Victoria Wood OTR/L

Sensory Room Rules, Protocols, and Guidelines 

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Today’s post on sensory rooms in schools is part of a series focusing on sensory rooms. We are going to explore the rules, protocols, and guidelines to using your sensory room. Other posts in the sensory room series highlight benefits, why have one, things to consider, cleaning materials, supervision, use by teachers and aides, building a sensory room on a budget, and sensory room equipment.

Sensory Room Ideas for the Classroom or School Setting

Sensory rooms don’t have to be large spaces or a whole classroom space. They simply need to meet the sensory regulation needs of the students who use them. Thoughtful sensory room ideas might include calming lighting (like string lights or dimmable lamps), soft textures (bean bags, floor cushions, or weighted blankets), and sensory tools (fidget bins, noise-canceling headphones, or resistance bands). Visual schedules or picture symbols help guide kids through activities like wall push-ups, deep breathing, or swinging, depending on what’s available in your space. Keep it flexible, what works for one student may not work for another.

sensory room rules and protocols

Why do we need sensory room rules, protocols, and guidelines?

Did you know that a sensory room is considered a controlled and intentionally created space that provides multi-sensory resources to support a student’s sensory needs? This space is used in the school environment to help students with regulation and sensory needs to help them engage in learning.

Because of this, it’s important to have some sensory room rules and guidelines in place. The therapy providers reading this might be thinking, “Oh yes. We need to definitely regulate and maintain the integrity of the sensory room as a therapeutic tool”. It’s an option for supporting self-regulation.

Unfortunately, chaotic and unpredictable environments are sometimes created when a room is poorly designed, or personnel are not trained how to properly use the room. It is essential that the support personnel like teachers, teacher aides, and other staff understand how to use the room itself, not just the equipment inside it. 

In the sensory rooms that I’ve seen in place, some of the issues that come up include:

  • Something that we often see is that the paraprofessional takes their student to the sensory room for scheduled sensory breaks throughout the school day.
  • Items in the room might be used incorrectly, or the student wandering around and trying a few things.
  • Items are broken
  • Materials are not put back into place, leaving the space a mess
  • Students might be taken into the sensory room as a reward
  • Students are taken into the room after they are in a state of dysregulation.
  • Students use equipment like sensory swings very aggressively or unsafely
  • Students might be in the room unsupervised
  • There might be too many students in the room at once.
  • Staff haven’t been trained on the “why” behind the sensory input.

This list is just the beginning of the iceberg! So many therapy providers have experienced different things when it comes to a calming space.

People who do not understand sensory processing difficulties, may see the sensory room as a playground or free-for-all space. While it is designed for some freedom of movement, your sensory room is best used with some direction and instruction.

The last thing you want to have happen in your sensory space, is for your student to feel/act worse than when they came in. Instructors who are given some rules, protocols, and guidelines, are better equipped to use the space to benefit each student’s unique needs.

It is more important how you use the space not what you have in it. One of the most common mistakes is to go into a sensory room and turn on every piece of sensory equipment. This can be very over stimulating for some. If used incorrectly students can exhibit self-injurious or aggressive behavior.

Remember the equipment is only as good as the person using it. 

Creating a Calming Space for Kids

One of the most important things to remember is the goal of the space. A well-designed sensory room is more than just a break area where kids can go to chill out. The space should be a calming space for kids that teaches lifelong regulation strategies. This environment should support a child’s ability to reset and return to the classroom feeling focused, safe, and in control. Include elements that support proprioceptive input (like pushing, pulling, or heavy work), vestibular movement (like gentle rocking or swinging), and tactile experiences (such as bins filled with dry rice, fabric swatches, or play dough).

Keep the space quiet and predictable, with clear boundaries so kids know this is a place for self-regulation and not playtime.

sensory room guidelines and rules

What your sensory room should not be

There are many positives of having and using a sensory room in a school setting.  It is important to use the space well, so it does not get a bad name. People might complain they sent their kids to the sensory room and they came back more out of control than before. You may have heard that Johnny acts out so he can get sent to the sensory room. Maybe teachers say their kids never “earn” their chance to use the sensory room. 

These are common misconceptions and results of a poorly controlled space.

What to avoid when Setting up Sensory Room Guidelines

There are some things we’ve seen in the school settings that are actually counterproductive when it comes to setting up a sensory room. Some things that might be ineffective for students and staff include:

  • Don’t let the sensory room become a free for all space to send students to. The time needs to be planned and structured to work well.
  • Don’t make the sensory space a punishment for students. Getting the explosive student out of your classroom is important at times for the safety of the other students, going to the sensory room is not considered a punishment. It is a space to work on self-regulation and feel better so they can learn. Students who feel this is a punishment may avoid the sensory room when they can benefit from it, or may act out to get a change to go to the sensory room. 
  • Don’t let the space be used incorrectly. When not used correctly, some students are demanding a sensory break every 20 minutes because it is fun to get out of class.
  • Don’t make the sensory room a reward or something that must be earned. While the sensory room space is usually a positive experience and a reward, students who are out of control are not going to be able to earn this sensory break.  It needs to be recognized by the staff that your student needs a break, and explained that they need to work on their Zones of Regulation, or slow their engine down (Alert Program).
  • Don’t let the sensory room be a babysitter. We’ve all seen it; Teachers and staff need a break too. However, this space is not for students to be dropped off and left.  It is a supervised space with direct coaching.
  • Sensory rooms must not be used for the purpose of separating students from their peers, either during class or break times.
  • This space is not an alternative curriculum or alternative to formal education.
  • Sensory rooms are not alternative play spaces for students who prefer not to play outside.
  • A school sensory rooms must only be used for students who have been assessed by an occupational therapist as having sensory needs, and in accordance with the occupational therapist’s recommendations.

Knowing what NOT to make from a sensory room can help to define the guidelines that allow us to use the space effectively…

Sensory Room Rules

Each space is going to be unique and have a different set of rules, however, there are some basic rules staff can follow:

  1. If your kid makes a mess, clean it up
  2. During cold and flu season it is best practice to wipe down equipment after using it, or use a sanitizing spray
  3. When you must leave a mess behind, due to time constraints, or some other circumstance, leave a note and your plans to return. Example: this swing is soiled, please do not use it. I will take it home and wash it.
  4. Keep fingers out of drawers, cabinets, closets, desks, or other “off limits” spaces. Restrict access to the sensory bin if your student is likely to throw birdseed all over the room.
  5. Keep all sensory room materials in the sensory room.
  6. Children should stay a safe distance from other kids on swings, being careful not to run or walk in front of or behind moving swings.
  7. Limit visits to 20 minutes. Be prepared to leave the room if an emergency student needs to come in.
  8. Limit the number of students in the sensory room to a certain number. This will depend on the size and space available in the room.
  9. Be considerate of the equipment and space. Some items are expensive and budgets are small. Schools with limited budgets do not replace equipment quickly.
  10. Supervision -Students using the room should be supervised at all times. Without one-on-one direct input, equipment can be damaged very easily. When you are on a tight budget, it is painful to see something broken.

Guidelines for your sensory space

If you are a therapy provider that was consulted to set up a sensory room in a school or if you are helping to create the sensory space, it’s a good idea to come up with some guidelines to help define how the room will be used.

These are things to consider to help keep the space effective for the students that truly need it.

  • Decide if the room is going to be exclusively used by therapists and their students, or accessible by teachers (who may not have the skilled training, or supervision) to bring their class.
  • Decide how items will be labeled or classified. It can be really helpful to itemize the items
  • Who has priority over this space?  Is it an equal space for anyone, or does a treating therapist working with a student have the right to refuse more students coming in.
  • Scope out the room before bringing your class in there.  If a child is out of control, or having a meltdown, it is best to wait before bringing your ten students into the sensory room. Our teachers often call down to the sensory room (also inhabited by therapists) to see who is in there, and if the time is appropriate.
  • Adult supervision should be a given when working with children with special needs. They may have poor impulse control, muscle movement, and reaction times.
  • Use the room as proactively as possible by incorporating sensory escape/space time into their daily routine
  • Determine the desired outcome for the student. Is it to give them an escape from the busy sensory filled classroom or a sensory break? Would the student benefit from a calming or alerting activity? What equipment are you going to use to meet the student’s needs?
  • Guide the student towards either calming or alerting activities, depending on what he/she needs.  If the student needs alerting activities, ensure to do some calming, organizing activities afterwards before they return to class, so they are ready to focus and concentrate. Please see our movement break booklet and video here for more information
  • Explain how the prescribed item will be used, including the goals that the item will help to achieve, how long the item can be applied for and when it must be removed based on that assessment.
  • Consider the data. How will you keep track of who has used the space? How will you determine who needs what equipment? How will you know if something helped a student?
  • Equipment tracking- One guideline to consider is the status of the items in the sensory room. One thing we know for sure is that items that are used by kids tend to be used to their very end. So who will be responsible for making sure the sensory swings are working properly and that the ceiling attachment is still safe and secure? Who will monitor the items to make sure nothing has broken and to fix or replace them when they are?
  • How will you move kids through their time in the space? Will you use a visual schedule? A choice board? Timers?

Sensory Room Guidelines: Understanding Who Benefits Most and Who Doesn’t

It’s important to remember that the sensory room is not for everyone.

Sensory rooms look like great play spaces. It’s the engaging items that look like toys. There are fun play things, lights, and items that might not be seen all that often. However, these are sensory tools. They are not for everyone to use, and for good reason.

There are expensive pieces of therapy materials and equipment in there that can easily cause harm. It is also a dedicated space for sensory processing and regulation. 

Just like everyone does not get to hang out in the Nurse’s office every day, they do not get to go to the sensory room either.

One of the most important guidelines is to regulate who goes in there, so there is not a constant flow of students going in and out. Teachers will need to count on this space being free and available when they need it.

Sensory Room Protocols

These sensory room protocols are not steadfast laws or rules. They are good guidelines to follow to be compliant with least restrictive environment.

