How to do “Push In” Occupational Therapy

occupational therapy collaboration

Are you a new school based occupational therapist wondering how to implement a “push in” therapy service delivery model?  Perhaps you have been practicing for a while and are looking for some tips to transition your services from your therapy space to the classroom. For additional reading, the OT Toolbox has a comprehensive post on occupational therapy in school system.

How to implement push in occupational therapy and push in therapy services in school based occupational therapy interventions.

What is Push-in occupational therapy in schools?  

Push in” services is a term used to describe school based occupational therapy services provided when students are participating in their natural environments. 

At school, these environments can include the classroom, the cafeteria, the playground, or any other setting that a student accesses during the school day. 

We’ve worked in the cafeteria on sensory needs for example, or to work on feeding needs. 

Push-in Occupational Therapy Services

Changes in legislation with the addition of the No Child Left Behind law, began a shift in service delivery models for school-based occupationlal therapy over the last 20 years.  This shift has refocused school based therapists on inclusion, providing services in the natural environment.  

While occupational therapy in schools has always had it’s fair share of challenges (schedules and caseloads to name a few), shifting our focus to providing therapy services in the student’s natural environment, is supported by research and highlights our strengths as occupational therapists.

This challenge is a good change for related services.

We can rely on evidence, but what does it say about push in services in the school environment? 

What Is Push-In Therapy?

Push-in therapy is a collaborative service delivery model where therapists, like occupational therapists and speech-language pathologists (SLPs), work directly in the classroom setting instead of pulling students out for separate sessions. This allows for real-time support, integration into classroom routines, and alignment with instruction.

Research by Cirrin and Nelson recommends clinical reasoning as to the approach for improving communication outcomes and functional participation in the least restrictive environment.

How Push-In Therapy Supports Kids in the Classroom

During push-in therapy sessions, therapists might work alongside the classroom teacher during circle time, small group instruction, or a planned classroom activity.

They may embed prompts to support communication skills, use curricular vocabulary, or incorporate fine motor strategies for students with OT needs. This model benefits not just the student with IEP goals, but also their peers, by promoting inclusion and shared learning.

Benefits of Push-In for OT and SLPs

For school-based SLPs and OTs, push-in therapy allows for greater collaboration and real-world application of skills with the educators actually teaching the students each day.

For example, a speech therapist might focus on social communication and articulation during group lessons, while an OT might work on posture and tool use during writing tasks. The therapist can adjust support dynamically, ensuring engaging, functional interventions for age-appropriate children in elementary school classrooms.

Push-In vs Pull-Out: What’s the Difference?

While pull-out therapy can provide focused one-on-one intervention, push-in services offer a unique opportunity for generalization of skills in the natural learning environment.

Studies examining the effects of different service delivery models show that integrating therapy into the classroom supports better long-term communication outcomes and academic participation.

What are Push In therapy services? Wondering what push in occupational therapy looks like for the school-based OT? This resource explains how to implement OT services right in the classroom.

Are push in services as effective as pull out?

Yes! Push in services can be just as effective, or even more so, than pull out. Several studies (Reid et al, Villeneuve) have examined school-based services and the effectiveness of collaborative consultation. 

Not only do students make progress at a faster rate, teachers and parents report improved satisfaction as well.  Many occupational therapists can probably relate to the experience of having a teacher ask you what “magic” you performed with a student while in a pull out therapy session. 

One of the huge benefits of push in therapy, is doing that “magic”  in context so other educators can see it happening in real time!

As a school based occupational therapist, it might feel easier or more effective to pull your students out of class into a controlled therapy room to provide intense one on one therapy.

While your session might feel successful, it is not realistic. The difficulties your student is having is within the classroom, not the self contained therapy room.

How do you make the shift from pull out to push in?  First, you need the support of your special education team – the parents, administrators, and teachers.  Get this support by teaching and showing them what you know, and the benefits of being in the classroom.

It will take time to earn their trust, as you are seen as an intruder in their classroom.

Conducting Observations during Push-In Therapy

The first step is conducting observations of your students during the evaluation process.  These observations should take place across school environments where they are engaged in occupations and activities of daily living.  

This can include the playground, cafeteria, mainstream class, special education, resource, art, computer, library, or all of the above.

It is important to try to gather information from the teacher and parents to narrow your focus and understand their concerns, before deciding when and how to observe a student. 

Depending on the areas of difficulty, you may need to observe transitions for children, work time, managing clothing at arrival/dismissal, the lunch routine in the cafeteria, or their ability to access the playground at recess.

