What Do Pediatric Occupational Therapists Do?

what do pediatric occupational therapists do

Pediatric occupational therapy (OT) is a branch of occupational therapy that focuses on helping children with various physical, cognitive, and developmental disabilities or delays to perform daily activities and tasks. Pediatric OTs and OTAs support children of all ages, from infants to adolescents, but also the families, caregivers, and, in the school-based occupational therapy environment, educators, paraprofessionals, and anyone that is on the child’s support team.

Pediatric Occupational Therapy

What is a pediatric occupational therapist is a question that comes up a lot. “Pediatric occupational therapist” may be a term you have come across before. But what does it mean, exactly? You may be one of many people thinking to themselves, my kid doesn’t need a job, so what do you do?

Related: Have a child in therapy? Read more about specific activities your child may do in occupational therapy sessions.

What do pediatric occupational therapists do


Occupational therapy can seem like a misnomer, because these therapists don’t necessarily help people maintain careers. Although – they can! Allow me to explain.

When you search the word ‘occupation’ on Merriam-Webster, the first definition they provide is “an activity in which one engages”. For ease of explaining, many occupational therapists choose to define occupations as activities, or as meaningful activities, that you regularly engage in.

Occupational therapists seek to improve one’s engagement with their
occupations, which does include the work that they do in their career.
Pediatric occupational therapists do just the same, but for kids! They ensure that your child can best perform the occupations in their life. Below is a list of occupations that most children engage in.

All these occupations require many skills and abilities to successfully complete. To the untrained eye, it can be difficult to break down these everyday activities into their separate skills.


Occupational therapy practitioners complete something called an activity analysis to analyze the components of a single task.

They take something that can often feel automatic, like writing our names or putting on a shirt, and break it down into the smaller steps and skills that are required to complete the actions. The examples given, writing
one’s name or putting on one’s shirt, require gross motor skill, fine motor skill, intact cognition, and more.

Pediatric occupational therapists will evaluate a child for their fine motor skills, for example, so that they can determine their abilities to feed themselves, write in their role as a student, or manipulate small objects for play.


Additionally, your pediatric occupational therapist may address social and mental wellness needs of your child, as social and mental health is just as important to the engagement in occupations as physical health.

Pediatric occupational therapists help children achieve skills in functional tasks or their daily occupations. These are the things that occupy their time.

Does MY CHILD NEED OCCUPATIONAL THERAPY?


Your child may be recommended occupational therapy if they are showing signs of developmental delay in physical, social, emotional or mental domains. They may also benefit from occupational therapy to improve their handwriting , attention, or self-regulation.

Although each case is unique, occupational therapy is usually recommended to help your child become more independent. If your pediatrician or another health care professional suggests looking into
occupational therapy for your child, they will likely tell you why.

WHERE CAN MY CHILD RECEIVE PEDIATRIC OCCUPATIONAL THERAPY?

Pediatric occupational therapists provide their services in a number of settings. Many of them work in schools, outpatient therapy clinics, or in hospitals. Others work in community and home settings.

Occupational therapists provide interventions for people of all ages, and typically pediatric occupational therapists will serve newborns to age 18.

For those who are over 18, they are able to receive school-based occupational therapy services while they are still in high school, which can be up until age 21 or 22, depending on what state you live in.


WHAT Does an occupational therapy SESSION LOOK LIKE?


When your child first meets their pediatric occupational therapist, they will be evaluated. Typically, the first appointment is a bit longer than the ones that follow, so that a thorough evaluation can be done.

During that time, the therapist will use standardized and non-standardized assessments to determine where your child is physically, socially, emotionally, and/or mentally. Assessments may be done by the child on paper, or through a parent survey, or through therapist direction and observation.


Occupational therapists always strive to be evidence-based and client-centered in their practice. This means that whatever assessments and treatments they use with your child are backed by research and experience (evidence-based) and are specifically geared toward your child’s interests and needs (client-centered). Depending on the child’s age, interests and abilities, pediatric therapy can often look and feel like playing.

Read about occupational therapy play here.


In order to keep a child motivated, familiar tools are often used in therapy. Things like blocks, Legos, trampolines, Play-Doh, puzzles, scooters, beads, and gym mats can be found in just about any pediatric therapy clinic. The therapy that your child receives depends on the following factors: their therapeutic needs, your goals for therapy, the treatment setting and available materials, and the reimbursement coverage.


WHAT do PEDIATRIC OCCUPATIONAL THERAPISTS DO?

Now that we have laid some groundwork for what occupations are, where pediatric occupational therapists work and why a child may receive treatment, we can discuss all that pediatric therapists do. They help kids gain skills in functional tasks.

The goal of pediatric OT is to help children achieve independence and improve their quality of life by addressing their unique needs and challenges.