  • There needs to be a system in place to monitor and ensure regular cleaning and disinfection of equipment and surfaces to prevent the spread of infections.
  • Check your equipment. Make sure your hanging device is secure and rated for the weight and size of your participant. This is important on a regular basis.
  • Accidents will happen, even if you are standing right there, but these will be easier forgiven if you were supervising your student when this happened. Have paperwork in the room for documenting any incidents.
  • The sensory room should have a phone or overhead system in order to call either the main teacher, the front office, or for staff to call into the room.
  • Provide some sort of floor padding or crash pad. Concrete floors are not forgiving.
  • Supervision- This is both a rule and a protocol because it’s so important. There needs to be constant supervision of clients, particularly those at risk of falls or those using heavy or complex equipment.
  • Equipment must stay in the sensory room. This is a rule you can use, or decide to have a borrowing system for certain items. Loaning equipment is nice; however, it comes with risks, and takes away from the use of everyone.  If you have a large budget, you may be able to have multiples of certain items to loan.
  • Setting up a staff in-service is important. Providing proper training on the correct use of the equipment is a must for any school staff that will be in the room.

Supervision in a Sensory Room

One factor that we’ve mentioned over and over again in this blog post is the supervision aspect. It’s SO important for the safety of the students using the room that the time is supervised.

But, for busy therapy providers and busy teachers, there’s just not a moment to spare in the school day.

So, the question remains: Who is “in charge” of this space? And then, how do you keep the room from becoming a free-for-all where the items in the room are misused and broken or misplaced and kids are using equipment without supervision?

We came up with a few ways to go about this. Some of these are strategies that we’ve seen in place in various schools. Others are things you can try. Not every school building will see success with these strategies. There are different student needs, different levels of support from administration and educators, and there is different levels of buy-in. The main thing to do is consider the options and think about what might work in the specific school ecosystem that you are servicing as a provider.

How to structure a sensory room for success (supervision and usage)

  1. Hang rules for usage in the sensory room.
  2. Have a sign in sheet on the door.
  3. Make a rule that anyone using the room MUST clean up before they leave the room. When they check out, put a box to mark that they cleaned up the room.
  4. Limit the number of occupants at any one time. Depending on the size of the building and number of students that benefit from the room, that might be as little as 2 students to up to 6-7. Remember that co-regulation occurs even from a distance and that if a student is in a state of dysregulation, that can throw off others in the room. Consider having a station outside the room, like sensory paths or posters hanging on the wall that can be a transition space or an area where students can go if the room becomes inefficient because one individual is having a meltdown. This might lead to using the room with only one individual at a time. It all depends and should be a fluid status.
  5. Students might benefit from using the sensory room at a specific time in their day. A paraprofessional might be the one to take them to the room.
  6. Ensure staff is trained on the items in the sensory room.
  7. Color code the items in the room for type of sensory input. Students will have colors associated with their needs/regulation states and can select from one of those options.
  8. Use a check in/check out system where students can rate their levels of regulation (either with Zones of Regulation or Alert program for example). Then they can check out. Keep track of the data.
  9. Consider having students take off their shoes when entering the room.
  10. Consider limiting usage of the room to 10-15 minutes.
  11. Consider setting up a sensory diet for students who use the room often. They can have a checklist of items that meet their needs and use a rating system for marking off how they feel before using sensory room items and then after.
  12. Post a stop and breath sign at the door so that there is a period of deep breathing before entering the room and before leaving the room.
  13. Educate the staff that the sensory rooms should not be used with students who are in an agitated state. They should not be used as a punishment (i.e. in replacement of recess or as a time out.)
  14. Educate the staff that students should be used appropriately when the student asks for a sensory break or as part of a planned sensory diet. Here is information on how to create a sensory diet.
back to school sensory room rules for the school year.

Sensory Room Rules for Back-to-School Success

The start of the school year is the ideal time to review or establish clear sensory room rules. Just like classroom expectations, sensory room routines help kids use the space effectively.

Consider posting a simple visual chart with steps like: “Enter quietly, choose one tool, set the timer, use the tool safely, return to class.” Take time in the first few weeks of school to teach and model sensory room routines, even for kids who used the space last year. Routines can be forgotten over the summer.

Reteaching & Regulating Throughout the Year

Sensory room use isn’t “set it and forget it.” Sometimes you need to touch back on the rules again. Here are some tips:

  • Plan to reteach rules throughout the year, especially after breaks or if usage becomes inconsistent.
  • Build in proactive check-ins during transitions or after lunch when regulation needs spike.
  • If you notice kids treating the sensory room like a reward or play zone, revisit your classroom’s regulation strategies and work with the team (OT, SLP, and teachers) to reinforce the space’s purpose.

With consistent expectations, the sensory room becomes a trusted tool for calming, organizing, and supporting students in the classroom.

A final thought on using a sensory room

A sensory environment is a working/changing type of space. It will change depending on the needs of the current students, as well as staff. Rules and protocols may change over time, depending on the space, and who is using it. We have added several different protocols this year at our school based on experiences that have gone well, and not so great.

Ideally, a school would have several different sensory rooms.  One that is quite safe with padded walls, floors, and soft everything, and another with more equipment for active regulation and heavy work.  Until then, make sure you are supervising your students in this space, and training those you work with to do the same.

For additional information, check out this article for additional information on sensory needs.  Here is a great resource on sensory rooms.

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.

What you Need to Know about Interoception

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Interoception and mental health

Interoception is a sensory term you may not have heard of before…but you have certainly felt or been impacted by the processing of our interoceptive sense! Internal feelings of hunger, fatigue, thirst, body temperature, digestion, and other internal systems offer a certain “feeling”, right? This is your interoception sensory system at work! Here, we’re covering everything you need to know about this complex sense, and taking a detailed look at how interoception impacts function.

Interoception and mental health

How Interoception Affects Mental Health

One thing that I wanted to share is some information I’ve been hearing about on various podcasts. It seems like, recently, there is an upshift in environmental input that we’re all trying to process. It’s the never-ending distractions of notifications, more visual clutter, constant notifications, and an overwhelming stream of opinions coming from every direction. With the increase in phone use and social media scrolling, many people are tuning outward instead of inward. We’re checking for reactions, updates, and validation from others, instead of pausing to notice how we feel inside.

This constant outward focus chips away at our ability to notice internal cues like hunger, fatigue, anxiety, or even calm. The result is a kind of sensory and emotional overload that leaves our nervous systems in a chronic state of activation. When the brain is flooded with external sensory information and social comparison, there’s less space to process our own internal signals.

Over time, this can impact emotional regulation, self-awareness, and mental health, especially in children whose brains are still developing. Helping kids tune into interoceptive signals is one way we can start to counterbalance that overload and support their emotional and cognitive well-being.

That’s where emotional health and interoception comes in.

Interoception, the ability to sense internal signals like hunger, heart rate, or the need to use the bathroom, is foundational to emotional health and mental well-being. When the brain accurately interprets signals from the body, it helps a person understand their emotional state, manage stress, and make decisions that support regulation. For kids with ADHD or executive functioning challenges, the connection between brain development and interoceptive awareness is especially important.

Difficulty noticing or interpreting internal cues can lead to emotional outbursts, anxiety, or trouble with impulse control. One thing I heard in a recent podcast is the mind-body connection. This is where the vagus nerve plays a key role: it links the brain to many internal organs and helps regulate the body’s stress response.

Part of it is just being more aware of our internal ticking. Strengthening interoceptive awareness through body-based strategies supports the development of the prefrontal cortex. This is the part of the brain responsible for attention, planning, and self-control. By focusing on interoception, we’re supporting body awareness AND laying the groundwork for improved executive functioning and emotional regulation.

Interoception sensory input impact regulation, modulation, and function.

Let’s talk more about what interoception is…

Interoception The 8th sense

Did you know that the five senses we were taught in school is not actually a complete list of a human’s senses? In fact, there are 7 or 8 senses that humans experience, depending on who you ask.

Understanding our many senses helps us comprehend how we and others experience the world around us. For the sense we are highlighting today, it is how we understand what is going on inside of us. Check out this post on the OT Toolbox regarding Multisensory Learning: Emotion Activities.

Definition of the interoception sense

Interoception is the sense of oneself; it is the ability to understand the body’s physical signals that tell you when you are hungry or full, thirsty or quenched, hot or cold, scared or calm, etc.

Interoception refers to the body’s ability to identify and process internal actions of the organs and systems inside the body. This lesser-known sensory system helps you understand and feel what’s going on inside your body. You can then make essential decisions about eating when you are hungry, drinking when you are thirsty, going into the restroom when you need to toilet, and other physical actions.

There are nerves throughout the body that send these signals to the brain to help regulate the body, and promote homeostasis. 

Some of these signals require a conscious act, like drinking water when we are thirsty, while others are non-conscious, like sweating when we are hot.

Interoception comes into play when we consciously realize, “Oh, I am sweating because I feel hot, I should take off my jacket to cool down.” 

Information on interoception, this blog post covers the definition of interoception, and interoception sensory strategies.

How Does Interoception Impact Function? 

Interoception can be thought of as a mind-body connection. Having a strong interoceptive sense would mean that you have a strong sense of the physical self, and what you need to promote comfort at any given time.

Being able to confidently act on your body’s needs, makes everything a bit easier. You are likely able to make it to the bathroom before an accident, eat food before you feel light-headed, and stop eating before you feel sick. 

But what about individuals who are not able to accurately process the bodies internal signals? They may find it more challenging to be potty trained, have a healthy diet, or emotionally regulate. 

The ability to understand and respond to our body’s needs is a huge factor in our independence. If we don’t quite know what our bodies need, it makes everyday activities much more challenging, and focus on school or work tasks may dwindle. 

Interoception even has to do with how our body moves, the action of bones in the skeleton, bone growth (growing pains have a lot of “pain” that is felt internally for kiddos who are rapidly growing! Be sure to check out this related blog on bone names to help tach kids about this concept.

Functionally, interoception impacts so many areas of everyday tasks:

  • Eating
  • Drinking
  • Sleep
  • Toileting
  • Getting dressed (putting on temperature-appropriate clothing, or taking off clothing before becoming overheated)
  • So many more considerations!

Interoception and Emotion 

Interoception has a strong connection to emotional processing because of the physical way that we experience emotions. Our muscles clench when we are angry, quiver when we are scared, and relax when we are calm.

Likewise, the stomach may feel upset when we are nervous, and one might get a headache from frustration. People with good interoception can relate these physical feelings to emotions. 

If a person sensory processing differences, the signals from the body may not be accurately represented or relayed to the brain. They may be muddied or confusing, leading to a misunderstanding of what the body is trying to tell the brain. Because of this, a tickle may feel like pain, or a person may not know why they are experiencing discomfort. 

Without interoception, labelling emotions is then a bit more challenging, as well as understanding how to remedy undesired feelings.

