Pediatric Occupational Therapy Process

Fine motor skills refer to the ability to move muscles in the hands, fingers, and wrists to grasp and manipulate objects for use.  Effective fine motor skills require a strong foundation of support at the trunk and shoulders and hand strength and hand-eye coordination.  Children need to develop fine motor skills for a variety of activities throughout the day, including holding a toy, using a spoon, grasping a crayon, fastening buttons, cutting with scissors, and writing. when a child uses their hands and fingers to hold and manipulate objects for use. Fine motor skills require a strong base of support at the trunk, hand strength, hand-eye coordination— the ability to see something and respond with the right movements in the hands and fingers, and intact sensation. Examples could include holding a toy, using a spoon, grasping a crayon, buttoning or snapping. 

Self-care and daily living skills involve caring for one’s own needs to facilitate independent living across a range of environments, including home, school, and the community. Self-care skills include self-feeding and drinking (with use of fingers, utensils, cups), dressing, bathing, grooming (i.e., tooth brushing, combing hair, nail trimming), meal preparation, and toileting. Other important self-cares include proper sleep routines and safety awareness.

Visual motor integration is the ability of the eyes and hands to efficiently communicate to accurately copy, draw, or write what is seen and accurately place objects within a given space. Visual motor skills allow a child to effectively coordinate their eyes and hands together for a variety of tasks. These tasks may include handwriting, cutting, building with blocks, copying shapes, tying shoelaces, and completing puzzles or mazes. Common signs a child has poor visual-motor skills may include the inability to accurately copy information, reversing superficially similar letters (such a ‘p’ and ‘q’ or ‘m’ and ‘w’), turning of the head while reading, head tilting, and/or closing one eye while reading

Play is the primary occupation, or “job,” of children.  Play can take on many forms throughout childhood, including solitary play, parallel play, imaginative play, physical play, or play with peers. 

OTs help foster general well being by enabling children to become more independent with social participation and interpersonal skills. Increased independence in these skills allows for more positive experiences during play, academics, and other situations where social engagement is an integral part of the task. Occupational therapists work with children to help them better understand (their) emotions and social roles, learn how to solve problems, and adjust to change. Signs your child may need assistance with social skills include difficulty making or maintaining friendships, and/or difficulty managing emotions and regulation.

When it comes to feeding, Occupational Therapists look at the “why” behind difficulty with mealtime participation. Our therapists will explore if a child has difficulty feeding due to challenges with underlying postural skills to maintain an upright seated position for eating and drinking, demonstrate postural fatigue, limited skills to self-feed, decreased concentration and attention, and/or difficulty with sensory processing. Children who struggle with processing sensory information may present with a variety of behaviors around food. The different sights, sounds, smells and tastes of food may be overwhelming for some children and result in distress, emotional upset, or refusal.  can be too much for some children and they may become distressed or upset.

Self-regulation is the ability to control or adjust emotional responses, behaviors, and attention. A person with appropriate self-regulation can control and adjust their responses in socially accepted ways across environments. Signs a child may need help with regulation include increased tantrums, emotional reactivity, need for control, impulsive behaviors, easily frustrated or overly compliant, a movement seeking. Often children with poor emotional regulation will seek out increased pressure and movement (e.g. constant spinning, running around, jumping, crashing). Children may also have difficulty accepting changes in routine or transitioning between tasks.

Sensory processing is the ability to receive, interpret, and respond to incoming information through our many senses. These senses include auditory, visual, tactile(touch), gustatory(taste), olfactory(smell), proprioceptive(body and movement awareness), vestibular(sense of balance and spatial awareness), and interoceptive(internal body sense: hunger, thirst, need to toilet). When the sensory system is disrupted, it may cause heightened responses or difficulty responding to various sensations. Signs of sensory impairments may include resistance to wearing or eating certain textures, strong responses to noises, and decreased pain response. 

Occupational therapists can evaluate the underlying components that support a student's handwriting, such as muscle strength, endurance, coordination, and motor control.  In addition, occupational therapists can collaborate with parents to develop activities for home to support good handwriting skills. Handwriting is a complex process of managing written language by coordinating the eyes, arms, hands, pencil grip, letter formation, and body posture. The development of a child's handwriting can provide clues to developmental deficits that could hinder a child's academic success.