Pediatric OTs use a variety of techniques and tools, such as sensory integration therapy, play-based therapy, fine motor skill development, and adaptive equipment to help children achieve their goals.

This includes:

  • Play
  • Self-care skills- getting dressed, grooming, bathing, caring for oneself and the tasks associated with self-care
  • Feeding and eating
  • Learning and being a student
  • Leisure activities
  • Sleep
  • Toileting and potty training

And all skills or aspects that allow kids to perform these “jobs”:

  • Motor development and motor planning
  • Feeding and oral motor skills
  • Cognitive development
  • Visual processing skills
  • Sensory processing
  • Self-regulation
  • Social and emotional skills
  • Emotional-regulation
  • Social participation
  • Executive functioning skills- organization, attention, working memory, planning, prioritization, impulse control, and other skills
  • Fine and gross motor skills
  • Safety in the home and community
  • Balance and coordination
Occupational therapists work with kids on daily occupations or daily skills that make up the child's day.

Pediatric occupational therapy providers do all of this and more. They screen and evaluate clients, write treatment plans and achievable goals, educate families and teachers, consult with other therapists and social workers, supervise Certified Occupational Therapy Assistants (COTAs), and determine the best possible path for your child. And then, when that path doesn’t work, they modify and try again.


What do pediatric occupational therapists do? They do all that they can to help your child be as successful as possible.

Pediatric Occupational Therapy FAQ

A few key and important points about pediatric occupational therapy can help to better explain pediatric OT.

Who does pediatric occupational therapy providers work with? Some of the conditions that pediatric OTs may treat include autism spectrum disorders, cerebral palsy, developmental delays, Down syndrome, sensory processing disorders, and more. Pediatric OTs also work closely with those who support their clients, including: parents, caregivers, teachers, and other healthcare professionals to create individualized treatment plans that address the child’s specific needs and goals.

In addition to helping children with physical and developmental disabilities, pediatric OTs also assist with emotional and behavioral issues that may affect their ability to function and participate in daily activities.

Where do pediatric occupational therapy providers work?

Pediatric OTs may work in a variety of settings, such as schools, early intervention settings in homes, hospitals, clinics, outpatient clinics, and private practices.

In the school setting, pediatric OTs and OTAs may support clients in the classroom (also called a push in model of therapy service) or in a pull out setting, depending on the needs. School based OT providers support students with education so that they can reach their full capacity.

Common areas addressed includes:

  • Handwriting
  • Fine motor skills impacting pencil grasp, cutting with scissors, manipulating school materials
  • Self-regulation needs
  • Clothing fasteners and self-care related to toileting or changing clothing for gym class
  • Eating and managing food containers in the school lunch room
  • Organizational needs related to executive functioning issues
  • Other areas

School based OT can include early intervention in the preschool setting, early school years (kindergarten through primary school), middle school OT, high school OT, and even transitions post-high school

In the outpatient setting, a medical model of therapy can be addressed in the pediatric occupational therapy setting. These areas may include:

  • Physical dysabilities impacting functional tasks
  • Sensory processing needs/sensory integration
  • Feeding skills
  • Fine motor skills impacting functional performance
  • Gross motor development
  • Balance, coordination, mobility, etc.
  • Executive functioning skills
  • Social emotional development
  • Sleep
  • Behaviors impacting functional participation
  • Many other goal areas!

What does a pediatric occupational therapy professional do in therapy sessions? Pediatric OTs often focus on helping children develop daily functional areas, and depending on the setting (school based OT or outpatient), this can differ vastly with the educational model of OT vs. the medical model of occupational therapy. Common areas addressed in pediatric occupational therapy includes: self-care skills, such as dressing, eating, and toileting, which can have a significant impact on their daily lives.

Finally, pediatric OT is an important part of a child’s overall daily functioning and life and can help children with a wide range of needs achieve their full potential.

Regenerate response

Sydney Thorson, OTR/L, is a new occupational therapist working in school-based therapy. Her
background is in Human Development and Family Studies, and she is passionate about
providing individualized and meaningful treatment for each child and their family. Sydney is also
a children’s author and illustrator and is always working on new and exciting projects.

Transition Services

Transition services

When learners are young, first starting kindergarten, it seems hard to imagine they will ever require transition services following graduation from high school. Time flies, and before you know it, they are getting ready to graduate. However, for students to move from the school system and special education services into adult services, there is a ton of preparation involved in transitioning out of high school, or a life skills program. This post will highlight the importance of transition services, what is available for special needs students after high school, and the process of developing an individual transition plan.

Part of the transition period may include an activity analysis with focus on the aspects of functional tasks an individual may need to complete with increasing independence so that there is a movement toward supports or modifications.

Transition services to help students who have disabilities and/or special education needs prepare for life beyond high school.