Children may act out in aggression, cry or scream uncontrollably, or show other signs of sensory dysregulation, potentially due to a lack of interoception. 

If you know a child who has multiple characteristics of reduced interoception, like potty accidents, over/under eating, and emotional dysregulation, they may benefit from therapeutic intervention to improve their body awareness. 

The interoception system plays a part in feelings and emotions, too.

When we feel anxious or worried, we might feel a tenseness about us. Our heart rate might speed up, and we feel that anxiety coursing through our systems.

But for the child with difficulty expressing these feelings, they can’t tell us what they are feeling on the inside. They don’t have the words to identify specific interoceptive feelings they are having.

Others might not recognize a racing heart. They might not realize that physical implication of anxiety or worry because they can’t actually feel their racing heart (when it is very much racing).

When one feels anxious about a situation or an idea, we can help them to focus on their heart beat. We can help them take deep breaths to calm down. This focus on how their body is responding can help their internal state match the environment.

Other ways to help with interoceptive identification include habit and routines to help us feel organized. When we know what to expect, we feel a lot more organized. The body is able to modulate better.

As we increase the challenge, we have to also increase our supports. We can use some external organizational strategies (deep breaths, awareness, mindfulness, heavy work, routines) to help compensate for the lack of internal ability to organize ourselves.

When we are disorganized, this is where we can fall apart. We have to be mindful ahead of time, and be accommodating and accepting of immature nervous systems, whether this is with our children, our spouse, or ourselves.

Tips for Improving Interoception 

There are all sorts of activities you can do with children to help increase their interoception skills. Below you will find tips for improving interoception, including mindfulness, and children’s books on topics like emotions, potty training, and problem solving. 

  • Modelling how you understand your bodies signals may also help – be sure to emphasize how you are feeling, and what you will do about it! 
  • Mindfulness – the act of intentionally connecting to oneself and/or the world around them. This can help an individual get “out of their head” and feel more grounded in the present moment. By doing so, it may improve self-awareness and a positive mood. Mindfulness is not just great for improving interoception – see this article for more information
    • This video guides a progressive muscle relaxation. Intentionally contracting and releasing muscles brings more awareness to the physical body, and deepens the connection that we feel to it.   
    • Here we have another video that guides mindfulness, in the form of a “body scan”. It also adds a great piece of education for children on what it means to understand their bodies signals, and why it is important. 
    • The OT Toolbox has this great list of more active ways to explore mindfulness through gross motor play. 
  • Focus on awareness- So often, parents, children, clients, educators, and even professionals are not aware of ALL of the ways that the interoceptive sense impacts everyday functioning, learning, and daily participation in everything one does throughout the day. Educate, educate, educate! Then, bring that awareness to a full circle with activities that take the concept of interoception in daily tasks home. For example, you can cover how sleep is impacted by interoception and incorporate a few of our hibernation activities. Without interoception, animals that hibernate would not instinctively know to fill up on foods before winter and to keep eating even when they may feel full. Then that sleep that allows them to slumber through the winter is in effect. It’s all related!
  • Try calm down toys– Use a variety of supports in the form of play to support regulation needs. This can offer heavy work, regulating movement, or calming input.

Books to Improve Interoception

Below are Amazon affiliate links to resources and books on interoception and internal states.

  • We Listen to Our Bodies is a book that follows a young girl as she feels emotions through her day. The physical representations of emotions are highlighted in ways that are familiar to young children.
  • For a similar read pick up this book, that follows a boy and his day full of feelings at the zoo! 
  • Time to Pee by Mo Williams is a great book that helps kids understand how to respond when they have that ‘funny feeling’ in their tummies. 
  • I Feel… activity books have been praised by therapists for their ability to make learning mindfulness fun! The activity book linked here focuses on sickness in the body and what it feels like to be sick in different ways. 
  • The OT Toolbox has a great resource called the Sensory Lifestyle Handbook to tie sensory processing together
  • For more children’s books on mindfulness to elicit peace and calm, check out this resource:
Sensory lifestyle handbook- How to create a sensory diet

While interoception is new and lesser known, it is an important sense to have.

3 Easy Interoception Exercises

Here are 3 simple, OT-informed interoception exercises you can add to your blog post to help kids or adults build awareness of internal signals connected to mental health and emotional regulation:

1. Heartbeat Check-In

Purpose: Build awareness of internal rhythms
How to do it:

  • Sit or lie down in a quiet space.
  • Place your hand on your chest or wrist and try to feel your heartbeat.
  • After some light movement (like running in place or doing 10 jumping jacks), stop and notice the change in heart rate.
  • Ask: Can you feel your heart beating faster? What does it feel like inside your body?

This builds connection between physical exertion and interoceptive feedback which helps the brain tune in to emotional states like anxiety or excitement.

2. Breath Awareness with Temperature Shift

Purpose: Increase mindfulness of breath and physical sensations
How to do it:

  • Take a slow breath in through your nose and out through your mouth.
  • Place your hand in front of your lips and notice the temperature of your breath as you exhale.
  • Alternate between fast and slow breathing.
  • Ask: What do you feel? Warm air or cool air? How does your body feel when you breathe slowly vs quickly?

Noticing temperature, speed, and rhythm of breath can help kids understand when they feel calm vs overwhelmed.

3. Stomach Signals Scan

Purpose: Tune into hunger, fullness, and emotional gut feelings
How to do it:

  • Before a snack or meal, pause and ask: What do you feel in your stomach? Is it growling? Empty? Full? Comfortable?
  • After eating, check in again: How does it feel now?
  • Practice describing the sensations with emotion words too: Does nervous feel like butterflies? Does sad feel like a heavy feeling?

This exercise helps strengthen the connection between body cues and emotional labels. This is critical for emotional regulation and self-awareness.

What do you think? Would these simple interoception exercises help you?

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

 

How to do “Push In” Occupational Therapy

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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:

    Back to school activities for occupational therapy or the classroom
    Back to School Bundle
    Back-to-School Motor Skills Kit
    Back to School Activity Kit

    Sitting Positions on the Floor

    by
    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.

    Grasp Patterns

    by
    Hands holding items with different grasp patterns like pencil, spoon, key, scissors, ice cream cone. Text reads "types of grasp patterns"

    Today we are looking at Grasp Patterns, or the aspect of fine motor skills that involves the physical placement of the fingers on items we use to complete daily tasks. We will explore the types of grasp patterns (lateral key, hook, cylindrical, pincer, etc.) and offer activities to support development of each grasp pattern.

    These various types of grasp patterns are important to understand when using finger strength exercises to build grasp and pinch strength in fine motor tasks.

    Fine motor skills like how a child holds a pencil, or how they hold a toy like building blocks are all part of fine motor development. But for children that are school-aged, it can be really unmotivating to do these same tasks over and over again. One item to try is our Yearlong Fine Motor Planning system and Data Collection Bundle. It makes working on these types of skills easy and fun.

    grasp patterns

    Grasp Patterns

    A grasp pattern refers to the motor positioning of the hand on a utensil, or the specific type of grip used by the fingers and thumb to hold and manipulate objects. Variances in patterns of grasp promote refined coordination in motor skills, or finger dexterity.

    Various grasp patterns are needed to:

    • Hold objects like pencils, paint brushes, or crayons
    • Hold and manipulate a toothbrush
    • Squeeze a bottle of toothpaste
    • Hold and turn a doorknob
    • Hold and use a key
    • Turn a page in a book
    • Hold an ice cream cone or a hairbrush
    • Hold something round like a small ball

    In this post we will take a look at the developmental grasp patterns that we use for fine motor skills.

    why do we notice grasp patterns?

    Occupational therapy practitioners tend to spot atypical grasp patterns from a mile away. Apparently I am acutely aware of the different grasp patterns and look for them. I was having dinner with a friend and her four year old son a few nights ago. I was discretely checking out his grasp pattern. Or so I thought. When she caught me looking, I confessed that I was looking at his grasp pattern, she said, “I know”. Luckily for me, he had a nice grasp pattern, so I did not have to go down that rabbit hole.

    The reason I am aware of grasping patterns and notice them, is the amount of dysfunction I see.

    Kids are being pushed too fast to develop grasping patterns that they are not ready for. This is one of the issues that comes up with pushing preschoolers to write. With the use of technology, you’ll also see a switch from previous grasp patterns into those that use stronger muscles in the hands caused by overuse of the muscles needed to hold cell phones and swipe on screens. Check out symptoms of too much screen time for more information.

    Each grasp pattern develops at a certain age. Find out what activities you can do to support these developing grasp patterns.

    development of grasp patterns in infancy

    When babies are born, they do not notice their hands. Primitive reflexes drive grasp patterns at this stage.

    They have a palmar reflex, in which their fingers curl around something (usually a parent’s finger) placed in their palms. This reflex becomes integrated around four months old, and is replaced by volitional behavior, meaning the child has to intentionally initiate the action.

    palmar grasp pattern

    Around four months old, the child holds an object against the palm, as their fingers curl around it. The thumb does not yet oppose the fingers. This is a crude palmar grasp. Babies grasp large objects, often when placed in their hands.

    At six to eight months the thumb starts helping in the palmar grasp pattern. The child holds an object against the palm but is now supported by fingers around the top and the thumb on the side. The radial (thumb) side of the hand is known as the precision side, meaning this grasp pattern is now more precise than before. This is called a radial palmar grasp.

    radial digital grasp pattern

    Around eight to twelve months the radial digital grasp pattern emerges. When using a radial digital grasp, you hold an object between the fingers and opposed thumb. The fingers are now strong and coordinated enough to hold an object without exterior stabilization from the palm.

    pincer grasp

    Pincer grasp is the next grasp pattern. About ten months an immature pincer grasp begins to emerge. Babies are beginning to use isolated fingers and the opposed thumb to grasp an object.

    Around the twelve month mark, babies demonstrate a more refined pincer grasp pattern. You hold an small object between the thumb and first finger. This is the time when babies are working on feeding themselves with dry cereal and finger foods. While this is definitely a messy stage, finger feeding is a great way to boost your baby’s independence!

    Finger isolation begins to happen during this time. Baby learns to point or poke their finger into something.

    raking grasp

    Around the time that the the child develops a pincer grasp, they also use a raking grasp. This is where the child sweeps all fingers to pick up an object. Babies often get frustrated at this stage because they get little bits of food stuck in the palm of their hand, and have not yet learned to move it out to their fingertips. The whole hand ends up in the mouth at this stage. Keep providing opportunities for practice.

