Occupational Therapy for Children: Assessment, Goals and Interventions
What pediatric occupational therapy is, who it helps, how OTs assess children, example goals, the main interventions and where children receive OT.
What is occupational therapy for children?
Occupational therapy is a broad field that treats people from newborns to the elderly. Occupational therapy for children has a very important role in helping kids become independent in every area of life.
Typical human development is the knowledge base of pediatric occupational therapy. When a child’s early physical or mental development has difficulties or impairments, the children’s occupational therapist works on these areas to help them recover and progress. Read more: what is occupational therapy? and what do occupational therapists do?
Play: a child’s main occupation
Occupational therapy focuses on the “occupation” of a child. You may wonder how a newborn or a 6-year-old can have an occupation, but from an OT point of view, every human being has occupations. A child’s occupations are play, exploring the environment and social interaction.
Disability or impairment restricts a child’s play and makes them dependent on others. Other skills then develop less well, creating problems in self-care.
Play is considered the primary occupation of a child. It helps the child learn new skills, improves social and family interaction, and develops motor, social, cognitive and self-care skills. Play activities are central to an OT session because they engage and motivate the child and raise their focus and performance. Play is a key focus in practice with children, and acts as a catalyst for motor and cognitive development.
Who does pediatric OT help?
Occupational therapy works with children with conditions such as:
| Area | Examples |
|---|---|
| Developmental conditions | Developmental delay, autism, ADHD, developmental coordination disorder, learning disability, intellectual disability, sensory processing difficulties |
| Neurological | Cerebral palsy, brain injury, spina bifida, neuromuscular conditions |
| Genetic | Down syndrome and other chromosomal conditions |
| Orthopedic | Hand injuries, fractures, congenital limb differences, juvenile arthritis |
| Early life | Prematurity, low birth weight, feeding difficulties |
| Emotional and social | Anxiety and other difficulties that get in the way of daily life |
Beyond these established diagnoses, OT helps any child who has difficulty with daily tasks and depends on others more than expected for their age.
Occupational therapy assessment for children
The pediatric occupational therapist evaluates the child and their environment to gather the information needed to plan intervention. The OT asks what the child wants and needs to do, and identifies the factors that support or block their participation in daily life.
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Occupational profile
Referral concerns, an interview with parents or caregivers and, where possible, the child.
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Observation
Watching the child perform self-care, play and school activities.
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Standardised tests
Measuring physical, cognitive and psychosocial performance against age norms.
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Goals together
Realistic, achievable goals agreed with the family.
The evaluation of a child’s occupations covers three things, in the language of the Occupational Therapy Practice Framework:
- Performance skills: for example gross motor skills, fine motor skills and process skills
- Performance patterns: habits and routines
- Contexts: cultural, physical and social
The OT also evaluates neuromotor functions: posture, coordination, gross and fine motor skills, muscle tone, range of motion, primitive postural reflexes, eye movements (focusing on and tracking an object), and arm and leg strength and endurance. Perception and thinking skills are assessed too, along with self-care, mobility, communication and social skills; for this the OT may use the WeeFIM (Functional Independence Measure for children).
Standardised assessments
Many standardised assessment kits and scales are available. Which one the OT chooses depends on their observations and the child’s difficulties. Standardised tests help with:
- Medical or educational diagnosis
- Documenting developmental and functional status
- Planning intervention programs
| Test | What it measures |
|---|---|
| Peabody Developmental Motor Scales | Gross and fine motor skills from birth to about 6 years |
| Pediatric Evaluation of Disability Inventory (PEDI) | Self-care, mobility and social function |
| Sensory Profile 2 | How a child responds to sensory input in daily life |
| Assessment of Motor and Process Skills (AMPS) | The quality of performance in everyday tasks |
| Bruininks-Oseretsky Test (BOT-2) | Motor proficiency in school-age children |
| Beery VMI | Visual-motor integration, important for handwriting |
| WeeFIM | Independence in self-care, mobility and cognition |
Occupational therapy intervention for children
A typically developing child moves into and out of positions fluidly and easily, exploring their world, learning about their body and developing motor, cognitive, sensory and social skills. Children with motor control difficulties struggle with these activities and depend on others for daily routines. The occupational therapist works out how to help the child control their movements so they can engage in their occupations.
