Colleen Beck, OTR/L is a pediatric occupational therapist and the owner and author of The OT Toolbox website. She manages all of The OT Toolbox social media accounts and runs the popular newsletter.
Read about Colleen's experience and career as an occupational therapist, including how The OT Toolbox began on our About The OT Toolbox page: https://www.theottoolbox.com/about-us/
Colleen created The OT Toolbox in 2011 and since then has written thousands of blog posts designed to support therapy providers, educators, parents, counselors, admin, and caregivers in promoting the healthy development of kids.
Check out Colleen's blog posts below:
If working on developing fine motor skills this Fall is something you’re focusing on, these Fall fine motor worksheets are the way to go. Add these printable clip cards use clothes pins or paper clips to develop hand and finger dexterity and grip and pinch strength to a Fall theme. Use these Fall leaves clip cards to several of our favorite Fall fine motor activities for developing hand strength, pinch, grip, and dexterity in the hands.
These fall fine motor worksheets are clip cards that combine a print and play activity.
It’s easy to set up this Fall fine motor worksheet into an interactive, and hands-on fine motor activity:
Just print out the Fall leaves worksheets.
Then laminate or use as a paper form. Cut out each circle.
Then, kids can clip clothes pins or paper clips onto each circle as they count and match clips to the Fall leaves on the cards.
Fall Clip Cards for Fine Motor Development
Fall clip cards are a seasonal and engaging way to build essential fine motor skills in young children. These hands-on tools typically feature colorful autumn-themed images—like pumpkins, leaves, or acorns—and require children to clip a clothespin to the correct answer or matching image. This simple action offers big benefits, especially for developing the small muscles of the hands that are needed for tasks like handwriting, buttoning, and using scissors.
Using clip cards targets pincer grasp, which strengthens the muscles between the thumb and index finger. This grasp is essential for pencil control and other precision-based movements. In addition to hand strength, clip cards promote hand-eye coordination, bilateral coordination (using both hands together), and visual scanning, all of which are important foundational skills for classroom success.
The fall theme adds an extra layer of excitement and relevance, especially for preschoolers and early elementary students. Kids can work on matching letters, numbers, shapes, or even simple math problems, all while building motor skills in a fun, low-prep way. Clip cards can be used in centers, therapy sessions, or at home, making them a versatile tool for both educators and therapists during the autumn season.
Why Use Fall Fine Motor Tasks Like this one?
This activity is a powerful hands-on activity because it builds skills in many areas. Clipping clothes pins to paper or cards like this Fall themed activity develops several skill areas:
address hand separation into a fine motor side and a power side
Separation of the two sides of the hand allow for more precise use of the thumb. Hand separation starts when a baby bears weight through their arm and ulnar side of the hand while carrying a toy in the radial side. This simple activity developmentally lengthens the muscles of the ulnar side.
Intrinsic strength-The intrinsic muscles are the muscles in the hand that define the arches of the hands, bend the knuckles, and oppose with the thumbs.
Arch development: Arch support in the hand is related closely to the separation of the sides of the hand. Refinement of fine motor skills in the hand (the radial side) happens when the power half (the ulnar side) is stabilized.
When kids hold the circle card, they use their non-dominant hand to hold the card, and can use their dominant hand to clip clothes pins onto the cards. Kids can count the number of leaves on each card and attach the same number of clothes pins.
A functional fine motor grasp and manipulation of objects is more accurate when the ring and pinky fingers are flexed (bent) into the palm. This positioning stabilizes the MCP arch and allows for control of the pointer and middle fingers.
This repeated clipping task combines heavy work proprioceptive input through the hands and develops refined strengthening of the arches of the hands. All of this occurs while children count and combine fine motor skills with math.
It’s a great Fall preschool activity or a Fall kindergarten math center where kids are combining math with fine motor skills…and a Fall theme!
Be sure to find out more information on development and when this type of activity is appropriate by reading about fine motor milestones.
Free Fall Worksheets
Want to add these Fall fine motor worksheet clip cards to your therapy toolbox? Enter your email address into the form below. You’ll receive these fine motor math worksheets in your inbox!
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.
When kids really struggle with handwriting, it is difficult to improve because sometimes doing hard things is just too hard. In this blog post we have strategies and support ideas to help kids become more motivated to practice handwriting.
How to Make Handwriting Practice Motivating
Handwriting practice doesn’t have to be boring, especially for kids who struggle with motivation. When we shift away from rote repetition and worksheets and instead tap into children’s interests, handwriting becomes more meaningful and enjoyable. Kids are more likely to engage when writing is connected to things they care about or when it feels like a game instead of a chore.
Instead of copying random sentences, try embedding writing into creative play, movement, or sensory-based activities. Write secret codes, make lists of favorite foods, or create silly stories together. By giving kids a purpose for their writing—like labeling an art project or writing a card to someone they love—they naturally become more invested in the process.
As pediatric occupational therapists, we know that motivation is key to building functional skills. The goal isn’t constantly using neat handwriting in every situation, but rather function. You want to see developing confidence, independence, and a positive relationship with written communication. Through fun, intentional activities, kids can build endurance, pencil control, and letter formation in ways that actually stick.
3 Quick and Fun Handwriting Activities That Motivate Kids
Write a menu for a pretend cafe– Kids can create and decorate their own menus with silly foods or themed snacks (great for working on spacing and letter alignment).
Design and write a card– Have them write a short message to a grandparent, sibling, or teacher, then decorate the card with drawings or stickers.
Handwriting target game– Tape paper targets with writing prompts to a wall. Kids throw a soft ball or beanbag to hit a prompt, then copy it onto a clipboard or whiteboard nearby.
Here, we’re talking all about reluctant writers. We’ll cover WHY kids hate to write, and we’ll discuss strategies to engage kids that are reluctant to write. You’ll also find TOYS and TOOLS to engage and motivate children that hate writing.
We’ve already covered fine motor toy ideas and pencil grasp toys, which can be a resource for reluctant writers. Today is all about play–based strategies to support reluctant writers.Our related blog post on name practice in kindergarten offers more strategies to support the child who is reluctant to write, particularly for beginners struggling with underlying skills needed for handwriting.
Amazon affiliate links are included in this blog post. As an Amazon Influencer, I earn from qualifying purchases.
Reluctant Writers
It’s very common for kids of all ages to be a reluctant to write. Challenges such as not knowing letter formation, struggles with dysgraphia, or difficulties with visual perceptual skills or visual motor skills that impact legibility can mean that kids just hate to write.
They hate to practice handwriting.
Motivating struggling writers to actually practice the underlying areas in which they struggle can be a challenge. For kids that HATE to write, meaningful and motivating is key! These writing activities for reluctant writes will make handwriting fun so that kids can work on the skills they need to work on.
Practice writing? “But Mom! I don’t like to write!” Sound familiar? Many kids (Many, many!) just aren’t into practicing their handwriting at home. School and homeschooling can be exhausting for kids when they have to do certain topics that they just aren’t interested in. And handwriting is often one of those topics.
Hopefully, you’ll find some motivating handwriting activities in today’s post that will help your reluctant writer pick up that pencil and start writing!
Handwriting Ideas for Reluctant Writers
Many kids just aren’t into practicing their handwriting at home. School and homeschooling can be exhausting for kids when they have to do certain topics that they just aren’t interested in. And handwriting is often one of those topics.
Often times, kids balk at having to do repetitive writing. I mean, would you want to write a word or sentence 10 times in a row? Sometimes a functional activity that is meaningful and helpful can motivate a child to want to pick up a pencil. In the end, emphasize handwriting quality over quantity and functional handwriting over perfection.
Here are a few easy hands-on strategies to help with “non-handwriting” ways to work on handwriting:
Motivating Handwriting Activities Quick Tip: Try using “handwriting toys” to sneak in the handwriting practice in fun ways that seem more like play than writing practice.
Try a fun activity like our ice cream writing activity! Kids love it.
Fine Motor Quick Tip: Using a neutral or extended wrist is so important for pencil grasp, endurance in handwriting, and small motor movements of the fingers in isolation of the wrist. If your student is using a flexed (or bent) wrist, try paper position and placement. Encourage fine motor activities performed on a vertical surface or slanted surface.
.
How to engage reluctant writers
{{This post contains affiliate links.}}
You can throw in the fun colored ink pen for extra smiles from your reluctant writer, but we wanted to share ideas to work on functional skills like handwriting using mainly items you can find around the home.
Try a few of these fun ideas with your student or child:
Write Jokes. Look up jokes in a joke book and write them on index cards. Send them to a friend in the mail, drop one in a neighbors mailbox (if you know the neighbor and first let them know to expect something in the mail!) or give one to teachers. Find a buddy who would be interested in exchanging jokes.
