Victoria Wood OTR/L, Author at The OT Toolbox

What You Need to Know About Sensory Food Issues

October 17, 2023August 29, 2022 by Victoria Wood OTR/L

Sight, smell, taste, and touch are some of the contributing factors to a child’s sensory food issues. How it looks, smells, the consistency/texture of the food, and the way it feels on the fingers or utensils can make a child/learner feel uneasy, uncomfortable, and unwilling to try. Children and older learners struggling with sensory issues with food, are often lacking a good variety of foods that contain proper nutrition for their health and development.

Sensory touch is a huge piece of this; not only the texture of foods in the mouth but the “feel” of foods as we handle them and chew them.

sensory food Issues

There is a range when it comes to determining sensory eating disorders. From extreme food aversion to the simplest of sensory food preferences. We all have probably experienced some aspect of this, at one time or another because everyone of us has different levels of sensory aversions.

Think about a food that you don’t prefer just because of the texture. Maybe it’s biting into a banana or a mushroom. Perhaps it’s chewing the stringiness of asparagus or celery. Does the sensory aspect of food textures like drinking smoothies or biting into a mushroom throw you off? There are many aspects of eating that are rooted in the senses.

We as OT practitioners know that a colorful plate of food is contains essential food groups and healthy eating choices to help a child blossom and thrive. Children and older learners who struggle with sensory food issues, often can not climb this hurdle for themselves without OT intervention. OT practitioners are experts in play-based therapy, and feeding therapy is no different. OT’s enjoy making eating fun while improving the sensory culprits that challenge a child’s success with feeding.

Oral Motor Vs. Sensory Food Aversions

As a side note, picky eating is not always a “sensory” issue. Sometimes there can be oral motor issues at play or other considerations.

We have a variety of resources on the website related to oral motor considerations as this can be a safety issue when it comes to oral motor development and “pushing” kids to try new foods. You’ll want to check out these oral motor resources if you are concerned or questioning a sensory aspect of feeding challenges or an oral motor issue:

Pediatric Feeding: Is it sensory or oral motor? This blog post includes a printable handout. (Also available inside the Member’s Club under Educational Handouts)
Feeding Developmental Milestones– This resource covers developmental progression which can play a role in sensory food issues at each stage.
Executive Functioning skills and meals– This blog post covers other aspects of cognition and safety of meals- including impulsivity, processing speed, coordination, and choking hazards.

It’s important to always seek out professional advice when it comes to feeding challenges in kids.

sensory food exposure and feeding therapy

The hierarchy of sensory exposure during feeding therapy, provides a good introduction and follow-through of steps to sequentially build sensory exposure to foods. The ultimate goal is being successful interacting or eating the non-preferred food. Eating and mealtime is a multi-sensory experience that children with sensory food challenges may have difficulty viewing in a positive way. Even the tolerance of the food in the same space is a successful step!

Aside from clinical assessment, this Food Inventory Questionnaire can help the therapist, develop a proper treatment plan. It gathers important data about a child’s current preferences, so that likes and dislikes can be established, to begin food introduction and food chaining in feeding therapy.

Children use their sense of sight to look at their plate of food, surroundings, and those who are joining the mealtime experience

We’ve all looked at something and thought, ‘That is really gross…YUCK’! Children who have sensory food aversions are “grossed out” when they see some foods. Along with “yuck”, comes gagging, coughing, face squinching, head-turning, hands to mouth, plate pushing, and even covering the food to hide it.

In their state of fight or flight, learners will try anything to avoid looking at the food, let alone eating it. Read more about this aspect in our resource on the limbic system.

Sometimes children get overwhelmed when they look at a plate, especially if the plate is packed to the edges with food, if the food on the plate is touching, or they do not see anything they like. How can you help kids who struggle with a visual aversion to food?

Visual Tips and Tricks

One strategy to support sensory food needs is to use the power of the visual sense. This can be explained in more detail below. We’ll cover several areas:

Food separation on the plate
Fun foods and fun presentations
Motivating snack mats or plates

Food Separation –

This is an easy strategy to implement by simply separating the food with a good distance between each food choice, so that food does not touch. A muffin tray is another excellent way to keep food from touching.

Another fun idea is to turn mealtime into a game, to provide a little distraction from the actual act of eating. Hopefully the activity will make eating a more positive experience, rather than a dreaded one.

Take a look at a few products available for this technique, that provide food separation by design:

(Amazon affiliate links below)

Dinner Winner Food Game Tray is a food tray that is designed like a board game and the child travels the food sections to get to the end where a special treat awaits
SpinMeal Plate is a plate where an arrow is in the center of the sectioned food plate. The child spins the arrow to choose the food compartment to try
Divided Kids Dinner Plate is a colorful portioned plate that contains encouraging words to provide ongoing motivation
Sectioned Dinnerware Plate is a game board where a child gains points with each section of food trialed or eaten
Divided Lunch Trays are simple divided trays that are solid in color, making them less visually distracting for children who may become overwhelmed with all of the visual clutter of the other game trays and plates

Smaller Plate and Utensil – Using a smaller plate with less food, helps the child feel less visually overwhelmed with how much they will have to eat. Using a smaller spoon or fork to scoop or pierce, can give the child a better feeling of manageable food amounts. Read more about tips and strategies to help kids learn to hold a spoon and fork.

Fun Food

Make food look more fun and less ‘foodie,’ as you create images and scenes with the food, making it more enticing to trial. Who doesn’t want to eat rainbow snacks or how about Flower snacks? These treats are fun to look at, and motivating to eat.

Food Art Snack Mats – Try using fun snack mats you print and laminate. This can be used as a fun visual background while eating.

It’s easy to get the kids involved in making a variety of food art snack mats, and games to support mealtime with kids.

Children use their olfactory sense to smell the flavors of the food, both while it is cooking and on their plate

“Shuwee, that stinks!” Yep, we’ve all said it about something. The neighborhood skunk, the car exhaust in front of us, the litter box, and even the spices in the kitchen.

Children who have olfactory sensitivity smell food odor at a much higher level of intensity. They pinch their noses, turn their heads, try and leave the table, or vomit/gag in response to the smell.

Check out the strategies below to help desensitize a child to the food smell. Slowly introduce smells of varied scents from light to heavy, to build desensitization more easily.

Olfactory Tips and Tricks

Essential Oil Set-up – Set up the space for eating by using a calming scent of essential oil that is easily tolerated by the child in the eating area. Essential oils can calm anxiety related to eating, and desenstize the system to the food odors. Hopefully this will make a child more tolerant to the less preferred smells

Coffee Bean Support – Use a few coffee beans near meals, as the coffee scent can help neutralize the smell of some foods. If your learner has an aversion to coffee, you might need to try a different neutralizer

Cold vs. Hot – Naturally, cold foods do not smell as strongly as warm/hot foods. If colder foods can be tolerated by the child, try serving foods cooler, to reduce the food odor naturally.

Kitchen and Dining Modification –

Addressing environmental considerations can have a big impact. Try these strategies:

Consider moving mealtime experiences outdoors.
Remove the child from the kitchen/dining area as some of the cooking smells from hot foods will linger for longer periods of time, within these rooms.
Open a window or patio door, or using a fan when cooking, to help reduce the amount of odor emitted into the room. This can lessen the aversion to smells.

Meal Prep Warning – Before cooking, warn the child that cooking will begin soon, as this can help the child prepare their sensory system mealtime, as they use some of their learned coping techniques.

Cover the Smells – If serving food on the tabletop for the entire family, try covering each dish with a napkin to limit the amount of odor from each of the served foods.

olfactory play

Scented play activities– Scented sensory bins, scented play dough, or other scented play activities can inspire calming or alerting scented play.

Smell Bottles or Sniffing Jars – Create some fun sensory sniffing jars with varied smells to help the child start processing a variety of smells. These jars are created by placing a variety of scented objects into small containers with holes in the lid of the jar. The smell will rise out, and the child can sniff at manageable distances. The larger the hole, the more the scent is dispersed. Some ideas include cinnamon, coffee, coconut, lemon, lavender, peppermint, etc. Create these smell jars to play with, by stacking and matching to the card images of the scents, or play a fun guessing game, by smelling and guessing what scent it is, then matching the jar to the card image.

Children use their sense of taste to determine if they like the flavor of a food

Lip grimacing, lip tucking, and hiding lips with a hand are some of the actions a child with sensory food issues will make when presented with food toward their lips.

