Sense of Movement and Balance: Development of a Child’s Vestibular System

Judy Benz Duncan, Occupational Therapist

Does your child seem to have a motor, always be on the go, loves to spin, twirl, rock or swing for hours at a time? They may need support to help mature their vestibular system to age-appropriate levels.

A child’s sense of movement and balance is centered within their vestibular system. The nerves that control the vestibular system and reactions, are located within a child’s inner ear where they sense changes in gravity and movement.

The vestibular system works by telling a child’s brain what direction they are moving in, whether their head is up, down or turned to the side, and helps a child feel the need to change and adapt their posture or position in order to stay upright and erect. Some children do not register movement as well as others might, and so they tend to seek out movement so much so, that it seems like it is all the time!

Vestibular System Development

In some children, their sense of vestibular movement is under-responsive, so these children continue to seek movement experiences. Sometimes children seek movement unconsciously even when they are involved in eating, watching TV, or listening to a story. The vestibular system provides information about movement and gravity. The sense also tells about the body motion, it’s direction and speed.

Seeking out movement is a normal stage of development for preschoolers, however if you think your child is even more active than most young children their age, seeming to be always on the go, spinning, twirling, or swinging for hours at a time then their vestibular system may not have matured yet. An immature vestibular system makes it extremely difficult for a child to be able to sit, focus, attend, and concentrate on tasks that they will find in pre-school or school settings.  

Examples of Sensory Seeking Behaviors:

Some common behaviors seen in sensory seekers include

o   They look for MORE sensory stimulation

o   Difficulty with sitting still, needing to move, fidgets, touch or talk excessively (these behaviors may be misdiagnosed as ADHD)

o   May rock for hours on end; may unconsciously rock while they are doing other things (eating, reading, watching tv)

o   May appear to be too “loud” and have difficulty knowing how loud they are talking

o   Seem to be constantly playing rough, or “roughhousing” with others

o   May be seen running, spinning in circles, loving the merry-go-round and fast paced rides

o   Seems to enjoy jumping, hopping, running into hard objects, bumping into furniture or people

o   May love just “twirling” around the room or outside without ever seeming to get dizzy

o   May like hanging upside down to self-swing sideways or back and forth

o   May have difficulty with or poor visual processing

o   May have issues with good spatial awareness

o   Poor balance

o   Difficulty with bilateral integration

o   Sequencing deficits during routine self-care and play tasks

o   Poor visual-motor skill development

o   Tends to stand too close; does not understand personal space, craves “bear hugs,” seems to always want to touch you with their body/hands/feet

o   May like oral motor stimulation that includes chewing on inedible items (toys, clothes, utensils, hard items), or wanting to eat hard crunchy or spicy foods

o   Sleep issues; poor ability to relax and nap or sleep

o   Seems to walk loudly or heavily, making lots of noise as they go

o   Seeking out behaviors may put them into unsafe situations

o   May seek out video games or fast-paced tv shows

o   Poor discrimination of body position or awareness of body posture

o   Poor discrimination of movement (speed, force, direction)

o   Subtle issues with knowing posture/position of their head

o   Trouble in negotiating the sequences of dynamic and active gross movement patterns

OT Activities, Ideas, and Suggestions for Development of a Child’s Vestibular System

The following activities, ideas, and suggestions may help you support your child in reducing the impact of their need for vestibular movement and promote maturing of that system.

Please speak with your child’s pediatrician, OT, ST, PT, and service providers for their input, advice and guidance before making or attempting changes – these ideas may or not be the best choice for your child, and working with those who do know your child is the best bet for success!

OT Vestibular Activities, Ideas, and Suggestions 

The sensory vestibular activities and ideas offered here, help to promote performance and tolerance to movement activities. They also provide functional fun challenges against gravity to help children that may have difficulties with their equilibrium, balance, self-regulation, vestibular maturity, and adjusting to changes in sensory input throughout a child’s normal day. Adding a few vestibular activities to the day allows for long-lasting effects. 

Talk with your child’s service providers – they can help modify, adapt, or give suggestions on how to make changes that will be the most effective for your child.

NOTE: Children that have impaired sensory systems may not be able to recognize when they have reached a point of “too much” input during the vestibular activity. Be aware and alert that sensory overload may present with pupil dilation, sweaty palms, changes in respiration, and disorientation. If your child withdraws or becomes overwhelmed with any of the activities or media presented, move on to something else!

