I’m Allison Miron, a pediatric occupational therapist and owner of Root to Rise Pediatrics Occupational Therapy Group. People often ask me what does an OT do with kids? Isn’t “occupational” similar to an occupation or a job? Well, yes it is and children have jobs too! They are learning to learn, to play, to eat, to dress, to take care of themselves, to be social and lots more. So as a pediatric occupational therapist, I help grow those skills and amongst many others.

So what is proprioceptive input?

Proprioceptive input is one of the internal senses of the body. It is the sensation received by the muscles and tendons to determine where your body is in space. Proprioception is important in developing body awareness; for example knowing where all your body parts are when walking past a kitchen island so you don’t hit your hip on the corner.

What are weighted blankets

The idea to use a weighted blanket comes from the experiences that people have during the day with proprioceptive input. Many people report feeling calming sensations upon receiving a big squeeze, hug, using a body sock, squeeze machine or other tool to get proprioceptive input. The weighted blanket is a tool that is thought to provide proprioceptive input at night time.

Depending on how your body processes sensation or the stress your brain is experiencing you may need more proprioceptive input than is typical from day to day activities. That sensation in the body can tell the brain you are safe and secure. For many people, proprioceptive input will invite the brain to move from a more stressed sympathetic state to a calmer more parasympathetic response (ventral vagal response).

One might describe the sensation of a weighted blanket as being similar to that of wearing a lead vest at the dentists. For those who really benefit from additional proprioceptive input, you can often see the changes in their body as soon as they try a weighted blanket...if... it helps their body. When you ask them how it feels in their body, they will often describe how it helps their body feel “good” in some way. Often when using sensory tools, you will see immediate changes in the body, either positive or negative. This is very helpful when investigating what tool might be helpful for you child!

Some signs to look for that tell you their body is benefiting from this extra proprioceptive input:

Slower breathing
Relaxation in the body (instead of rigid tension)
Stronger connection and engagement to people around them
Change in facial expression
Calmer energy and presence

What is the research saying

In 2018, a systematic review was made of the current evidence. The results indicated that given the quality of the evidence and results of the study, a weak recommendation for the use of weighted blankets can be made (Denny, E et Al, 2018). Further research is needed. There is some research in the area of weighted items to suggest improvements in attention and on-task behaviour, increased speed of processing and having an impact of arousal level (Reynolds, S et al 2015) (Hung-Yu, Lin et Al. , 2014) Although research is limited at this point, there are many anecdotal stories that describe improvements in sleep when using a weighted blanket. There is anecdotal evidence showing benefits for people with many disorders including: autism, SPD, PTSD, chemotherapy, dementia, Fetal Alcohol Syndrome, multiple sclerosis, detoxing, ADHD, and many others (Cara K, Growing hands-on kids)

Weighted blankets are thought of as providing deep pressure that is reported to help clients self-regulate, diminish episodes of maladaptive behavior and anxiety or stress, and improve attention, sleep, and mood (Shulman, 2018). Ultimately, the evidence is lacking but people are only starting to understand the complexity of the sensory systems in each individual's unique body.

If this is a tool that you would like to explore, create key observables that will help you measure whether the tool is helpful or not.

Another option that fewer people are aware of is the use of compression instead of weight to get proprioceptive input. A compression sheet will provide a different sensation to the brain then a weighted blanket will. A compression sheet is similar to a large stretchy pillowcase that slips over the entire mattress. It is made primarily of lycra and will provide resistance when you slide into it. A compression sheet should be evaluated for safety on a child-specific basis. Just like a weighted blanket, the child should be aware and old enough to be able to safely get out of the compression sheet independently. If you are trying to determine what might be the best fit for your child, consultation with an occupational therapist will be helpful.

Things to consider

Have you ever consulted with an OT who has determined that your child would benefit from proprioceptive input?
Have you, caregivers or teachers observed that your child seeks sensations of being squeezed such as shoving themselves into the couch cushions, intentionally crashing into things, often asking for hugs or body squeezes?
Does your child try to wrap themselves tight with blankets?
Does your child like tight or compression-like clothing that gives their body a squeeze?

