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While experts debate just how many senses a human has, most people know the basic five: Sight, hearing, smell, taste, and touch. At RiverView Health, members of the Occupational Therapy Team now offer pediatric therapy for a lesser-known, but just as important sense, interoception.

Interoception is the sense that helps you understand and feel what's going on inside your body as receptors inside your organs send that information to your brain. For example, you feel hunger pains when you're hungry and a dry mouth when you're thirsty.

However, for children with sensory processing issues, the brain may have trouble making sense of that important information, leading to problems with activities like toilet training because the child doesn't understand when their bladder is full. A child lacking interoception may not understand when they are hot or cold, in pain, or about to vomit.

Lack of interoception sense may also cause a child to act out in aggression, cry or scream uncontrollably, or show other signs of sensory dysregulation because they are confused by their body's signals and don't understand what to do to make themselves comfortable.

RiverView Services

Maddie Engelstad, MOTR/L, Stacy Spray, OTD, OTR/L, and Marrisa Jevne, COTA, are specially trained in the interoception curriculum and began offering the new therapy to pediatric patients at RiverView in the fall of 2023.

"The primary issues or deficits I see in patients who benefit from interoception skill building, are those who are having a hard time connecting their brain and body," shared Engelstad. "Usually, I see this in patients with Autism Spectrum Disorder, ADHD/ADD, Sensory Processing Disorder, or any child that has difficulty with emotional regulation. The other population I've seen this benefit is patients with difficulties with bladder and bowel management and learning to understand feelings of urgency, pressure, and those internal signs that don't always make sense or we may forget about if we're busy playing and learning."

If interoception therapy is determined appropriate for the patient after an evaluation, caregiver input, and clinical observations, the therapists conduct "experiments" about each part of the body, shared Spray, including outside (hands/fingers, feet/toes, mouth, eyes, ears, nose, voice, cheeks, skin) and inside (muscles, lungs, heart, brain/head, stomach, bladder) the body. An example Spray shared for the mouth is having the child suck on an ice cube for 5 seconds, then describe how that made their mouth feel. The child can pick from a list of words or make up their own if they would like.

"The children I have seen who have shown improvement with their interoception skills are identifying how their body is feeling more independently and recognizing what the feeling means for them," Spray reported. "For example, a child may notice their heart is going faster than normal and recognize that this is because they are excited or anxious. They are then able to determine an appropriate action to take to assist with regulating their heart rate.

"The goal is for the child to make these connections with increased independence and it's so fun to see when they are in therapy sessions and making the connections with decreased assistance over time. It's even more exciting when the parents are coming to therapy sessions with comments, such as 'he was able to tell me yesterday that he was needing a drink of water because he noticed his mouth was feeling dry,' demonstrating the interoception curriculum is carrying over into daily life situations."

Engelstad said the curriculum is great for patients as young as 4-5 years of age and up to 12 and 13 years old.

"They start to understand why their body feels a certain way and how that relates to their emotions," Engelstad stated. "The 'experiments' bring to light sensations that they have felt, but didn't know what those sensations meant or weren't able to relate the sensation to particular emotions."

Jevne also reported that through the therapy, she had seen significant improvements in the children's ability to identify their body signals to help them recognize their emotions.

Implementing Interoception Curriculum at Every Level

While Engelstad said she started offering the therapy in October of 2023, she's found it helpful in other therapies she offers and has integrated it into all of her patient sessions, whether she's directly focusing on interoception skills or other therapies that focus on self-regulation, coping skills, and frustration tolerance building.

There are many activities you can do with children to help increase their interoception skills, including asking them questions about how they are feeling and discussing those feelings or reading them children's books on topics like emotions, toilet training, and problem-solving.

If you have concerns about your child's development, talk to their primary care provider or call RiverView's Rehab Services Department at 281.9463 for more information on interoception therapy. The Rehab Services Team also offers free developmental screenings if you have concerns about your child's development.

Maddie Engelstad, MOTR/L

Stacy Spray, OTD, OTR/L

Marrisa Jevne, COTA