    One way to decrease the raking grasp is to provide small objects one at a time, or far apart from each other. Young children us raking to grasp many objects at once, like a large pile of cereal.

    Grasp Patterns and Motor Control

    Now that babies have the basic ability to reach for and grab and object, the grasp pattern becomes more refined, with the development of hand-eye coordination. This will allow your child to manipulate objects, play with toys, open and close things, and eventually use tools.

    Pencil grasp development is one direction the grasp pattern takes as the child learns to hold and use tools (crayons, markers, scissors). A pencil or crayon grasp introduces a new set of challenges, because now purposeful movement is required to manipulate the tool.

    The key to an effective, functional pencil grasp is one that allows for dynamic finger movements (to move the pencil around to write), slight wrist extension, and appropriate force modulation so the hand does not become fatigued during writing tasks.

    gross grasp pattern

    This motor control starts with a Gross grasp. The gross grasp pattern is used when squeezing all of the fingers shut around an object, like when holding the handle of a suitcase.  

    Gross grasp is important in tasks like holding a cup, spoon, hairbrush, or tube of toothpaste.  To do these activities, you need to squeeze your whole hand shut and maintain endurance to complete the activity.  

    Development of the hand arch and thumb web space is important for these functional skills and gross grasp plays a part.  

    Initially, at around 12-18 months, children typically rely on a palmar or gross grasp, similar to when grasping toys. This is also referred to as a fisted grasp, because it appears as if the child is holding the crayon in the middle of their fist.

    The gross grasp is also known as the cylindrical grasp, or the palmar supinate. It is a fisted grasp with the thumb wrapped at the top of the writing utensil. This is usually accompanied by scribbling. This is considered a primitive grasp. This grasp does not involve finger movements to color, instead relying on less precise movements at the elbow and shoulder joints.

    Allow your child to manipulate large tools such as (Amazon affiliate link) chunky crayons. These can be egg shaped, or small chubby crayons. It is too early to be introducing regular crayons, markers, and pencils at this point. To do so leads to poor grasping patterns and compensation strategies.

    A power grasp is a variation of the gross grasp that emerges later. This is used when heavy or forceful grasp is needed, such as using a hammer. The thumb helps
    to stabilize the shaft of the tool rather than opposing the fingers.

    other variations of the gross grasp pattern

    In the gross grasp, or power grasp patterns, strength is required and involves holding an object between partially flexed fingers and the palm while the thumb opposed or adducts in order to provide pressure against the fingers.

    • Hook grasp – the fingers hook around an object with or without the assistance of the thumb. This is usually a smaller diameter object. An example of this is gripping the handle of a shopping cart, holding a bucket by the handle, or carrying a briefcase.
    • Spherical grasp – the fingers spread open wide to grasp a circular object such as a ball or an apple.
    • Conoid grasp – this grasp is used to hold cone shaped objects such as an ice cream cone. The thumb and fingers oppose to hold a cone shaped object with the apex of the cone at the ulnar side of the palm. The ring and little fingers provide extra control and stability at the smaller end of the cone.
    • Lumbrical grip – this grasp is used to grasp an object with all five fingers without curling around it. Examples of this are holding playing cards, or grasping a large book.

    variations of the Precision grasp pattern

    In addition to power grasp patterns (gross grasp, or the power grip) , we also have precision grasp patterns. These prehension grasp patterns typically describe the object that is being grasped, or the finger placements on an object.

    While the pincer grasp is a great grasping pattern for holding small objects, it is not the only type of pinch grasp we use.

    • Lateral Pinch (Key pinch) – The lateral pinch is also known as a Key Pinch, or Key Grip. This is because you can picture the positioning of the fingers and thumb as they would be to hold a key between the pad of your thumb and the lateral side of your pointer finger. While the pincer grasp is finger tip to tip, the lateral pinch uses the side of the index finger to push against the thumb. We see the lateral pinch while holding a key in a lock to turn it, pulling up pants, or tearing paper. Here are some clothespin pinch exercises to improve the different types of pincer grasp patterns.
    • Three Jaw Chuck – this is also known as the palmar pinch. The thumb opposes against the tips of the first and second fingers to secure a small object. This is often used to pick up and hold objects that are slightly large for a pincer grasp, such as chess pieces, or building blocks.
    • Tip Pinch – this is more refined than the simple pincer grasp. The pincer grasp usually uses the pads of the finger tips, where the tip pinch grasps the object closer to the tips of the fingers. This can be used to pick up tiny objects such as pulling a pin out of a pin cushion.

    We have a video showing these different types of grasp patterns. Check out how we used clothes pins to support strengthening and development of these different pinch types (If you can’t view the video, check it out on The OT Toolbox YouTube channel):

    development of writing grasp patterns

    Before a child can hold a writing tool with a dynamic tripod grasp, they go through several stages in order to be able to use this functional grasp. This is due to the development of the arches of the hand, the musculature of the hand, and bone formation.

    • Digital pronate grasp pattern – this grasp emerges around two to three years of age. The fingers are now pointed down towards the bottom of the writing utensil, however, all the fingers are being used along with a lot of whole arm movements. This is also a common grasp for self-feeding with utensils.
    • Five finger grasp – all of the fingers are involved in holding the writing utensil here, which may continue to limit dynamic finger movements. It marks the first turn toward a neutral wrist position (no longer pronated) and begins to appear similar to a functional grasp. Typically all of the fingers are touching the pencil, but closer to the end of the fingers than the palm. Often children get “stuck” in this grasping pattern, unable (or unwilling) to move to the next stage.
    • Around four to five years old, a static quadrupod grasp develops. Static means that the fingers still do not actively move, instead writing motions are driven by the wrist, elbow, and shoulder joints. Quadrupod refers to the four fingers that are involved (index, middle, ring + thumb). Children begin to show separation of the digits of the hand as the pinky finger is not actively engaged in grasping the writing utensil. Learners often maintain this grasping pattern into adulthood.

    the start of the tripod grasp pattern

    • At the same time as the static quadrupod, or shortly after, a static tripod grasp may emerge. Some learners do not use a quadrupod grasp, but move right into a tripod grasping pattern. They hold the writing utensils crudely and use the whole pads of their fingers on the writing utensil. There also may still be some wrist range of motion and forearm movement to move the pencil, with the fingers not moving (static). The static tripod grasp is a 3 finger grasp, two fingers pinching the writing utensil and the 3rd (middle) finger tucked to the side of the pencil, forming a tripod. The 4th and 5th fingers are usually static next to these fingers and do not tuck into the palm of the hand yet.
    • Separation of the sides of the hand– This motor skill is where we see precision skills with stability offered through the base of the hand. Paperclips are the perfect small item to hold in the palm of the hand, engaging the ulnar side of the hand, while encouraging movement and precision with the pointer finger, middle finger, and thumb. This skill is so important for fine motor precision in tasks like pencil grasp and managing clothing fasteners or tying shoe laces.
    • Finally around ages five to six, a dynamic tripod grasp emerges. Dynamic means that the fingers are now actively moving the writing utensil to produce written strokes. This helps prevent fatigue and increase legibility during writing tasks. Tripod refers to the 3 fingers involved (index, middle + thumb), while the ring and pinky finger are now separated and tucked into the palm. Here is a great post on activities to work on developing a tripod grasp.
    • In-hand manipulation– Paperclips can be used as a manipulative item for transferring from the palm to the fingertips or vice versa. This is an essential skill needed in pencil grasp and other functional tasks.

    tips and activities to improve grasp pattern

    While development of grasp pattern seems to come naturally to some children, others need a little help along the way. Providing activities and toys to help promote good development is a great way for all children to learn.

    • Offer tiny items for your child to practice picking up. If you are fearful of children playing with tiny objects, you can use food items such as sprinkles, cereal pieces, raisins, dried fruit, tiny pieces of cookies, or small cooked macaroni/rice
    • Placing small toys in an ice cube tray to encourage use of a pincer grasp
    • Coloring with broken crayons to encourage use of a tripod grasp
    • Have children hold a small pompom or coin in their fourth and fifth digits to promote a tripod grasp pattern
    • Practice writing or coloring on a vertical surface to promote wrist extension and dynamic finger movements
    • Engage in tactile play to help with mapping the hand
    • Playdough is always a great activity for helping to build grasping skills
    • Strengthen finger and arm muscles. Some fun activities include using squirt bottles, doing wheelbarrow or animal walks, playing with Legos, and squeezing resistive putty
    • Life skills are great tasks to build grasping patterns. Working on fasteners, grooming, cooking, self feeding are functional activities that work on grasping patterns. You can initiate play using household items for inexpensive skill-building or therapy at home.
    • Kitchen tools make great activities to develop grasp patterns. Check out our post on cooking and fine motor skills to get started. Get out the tongs, pincers, measuring cups, small containers to open/close, bottles for pouring, spoons, potato peeler, cracking eggs, a can opener, etc. This can be done in pretend play, or during a cooking task. Something as simple as muffins can use several tools.
    • Bead activities
    • Pom pom activities
    • Paperclip activities
    • Activities using just a deck of playing cards
    • Activities using just craft pom poms or cotton balls
    • Clean out the junk drawer – you would be amazed how many items are in the junk drawer that can be used to strengthen fine motor skills. Use buttons, coins, pieces of paper, stickers, string, chip clips, or whatever you can find
    • Create a fine motor toolkit – head to the dollar store and pick up some needed items to make your own toolkit. This can include blocks, beads, cut up sponges, scissors, stickers, playdough, putty, string, paper, and anything else you see. Put all of these items in a shoebox or clear tote. We love putting together occupational therapy toolkits. You could also try some of our printable, digital toolkits, like our back-to-school toolkit.
    • Use crayons to gain all of The Benefits of Coloring
    • Set up a bin rotation system – have fine motor stations or small pencil boxes with different fine motor activities in them. Students can rotate through the bins as they master them.

    the key to developing great fine motor skills

    “Don’t wait for the right opportunity: create it.” — George Bernard Shaw

    Create opportunities for children to learn and grow. This does not mean buying all of the latest toys and gadgets, or parking your kid in front of an Ipad. Provide the materials, and guidance needed for success.

    It is much better to build the skills a child needs, than to spend months and years undoing the damage.

