“Cookie Cutter Therapy”- Why it’s OK with me….

The other day I did an autumn arts and crafts project with all of the students on my caseload.

Every. Single. One.

Kindergartners as well as fourth graders.

Very often we hear about the problem of a “cookie cutter therapist”.

Meaning – a therapist that does one thing with every single student regardless of their goals or deficit areas.

A lot of people have a problem with this and so do I – sometimes.

I might sound like I’m contradicting myself because I said I’m OK with doing the same activity with every single student but here’s the thing:

One of an occupational therapist’s best and greatest qualities is creativity and flexibility. Teachers have this gift, too!

Every single child has different goals – so tweak that activity to work for them!

Change it Up!

Here are some ways to tweak this simple fall craft.

  • For really weak fine motor skills, take one piece of tissue paper in each hand. Hold the student’s hands up in the air like a “Y”. Crunch the tissues into little balls without using his other hand or his chin or even his belly to help with the crunching.
  • To work on mid crossing midline; place the paper to the other side of the student’s body.  Put the helping hand on vacation (meaning behind his back). His dominant hand has to crossover in order to glue on the leaves of the tree.
  • My student with weak grip strength had to use a clothespin to pick up each tissue ball and place it on the tree.
  • My student with really poor scissor skills had to cut the tissue before he crunched. He also cut a piece of green construction paper to make grass for the bottom of his picture.

So – if you were a random person standing at the door of my occupational therapy room, you’d see every student come out with a picture of a tree with different colored fall leaves on it.

It might look like I’m doing cookie cutter therapy but I’m not.

It’s ok to re-use an Idea

My point is – give yourself a break! It’s OK to do the same or similar activity with different students.

Just use your creative mind to tweak it to work for that student and the needs of that student.

For teachers, this may mean creating groups of students who will complete the task in a different way. For example, the red table will use clothespins to pick up the leaves and the blue table has to crunch with two hands in the air in the shape of a Y.

Once you give yourself permission to do one activity with all the kids; you’ll see how easy it is to change it up.

Need an AMAZING Activity to do with your kids this week?

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Toileting and Sensory Processing

toileting, potty training, pooping, teaching to poop, poop in potty, poop and sensory issues

Potty-training can be a challenge for parents, but it’s also an important part childhood development. The normal struggle can be even more difficult when there are sensory processing issues. Recognizing that they need to go, wearing big girl or big boy underwear, and being able to use different toilets can all be impacted by sensory processing.

Why does Sensory processing matter?

Toileting requires a significant amount of body awareness.  Children have to understand how their body is feeling, learn how to release their bowel and bladder muscles in order to go, and feel that they have “finished” and their bowel or bladder is now empty.  

Sensory processing is a natural part of the toileting process. 

A bathroom environment can be overstimulating to start with.   We receive sensory information from our eyes, ears, skin, muscles, and joints and our brain’s job is to organize the information, select the important parts, and disregard the rest. When a child’s sensory systems are functioning appropriately,  they are able to participate in activities of daily living such as potty-training.  However, if the sensory systems are not integrated properly, toileting can become problematic.  

Everything parents Need to know

  1. WHAT IS SENSORY PROCESSING?
  2. HOW SENSORY SYSTEMS RELATE TO TOILETING
  3. BODY AWARENESS NEEDED FOR TOILET TRAINING
  4. PROBLEMS
    1. POOR INTEROCEPTION
    2. SENSORY DEFENSIVENESS
    3. POOR REGISTRATION OF SENSORY INPUT
    4. SENSORY SEEKING
    5. SENSORY AVOIDING
  5. HOW TO HELP: 15 AMAZING STRATEGIES FOR TOILETING
  6. CHILDREN WITH SPECIAL NEEDS

what is Sensory Processing?

Sensory Processing refers to how the nervous system detects, regulates, interprets and responds to sensory information.  Sensory Processing is an important factor in considering a child’s attention, memory, behavior, and function (Ahn, Miller, Milberger, & McIntosh, 2004; Gardner &Johnson, 2013).   A child’s brain needs to be able to register sensory information from the environment and react appropriately to it.  If a child has difficulty regulating and processing sensory information, they may have Sensory Processing Disorder.