Occupational therapy goals for children
After the full evaluation, the children’s occupational therapist sets goals that are achievable and realistic. Goals depend on the problem areas, and every child is different. A child with cerebral palsy or developmental delay may have mainly motor difficulties, while an autistic child or a child with ADHD may have mainly sensory difficulties.
| Example goals | |
|---|---|
| Cerebral palsy | Manage muscle tone; improve coordination, balance and hand function; improve communication; improve transfers from one surface to another; independent sitting, standing and walking; improve play; improve daily-living tasks and handwriting; toilet training |
| Autism and ADHD | Improve attention and sitting tolerance; reduce sensory difficulties such as tactile defensiveness; improve social interaction; follow multi-step instructions |
Problem 1Can't sit without support (child with cerebral palsy, age 2)
GoalIndependent sitting for play
- Will sit on the floor with hand support for 2 minutes while playing
- Will sit on a bench without support for 30 seconds, reaching for a toy in front
Problem 2Tactile defensiveness (autistic child, age 4)
GoalTo tolerate messy play
- Will touch dry rice or beans for 2 minutes during a game
- Will finger-paint with one finger for 1 minute with an adult nearby
Occupational therapists manage these difficulties with different techniques and approaches. Here are some of the main problem areas and how OTs address them.
Motor control
Motor control is the ability to regulate or direct the mechanisms essential to movement. OT intervention goals may address abnormal muscle tone, sensory dysfunction, muscle weakness and poor endurance. Approaches include:
- Sensory integration
- Neurodevelopmental therapy (NDT)
- Strength training
- Perceptual-motor training
These interventions reduce the underlying difficulty and improve performance: postural control, balance, visual perception and body awareness.
Sensory integration
The sensory integration approach is based on the senses and how they adaptively work together. When a child’s senses are not well integrated, they may have sensory processing difficulties. A pediatric OT uses sensory strategies such as joint compression, a blanket wrap or slow rocking to manage sensory issues such as inattention, balance difficulties, avoiding touch and hyperactivity. The therapist seeks an adaptive response: a motor behaviour that supports effective interaction with the environment. Equipment such as scooter boards and bolster swings is used. Read more: sensory integration and sensory diet.
Neurodevelopmental therapy (NDT)
NDT provides a sound foundation for treating children with cerebral palsy and hemiplegia. It is based on normal development and movement. The therapist develops a program that helps the child avoid abnormal movement patterns caused by abnormal muscle tone. Pediatric OTs use NDT to promote the highest level of functional recovery based on relearning normal movement, rather than on compensation. Quality of movement, control and coordination are emphasised. NDT techniques include:
- Weight-bearing on the affected side
- Trunk rotation
- Facilitating slow, controlled movements
- Proper positioning
- Including the affected arm in functional activities
Read more: developmental frame of reference.
Hand skills
Hand skills are critical for activities of daily living. A child with poor hand function has fewer opportunities to experience the environment. Hand skills depend not only on the hand muscles, but also on posture, cognition and visual perception. They are also called fine motor skills.
OT addresses visual-motor integration (the interaction of visual skills, visual perception and motor skills) and the hand skills of reaching, grasping, carrying and voluntary release, in-hand manipulation, and using two hands together. Therapy to improve hand function includes improving postural tone and control, muscle strength and isolated arm and hand movements, and using splints and adaptive devices.
Social participation
Promoting a child’s social participation with family, friends, classmates and caregivers is an essential part of OT. OTs improve social participation through individual and group therapy programs and consultation.