Transition Services

For neurotypical learners, preparation for graduation might look very different than those in a special education curriculum. Neurotypical learners may take SAT, or ACT tests, research and apply to colleges, begin choosing a career or job path, and make plans for their independent future. 

Their special education counterparts have different work to do in order to be prepared for transitioning out of high school.  

Following high school, students move from an individualized education program (IEP) to post-school adult work, or post-graduate education. Adult education can look like many different things, and determining that course of action is part of the transition plan while in high school. 

However, there are other considerations, for transitional support for post-high school, too:

  • Postsecondary education
  • Community participation
  • Acquisition of daily living skills (including shopping for food, cooking meals, paying bills, managing funds, home management tasks such as laundry, cleaning, etc.)
  • Development of employment skills including filling out forms, completing work resumes and applications, completing an interview process, time management, following a schedule, etc.
  • Related services needed, including vocational training, day care support, day school, functional vocation evaluations, etc.
  • Vocational rehabilitation, including a functional vocational evaluation
  • Other post-school activities

Types of Diplomas

Well before determining transition services, the IEP team will determine what type of diploma track the student is working on.  

There are different options that need to be weighed carefully as early as elementary or middle school. This consideration is part of the pre-graduation transition support.  These types of diplomas that are part of the transition from high school to post-high school include:

  1. High school diploma
  2. Certificate of completion
  3. Career readiness degree

Traditionally students were eligible for a high school diploma or a certificate of completion.  In the past few years, students can receive a third type of diploma, a career readiness degree.  

The career readiness degree type of diploma is more valuable than a certificate of completion, as it demonstrates students have job readiness skills.  Certain students with mild intellectual disabilities may qualify for this diploma track.

Types of Transition Services

When it comes to identifying various levels of support following the high school setting, individuals can explore various options. The services depicted below take into consideration the individual child’s needs.

A common question is what are examples of transition services. There are many varied post graduation paths students can take:

  • Life skills programs – Life Skills programs are educational programs designed to help young people learn the skills necessary for independent (or semi-independent) living. Most programs are found in residential environments and provide training in: social function, time management, personal hygiene, career exploration, money management, and life skills training.  Paperwork and waitlists are often extensive and long, it is recommended families start this process early. Life skills cooking activities are one strategy. These Life Skills task cards are another tool.
  • Adult day programs or care centers
  • Job shadowing – these can be done through a vocational or life skills program or provided independently through private employers.  Several companies and industries have created an entire model surrounding hiring learners with disabilities.
  • Adapted college programs-  This article on college planning for students with disabilities is a good resource and place to start
  • Vocational education – These programs provide counselors who can help learners explore interests, skills, and abilities, determine support needs, develop employment goals, and provide an Individual Plan for Employment (IPE).  The program may provide job placement assistance, supported employment services, job coaching, skills training, and guidance.
  • Post-secondary education- This type of transition service supports students aged 18-22 years old who have aged out of typical high school graduation age (18 years) and have completed the high school education portion of their programs, but may still have needs in various areas: provision of functional vocational evaluation, vocational rehabilitation services, life skills employment needs, post secondary education/training, skills in independent living, and community connections.
  • Another idea is to do community service using these service ideas. This can be a great way to practice practical life skills while serving others.

Transition Services on an IEP

Each state in the US may have differences in transition services that are outlined on an IEP while still in the school system. 

In South Carolina, for example, once a student is thirteen (this may be different depending on each district), a transition program is added to their Individualized Education Program (IEP).  

This begins the process of developing career readiness skills, identifying interests, and making plans for post graduation.  A Special Education Transitions Coordinator will often be added to the IEP team. 

Why start a Transition Plan early?

It is important to start transition services as early as in middle school or early high school for some students. One main reason is to include transition supports in the IEP to support the transition out of the high school setting. 

There are many reasons why this is important.

  • The waiting lists for programs and services are very long.  It may take years to get into a residential program or adult daycare.  The need far outweighs the resources. While it might seem ridiculous to put a 12 year old on a list for post high school services, waiting lists may be this long where you live.  Have conversations early with families.
  • There is a lot of planning that goes into preparing a young adult for life after graduation. Funding sources need to be in place, placement, programs, etc., all take time with many moving parts.
  • The individual child’s needs can be addressed while in the high school setting, including offering courses of study that meet the student’s interests. Some ideas include peer buddy programs for activities or sports. Other ideas include participation in pre-employment transition services in the high school setting: participating in a school store, an in-school coffee shop, job shadowing in the cafeteria or library for example. Each opportunity can foster the student’s strengths.
  • While neurotypical students learn life skills through observation and limited instruction, learners with special needs take a significant amount of training and practice to master certain skills. For example, managing laundry may take months to learn the basics.
  • While it is difficult to predict the future when talking about the future of an 11 year old, it does not hurt to start preparation early, and leads to a smoother transition.
  • Mentoring opportunities can progress for several years and offer an opportunity to learn over the course of the high school education. 
  • In some cases, guardianship changes may need to be considered.