Sensory Processing Disorder is a neurological disorder in which the sensory information that a child perceives results in abnormal responses.   Children who have difficulty processing sensory information often have inconsistent responses because they have a hard time discriminating between which sensory information is important and which can be ignored.  

It is important to note that many children (and adults for that matter) have difficulty with processing certain types of sensory input.  Typical things such as disliking certain smells or textures, feeling seasick on rides, or preferring certain foods do not necessarily mean that a child has sensory processing disorder. They may simply still be learning to process certain sensory stimuli.

toilet training, potty training, toileting readiness, developmental checklists

There are eight  sensory systems in our bodies:

  1. Tactile System (touch)
  2. Vestibular System (balance)
  3. Proprioceptive System (position in space)
  4. Olfactory System (smell)
  5. Visual System (sight)
  6. Auditory System (hearing)
  7. Gustatory System (taste)
  8. Interoceptive System (internal body awareness)

Interoception is our ability to sense what is going on inside our bodies internally.  It includes sensations such as thirst, hunger, fatigue, pain, breath, itchiness, nausea, temperature, etc.  It also includes our sense of if we have a full bladder or bowel, and if we have “released” it. (Garland, 2014).

An Explanation of the Sensory Systems related to Toileting

The proprioceptive, vestibular, and touch senses are primary influences on the integration of our senses.  The interoceptive sense also plays a crucial role in developing the foundational body awareness needed to function as a child.

When a child is unable to integrate and react to sensory information appropriately, the child will not interact with his environment in a functional manner.  He may have exaggerated responses to typical noises or sensations or withdraw from certain stimuli. The child cannot consistently process sensory information, so their responses will be inconsistent, too.

If the child has decreased body awareness, they may demonstrate an inefficient grading of force or movement.  For a boy, this may mean they have difficulty using the right amount of force when holding or aiming the penis.  This might result in a child pressing so hard that it’s difficult to pee,  holding too tightly, or having difficulty holding steady.

Our vestibular system helps us to maintain our balance. The fluid in our inner ear moves as our head moves, sending messages to our brain about where our body is in space (Abraham, 2002).   Some children with vestibular dysfunction present with “gravitational insecurity“, which makes them seek a secure position during activities. They may dislike swings, being picked up, or participating in activities in which they are not in control of their body in space.  These children might be fearful when attempting to sit on a “grown-up” toilet where their bottom is unsupported because they feel like they may fall.

Children with vestibular, tactile, and proprioception difficulties may have difficulty with eye-hand coordination and depth perception. It may be difficult for them to aim appropriately or estimate where to stand.

Many children with sensory processing difficulties have auditory sensitivities that interfere with toilet training.  Think of the loud echoes, flushing toilet, the hand dryers, etc.  Noises that are simply loud to an adult can be piercing to a child with auditory sensitivities.

Tactile sensitivities can interfere with toileting, too! Children may dislike the sensation of pooping, wiping, or even sitting on a hard seat.   If they are under-responsive to touch, they may not realize that they aren’t covering their hand properly with the toilet paper, they aren’t wiping well enough to clean themselves, or that they’ve soiled their clothing.

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Sensory Processing and Body Awareness needed for Toilet Training

When our body is able to receive and interpret the signals from our skin, muscles, and joints, we are able to feel and know what our body is doing without looking at it.  When a child has poor body awareness, it can lead to difficulty coordinating their body to do all of the components that are involved in toileting.   It is not automatic to feel the urge to go and just go to the bathroom.  Each step of the task must be thought out and carefully performed, so it is important to be patient.  It’s hard to know what to do if you can’t feel what you are supposed to feel!