    Grasp Patterns in Occupational Therapy: Everyday Function Matters

    Understanding grasp patterns in occupational therapy goes beyond identifying how a child holds a pencil. 

    Different grasps support specific daily tasks. Think about the hook grasp you use to hold a grocery bag. It’s different than the lateral grasp needed to hold a key.  These grasps involve not only the thumb and index finger but also the ring finger and other stabilizing muscles. 

    Linking these grasp patterns to meaningful, real-world functions helps caregivers and teachers understand why grasp development matters. An occupational therapist will assess how grasp impacts tasks like dressing, utensil use, and tool manipulation, supporting functional independence at home and in school.

    Tenodesis Grasp OT Applications: Wrist Position and Passive Control

    The tenodesis grasp is an important concept in OT, especially when working with children who have limited active hand movement or neuromuscular conditions. 

    Tenodesis grasp uses a passive grasp that results from extending the wrist, which causes a natural curling of the fingers. This means the individual is able to hold objects without active finger flexion. 

    In therapy, this can support function in children who lack traditional mature grasps due to muscle weakness or motor planning challenges. 

    Including tenodesis grasp OT interventions helps promote adaptive function when different grasps are not yet developed or need alternative support strategies. An occupational therapist may introduce wrist positioning tasks to reinforce this pattern and support daily tasks that require grasp.

    Functional Grasp Activities and Therapy Tools

    Using targeted functional grasp activities is key to strengthening the hands and supporting various grasp patterns! That’s what makes occupational therapy what it is. 

    Therapy tools like pegboards, theraputty, and vertical surfaces encourage hand use in multiple directions and positions. These tools also promote activation of the ring finger, which plays a crucial role in grip stabilization. But, are they functional tasks that you might see in a typical day for this person? Probably not. What if you did the same type of motor plans by having them push seeds into dirt? They could hold a dish and dry it with the other hand. They can push a button into a button hole. Now we’re talking function!

    Writing on a vertical surface, for example, supports wrist extension and naturally promotes finger isolation for more refined grasp control. What if you had the person working at a vertical plane to wash a window or hang a picture? These are great vertical plane tasks that build strength and grasp.

    Activities like pulling clothespins or squeezing putty help build hand strength and coordination needed for different grasps, and are commonly recommended by an occupational therapist as part of fine motor intervention plans. You can incorporate functional tasks by having the person clip papers together or clip clothes pins onto a string to hang clothing.

    Pencil Grasp Development and Fine Motor Strength Exercises

    A mature pencil grasp is the result of consistent practice and well-developed hand strength. During pencil grasp development, children move through a sequence of different grasps, starting with the palmar grasp and progressing toward mature grasps like tripod or quadrupod. 

    Strengthening the fingers, especially the ring finger and pinky, helps provide the stability needed for efficient writing. Fine motor strength exercises such as squeezing theraputty, stringing beads, or using resistance tools are often part of an occupational therapist’s toolkit to improve endurance, motor planning, and finger control during writing and tool use.

    Mature vs Immature Grasp: Troubleshooting by Age

    Distinguishing between mature vs immature grasp patterns allows parents, teachers, and therapists to know when intervention may be needed. 

    For example, if a child is still using a fisted grasp by age 5, it could signal the need for extra support in developing more refined mature grasps. 

    Common signs include overuse of the entire hand, underuse of the ring finger, or switching between different grasps inconsistently. An occupational therapist can evaluate grasp use during daily tasks and suggest grasp progression activities that encourage finger coordination, hand strength, and control. These strategies help guide children toward functional, age-appropriate hand use for both school and self-care.

    Working on fine motor skills, visual perception, visual motor skills, sensory tolerance, handwriting, or scissor skills? Our Fine Motor Kits cover all of these areas and more.

    Check out the seasonal Fine Motor Kits that kids love:

    Letters Fine Motor Kit
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    Summer Fine Motor Kit
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    Spring fine motor kit
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    winter fine motor kit
    Winter Fine Motor Kit

    Or, grab one of our themed Fine Motor Kits to target skills with fun themes:

    Want access to all of these kits…and more being added each month? Join The OT Toolbox Member’s Club!

    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.

    Get the Yearlong Fine Motor and Data Collection Bundle today!

    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.

    How to Support Sensory Issues with Hair Brushing

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    Sensory hair brushing

    For many children, hair brushing is a challenging ADL task due to difficulties with sensory regulation. Using tools such as a sensory brush or a sensory diet can help support sensory issues that impact hair brushing. Individuals with sensory challenges related to their scalp can be further exacerbated by knots, pulling of hair, shampooing, or daily stress when it comes to this hygiene task. Fortunately there are some tips to help sensory needs and hair brushing.

    Sensory hair brushing can be a daily challenge for children with tactile sensitivities or sensory processing differences. For some kids, the feel of a brush on their scalp or hair can trigger discomfort, anxiety, or even meltdowns. This guide shares sensory-friendly hair care strategies that support kids who struggle with hair brushing due to tactile defensiveness. You’ll find practical OT hair brushing tips, tools like a vibrating hair brush for sensory needs, and ideas for creating a calming routine that makes hair brushing more manageable.

    If you’re looking for a sensory brushing protocol, advice on scalp brushing from an OT perspective, or simple sensory brushing strategies that work, this post is packed with helpful insights to support your child’s grooming routine.

    NOTE: The information and strategies in this blog post on sensory hair brushing will not be appropriate for all types of hair and all sensory issues.

    Sensory Hair Brushing

    Individuals with sensory processing sensitivities may feel that getting their brushed hurts, or may find it overstimulating.

    Other children may have challenges with hair brushing as it signals the morning routine is almost complete. They associate hair brushing with having to go to school or daycare, which increases their anxiety. Whatever the reason your child dislikes having their hair brushed, it can be very disruptive to your child’s routine, and anyone else in the home as well.

    Sensory Hair Brushing Tips

    Check out the tips below to help alleviate stress with hair brushing. 

    Tip #1: Brush hair while in the tub or sink

    When you brush your child’s hair in the tub or sink:

    • You can build on the relaxed mood to complete a stressful task
    • Warm water temperature offers calming sensory input.
    • Having probably just washed your child’s hair, the conditioner/oil (depending on hair type) will help to allow a comb to slip through your child’s hair with ease.
    • You will also be able to work out any larger knots they may have with your fingers much easier as the water runs in the direction of hair growth.
    • Your child will more than likely be distracted with toys that are in the tub/activity occurring around the sink area, keeping the focus off having their hair brushed.
    • Make sure to braid or put it into a top knot if your child’s hair is long, to prevent tangles in the morning. 
    • Bonus Tip! Don’t have time to wash your child’s hair every night, or don’t take a bath daily? Use a spray bottle to moisten your child’s hair, then brush it out. You can use a detangle to bring an extra element of fun to it too! 

    When it comes to brushing, the most important thing is to set up a routine, using the hair brushing techniques that work for the child’s hair type. Stick to that routine. Consider using a visual schedule, written schedule, or checklist.

    Tip # 2: Turn hair brushing into a Game 

    Using humor and distraction in the form of a game is another great way to help your child feel less stress and sensory issues during hair brushing. You can have them “earn” points for each stroke or set of strokes, have a countdown, or sing a silly song.

    Tip # 3: Use Role Play in Hair Brushing 

    Children learn best through play! Practice with a doll or let them brush your hair. As you do this, talk about how they are feeling and acting when they are brushing your hair. Are they being gentle? What can they do if they hit a knot? 

    It will also be helpful if you talk to them about how you’re feeling or how the doll might be feeling while having their hair brushed. Do you feel calm? Is getting your hair brushed hurting you?

    Make sure that you emphasize the positives as well! You can use real terms such as sensory issues with hair brushing, and explain what is happening.

    Share with your child how good it feels to have your hair brushed, that it makes you feel clean, and that it makes you look ready for the day. 

    Tip # 4: Let Your Child Do it Themselves

    When you give your child control of an activity, you take away fear of the unknown, or in this case, give back control over what you are asking to be done.

    This works well for children who say that you’re pulling too hard, their scalp is super sensitive, or they dread having to work out knots. By letting them brush their own hair, they are in charge of the pressure, pace and how they work through knots in their hair.

    Your children may also be more willing to participate if they know that they are in control of the situation. Be on standby in case they need help! 

    If the whole hair brushing process can’t be done by the child, let them participate in some aspect. That might be applying conditioner/oil. It might be that they hand the brush or comb to the person brushing. The main concept here is taking ownership in the task through active participation.

    Tip # 5: Use a Wide Tooth Comb 

    A wide tooth comb will slide through hair much easier, and with less resistance than a traditional brush.

    Another perk to a wide tooth comb is that it doesn’t have bristles, which many kids find irritating to their scalp, and often gets caught easily in long hair. 

    Amazon (affiliate links) has several different types of brushes and combs for sensitive scalps. They also have detangling brushes. Just type “sensitive scalp brush” into the search box.

    Or try a comb with wider teeth (affiliate link), depending on the hair type.

    Tip # 6: Hold Hair Close to the Scalp 

    Whether your child has long or short hair, holding hair close to the scalp or placing your other hand on their head can help to limit the amount of tugging they feel during hair brushing.

    Limiting the tugging sensation by keeping their head stabilized will also prevent activation of the inner ear, which can be alerting or cause dizziness. If they are particularly sensitive to the tugging sensation, or have poor head/neck control, they may be compensating by letting their head drop back with the slightest of tugs. 

    This is particularly important for children with long hair, as brushing down the back can elicit the startle reflex.

    Tip # 7: Use a Timer 

    Using a timer is a fail safe tip for working on tolerance of any activity. Set the a timer to see how long your child can tolerate having their hair brushed as a baseline, then add 5 seconds once a week until you are able to thoroughly brush their hair.

    A countdown timer (affiliate link) is very effective. You can use the timer on your phone or you can look for a visual timer app to add an extra layer of fun. Many visual apps have surprises at the end or turn colors as the app is counting down. 

    If you do not want the added input of electronics during this calming time of day, a separate timer (affiliate link) is best.

    Tip # 8: Use a Social Story 

    A social story is a book created about any activity that your child has challenges with. The story talks about what’s going to happen, how it will feel, and the appropriate social responses that your child should have with the activity. Read the story to them right before completing hair brushing to maximize its effect! 

    Don’t have a social story? Ask your therapist to help you create one. You can also find free social story generators online, or use a premade one. 