There are a set of steps feeding therapists use to help a child eventually eat a non-preferred food.

First, the food is brought to the lips much like kissing.
Then they lick the food.
Make teeth marks in the food.
Take a bite of the food.
Finally, chew and swallow the food.

These are not all of the steps needed to approach gustatory aversion to food, and it’s important to acknowledge that each individual with sensory food issues will present differently.

Each of these steps will build the skills the child needs to successfully try new foods, eventually adding them to their diet.

Importantly, being a cheerleader for your child with sensory food issues or struggles is important. Try these tips for supporting small successes:

Be patient, and celebrate each step as a success.
Give a high five, a hug, or a cheer.
Focus on whatever motivates the child to keep trying!

Gustatory Tips and Tricks

Some of these tips may help with the gustatory, or sense of taste as a strategy and powerful component in supporting sensory eating needs:

Sauce and Condiment Support – Use sauces or condiments as a support tool during feeding sessions, to provide a muted or masked taste of a trial food, to build acceptance of the food within the child’s diet. Broccoli with ketchup still has all the nutrients of this vegetable.

Spice Limits – Think about the spices used when cooking food, and try to limit some spices that are non-preferred, until the child can accept small amounts, that can be increased over time.

Children use their sense of touch to understand their food

“That feels gross! It’s mushy, slippery, sticky, hard, bumpy, etc.” There are many ways that texture food aversions can develop in children. The way they imagine it feels, the way it actually feels, or the way it feels transporting to the mouth. The best way to approach textural aversions is to introduce textures in a less threatening way – by play!

Always remember when playing with food that the goal is not just to eat, but to interact and build positive associations with food, and become more comfortable with the various aspects of it including texture, shape, color, smell, etc. Let the journey begin with the hands and the eyes.

Tactile Tips and Tricks

Sensory bins – They are a classic OT tool.

Make sensory bins use cooked foods too! Remember if the food is cold, the smell is less intense, or many times there is no odor at all. Try using cooked spaghetti, pasta, rice, or veggies, some crumbled-up toasted bread, bagels, or rice cakes as a sensory bin. Note: Always be cautious when using cooked foods, making it a habit to throw out after play, for safety.
Another idea is to make sensory bins containing play items that look like the foods a child has an aversion to. Simulated cooked spaghetti could be a yarn bin, toasted bread could be a cut-up sponge bin, and whipped cream could be a shaving cream or cotton ball bin. In addition, use the typical food items like dry beans, dry rice, dry pasta, graham cracker crumbs, oats, and water, as sensory bins for exploration.
Make the bins more appealing by tossing in some fun toys, burying them, use fun voices to talk for the toys, or use a Mr. Munchie Man ball to support fun playtime. Kids love to see Mr. Munchie Man try smelling, kissing, and eating some of the textured items in the bins.
Model play, by getting your hands into the bin, getting dirty to show the children this is a fun activity.
Another strategy is to give the child utensils to poke around in the texture bins if they are resistant to placing their hands inside. Eventually work toward using smaller utensils and tongs until they become more tolerant and willing to dig in with their fingers and hands.
Messy eating is another strategy that can work, too.

Food Presentation Changes

Think about the different ways you can change the texture of foods that children dislike, or change the presentation of the food, by adding something or making it differently.

Some ideas include:

Presenting toasted bread instead of soft bread
Yogurt with granola instead of plain yogurt
Roasted or fried potatoes instead of mashed potatoes
Banana slices with granola instead of plain banana slices
Sliced or chunked apple pieces instead of applesauce
Shredded meat instead of whole
Shredded cheese instead of sliced or chunked cheese
Covering pancakes with apple butter instead of syrup

Food Art Snack Mats

Grab a few food art snack mats and turn food into playtime fun while exploring textures.

Make a Face using fruit pieces on a laminated placemat
Cut out circles to create a space for a plate, cup, and on a paper placemat. Then, add paper forks and spoons. Laminate to create a reusable placemat the kids can decorate.

Non-edible Sensory Recipes

Check out these fun sensory dough recipes, and have fun making something that children can play, with while exploring a variety of textures. These recipes are simple to follow, and make the perfect tactile experience, while also providing ownership of the end product, as they make it themselves.

The recipes include play dough, Oobleck slime, Flubber, kinetic sand, silly putty, and cloud dough. A variety of textures to explore and digital download includes learning activities related to each recipe too!

Tips for sensory food issues

A few quick last thoughts on making the journey to mealtime a success for each child. When sensory food issues and challenges arise, keep these things in mind:

Always honor the child’s responses to food interactions and be sensitive to their feelings.
Never force a child to participate in actual eating of food until they are ready. You can nudge, but never make it forceful.
Give the child as much control as possible by letting them make some choices, like what spoon or plate to use, or what beverage they want to drink. Try allowing them to pick their placemat or table cloth for setting their meal.
Give them choices that are sufficient enough for their needs, but not overwhelming.
Understand and accept that helping a child overcome food sensory aversions will take time and effort as your support each step in their journey.
Keep practicing, and keep working. Even the smallest of steps forward are still a success, and they should be celebrated!

This sensory food issues post is part of a feeding series. Be sure to check out the other posts available on this topic. The Sensory Lifestyle Handbook is a great resource to understanding sensory struggles.

The Sensory Lifestyle Handbook walks you through sensory processing information, each step of creating a meaningful and motivating sensory diet, that is guided by the individual’s personal interests and preferences.

The Sensory Lifestyle Handbook is not just about creating a sensory diet to meet sensory processing needs. This handbook is your key to creating an active and thriving lifestyle based on a deep understanding of sensory processing.

Sensory Food Aversion Handout

When sensory food aversion is a real struggle in a household, everyone in the home can be affected. Educating on how to support an individual with sensory food aversions is key.

We’ve created a free handout that does just that. This printable sensory food aversion handout covers the strategies addressed in this blog post as an educational resource. While it’s not intended as a replacement for therapy, the handout covers strategies and supports that can be used along with therapy services and individualized interventions.

Therapy professionals can use this handout as an educational tool to support the needs of families.

Print off this sensory food strategies handout and add the resource to your therapy toolbox.

Enter your email address into the form below.
Check your inbox for the email containing the printable.
Print it off and go!

Or, OT Toolbox Member’s Club members can access this printable resource inside the Member’s Club. Log into your account and head to Educational Handouts. You’ll find the printable there.

Sensory Food Aversion

What is sensory food aversion, and how can we “fix” this? These questions will be answered in this upcoming post. There are many reasons learners are not able or willing to try new foods. There are many adults that only eat a handful of foods. This is not news. What is news, is that with the right treatment, and a willingness to change, food aversion is treatable. The keys are the right treatment, and a willingness to change.

What is sensory food aversion?

For billions of people, eating is enjoyable and comes naturally. For the rest, eating is a chore. One research study suggests 35% of Americans consider themselves picky eaters. In order to provide the “right treatment” it is first important to understand what is going on. To accurately diagnose a sensory food aversion, it is helpful to rule out what it isn’t.

food aversion causes

When it comes to Sensory food aversions to certain food textures or types of foods, it’s important to rule out medical issues.

As scary and difficult medical issues feel, apart from eating disorders, they are much easier to treat than sensory based food aversion. It is akin to prescribing glasses to the visually impaired, rather than enduring months of vision therapy.

Reflux – this condition can cause pain or discomfort minutes or hours after eating. A person may associate this discomfort with a particular food, and avoid it later
Vomiting – if you have ever vomited after eating a certain food, you understand this one. Even if it was not the food’s fault, the negative association with the last food consumed can last a long time
Tonsillitis – enlarged tonsils can make it feel like the food is getting stuck in the throat, or cause pain/pressure as it passes
Eating disorder – ARFID is the term being used for food avoidance. Avoidance Restrictive Food Intake Disorder is what is often diagnosed instead of picky eating. Anorexia and Bulimia are common eating disorders where the brain isn’t communicating well with the body. There are mixed messages being sent about body size, the effect of food on the body, or a projected self-image.

food aversion psychology

Take into account Social/Emotional Challenges when it comes to sensory food preferences and aversions.

While these social and emotional challenges are not easy to overcome, they are more straightforward to understand than sensory based eating challenges.