Typically, toddlers and preschoolers spend a lot of time learning the “ins and outs” of toileting.   Children are expected to be toileting independently before entering Kindergarten.  Children with difficulties modulating sensory input find potty training to be a much bigger challenge than a typical child.  The bathroom can be an overstimulating environment, so asking a child with sensory integration difficulties to focus on the task at hand (ie; peeing or pooping) is a challenge if they are overwhelmed with fear or anxiety about other sensory signals they are receiving.  Problems with toileting and sensory processing might include (but not be limited to) the following:

Toileting and Sensory Processing Problems

1. Toileting and Sensory Processing Related to Poor Interoception

  • May be unaware that his bowel or bladder is full.
  • Feels that they need to go, but not be able to discriminate whether they need to urinate OR have a bowel movement.
  • Unable to “push” in order to go; don’t understand how to make those muscles work
  • Cannot feel that they have had an accident or that their clothes are soiled.
  • Unable to bend and reach behind them to properly wipe

2. Toileting and Sensory Processing Related to Sensory Defensiveness

  • Dislikes the feeling of “peeing” or “pooping” and withholds.
  • Fearful of falling into a regular sized toilet
  • Dislikes the feeling of wiping or being wiped.
  • Prefers the parent to wipe them
  • Does not like to wash their hands
  • Takes off all their clothes to use a toilet
  • Avoids flushing the toilet

3. Toileting and Sensory Processing Issues Related to Poor Registration of Sensory Input with a Hyperactive or Over-reactive Response

  • The child is fearful of the sensations involved when they pee or poop.
  • Reports that the act of “peeing” or “pooing” hurts terribly, crying, etc.
  • Extreme reaction to the sound of the flush or the air dryer
  • Gags, or chokes at the smell of the poop
  • Visually distracted by details in the bathroom, including lines in the tile, dust on the floor, etc.

4. Toileting and Sensory Processing Related to Sensory Seeking

  • Repetitively flushing the toilet
  • Fecal smearing
  • Repetitively having accidents in pants, enjoys the sensation
  • Playing in the water
  • Playing in the sink
  • Asks to use the toilet in public constantly

5. Toileting and Sensory Processing Issues related to Sensory Avoiding

  • Avoids wearing big girl or big boy underwear, prefers a diaper
  • Will tell you when the diaper needs to be changed, doesn’t want a wet diaper
  • Difficulty tolerating new bathrooms, public bathrooms, etc.
  • Covers ears when flushing, air hand dryer goes on, etc.
  • Holds nose for bowel movements
  • Avoids using certain toilets with “hard” seats
  • Avoids going into the bathroom, “sneaks off” to poop in diaper behind a couch, etc.

potty training, sensory processing

How to Help: 15 Amazing Strategies for Toileting

1. Try a  4 in 1 Stages Potty Seat which is closer to the ground and fits a smaller bottom. It also helps transition to use a grown-up toilet

2.  Try fun potty seats like this Race Car Potty and Character Underwear that are motivating!

3.  Try using flushable wipes and a Wipes Warmer to make the experience of wiping more enjoyable

* one consideration for this is that your child may begin to rely on it…. if you are out in public and don’t have warm wipes, will it be a problem?  Take that into consideration before making it part of your routine.  But if you are desperate, it’s worth a shot!

4.  Sing Songs to make toilet training more fun:

  • “Let it go! Let it go!”
  • “Push it out, Push it out, WAY OUT!”
  • “Pee Pee in the Potty, Pee Pee in the Potty!”
  • “I just want to Potty all the time, Potty all the time, Potty all the time!”

5.  Use painter’s tape to make a line for boys to know where to stand

6.  Offer Toilet Targets  or use goldfish crackers or fruit loops (get the pee in the hole!)

7.  For children who aren’t sure if they have to pee OR poop, let them sit.  It’s hard to tell which muscles are which.

8.  Provide an inviting environment depending on your child’s sensory needs:

  • For a sensory seeker, bright lights, fun music, and toys alerting aromatherapy (peppermint and eucalyptus).

  • For a  sensory avoider, soft lighting (night lights) and music, calming aromatherapy (lavender and chamomile).  *Click for more info about Aromatherapy

9.  Let your child leave the room before flushing if they are defensive, OR let your child choose if they flush or you do.

10.  Use earplugs to block the sounds, (especially in a public bathroom), OR keep post-its in your bag to put over the automatic sensor.

11.  Use a soft toilet seat.

12.  Keep a  Potty Training Chart   or offer Potty Reward Stickers for Boys or Girls

13.  Try a toileting schedule. Have your child sit on the toilet every 15 minutes for a few minutes. If they go, Wahoo! big Praise. If not, that’s ok, we’ll try again in 15 minutes.