Push-in Services and Goals

Once your evaluation is complete and you are recommending occupational therapy services in the natural environment to the team, how do you get teacher and parent buy-in?  This may take time, and more importantly, it will take data collection.  

Here is a breakdown of the fine motor skills needed at school to help with your goals setting and data collection.

One of the most important factors in success will be writing goals and objectives that are clear enough for anyone to observe the skills and collect data

Clear, measurable, observable behaviors and/or skills need to be documented in the IEP or 504.  It needs to be measurable, relevant, and doable!  

Check out the SMART goals ladder worksheet on the OT Toolbox for information on creating goals.

The OT Toolbox has a great resource available for Occupational Therapy documentation in the school setting.

When educators feel empowered to carry out OT interventions, the success of the students will increase.  Additionally, when parents can easily observe skills at home, they will be more supportive of the therapy model. 

When the skills being addressed are supported throughout the school day and at home, students have a much greater possibility of generalizing those skills across all environments. 

OT Collaboration in the classroom

As you begin to provide push in occupational therapy services for your students, it is important to collaborate with the team.

While the Occupational Therapist provides services in the natural environment teachers and/or paraeducators can observe, ask questions, and get feedback from the therapist.  The entire team will be the ones implementing your interventions and collecting data when you are not there. 

It is essential they feel confident in executing your interventions.

Ways to build collaboration as a school-based OT:

  1. Set the tone through open and reciprocal communication that all members of the team are valued and equal. Get input from all members of the team including; teachers, paraeducators, parents, and the student.
  2. Provide modeling for staff.  Advocate to administrators it is critical for staff involved to observe you working with a student on their occupations.  
  3. Provide coaching to the educators implementing your plan.  Once you have been able to model for staff, spend time observing and coaching them while they are working with the student. We explain this in great detail in our blog post on executive function coaching.
  4. Make data collection easy and doable.  Develop simple, easy to use data collection forms that do not require time and/or effort to complete.  It could be as simple as a tally mark or checking a box on a chart.
  5. Check back in with the team frequently to monitor how it’s going and to make changes to the plan if needed.

One final thought… keep the focus on participation and occupation! The team will see results and your students will find success.  Don’t be afraid to let your school community see the value occupational therapy adds to your student’s participation in school!

Occupational therapy collaboration in the classroom handout

Free OT Collaboration Handout

Want a free printable handout explaining OT collaboration in the school environment? This is a useful tool for school-based occupational therapy practitioners to explain OT services in the educational model as a collaborative member of the team.

Enter your email address into the form below, and the handout will be delivered to your inbox. Or, if you are an OT Toolbox Member’s Club member, log in and then head to Educational Handouts section of the membership. Not a member? Join today and access hundreds of free resources here on the website without having to enter your email address for each item. Plus gain new resources each month.

FREE HANDOUT- Collaboration in the Classroom

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    Katherine Cook is an occupational therapist with 20 years experience primarily working in schools with students from preschool through Grade 12.  Katherine graduated from Boston University in 2001 and completed her Master’s degree and Certificate of Advanced Graduate Study at Tufts University in 2010.  Katherine’s school based experience includes working in integrated preschool programs, supporting students in the inclusion setting, as well as program development and providing consultation to students in substantially separate programs.  Katherine has a passion for fostering the play skills of children and supporting their occupations in school. 

    References

    Reid, D., Chiu, T. Sinclair, G, Wehrmann, S., Naseer, Z. Outcomes of an occupational therapy school-based consultation service for students with fine motor difficulties. Canadian Journal of Occupational Therapy. 2006; 73: 215-224.

    Villeneuve M. A critical examination of school-based occupational therapy collaborative consultation. Canadian Journal of Occupational Therapy. 2009;76(1_suppl):206-218. 

    Add this handout to our other school resources:

    Easy Shapes School Bus Craft

    School Bus craft for screening skills during back to school time

    School buses and the back-to-school season is the perfect time for a fun, low-prep bus craft that supports creativity and fine motor skills. We love using back to school themed activities in occupational therapy sessions for a reason…This paper bus activity is ideal for young kids, toddlers, kindergartners, and even older kids. Using simple materials like cardstock, glue, markers, and printables, this craft is a great option for the first day of school, a classroom display, or a back-to-school school activity.

    An easy school bus craft is just what kids need before back to school, along with a little crafting fun!


