by Lynda Farrington Wilson
Sensitive Sam: Sam’s Sensory Adventure Has a Happy Ending by Maria Roth-Fisch
This is Gabriel Making Sense of School by Hartley Steiner