14.  Provide a Kitchen Timer for set “potty” sitting times.  Let your child set the timer so they are a part of the process.

15.  If your child is fearful of the sensation of pooping in the toilet, have them help you dump the poop from the diaper into the toilet and then flush it.

Toileting and sensory issues

Toileting and Sensory Processing in Children with Special Needs

Very often problems with potty-training, such as accidents, difficulty recognizing if they have to go, struggles with hygiene, fear of flushing, and refusal to use the toilet are the result of an inefficient sensory processing system.  It is important to note that children with developmental delays and other diagnoses may need more time to be trained.   As parents and educators, it is essential to treat the process with patience.  Your child has a lot of information and sensory signals to make sense of and every child has to go at their own pace.  Do not feel the “peer pressure” from other parents that your child “should be” ready.

Sensory Processing Resources

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potty training, toileting, toilet training, developmental checklists, ready for potty, potty and sensory, poop and sensory

Additional Potty Training Resources

Establishing Toileting Routines for Children Tips – a Printable from the American Occupational Therapy Association

6 Tips for Successful Potty Training from the American Occupational Therapy Association

References

Abraham, M. C. (2002). In Pressnal D. O., Wheeler K. (Eds.), Addressing learning differences: Sensory integration; practical strategies and sensory motor activities for use in the classroom. Frank Schaffer Publications.

Ahn, R., Miller, L., Milberger, S., & McIntosh, D. (2004). Prevalence of parents’ perceptions of sensory processing disorders among kindergarten children.  American Journal of Occupational Therapy, 58, 287-293.

Crozier, S. C., Goodson, J. Z., Mackay, M. L., Synnes, A. R., Grunau, R. E., Miller, S. P., et al. (2015). Sensory processing patterns in children born very preterm. American Journal of Occupational Therapy, 70.

Daunhauer, L., Fidler, D., & Will, E. (March 2014). School function in students with down syndrome. American Journal of Occupational Therapy, 68(2):167-176. 

Garland, T. (2014). Self-regulation interventions and strategies. Eau Claire, WI: PESI Publishing & Media. Shelly J. Lane, PhD, OTR/L, FOATA, Isabelle Beaudry-Bellefeuille, MScOT; Examining the Sensory Characteristics of Preschool Children With Retentive Fecal Incontinence. Am J Occup Ther 2015;69(Suppl. 1):6911500194p1. doi: 10.5014/ajot.2015.69S1-PO6099.

Functional Skills for Kids

Do you have an amazing toileting trick or tip? What potty training strategy helped your child?

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A Valentine’s Day Motor Monday: Super Simple Hand Strengthening

I have a confession: I love the Dollar Store.  I just do.

The problem is that it’s impossible to leave without a few extra things.

BUT – that’s how I ended up with my latest and greatest Valentine’s Motor Centers.  

I swear I just went in there for a couple of birthday cards, but when I saw the “seasonal section” filled with Valentine’s Goodies, I couldn’t resist.

These adorable pink and red Valentine’s Day “table scatter” hearts were the perfect size for little hands to work on grasping.  I just started adding to my basket.  

Sigh.

Why resist?  It’s for the children!

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core strength

How To Support Your Child’s Core Strength Development Every Day

Back in the olden days, my parents had to walk to school 2 miles each way. Barefoot. Uphill. And they had to walk home for lunch, too.   Motor skill development wasn’t such a problem back then.

As a child, I never questioned how it was possible that it was uphill both ways, but now I get the feeling they may have been exaggerating.  Just a bit.

In today’s day and age, kids hardly ever walk to school.  Or anywhere, for that matter.  Even the ones who live down the block get dropped off by parents on their way to work.  I can see how this is easier during the morning rush and safer than letting your child wander the streets alone.  But kids need exercise.  And the truth is, there are easy ways to make sure you are supporting your child’s health and gross motor skill development every single day. Continue reading

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fine motor Scissors

Fine Motor Skills and Cutting

Learn how to improve your child’s cutting skills with these simple tips from a pediatric OT.   *This post contains affiliate links

How to Improve Your Child’s Cutting Skills 

“Cutting?”   The mom looked at me nervously…. “Um, I’ve never given my child scissors…. I don’t want him to hurt himself….”   Her face turned red.   “Should I?!”