Memories – while some people associate foods with great memories, others associate it with negative experiences. Perhaps this food memory is associated with a medical issue, a food that did not taste right, or a negative eating experience.
Social – eating tends to be a very social event. Eating with friends, eating in front of others, or cooking/serving family and friends. Those with an eating disorder or social anxiety, do not like people to see them eat for a variety of reasons. They may not like watching others eat either.
Feeling trapped – once that first bite is in the mouth, there is no going back. Taking an unknown bite often feels like jumping head first into an icy pool. The risk involved in taking just one bite may be too overwhelming. Better to stick with the safe crackers instead.
Emotions – not being able to eat what others are enjoying can be embarrassing. It can provoke anxiety, mistrust, frustration, anger, disappointment, or shame. Are these feelings worse when a person avoids the food, or tries and does not like it?
Risk avoidance – Is it better to play it safe, or jump into that icy water? Some people are born risk takers, ready to take a leap, while others prefer to take it slow and just dip one toe in first. Eating something unfamiliar feels risky.

It might be Sensory Sensitivity.

Sensory information is bits of data taken in by the sensory receptors. When the information comes in correctly, data is processed, leading to a satisfactory outcome. When the sensory receptors do not transmit accurate information, trouble ensues. To the avoider, input can be too noisy, sticky, wet, bumpy, dizzying, heavy, painful, itchy, and 100 other complaints. The seeker, on the other hand, can not get enough input. Things are not loud enough, rough, spicy, hot, cold, exciting, stimulating, sticky, or 100 other needs. The learner who is sensitive may experience the following when it comes to eating:

Tactile sensitivity – the mouth has tons of sensory receptors. The sensory receptors send messages to the brain to process the information. For some, the messages come in LOUD. This food is too sticky, crumbly, soft, gritty, lumpy, dry, or slimy. Touch is not limited to the mouth. The feel of food on the hands can be overwhelming also.
Taste sensitivity – there are many different types of taste buds. Young children have more taste buds than their adult counterparts. People lose taste buds as they age, possibly making foods more tolerable in adulthood. There are taste buds to register sour, spicy, and sweet. Those taste receptors may be sending messages that register as too sweet, sour, spicy, tangy, salty, bitter, spoiled, or just different.
Olfactory (smell) sensitivity – Do you know someone who gags at certain smells? Like the other senses, the receptors in the nose are sending mixed messages. For a foodie, the smell of food cooking is wonderfully intoxicating. The avoider finds it toxic. Smells may trigger bad memories, signal the brain that it is time to eat, or set off alarm bells. There are some places where food smells seem worse, such as enclosed spaces, (airplanes, offices, cars) or overwhelming places (restaurants, grocery stores, the food court).
Auditory – Yes, the sound of food can be a trigger. It could be the sound of food cooking, or worse, the sounds involved in eating food. Misophonia is a condition of auditory sensitivity that causes rage outbursts, often associated with the sound of people chewing.
Visual – How the food appears can be a trigger for many. It might look “weird or gross” to a picky kid. Just the sight of some foods is enough to turn people off of eating. How easy would it be to eat something that resembled cat food to you? Watching other people eat is not easy. Some people have terrible eating habits. To someone sensitive, this can easily be another big trigger.

The seeker craves input, and can not get enough. Food can be similarly frustrating as it is to the avoider, as the seeker constantly needs something to feel satisfied.

Tactile: may play with food, put their fingers in their mouth, eat non food objects, constantly crave food, like cooking with their hands
Auditory: these folks love sounds. They like it LOUD. They also do not notice sounds around them. They are not bothered by their own chewing or gulping, or the noises of those around them
Taste: they like it spicy! The hotter the better. They like cooking with different tastes and experimenting with foods. These learners like extremes when it comes to foods. Sour, spicy, hot, icy cold, bitter, mixed tastes, or unusual combinations
Visual: the visual seeker loves to surround themselves with input. They are not bothered by bright lights, messes, or visual chaos. They gravitate toward food presentation, watching cooking shows, or simply shopping for food.
Smell: seekers in the smell department love the odor of food cooking. Walking by a bakery is like heaven to them. They tend to smell everything. Often these smell seekers are unaware of smells around them because it does not register. They may not notice someone with lots of perfume, a burning smell, or a dirty diaper.

Treatment for sensory food aversion

The first stage of treatment is understanding what is going on.

Help your learner vocalize what they are experiencing. This may feel like a new language for them, so it can take a lot of practice
Teach your learner to explore with words, rather than emotions or behavior
Ask questions. What does the food taste like? Is it bitter, sour, spicy, sweet? How does it make you feel? Are you anxious, frustrated, depressed, angry, or just apathetic about food? What does the food feel like in your mouth? How does it smell? Try to expand vocabulary beyond “yucky” or “gross”. What can you hear while we are eating? Try and ask questions to cover all of the senses
Present different sensory strategies and input to help your learner understand what is happening and begin to adjust to sensory input.
The book, (Amazon affiliate link) Seeing your Home and Community with Sensory Eyes, is set up in this format to help you understand the how and why these sensory challenges happen, and what to do about it

The next stage of treatment is balancing the sensory system

For the seeker, balance may look like adding more of the right input to satisfy the sensory systems. The avoider will need a dose of systematic desensitization to get the system used to receiving and cataloging sensory input.

Systematic desensitization is a long fancy word for teaching your learner to slowly get used to something. The Sensory Oral Sequential SOS method of eating involves slowly desensitizing the brain/body to a new food. It starts with being in the same room as the food, and 27 steps later the food is swallowed.
Making small changes to foods, having your learner engage with food, giving them control over food choices is a good start.
Tactile – work in and around the hands and mouth. Provide safe choices for touching with the hands such as dry rice, dry beans, sand, play dough, birdseed, shaving cream, or slime. Start with dry textures, moving toward wet and sticky. “Safe choices” refers to something that is not threatening. Playing in birdseed is not threatening to your learner because they know they are not expected to eat it. When comfortable, you can move your learner to engaging with actual food such as whipped cream, pudding, fruits, or a bowl of dry cereal. Decrease tactile sensitivity in the mouth. Use a vibrating toothbrush, an icy washcloth, Twizzlers left out to harden overnight, sour spray, or popsicles to get the mouth used to different temperatures and textures.
Auditory – practice listening to different types of sounds and music. There are videos of people eating and chewing to desensitize your learner. These are difficult to listen to, so wade in slowly. As an alternative, provide noise canceling headphones for a while to help your learner tune out sounds.
Visual – check out videos of people eating, food preparation, presentation of foods, cooking channel, kids cooking shows. The idea is to desensitize the learner to reduce triggers.
Olfactory – work on smell aversion by providing more smells to balance the sensory system in the nose. These can start out pleasant like lemon or peppermint. Open the spice cabinet for sniffing. See if your learner can identify items by their smell. Coffee beans are great to have around as they cancel out smells in the nasal passageways. Once someone is triggered, have them smell the beans to reset their system.
Taste – practice tasting and identifying. Make a conscious effort to teach your learner to describe the food. Try very different tastes. Some people love spicy foods, others can’t get enough of sour (try Warheads sour spray, or lemon juice). Different dipping sauces can help. Ketchup seems to help immensely. Other dippers could be honey, ranch dressing, mustard, sugar, salt, peanut butter, butter, barbeque sauce, honey mustard, etc. Many picky eaters do not like spices or anything extra at all. Be mindful of this. If this is the case, serve very plain foods for a while. Mixed textures are more difficult to tolerate as they have several different tastes in one. The temperature of food can have different effects. Some picky eaters like everything at room temperature. Not too hot or cold for these folks.

Other strategies to treat sensory food aversion:

Keep a food log of what foods are consumed, how they are tolerated, and the response to input. The food log may show similarities and patterns.
Try and work through unusual eating habits such as no food touching, eating all of one food before the others, needing a certain cup/plate/bowl, not being able to pick up finger foods, or refusing to go places that serve food. While these are not life threatening, they are noticeable and can be changed to be more socially acceptable.
Have one meal a day reserved for feeding therapy. The other two meals can be as the learner likes it. This alleviates some pressure for the learner and their family.
Put foods on the plate and announce they are just there for show. You don’t expect them to be eaten. Sometimes taking the pressure off of trying allows learners the freedom to try
Serve small portions so that sensory receptors are not overwhelmed with too much visual, auditory, or olfactory input.
If your learner is sensitive in many sensory categories, it might be wise to limit stimuli in one or more areas while working on another. Some examples would include; noise canceling headphones, having your learner eat without an audience, limiting overwhelming smells, providing utensils and non finger foods.
Take a food vacation sometimes. Once in a while it is ok to just leave this condition at home. Pack a sandwich if you are going somewhere that offers no favored foods. Let your kid survive on bread rolls for a week on vacation. This is hard to do, but worth it in the long run. Just don’t make it part of the norm to avoid food tasting.