Try using any of the following strategies, paying close attention to your child’s tolerance levels:

Your child may only tolerate one or a few of the ideas suggested – remember it’s trial and error and giving your child some control over what they will work with will help in preventing sensory overload.

o   Provide your child with plenty opportunities to engage in active play to help develop their sense of movement and support the acquisition of motor skills 

o   Visit the park and let them run around and play on the playground equipment – supervise for safety 

o Bouncing on a mini trampoline or therapy ball with consistent, rhythmic patterns

o Playing hopscotch

o Attending a gymnastics center for supervised class

o Swinging in a hammock, swing, or swing rope, or in gymnastics class

o Spinning on swivel chair, scooter board, or sit and spin

o Rocking using a rocking chair or rocking toy ride-on horse

o Climbing on kid-safe ladders, monkey bars, kid play rope web,

o Upside down time on a trapeze, monkey bars or in gymnastics class

o Play in active outdoor games that are kid-friendly and supervised for direction and safety, like hockey, football, soccer, volleyball, basketball

o Play on kid-friendly slides

o Riding on a roller coaster

o Swimming in a kid-class, YMCA program, or summer camp

o Sensory Gonge Top (CLICK & GO for Blog on Sensory Gonge here on TheraPlay4Kids.com) As always, before using a Gonge, consult and plan with your child’s services providers and doctor, to ensure everyone is on the same page, you are receiving any training, instruction, and guidance you need. Your child needs everyone working together!

o   Kid classes for martial arts or yoga

o   Gymnastics (kid classes, or kid-safe areas at a facility)

o   Watch your child to see if there is any pattern to their movement. Do they rock or fidget even when watching the TV or eating their meals? Is the movement more obvious when they don't like the task e.g. they don't want to sit and eat because they really want to get back to playing?

o   Use of Fidget Toys (CLICK & GO for Blog on Fidget Toys here on TheraPlay4Kids.com)    

o   Make sure your child has lots of opportunities to work off their energy throughout the day. Plan ahead and give variety to your weekly plan to keep interest and participation high.

o Use an air cushion or wiggle pad for movement when your child needs to stay seated during tasks or activities that require focus and attention

o Heavy work activities (CLICK & GO for Heavy Work Blog here on TheraPlay4Kids.com) 

o   Body part awareness activities (CLICK & GO for Body Part Awareness Blog here on TheraPlay4Kids.com)

o   Don't let the weather stop you from going out and about; an outing on a rainy or snowy day can make the difference between your child being up during the night and everyone having a good night's sleep!

o   If your child tries to move even when sitting, try different types of seating surfaces.  Child size swivel chairs or rocking chairs are great if you have the space for them. Try sitting on a large beach or therapy ball, or an inflatable peanut shaped ball that they can sit over with one leg on either side, or even a wedge-shaped air filled cushion that can be placed on a dining chair for your child to sit on at mealtimes.  These all provide your child with a sense of movement even when they are sitting 'still'.  

o   Set up an obstacle courses inside using furniture, pillows and blankets, empty box to crawl through, a taped line to follow, creating areas to crawl on, under and through. Outdoors, you can use things like hula-hoops to jump in to and out of, adding in movement task “stations” that ask them to perform jumping jacks, commando crawling, bear walking, walking on a line or low balance beam, and other creative movements that challenge your child to balance, crawl, jump, skip, and run.

o   Hippotherapy or Equine Therapy (check for what is in your area!) 

o   Activities and games where your child needs to Stop and Start their movements are often more stimulating than the movement itself. Playground activities where your child can change direction, come to a sudden halt, or move at both fast and slow speeds are all great choices. Some activities you could try could be Tag, Duck-Duck-Goose, Hopscotch, running an obstacle course with stop and freeze sections, playing Musical Chairs or Musical Statues, are a few outside (and inside if you have the room) games

o   Try using a see-saw, swinging on the monkey bars, using the merry-go-round

o   Prone swinging (use a swing with soft wide base for comfort)

o   Small rubbery bounce pads / wiggle pads

o   Try using a vibrating cushion for short periods of time.  Intense vibration may provide the movement stimulation your child is seeking

o   Use a child sized rocking chair where the gentle rocking motion can be quite calming and relaxing

o   Try offering your child a weighted blanket to wrap round themselves or put over their knees

o   Lycra body sock / sensory bag (CLICK & GO for Article/Info on Sensory Bag and Compression Clothes here on TheraPlay4Kids.com) 

o   Using body awareness (proprioceptive) input can help suppress the need for movement input.  (CLICK & GO for Blog on Developing Body Awareness here on TheraPlay4Kids.com)

o Do you have a therapy or exercise ball that your child could sit on while they are watching TV, sitting at the table, eating or doing a sit down activity? Try a therapy ball for your child to lay over while they watch TV, play with a toy, or read a book. For those with decreased balance, try a peanut-shaped ball to straddle.

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