Challenging behaviour
Children with a variety of disabilities may show challenging behaviour that interferes with daily life. Behaviour management strategies that prevent and reduce challenging behaviour are an important part of OT.
| OT's role | Strategies parents and teachers can use |
|---|---|
| Prevent challenging behaviour | Minimise unpleasant triggers; create an environment where the child can succeed; support self-regulation |
| Support the behaviour you want | Meet the child's sensory needs; build new skills; use positive reinforcement |
| Intervene when it happens | Stay calm, keep the child safe, and use a consistent plan agreed with the team |
Feeding
Some children don’t get enough nutrition because of feeding difficulties, which may be due to developmental or sensory issues. Good nutrition is essential for growth and development. The OT has sound knowledge of the anatomy and physiology of the mouth and can help with sucking, drinking, biting and chewing, using environmental adaptations, positioning, sensory strategies, adaptive equipment and changes to the texture of food and liquids.
Activities of daily living
A child’s daily living suffers when they can’t take part in self-care, whether because of motor delay or sensory issues. Daily-living tasks are at the heart of OT. OTs train children in toileting, hygiene, dressing and the use of assistive technology, and recommend changes to the environment.
Play
Play has always been part of the pediatric OT’s approach, because it is a child’s primary occupation. Play helps a child learn new skills and master old ones. It is part of the developmental frame of reference and the sensory integration approach, and OTs use it as a therapy tool.
Pre-writing and handwriting
For school-age children, occupations include reading and writing. Writing is needed for stories, written exams and much more, and it is a complex process requiring both motor and thinking skills. The OT understands the problem and may use a remedial or compensatory approach. Techniques target sitting posture, pencil grip, perception, visual-motor integration and eye-hand coordination.
Where do pediatric OTs work?
| Setting | What OT focuses on there |
|---|---|
| NICU | Positioning, feeding and developmental care for premature and medically fragile babies |
| Early intervention (birth to 3) | Family-centred therapy, often at home, for babies and toddlers with delays |
| Schools | Handwriting, classroom participation, sensory regulation, self-care and access |
| Hospital pediatric rehab | Recovery after injury, surgery or illness |
| Outpatient clinics and private practice | Sensory integration, motor skills, feeding and daily-living goals |
| Telehealth | Parent coaching and home programs |
For babies and toddlers specifically, see occupational therapy for infants and toddlers.
Summary
Occupational therapy is an integral part of children’s rehabilitation. Occupational therapists work with children with disabilities and developmental differences to help them become as independent as possible, using a range of approaches built around play.
Related guides: Dyspraxia (DCD), Handwriting skills, Executive function skills, Visual perceptual skills, Pediatric OT goals, Cutting activities for preschoolers, Hand strengthening activities.
References
- Case-Smith J, O’Brien JC. Occupational Therapy for Children and Adolescents. 6th ed. Mosby.
- Kramer P, Hinojosa J. Frames of Reference for Pediatric Occupational Therapy. 3rd ed. Lippincott Williams & Wilkins.
- Horowitz L, Rost C. Helping Hyperactive Kids: A Sensory Integration Approach. Hunter House.
- American Occupational Therapy Association. Occupational therapy practice framework: domain and process, 4th ed. American Journal of Occupational Therapy. 2020;74(Suppl 2).
Frequently asked questions
What is pediatric occupational therapy?
What does a pediatric occupational therapist do?
How do I know if my child needs occupational therapy?
What is the difference between pediatric OT and physical therapy?
Where do children receive occupational therapy?
How long does a child need occupational therapy?
Written by
Payal Mehta, OT
Payal Mehta is a practising occupational therapist and co-founder of Occupational Therapy OT. She writes on pediatrics, sensory integration, and mental-health practice.
All articles by Payal →This article is for general education and is not a substitute for individualized assessment or treatment by a licensed occupational therapist. Always seek the guidance of a qualified professional for specific concerns.
