What is an Occupational Therapist for children?
An Occupational Therapist is an Allied Health professional with university training in assessing and supporting the ‘occupations’ of an individual. Occupations are the things that a person needs, or wants, to do as part of their life roles in their day to day life. For children, in their role as friends, students and sons or daughters, their occupations include playing with their toys and friends, learning to take care of their bodies, and learning how to follow group rules and be a learner as part of a group. ‘Occupational Performance’ is when the child has the right skills to do their occupation, and their environment supports them to do just that. When there isn’t a great fit between the environment, occupation and the person we see a breakdown in occupational performance – this is where an OT can help! To provide an example – imagine all the skills a child needs to join in at group time. They need to have the cognitive understanding of the routines and rules of being part of a group, the attentional skills to focus on their teacher and ignore distractions, and the motor skills to sit with their legs crossed on the carpet. An OT can help the child to build their skills – or make modifications to the environment or the occupation – to help the child be successful in their day to day life. The role of an OT in working with children can be extremely broad, so this blog aims to discuss some of the most frequent areas of practice that our OT team at BillyLids Therapy supports.
Key areas of paediatric occupational therapy
Fine and Gross Motor skills
A common reason a child may see an Occupational Therapist is to support their fine motor skills. Fine motor skills involve the ability to grasp, release and manipulate utensils with control and precision to do things such as draw, write, cut, build or open. An OT is able to assess a child’s underlying skill components – such as postural control, muscle tone, joint mobility, visual perception – and how these relate to the child’s fine motor skills and ability to complete functional tasks such as dressing and handwriting. With an understanding of which skills require support, an OT can tailor a playful yet targeted therapy program to build these foundational skills, and to promote a child’s fine motor skills and build confidence in themselves.
Occupational Therapists also have a role to play in supporting children’s gross motor development. OT’s have a unique skill set in understanding how a child gains sensory information from their environment and their bodies, to plan coordinated movements, and to adjust these movements based on the motor feedback system from their bodies. Using a sensory integration framework, an OT can challenge a child’s strength, postural control and motor planning, by integrating sensory input from their visual, proprioceptive and vestibular sensory systems. At BillyLids Therapy, we have access to a sensory gym with suspension equipment, to allow children to gain the full benefit of sensory integration therapy to develop their gross motor skills. We also have a great network of external Physiotherapists who we love to collaborate with, for children requiring support with mobility, positioning, transfers, early gross motor milestones (such as crawling and sitting) and endurance.
Skills for school
Handwriting is a very common referral concern which we receive in OT, for parents wanting their child to succeed at school. This is because when children are not able to automatically remember how to form and write a letter – and have to think hard about how to write – this limits the mental space available to take in other learning in the classroom. Similarly, if handwriting is slow and effortful, their physical effort is being monopolised by handwriting – effort that could be better spent in learning new academic skills. When approaching handwriting concerns, OT’s are able to complete a comprehensive assessment to determine underlying handwriting issues to develop a targeted yet fun program to achieve automaticity in letter formation, and ease and comfort in handwriting. Handwriting is an extremely complex skill set, requiring foundational fine and gross motor skills, visual perceptual skills, as well as letter recognition and formation skills.
There are many other skills which a child needs for success at school which an Occupational Therapist is able to assist with. Skills include being able to organise their school belongings, maintain attention, cope with big feelings, and transition between tasks throughout the day. Sometimes the support an OT provides may be best completed in the learning environment. Support can involve education with the child’s educators or making adjustments to the physical space to support their success.
Self-regulation
Self-regulation is the ability to modulate our energy levels to match a task (eg. calm and focused to read, or high energy to play soccer) while also managing our emotions in a socially acceptable way, to do the things we need to do. This is an emerging skill in childhood, however, some children do need more support in this area compared to their peers. Self-regulation consists of a number of skill areas, which OT’s are able to help with.
Sensory processing is an important component of self-regulation skills, that Occupational Therapists have a unique skill set in assessing and supporting. Sensory processing is the theory describing the way in which an individual notices and responds to sensory input from their environment as well as inside their body. Some kids have a low threshold to sensory input, so may ‘get the ick’ from certain textures of food (or even the way it looks!) or not like certain clothing such as tags on shirts or seams on socks. They may get easily overwhelmed or distracted when there is lots of background noise or things to look at. Other kids can present with a high threshold to sensory input, so they may ‘miss’ cues from their environment, such as noticing when their teacher is giving instructions to the class, or tripping on cracks in the pavement as they haven’t noticed they are there. They can also ‘miss’ cues from their body, not noticing that they are hungry, hot, or tired until they are completely overwhelmed. Any of these differences can impact a child’s self-regulation. From being distracted from needing to seek movement… or being quick to meltdown due to being overwhelmed by the sensation of clothing before the demands of their school day have even started. An OT can work with a child and their family to support the child’s individual sensory processing needs and ultimately improve their self-regulation skills.