Write letters to favorite celebrities. Use those interests and look up addresses to your child’s favorite artist, musician, or sports hero. Kids can compose a letter and address the envelope.
Exchange letters with a pen pal. Kids can exchange letters with friends and relatives in other states or towns. Getting mail addressed to themselves is very rewarding for a child.
Pass notes. Write short notes to members of the family. Leave them in places where they will be found, like on bedroom dressers or in shoes. Notes might be simple things like, “Don’t forget about soccer practice today.” or fun things like, “Do you want to play checkers?”
Plan a scavenger hunt. Write out hints on slips of paper. The child can plan the steps and hide notes for family members or friends.
Practice letter formation during fun games like Tic Tac Toe. Instead of x’s and o’s, write printed or cursive letters in the squares.
Write your own comic books. Draw large rectangles on a page for a comic story. Students can draw pictures and write comic bubbles for handwriting practice.
Make a creative journal full of creative handwriting ideas. We did ours with a cursive handwriting, but you could use these ideas for printed handwriting, too.
Tape paper to a window and write on the paper.
Location, location, location! Change spaces for something fun and different: go to the library and try the tables there. Write outside with a clipboard. Where can you go to write that is new and fun?
Change positions. Sit on the floor and write on the chair seat. Lay on couch cushions and write on the floor on a clipboard.
Take brain breaks. Every 3-4 minutes, take a mini-break for jumping jacks or wall push-ups.
Write to classical music.
Functional Handwriting for reluctant writers
Often times, kids balk at having to do repetitive writing. I mean, would you want to write a word or sentence 10 times in a row? Sometimes a functional activity that is meaningful and helpful can motivate a child to want to pick up a pencil, especially when they are hesitant to try a writing task. Try some of these functional handwriting tasks:
Write out the family grocery list.
Write your family’s return address on bills.
Write out a family calendar with sports schedules, outings, and family night events.
Write out the phone messages from an answering machine.
Write out the day’s schedule on a weekend day.
Write out favorite television shows. Add the day, and time of each show.
Write out a holiday or birthday gift wish list.
Write out a list of items to pack for vacation. Include little squares next to each item to check off as items are packed.
Practice forming letters and words in shaving cream.
Want to print off a list of handwriting ideas for reluctant writers to send home with your therapy caseload? Now you can add this list to your therapy toolbox! Join us in the free, 5 day email series where you’ll get this free 2 page list of writing ideas for reluctant writers. You’ll also access other handwriting handouts to cover areas of handwriting issues.
Looking for more ways to help your reluctant writer get more “into” writing? These toys, tools, and games will inspire and encourage your child to want to pick up the writing tool and play.
The best thing is, they won’t even realize they are practicing handwriting and doing “work”! While these tools and toys are not free, they are ideas to try. If you have family asking for gift ideas, you might want to pass a few of these ideas along. Here’s to writing and loving it!
Amazon affiliate links included below.
Kids love a dry erase board and this Crayola Dry Erase Activity Center (affiliate link) will be fun for them to practice letter formation and writing.
The Crayola Dry-Erase Activity Center Zany Play (affiliate link) can be a fun way to practice individual letter formation. Ask your child to practice letters in each box. Kids can also work on starting/stopping the writing tool on the dots, which is great pencil control practice and needed for handwriting legibility.
Writing on this Crayola See Thru Light Designer (affiliate link) is bright and colorful and a great way to really work on letters while your child is captivated by the light animations and color effects.
For students who love to draw (or have a slight interest in drawing), this Crayola Light Designer (affiliate link) will be a huge hit. Even though they will not be writing letters and words, kids can draw with the writing tool to create 3D images of their drawings. This is a motivating tool for reluctant writers, and beneficial for pencil control and dexterity, helpful in handwriting.
For kids who say “I can’t think of anything to write!” (sound familiar?) This creative storytelling game, Rory’s Story Cubes (affiliate link), will be a fun way to inspire. Play the game and write out stories as a family. This sounds like a great Family Night activity!
Completing mazes are a great way to practice pencil control, line awareness in handwriting.
Try a maze book like this Extreme Mazes (affiliate link) with your reluctant writer.
Mad Libs Game (affiliate link) is a great way to practice handwriting on lines and in smaller spaces. For kids who can not write as small as needed to write in the book, use a piece of paper for filling in the answers.
The handwriting practice that kids get with a Spirograph (affiliate link) is big: Pen control, bilateral hand coordination, and proprioceptive feedback. Creating these fun art pieces are motivating and fun!
Toys for Letter Formation
Helping kids to work on letter formation can help them to become more confident in their handwriting. Try these engaging toys to support written work:
Chuchik Magnetic Drawing Board-(affiliate link) Use the magnetic pen to “write” letters and then erase them, adding repetitions in letter formation.
Coogam Wooden Letters Practicing Board– (affiliate link) Use the wooden board to trace and form letters. Then place a paper over the board and use a crayon to form the letters using the textured letters.
Want a printable copy of our therapist-recommended toys to support reluctant writers?
As therapy professionals, we LOVE to recommend therapy toys that build skills! This toy list is done for you so you don’t need to recreate the wheel.
Your therapy caseload will love these handwriting toy recommendations. (There’s space on this handout for you to write in your own toy suggestions, to meet the client’s individual needs, too!)
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.
One very fun Thanksgiving activity that supports development in occupational therapy is using Thanksgiving printables to work on specific skill areas and these free turkey templates are just one more. Not only are printable sheets perfect for using at the Thanksgiving dinner table, but kids can have fun working on turkey puzzles, turkey coloring pages, and even using as Thanksgiving decorations. Below, you’ll find some free Thanksgiving printables to build skills!
This is one version of our free printable turkey templates. Cut out on the bold lines. It’s a simple cutting shape for kids working on scissor skills. Then, we colored the turkey. Finally, we used push pins to press the turkey into our foam board.
Thanksgiving Printables
These printable Thanksgiving worksheets are awesome tools to encourage gratitude and foster learning…and with a Thanksgiving theme! What better way to bring in the season of giving and counting blessings than starting at home?
Occupational therapy crafts are crafts that support skill development through the functional task of crafting. We love to use items like the turkey templates shown below, because you can adapt and modify the craft template to meet the needs of each individual. You can find other Fall crafts here on the site that support these goals.
Fire up those printers, because this round-up has you covered for Gratitude and Learning everyday up to Thanksgiving!
Some of our favorite printable Thanksgiving activities include:
Be sure to add these printable resources to your therapy toolbox and learning fun!
Print off these Thanksgiving turkey templates!
turkey cut out template
We wanted to make a turkey cut out template that you could use with a variety of ages and skill levels. This free Thanksgiving activity includes several turkey printables:
Several color and cut turkey templates with guided lines for scissor skills. You can use the turkey with the cutting lines that meet the needs of each student on your caseload or in your classroom. Focus on line awareness and visual motor skills to cut along the graded lines.
Thankful Turkey Craft- Color and cut out the turkey craft template. Then work on handwriting skills to write in something that the student is thankful for. This would go well with our Thanksgiving tree or our gratitude leaves.
How to use a Printable Turkey Template
Not only are they a fun way to support development, you can use these printable turkey templates for many areas of skill development:
Once you’ve printed out your turkey templates, you can use them in a variety of ways to extend the skill-building:
Disguise the turkey printable- Glue a variety of small objects on the turkey (like covering them in glitter!) or make the turkey a costume to disguise him into something or someone else. You can also use our disguise the turkey digital activity.
2. Decorate the turkey printable with tissue paper art- Crumble up bits of tissue paper and cover the turkey. This is a great finger strength activity.
3. Dot painting turkey- Use bingo dabbers or the end of an eraser dipped in paint and paint the turkey with dot art. This is a great activity for eye-hand coordination skills, and if you use a pencil to paint the turkey, or cut a cotton swab into half, you can work on developing pencil grasp.
There are more ways to extend this turkey template activity, too:
Hang the free turkey printable on the wall and use it for coloring or placing stickers on the turkey (pin the feathers on the turkey, anyone?). This is a nice way to work on shoulder stability and wrist extension, which are needed for fine motor control and finger dexterity.
Use the turkey printables in scavenger hunts and obstacle courses.
Glue real feathers to the turkey templates to incorporate various textures.
One activity that we did was to work on a variety of fine motor skills using the turkey printable. I selected one of the turkey cut outs that had a thick cutting line.
Then, we cut out the turkey and colored in the sections of the turkey’s feathers and body. Some of the crayons were broken to encourage a tripod grasp.
You can see the final activity in the image and a video showing how to do this craft below.