For the non “foodie” this condition is exhausting. It feels like mealtime comes around 18 times a day. One meal is finished, and it is time to start working on the next. Enjoyable events like birthday parties and family gatherings evoke anxiety because of the food being served, rather than feelings of happiness. Start by understanding what is happening, talking about it, then finding the right treatment for the learner with sensory food aversion.

Regina Parsons-Allen is a school-based certified occupational therapy assistant. She has a pediatrics practice area of emphasis from the NBCOT. She graduated from the OTA program at Caldwell Community College and Technical Institute in Hudson, North Carolina with an A.A.S degree in occupational therapy assistant. She has been practicing occupational therapy in the same school district for 20 years. She loves her children, husband, OT, working with children and teaching Sunday school. She is passionate about engaging, empowering, and enabling children to reach their maximum potential in ALL of their occupations as well assuring them that God loves them!

Note: while this post refers to children, people of all ages and stages suffer from sensory food issues. Many of this information pertains to any age, and can be used for different age groups.

DIR Floortime and Floor Play

February 23, 2023August 24, 2022 by Victoria Wood OTR/L

Have you heard of DIR Floortime as a tool for helping children thrive and achieve their greatest potential? Occupational therapy professionals often use Floortime, or the DIRFloortime (or Floortime for short) as one of the tools in their therapy toolbelt. The fact is that floor play for infants, babies, and toddlers is so effective in many aspects of play, but we wanted to cover a bit more about the Floortime approach to development and learning.

In this post we will explore the various types of floor play, including DIR Floortime, for children of all ages, as well as explain why playing on the floor with your child is important. Play age and stage of development guides DIR floortime as well as floor play in a general sense.

What is Floor Play?

First, let’s cover what we mean by floor play. In this blog post, what we mean by floor play is just that: play on the floor!

Children will play just about anywhere – most are skilled at making any landscape their personal playground. The most commonly accessible playground, however, is the floor! So much play and movement can happen on the floor, which makes it a perfect location for developmental milestones to occur in little ones. Older children continue to be drawn to the floor as they sit down to play with trucks, dolls, and build forts.

When babies and infants are on the floor, they can develop and learn during tummy time, but also while on a play mat in a variety of positions.

Older babies strengthen their bodies and learn how their movements are in their own control while playing on the floor. They learn about the world around them this way. They gain motor skills and begin to engage with toys through play on the floor.

Toddlers develop social emotional skills, refined motor skills, strength, coordination, and eye-hand coordination skills through floor play.

Older children build more strength, endurance, postural control, social emotional skills, confidence, self-regulation, and executive functioning skills through floor play.

There are so many benefits to getting down on the ground with your child an engaging in floor play, no matter the age!

Related, this article on parallel play describes additional information on play at different ages and stages.

Floor Play For Babies

Why should I put my baby on the floor? Isn’t it dirty? How do I keep them safe down there?

Check out this post on Floor Play for Babies for a specific floor play idea for young children.

For young children, movement may be reduced as a result of placing babies in “containers” or seats. This limited movement opportunity can impact typical development and reflex integration.

Floor Play Activities

Isn’t it dirty? Some floors are dirty. Some houses have dirt floors. Never take for granted that your patient has a great/clean environment to play on the floor. Provide a washable tablecloth, sheet, blanket, or large mattresses on the floor to encourage movement.

In fact, playing on the floor with our children is so important that a model was born from it, called DIR Floortime.

What is DIR Floortime?

DIR Floortime stands for Developmental, Individual-Differences, and Relationships. It is a model used primarily to guide caregivers of children with Autism Spectrum Disorder (ASD). As you can imagine, this model guides parents to use the most important place for child-led play,…the floor!

The DIR Floortime model emphasizes the importance of following a child’s lead, joining them on the floor, at their height, playing with them based on their choices.

dir floortime is different than other programs

Many programs for Autistic children are designed to help them change, in order to act more like children without Autism. However, this can be an area of concern. Floortime therapy encourages acceptance and appreciation of who the child is, and highlights that caregivers can best support the child by following their lead.

Through this type of interaction, caregivers can build strong relationships, and improve the social-emotional skills of the child.

DIR Floortime training is a certification process that teaches and promotes an approach to intervention. The training is appropriate and targeted for therapy professionals working in preschool through school-aged students. Through the DIR/Floortime principles, therapy professionals learn and intervene through practice, self-reflection, and mentorship, while meeting the needs of their clients in different environments and settings.

Although DIR Floortime interventions are primarily used as a model to better understand and build relationships between an ASD child and their caregiver, I find it a great model for any child-adult relationship.

Learn more about DIR Floortime principles on their website.

Playing on the floor with your child not only leads to gains in motor development, but as DIR Floortime and various researchers report, playing on the floor is also integral to the development of social and emotional skills! It’s a win-win-win.

floor time Activities by Age:

As your baby ages into a toddler and into a child, they will continue to benefit from playing on the floor with you.

Infants and Babies

Floorplay activities for babies is a good resource to check out when it comes to development and the infant/baby. It’s during the early years that the young baby support development of motor, sensory, and cognitive skills. It’s important to engage with your baby during floor play time, both when laying in tummy time or on their backs or sides.

Babies should be interacted with during floor time play, and not just placed on the floor with some toys or a play mat.

Some activities for this age include playing on the floor and engaging with baby by:

Singing songs
Getting close to baby’s face and making eye contact
Baby massage
Rubbing baby’s back while humming or singing

During the vast stages of baby development, floor play is about engaging with your little one. Tummy time can still be a challenge for this age, but keep going! This is a great age to engage with eye contact, physical contact while supporting emotional development and continued motor and cognitive skills.

Spend a lot of time talking to baby during floor play. Use different tones of voice, and make sounds with your mouth and tongue when talking and playing to baby. This is a great way to develop auditory processing skills, too.

Floor play during the first year can include (among many other play ideas) a means for motor skill development too:

Play mats
Toys scattered on the floor to encourage reaching, rolling, and sitting
Sing and speak nursery rhymes and gently move baby’s arms and legs during floor play
Supporting baby on lap and reading books, talking, and interacting/engaging with baby
Mirror play

For older children: toddlers, preschoolers, and older kids, floortime is a fantastic way to support development through engaging with the little one in a respectful and playful way. Floorplay is fun! It’s a joyful way to support a young child’s development.

When it comes to specific activities and play ideas, the most important thing to remember is to make the play time meaningful. This looks like themes or activities that align with the individual’s interests.

Consider the following when coming up with floor time activities:

Favorite topics
Favorite characters (from TV, movies, books, games, videos, etc.)
Favorite colors
Preferred activities
Sports
Seasonal activities

While floortime can cover any topic or theme, the most important piece is getting down on the floor with the child and playing! Let the play be guided by the child and

the best part of floor play

The best part of floor play, is how easy and inexpensive it is to support your child by playing on the floor with them. You don’t need the “best” toys or even any traditional toys at all. Your body, voice, household objects (blankets, paper, remote control, books), creativity, and a positive attitude will go for miles.

For even more ideas of how to play with your infant or child on the floor, check out this great post for toddler play ideas.

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

June 19, 2023August 15, 2022 by Victoria Wood OTR/L

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.

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.

Change is hard, and some stakeholders might question a change to the way occupational therapy services are delivered in school, especially if it’s always been done a certain way. We can rely on evidence, but what does it say about push in services in the school environment?

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:

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.
Provide modeling for staff. Advocate to administrators it is critical for staff involved to observe you working with a student on their occupations.
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.
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.
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.

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

Visual Noise and Learning

August 8, 2022August 5, 2022 by Victoria Wood OTR/L

In this post you will be discovering how to create a calm classroom, specifically tips to avoid the visual noise that distracts learning in the school environment. Classroom décor and organization can directly effect the engagement level of children in any classroom or learning space. When the environment is too visually stimulating, a student’s ability to focus becomes difficult. Keeping children’s attention can become frustrating. When a classroom environment that is soothing and organized is created, children are better able to stay engaged. In this blog, you will learn about the three different ways to make your classroom visually calm.

What is Visual Noise?