If you are planning to introduce a new sensation via a blanket or sheet to a child who is very sensitive to sensation, be mindful how you introduce it. Slow and steady is best - let them explore at their own pace alongside a safe and connected adult. That safe and connected adult will be responsible to keep the child regulated during the introduction of this new item since it may invite dysregulation simply due to its novelty. You may introduce and invite the child to feel it on their body over multiple days so it can become familiar.

To calculate the appropriate weight start at 10% of your child’s body weight. You might need to decrease the weight if your child is not safely able to remove the blanket. You might increase the weight over time if they are looking for more proprioceptive input. This is just a starting point - use your judgement... you know your child best! The child needs to have the capability and cognitive capacity to remove the blanket at any moment in time. The blanket should always be resting on top of the child; NEVER wrap the child like a burrito. I would recommend starting with the blanket during the daytime. Use it when cuddling or reading books. This allows adults the opportunity to observe whether the child can easily remove the blanket if there is any laboured breathing, skin redness or discoloration.

ALWAYS check in with your child

Always, always check in with your child. Ask and teach them to describe how their body is feeling prior to using a tool and then what it feels like using the tool. Teach them to tune into how the sensations in their body influence their feelings and emotions. This may be difficult for your child especially if they are seeking additional proprioceptive input! They may not know how their body is feeling or how to describe it. You can also use these tools during the day when a child is taking a break, relaxing or feeling overwhelmed. During daytime use, the child might prefer to wear as a shawl, draping over the shoulders.

For children under 3 years of age, these tools are NOT recommended. If your child is under 3 and you believe would benefit from additional proprioceptive input. You might explore creating play opportunities using lycra with an occupational therapist. These might also be helpful as part of your bedtime routine.

Keep in mind that each and every person’s sensory system is changing moment to moment so check in, often, to determine if this (and any other tool for that matter) is appropriate. If you are unsure, reach out for support from an occupational therapist in your community. Have you checked your insurance benefits to know what you are covered for? Insurance companies are starting to cover these therapies more and more.

You can contact me below or search for an OT in your area using the Canadian Association of Occupational Therapists search engine.

Bio

Allsion Miron Registered Occupational Therapist.png

Hi, I’m Allison! I would describe myself as a passionate problem solver. As an occupational therapist, I look at each child as a whole person. I want to understand why they are having a difficult time with a task and how it's affecting everything else. This allows me to come up with innovative, personalized strategies to teach your child in a motivating and playful way. I meet kids where they are in the moment; if they are melting down I am the calm that helps them regulate and if they need a boost I am the energetic motivator.

I have always been inspired to work with neurodiverse kids. As a young adult, I taught adapted swimming lessons and volunteered with the special olympics before attending University. I went to McGill University for a Bachelor's in Rehabilitation Science and then a Master's in Occupational Therapy. Through extensive additional training in various areas, I have developed my own style prioritizing connecting with the child and family, building emotional regulation skills, empowering the families to have the tools when they are no longer my clients and growing the skills that are missing to achieve their goal.

I have always taken clients privately outside of my full-time work. I love getting to spend more time with kids so I took it to the next step and made my private practice official!

Meet Root to Rise Pediatrics | Occupational Therapy Group. Check out my website at www.risepediatrics.com or on social media via facebook and instagram. You can always also contact me via email info@risepediatrics.com or by phone (403)466-1315.

Sources:

Denny, E. Folkes Jr, W. and others. A systematic review of efficacy of weighted vests and blankets on people with ASD or ADHD. June 2018

Koscinski, Cara. The Ultimate Guide for Weighted Blankets. Growing Hands on Kids. https://www.growinghandsonkids.com/ultimate-guide-weighted-blankets.html

Lin HY, Lee P, Chang WD, Hong FY. Effects of weighted vests on attention, impulse control, and on-task behavior in children with attention deficit hyperactivity disorder. Am J Occup Ther. 2014;68(2):149‐158. doi:10.5014/ajot.2014.009365

Reynolds S, Lane SJ, Mullen B. Effects of deep pressure stimulation on physiological arousal. Am J Occup Ther. 2015;69(3):6903350010p1‐6903350010p5. doi:10.5014/ajot.2015.015560

Shulman, Danielle. Benefits of weighted blankets for kids with Autism and ADHD. Write Steps Pediatrics Therapy.http://writesteps.com/benefits-weighted-blanket-kids-autism-adhd/