    I don’t want to even think about the end of summer and the start of school.  The summer fun is quickly passing by with long days of outdoor play and water activities.   We’ve got a few of the cousins heading back to school this fall.  A couple on the school bus and a few that will be starting up preschool for the first time. 

    New classes, new book bags, and new school shoes happen before the summer fun has even ended.  With all of the newness happening, this mama wanted to touch on an old familiar theme with the start of school quickly approaching.  


    This school bus craft was a fun way to create while we explored easy shapes.  This was a great craft for my two year old as we talked about the start of school and some easy shapes.

    Kids will love to make this school bus craft as a back to school craft that helps kids learn shapes.

    Back to School Craft

     
     
    This post contains affiliate links. 
     
    Easy shapes school bus craft
     
     

    School Bus Craft

    For this craft, all you need is a few items.
     
    I cut a few simple shapes from the paper.  An older child who is working on scissor skills could cut these shapes.
     
    Building our school bus was fun!  We moved our shapes around until we liked the bus.  This was fun for Big Sister (age 6) as she helped us build the bus and made sure the windows were where she liked them. 
     
    Baby Girl (age 2 and half) worked on her shape identification with this craft.  Big Sister and I would hold up a shape and ask her what it was.  She was loving the shape test!
     

    We glued the shapes in place on our bus when we got it looking like we wanted.  Big Sister used some scrap paper to draw bus stops for our bus.  I love the “baby stop”!

    school bus craft for learning shapes and preparing for back to school

     

     

     

    Easy Bus Craft for Kids of All Ages

    As an OT in schools, I love this craft to start off the school year because you can get a quick look at scissor skills, fine motor skills, planning and executive function, and much more. It’s a wonderful way to welcome the new school year with hands-on learning.

    Simple Steps and Creative Add-Ons

    This paper plate school bus craft (or use cardstock to make a more structured paper bus) is great for easy crafting in small groups or as part of a station activity. Add a black line for the road, draw headlights on the front, or invite kids to sketch their own child’s face in the windows for a personalized touch.

    Need a quick solution for class? Provide step-by-step instructions with a visual example, or print out bus shapes with cut-and-paste parts to make this a preschool craft that’s both fun and functional.

    Make It a Wheels on the Bus Craft!

    Turn your bus project into a Wheels on the Bus craft by adding interactive features to go along with the classic bus song. Use paper brads to make spinning wheels, or glue on circles cut from black construction paper. Attach craft sticks to act out the song as a puppet or prop during circle time. You can also label parts of the bus (“doors go open and shut,” “wipers go swish swish swish”) to reinforce early learning concepts while you craft.

    This is a fun idea that pairs perfectly with music, group time, and creative movement!

    Turn It Into a Pigeon Rides the Bus Craft

    We have many preschool book activities here on The OT Toolbox. This paper bus craft is a perfect way to extend the craft into the book, Pigeon Rides the Bus!

    Turn this craft into a Pigeon Rides the Bus craft inspired by Mo Willems’ beloved character. Simply add a drawing or cut-out of Pigeon riding in or driving the bus. Kids can glue Pigeon onto the driver’s seat or draw him peeking out the window using a marker or crayon. Pair the craft with a read-aloud and follow-up discussion to build on literacy and comprehension skills.

    This is a great way to tie in book-based learning with preschool crafts or kindergarten art projects.

    Why This Craft Works for Young Children

    This school bus art project uses simple crafts and easy paper crafts to build important early skills:

    • Promotes fine motor skills through cutting, gluing, and coloring
    • Encourages creativity and storytelling
    • Supports classroom community with a shared fun activity
    • Perfect for first week of school routines

    It’s one of those easy craft ideas that is great for building connection and confidence in your preschool class or at home.

    School Bus craft for screening skills during back to school time

    With one cutting craft, you can assess many areas:

    Fine Motor Skills

    • Cutting: Children cut squares, rectangles, and circles, which targets hand strength, bilateral coordination, and scissor skills.
    • Pasting/Glue Control: Squeezing glue bottles or using glue sticks promotes hand strength and precision.
    • Grasp Patterns: Encourages tripod grasp and refined finger movements when handling small shapes.

    Visual Motor & Perceptual Skills

    • Visual Discrimination: Identifying and matching shapes (square windows, rectangular bus body).
    • Figure-Ground: Picking out shapes from a group of cut pieces or worksheet.
    • Visual Closure: Recognizing the bus even if parts are missing or partially hidden.
    • Visual-Spatial Awareness: Placing parts of the bus (windows, wheels, stripes) in correct orientation and location.