When working with children, teachers think about all of the colors of the rainbow, and want to make classrooms bright and cheery. So many classroom theme sets have fun colors, bright designs, and patterns, contrasting bulletin board boarders, etc. Many believe that having a colorful classroom will keep children interested and engaged.

Visual Noise is just that: a visually distracting, or “noisy” visual scene in the classroom. A lot of teachers set up bulletin boards throughout the room with cut-outs in various themes: animal/monster/any theme , alphabet stickers, and painted murals on the walls. Maybe your classroom has a circle time rug that includes the ten different color squares. Perhaps you want to make sure all the children have something they like to do, so you have 20 fine motor choices in the manipulative area.

There is just one problem with using these types of visuals in the classroom, they are distracting!

The bulletin boards all around the room are adorable, and fun to look at. So during circle time, you might find a child gazing at the wall, figuring out what new item is there.
When there are rugs filled with colors, you may notice children looking down at the rug, maybe at the bright colors, while singing the color song in their head.
If teachers provide too many choices in one area of the classroom, children work with one toy for three minutes, then they are onto the next, without honing in, or practicing the skills that were intended.
For young children, and lots of adults, less is more!

visual processing

Humans use vision from birth, to engage with the world around them. The way your brain process what you see, impacts how you interpret your interactions with the environment, and the people around you. To learn more about vision, this amazing PDF discusses visual hypersensitivity and under-sensitivity (or sensory seeking).

There are some visual processing red flags that may indicate difficulties with visual processing or ocular motor control:

Increased sensitivity to light
Easily distracted by visual stimuli, or difficulty sustaining visual attention to an activity
Frequently squints, rubs eyes, or gets a headache after visually demanding tasks such as reading, using a phone/tablet/computer, or watching television
Loses place in reading or writing
Trouble finding things they are looking for, even when they seem to be “right in front of them”
Distractions with reading
Difficulty tracking visual information
Difficulty initiating or holding eye contact
Difficulty focusing on one piece of visual information
Increased fear of, or desire for, being in the dark
Difficulty discriminating between similar shapes, letters, or pictures
Letter reversals or number reversals
Difficulties with handwriting such as letter reversals, sizing, spacing, or alignment of letters
Frequently loses their place while reading or copying
Often bumps into things
May be slow or hesitant with stairs
Difficulty with visually stimulating activities, i.e., puzzles, locating objects in pictures, completing mazes, word searches or dot-to-dots
Trouble knowing left from right or writing with both hands

How to reduce visual noise when planning your classroom

When planning out your classroom, visual stimulation is important, however there are many ways to make sure there is reduced visual noise, so the environment is not overwhelming.

Think about how you feel when you go to the spa. Those deep earthy wall colors calm your bodies and nerves instantly! The Montessori and Reggio Emilia educational philosophies advise visual components as a way to keep their classroom calm and focused.

The Reggio Emilia philosophy recognizes the environment as the child’s third teacher. What is in a child’s environment, how it’s organized, and what it looks like, directly impacts what a child will learn that day.

two ways to make sure your environment is visually calming

Colors – When picking out colors for your classroom, whether it be for the furniture, rugs, or wall decor, the best way to support a calm visual classroom, is to choose more natural colors. These include blues, greens and browns.

Choose toy baskets, or white bins, as opposed to brightly colored ones.
Consider turning toy shelves around or covering with neutral fabric to further reduce visual noise.
Choose predictable carpet rugs (Amazon affiliate link) like this one, instead of random colorful squares. Carpet samples of neutral colors are an excellent idea to create boundaries while limiting visual distraction.
When decorating your walls, allow for empty blank space, and use more of children’s artwork. Consider the use of cloth and fabric.

Classroom Organization – When choosing how many activities and materials to place in each are of your classroom, keep in mind that less is more! When children have too many options to choose from, this can create a short attention span, and overwhelm from choice overload.

Organization in the classroom can mean stacks of papers, tons of sticky notes, messy desks, and disorganized files, too.

In a typical preschool classroom, there are 8 areas of learning: art, fine motor, science, reading, dramatic play, block, large motor and snack! When you use furniture to visually create specific spaces for each center, the classroom is organized, and children know what is expected of them in each area.

Older classrooms may not have the toys, block areas, and motor components, but there are designated areas: group areas, centers, desks, cubbies, or lockers, teacher areas, information centers, etc. All of these areas can be considered when it comes to visual input.

This blog from Lovely Connection, on preschool classroom set up, includes important aspects to think about as you plan your classroom layout. She includes information about including noise, popularity, supervision, boundaries, space, and the race track (when kids run around the room in a circular pattern!)

What happens when children are still overwhelmed, even when the environments are visually calming?

When a child feels overwhelmed for any reason, having a calm down corner, that is easily accessible and they can stay in as long as they need, is a must have. My “Soothing Sammy Emotions Program.” is an effective calm down area because students are excited to spend time with the adorable golden retriever Sammy. Not only does “The Sammy Program” teach children how to calm down, it guides them through communication and problem solving situations in a visual way that isn’t overwhelming.

Check out this great blog about visual processing and visual efficiency from the OT Toolbox archives. When a child has visual processing difficulties, they have a harder time taking in visual information, and processing it in order to make sense of it.

This visual processing bundle, also available in the Toolbox, can support children who are demonstrating visual processing challenges.

The Sensory Lifestyle Handbook (also available on Amazon) written by Colleen Beck of the OT Toolbox, is a great resource to start understanding sensory processing disorders.

A final note about visual noise

Visual noise doesn’t only occur indoors, it can happen outdoors, especially if there is a lot of activity and sunlight. Being mindful of the visual stimuli outdoors, is just as important as setting up an indoor classroom.

If you have a child who is having a hard time visually processing their environment outside, these visual sensory activities can be completed outdoors to support their sensory system.

While considering visual sensory overload in the classroom, also be sure to check out our resource on auditory sensitivities in the classroom. Both are very useful in setting up an inclusive classroom environment for success.

Classroom themes are adorable and cute! When planning your classroom, keep in mind how “busy” and overstimulating different colors and amount of objects can be. This will help keep your students calm and engaged. Although everyone processes their environment differently, anyone can all benefit from a more calming environment, especially when learning new skills!

Jeana Kinne is a veteran preschool teacher and director. She has over 20 years of experience in the Early Childhood Education field. Her Bachelors Degree is in Child Development and her Masters Degree is in Early Childhood Education. She has spent over 10 years as a coach, working with Parents and Preschool Teachers, and another 10 years working with infants and toddlers with special needs. She is also the author of the “Sammy the Golden Dog” series, teaching children important skills through play.

Life Skills – Cooking Activities

April 12, 2024July 25, 2022 by Victoria Wood OTR/L

Life skills-cooking does not mean learning to make gourmet meals. It means meal preparation to survive. No teenager should go off to college without the means to cook Ramen, macaroni and cheese, cereal, and a peanut butter and jelly sandwich. Add pizza and Taco Bell to their meal plan, and voila, a complete teenage diet! Life skills tasks like cooking is an essential Instrumental Activity of Daily Living that occupational therapy professionals address.

The goal for any caregiver should be to help their child be independent enough to live alone, or at least care for themselves.

Learning independence and life skills, starts at a very young age. Toddlers learn how to dress themselves, basic hygiene, and where to put their belongings. As they become school aged, children need to learn higher level life skills such as laundry, cleaning, grooming, and cooking.

For some kids that struggle with manipulating utensils as a result of fine motor, visual motor, or cognitive skills, these cooking activities can support development. This is especially true with learning to hold a fork and spoon as well as using utensils to self-feed and cut with a knife and fork, safely.

Life skills cooking checklist, recipes, and tips

Life skills Cooking activities

Life Skills Cooking activities not only teach important meal preparation, they address a wide variety of areas.

We’ve covered a bit about the benefits of cooking in previous blog posts:

And, these areas are just the beginning. Some other important areas of development that occurs through cooking tasks include:

Measuring items involves math, computation, dexterity
Reading a recipe – scanning, reading, decoding, processing language
Following directions including sequencing, working memory, problem solving
Fine motor skills are needed to use utensils, cut with a knife, stir, scrape with a spatula, use tongs, crack eggs, spread an item, or scoop food
Bilateral coordination – pouring from a container, holding an item while cutting with the other hand, holding a pan steady while stirring or flipping objects, opening containers, putting items together
Attention to details, timing, frustration tolerance, organization

The OT Toolbox has an informative post on teaching Following Directions using Cooking

The amount of skills addressed during cooking activities is a great incentive to use them in your treatment sessions, while working with learners of all levels. While it is not essential for all of your learners to be able to bake a cake, look at all the skills it addresses!

