What exactly do pediatric occupational therapists do?

Parents, if you’ve never heard of occupational therapy (OT), you’re not alone.  Very few people know what pediatric OT is. It is like a somewhat-taboo but internal “frequently asked question” that parents have, but are sometimes embarrassed to ask while seeking the advice of an occupational therapist to help their child: “What exactly is OT for children?”

 No need to be shy.  Ask away!

 Here’s an honest and straightforward answer.

So why the word “occupation”? Your child’s daily life “occupations” include taking care of self and others, participating at school, in home and community life, and of course, the best childhood pastime of all: PLAYING! 

Pediatric occupational therapists are holistic whole-child development specialists. Occupational therapists help analyze your child’s skills, their environment, and their daily tasks…and find exactly where the problems are that get in the way of your child playing, participating, and learning.
 It might go something like this:

A parent calls and explains the challenges their son Sam is having in 1st grade.
 “Sam just won’t sit still during circle time in the classroom. The school calls me several times a week because he’s hit someone or lashed out, or had a meltdown. He has trouble following directions at school. And at home he won’t sit at the dinner table to eat.  He’s constantly- always- moving! Running around the house, jumping off the couch- it’s driving me crazy at home too. Trying to sit down to do homework is impossible.”

Or maybe it is a totally different story, like Kayla’s parents share:
 “She is so lethargic, and doesn’t like to play with friends. She prefers to be by herself and avoids playgrounds. At school her teacher says she needs a lot of prompting to start her work and needs directions repeated all the time. She totally avoids writing and resists us when we try to help.”

To figure out what is going on with Sam, Kayla, or with your child, the OT would complete an OT assessment. Assessment involves testing, observations, interviews, and most importantly, getting to know your family and your child’s needs, and your unique hopes and dreams for outcomes that may be possible with occupational therapy. After assessment, the OT will interpret the data to identify the underlying reasons your child may be having difficulties in daily life. Pediatric occupational therapists assess children’s skills in the following areas:

Gross motor skills

How your child moves their body in large-motor tasks such as running, jumping, and climbing.


Fine motor skills

How your child uses their hands and fingers in small-motor tasks such as using a pencil or cutting with scissors.


Self-help skills

How your child completes daily tasks (such as eating, brushing teeth, managing belongings) to take care of themselves.


Visual perceptual skills

How your child interprets and processes visual information. 


Social/play skills

How your child interacts with peers and other people in both structured and unstructured play settings.


Executive function & self-regulation

How your child plans, attends to, and executes goal-directed activities, and regulates emotions.  


Sensory processing

How your child notices and responds to sensory input. Some children are under- or over-responsive to sensory input, which can negatively impact their attention, learning, and/or mood. Occupational therapists consider a child’s sensory processing in the eight senses: (Yes- eight! Did you know your child has EIGHT senses?)

1. Visual
2. Auditory
3. Smell
4. Taste
5. Tactile (Touch)
6. Vestibular (Balance & Movement)
7. Proprioception (Body Awareness & Control) 
8. Interoception (Awareness of Internal Organs and Systems)


To use our children’s stories from above –

Sam might have underlying sensory processing issues that impact his ability to sit, attend, and learn.  His play and social skills may be lacking. He may have difficulty developing a plan for goal-directed activities. He may have visual perceptual issues that make him feel confused and overwhelmed during school.

Kayla may have weak core strength and poor fine motor skills, making school feel like an uphill battle for her. She might need extra sensory input to activate her attention and energy to play. She may have challenges with balance and movement that make her hesitant to climb or explore outside. She also might have visual perceptual challenges that cause her to “check-out” when at school.

If OT services are recommended after assessment, specific goals should be written in collaboration with you, to direct OT treatment toward outcomes that really matter to you and your child. The goals should state exactly what OT treatment is aiming to change in your child’s everyday life experiences, to help reach our main goal to: HELP MAKE LIFE EASIER! 

To do this, the occupational therapist will use evidence-based interventions as much as possible during treatment sessions, using a variety of strategies that have been proven in research or tested by expert therapists to be effective. When you as a parent are paying a lot of your hard-earned money for professional OT services, your therapist should use proven and effective techniques in therapy sessions. When your therapist uses experimental therapy techniques, they should be clear with you about the emerging (or lack of) clear scientific evidence for those techniques. Your occupational therapist should also refer you to other specialists if your child’s underlying challenges are honestly best addressed by a different professional’s area of expertise, for example, a mental health counselor for mental health needs, or a learning specialist or educational therapist for academic needs.

So, in summary: pediatric occupational therapists assess and treat a child’s underlying challenges that are the foundation for efficient learning and participation in daily life. 

If you think YOUR child needs help, contact a local pediatric occupational therapist. If you have concerns, don’t delay in seeking help. Early intervention is the best way to positively impact your child’s future development! 

About the author

Laura Figueroa, MS, OTR/L is a pediatric occupational therapist and assistant professor of occupational therapy at Samuel Merritt University. She is the founder of Outdoor Kids OT, a local private OT practice specializing in group OT services for children held 100% outdoors in local nature areas. www.outdoorkidsot.com

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