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Massage Today
February, 2016, Vol. 16, Issue 02

Understanding the Seven Senses in Pediatric Massage


When we are born, we go through a series of changes which lead into our adult life. From growth and physical development, to a myriad of sensory experiences, which help to form who we are and how we take in the world.

Some children's senses integrate at a different rate, and they may experience what is known as inefficient sensory integration. When too much information enters the brain and nervous system, the child may be unable to cognitively process what is happening. In simple terms, they may not be able to filter input in the same way as another child. Carol Kranowitz, has helped to define three causes of poor sensory integration:

  • Inefficient sensory intake (hyper or hypo sensitivity).
  • Neurological disorganization (a failure to receive information, inconsistent reception of information, or an inability to integrate the information with other sensory information to make the information useful).
  • Inefficient motor, language, or emotional output (this may be due to inefficient processing of sensory information to produce feedback and allow for meaningful behavior).

Just as we would adjust our session for each adult client, we would do the same for children. However, for those with sensory integration differences we need to take into consider all seven senses when making such adjustments.

Proprioceptive System

girl - Copyright – Stock Photo / Register Mark The proprioceptive system is the unconscious awareness that tells us our body position relative to other body parts and to the environment. This system provides information that helps a child understand movement and touch. This unconscious sense contributes to the development of motor planning which aids us in movement and action. In many cases, when we receive appropriate propriopceptive stimulation, hyperactivity tends to decrease. It is rare that proprioceptive input would cause an overload the nervous system and cause anxiety.

The proprioceptive system is connected with both the tactile and vestibular systems. Tactile-proprioceptive (somatosensory) is the simultaneous stimulation of touch and body position, while the vestibular-proprioceptive perception is the simultaneous awareness of head and body positions while moving in the environment.

For children, receiving even pressure during your therapeutic session can not only be received as calming input, but can provide much needed proprioceptive input. Using still hands placed on the body in a consistent and routine pattern, can often be much more calming for children, as opposed to lots of continuous and non-patterned gliding motions.

Vestibular System

The vestibular system is the sensory system that responds to the position of the head in relation to gravity. The neck, eyes and body adjust constantly with movement of the body. In general, stimulation of the vestibular system does not cause any conscious sensation, although some low frequency stimulation may cause nausea, dizziness or rhythmic eye movements.

There are two main components of the vestibular system, which include:

  • Defensive component which allows a child to discriminate visual stimuli, maintain balance and aids in the automatic reflex to protect our bodies.
  • Discriminative component which helps us to react to the environment with more mature motor responses. This system has a close relationship with the auditory and visual systems and therefore, has a critical role in the modulation of other sense systems.

For children with vestibular differences, positioning during your session becomes important. If we ask a child to lay or sit in a position that causes them to be off balance, we may create an uncomfortable environment. Movement should be slow and strategic, which includes any movement from therapy mat to chair to massage table.

Tactile Functioning

The sense of touch is critical in helping us to function on a daily basis. For all children, receiving repetitive and consistent tactile stimulation is necessary. Tactile stimulation helps to keep us organized and functioning. Through our sensory receptors, we feel sensations of pressure, vibration, movement, temperature and pain. Just as the vestibular system has two components, the tactile system does as well.

The protective system is a more primitive component that alerts us when something potentially dangerous is touching our bodies. The body reacts against the environment to protect itself from being harmed by evoking a fight or flight response while at other times will simply alert the nervous system.

The discriminative system is more advanced and provides us with details about touch such as, the pressure, texture, and area where the touch is provided on the body. A successful tactile system depends on a balance between both the protective and discriminative systems. When this system is not balanced tactile defensiveness or under-responsive tactile discrimination results.

With touch therapy, we have a variety of options to help create the best session. We can use lubricant, or not and we can use a variety of tactile tools, puppets and textures. Spend the time to really find out what is best for each individual as far as pressure, movements and use of lubricant.


This system is responsible for our sense of smell and ability to detect odors in our environment. For some children, they may have a heightened sense of smell that can lead to a fixation in wanting to smell a particular scent, or the opposite, an aversion to a distinct odor. With this is mind, it becomes even more important to create an unscented environment for pediatric clients and patients. Particular caution needs to be extended to the use or introduction of any essential/aromatherapy oils. Using such oils is not advised with children unless you have significant training in the area and know that you are using a quality oil.


Eyesight is only one component of vision, however there are four other components that are also influenced by the vestibular system that do aid in visual processing. The four components attributed to vision include:

  • Fixation (ability to fix eye gaze on a stable object).
  • Tracking (ability to follow a moving object).
  • Focusing (ability to focus on one object without being distracted by others).
  • Binocular-vision (ability to combine the two pictures from both eyes into one).

Providing an environment free of overwhelming visual stimulation is key. If there are too many busy patterns, if the room is too bright (i.e. pediatric dentist office), you may have a child who becomes overwhelmed visually and cannot calm to receive touch therapy well. You are often better served with a simple, plain environment or a single visual focus.


Audition involves both the process of "hearing," as well as the process of what is being heard. The act of hearing is not to just physically to detect sounds, but also to integrate and assimilate the sound information received by the environment. Audition is also associated with the vestibular system.

In our work then, the standard massage environment set up with classical music or those containing animal sounds, may not be as soothing to a client with auditory processing differences. Music choices, or the lack of, should be considered when creating the best environment for a pediatric massage to take place.

Oral Stimulation/Taste

One of the very first ways we explore our environment as an infant is through the action of bringing items to our mouths. The compact presentation of tactile receptors in the lips, mouth, tongue, cheeks and gums are all stimulated and give us information about the object. As we grow, we continue to depend less on oral stimulation to understand our environment, however, this sense still plays a strong role in our daily functioning.

As therapists, we need to observe children for biting, grinding and other oral behaviors which may be an indication of possible anxiety, or self stimulation of the oral cavity. Providing targeted massage can often address a need for oral stimulation whether extra-orally, or intra-orally by trained providers.

Click here for more information about Tina Allen, LMT, CPMMT, CPMT, CIMT.


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