Sometimes I ask myself why I am teaching a learner to bake a cake, when it is not a basic necessity. Then I am reminded of the core skills it teaches to be able to move onto higher level cooking activities.

A learner who can not follow a basic recipe on a box, will struggle to read from a cookbook. Someone who can not mix two to three ingredients, will struggle to work with seven in a salad.

The OT Toolbox has a great collection of resources called, Cooking with Kids. It is full of recipes and cooking ideas.

It’s great when you find recipes that have different steps that can be offered to kids when helping in the kitchen. For example, our Greek turkey burger recipe has different steps that can be offered to target specific skills: chopping, slicing, stirring, mixing, scooping, grilling.

Life Skills Cooking ideas

Use these ideas as cooking tasks for learners to start off with. The cooking tasks listed below are great beginner cooking tasks to support development.

Cake from a mix- easy to follow directions with minimal ingredients. Tasty results!
Muffin mix- Martha White and Jiffy Mix often just call for milk and possibly an egg
Macaroni and cheese- this works on a plethora of skills as mentioned above, it is yummy, and a staple for children and young adults. Add some meat and a vegetable, and your learner can have an entire meal
Cookies- start with the ones that are pre formed, or slice and bake
Ramen Soup- what could be simpler than heating noodles and water on the stove or microwave? Again, easy to learn, low cost, filling, delicious, and can be served plain, or with add-ins such as meat or veggies
Pancakes and waffles are a great staple that work on many skills, using limited ingredients. You can use a mix to grade down the activity or use a homemade pancake recipe to offer more opportunities for measurement and pouring.
Sandwich preparation– Sandwiches are a great basic item that involves problem solving, sequencing, following directions, and fine motor skills. This is a safe option for learners to make on their own, as they do not have to use a heating element, and can spread items with the back of a spoon instead of a knife for added safety.
Frozen dinners- early or lower level learners may need to spend time working on making frozen dinners using the microwave. While this seems like a simple task, it still involves several steps, including problem solving and judgment.
Rainbow Smoothie- This is a great way to add different fruits as nutrition but also a way to practice slicing bananas, chopping different textures, pouring liquid, managing buttons on a blender, and using safety strategies: blender buttons, placing the lid, using a knife, reaching into a blender, plugging in a kitchen utensil, washing dishes, etc.

Beyond the Basic Cooking Activities

Once your learner has mastered a few basic skills, it might be important or relevant to teach these next level skills. If your learner is not likely to ever need these skills, you can continue to work on mastery of basic food items.

Cooking vegetables like potatoes, carrots, broccoli
Grilling meat, either on an actual grill or countertop grill. The George Foreman grill is relatively easy to use
Using a crock pot to make a soup or stew
Baked goods: making cookies or muffins from scratch
Cooking meals that involve more than one pan. Learning to time spaghetti and sauce, or meat and vegetables

Sensory Based life skills Cooking Activities

Cooking is a great way to engage sensory seekers and avoiders. It is helpful to work with picky eaters on cooking, as well as those with tactile sensitivity. Making food can be motivating. as your learner may be more excited to try something they have created.

Pizza – mixing, kneading, rolling, pounding, stretching the dough. Touching the toppings adds different sensory components
Pretzels – similar to pizza, learners have fun creating pretzel shapes
Cut out cookies – rolling, cutting, sprinkling, and tasting
Meatballs – mixing, rolling the meat into balls
Salad – handling different items, cutting, sorting, and preparing
Lasagna – while this might not be a young learner’s favorite, it is a messy task that involves several textures

Tips and Strategies for teaching Life Skills cooking

These tips are helpful for all learning, not just cooking.

Break the tasks down into smaller chunks to make them more manageable. The learner may not be able to do all the cooking, but can probably stir items in a bowl or pour ingredients
Choose times for learning when there is not a rush. Learners cannot work under pressure
Set realistic expectations. Your two year old might not be able to make a sandwich independently. That’s ok, they can help find the ingredients
Accept mediocracy. Learn to accept food might not look or taste the best.
Before starting, think about any sensory/motor/logistical components of the task and problem solve through them
Backward or forward chain. Backward chain would be to do all of the work for your learner, then have them come in and finish the final step. This offers a sense of accomplishment. Forward chaining is having your learner do the first step, just before they become overwhelmed, you finish for them. This gives confidence that they can do some of the tasks, if not all
There are many steps for a learner to remember during any life skills task
Minimize distractions and sensory input prior to starting
Stay calm and do not add more pressure
Let your learner do for themselves, only intervene when they start to get upset. Do not rush to fix everything so quickly. They will not learn that there is a problem if you constantly fix the errors before they notice the problem
Give the learner opportunities to be independent, even at a small task

If your learner has sensory related concerns, the OT Toolbox has a great resource called the Sensory Lifestyle Handbook, with checklists and strategies to weave sensory activities into your learner’s day

Life skills checklist

Cooking skills can be developed from a very young age. These cooking tasks listed below promote cognitive development, direction-following, decision making, motor skill work, and many other areas.

Important things to note:

We’ve separated these tasks into ages, but this is a generalized list of ages. Some kids will not accomplish the tasks listed below, and that’s ok! It’s a way to know where and when to work on age-appropriate cooking activities with kids.

This list is also not necessarily guided by age. While ages are listed below, the cooking tasks can be viewed as a sequential progression based on cognitive skills needed, safety considerations, executive functioning development, etc. Look at the list as a guide to progress toward life skills achievement in the area of cooking skills.

When you view the cooking life skills checklist below in that way, it can be used to support life skills development for any age, including teens, adults working toward more independence with cooking abilities.

Toddler Cooking Skills

Generally these tasks can be accomplished from 1-2 years of age, during the toddler years.

Help rinse fruit and veggies
Pour with assistance
Tear lettuce and other leafy foods
Stir with assistance
Brush butter or olive oil on foods
Retrieve and sort ingredients in the kitchen
Sort ingredients
Turn pages in recipe book
Obtain utensils when setting the table
Help identify items in the grocery store
Help wipe up safe spills
Drain small canned foods with drainer
Sprinkle seasonings or cheeses
Dipping food items into sauces, oils, etc.
Learn essential safety rules in kitchen
Open/close cabinet doors and drawers

More specifically, some cooking skills broken down by age include:

2 Years

Stack cups
Place utensils into a basket or caddy (not sorted)
Wipe up spills with direction and support
Bring dinner plate to sink
Passive participation in cooking (playing in the kitchen while an adult is cooking)
Pretend play cooking with toys, kitchen toy set, etc.

Preschool Cooking Skills

During the preschool years, young children are developing more motor skills, behavioral and emotional regulation, and cognitive processes. These relate to less support with some of the previous tasks, as well as more independence with others.

Some ways your preschooler can help in the kitchen:

Rinse fruit and veggies
Pour liquids and dry ingredients with assistance
Tear lettuce and other leafy foods
Stir with assistance
Brush butter or olive oil on foods
Retrieve and sort ingredients in the kitchen
Sort ingredients
Obtain utensils when setting the table
Help identify items in the grocery store
Find recipe in recipe book
Help wipe up safe spills
Drain small canned foods with drainer
Sprinkle seasonings or cheeses
Dipping food items into sauces, oils, etc.
Learn essential safety rules in kitchen

Broken down into age group, try using these cooking tasks to develop skills:

3 YEars

Sort utensils into a caddy
Help set the table, using support and visual/verbal cues
Wash hands before a meal
Help clear the table
Pretend play to feed and cook for baby dolls or toys

4 Years

Set the table
Dry dishes (non-breakable)
Pour water from a pitcher into cups (not filled completely) with spilling
Help with cooking with one step directions: gathering ingredients, pouring, mixing, kneading, stirring at a counter
Cut dough with cookie cutters

5 Years

Help to make snacks
Scoop dry ingredients
Open containers with assistance
Slice bananas or other soft fruits

Elementary Cooking Skills

As children gain more precision and dexterity, as well as ability to read and write, they gain more independence in cooking tasks. These activities can be a great help around the home as the child aged 6-8 helps out in the kitchen.