    Bilateral Coordination

    • Cutting with Stabilization: Requires use of one hand to stabilize the paper while cutting with the other.
    • Assembly Tasks: Holding the bus body with one hand while placing and pressing shapes with the other.

    Executive Functioning Skills

    • Planning and Sequencing: Following steps in order (e.g., bus body → windows → wheels).
    • Working Memory: Remembering shape placement and order from visual or verbal instruction.
    • Inhibition: Waiting to glue or cut at the appropriate time within the task.

    Language and Cognitive Skills

    • Shape & Color Identification: Naming shapes and colors while assembling.
    • Following Directions: Completing a multi-step task with adult guidance or peer modeling.
    • Concept Development: Understanding positional concepts like “on top,” “next to,” “under.”

    Postural Control & Endurance

    • Seated Tolerance: Sitting upright to complete a tabletop activity from start to finish.
    • Core Engagement: Maintaining posture while using both hands in front of the body.

    Sensory Processing

    • Tactile Input: Handling paper, glue, and possibly stickers or markers.
    • Proprioceptive Input: Using controlled hand pressure for cutting and gluing.
    • Visual Input: Tracking lines while cutting and scanning for shape placement.

    Social and Emotional Skills

    • Turn-Taking and Sharing: During group crafts, materials may be shared.
    • Task Completion: Builds confidence by following through on a start-to-finish task.
    • Self-Expression: Decorating the bus with additional details or personalization (child’s name, colors).

    For more ways to focus on scissor skills, and the WHY behind development of cutting with scissors, check out our resource, The Scissor Skills Book.

    Check out The Scissor Skills Book for tips and strategies based on development from school based occupational therapists and physical therapists.

    Colleen Beck, OTR/L has been an occupational therapist since 2000, working in school-based, hand therapy, outpatient peds, EI, and SNF. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. Read her story about going from an OT making $3/hour (after paying for kids’ childcare) to a full-time OT resource creator for millions of readers. Want to collaborate? Send an email to contact@theottoolbox.com.

    Sitting Positions on the Floor

    Image has pictures of different sitting pictures and labels of names of sitting positions.

    In this post we will explore the classic crisscross style of sitting, as well as acceptable alternative sitting positions on the floor. We will explore floor sitting for circle time, gym class, and other classroom learning situations. Not only are we learning about alternative sitting positions on the floor, I am hopeful you will become an advocate for the students you serve. Another resource to check out is our post on flexible seating options for the classroom.

    When it comes to sitting positions for kids, the classic criss cross applesauce is often the go-to during circle time and classroom activities. But for many children, especially those with sensory needs, motor planning challenges, or postural control difficulties, this position can be uncomfortable or even inaccessible. It’s important for educators, therapists, and caregivers to recognize that alternative sitting positions for circle time are not just acceptable, they’re essential for an inclusive learning environment. Whether a child is a kinesthetic learner or needs additional support to feel regulated, offering flexible floor sitting positions can make a big difference.

    We need to think about the spine, the lower back, tight hamstrings…there is a lot more than just sitting up straight and paying attention during circle time or floor time learning. Let’s talk about best positions for sitting on the floor in the classroom…

    children sitting on the floor in different positions, text reads "sitting positions"

    There are many versions of sitting positions on the floor and depending on the sensory motor considerations of each child, these floor sitting positions facilitate learning.

    Image has pictures of different sitting pictures and labels of names of sitting positions.

    We made this image of types of sitting positions but this visual is just the beginning. There are many other sitting positions that can be used for comfort, function, and sustained positioning on the floor.

    Sitting positions on the floor

    At least ten times a day I hear a teacher say, “come on in and sit crisscross applesauce.”  This type of cross-legged sitting used to be called “Indian style” or “Tailor sit” before that was deemed insensitive. I cringe when I hear this, not only because of the silly name “crisscross applesauce, but because this sitting position on the floor should not be a universal request, or the only choice students have for seating.

    In the preschool setting, we usually have a circle time or floor activities where sitting on the floor is part of the school day. For kids that struggle with sensory motor skills, this can be a real challenge.

    Read our blog post about Crossing Midline Activities for Preschoolers for a developmental explanation of this age range and how we can support young kids in functional midline tasks like sitting on the floor for story time or for preschool circle time.

    One way to support these sitting positions is by using a ball pit as a therapy tool.

    Types of SITTING POSTIONS ON THE FLOOR

    There are several different types of sitting positions on the floor that are seen in classrooms. There are pros and cons to all of them.