There are so many ways to use these Thanksgiving printables!
Free Thanksgiving Printables
This free turkey printable is just one of the many free Thanksgiving printables we have here on the site. You’ll also want to grab these other Thanksgiving printable sheets:
Below we have a set of free Thanksgiving printables created into a printable pack that you can use this time of year. To grab the set, enter your email address into the form. You’ll receive an email where you can download the free activities and go from there.
These PDF resources are included in our OT Toolbox Member’s Club. Inside the club, you’ll find a Thanksgiving Therapy Theme with many other turkey and gratitude themed Thanksgiving printable materials. You’ll also find inspiration for Thanksgiving themed, hands-on activities to incorporate fine motor skills and hand strengthening this time of year.
Thanksgiving Printables for Learning and Gratitude!
Grab the Thanksgiving Fine Motor Kit for printable, hands-on activities to support development this time of year.
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.
Fall is the perfect season to incorporate scissor skills and fine motor activities into fun, themed crafts, and this scarecrow project checks every box. Whether you’re working on cutting practice, pencil grasp development, or visual motor integration, this craft combines it all with a seasonal twist. Plus, it’s a great way to tie in academic skills like math facts or handwriting practice. Be sure to explore our collection of scissor skills activities, fine motor tasks, fall fine motor activities.
If you need a math craft idea that is perfect for this time of year, this is a good one because you can target the skills or areas that you need to based on the child’s needs.
This scarecrow craft can be used for any grade or age. Kids can be resistant to practicing extra math facts and practicing skills that they’ve learned in school or homeschool. But often times, math skills like adding and composing numbers up to 1000 in this second grade math activity NEED additional practicing at home. So how do you get that extra practice in without pulling teeth (or pulling out your own hair!)?? Playful Math activities make learning and practicing skills fun. We made this Math Scarecrow Craft to practice second grade math, including place value and composing numbers…but you can make it age-appropriate for preschool on up through elementary-aged kids.
Scarecrow Craft
This post contains affiliate links.
To make this scarecrow craft, you’ll need a few materials:
To make the scarecrow craft (and totally sneak math into this Fall craft):
Scarecrow Craft for Kids
First, snip the Goldenrod cardstock into long strips about 1/2 inch wide. Cutting the cardstock in long cutting lines is an excellent exercise in scissor skills. The cardstock provides a thicker resistance than construction or printer paper. This added resistance provides feedback to kids who are working on line awareness and smooth cutting lines.
You can draw lines on the cardstock with a pencil/pen, or if the child needs more assistance with scissor skills, make the lines with a thick marker. Cutting the long strips of cardstock require the child to open/shut the scissors with smooth cutting strokes as they cut along the lines. Cutting all of the hair straw strands for the scarecrow craft is quite an exercise in scissor skills!
Next, you’ll have the child cut a large circle from the Ivory Cardstock. We used a bowl and traced a circle, but you could also have the child draw their own circle. This will become the face of the scarecrow. Cutting a circle with smooth cutting strokes is a more difficult task for children than cutting strait lines. Kids may need verbal and physical prompts to cut along the curved line with accuracy.
You can draw a hat-ish shape from the brown paper bag. I say hat-ISH because a scarecrow often has a floppy and battered hat on his head, so a hat shape that looks mostly like a hat is just about perfect for this scarecrow craft!
Kids can cut the hat shape and may require more assistance with this part. Cutting a material like a brown paper bag is more difficult than cutting regular printer paper, so the flimsy-ness of the paper requires more skill and accuracy with scissor control and line awareness.
Jagged lines make this scarecrow look authentic, though, so feel free to add more snips and cuts into the hat, too!
Next, you will crumble up the paper hat shape. My daughter really got into this part. “Crumble up this paper?? Awwww Yeah!”
Crumbling paper is a great fine motor strengthening exercise for children. They really strengthen the intrinsic muscles of their hands with paper crumpling. What a workout this scarecrow craft is!
Glue the hat in place on the scarecrow’s head.
Scarecrow Math Craft
To make the hair of the scarecrow, glue the goldenrod strips on the head and along the hat. Cut a triangle from the orange cardstock for the scarecrow’s nose. Use buttons, paper scraps, and ribbons to dress up your scarecrow, adding eyes, mouth, and any other decorations. We received the buttons we used to make the eyes from our pals at www.craftprojectideas.com. Add a smile and your scarecrow is ready to decorate walls and doorways this Fall!
But wait! Make this cute scarecrow into a Math activity that the kids will Fall in love with. Yep, I went there.
Place Value Craft
To incorporate math into this scarecrow craft, use those paper strips. We made this activity perfect for practicing second grade addition skills.
My second grader has been working on building numbers up to 1000. On the strips, I wrote a three digit number on the end of many of the paper strips. She then chose different ways to describe that number. She wrote out the number in words on some strips.
On other strips, she built the three digit number using Common Core strategies. For example, I wrote the number 421 on one strip. She demonstrated how to “build” that number by writing “400 + 20 + 1”. This technique helped her practice skills she’s learned at school while understanding what makes up a three digit number. She was able to identify the hundreds, tens, and ones in a three digit number. Work on and discuss place value and number order with this activity.
The nice thing about this scarecrow craft is that you can adjust the math to fit any age…or just make the craft without the math facts for a super cute Fall Scarecrow!
Scarecrow Math Tips
How can you make this Math Scarecrow Craft work for your child’s needs? Try these ideas:
Adjust the activity slightly by working on math facts. Write a number on the end of the strip and ask your child to write the addition or subtraction problem on the length of the hair.
Write the SAME number on the end of each strip. Ask your child to write each strip with different math addition problems that make up different ways to reach the number. For example, write the number 16 on each strip. Your child can write 8+8 on one strip, and other strips with 10+6, 12+4, 20-4, etc.
More Scarecrow Activities
Looking for more scarecrow activities? Below are scarecrow activities for kids that cover a variety of areas: math, language arts, art, and more.
Stop by and see what our friends have come up with using this week’s Scarecrow theme:
Scarecrow Syllables for Second Grade – Use a scarecrow activity to help with early literacy skills in this creative scarecrow activity from Look! We’re Learning!
Scarecrow Measures – Another scarecrow math activity, this one from Crafty Kids at Home is a fun addition to a Fall themed learning plan.
Scarecrow Silhouette Art Project – A Scarecrow craft that the kids will love is fun to add to your therapy plan. Use this idea from School Time Snippets.
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.
Moving the pencil within the tips of the fingers to switch from writing to erasing. Passing small beads from the palm of the hand to the finger tips. Holding a stack of coins in the palm while counting out the amount needed to pay for an item.
These are all in-hand manipulation tasks, and can be a problem when it comes to performing functional tasks related to these fine motor tasks. Sometimes a child appears clumsy with their small motor movements. They use two hands for tasks that normally require just one. Today, I’ve got a fun way to help with these difficulties by working on in-hand manipulation skills using coins.
The Three types on In-hand Manipulation
There are different types of movements which allow us to manipulate objects within the hand. Every task that we do within the hand uses a combination of these movements. These are the three different types or components of in-hand manipulation:
Translation
Shift
Rotation
Translation is using your fingers to moving a little item from your palm to your finger tips (or your fingertips to squirrel the item into the palm). When you hold a coin in your palm and manipulate it to your finger tips to push it into a piggy bank or vending machine, you are demonstrating palm-to-finger translation.
Shift is moving an object using the pads of your fingers…adjusting the pencil grip is demonstrating finger shift. Another example might be manipulating a button or a zipper with the finger tips.
Rotation is rolling an object using the fingertips. Examples of rotation are rolling a pencil in your fingertips, turning a pencil over to use the eraser, or opening a bottle top by rotating the lid on your finger tips.
These fine motor skills are needed for functional tasks like managing a pencil or crayon during handwriting, opening containers, managing coins or small items, manipulating a spoon/knife/fork, adjusting the paper when cutting with scissors, and fastening buttons or shoe laces.
In-Hand Manipulation Activity with Coins
I grabbed a piece of cardboard from a pizza box lid. Cut the cardboard into a manageable sized rectangle and use a sharp knife to cut a slit. Make sure the slit is vertical as this is similar to a coin machine and encourages efficient positioning of the wrist and fingers for functional use.
To work on in-hand manipulation needed for functional tasks, use play money to press the money through the slot. Ask your child to grab up a handful of the coins and push them through the slot one at a time. Using the non-dominant hand to hold the cardboard is an exercise in bilateral hand coordination, making this a great pre-handwriting exercise. (Use this activity as a writing warm-up exercise!)
How to use coins to work on in-hand manipulation:
Rotate the coins between the pads of the thumb and pointer finger/middle finger.