Cut and dice fruits and vegetables
Use the toaster
Crack eggs with some shells
Preheat the oven
Use a can opener
Use a peeler and corer for potatoes and apples
Spoon and place food items into pans or trays
Begin to stir food on stovetop with supervision
Help make the grocery list
Clean up simple to moderate spills
Transfer food bowls and plates to table
Help make a grocery list and identify food items at the store recognizing cost
Begin to read recipes and follow the steps with guidance
Whisk and if older, use a mixer with guidance
Use the microwave with support
Help load and unload the dishwasher

Broken down by age, these cooking tasks can look like:

6 Years

Empty dishwasher and put away dishes
Pour water, milk, or juice without spilling
Put away groceries
Make a simple snack
Pack a basic lunch
Make sensory play recipes like slime, goop, oobleck, etc.

7 Years

Mix, stir and cut with a dull knife
Pour cereal and milk into a bowl

8 Years

Load the dishwasher
Spread peanut butter on bread
Read and follow a basic recipe
Make a grocery list
Crack an egg

Older Kids Cooking Life Skills

The cooking tasks listed below can be started with older kids. This list is a great place to start for the teen or young adult who hasn’t had much experience in the kitchen. For graduates heading off to college, or the young adult going out on their own, go through this list to ensure life skill development in the kitchen:

9- 12 Years

Make scrambled eggs
Cook hot dogs
Read and understand nutrition labels
Plan a balanced, healthy meal for the family
Write down a recipe
Complete cooking tasks in a certain amount of time
Use a microwave with assistance
Cut, slice, and dice fruits and veggies
Crack eggs without shells
Use a can opener, peeler, grater, whisk, and corer
Drain larger food items
Follow basic recipes
Complete baked good recipes with guidance
Make sandwiches and salads
Use stove top to complete simple frying such as grilled cheese and eggs
Stir and sauté foods on stovetop with supervision
Help plan and develop a grocery list
Clean up advanced spills
Transfer some hot food bowls and plates to table
Help to identify food items at the store recognize cost
Begin to read recipes and follow the steps with guidance
If older, use a mixer with guidance
Use the microwave with guidance
Load and unload the dishwasher

13 Years and older

Slicing raw meats with various knives and utilizing hygiene safety
Chopping ingredients using various knives
Using stove top and oven
More independence with making recipes
Using various kitchen appliances such as mixers, blenders, grills, wok, grater, etc.
Complete operation of dishwasher
Frying foods on stove top
Use a peeler, chopper and corer
Retrieving hot items from stove top and oven with oven mitts
Planning a meal, building a grocery list, and shop with guidance in budget awareness
Clean up significant spills utilizing proper sanitation
Transfer got food bowls to table
Reading and completing multi-step recipes

Here is another great checklist from the Focus on the Family website.

Common Pitfalls with Cooking tasks

There will be roadblocks with unexpected twists and turns along the way. Expect these, and learn to adapt quickly as needed. Here are a few:

What if the timer goes off but the item is not yet ready?
The timer has not gone off yet but the item is clearly burning
Your learner adds too much or little of an ingredient (hopefully they will learn from mistakes or the item will still taste ok)
There are multiple items to attend to at once, and your learner forgets something
The item ends up a complete disaster
You realize there are some serious safety concerns (learner does not understand how hot something is, or how to handle hot objects)

These examples come from my personal experience. I did not think of these variables that ended up happening in my sessions. I had to learn to let go of some control, as long as my learner was safe. There were definitely some mistakes and disasters.

True story: I worked with a sixteen year old for several months. One of her main goals was life skills cooking. She had difficulty with problem solving. I decided to let her make mistakes, so she could learn from them. I figured that a cup of salt instead of sugar, or a cup of oil instead of a quarter cup, would ruin an item enough to teach her to be more careful. It turned out by some miracle, each of these items turned out ok! They tasted fine to her, and she could not tell there was a mistake. That was one of those life lessons for me, to learn to back up and let go of some control.

Cooking Tips

Start early
Practice
Be realistic (your learner may never want to learn to cook more than Ramen, PBJ and Mac&Cheese)
Create room for error and problem solving
Mix things up so your learner can learn to be flexible
Do not be that parent who sends their teenager off to college with zero life skills
Even the lowest level or smallest learner can often help with some part of the task if they can not do it themselves (I work with a boy whose job is to watch the baby and yell when she wakes up)
Cooking with learners can be a fun AND yummy treatment session!
Use a picture story sequence to work on individual tasks of cooking. This is a great strategy for all aspects of cooking life skills!

For the record, my daughters went to college well prepared in the life skills department. The common sense department was clearly lacking (the prefrontal cortex does not develop until mid 20’s). My stepson, on the other hand, has neither life skills, nor common sense. Bless his heart!

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.

NOTE*The term, “learner” is used throughout this post for readability. This information is relevant for students, patients, clients, preschoolers, kids/children of all ages and stages, or whomever could benefit from these resources. The term “they” is used instead of he/she to be inclusive.

Vision Books for Developing Skills

October 17, 2023July 20, 2022 by Victoria Wood OTR/L

Vision books to develop visual processing skills

In this post, I have highlighted references to vision books that can specifically be used in therapy interventions to support the development of visual processing skills. These are the Top 9 Books for addressing vision concerns, that might be incorporated into visual therapy, or occupational therapy activities. Each of these visual skill building books covers aspects of visual perception, visual processing, and visual motor skills.

Start by reading, “Visual Problems or Attention” to help decipher the cause of visual processing difficulties.

After reading Visual Problems or Attention, check out the Visual Screening Packet available on the OT Toolbox to further assist in diagnoses and treatment.

For more information on vision skills, check out this post from the OT Toolbox archives.

Vision Books

Looking for books on vision, visual motor integration and visual perceptual skills? Check out the list of books below that are chock full of information and treatment ideas!

Many of these books have reproducible pages, or can be laminated/placed into plastic sleeves to be reused.

Vision Book: Eyegames

The list of vision books below are linked to Amazon affiliate links for ease of searching, however they can be also found by googling the titles.

An OT and Optometrist Offer Activities to Enhance Vision! (affiliate link) By Lois Hickman and Rebecca Hutchins is an easy and fun vison book with games and exercises for developing visual skills.

This vision book is an easy read about vision deficits, and how they impact function. It has a checklist of red flags to be on the lookout for. There are also loads of great therapy activities to target each skill deficit. Activities are geared for a variety of function levels, along with easy task gradation. Activities are designed to be completed in the home, clinic, or school settings.

Vision Book for Visual Tracking Exercises

Visual Perception, Visual Discrimination & Visual Tracking Exercises for Better Reading, Writing and Focus (affiliate link)

The next set of vision books are created by Bridgette Sharp, and Bridgette O’Neil. These books make for a great set of tools to have in your bag.

The Visual Tracking Exercises Book is a beginner book for developing tracking skills. As a bonus, you can use this with learners who are working on left/right awareness as well. Worksheets are varied with numbers, shapes, patterns, color, and black and white fonts, to help keep things interesting.

Vision Book for Scanning Skills

Advanced Visual Scanning Exercises (affiliate link)

As it says in the title, this visual perception book is for your advanced learners who are continuing to work on strengthening their eye muscles, gearing up for chapter book reading, and increased desk work. Patterns become more complex, and are in black and white only.

It can be helpful to read more on what is visual scanning and check out the red flags section and then use this vision book if needed.

Visual Scanning Exercises for Young Students (affiliate link)

This visual scanning beginner book has a variety of simple grid patterns with large colorful pictures for younger children, beginning learners, pre-readers, and children who are behind in reading readiness due to tracking and scanning issues. The images are large, colorful, and have plenty of variety to keep them engaged in therapy.

Vision Books, Visual Scanning for Students (affiliate link)

This Ready to Scan vision book is for more advanced scanners, or for kids/learners who are skipping lines when reading or copying. It’s a great resource for building endurance and eye muscle strength. As a bonus, use the patterns for reversal training and directionality!

BIG BOOK: Beginners, Intermediate & Advanced Visual Scanning Exercises (affiliate link)

Like it’s title says, this book has something for everyone. This is a great place to start your toolbox for visual skills. Patterns work through a progression, starting with large images, moving onto smaller images. They present a variety of pictures and geometric shapes, both in color and black/white. This book is a great place to create home programs with and homework from each session.

Vision Book for Visual Tracking

Vision books, Visual Tracking Exercises with 100 High Frequency Sight Words (affiliate link)

If you’re looking to change it up from geometric patterns and pictures, this book is a great option. The book consists of a variety of exercises using sight words. Use the pages to work on discrimination and word shape training as well.

