sensory diet
OBSERVATIONS FOR SENSORY DIET
Specific For: _____________________
Requested By:
Occupational Therapist
Note: Please make daily observations of your child’s behaviors and write notes in the spaces provided.
AM Wake-Up:
____________________________________________________________
Mid-Morning:
____________________________________________________________
Lunch:
_____________________________________________________________
Mid-Afternoon:
_____________________________________________________________
Evening:
_____________________________________________________________
Bedtime:
____________________________________________________________
During the night:
_____________________________________________________________
Outdoors:
_____________________________________________________________
Public Places:
_____________________________________________________________
Additional Notes:
BEDTIME:
Stop or Decrease Excitatory Vestibular Activities(ie, fast movements, quick changes or direction, rotary, or orbital movements) 2-3 hours before bedtime including Running, Spinning, Jumping, Swinging, Rocking,etc.
Decrease Caffeine Intake
Bathtime-
Þ Make environment warm
Þ Use lavender scented bath products
Þ Use long, deep pressure strokes with wash cloth up/down arms, legs, back.
Þ Use straws to blow bubbles in the tube or blow around toy boats in water(Blowing provides calming effect)
Þ Dry off with heavy towel using long, deep pressure strokes.
Þ Massage using lotion (preferably unscented)
Þ Have child push parent from bathroom to bedroom (provides proprioceptive feedback)
Þ Provide brushing and joint compression protocol.
Þ Use weighted blanket, weighted animal, etc.
Þ Provide bear hugs
Þ Use calming CD such as classical music or ocean sounds
Þ See Calming Vestibular List
PUBLIC PLACES:
30-45 minutes prior to going out- Provide
Specific For: _____________________
Requested By:
Occupational Therapist
Note: Please make daily observations of your child’s behaviors and write notes in the spaces provided.
AM Wake-Up:
____________________________________________________________
Mid-Morning:
____________________________________________________________
Lunch:
_____________________________________________________________
Mid-Afternoon:
_____________________________________________________________
Evening:
_____________________________________________________________
Bedtime:
____________________________________________________________
During the night:
_____________________________________________________________
Outdoors:
_____________________________________________________________
Public Places:
_____________________________________________________________
Additional Notes:
BEDTIME:
Stop or Decrease Excitatory Vestibular Activities(ie, fast movements, quick changes or direction, rotary, or orbital movements) 2-3 hours before bedtime including Running, Spinning, Jumping, Swinging, Rocking,etc.
Decrease Caffeine Intake
Bathtime-
Þ Make environment warm
Þ Use lavender scented bath products
Þ Use long, deep pressure strokes with wash cloth up/down arms, legs, back.
Þ Use straws to blow bubbles in the tube or blow around toy boats in water(Blowing provides calming effect)
Þ Dry off with heavy towel using long, deep pressure strokes.
Þ Massage using lotion (preferably unscented)
Þ Have child push parent from bathroom to bedroom (provides proprioceptive feedback)
Þ Provide brushing and joint compression protocol.
Þ Use weighted blanket, weighted animal, etc.
Þ Provide bear hugs
Þ Use calming CD such as classical music or ocean sounds
Þ See Calming Vestibular List
PUBLIC PLACES:
30-45 minutes prior to going out- Provide