    Bonus Tip! If a social story is too long or advanced for your child, try using a visual schedule! This is a simplified version of the social story and can be adjusted based on your child’s abilities. 

    Implementing Tips for sensory issues and hair brushing

    These tips can help to break any negative behaviors or emotions that may surround your child’s sensory issues with hair brushing, and give you a foundation to start a fresh routine.

    Start by trying one recommendation that you think will work for your child, give it a week, and if it’s still not working, try another.

    Working through hair brushing challenges takes time, and is a trial-and-error process. Hopefully you will find these tips helpful!

    Looking for more resources?

    The OT Toolbox has a great resource called The Sensory Resource Handbook for tackling sensory issues related to hair brushing and creating a sensory diet for the many difficulties you are your child may be facing.

    One of our new bloggers has a great resource on Amazon called Seeing Your Home and Community with Sensory Eyes (affiliate link). This is a new manual for parents, therapists, and caregivers to understand, accommodate, and treat tricky sensory situations and community settings with real life strategies, tips, and understanding.

    Best Tools: Vibrating Brush, Scalp Massager & Soft-Bristle Options

    When supporting a child with autism or sensory processing disorder (SPD) during hair care tasks, the right hairbrush can make a huge difference. Look for soft, flexible bristles that glide gently over the scalp without triggering tactile sensitivity. 

    A vibrating brush or scalp massager may help reduce discomfort by providing calming deep pressure input that overrides the lighter, more irritating sensation of hair strands moving across the skin. 

    For many autistic children, even small sensory details like the tastes of products, the texture of clips, or the sound of clippers can be overwhelming. 

    Choosing an unscented shampoo (and other fragrance free products) and using a detangle sprays with a smooth glide can reduce frustration before the brushing even begins. For some families, shifting to a low-maintenance hairstyle can also reduce stress and make hair care more manageable. 

    Sensory Hair Brushing Troubleshooting Guide

    Hair brushing struggles often go beyond behavior. The issues might be rooted in how a child’s body processes sensory information. A child who avoids brushing may be responding to loud noise in the bathroom, bright light, or the feel of a strip of hair touching their face. 

    Try brushing with your child seated on your lap or in a calming, seated position on the floor to help ground the vestibular system. 

    Use deep pressure techniques like a firm shoulder squeeze or a short massage to prepare the body. If your child has an aversion to traditional brushes, try using fingers or a brush with soft, flexible bristles. 

    Keep scissors, clippers, and other tools out of sight until your child feels calm and secure. Adding patience, routine, and calm pacing can help build tolerance over time. 

    Quick Reality-Check: When Traditional Brushing Isn’t Working

    For some kids, brushing just won’t be tolerated without adaptation. Children with SPD may feel pain or panic from the light touch of a hairbrush. They might respond by running away, flinching, or crying before the brush even gets close. 

    These reactions are not defiance or tantrums. They’re nervous system responses to overwhelming sensory input. In these moments, step back and reduce expectations. 

    Shift to simpler tasks like brushing in small sections, doing a gentle scalp massage first, or using detangle spray during or after a shower to make brushing easier. It’s also okay to skip brushing on hard days or use tools like wide-tooth combs. 

    Working up to full grooming over time helps build trust and confidence, and sometimes that’s more important than a perfect hairstyle. 

    Sensory Diet Routine: Prep > Brush > Calm

    Creating a routine for hair brushing can support the body’s sense of predictability and reduce anxiety. 

    Start with prep activities that provide calming input, such as deep pressure through bear hugs, joint compressions, or heavy work like pushing a laundry basket. This helps regulate the vestibular system and makes the body more ready to process sensory information. 

    Move into brushing in a quiet, distraction-free space. Let the child hold clips or the brush first to build positive associations. 

    End with a calming activity: reading, swinging, or snuggling with a favorite toy, or whatever works for the individual. This routine will reinforce success. 

    For kids who struggle with haircuts or hair washing, breaking each task into smaller steps and reinforcing each one with praise or a preferred activity can create more success. With consistency, sensory brushing routines become less about struggle and more about connection.

    Sensory-Friendly Hair Tool Recommendations

    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.

    Free Chores Checklist for Kids

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    free printable chores checklist for home or school

    As part of our chores and executive function expose, here comes another FREEBIE! The School and Home Chores list can be yours by adding your email below. This downloadable worksheet is part of a series of free resources including: age-appropriate chores, chores and executive functioning skills, foresight in a task, sensory chores, and a task tracker. 

    Printable chores checklist for home or school

    While any time of year is perfect for initiating and instilling chores in our children, Summer is the easiest. Chores are always one of my top picks as the perfect Summer home program! You have more time in the summer for teaching, practicing, and focusing on specific skills.  Build your chore list and practice during the summer holiday, making it a breeze once school starts again.

    CHORES checkLIST

    Once you have reviewed and understood age appropriate chores, begin by making a list of what you think your learner is capable of learning. Our free Chores List worksheet is a great visual aide.

    You can use this sheet to write in lists of daily chores and then the child can check them off as they are completed. Hang it on a fridge or in the home and use it to track chores.

    Getting kids involved in chores can be a lot of work. There is no doubt it is faster and easier to do it ourselves, but then we rob our young learners of the opportunity to learn real life skills, build independence, confidence, and learn to problem solve.

    WHAT ARE THE BENEFITS OF DOING CHORES?

    I mentioned independence, confidence, and problem solving above.  What other opportunities can you build by working on chores with your kids?

    • Build independence 
    • Establish routines, which creates a sense of comfort and security 
    • Become more responsible 
    • Develop a sense of confidence (or improve their self-esteem) 
    • Learn time management and/or organizational skills 
    • Understand the importance of teamwork 
    • Cope with frustration and delayed gratification  
    • Develop resilience, so they can deal with the realities of life  

    HOW TO GET STARTED WITH A CHORES LIST

    Sometimes getting started is the hardest part for both kids and adults!  Having a plan or foresight in a task, can help.  Here are a few pointers to get you started:

    • Start young…teach expectations early.  Young children get excited about helping around the house.  Build this sense of purpose early, to help keep the momentum when the tasks get harder or less fun. Starting while your learners are young can have a lasting impact.
    • Explain the purpose of chores…explain that everyone in the family has a role in maintaining the home.  Everyone should contribute in some way. Help them see that dividing the work makes it easier for everyone and frees up more time for the fun stuff.
    • Begin small…start in small doses or chunks. Try backward or forward chaining.  In backward chaining, teach your learner the last step of the task.  You do all the items while they watch, then have them do the last part. This gives them a sense of finishing something. Forward chaining is the opposite.  Have your learner do all the pieces they can, then you finish it for them.  Start first with demonstration, moving on to cooperation, then independent work. Try mastery of one task before adding another.
    • Keep chores age appropriate… understand the unique needs and skills of your learners. Not all learners are going to fall in the exact range of the age-related chore list. If something is too difficult, it may cause defeat and can hurt their confidence, making it less likely they will want to do chores in the future.
    • Let your learner get involved…if your child has expressed an interest in something around the house, start there.  Some kids love the heavy work of using the vacuum, or sorting toys.

    How to use the free chores list

    This chores list is simple and straight forward. The free printable may either be your jumping off point, or the resulting list, after chores have been established.  Sometimes less is more. Limiting visual information can be helpful to making the important information stick out.

    Make a list for each day of the week.  In the “other tasks” section, you can add other jobs, or a reward tracking block. Everyone needs to work for something to stay motivated. As you make your chores list, you can add the everyday daily living tasks that are expected, such as brush teeth, shower, get dressed, etc. Then add the weekly chores to the list such as laundry, vacuuming, dusting, sorting toys, dusting, or whatever your learner can do.

    • Try laminating the chores checklist for ease of reuse.
    • Decorate the list in fun colors, or print it on colored paper
    • Younger learners may need picture symbols instead of phrases
    • Enlarge the list if needed to make it stand out

    Add additional resources such as this great life skills and chore activity packet bundle.

    HOW TO HELP KIDS BE SUCCESSFUL AT COMPLETING THEIR CHORES LIST

    Starting your chore list and teaching the tasks is just the beginning. Here are some great tips for helping kids be successful:

    • Be clear about expectations. Kids cannot read between the lines, so don’t leave anything up for interpretation. Be clear and direct about the expectations. For example, asking a child to clean their room is vague. Be clear about what a clean room means. For example, put away clean clothes in drawers or their closet, place dirty clothes in their hamper, put books on their bookshelf, etc. Some kids may also benefit from having a chore chart or other visual reminder of what chores they are expected to complete and when they’re expected to complete them. 
    • Create routines, and be consistent. If something is inconsistent, it’s hard for kids to understand the expectations, which can cause confusion or frustration. Try to be consistent when it comes to when and how chores are completed. For example, make the bed every morning and put dirty dishes in the dishwasher after meals. 
    • Be a good role model. Kids are more likely to do something if they see us doing the same thing.
    • Try to have fun. It is normal for kids to dislike doing chores. Many grown-ups feel the same way! But simple things, like playing music, can make cleaning more enjoyable. Get creative by turning chores into games. Make sorting laundry into a basketball game by tossing lights and darks into separate laundry baskets, or set a timer and try to beat the buzzer (complete the chore before the timer goes off).
    • Encourage self-praise by asking kids how they feel when they complete their chores. Do they feel satisfied, accomplished, or proud? If giving praise, try to focus on their effort rather than the outcome. For example, instead of saying, “You’re doing a good job!” Try saying, “I notice that you’re working really hard to get that surface cleaned.” 

    ROADBLOCKS TO COMPLETING THE CHORES LIST

    There will be roadblocks and setbacks as the chore list is designed and implemented. That is real life.  Try and problem solve some of the road blocks.

    It is normal for caregivers to get frustrated when the chores are not being done right, or kids are refusing to try.  This is normal on both sides.  Try and understand why they might be refusing, or not completing the tasks as instructed.  Are they unsure of expectations?  Is the chore developmentally appropriate? Do they have the focus to complete the chore?  How are their executive functioning skills (problem solving, task initiation, self-reflection)? Is there something else going on entirely (sensory)?

    Keep your expectations realistic. Understand that the chores are not likely to be done the way you do them. Except mediocracy. Pick your battles. Try and be patient, resisting the urge to jump in and help too soon.

    Keep following the OT Toolbox for more free worksheets like this chores list to add to your resources.

    Free Chore Checklist

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      Built with Kit

      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.