    Teachers may tell you that sitting on the floor in one specific way (criss cross applesauce) creates uniformity and structure. If everyone is sitting quietly in the same position, there is less distraction in the group.  Children benefit from rules and regulations. 

    This is a great answer, however, not all children can comfortably sit in this position, thus causing more distraction as they struggle to find a comfortable seating posture or retain crisscross applesauce.

    You might see a version of these various sitting postures during circle time activities, during play, or during various centers. Let’s go over each type of sitting position.

    Cross-legged position

    Since “crisscross applesauce” or cross-legged position is the most often used, let us start there.

    This cross-legged position involves both knees bent, crossing feet at the ankle, with both ankles on the floor.

    There is a rhyme that accompanies the crisscross applesauce phrase:

    “Crisscross, applesauce

    Hands on lap, gingersnap

    Sit up straight, chocolate cake

    On your rear, root beer

    Zip your lip, cool whip.

    Shhh, now you are ready to listen!”

    Pros of Criss Cross Applesauce Sitting Position: the body is in a compact form with legs and arms “inside the vehicle.” It is a universal sitting position, known or taught to most children. If everyone is in the same sitting positions on the floor, there tends to be uniformity and less distracting chaos.

    Cons of Criss Cross Applesauce Sitting Position: it is uncomfortable for many people. It can be difficult to stay in the same position for long periods of time, due to fatigue, discomfort, sensory challenges, and inattentiveness. There is not a wide base of support with the knees off the ground and arms tucked inside the lap.  Some students need more support.

    Alternative Sitting Positions for Circle Time

    Not every child can or should be expected to sit the same way during circle time. Offering alternative sitting positions for circle time can help meet the needs of all learners while promoting engagement and attention. 

    Some children may benefit from long sitting (legs extended), side sitting, kneeling, or even tall kneeling to stay regulated and focused. These options help reduce discomfort and allow children to choose the position that works best for their bodies. Encouraging choice also fosters autonomy and supports self-awareness during group learning activities.

    Criss Cross Applesauce Alternatives

    Although “criss cross applesauce” is a common classroom cue, it’s not a one-size-fits-all solution. Kids with sensory processing differences may find the posture overstimulating or too restrictive. 

    Others may lack the core strength or flexibility to maintain this position for any length of time. Instead, allow children to use alternatives like side sitting, tailor sitting (with legs loosely crossed), or even lying prone on their stomachs with elbows propped. These criss cross applesauce alternatives still allow for group participation without forcing an uncomfortable posture.

    Alternative Sitting Positions for Kids

    1. Tailor Sitting

    Similar to criss cross applesauce but with the legs more loosely crossed and knees wider apart. Easier for kids with tight hips or core weakness.

    2. Side Sitting

    Both legs are bent and tucked to one side of the body. One hip is on the floor, and the child may lean slightly to that side. Offers a more relaxed position and can help with balance.

    3. Long Sitting

    Legs are extended straight out in front of the body while sitting upright. Great for stretching the hamstrings and promoting postural awareness.

    4. W-Sitting

    Knees are bent, and legs are positioned outside the hips in a “W” shape. This position is common in young children but may place stress on the hips and joints, so it should be used with caution or avoided if advised by an OT.

    5. Kneeling

    The child sits on their knees, with legs folded underneath and buttocks resting on their heels. Can offer more postural support than cross-legged positions.

    6. Tall Kneeling

    The child kneels with hips extended and buttocks lifted off the heels, creating a straight line from the knees to the shoulders. Engages core muscles and can provide proprioceptive input.

    7. Half Kneeling

    One knee is on the floor while the other foot is flat in front, creating a “lunge” shape. This position can help with balance and muscle strengthening.

    8. Prone (Tummy Time) Position

    The child lies on their stomach with elbows bent and propped under the shoulders, supporting the upper body. Great for building upper body strength and providing calming input.

    9. Squat Sitting

    Child sits low to the ground in a squat with feet flat on the floor and knees bent. This position supports proprioception and is often natural for younger children.

    10. Standing or Wall Sitting

    Child stands or leans against a wall during group time. Helpful for those who need movement or find floor sitting uncomfortable.

    11. Sitting on a Cushion or Wedge

    Child sits on a small cushion, wobble seat, or wedge to provide more comfort and/or movement while staying seated.

    12. Sitting on a Therapy Ball or Active Stool

    Although not a floor option, this is ideal for seated classroom activities at a desk. Allows for movement and builds core strength.