Transition Services for Middle School to High School Special Education

How does the curriculum change for middle and high school students in special education?

This is a difficult transition and conversation to have with families.  There is a distinct shift when a student in a special education program enters middle and high school.  

The focus moves away from a traditional curriculum, toward a life skills based program.  This can be hard for families to accept that the goals will not be weighed as heavily on reading, writing, and math, but geared toward job training, self help skills, community awareness, safety readiness, and more independent living.  

Families feel as though the educational system has given up on their child learning to do algebra, write a research paper, or something as simple as writing their address and phone number.  

As mentioned earlier, life skills training takes a significant amount of training and practice.  There is not enough time in a school day to focus fully on both standard curriculum and self help skills.  The decision is made with the team to determine the best course of action for the student.  

While there will still be educational skills and objectives addressed, they may be more focused toward life skills.  For instance, instead of traditional math, the goal may be centered around money management, telling time, sorting, and counting.  

Writing goals might focus on writing essential safety information, or having a name stamp to produce this.  Reading can be channeled toward reading safety signs, filling out an application, reading a menu, or following basic recipe directions.

This blog post on the OT Toolbox about occupational therapy for teenagers explains this concept more in depth.

Activities To Help Students With Disabilities Get Used To A New School

Supporting individual student’s strengths with transitions to a new school can be a consideration, too. Students typically move from elementary to middle school to high school and they post high school environments. 

The transition supports in this post can help with this process as well.

Part of that is helping kids fit in at a new school with peer supports and a plan.

Transition Iep Goals

Transition IEP goals need to include a coordinated set of activities with a target goal in mind. The process to move toward transition should be based on the student’s strengths, personal interests, and facilitate movement toward post-graduation and community integration.

Being that the process is so individualized, transition IEP goals may include versions of this: 

  • Counting Money- At the end of each school day, student will count and record the amount of money earned that day from the classroom token economy, with % accuracy in X of X trials. 
  • Job application goal- Student will fill in the personal information section of a job application registration form, with % accuracy in X of X trials.
  • Work research goals- Student will research jobs and complete a job application with % accuracy in X of X trials. 
  • Job interview goal- Student will prepare for, dress appropriately for, and participate in a mock interview with % accuracy in X of X trials. 
  • Medical Forms-Given a medical form (printed or website), Student will fill out the form in X of X trials with % accuracy. 
  • Fine motor/Handwriting: Signature goal- Student will sign his/her first and last name in cursive, with % accuracy in X of X trials.
  • Life skills goals- Given X recipes, student will write a grocery list for ingredients needed (with no more than X ingredients needed) with % accuracy in X of X trials. 
  • Self-care goals
  • Communication goals
  • Technology goals
  • Community goals
  • Independent functioning goals
  • Pre-vocational goals
  • Vocational goals- Given a job task, Student will complete # tasks within # minutes with % accuracy over X out of X opportunities. 
  • Study skills goals
  • Social skills goals
  • Work habits goals

How Families Can Help

Families can support the child’s movement from school to post-education services by supporting the transition. The Life Skills Task Cards are one tool to work on various aspects of life skill work with a punch card type of strategy to offer motivation and meaningfulness. Some ways that families can help is by:

1. Do work-related and household chore tasks at home as part of a family team: making a simple meals like sandwich, setting the table, running the laundry, folding laundry, sorting utensils, loading the dishwasher, cutting the lawn, etc.
2. Provide opportunities to practice skills in the community (ordering a meal, scheduling an appointment, paying a bill, purchasing groceries, etc.)
4. Work on communication skills (phone, e-mail, social media), including safety issues
5. Talk about and go through meal prep together. Plan meals, purchase groceries for meals, making healthy choices, storing food, etc.

6. Make and cancel medical appointments
7. Teach student about any medications she/he is taking
8. use a calendar to keep a schedule of important dates.
9. Teach money skills.
10. Give the student and family a copy of “What you should know about Wisconsin LAW Booklet”
and talk about what changes when the student turns 18 years of age
11. Practice community navigation: crossing roads safely, taking abus,calling anUber,etc.

Final thoughts on Transition Services

This information is the tip of the iceberg in terms of readying students for a life after secondary school. The child’s movement through services does not need to be complicated. Some final tips for a successful transition after high school include:

Focus is on the functional achievement of the child and ensuring a successful transition for the student. 

Create a good team of professionals to help with these transition services. 

Consider the community experiences. There may be many opportunities in the community for job shadowing, and learning on the job for a results-oriented process. 

The following are a couple of other general resources to start the journey.

Consider provision of a functional vocational evaluation as part of the process.

Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.

Life Skills task cards
Life Skills Task Cards offer practice opportunities for everyday tasks in the home or life skills classroom.