Grab a handful of coins and place them into a slotted container.
Pick up coins one at a time and “squirrel away” into the palm.
Push coins into a piggy bank or slotted lid (Slice a hole in a recycled plastic container like a yogurt container)
Slice a slit in a piece of cardboard like we did below. Using a small piece of cardboard allows you to hold the cardboard when pushing the coin through the slot. Read on:
When a person writes, they need to hold the paper steady with their non-dominant hand while manipulating the pencil with only their dominant hand. They need to adjust the pencil motions, twirl it around to erase, pinch and “crawl” up the pencil to adjust small movements in the hand as they write on the paper. Holding the cardboard in the non-dominant hand prevents the child from managing the money with both hands.
While pressing the coins into the cardboard, work on money and change making skills like we shared here.
This post contains affiliate links.
More Fine Motor activities you will LOVE for working on handwriting, pencil grasp, and manipulating small items:
3 Fun & Practical Coin-Based Fine Motor Exercises
All you need is a handful of coins to start working on fine motor skills, including in-hand manipulation. Here are some ideas:
1. Coin Flip and Store– Place a pile of coins on the table. Have the child pick up one coin at a time, flip it from palm to fingertips (translation), and place it into a small container.
Challenge upgrade: Use smaller coins or require the child to sort coins by size after flipping.
2. Coin Stack Race– Give the child a handful of coins to hold in their palm. Using just one hand, have them move each coin to their fingertips (one by one) and stack them into a tower without dropping any.
Skills targeted: In-hand manipulation, precision control, fine motor endurance.
Therapist tip: Time the child or challenge them to beat their own record.
3. Coin Slot Shoebox Game– Cut narrow slots into the lid of a shoebox labeled with coin values. Have the child sort and insert coins using only one hand, pulling them from their palm to fingertips before dropping into the correct slot.
Skills targeted: Translation and rotation, finger strength, visual-motor integration.
Home version: Use piggy banks or DIY coin banks made with containers and lids (a yogurt container or small butter container works well.
Here are more ideas to work on in-hand manipulation skills:
Besides using just coins, you can add other fine motor ideas to improve the coordination and dexterity needed for the three types of movements of in-hand manipulation. In our Yearlong Fine Motor and Data Collection Bundle, we have a full year of activities.
Looking for a consistent way to support fine motor skills all year? This yearlong fine motor system includes seasonal activity kits and monthly data collection tools to support planning and progress monitoring.
If fine motor planning and data collection feel overwhelming, you’re not alone. This done-for-you yearlong bundle organizes seasonal activities and monthly screening tools in one system.
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.
We’ve shared much information on visual processing over the last few months. You’ve seen tips for addressing convergence insufficiency, visual tracking concerns, and other visual skill areas. Today we are talking about saccades and activities to improve saccades. These are the eye movements that allow the tracking skills necessary for reading comprehension, handwriting, and so many other areas. The saccade activities listed below are eye exercises that can help enhance visual processing skills. These visual tracking exercises can help with smooth pursuit of vision, in order to improve learning problems and other visual therapy concerns.
Visual Saccades Activities
You’ve identified impaired saccadic movements, the child has seen a developmental optometrist and maybe has corrective lenses, but is still struggling. Now what? Check out the activities below to incorporate into therapy and home programs that address poor saccadic movements directly.
This activity addresses saccadic movements on a large scale and challenges the child to stretch their eye muscles into the peripherals and back again. The objective is to hit the first target, catch the ball and hit the second target while moving only your eyes. This pattern is completed for as many times in row the kiddo can without dropping the ball or missing the target.
The larger the distance between the targets, the harder the challenge is. Wall Ball also doubles as a dissociation activity of the eyes from head movements.
All you need for Wall Ball is a ball, two targets and a wall or solid structure to bounce the ball off of. The ball can be any size as long as it bounces back directly to the child. Tennis balls and kick balls work the best. The smaller the ball, the more challenging the task is. Grade the activity to meet the kiddo’s needs and abilities as he/she progresses.
How to Play Wall Ball
Begin with the target approximately four feet apart at eye level on the wall. Start with a horizontal line progressing to vertical, and then diagonal.
The kiddo should be standing approximately 3 feet from the wall so that they can see both targets without having to turn their head. This part is important as we want to work only the eye muscles. If the child cannot see both targets without moving their head, adjust the distance of the targets first and then the position of the child as needed.
Increase the challenge by adding paired colored targets and calling out what pair to hit one at a time or in a sequence. As the kiddo’s saccadic patterns become better and smoother, the time needed to complete the task will be shorter.
Read Word Searches to work on Saccades
Reading requires very precise and accurate eye movements. When these patterns and muscle movements are not natural, they have to be taught and can be a significant challenge for children with impaired saccadic movements.
The objective of Word Search Reading is to have the kiddo read the letters or symbols of the word search out loud without deviating from the line, or skipping a line once back at the beginning of the pattern.
Word Search Reading Directions:
Begin with a simple word search to establish the child’s abilities. A 4×4 line word search is usually a good place to start. As the child’s skills increase or this is too easy, increase the size of the word search. The larger the word search, the harder the child has to work to move their eyes in a smooth movement across the page and back to the next line.
Word search reading can be completed as a table top task, or a vertical surface. It is good to practice both skills as saccadic movements are needed in a variety of settings, not just for reading and writing.
Word Search Reading patterns can be left to right/top to bottom, or top to bottom/ left to right. There should be an emphasis on left to right patterns initially as this is the way that we read and write. As the child’s skills increase, patterns can be reversed right to left/top to bottom and top to bottom/right to left. The more patterns that the child’s eyes are exposed to, the easier fluid movements between any given set of points will become.
While I have listed very set patterns for this activity, it is important to remember that saccades is the fluid, coordinated movement of both eyes between ANY given set of points in ANY plane or position.
Modifications for Word Search Reading to Address Visual Tracking Needs
Word Search Reading activities can be very difficult and result in the kiddo being frustrated as it is making their eyes work in ways that they are not used to. However, there are a few modifications outside of the size of the word search that you can utilize to develop the just right challenge for each kiddo.
The first modification is blocking out lines they are not supposed to be looking at. A ruler or a sheet of paper is a great place to start with this modification. If this is still not enough support and they are skipping letters in the line or reversing letters, try having them track with their finger or a special “tracking tool” (pencil with topper, fun pen, etc.).
Sometimes, even utilizing a finger or tracking tool is not enough and there is still too much visual input and their eyes are trying to jump ahead. In this case, an index card with a slot cut to fit one to five letters at a time can help keep their eyes moving in a nice line.
While word searches are great, if you have a child that is struggling with letter recognition, this task can be completed with numbers or symbols. The main premise is that whatever items you use, are in a grid pattern.
Adjust the challenge and supports as the kiddo gets better at reading the letters in the given pattern to create the just right challenge.
Saccadic Eye Movement exercises
Below are some scanning exercises to work on visual saccadic eye movements.
1. Letter Stick Scanning
Materials: Craft sticks, marker How-to: Write random letters or numbers down a craft stick. Hold two sticks up and have the child call out each letter as they jump their eyes back and forth between sticks. You can also use colored dots or shapes to make this easier. Goal: Promotes left-right eye jumping and visual accuracy.
2. Wall Sticker Walk
Materials: Stickers, index cards, masking tape, flashlight How-to: Place one sticker on each index card. Tape the index cards to the wall. Use a flashlight to highlight a letter or word for the child to find. Have them “jump” their eyes from one target to the next while standing or walking between the cards. Goal: Combines gross motor and eye movement coordination.
3. Pyramid Saccade Challenge
Materials: Printed saccade pyramid (e.g., letter A to D, F to G, etc.) How-to: Print a saccadic pyramid with non-linear letter patterns. Call out letter pairs and have the child find and track them quickly across the page. Goal: Strengthens diagonal and complex saccade patterns.
4. Visual Scanning Tape Lines
Materials: Masking tape, wall space, marker How-to: Create two vertical tape lines on a wall with random letters spaced down each line. Call out letter pairs and have the child visually scan between them without moving their head. This is a larger version of the craft stick scanning activity mentioned above. You can also position the tape strips in different planes. Try putting one on a slight diagonal. Or place both in a horizontal line. Mix it up. Goal: Encourages head stability and horizontal saccades.
5. Letter Ball Toss
Materials: Ball, marker How-to: Write letters or shapes on a ball. Toss it to the child and ask them to name two shapes or letters as their eyes land on them. Goal: Engages saccades under dynamic, moving conditions.
6.Word Search Scan
Materials: Word search page, pen How-to: Circle random letters on a word search page. Ask the child to scan from circle to circle and name the letters. Goal: Boosts scanning, attention, and accuracy.