      Honey Bee Sensory Bin

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      This bee sensory bin for preschoolers is a great sensory bin activity for a honey bee theme. Letter cards with bees and matching honeycomb cards.

      I am not sure how I feel about honey bees.  The fat fluffy ones are kind of cute. You can buy honey bee themed everything out there. You might just forget their sting for a minute. Today, as part of our sensory bin series, we are focusing on the Honey Bee Sensory Bin. Despite the mess they make, therapists love sensory bins! They are a useful and creative way to address sensory stimulation as well as cognitive skills.  Here at the OT Toolbox, we are offering a series of posts highlighting different sensory bins, including this cute Honey Bee Sensory Bin, along with activities to engage young learners.

      This bee sensory bin for preschoolers is a great sensory bin activity for a honey bee theme. Letter cards with bees and matching honeycomb cards.

      A Honey Bee sensory bin is just one of thousands of options you can choose from. It is easy to make your own sensory bins. Add different activities to make it multi-dimensional.  With a membership to the OT Toolbox, most of the materials are free or a minimal cost.

      HONEY BEE SENSORY BIN

      For the sake of this lesson, we can pretend I love honey bees!  I am sure I would love making a honey bee sensory bin, as no live bees are used in the making of this activity.

      Fun facts; Honeybees have five eyes: two compound eyes and three smaller ocelli. They use a special dance called the “waggle dance” to communicate the location and quality of food sources.

      If you are new to sensory learning, it is important to understand what a sensory bin is, and what it can offer your learners. If you follow our posts, you have probably read about this topic, or are familiar with the popular sensory bin.

      A sensory bin is a shallow container that combines filler material and various small odds and ends. You fill the bin with a filler material such as sand or rice, then add items from around the house such as spoons or measuring cups. Let your child explore the items and have fun playing.  This great article on Sensory Base Fillers highlights the different options for bases and fillers.

      WHAT ARE THE BENEFITS OF A SENSORY BIN

      The obvious answer is “to stimulate or desensitize the sense of touch.”  Sensory bins are so more than just a tactile experience. There are just so many benefits of sensory play that you can facilitate using a sensory bin.

      • Improve fine motor skills: Digging, scooping and pouring, and stirring, can strengthen your child’s hand muscles and improve fine motor skills.  Include oversized tweezers, spoons, and funnels to encourage your child to practice the type of grasping skills they will need to feed themselves and write.
      • Sensory exploration: this one is obvious, but other senses are stimulated in addition to touch.  Vision, auditory, smell, and proprioception can be elicited using the honey bee sensory bin.  Kids will enjoy running their hands through the filler material and watching what happens as they pour it out. Many materials you can put in a sensory bin provide a wonderful tactile sensation. You can vary the materials to make the tactile experience different textures. For those with tactile defensiveness, a sensory bin is a great tool.
      • Intellectual skills: while it may seem like they are just playing, this is the occupation of a child. Through play, children learn cognitive skills. They can learn about measurement using measuring cups, add letters and numbers for academic enhancement, or sort items.
      • Calming experience: for those without sensory aversion, playing in sensory material can be soothing. Use bins like the honey bee sensory bin to take a sensory break.
      • Language development: once the sensory system is satisfied, we often see a burst of language (verbal or non-verbal). Use this time to ask questions, talk about hidden objects, talk about more/less, what they see, and what they are doing.
      • Cooperative play: when two or more people play in the sensory bin, there are opportunities for cooperative play. Sharing, turn taking, and working together are good skills to learn.

      WHAT AGE ARE SENSORY BINS GOOD FOR?

      This depends on your level of supervision. Toddlers under 18 months explore by putting everything in their mouth. I like to offer edible options for most of my sensory bins. Remember that while it may not taste great, dry rice/birdseed/couscous, and pasta are edible.

      I like the idea of soaking chia seeds as a texture, or using cooked spaghetti. I just saw a cute idea for a sensory bin for infants. While they are practicing tummy time, fill a cookie sheet or shallow pan of water and/or bubbles for splashing.

      I do not tend to leave my students of any age unattended in these sensory bins; if for no other reason than to contain the mess.

      Safety Tips for Using Sensory Bins

      Toddlers and preschoolers should always be supervised when using sensory bins to discourage them from eating the materials.

      Here are some more safety tips for making sensory bins: 

      • Don’t use items that pose a choking hazard, either as filler material or odds and ends.
      • All sensory bin materials should be nontoxic.
      • Use a tube to test if objects are a choking hazard, particularly if they’re round or elliptical in shape.
      • Don’t use raw kidney beans, since swallowing as few as four or five can cause severe nausea, vomiting, and diarrhea.
      • Avoid use flour in your bin because it can be aspirated and affect breathing.
      • Only use sterilized sand such as the type sold as play sand.
      • Avoid using Styrofoam peanuts since they are a choking hazard.
      honey bee sensory bin in a yellow tray with black beans and honey bee letter cards.

      First, print off the honey bee sensory bin letter cards from The OT Toolbox.

      HOW TO MAKE A HONEY BEE SENSORY BIN

      The supplies needed for the honey bee sensory bin are easy and inexpensive to find. Most of the items can be found at the dollar store or Amazon. Supply list:

      • Dry split peas- found at the dollar store or Amazon
      • Fake flower petals- found in the floral section at the craft store or Dollar store.
      • Honey bees- make your own with chenille stems (pipe cleaners) wound around a clothespin, wax paper wings, and googly eyes. We have an example of these bee clothes pin crafts here.
      • Or buy little bee figurines on Amazon. I chose the cute ones, but there are realistic bees for sale.  
      • Sensory trays– Amazon has several to choose from. You could also use a foil serving dish, cafeteria tray, or a plastic bin. If you are on a tight budget, a shoe box, shipping container, or baking tray will do the trick.
      • Ready-made honey bee sensory bin. If home made and crafts are not your thing, Amazon has you covered!  I am crafty but this is cute!
      • Edible hand-made sensory bin– this one is made with dry pasta and rice with some cute bees thrown in.
      • Orange/yellow pom poms
      Image is a Child pinching a honey bee letter card in a bee sensory bin. text reads: honey bee sensory bin.

      Image is a Child pinching a honey bee letter card in a bee sensory bin. text reads: honey bee sensory bin.

      HOW TO USE THE HONEY BEES SENSORY BIN

      • Add all the items into the sensory bin. Either add them separately into sections in the bin, or mix all together
      • Use the honey bee sensory bin cards that we have inside The OT Toolbox membership. These are great for using pincer grasp, visual scanning, visual memory, figure ground, and visual closure skills.
      • Cut out letters, numbers, and BEE words and laminate them (alternatively you can print on cardstock to make them last longer)
      • Further enhance learning by asking students to copy the letters, numbers, or honey bee words onto paper or a white board
      • Students can pick up the pieces with their fingers, tweezers, or tongs. Tongs add a fine motor element for dexterity, coordination, separation of the sides of the hands, pinch strength, developing grasp, and opening the web space
      • Use the bees as sentence starters or research projects to encourage learning.
      • Show students fun facts about honey bees and have them copy them off the board (far point copying), or paper for near point copying skills.
      • You can encourage them by demonstrating how to scoop and pour and talking to them about what they are doing. You can encourage their literacy skills by talking to them while they are playing and hone their math skills by letting them measure and pour. 

      MEMBERship comes with great perks!

      The best way to get all the resources available on the OT Toolbox is to become a member.  This gives you access to the archives, and thousands of free resources. One of them is the honey bee or spring theme.

      ADDITIONAL HONEY BEE SENSORY BIN ACTIVITIES

      • Put a small toy honey bee in an ice tray and freeze it, then add it to a water bin on a hot day.
      • Put your bin in an area that is easy to clean up or take it outside.
      • Fill a bin with shredded newspaper and hide plastic bees in it.
      • Create a whole lesson plan with your honey bee sensory bin as the starter. Use books, printables, gross motor games, and board games
      • For a wet texture, try shaving cream, water beads, jello, cornstarch/water, pudding
      • Do the just right challenge encouraging reluctant learners to try new things, or demonstrate the activity first

      ADD TO YOUR HONEY BEE SENSORY BIN THEME

      Of course; this search is much easier is you become a member of the OT Toolbox.  Once you become a member of the OT Toolbox, it is very simple to find resources, both current, and in the archives. Type in the skill, category, item, or idea you are looking for.

      MORE FUN HONEY BEE FACTS

      • The honey bee is the only insect that produces food eaten by man.
      • A honey bee typically visits 50 to 100 flowers during a collection trip.
      • A honey bee would have to fly around 90,000 miles, over three times around the globe, to make one pound of honey. It would take one ounce of honey to fuel her flight around the world.
      • The average honey bee will actually make only one twelfth of a teaspoon of honey in her lifetime.
      • A populous colony may contain 40,000 to 60,000 bees during the late spring or early summer.
      • Worker honey bees live for about 6-8 weeks in the spring or summer, but up to 6 months during the winter.
      • A new queen may mate with dozens of drones over a 1-2-day period.
      • The queen is constantly fed and groomed by attendant worker bees.
      • The queen lives for up to about 5 years. She is the busiest in the spring summer months, when the hive needs to build to its maximum strength, and lays up to 1500 eggs a day, which may equal her own weight.

      MEMBERSHIP HAS ITS PERKS

      Want to add this resource to your therapy toolbox so you can help kids thrive? Enter your email into the form below to access this printable tool.

      This resource is just one of the many tools available in The OT Toolbox Member’s Club. Each month, members get instant access to downloadable activities, handouts, worksheets, and printable tools to support development. Members can log into their dashboard and access all of our free downloads in one place. Plus, you’ll find exclusive materials and premium level materials.

      Level 1 members gain instant access to all of the downloads available on the site, without enter your email each time PLUS exclusive new resources each month.

      Level 2 members get access to all of our downloads, exclusive new resources each month, PLUS additional, premium content each month: therapy kits, screening tools, games, therapy packets, and much more. AND, level 2 members get ad-free content across the entire OT Toolbox website.

      Join the Member’s Club today!

      COMING SOON

      Stay tuned for more posts featuring great sensory bin ideas. Upcoming: baseball, honey bee, beach ball, shapes, backpack, school, and more!

      **Do not forget to sign up to be a member today to get easy access to all the resources you need to be an efficient and effective therapist.

      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.

