Normalising sensation

What is normalising sensation?

A normalising sensation programme helps children who have not been ready to eat and drink. It helps children to feel relaxed about their face being touched. This can help them to get ready for eating and drinking in future. It will also help with keeping their mouth healthy (oral hygiene).

Why does my child need to practise this?

Children who have been poorly have often had medical procedures which feel ‘negative’. They may have had tubes in their mouth or nose. They may also have had a long time without eating or drinking. This can make children worried about things being near their face. This is called facial sensitivity or oral aversion.

Children need to feel relaxed about things touching their face before they are happy to eat and drink. Speech and Language Therapists recommend ‘a normalising sensation programme’ for children who are worried about things touching their face.

Signs that your child is sensitive

Eating, drinking and mouth sensitivity

• Turns head away if lips are touched
• Faster breathing or a colour change when face is touched
• Gagging
• A ‘pained’ look or facial grimace
• Crying when being fed or if face is touched
• Vomiting
• Blinking, eye rolling or staring when face is touched
• Does not like teeth being cleaned
• Only likes certain textures of food

Sensitivity in other places

• Avoids having hair brushed
• Avoids face washing or wiping
• Does not like being touched by other people
• Does not like clothes being pulled over their head
• Gags if certain foods or textures go on hands
• Dislikes mess on hands or being near things that are messy

Normalising sensation programme

Practising the plan below will help your child be more relaxed about touch. It aims to help them accept:

1. Body touch
2. Touch to their face
3. Touch around and inside their mouth

Always complete the practice in this order. Your child needs to be happy with touch before they are ready to have mouth care or to eat and drink.

Before you start

• Allow lots of time to practise. Do not rush.
• Practice can be short but do it several times a day. Even 1 minute of practice can help.
• Make sure your child is sitting or lying in a balanced, well supported and relaxed position. A physiotherapist or occupational therapist can show you if your child needs extra help.
• Make sure you are only touching your child with your hands. Keep clothing (e.g. sleeves) out of the way.
• Make sure your finger nails are short and clean.
• Staff working with your child need to wear gloves for step 3.
• Parents can use a clean finger.

Things to remember

• Use a firm touch. It should not leave a mark or a colour change to your child’s skin.
• Do not use a ‘tickle’ touch. This is not relaxing for people who are sensitive.
• Keep the practice relaxed and fun.
• Stop if your child shows any sign of discomfort or upset at any point in the practice.
• Always do the practice in the same order.
• Play music if this helps your child to relax.
• Keep your voice calm and soothing.
• End each practice on a positive note.

Step 1 – Body Touch or Body Massage

1. Place your hands on the middle of your child’s chest. This helps your child to relax.
2. Your touch needs to be firm but gentle.
3. Do slow firm strokes on your child’s legs. Keep the movements at the same speed. Do both legs at the same time (symmetrical).
4. Move back to your child’s chest.
5. Do slow firm strokes of your child’s arms and hands. Keep the movements at the same speed. Do both arms at the same time (symmetrical).
6. Older children – use a calm and soothing voice. Tell your child what body part you are touching.
7. Younger children – sing a song to help them relax, for examples, use the tune to Tommy Thumb … Bobby’s arms, Bobby’s arms, where are you…?

Step 2 – Face Touch

1. Practice this away from meal times to start with.
2. Help your child get ready for face touch by touching/kissing their arms. Move their arms towards their face as you do this.
3. You can also do firm kisses on child’s face.
4. Remember to keep movement slow and at the same speed.
5. Do both sides of the face at the same time.
6. Start with touching your child’s forehead. Start in the middle and do 3 strokes from the middle to the side, near the hairline.
7. Do 3 strokes on both sides. Start in the middle near the nose. In a circle move along the cheekbone to the outside and down towards the corner of the mouth.
8. Next do 3 strokes on both sides of the nose from the bridge of the nose to the nostrils.
9. Next do 3 strokes from the bottom of your child’s chin up to their mouth.
10. If your child is happy and relaxed you can move onto step 3.

Step 3 – Touch around and inside the mouth

1. Do 3 strokes on your child’s top lip.
2. Do 3 strokes on your child’s bottom lip. Use your little finger if your child is under 5 and an index finger if your child is older. You can also encourage older children to do this part themselves.
3. Place your finger on the bottom gums, just to one side of the middle.
4. Slide your finger along the gum line towards the back of the mouth and back again. Only go as far back as your child will allow. Repeat 3 times.
5. Keeping your finger on the gum, turn it so that the padded part faces your child’s cheek. Push out the middle of the cheek and massage in a circular motion.
6. Return your finger to the centre of your child’s mouth. Repeat the same on the other side of the lower gum and cheek.
7. Now do the same on your top gum.
8. Slide your finger along the gum line and back again. Repeat this 3 times.
9. Return your finger to the middle of the gums and repeat on the other side.
10. Place your finger on the tip of your child’s tongue.
11. Using a firm touch, slowly stroke your finger to the middle of your child’s tongue 3 times.

You can try the step 3 routine with your finger dipped in water or milk when your child is happy with this sequence.

Keep practicing each day with your child. Remember to stop if you notice any signs that they are not relaxed. As your child gets happier with the practice begin to do it in everyday routines like face washing and teeth cleaning.