9. Paint Dot Tracker
Materials: Dot art worksheet page, paint daubers or dot markers, pencil How-to: On a dot art worksheet, use a pencil or pen to write in letters of the alphabet in random order. Kids must scan and name the alphabet letters in order as they jump from dot to dot to fill in the worksheet. Goal: Adds a visual discrimination and color recognition element.
10. Emoji Eye Movements
Materials: Printable eye emoji picture, mirror How-to: Have the child copy different eye directions or mimic eye movements while watching themselves in a mirror. Goal: Increases awareness of eye position and movement range.
Visual Saccades Activity: Timed Copying Tasks
One of the best activities to work on saccades is to complete table top activities. This simulates what kids do in school the best, and allows you to find where the breakdown is, and provide supports as needed.
Start with a small activity like a spelling list or site words on table next to the child and have them copy the words onto a piece of paper. Once they are able to do this in a reasonable amount of time increase the challenge to 3-4 words in sequence or short sentences, and then eventually a whole paragraph or short story. This set of activities is referred to as near point copying and is the foundation block for other copying tasks.
When they have mastered near point copying, it is time to move onto far point copying. This is when the items that are being copied are more than 18 inches from the child. Examples include copying from a SmartBoard or whiteboard, or off posters around the classroom. Eventually, this translates into taking notes in higher level education.
The same premise of starting small and building into larger tasks applies to far point copying as well. Utilize a timer to challenge the child to beat their best time and also to track progress. As they become stronger at looking between the two points without losing their spot, the faster the activity will go.
Visual Saccade Exercise: Speed Popsicle Sticks
Like Word Search Reading, this activity challenges the precise movements needed for efficient saccadic movements. Speed Popsicle Sticks is more exercise based then the other activities presented in this post and should be monitored for fatigue and strain like other exercise based activities. This activity is challenging and should be done with children who are able to follow directions and verbalize feelings of discomfort in their eye muscles.
The premise of this activity is to have the child look as quickly as they can between two points without losing focus or deviating from the path in a given amount of time. Popsicle sticks with stickers at the end of them work great at points to focus on.
1. Begin with the child sitting in front of you with their feet grounded.
2. Hold the popsicle sticks approximately 12-15 inches apart, and 15-18 inches away from the child’s face.
3. Then instruct them to look at first one sticker, bring it into focus, and look at the next sticker bringing it into focus before moving back to the first sticker.
Start with a short amount of time, such as 10 seconds to begin, and 2-3 repetitions with a break in between each repetition. Increase the amount of time to complete the activity as the kiddo’s eyes get stronger and they are not complaining of fatigue. Set a cap on time around 45 seconds for this exercise, and keep repetitions low.
Be sure that you listen to the child if they are complaining or are requesting a break. You do not want to cause eye fatigue or strain accidently.
Games to Encourage Saccades
There are some great ready-made games on the market these days that challenge saccadic movements. Below is a list of a few of my favorites to utilize in therapy or for gift ideas for parents and home programs.
Frequently Asked Questions About Saccadic Eye Movements
Here are some of the most common questions that come up about visual saccades:
What is a visual saccade? A saccade is a quick movement of the eyes that allows us to shift our gaze from one point to another. These precise eye movements are essential for reading, scanning, and daily tasks that require eye tracking and visual perception. Poor saccadic control can impact coordination, reading fluency, and attention.
What controls saccadic eye movements? Saccadic movements are controlled by the visual system and areas of the brain responsible for motor planning and cognitive skills. Healthy saccades rely on the integration of proprioception, oculomotor skills, and central processing.
Can saccades be trained or improved? Yes! Vision therapy guided by an eye care professional or vision therapist can strengthen saccadic movements. Training exercises improve accuracy of eye movements, hand-eye coordination, and overall visual perception.
How do you treat saccadic eye movement problems? Treatment may include a comprehensive approach using vision training, toys, and puzzles to target eye tracking. Activities like flashlight tag, reading grids, or even scanning games help retrain saccades with professional guidance.
What are saccadic and smooth pursuits exercises? Saccadic exercises involve shifting the gaze quickly between two or more targets—like reading alternating letters or tracking flashing lights. Smooth pursuit exercises help eyes glide smoothly to follow a moving object. Together, they build strong oculomotor coordination and support academic and daily activities.
How to perform saccades at home? Try holding two targets (like stickers or pencils) about 12 inches apart. Have your child move their eyes back and forth quickly without turning their head. Keep sessions short and fun, and include activities in their daily routine for consistency.
What causes poor saccadic eye movements? Issues like delayed oculomotor development, concussion, or visual perception disorders can lead to poor control of tracking. Children with reading difficulties or attention issues may struggle with saccades, often needing professional evaluation and support.
What do saccadic eye movements indicate? They reflect how well the brain and visual system are working together. Inaccurate or jerky saccades may signal challenges in coordination, attention, or underlying visual field concerns.
Are there recommended tools or toys to improve saccades? Yes! Activities like flashlight tag, puzzles, and tracking games help. You can also use printables, reading strips, or worksheets that guide the eyes between targets. Some families benefit from apps or computer-based vision training programs.
How can I get more guidance on this topic? Talk to a qualified vision therapist or eye care professional for individualized support. You can also sign up for our newsletter to get related resources, exclusive offers, and in-depth information on topics like saccades, smooth pursuits, and the future of eyewear.
Final Note on Activities to Improve Saccades
Practice, practice, practice! That is one of the biggest parts in helping a child develop motor patterns, and saccades are no different. With the just right challenge in place and encouragement, the kiddo’s saccadic patterns should become stronger and more fluid leading to increased success with visual tasks.
Looking for more information on vision deficits? Check out my OT Vision Screening Packet for useful handouts, checklists and a screener tool.
This visual screening tool was created by an occupational therapist and provides information on visual terms, frequently asked questions regarding visual problems, a variety of visual screening techniques, and other tools that therapists will find valuable in visual screenings. Click here to read more about the Visual Screening Packet. This is a digital file. Upon purchase, you will be able to print the 10 page file and print off to use over and over again in vision screenings and in educating therapists, teachers, parents, and other child advocates or caregivers.
This article was written by The OT Toolbox Contributor, Kaylee:
A little about Kaylee:
Hi Everyone! I am originally from Upstate N.Y., but now live in Texas, and am the Lead OTR in a pediatric clinic. I have a bachelors in Health Science from Syracuse University at Utica College, and a Masters in Occupational Therapy from Utica College. I have been working with children with special needs for 8 years, and practicing occupational therapy for 4 years. I practice primarily in a private clinic, but have experience with Medicaid and home health settings also. Feeding is a skill that I learned by default in my current position and have come to love and be knowledgeable in. Visual development and motor integration is another area of practice that I frequently address and see with my current population. Looking forward to sharing my knowledge with you all! ~Kaylee Goodrich, OTR
In this blog post, we are covering therapy for picky eaters. Occupational therapists and speech therapy practitioners often cover extremely picky eating in therapy sessions, but how do they know where to begin with food therapy? Let’s cover specifically how to help extremely picky eaters, food for picky eaters, and therapy suggestions for extremely picky picky eating disorder.
Therapy for Picky Eaters
Fifty years ago, feeding therapy this would not have been a popular topic. Children ate what was provided, like it or not. Sometimes parents would spare the child and leave the offending objects off of the plate. More often than not, children over the age of four were expected to eat what everyone else was eating.
Fast forward to 2022. There has been a huge rise in allergies, picky eaters, and problem feeders. How to help extremely picky eaters has become the forefront of many occupational therapy sessions and referrals.
There has been a marked rise in food sensitivity (gluten intolerance, lactose intolerance) or allergies to certain foods. This goes hand in hand with the rise of anxiety, illness, ADHD, autism, and poor immune response.
Understanding Picky Eating in Young Children
Picky eating is a common concern among parents of picky eaters, especially during early childhood. It’s not unusual for a toddler to reject unfamiliar foods or stick to a very limited range of favorites. While many children outgrow picky eating, others may need additional support from professionals such as pediatricians or psychologists to ensure they’re receiving the right treatment and nutritional balance.
Picky Eater List
There is a difference between oral motor skills that impact feeding abilities and a child’s picky eating. Foods that make the “picky eater’s list” might include certain food texture issues, food mixtures, food sensory issues like crunchy foods, and even foods that require utensils.
A short list of some foods that are not on the plate of extremely picky eaters might include:
Sandwiches
Rice
Chicken breast or other meats
Carrots
Cheese
Sauces
Vegetables
Fruits
Obviously this is a short list and any number of foods, food types can be on a picky eater list. Any other number of foods or food combinations
Looking at this list, you can see the limitations in nutrients, vitamins, proteins, and brain-building foods that are missing from the plate of an extremely picky eater.