      Mental Health For Students

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      Image of a stressed out brain. Image reads "mental health and students"

      Mental health is something all of us need to be aware of. School based occupational therapy covers many basis simply because of the school-based occupations and functions that students in the school environment do on a daily basis. Mental health is one aspect that impact students from kindergarten through high school and it’s a consideration that school-based OTs need to keep in mind. In this blog post, we’re covering information and resources about mental health for students.

      Mental Health for Students

      The number of cases of mental illness continues to rise dramatically.  Mental Health for students is a big topic to cover. According to the National Institute of Mental Health, 1 in 7 children and teens worldwide experience a mental health condition. In the US, 49.5% of adolescents have a mental disorder, and 22.2% of those have severe impairment or distress. 1 in 7 children and teens worldwide experience a mental health condition. In the US, 49.5% of adolescents have a mental disorder, and 22.2% of those have severe impairment or distress.

      Young people used to be relatively unscathed from psychological difficulties. It was believed children had no stress and nothing to worry about. According to a study posted by the American Psychological Association; In recent years, evidence reveals the contrary. The rate of individuals reporting symptoms consistent with major depression in the last 12 months increased 52 percent in adolescents from 2005 to 2017 (from 8.7 percent to 13.2 percent) and 63 percent in young adults age 18 to 25 from 2009 to 2017 (from 8.1 percent to 13.2 percent).

      There was also a 71 percent increase in young adults experiencing serious psychological distress in the previous 30 days from 2008 to 2017 (from 7.7 percent to 13.1 percent). The rate of young adults with suicidal thoughts or other suicide-related outcomes increased 47 percent from 2008 to 2017 (from 7.0 percent to 10.3 percent).

      There was no significant increase in the percentage of older adults experiencing depression or psychological distress during corresponding time periods. The researchers even saw a slight decline in psychological distress in individuals over 65.

      How can we care for the mental health for students?  We can start by looking at what we believe causes, or exacerbates mental illness.

      WHAT CAUSES MENTAL health issues IN STUDENTS?

      What has changed in the past fifty years to cause an increase in stress and disability? People always ask me if there is an increase, or are we just noticing and diagnosing more?  I believe both is true. We are noticing and diagnosing every twitch, however, there are definitively more people struggling now. 50 years ago there was a stigma to acknowledging mental health issues.

      The diagnostic criteria for diagnosing has changed during the past couple of decades.

      To provide mental health for students, we first need to unravel how they are getting to this point. Take a look at the wellness wheel. Basically this wheel has a spoke with different areas and components that make us each who we are. Every person’s wellness wheel will be different, and that’s ok! The variances make us who we are. However, the outer ring has underlying components that impact each of us.

      You’ll see spokes on the wellness wheel for emotional, intellectual, spiritual, physical, occupational, and social. If one of these spokes are deflated, or deficient, we might see mental health issues like stress, anxiety, worries, or even harsher results.

      Environmental impacts on mental health

      We can also take a look at how environmental considerations impact mental health. These issues compound on our students because they might have something at home that they bring with them to school, emotionally. They might experience different things at home and then think about it at school. It’s a trauma response in some cases. In other cases, it might not seem like not getting enough sleep or a nutritious diet effects mental health, but it does. And we see that overflow at school when our students are under stress of keeping up with their peers, socializing, stressing out about grades or physical performance, or any other aspect of the school day.

      Here are some environmental considerations that impact mental health in students:

      • Diet impacts mental health. People eat horribly now. Everything is processed, full of colored dyes and preservatives, or artificial ingredients. Efforts are being made in schools to add some healthy choices, but kids are not picking fruit and vegetables. Schools also realize students need to eat something, so they opt to offer popular choices like sugary cereal, Pop Tarts, Doritos, pizza, bread sticks, and French fries. I cringe when I see what parents pack for their kid’s daily snack. It takes work to make your children eat and enjoy healthy food. I would rather eat a Pop Tart than carrots. There have been correlations between colored dyes and attention problems.
      • Exercise and mental health (or lack of exercise). Schools make efforts to send students outside for recess, but they can not make them play. If the weather is slightly off, they stay indoors and watch movies. Parents are not sending their children outside to play all day, or taking them to the park. We have students come to our school program at age four, and have no idea how to play on a playground. Heavy work organizes the sensory and central nervous system. This impacts brain function.
      • Genetics and mental health– There is definitely a genetic component to what is plaguing our young people. This goes for all types of genetic diagnoses. For example, the rate of autism was one in ten thousand thirty years ago.  It is now less than one in 40. When interviewing parents, more often than not, one of the parents admits to anxiety, depression, mental illness, ADHD, or some other ailment. When there is a diagnosis or undiagnosed challenges that students experience, there can be mental health issues also occurring, simply because of the challenges that neurodiversity brings in various settings and environments.
      • Technology and mental health– People rave about technological advancements, but they do not spend enough time assessing the damage it is doing. The magnetic waves emanating off technology is harmful. There is a relatively new term, Virtual Autism, on the rise. Post–Digital Nannying Autism Syndrome (PDNAS) in another term used for virtual autism. Check out my post on Virtual Autism for more insight. Children with autism are prone to anxiety ,obsessive-compulsive traits, social anxiety.  Screen time is associated with increased risk for OCD and social anxiety, while contributing to high arousal and poor coping skills. Serotonin regulation and amygdala changes have been implicated in screen time.
      • Social media and mental health– Everything seems to be public knowledge. Rumors spread like wildfire. Bullying and harassment continue to rise. There is a lot of pressure to live up to the expectations of friends and celebrities on social media. People unknowingly skew their social media feeds. They post only the great things happening, or fill their feed with unhappy thoughts depending on their mood.  My Facebook feed looks like one vacation after another. I have had friends facing divorce, that came as a surprise to everyone, solely based on their social media profile. While this can be a great way for people to connect, it causes anxiety and stress at the same time.
      • Internet accessibility and mental health– Information is just a button away. We used to have to wait to talk to a doctor; now we can Google our symptoms. This helps people stay informed, but also has the potential to cause undue worry. Because everything is just a touch away, we do not have to wait for anything, or exhibit impulse control. Young people have access to inappropriate content that they are not mature enough to understand, or find themselves addicted to gambling, pornography, shopping, or diagnosing all their friends with illness.
      • People are not talking (or listening) – This is a big one but not something that we think of right away. Conversations consist of video clips, memes, and text messages. That is not adequate conversation for processing feelings and information. Non face to face communication can be misinterpreted.  Parents and teachers are busy. They are not sitting down talking with children and really listening to what is being expressed. In addition, children are not building the social skills to know how to talk about their feelings.  If you read about teen crime or suicide, there is often something caregivers missed because they were not paying attention.
      • Pressure to succeed and the mental health issues that result– A grade of 70 or a C is an average grade. When did people decide a C was below average, and only A’s were acceptable?  There is a ton of pressure for students to make all A’s, whether they are in fact A students or not. Teachers are blamed if they are not giving out enough 100’s on papers. If your friends around you are all getting great grades, and you are average, it can feel like a failure. My daughter hung out with gifted students. The norm in her social life was to be above average. When she, or her peers were not perfect, there was an uptick in anxiety and negative coping.

      WHEW, THAT IS A LOT GOING ON

      The list above is only the tip of the iceberg. None of those theories occurs in isolation. Many students are affected by several factors at once. This can be a double or triple whammy to their fragile mental health. I have sleepless nights thinking about the damage we are doing to our young people. I am afraid we are not going to turn the clocks back to a simpler time, but continue to cause more difficulties for children. What do we do?  We put a small band aid on a gaping wound.

      HOW DO WE HELP IMPROVE MENTAL HEALTH FOR STUDENTS?

      Mental health promotion and prevention interventions aim to strengthen an individual’s capacity to regulate emotions, enhance alternatives to risk-taking behaviours, build resilience for managing difficult situations and adversity, and promote supportive social environments and social networks.

      There are some factors like genetics that we are not able to readily change. We can however, change many of the other factors. It starts by providing a better environment and foundation for our kids. Parents can start this at home. As therapists, provide education to families on the importance of diet, exercise, and a good sleep routine.

      1. Limit technology – The Academy of Pediatrics recommends that children under the age of two not be exposed to screens at all, 2–5-year-olds less than one hour per day, and older children be limited to two hours a day.  Therapists can be mindful of adding technology to treatment sessions. Yes, children will work better for an iPad, but there has to be a better way. It’s a must to balance screentime for kids and teens. This screen time checklist is a good way to get started.
      2. Limit or be vigilant about social media presence. Parents hate to have to watch their kids Instagram, TikTok, and Facebook feeds. It feels like an invasion of privacy to be looking over their shoulder, or snooping on emails and text messages. As a therapist, be vigilant to what your students have access to.
      3. Normalize appropriate grades. Emphasize appropriate expectations for students. Not all students can achieve great grades, but rather they should be pushed to their potential and demonstrate good effort. Encourage children that the most important measure of success is effort.
      4. Talk with your kids. Start by teaching them to express themselves, either through words or pictures. Mental health for students starts by talking and listening. Practice listening. Children will often open up in therapy sessions (OT, PT, speech) because we have helped them with self-regulation, and they are in their just right zone.  We take the time work with them one on one, or in small groups. We put a significant amount of pressure on ourselves to provide jam packed treatment sessions. This is a great work ethic, but make sure there is time for talking and listening. I will often get much further in OT sessions with a student, than if they go to traditional counseling.
      5. Educate on mental health. Start talking to school administration, teachers, parents, and other community members. Make them aware of the challenges facing our students. I wish more parents had parenting classes, and pediatricians were more vigilant.  OTs often build a great rapport with parents and other support people.  We become trusted members of the team. Use this trust to provide support and education to families.

      WHAT HAPPENS WHEN STUDENTS ALREADY HAVE MENTAL ILLNESS, and we are beyond prevention?

      Sometimes, despite all our efforts, students still suffer with mental illness.  We need to be hyper vigilant with these students.  After removing and monitoring potential hazards, we need to offer support. Support comes in teaching coping skills. Students often lack the skills to deal with adversity. Not only do they not have the skills to talk about their feelings, but they do not have the mechanisms for dealing with them. 

      Provide resources and help with:

      This is a heavy burden and conversation. It is easy to get bogged down in all that effects our young people. Like I mentioned, I lose sleep over this. I try to remind myself to do what I can, and help one person at a time. I try and practice what I preach (although I could eat better and shop less). Try and be an advocate for change, even if it only effects the mental health of a couple of students.

      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.