Emotional regulation skills is another foundational skill component that contributes to self-regulation. For many of the children we help, who experience challenges with their self-regulation skills, they miss cues from their body to tell them how they are feeling and need to develop skills in labelling their own emotions as a foundation to more sophisticated skills. We work with children to understand their body cues, to help to learn things such as ‘when my hands are in my mouth, I can’t think and I don’t know what to do or say – my body is telling me I feel anxious.’ Using our sensory modulation skill set, we work with kids to experiment with different sensory inputs such as deep pressure, movement and heavy work to alter their emotional state and understand strategies in their ‘emotional toolbox’. Where ‘talk’ therapy or cognitive skills are necessary for a child to further develop their emotional regulation skills, we can work collaboratively with your child’s Psychologist or help you to engage with this support.
This child is sitting with a weighted toy. The purpose of this is to provide deep pressure and sensory input to the body, creating a calming effect for children with sensory processing disorders.
Play
When a child plays easily and confidently, it can look like there are not so many skills involved – children just know how to play? But when a child is still developing their play skills, and instead they may be tipping toys on the floor, constantly seeking adult help to play or wandering aimlessly it becomes more apparent that there is in fact skill involved. There are many types of play, however, Occupational Therapists will often be involved with supporting children’s pretend play skills. When children use their imagination to pretend play, they are making sense of their world, developing their language and problem solving skills, and building skills that support their self regulation and social skills. Pretend play skills begin to develop from 12-18 months of age, and are quite simple at this time. Children copy familiar stories in their play, like eating and sleeping, tend to use real items and their play often has a couple of steps that are repeated a number of times. Pretend play skills develop rapidly over the next few years, increasing in their complexity in relation to themes, the language children use to narrate their experiences, their ability to use object substitution (for instance, to use a block as a phone) and involve toys such as stuffed animals or a doll as a ‘person’ in play. An Occupational Therapist is able to assess a child’s pretend play skills, including their ability to self-initiate play, as well as the sophistication of their skills in play. Therapy for play skills is fun and an OT will get down to the child’s level and play with the child at their skill level, before challenging them to introduce new skills. For instance, if the child is able to drink from a cup in play the OT might introduce a doll drinking from a cup, or pretending to drink from a block that is now the cup.
Access
Occupational Therapists also have a unique skill set in supporting individuals to access different environments or occupations that may otherwise be inaccessible for them. At BillyLids Therapy, we have OT’s with specialised experience in supporting access in children, particularly children with physical disabilities. The support we can provide ranges from the complex – such as full home or vehicle modifications, or highly specialised wheelchairs – through to more simple solutions such as adapted cutlery or clothing. When supporting children with access, a team approach is usually necessary and we will often collaborate with other allied health professionals (such as your child’s physio or speechie) when delivering a solution.
Self-Care
Throughout childhood and beyond, children are learning skills to take care of their bodies, and skills that will allow them to one day live independently. In Occupational Therapy, we call these skills ‘ADLS’ (activities of daily living – essential self-care skills for taking care of our bodies) and ‘IADLS’ (instrumental activities of daily living – daily living skills to enable us to live independently). Children are learning many skills to take care of themselves, such as to listen to their body and drink water when they need it, use the toilet instead of nappies, to feed themselves using cutlery, and to dress themselves. They are also learning simple independent living skills such as how to pack away toys, take care of pets like to fill their water bowl or feed them food, or to help with family meals like to put knives and forks on the table. It can be really difficult for parents to gauge if their expectations of their child’s independence is appropriate for their age, or if a child should be more independent than they are by now. There are many reasons which can underlie a child’s difficulty developing independent living skills, such as fear, sensory aversions, difficulty with sequencing and recall to know the steps to do a task, or physical delays. An Occupational Therapist is able to assess a child’s ADLS and IADLS and discuss with parents appropriate goals for their child’s independence in self-care and daily living skills, as well as identifying skills that are contributing to the child’s difficulties. By understanding the goals of the family and the child’s support needs, an OT can develop a therapy program to address underlying skill challenges, as well as make adjustments to the environment or occupation (eg. to simplify a task or to trial use of assistive technology) to allow the child to be as independent as possible.
What might occupational therapy look like for my child?
Regardless of setting, age or support needs, the Occupational Therapy process follows the same general process for most clients. This begins with an assessment which investigates concerns – at BillyLids, this is the developmental concerns for the child as identified most typically by the family. However, concerns may also be identified by the education, medical or the wider therapy team. We may use a variety of standardised or informal assessments to determine ‘where a child is at’ with different skills, as well as to identify skill components, or barriers in the environment or occupation that is contributing to the developmental concern or difficulty with occupational performance. The next step is to set goals as a team – between the family, therapist and the child (and where appropriate, other stakeholders). This is an essential part of the therapy process, because if we don’t set goals, how will we know that intervention has been successful! The next step is to deliver an intervention through therapy – typically this is 1:1 with the child, but can also include upskilling family and other stakeholders to support the child, and potentially implementing changes to the environment or other adaptations. The final step is re-evaluation, which can include readministration of assessment or informal review of goals to confirm goal attainment. Individual OT sessions vary for each child, and your therapist will adapt activities to the child’s developmental age, specific goals and interests whether that is Bluey, Ninja turtles or Lego! Sessions can be conducted within our clinics or in community settings like schools, kindergartens, or homes, and our goal is to create a fun, creative, safe, and supportive environment.