It is not productive to get stuck in the “why is my child a picky eater”, but move forward to “what can I do about picky eating”. I am not just an experienced feeding therapist, I too had two picky eaters who survived on 3-4 different foods in their second and third year of development.
In order to help my daughters, I had to remove my thoughts impacting how I approached tackling that picky eater list for each child. That includes putting aside parenting/worry/anxiety/they’re starving persona, and put on my therapist hat. I am happy to report they are thriving adults who eat a huge variety of foods!
NOTE*The term, “learner” is used throughout this post for readability and inclusion. Not all picky eaters are children. This information is relevant for students, patients, clients, preschoolers, kids/children of all ages and stages or whomever could benefit from these resources. The term “they” is used instead of he/she to be inclusive.
When to Seek Support
If picky eating interferes with a child’s diet over an extended period or leads to issues like constipation or significant weight loss, it’s important to consult a pediatrician.
In some cases, psychologists can help address the sensory, behavioral, or emotional components of picky eating. These professionals may work alongside occupational therapists to explore strategies that support healthy eating habits in young children.
How to help extremely picky eaters
To learn how to help extremely picky eaters, it is important to define it first.
Picky eating is different from problem feeding. Often, but not always, extremely picky eating is actually a problem feeding disorder. This has recently been renamed Avoidant Restrictive Food Intake Disorder ARFID. ARFID is not classified with eating disorders such as anorexia and bulimia, as persons with ARFID or problem feeding do not restrict their intake due to body image.
The term picky eating includes:
Selective eating habits
Eats 10-20 different foods (preferred foods)
Will often eat more if hungry
Not missing entire food groups
Can often be bribed or rewarded for good eating
Can be distracted into eating
Adds new foods to their diet
Problem feeding (extremely picky eating) refers to:
Refusal to eat
Rigid eating habits (no food touching, specific brand, same plate, cut a certain way)
Eats less than 10 different foods
Will starve before they eat unwanted foods
Missing entire food groups
Behavioral reactions: gagging, vomiting, crying, anxiety, refusal to sit at the table
Increased sensitivity to the taste and/or texture of foods
No amount of rewards, bribing, punishing will magically make this go away
What is the difference between picky eating and problem feeding?
The picky eater will survive. They are likely to consume at least one meat, fruit, and vegetable and a bunch of carbs.
Continue to put out expected foods on the plate and encourage tasting of new foods. The problem feeder on the other hand, is not consuming enough calories, or getting the right nutrition.
A person surviving on four foods often gets tired of one of them, eating only three foods now. This is more of a dire situation and the treatment is complicated.
If you have a problem feeder, seek treatment from a therapist who is certified or has attended classes in feeding therapy. There is a lot that can go wrong working with problem feeders.
After viewing the list, if you feel the learner is more of a picky eater, there are several strategies that can help.
Following a feeding evaluation, feeding therapy can begin. Start a structured feeding problem including the following:
1. Feeding Therapy Interview
Interview the caregiver to determine the following:
What foods the learner eats – a specific list will determine texture, variety, color, or patterns. Are all the foods crunchy? Are they all brown?
How many foods the learner eats – less than 10 is a problem, 10-15 is picky, and above 20 is average. Count two different cookies as two items, two cereals as two items.
Medical history – Is there a history of reflux, G-tube, or NG-tube, swallowing issues?
Time frame for eating – A typical meal should last 20-30 minutes for a child.
Where the learner eats – Does the learner eat at the table or in front of the television? Do they run around the room catching a bite here and there?
Behavioral reactions during meal times – Does the child flee the table? Turn their whole body away from the food, vomit, cry, refuse to open their mouth, gag, spit out food?
Record information from caregivers and look for clues to feeding issues, other than the exhibited behavior. The person may have a history of reflux that makes eating very uncomfortable. They may have been verbally abused and shamed during mealtime, making eating an unpleasant experience. Perhaps the child has never had structure or routine during meal time, thus not making eating a priority.
2. Planning for Feeding therapy
Start treatment planning
Begin with the provided list of preferred foods to determine what foods to try first. A Food Inventory Questionnaire can be used for this step.
If the learner eats: crackers, pancakes, waffles, bread, and dry cereal, they may have a preference for white/brown foods that are dry. Some are crunchy foods and some are soft foods, but all are dry.
The next in order would be another dry brown food such as toast, bagel, cookie, or different type of cracker.
Once the child tolerates more brown dry foods the next texture in the same color family would be a banana or plain macaroni.
For the learner who eats only purees or smooth foods like pudding, yogurt, and baby food, the next step would be to try different flavors of yogurt or pudding. For a learner who only eats smooth foods, it is important not to vary the texture yet. After the child tolerates this texture, then a trial of applesauce may work.
Adding flavor choices and additional nutrients can be found in sauces or dips. While this can be a source of refusal for some kids, others prefer dips such as ketchup or ranch dressing.
Take a look at what the individual is gaining from these dips. Both can be high in sodium and that salt intake is preferred. Can you offer other foods to dip into the preferred choices?
Think about other similar options that may offer a similar sensory input through texture or taste:
butter for pasta rather than sauces
pizza sauce in place of ketchup
3. Feeding Therapy Treatment session
Ask the learner or their caregiver to provide two favored foods and 2-3 non favored foods. Having preferred foods decreases anxiety as the child is not presented with a plate of non favored foods.
It is important for the learner/caregiver to provide the food. Possible allergic reactions are diminished, as the caregiver is more aware of the learner’s diet. There may be cultural or dietary foods that the family prefers.
It doesn’t do any good for the therapist to work for weeks on waffles and applesauce, if the family does not offer these foods.
Food presentation – Present all foods on the plate in small portions, or a choice of two options with small bites of each. Avoid huge piles of non-preferred food, as it increases anxiety or sensory aversion.
Divided plates help ease anxiety, as do small portions. It can help to present the food as snacks, using a snack plate or small tea plate.
Food exploration- Start to encourage eating, or at least food exploration. Have the learner look at the food, touch the food, touch it to their face, give a kiss, give a lick, take a bite, chew, and swallow. This resource on sensory touch can offer more information and strategies to support tactile exploration.
There are 27 steps to eating from being in the same room as the food, to chewing and swallowing it. This makes learning to eat new foods challenging.
Offer food options- Allow the child to touch foods or use their fingertips to pick up and eat or taste the foods. In some cases, muscles and coordination are not appropriate for utensil use, limiting options.
Offer various food temperatures. Consider the sensory input offered by cooked carrots vs. raw carrots.
Offer various food cuts. Consider the amount of force needed to bite baby carrots vs. shredded carrots.
Food Therapy Progression
Food therapy interventions are about progressing through with small incremental changes to food offerings with observation and food challenges. Some food therapy goal banks are included below.
Learner is able to:
Be in the same room as the food, then in the same area as the food.
Sit near the food, then in front of the food without turning away.
Look at food, touch the non preferred item, smell the food.
Touch the food to face, then lips, then give it a kiss.
Lick the food, take a bite and spit it out, chew the food with the option to take it out.
While presenting and working on the feeding portion, observe for signs of oral motor issues that might indicate oral motor development considerations.
Does the learner chew from side to side or munch up and down?
Do they have good lip closure?
Do they have an intense gag reflex?
Can they move the food around effectively?
Can they bite into the food?
4. Carryover of Therapy for Picky Eaters
The ultimate goal is to carryover skills achieved in therapy sessions into a functional environment. Discuss techniques with caregivers and encourage them to try the same foods later in the day.
Remind them to be calm and not emotional during feeding time. The goal is to have fun with food and find mealtime enjoyable.
For more information on how to help extremely picky eaters, I have also published a helpful resource book (Amazon affiliate link) Seeing your Home and Community with Sensory Eyes for to understand different environments that may be impacting the eating habits of your child/clients, including the cafeteria, kitchen, restaurants, and more.
Feeding and toileting are two of the most frustrating, anxiety producing stages of childhood. Children start to exert their free will at this stage and can no longer be forced to do certain things.
Encourage parents, educate yourself on this topic, and spread the word, so problem feeding does not continue to rise along with other scary diagnoses.
This post is part of a series on feeding disorders/picky eating. Other resources you will find helpful include:
If you’re just getting started with feeding evaluations, it’s helpful to first learn how to do a food evaluation to better understand the root of picky eating.
If motor coordination is contributing to eating challenges, this post on oral motor problems and feeding covers what to look for and how to help.