    Floor Sitting Positions

    There are many types of floor sitting positions that support different needs. In addition to tailor and side sitting, children may prefer w-sitting, sitting on heels, or using a floor cushion or wedge for added comfort. 

    A therapy ball, wobble cushion, or floor rocker seat can also be helpful for children who need a bit of movement while seated. Having a variety of options available helps meet the needs of kinesthetic learners, children with core weakness, or those who benefit from sensory input during learning.

    Think About Postural Support

    Proper postural support is key when it comes to sitting for extended periods. Without support, children may slump, fidget excessively, or disengage altogether. Supporting posture can include simple strategies like providing a firm seating surface, allowing children to lean against a wall, or placing a visual cue on the floor to guide leg positioning. 

    For some children, adding external tools like a small footrest, cushion, or low stool can help stabilize their core and promote more upright posture. These supports can make floor sitting positions more comfortable and sustainable for kids with motor or sensory needs.

    Proprioception and Sitting

    The proprioceptive system plays a huge role in helping children understand where their bodies are in space, especially during seated tasks. Proprioception and body awareness are closely connected and sometimes, kids just don’t realize the way they are sitting. For kids with sensory processing challenges, sitting still can be hard without additional proprioceptive input. 

    Offering heavy work activities before circle time, like animal walks or wall pushes, can help “wake up” the body and prepare it for stillness. Seating tools like weighted lap pads, firm cushions, or kneeling positions can also provide that needed input during sitting. By tapping into the proprioceptive system, we support regulation and improve the child’s ability to focus during group activities.

    About W-Sitting

    Did you ever try to W sit? Do you know what a W sitting position looks like?

    I know many of you are cringing just thinking about the dreaded “w-sit.”  It is a popular sitting position on the floor among young children, especially those with low strength and/or muscle tone.

    In this position the legs literally form the letter W on the floor. When a child sits in a W sit position, their hips are internally rotated, while the knees are bent facing the midline, and the feet are positioned away from each side of the body.

    Pros of the W Sit Position: offers great stability while playing, due to the wide base of support.  It is very comfortable for long periods of time, for those flexible enough to effectively achieve this position.

    Cons of the W Sit Position: w-sitting is terrible for the knees and hips.  They are not meant to be in this position long periods of time. This wide based sitting position on the floor takes up a lot of space, especially when there are several children seated close to each other.  The hands do not naturally have a “bunny hole” to go into to keep them busy while sitting.

    Prolonged w sitting can be a sign of developmental difficulties. For others, w sitting offers a wider base of support which offers more proximal stability so the individual can use the arms and hands with refined dexterity. For the individual who struggles with core strength and stability, and sitting balance, a W sitting position can help with attention and focus.

    Children’s Hospital of Los Angeles has a different opinion. Their research claims that w-sitting does not cause hip problems, and most often children, by the age of eight, grow out of this habit on their own. 

    Dr. Goldstein explains, some children have more inward twist in their thigh bones than other children, so they can easily bring their knees in and feet out. In fact, for some children, sitting with their legs crossed in front of them may be uncomfortable because their thigh bones have less twist in the forward position than the inward position.

    Note: some children need this wide base in order to sit for several minutes. Without this wide base, they are unable to use the rest of their body to play with toys and engage. As they build core strength, students may be able to transition to a cross-legged pose.

    Long Legged Sitting position on the floor

    In this sitting posture, the hips are generally at 90 degrees with the legs extended out in front. The width of the legs, or how far apart the feet are, may vary depending on the type of support needed, and tightness in the back and hip structures.

    There are times when this is the only position a person can achieve on the floor due to tightness in the hips or legs. 

    Long legged sitting is a typical stage of development in children as they gain core strength, but is integrated into higher level sitting positions.

    Pros of the Long Legged Sitting Position: it can offer a larger base of support than cross-legged sitting.  Long sitting may be comfortable. This position may provide enough support to free the upper body to move and engage.

    Cons of of the Long Legged Sitting Position: this sitting pose takes up a lot of room.  If 30 children in the class sit like this, they will run out of carpet space. Long sitting can lead to posterior pelvic tilt, or slouching due to the stretch of the muscles, although some people have remarkable posture in this position.  It can lead to increased tightness as the student bends their knees or abducts their legs to get comfortable, thus making it difficult to straighten their legs later.  It is hard to reach forward to play with items while in this position. Sometimes this position is less stable as the child can easily tip over to the side or lean back too far. 