The poor mom was panicking as she asked me about kindergarten.  She was totally nervous that her son wouldn’t be able to keep up.  Trying to reassure her, I asked how he holds his pencil and how were his cutting skills.  And instead of making her feel better, I made it way worse!   Uh-oh.

(This happens all the time, by the way.  Moms don’t realize that kids should be cutting WAY before Kindergarten. But really – if you are worried that your kid will hurt themselves when they are sitting with you in the kitchen, do you really want them learning how to cut while the teacher is also supervising 20 other kids? )

Nah – better to get them started before school so they know what they are doing.  It gives them a “leg up” on the rest of the kids.    You can always give them those little safety scissors if you are worried that they will cut themselves.   Or the playdoh scissors, which don’t have real blades.

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10 pocketbook-sized toys to occupy your kid (instead of your phone!)

 handwriting, fine motor skills

I am totally on the “LIMIT TECHNOLOGY” for little kids bandwagon and am all about “Pocketbook-Sized Toys”! I have been so inspired by some articles I’ve read lately; especially a great article by Your Therapy Source (link at the bottom).  So I decided to make a list of 10 pocketbook-sized toys to occupy your kid (instead of your phone!)

As a public school OT, I work with Kindergarten students two days a week.  The continued decline in the basic motor skills of four and five-year-old children is VERY evident.  There are probably many reasons why, but I feel that lack of functional play time is a BIG contributor.    Nowadays, many kids have their own tablets, TV’s in their rooms, and an IPOD shuffle. They spend less and less time playing outside, which limits their gross motor skills, endurance, and coordination.   When they are inside, they spend less time playing with toys and using their hands and more time with technology.

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How to Throw a Kids Halloween Party…Sensory Style!

sensory processing, spd, sensory recipes, Halloween slime

Autumn:  pumpkin pie, costumes, and everything else.

As an OT, I love to get into the “Halloween Spirit” of things at school with my students.  Sensory recipes are always a great way to work on multiple skills at once, including Mixing, Measuring, Pouring, Stirring, and Kneading.

Cooking is a great way to work on fine motor skills, bilateral coordination (using two hands), dexterity, and functional life skills.

 Sensory recipes are a non-edible method of working on all the above skills, which is perfect for school.

Food Allergies at Halloween

It’s important to make sure that none of your students have food allergies or aversions when you bring a Sensory recipe into a classroom. Some of my kids have gluten-free diets or nut allergies, so when in doubt, I send a letter home with the ingredients a week before the activity to get permission from the parent.  Better to be on the safe side.

Halloween parties often include lots of candy and junk food. Instead of the typical sugar overload, why not set up a bunch of fun Sensory activities to get your kid’s friends in the Halloween Spirit?

Halloween Sensory Recipes

Here are my five favorite Sensory recipes – with a Halloween spin!

1) Halloween Dirt Doh

I’ve written about this recipe before, it’s a simple recipe with used coffee grinds.  Make a large batch and it’s perfect for a Spooky Coffin!

Here’s the recipe:

2 cups used coffee grinds (wet or dry)

2 cups of water (add it little by little until you get the consistency you want)

2 cups of flour (add more if you need to make the doh a little more doughy)

I asked my local bagel store to save me all their used coffee grinds for a few days before our Halloween party.  When I went to pick it up, they had three bags full.  Perfect!  I filled an “under the bed storage” tupperware container with my ingredients.

I let my students mix it up with spoons and their hands.  Then we hid some “spooky” items in the dirt – eyeballs, fingers, and bones.  Add a fake tombstone and voila!

Now you have an awesome spooky sensory activity that addresses tactile defensiveness, hand strength, and bilateral coordination.   Also – used coffee grinds have a distinct odor.  Kids who are picky eaters usually have a strong sense of smell, which can trigger a gag reflex.  Engaging in “smelly” activities is a good way to work on desensitizing the sense of smell.   Finding things that are hidden in a busy background is a visual perceptual skill called visual figure-ground.

Add a blindfold that takes away the visual component, and now you are working on stereognosis.  Stereognosis is the ability to recognize an object by using tactile information.  This means a person uses their tactile sense without using their vision or sense of vision or hearing to figure out what they are touching.  Just like digging in your purse for your phone, while looking at something else.

