Sensory: Brushing Program

These instructions for Children's Hospital of Philadelphia (CHOP) patients describe how to perform brushing therapy.

Important information:

Some children have difficulty with one or more of their five senses. These children may be uncomfortable when certain, normal, things touch their skin. They may be overly sensitive to light or unexpected touch, sudden movements, or loud noises. Problems with one or more of their five senses can affect all parts of the child's life including behavior, social skills, self-care, and learning. Brushing therapy tries to reduce these problems. This program uses deep pressure touch on the skin, heavy compression to the joints and muscles, and pressure to the inside of the mouth.

Patient instructions:

Technique

The key to positive results is the pressure touch sensation. The ideal pressure is like spreading peanut butter. The pressure touch should be applied at a steady pace but not too fast. The goal is even pressure and control of the brush.

Where to brush

Brush in a steady motion. Cover as much of that body area as possible but avoid brushing back and forth over the same area. The bristles should bend all the way over and all the way back during each stroke. The goal is to quickly fire up many pressure touch points in a large body area. This includes both arms, both sides of the hands, the back, the legs, and feet.

Where to avoid brushing

• Belly surface

• Head/face/neck area

• Inner/under arms

• Inner thighs

How to hold the brush

Apply smooth and even deep pressure directly over the skin. Brushing can be done over clothing, but directly on the skin is preferred. If you are brushing over clothing, it is important to hold the clothing, so it does not move over the surface of the skin.

Never scrub

Do not brush back and forth over the same area. If you are brushing larger areas like the back, legs and arms, keep moving the brush to new areas. When doing small areas like the hands, soles of the feet or the back of small children, it is difficult not to go back and forth over the same area, so brush a few times and move on to another area.

Compression

Do compressions right after brushing. Give 10 quick presses to the joints of the arms and legs. Compress the shoulders, elbows, and wrists and into the hips, knees, and ankles. Make sure that the joint above where you are giving compressions is extended and does not collapse. Hold the joint straight with your other hand if needed. Your child can do their own compressions by jumping in place and doing push-ups from the floor or wall. Completing their own compressions best.

Timing

Brushing and compressions should be done every 1 1/2 to 2 hours. The effects of brushing only last for about 2 hours. The purpose of the program is to help the child feel calm and alert, while also relaxed and comfortable.

Supervision

Your child's occupational therapist will decide if brushing is right for your child. They will teach you how to do the skills and check your child's response. If there is no positive change in your child after 3-5 weeks, the therapist will speak with you about what to do next.

Extra care

• Do not brush over sore areas of the skin like cuts, burns or rashes Never brush over weeping or open wounds.

• Report any unexpected responses, such as changes in behavior or changes in appetite to your child's occupational therapist.

• If the skin gets red while you are brushing, it may be an allergic reaction. Keep moving and avoid the red area. Check to make sure you are not scrubbing over the same area.

• If your child has painful joints, joints that are dislocated, or joints that are very loose due to low muscle tone, the joint compressions may need to be changed. Please ask the occupational therapist to help you with this.

• Speak with your healthcare team for approval before using the program with a child who has a medical condition.

Reviewed on December 21, 2022, by Diana Lansinger, MOTR/L