    As with w-sit, some children can only sit in this position due to disability, tightness/weakness of muscles, or instability. In my opinion it is better to allow a person to sit this way, if sitting in other positions impairs their function.  The end goal is function.

    An alternate seating option related to the long leg sitting posture is:

    • Bent Long Sit- The legs are both forward and the knees are bent. In yoga, this might be called a mountain sitting posture
    • Bent Legs Holding Knees- This position has the individual sitting with their legs in front of them with the knees bent. They may lean forward and hug the knees.

    Mermaid Sitting Position

    An alternative to the long leg sitting position is the mermaid sitting style, where the knees are both positioned to the side and back, in the same direction. This positioning offers greater base of support.

    Short kneel Sitting Position

    In the short kneel sitting position on the floor, the learner is sitting on their feet with their legs tucked under them.  This position can offer not only comfort, but needed sensory input.

    Short kneel is a developmental milestone that leads to pulling up to stand.

    Pros of a short kneel sitting position on the floor: this is a compact position with the legs tucked underneath.  It can be comfortable for long periods of time. Short kneel provides proprioceptive or deep pressure input while sitting, and often helps with self-regulation needed to attend to a lesson.

    Cons of a short kneel sitting position on the floor: children are sitting up higher in this position, making it difficult for those behind them to see. It can cause pain in the knees.

    An alternative sitting position to the kneel sit is:

    • Open knees kneel sit– the individual sits on their legs with their feet tucked under their bottom, but the knees are spread apart. This option offers greater base of support and stability through the core.
    Drawings of deferent sitting positions showing posture and deferent positioning of legs and arms in sitting postures.

    Image of different sitting positions on the floor from the World Distribution of Postural Habits, published in American Anthropologist in 1955.

    These are the most common alternate sitting positions on the floor we see in schools. There is also side sit, lotus, squat, tall kneel, and more. This drawing illustrates over 35 different sitting positions on the floor!

    How to offer alternative seating positioning on the floor

    • Teach children to stay in their personal space without touching others. You can do this by using a carpet with colored squares, taping squares to the floor, using rug samples, or mini swimming pools for each student.
    • Teach children that they cannot block another student’s vision of the circle time activity.
    • Unobtrusively put out the new possible seating options (cushions, fidget toys, lap pads, etc.) during free play so they are not so new and exciting that they take children’s attention away from the circle time activity.
    • Teachers can offer chairs in the back of the circle time area. Cube chairs, stadium seats, carboard boxes, wiggle cushions, or other alternatives. Consider DIY seating options.
    • How about weighted lap pads for children who cannot stay in one spot? They can be as simple as a sock weighted with rice, or sitting with a heavy backpack.
    • What about those children who seem to be in constant motion? Maybe they can have a squishy ball or fidget toy.  This opens another can of worms. Fidgets need to be tools, not toys, and taught to be used in a non-distracting manner. Here are some quiet fidgets you can try.  This article, The Ultimate Guide to Fidgets on the OT Toolbox provides some great ideas. Note that fidgets of any type should be used with caution and based on the individual skills and level of each child. It’s up to the educator/therapist/etc. working with the child to select appropriate and safe fidget tools for the child. Also note that The OT Toolbox is not liable for any fidget or recommendation used with children.
    • Maybe children who do not want to come to circle time can do a quiet activity in another area of the room.  While this does not seem like the right idea, it can allow the other 24 children to have a successful lesson.  Then work on problem solving getting this student involved in circle time.
    • Respect children’s attention span and keep circle time to 10 minutes.
    • Plan your circle time to include a welcoming time, an activity focus, and a closing tradition.
    • Tell children daily what is going to happen at circle time, first, second, third, so they know what to expect.

    Neurodiversity and sitting positions on the floor

    Above we illustrated some good reasons for children to all sit cross-legged on the floor. If all the students in today’s classrooms were neurotypical, with average tone, muscle strength, attention, and self-regulation, teachers might be able to expect all their students to sit in a uniform fashion.

    However, classes are full of neurodivergent students who do not fit into the same box as typical peers.

    Focus in classrooms needs to be on learning, not sitting positions on the floor.  In my opinion, as an occupational therapist, we need to offer students more options in classrooms to enhance their learning potential.

    Some teachers are getting on board with this, while others are resistant to change. If you are a therapist in the schools, a big part of your role is education. Use your knowledge to explain why you are requesting changes to the classroom.