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Sensory Processing 101 is a vital resource for parents, therapists, and teachers who work with children with Sensory Processing Difficulties.

Bet you do that a lot! I know I do…

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dirt doh, coffee grind doh

2)  Halloween Slime

A simple slime recipe can be altered a million different ways.  Add a bit of food coloring or washable paint and you can color it to fit any holiday or theme.  I used my go-to slime recipe, added a bit of orange food coloring, and gave my kiddies some cheap Halloween manipulatives to play with.

Here’s the recipe:

2 cups of Elmer’s glue

2 cups of water

2 cups of liquid starch (found in the laundry aisle)

Mix the glue and the water together to thin out the glue.  Then, slowly add the liquid starch. Mix together with a spoon, then knead with hands.  Add coloring to your liking.  Once the starch is all blended (I let the kids take turns kneading and squeezing the whole batch), split the batch into individual portions for each child.  Then the fun begins!  The texture of the slime can vary, which can alter your activity. I had one class that ended up with very “stringy” slime, which reminded us of spider webs!  Another class had very firm slime, which was perfect to make Jack o’ lanterns.  Add some cookie cutters, manipulatives, etc. and let the kids get creative!  You can even leave it white and let the kids create their own mummies or ghost faces!

 

slime, Halloween, oobleck,

slime, Halloween, pumpkin

 

3) Halloween Play-doh

– you can go simple and just buy playdoh, or you can whip some up the old fashioned way.

You can use cookie cutters to make witches, pumpkins, spiders, you name it!  I like to use a chip tray to give my kids cut up pipe cleaners, wobbly eyes, and tiny spiders.  The kids can make a Halloween creation of their own design.

spidertray, sensory activities, HalloweenHalloween playdoh, spider

 

4) Pumpkin Pie Playdoh

I am a pumpkin lover. I love the taste, but I also really love the smell! Like I said, it’s good to incorporate olfactory (smelly) stuff into your activities. It can help picky eaters to broaden their boundaries and it is a great way to incorporate multi-sensory learning into your lessons.

You can use a simple play-doh recipe and add some Pumpkin Pie Spice and some orange food coloring and you have the perfect Pumpkin Pie Playdoh!

Halloween sensory, sensory recipes, oobleck, slime

Here’s what you need to make the doh:

2 cups of flour (you can use gluten-free if you need to)

1/2 cup of salt

1 cup of water

a dash of pumpkin pie spice (a make your own recipe listed below if you can’t find it)

a couple of drops of orange food coloring or washable paint

Mix the flour and the salt together. Add the water bit by bit and keep mixing and kneading until you get a firm, doughy texture.  Add the pumpkin pie spice and the orange paint. I like to do this at the end because the kids can see where the paint isn’t mixed.  This gives them a visual cue to keep kneading, twisting and squeezing until the colors are blended nicely.

To make pumpkin pie spice:

1/4 cup of ground cinnamon

4 tsp. ground nutmeg

4 tsp. ground ginger

1 tbs. ground allspice

This results in quite a bit of pumpkin pie spice – you can half it if you want, but I love to keep it around and use it to flavor my coffee. Add a teaspoon to your regular coffee grinds and you’ve got some fabulous pumpkin flavored coffee.  Who needs Starbucks!? Budget Divas make their own!

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The Sensory Processing 101 Bundle sale ends Oct 31, 2017!

 

5)  Ghost Guts

My kids got a giggle out of this one!  I took a simple sensory recipe and gave it a Halloween name.  It went great!

Here’s what you need:

2 parts corn starch

2 parts shaving cream

You can give each kid a bowl or make it in one big batch.  I made it in a big Tupperware bowl and let my kids do the mixing.  I also hid some little white bones and spiders in there for my kids to pull out. They loved it.

ghost guts

 

I hope your Halloween party is a smashing sensory success!

Do you have any great Halloween Sensory Recipes to share with us?

Miss Jaime OT

Happy Halloween! ~Miss Jaime, O.T.

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Products You May Enjoy:

 

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Jelly BeadZ® Water Gel Beads

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