Meltdowns in children—particularly those with sensory processing disorders (SPD), autism spectrum disorder (ASD), or ADHD—can be overwhelming for both the child and caregivers. In pediatric occupational therapy (OT), managing these intense episodes is essential to improving a child’s ability to function and participate in daily life. Among the most effective strategies are deep pressure stimulation and other calming techniques designed to regulate the nervous system and reduce sensory overload.
Understanding Meltdowns
Meltdowns are neurological stress responses triggered by overwhelming sensory input, emotional dysregulation, or cognitive fatigue. They differ from tantrums in that they are not intentional or manipulative but rather involuntary and rooted in the brain’s fight-or-flight system.
Children with sensory processing challenges often have difficulty filtering and integrating sensory information, leading to:
• Hyperarousal (e.g., noise, touch sensitivity)
• Hypoarousal (e.g., sensory-seeking behavior)
• Poor self-regulation
What is Deep Pressure Stimulation?
Deep Pressure Stimulation (DPS) involves applying firm but gentle pressure to the body. This input activates the parasympathetic nervous system, promoting a sense of calm and safety.
Examples in OT settings include:
• Weighted blankets or vests
• Body socks
• Compression garments
• Deep hugs or squeezes
• Therapressure brushing (Wilbarger Protocol)
• Joint compressions
• Massage or rolling with therapy balls
Mechanism: DPS stimulates proprioceptive receptors in muscles and joints, which help the brain feel more “in control” of the body, decreasing anxiety and sensory defensiveness.
The Role of Calming Techniques
In addition to deep pressure, OTs use a variety of calming strategies to regulate a child’s arousal levels and prevent or de-escalate meltdowns:
Sensory-Based Calming Techniques
• Auditory: Noise-canceling headphones, white noise, calming music
• Visual: Dim lighting, sensory tents, lava lamps
• Olfactory: Aromatherapy with lavender or chamomile
• Tactile: Fidget tools, soft textures
Movement-Based Techniques
• Slow, rhythmic rocking
• Gentle swinging in a sensory hammock
• Animal walks (proprioceptive + vestibular input)
• Yoga or breathing exercises
Cognitive and Behavioral Tools
• Visual schedules to reduce unpredictability
• Social stories to prepare for transitions
• Zones of Regulation or Alert Program
• Mindfulness techniques adapted for children
Clinical Application in OT Sessions
Pediatric OTs often incorporate calming and deep pressure strategies into:
• Sensory diets – customized daily plans providing needed sensory input
• Self-regulation training – helping kids recognize and manage their own emotional states
• Environmental adaptations – creating low-stimulation therapy spaces
• Parent/caregiver coaching – enabling use of strategies at home and school
Evidence and Outcomes
Research supports the effectiveness of deep pressure and calming techniques:
• Studies show reduced cortisol levels (stress hormone) following DPS interventions.
• Parents and teachers report decreased frequency and intensity of meltdowns.
• Children demonstrate improved attention, emotional regulation, and participation in activities.
However, individual responses vary, and interventions must be tailored to the child’s sensory profile, preferences, and goals.
In pediatric occupational therapy, deep pressure and calming techniques are foundational tools for managing meltdowns. By targeting the sensory and emotional regulation systems, these interventions support children in achieving greater independence, participation, and well-being. OTs play a vital role in assessing each child’s sensory needs and crafting personalized strategies that extend beyond the therapy room into everyday life.