    FAQ: Common Questions About Sitting on the Floor

    As pediatric occupational therapists, we get a lot of questions where educators, admin, and other service professionals want to “pick your brain” about how to support students. Here are some common questions we get about sitting positions and attention, learning, etc.

    Q: Why can’t some kids sit criss cross applesauce?

    Some children have difficulty sitting criss cross applesauce due to challenges with core strength, hip flexibility, motor planning, or sensory processing. This position requires balance, postural control, and body awareness. These are gross motor skills that may be delayed or underdeveloped in some kids. For others, the position can feel uncomfortable or even painful, making it hard to focus during circle time.

    All of this is to say that kids sitting in a variety of positions is OK!

    Students with sensory needs may benefit from sitting options that offer movement, proprioceptive input, or a more stable base. Great choices include:

    • Sitting on a wobble cushion or therapy ball
    • Kneeling or tall kneeling
    • Side sitting or tailor sitting
    • Lying on the stomach (prone position) with elbows propped
      Providing sensory-friendly seating helps these students regulate their bodies and better participate in classroom activities.

    Q: What is the best classroom seating for kinesthetic learners?

    Kinesthetic learners often learn best through movement and physical engagement. Ideal seating options for them include:

    • Floor cushions or rocker seats
    • Standing desks
    • Therapy balls or active sitting stools
    • Opportunities to switch positions frequently
      Incorporating movement breaks and active learning also supports their learning style throughout the day.

    Q: How can I support kids who struggle with sitting?

    Start by observing what makes sitting difficult. Is it posture, attention, sensory discomfort, or restlessness? Support strategies may include:

    • Offering alternative seating options
    • Allowing frequent position changes
    • Using visual cues or carpet spots
    • Adding movement breaks before seated tasks
      Collaborate with an occupational therapist if sitting challenges are persistent or impacting learning.

    Q: What is flexible floor seating for preschoolers?

    Flexible floor seating means offering a variety of sitting positions that support a preschooler’s developing body and sensory needs. Examples include:

    • Criss cross, side sitting, or kneeling
    • Long sitting (legs straight out)
    • Cushions, small mats, or wedges
      This approach gives young learners the ability to choose positions that help them feel comfortable, regulated, and ready to learn during group time or quiet play.

    Occupational Therapy Tips for Floor Sitting

    Here are some tips for supporting learning when sitting on the floor. Start with some posture exercises to get started. Another tip is to take a look at retained reflexes. Then other tips include:

    Choose the Right Surface for Support

    The type of surface makes a big difference in floor sitting comfort. A firm but padded mat, folded blanket, or even a yoga block under the hips can reduce joint strain and improve spinal alignment. For kids who struggle with core strength or postural stability, sitting at the edge of a folded blanket slightly elevates the hips and helps maintain a more upright position.

    Encourage Proper Posture and Spinal Alignment

    Maintaining a straight spine and proper spinal alignment is important for reducing lower back pain, neck pain, and overall strain during floor sitting. Supportive tools, along with attention to posture, can help reduce fatigue and prevent discomfort. Encourage back support (e.g., sitting against a wall) when needed.

    Gentle stretching or tension release techniques can make sitting feel more relaxing and functional.

    Teach Floor Sitting Variations That Reduce Pressure

    For children who can’t sit criss cross applesauce, introduce alternative floor positions like the straddle, bent sit, or even a wider stance with feet hip-width apart. Kneeling variations may involve knees shoulder-width with the tops of the feet flat against the floor. For more advanced postural work (or when pairing with physical therapy), positions involving a front leg bent and back knee extended, like a modified lunge, can build awareness and mobility. Be mindful of weight distribution across wrists, front knee, and opposite knee if a child is using hands for support.

    Balance Duration and Movement for Better Function

    Sitting on the floor should be done in short periods, especially for kids working on human performance goals like blood flow, core strength, or lower body muscle development. Incorporating movement breaks, seated stretching, or switching positions often can support bowel movement function, increase circulation, and reduce stiffness. OT practitioners often integrate short seated tasks with embedded movement to encourage regulation and engagement.

    Focus on body awareness. This is huge. A lot of positioning needs comes back to strength, coordination, motor planning, body awareness, visual motor skills, and more. All of these areas contribute to functional performance.

    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.

    references on Sitting Positions on the Floor

    Hewes, Gordon W. “World Distribution of Certain Postural Habits.” American Anthropologist, vol. 57, no. 2, 1955, pp. 231–44. JSTOR, http://www.jstor.org/stable/666393. Accessed 26 Sept. 2023.