What do I do if I have concerns about any of the above areas for my child?
If you are reading through this article and are feeling unsure about whether your child would benefit from Occupational Therapy, there are a number of things you’re able to do. I often recommend as a starting point having a chat with your child’s educators to get their advice regarding your child’s development and potential need for OT support. Our educators tend to know kids quite well over time, and have the added benefit of seeing how they are able to perform different activities without their parents’ help and around other children. Another option is to schedule a child health nurse assessment, to have a chat with your GP or to review the developmental checklists at the back of your child’s red book (if you’re in Queensland!).
You may also be reading this article and thinking, yep, that sounds like my child, I think OT could be a really good idea to help them. If that’s the case, you are able to self refer your child to an OT at BillyLids Therapy. We are able to see privately paying clients, as well as self-managed or plan managed NDIS clients. BillyLids Therapy can help you understand different funding options that your child may be eligible for to help or cover the cost of therapy.
Links to further information
There is so much more to know about Occupational Therapy and how we can support children to develop skills to take on the world. So we have linked a few key websites and notable journal articles below:
Occupational Therapy Australia (OTA)
OTA is the professional association for occupational therapists in Australia. Their website contains valuable resources, publications, and information related to occupational therapy for children.
Relevant Sections: Position Statements, Guidelines, and Resources related to paediatric occupational therapy.
National Disability Insurance Scheme (NDIS)
The NDIS website provides information about support services and funding for children with disabilities, including those who may benefit from occupational therapy.
Children and Young People with Disability Australia (CYDA)
CYDA’s website offers resources and advocacy for children with disabilities.
Australian Institute of Health and Welfare (AIHW)
AIHW’s Website reports and publications related to child health and disabilities.
Australian Government Department of Health
The Department of Health website may have information on government policies, guidelines, and programs related to child health, including occupational therapy.
Relevant Sections: Child and Youth Health, National Disability Insurance Scheme (NDIS)
Raising Children Network
Raising Children’s Website offers evidence-based information and resources for parents and caregivers on various aspects of child development, including information related to occupational therapy.
Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review.
A systematic review to determine the effectiveness of occupational therapy interventions for children with disabilities. Journal: Australian Occupational Therapy Journal.
Novak, I., & Honan, I. (2019). Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review. Australian Occupational Therapy Journal, 66(3), 258–273.
Improving Motor Skills in Early Childhood through Goal-Oriented Play Activity
A study that emphasises the potential impact of purposeful play in promoting the development of motor skills among young children. Journal: Children (Basel).
Sutapa, P., Pratama, K. W., Rosly, M. M., Ali, S. K. S., & Karakauki, M. (2021). Improving Motor Skills in Early Childhood through Goal-Oriented Play Activity. Children (Basel), 8(11), 994. https://doi.org/10.3390/children8110994
Occupational therapy for children with cerebral palsy: a systematic review.
A review conducted to determine whether Occupational Therapy interventions improve outcomes for children with cerebral palsy (CP). Journal: Developmental Medicine & Child Neurology
Steultjens, E. M., Dekker, J., Bouter, L. M., van de Nes, J. C., Lambregts, B. L., & van den Ende, C. H. (2004). Occupational therapy for children with cerebral palsy: a systematic review. Clinical Rehabilitation, 18(1), 1–14. https://doi.org/10.1191/0269215504cr697oa
Effectiveness of occupational therapy for children with developmental coordination disorder: a randomized controlled trial.
A trial to determine if Cognitive Orientation to Occupational Performance was effective in improving performance and transfer of motor learning in children with developmental coordination disorder. Journal: American Journal of Occupational Therapy
Izadi-Najafabadi, S., Gunton, C., Dureno, Z., & Zwicker, J. G. (2022). Effectiveness of Cognitive Orientation to Occupational Performance intervention in improving motor skills of children with developmental coordination disorder: A randomized waitlist-control trial. Clinical Rehabilitation, 36(6), 776–788.
Systematic review protocol of the effectiveness of occupation-based and occupation-focused interventions used in occupational therapy to improve participation in everyday activities for young children with a disability [protocol].
Fischer, E., Green, D., & Lygnegård, F. (2022). Systematic review protocol of the effectiveness of occupation-based and occupation-focused interventions used in occupational therapy to improve participation in everyday activities for young children with a disability [protocol]. https://doi.org/10.37766/inplasy2022.6.0117
