A Guide to Understanding Pediatric Occupational Therapy

Activities of Daily Living (ADLs)

This is the primary focus of occupational therapists. We aim to help our clients become as independent as possible in areas of self-care including playing, dressing, bathing, grooming, eating, brushing teeth and cooking, to name a few.  With children, we are often teaching these skills for the first time.  Mastering these skills will take a lot of practice, time and patience as well as mastery of many of the foundational skills listed below.

Fine motor skills

Fine motor skills refer to the coordinated use of your hands and fingers for functional tasks.  Some tasks requiring strong fine motor skills are buttoning, zipping, writing, opening a carton of milk, brushing your teeth, and tying your shoes.

Visual motor skills

Visual motor skills involve integration of the visual system with motor movements.  These skills are important for independence especially as a child reaches school age.  It is crucial for reading, writing, and eye-hand coordination.  If the visual system is impaired, balance, coordination, motor skills, learning and self-care are among the areas that could be affected.

Sensory processing

Sensory processing refers to a person’s ability to take information from the environment using their seven senses (sight, sound, taste, touch, smell, movement, and position) and interpret that information to make sense of the world.  When any part of this system functions in an atypical way, the person struggles to make sense of their world, which can be a scary experience.  Occupational therapy can work to improve sensory processing in our kids and improve their ability to participate fully in life.

Reflexes

Primitive reflexes are automatic actions that are seen during infancy in response to stimuli.  As a child transitions through developmental movement patterns these reflexes are integrated.  If our reflexes are not integrated it can affect our overall movement patterns and development. Occupational therapy can work to integrate reflexes and improve functional skills.

Ideas to Promote Skill Development in Pediatric Occupational Therapy

Fine Motor/Grasping

  •  Playing with resistive toys for hand strengthening (tweezers, tongs, play dough, Legos, sand)
  • Stringing beads (smaller beads for older kids) or using lacing cards
  • Work on thumbs-up grasp on scissors
  • Opening containers
  • Work on fasteners (buttons, zippers, snaps) on own clothes, dress-up clothes, or dolls
  • Coloring with small or broken crayons
  • Work on writing or painting at vertical/inclined surfaces to help with grasp
  • Craft projects (stickers, folding paper, cutting, gluing)
  • Animal walks, crawling, monkey bars to help strengthen shoulders and arms, and help with prewriting skills (proximal strength = distal stability)

 Visual Motor Skills

  • Playing with puzzles
  • Building with blocks (building towers or copying block structures)
  • Prewriting skills – circles, squares, cross, tracing letters
  • Mazes and connect-the-dots
  • Play with marble toys, or ball activities (tossing and catching balls, etc.)

 Sensory/Social/Emotional Regulation Skills

  • Practice turn-taking games
  • Introduce new textures during art or sensory play (sand, shaving cream, finger paint)
  • Allow movement breaks between seated activities

Red Flag Warning Signs

Consider talking to your doctor about an occupational therapy evaluation when a child consistently demonstrates 3 or more of these items:

6 M- 1 year

  • Lack of tolerance for diaper changing/laying on back
  • Feeding difficulties
  • Not tolerating brushing teeth
  • Not tolerating bath time
  • Excessive or no reaction to sensory input (seeing, hearing, feeling, moving, etc.)
  • Excessive or no emotional reaction when separating from parent
  • Not Rolling (6-9 months)
  • Not Sitting (6-9 months)
  • Not tolerating tummy time
  • Not reaching for toys
  • Not bringing feet or toys to mouth
  • Not following objects with eyes
  • Not transferring toys from one hand to another
  • Not putting items in/out container
  • Not activating cause and effect toys
  • Not bringing hands together and playing with toys

1-2 year-old

  • Walking on toes more than 50% of the time
  • Not creeping
  • Not crawling
  • Not taking socks and shoes off
  • Not assisting with dressing
  • Not tolerating grooming activities (brushing teeth/hair, bathing, nail cutting, etc.)
  • Excessive or no emotional reaction when separating from parent
  • Excessive or no reaction to sensory input (seeing, hearing, feeling, moving, etc.)
  • Feeding difficulties
  • Showing a significant hand preference
  • Not picking up small items with pointer finger and thumb
  • Not able to stack blocks
  • Not able to make marks on paper with a writing utensil

2-3 Year-olds

  • Walking on toes more than 50% of the time
  • Poor functional play with toys
  • Using only one type of toy or only using toys in the same repetitive way
  • Inability to match shapes or colors
  • No interest in scribbling
  • Difficulty with transitions
  • Difficulty tolerating a variety of textures (finger-paint, shaving cream) or foods with textures
  • Difficulty tolerating directed activities

3-4 Year-olds

  • Walking on toes more than 50% of the time
  • Showing a significant hand preference
  • No interest in coloring/drawing
  • Inability to attend to seated task for 4-5 minutes at a time
  • Grasping toys and utensils in palm rather than fingers
  • Difficulty with transitions
  • Difficulty tolerating a variety of textures (finger paint, shaving cream) or foods with textures
  • Difficulty tolerating directed activities
  • Difficulty sharing toys or becomes agitated during peer play
  • Not able to cut across page

 4-5 Year-olds

  • Walking on toes more than 50% of the time
  • Inability to copy simple shapes or color within lines
  • Grasping toys and utensils in palm rather than fingers
  • Difficulty with any aspects of self-dressing (except shoelaces)
  • Difficulty with transitions
  • Difficulty tolerating a variety of textures (finger-paint, shaving cream) or foods with textures
  • Difficulty tolerating directed activities
  • Difficulty with turn-taking games
  • Difficulty standing in line without touching peers
  • Not able to cut along line
  • Difficulty with dressing self, grooming, bathing, utensil use
  • Difficulty sharing toys or becomes agitated during peer play

5 years and older

  • Walking on toes more than 50% of the time
  • Not showing a hand preference
  • Head on table or desk when writing/coloring
  • Trouble copying from the board
  • Poor coordination when playing on play ground
  • Poor eye-hand coordination
  • Not able to cut out shapes
  • Difficulty with dressing self, grooming, bathing, utensil use
  • Sloppy hand writing
  • Complaints of eyes being tired after school work/reading
  • Seems to take significantly longer than expected to complete tasks
  • Difficulty with transitions
  • Difficulty tolerating a variety of textures (finger paint, shaving cream) or foods with textures
  • Difficulty tolerating directed activities
  • Difficulty sharing toys or becomes agitated during peer play
  • Difficulty standing in line without touching peers
  • Difficulty with noisy or crowded environments