Safety and Health Concerns
Parents should also be aware of the risk of choking, particularly if children avoid certain textures or refuse to chew foods properly. Offering bite-sized pieces and observing during meals is key to safety, especially when introducing new items into the rotation. Constipation can also become a problem for children with limited diets, making fiber and hydration critical areas to monitor.
Building Confidence at the Table
Support from parents of picky eaters is essential. Offer a consistent routine around mealtime, serve familiar and unfamiliar foods together, and avoid pressuring your child to eat. Sometimes the stress of focusing on the “next meal” can escalate picky eating behaviors. Patience and gentle encouragement go a long way in helping children gradually expand their food preferences.
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.
As therapists, we often times see clients with vision needs that impact functional skills. Visual processing is a complex topic and convergence insufficiency is just one area. Read below to find out more about convergence in kids, to understand exactly what is convergence insufficiency, and how convergence plays into functional skills and learning.
**DISCLAIMER** I am not an optometrist, ophthalmologist or vision therapist. All information in this post is informational in nature only and should not be utilized in place of the appropriate professionals treatment and evaluations.
What is Convergence Insufficiency?
Vision is a hot topic among therapists these days. It’s a foundational skill that we often overlook, or don’t have a clue where to start even if we know that we need to address it. When our vision is impaired, so is our learning.
Vision screenings done in the school nurses or pediatricians office only addresses acuity, resulting in other underlying vision concerns being missed.
These concerns can go unaddressed for long periods of time until the child has received remediation services, OT and other services to address the child’s deficits. By the time we realize that vision needs to be re-addressed the child is struggling and does not find academic work enjoyable.
Underlying vision concerns are often hard to detect, with convergence insufficiencies being one of the most common issues.
What is Convergence
Before we can talk about convergence insufficiencies, we need to address what typical, intact convergence patterns look like. Simply put, convergence is our eyes ability to smoothly follow a moving target as a team, from a distance to a very near point, such as the tip of our nose.
Convergence is not only an active motor pattern, it is also a sustained motor pattern. Sustained convergence is utilized for the completion of near point work tasks. Intact convergence skills allow us to read, write, draw and catch a ball, and similar tasks with relative ease. When the system experiences difficulties, it can result in a convergence insufficiency.
Convergence insufficiency (CI) is an eye condition where the eyes have difficulty working together to focus on nearby objects. This can result in blurred or double vision, headaches, or eye strain—especially during near work like reading or using smartphone screens. In childhood, this condition may impact school performance and is sometimes mistaken for ADHD due to shared attention and visual symptoms.
Convergence Insufficiency
A convergence insufficiency is caused when the dynamic system of convergence/divergence is impaired or experiences stress. The impairment hinders the child’s ability to move their eyes in synchronized, coordinated, and smooth movements from a far point to a near point or near point to far point.
The ability to assume, and maintain sustained convergence patterns may also be significantly affected.
Causes of Convergence Insufficiency
Impairments to this system can stem from several different causes, with the most common reason being an eye muscle imbalance or weakness. Muscle imbalance and weakness can occur in one or both eyes. It is very dependent upon the child.
Other causes of a convergence insufficiency may be due to congenital neurological reasons, traumatic events, or other physical impairments that affect the eye. These are NOT the usual suspect for why a child experiences a convergence insufficiency and should be ruled out by an optometrist or ophthalmologist if there is a reason to believe this is the case.
Contributing Factors
Convergence insufficiency may be linked to eye muscles not coordinating properly. In some cases, nerves sending the proper message to the muscles may be delayed, especially after illness, lack of sleep, or a brain injury. Constant exposure to smartphones, tablets, and digital devices can also strain the eyes. Tasks requiring focusing at different distances, like switching between a board and a notebook, can further challenge a child’s visual system.
Screening for a Convergence Insufficiency
The most recognizable form of a convergence insufficiency found during a vision screening, is when the child is unable to follow the tracking item to within one half inch of their nose. When this happens, the child’s eyes may appear to “bounce” or “snap” back to a midline position despite the child’s best effort to find the item. This can happen with one or both eyes, and it is important to note in your screening what happened. In more severe cases, the child is unable to move their eyes to follow the tracking item to their nose.
More commonly, the child may be able to complete the convergence/divergence patterns, but experiences headaches, complains about their eyes hurting or frequently rubs their eyes with sustained convergence activities such as reading and writing.
It is also important to note, if the child is unable to sustain convergence at the end of the convergence/divergence pattern screening for more than a few seconds. This can also be an indicator that the child has a convergence insufficiency. This is one of the hardest skill deficits to identify as it is very subtle and difficult to see at times. If you suspect a convergence insufficiency, look for other red flags to support your observations.
Diagnosing Convergence Insufficiency
A standard eye exam may not be enough to detect convergence insufficiency. Instead, specific testing performed by an eye doctor trained in binocular vision assessments is needed. This can include evaluating eye movements, testing convergence ability, and reviewing the history of the patient, especially after a concussion or brain injury. Diagnosis often involves identifying the symptoms of CI and determining whether there is a result of true convergence weakness.
Red Flags of Convergence Insufficiency
A convergence insufficiency is often hard to identify in screenings alone. Below are a list of skills that may be affected if a child is experiencing difficulties with convergence.
● Frequent headaches ● Rubbing of the eyes ● Covering one eye consistently ● Red or bloodshot eyes ● Distress with reading tasks ● Distress with near and far point copying tasks such as copying from the board ● Difficulty with catching a ball ● Use of a finger to track their place when reading ● Sleepiness or fatigue during near point work ● Motion sickness ● Blurred and/or double vision ● Words appearing to “jump” or “move” on the page
If the child is experiencing any of these signs, have their vision checked by an optometrist to rule out an eye muscle imbalance that may be causing a convergence insufficiency.
Symptoms of Convergence Insufficiency
Some of the most common symptoms of convergence insufficiency include eye fatigue, double vision (diplopia), headaches, and poor depth perception.
Children may demonstrate frequent mishaps, like tripping on uneven surfaces, frequent spilling, or a misjudgment of physical distances like missing stairs. They may also struggle with eye contact or seem to lose focus during tasks. In more rare cases, issues like vertigo and suppression of vision may occur.
Treatment of Convergence Insufficiency
Convergence insufficiencies are diagnosed by an optometrist or ophthalmologist. It is important to note that an OT cannot diagnose a convergence insufficiency. She/He can only report their observations and recommend follow up with the appropriate health care provider.
Upon seeing an optometrist, corrective lenses or vision therapy may be recommended based on the child’s needs. It is VERY important that the child wear his/her glasses and complete vision therapy if recommended as prolonged convergence insufficiencies can result in permanent eye strain and damage.
Once the child has received their corrective lenses, and if vision therapy has not been recommended, OT can help provide foundational skill remediation and exercises to promote the development of the child’s convergence skills.
One way to identify any convergence issues is with a screening tool like the Visual Screening Packet. This resource contains tools for occupational therapy practitioners to identify visual convergence challenges. The therapy provider can then offer activities and supports for any issues that are identified. The screening resource can then be used to assess improvements following therapy sessions.
Be on the lookout for my next post, Activities to Improve Convergence Skills to further fill your vision tool box. Also be sure to check out my OT Vision Screening Packet for useful forms and handouts to help you identify convergence insufficiencies and other vision concerns.
Treatment Options for Convergence Insufficiency
Convergence insufficiency treatment may involve active treatment methods such as pencil push-ups, computer programs, or in some passive treatment plans, prism glasses or prism lenses. In rare cases, surgery may be required, such as for intermittent exotropia.
However, most treatment is non-invasive and focuses on improving convergence ability over time. Getting enough sleep and reducing screen time can also support recovery. Therapy may be customized depending on whether the individual struggles with stationary objects, close object focus, or near work tasks.
Supporting Children with Convergence Insufficiency
When working with children in therapy or classroom settings, it’s important to recognize symptoms of CI and consider how they affect academic and physical performance. Poor posture, stumbles, and struggles with stairs may indicate visual difficulties.
Classroom accommodations, proper lighting, and breaks from screen time can reduce symptoms. Collaboration with caregivers and vision professionals ensures a comprehensive approach to care.
Occupational Therapy Vision Screening Tool
Occupational Therapists screen for visual problems in order to determine how they may impact functional tasks. Visual screening can occur in the classroom setting, in inpatient settings, in outpatient therapy, and in early intervention or home care.
This visual screening tool was created by an occupational therapist and provides information on visual terms, frequently asked questions regarding visual problems, a variety of visual screening techniques, and other tools that therapists will find valuable in visual screenings.
This is a digital file. Upon purchase, you will be able to access the 10 page file and print off to use over and over again in vision screenings and in educating therapists, teachers, parents, and other child advocates or caregivers.
This spacing tool is an alien craft that kids can make and use as a spacing tool for handwriting. A spaceman writing tool is a powerful device to help kids with spacing in handwriting, specifically space between letters and words when writing. We’ve come up with a few different spacing tools in the past, and this space themed spacing tool helps kids better understand the concepts of spatial awareness for better legibility in written work.
Teaching proper letter spacing in handwriting doesn’t have to be boring—meet your new writing sidekick: the Spaceman Writing Tool! This fun, kid-made spaceman for writing helps children visually and physically separate words on the page. Whether you call it a word spacer tool, spaceman spacer, or star spacer handwriting tool, this simple craft stick Martian is a fun and effective way to improve spacing between words.
Perfect for occupational therapy for writing, classroom handwriting instruction, or home use, this DIY spacing tool for writing gives students a concrete visual cue to help keep their words from crowding together. It’s a space-themed handwriting exercise that brings structure, independence, and just the right amount of fun to writing practice.
This space martian spacing tool goes really well with our block light saber spacing tool!
Sometimes, a child’s handwriting doesn’t improve given time and practice in the classroom. You might see a child copying words or sentences and squishing all of the words and letters together in a long string. There might be no space or inconsistent spacing between letters and words. It can be frustrating for the child and their parent or teacher.
Spacing Tool
This spacing tool will help with spacing in handwriting in a fun way. My second grader and I had fun creating this Space Martian Spacing Tool and using it to practice spacing between words.
Spacing Tool for poor spacing in handwriting
This post contains affiliate links.
Poor spacing in handwriting can be a visual tracking problem. It could be visual inattention or poor hand eye coordination. Sometimes, spacing is just something that needs more practice and a visual prompt like this space alien can help.
We’ve shared other versions of spacing tools to support these needs:
This Writing Spacer Craft uses just a pipe cleaner to space between letters and words.
This pointer stick spacer uses a craft stick to create a spacing tool pointer stick, perfect for visual perceptual needs.
The spaceman writing tool that we made is a small, craft-based object (like a decorated popsicle stick) used to teach word spacing in handwriting. It’s commonly used in classrooms and occupational therapy for writing sessions to give students a consistent way to mark space between words.
Benefits of Using a Word Spacer Tool
I love using a visual tool like this one for several reasons.
Encourages consistent spacing
Improves legibility
Builds independence
Supports spatial awareness (important in OT)
Engages young writers in a multisensory way Include how this tool supports distal finger exercises by giving physical feedback between words.
Try this easy DIY version is actually a spaceman spacer for writing…but the alien version!
Make a Spaceman Writing Tool
You can easily make this spacing tool with just a few materials:
sticky back foam letter sticker “C” are all you need.
To make the spacing tool, ask students to use glue to add a small dot of glue to the back of the googly eye. What a great fine motor precision and eye-hand coordination job.
2. Next, stick the googly eye onto one end of the green craft stick.
3. Cut the letter C foam sticker in half. Glue each piece to the craft stick above the googly eye.
And that’s it! If you don’t have foam letter stickers, you could use small pieces of pipe cleaners or scraps of paper.
Here’s a video showing how to make this space alien spacing tool:
Use this handwriting spacing tool between letters and words. Encourage your child to move the spacer over between words. Sometimes, just that visual cue is enough to help. The physical act of moving the craft stick to space between words can provide enough input to a child that they become more aware of the need to space, and are able to carryover the skill without using the physical reminder for spacing.
HANDWRITING SPACING TOOL
Another easy way to make a handwriting spacing tool involves materials you have around the home, like buttons. The main thing to address with a handwriting spacing tool is a spatial awareness and using a craft that kids can make adds meaning and motivation to work on spacing between letters and words.
When kids learn to write, it can be difficult to work on all of the parts of handwriting. There is holding the pencil, and using muscles to maintain a grasp while writing sentences. Then there is letter formation. Putting it all together can be challenging.
In Kindergarten, children really work on letter formation, and especially lower case letter formation. When you throw in the lines and spacing to writing, it can be a real frustration for a new writer! That’s where using a fun spacing tool comes into play. It allows for appropriate spatial awareness in handwriting is accurately spacing letters within words and spacing words correctly within a sentence.
For another spacing tool idea, try this easy (and inexpensive!) way to create a Spacing tool using buttons. This spacing tool can be used in handwriting tasks, as a tool for spacing between letters and words.
How to make a spacing tool with buttons
Spacing between words and letters can be easy with this button spacing tool. It’s easy to make and can be created using items you already have. The cost of this activity should be very inexpensive, especially if you use items you already have.
To make spacing tool you’ll need just a couple of items: (This post contains Amazon affiliate links.)
Craft stick
Glue
Buttons
We used a colored craft stick and brightly colored button that we received from www.craftprojectideas, but you could use any material you have in your home. Have a bin of beads or crafting pom poms in your craft supplies? Use beads instead of buttons. Other ideas include craft pom poms or pipe cleaners.
First, glue one button to the end of a popsicle stick or even a pipe cleaner.
Let it dry.
Then, use the spacing tool while your child is writing words and sentences. Show them how to place the button spacing tool between words and sideways between letters.
This post is part of our 31 Days of Occupational Therapy where I’m sharing tips and tools for many developmental areas using free or inexpensive materials. For more spatial relations related to handwriting, check out our Visual Tracking activities.
Occupational Therapy Tips for Teaching Spacing with a Hands-On Approach
In occupational therapy sessions, teaching proper spacing between words often involves visual cues, as well as other areas in a multisensory learning experience. We need to see motor planning, spatial awareness, and self-monitoring during written tasks.
The spaceman writing tool is an excellent way to incorporate proprioceptive feedback and tactile input into handwriting instruction. Here’s how to make it more hands-on:
1. Physically Move the Pencil with Intention
After completing a word, instruct the child to set their pencil down briefly, pick up the spaceman tool, and place it against the end of the word. This pause gives their body and brain time to reset before starting the next word.
Then, the child uses their dominant hand to hold the pencil and their non-dominant hand to hold the spacer in place, which promotes bilateral coordination and fine motor precision. As they slide the pencil to the other side of the spacer, they get a physical sense of space, which helps internalize how much room to leave between words.
2. Add a Cueing Routine
Teach a routine like “Write-Stop-Space-Slide-Write” to support sequencing and executive function during written tasks. These verbal prompts paired with physical actions help students self-monitor spacing over time.
3. Use Heavy Work and Movement Breaks
Incorporate heavy work before writing (e.g., wall push-ups, towel wringing, or chair pushes) to activate proprioceptive input and support postural stability, which improves writing control and precision.
4. Encourage Consistency Across Settings
Have students take their spaceman spacer tool between home and school (or OT sessions and class) as part of their self-regulation and academic routines. This builds confidence and consistency in their handwriting performance, especially for children working on functional school-based goals.
Know a kiddo that loves all things space, astronauts, and planets? The Outer Space Fine Motor Kit is your chance to develop fine motor strength, dexterity, and coordination skills.
Addressing hand strength, endurance, and precision is out of this world fun! The Outer Space Fine Motor Kit includes:
Fine Motor Mazes
Fine Motor Ten Frames for motor activities
1-20 Star Counting Cards
Bead Copying Strips
Space Alien Directed Drawing Sheets
This fine motor kit includes 24 pages of printable resources. Included in this printable pack are:
Two pages of color coded bead copying strips
Two pages of blank bead copying strips
Four pages of “draw and write” directed drawing activities with a space theme (Includes 3 styles of handwriting lines: highlighted lines, single rule, and double rule)
Nine pages of fine motor mazes
1-20 Outer Space Counting Cards
Four pages of fine motor ten frames activities
These printable activities extend to work on a variety of other functional areas, too: handwriting skills, numbers, math, adding, subtracting, one-to-one correspondence, scissor skills, coloring, and more.
The Handwriting Book is a comprehensive resource created by experienced pediatric OTs and PTs.
The Handwriting Book covers everything you need to know about handwriting, guided by development and focused on function. This digital resource is is the ultimate resource for tips, strategies, suggestions, and information to support handwriting development in kids.
The Handwriting Book breaks down the functional skill of handwriting into developmental areas. These include developmental progression of pre-writing strokes, fine motor skills, gross motor development, sensory considerations, and visual perceptual skills. Each section includes strategies and tips to improve these underlying areas.
Strategies to address letter and number formation and reversals
Ideas for combining handwriting and play
Activities to practice handwriting skills at home
Tips and strategies for the reluctant writer
Tips to improve pencil grip
Tips for sizing, spacing, and alignment with overall improved legibility
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.
(THESE are my favorite brand and what I always recommended as a school-based OT!)