Start by reading up on what visual tracking is and then go from there with this vision workbook.

Visual Skills Book for Reversals

Letter reversals are related to vision skills. You’ll want to start by reading more on p and q reversals or b and d reversals. Others who write letters backwards can benefit as well.

The visual skills book, Brain Training for Reversals, is a brain training vision book consists of exercises specifically for reversals of b-d-p-q. Exercises range in complexity to address all skill levels. These brain training worksheets can also be used for scanning, to practice reading, and directionality. You can also use these worksheets similar to an eye spy game, by having the child look for all of one letter.

Visual Discrimination Book

Visual discrimination is a visual skill that impacts reading, writing, math, comprehension, and learning.

The Visual Discrimination book is great for grades 2-8 and focuses on finding patterns and solving problems through the use of colorful geometric patterns and images. This is great for critical thinking skills, along with working on spot the difference (visual disclination) tasks.

Book 9 is a higher level book, so save it for your older, more high functioning learners, or adult learners who are working at this reading level.

Spot the Difference Vision Books

Another great resource are “spot the difference” books! (affiliate link) There are hundreds of spot the difference books to choose from. These books not only address visual discrimination, but can also be used to work on following directions, scanning, item location in a busy environment, and general visual processing skills.

The OT Toolbox is offering a FREE visual perception packet to download and use with your learners.

Visual Closure Book

The Visual Closure Workbook is a 65 page digital file designed to impact visual perceptual skills for reading comprehension and efficiency, and the ability to visualize a complete image or feature when given incomplete or partial information.

Visual closure skills are essential for reading with fluency. It’s necessary for written work to happen without concentrating on each letter’s lines and curves. Visual Closure allows us to comprehend words and letters without actively assessing each line.

Challenges with puzzles, identifying sight words, copying in handwriting, math tasks, and other reading or writing activities require visual closure skills.

This workbook includes:

Information on visual closure and visual processing
Red Flags Indicating a Visual Closure Problem
15 ways to use the workbook and strategies
More Visual Closure Activities (use these tactics to grade the visual closure activities to meet individual needs, challenge, users, and support the development of skills)
Workbook – Level 1
Workbook – Level 2
Workbook – Level 3

This workbook is designed to provide background information on visual closure as a tool for understanding this visual perceptual skill. It’s a guide for advocating for common visual closure difficulties through the included screening tool broken down as “red flags”.

NOTE* The term, “learner” is used throughout this post for readability and inclusion. The previous information is relevant for students, patients, clients, preschoolers, kids/children of all ages and stages, or whomever could benefit from these resources.

Contributor: Kaylee is a pediatric occupational therapist with a bachelors in Health Science from Syracuse University at Utica College, and a Masters in Occupational Therapy from Utica College. Kaylee has been working with children with special needs for 8 years, and practicing occupational therapy for 4 years, primarily in a private clinic, but has home health experience as well. Kaylee has a passion for working with the areas of feeding, visual development, and motor integration.

Types of self control

June 6, 2023July 18, 2022 by Victoria Wood OTR/L

Did you know there are several types of self-control that impact the way we act, behave, speak, and move? These types of control impact how we learn, communicate with others, and function in our daily tasks. There is more to self control than controlling impulses and self-regulation. Understanding these various differences can make a difference in learning how to stop and think, and gain self control in daily occupations.

In this article, we will break down what the components and types of self-control are, and provide you options on how to improve this important skill.

WHAT IS SELF-CONTROL?

Before we can dive into each type of self-control, let’s define it at its basic level.

The definition of self-control is a component of inhibitory control, and refers to the ability to regulate one’s emotions, thoughts, and behavior based on and as a result of external and internal temptations and impulses. Self-control is an executive function and is a cognitive process that is necessary for regulating one’s behavior in order to achieve specific goals.

Break down of Self-control:

An executive function that gives the…
Ability to regulate emotions, thoughts, and behaviors…
With consideration for temptations and impulses…
In order to achieve goals.

3 TYPES OF SELF CONTROL

Although different sources may describe self-control in different ways, most can agree on 3 types of self-control.

Impulse control is one type of self-control

1. Impulse Control

Impulse control requires conscious thought, weighing the pros and cons of potential actions and their outcomes. For young children, this is nearly impossible. As we grow and the areas of the brain associated with executive function (the prefrontal cortex) develop, this ability becomes more accessible.

It is believed that the prefrontal cortex does not develop until age 24-30. Now you understand why teenagers and college students are so impulsive!

Poor Impulse Control –

Impulsivity, or acting before thinking, is caused by a lack of impulse control. In children, this may be seen as over-eating preferred foods, blurting out answers in class, interrupting others, or acting out in aggression.

More about what impulse control is here! Additionally, these impulse control strategies will get you started on addressing this area.

Emotional control is one type of self-control

Emotional Control

Everyone feels varied emotions, regardless of age or status. Adults may want to scream and stomp their feet when something does not go their way, but they are able to stop themselves, as such actions would be inappropriate. In fact, they are most often able to stop inappropriate actions, and choose the appropriate emotional response.

Emotional control is the result of a collaboration in the brain. Emotional intelligence and instincts are formed in the amygdala, then the prefrontal cortex controls what behaviors will exhibited. As with impulse control, young children will need time and education, in order to use their thinking brains to stop and control their emotional behaviors.

Poor Emotional Control –

Tantrums, sudden aggression, screaming, or crying uncontrollably, are all examples of poor emotional control. Usually it is young people who struggle with poor emotional control. Some adults, particularly those with mental health conditions, may also have limited emotional control.

When emotional control is limited, actions may be driven by emotions, not logic. Negative outcomes, that jeopardize health and safety, may ensue.

Motor control is one type of self-control

Movement Control

Movement control, also known in the literature as physical control, is one of the lesser known aspects of self-control. This type of self control is exactly as the name implies; it is the way in which we control the movement of our bodies.

The OT Toolbox covers the impact of poor self-control and resulting behavior, in this resource titled attention and behavior. The blog covers safety issues such as darting into a parking lot, touching a hot stove, and other movement related self-control situations.

Good movement control may be observed when a child sits upright at their desk, quietly, without extraneous movements, clearly ready to learn. Many people in organized sports also have good movement control, as they practice drills, and coordinate their bodies in order to meet a common goal.

Poor Movement Control –

Uncontrolled movement, hyperactivity, accidentally crashing into objects or people, and poor handwriting, may be associated with a lack of movement control. Having some wiggles before recess, then being able to sit still afterwards, does not pose an issue for most. In fact, it is pretty typical to need movement breaks throughout the day.

When a lack of movement control causes a child to be unable to complete schoolwork, be a part of a team in gym class, safety concerns, or safely move about the community or playground, intentionally crashing into others, hitting, biting, etc., it becomes more concerning.

Resources TO IMPROVE SELF-CONTROL

All children should be taught self-control. It is not something that they just inherently “know”. It is a complicated subject, that requires positive adult modeling, education, and of course, practice!

The OT Toolbox has tons of great posts on the types of self control and its impact:

Do you think that self-control should be taught in schools? There is already so much on our educators’ to-do list, but this one may be worth integrating.

Here’s why: Self-control is integral to the ability to learn and apply knowledge, but it is also important to a healthy social life, too!

Types of self-control information handout

Free Handout: Types of Self-Control

Education supports advocacy! The information in this blog has been created into a handy handout, designed for advocacy and education on the types of self-control. These aspects of executive functioning are not always connected as an executive functioning skill, so that’s where this handout comes into the picture.

Want a copy to add to your therapy toolbox? Enter your email address below. You’ll receive a copy in your email inbox.

This resource is also available inside The OT Toolbox Member’s Club. Members can easily access this printable as well as all of the other of free downloads on the site. No need to enter your email address for each one. Simply head to the dashboard page, go to the Educational Handouts toolbox, and print and go!

The Impulse Control Journal…a printable resource for helping kids strategize executive functioning skill development. When saying “calm down” just isn’t enough…

When a child is easily “triggered” and seems to melt down at any sign of loud noises or excitement…

When you need help or a starting point to teach kids self-regulation strategies…

When you are struggling to motivate or redirect a child without causing a meltdown…

When you’re struggling to help kids explore their emotions, develop self-regulation and coping skills, manage and reflect on their emotions, identify their emotions, and more as they grow…

Grab the Impulse Control Journal to build organizational strategies, planning, prioritization, habits, and mindset in kids.

Co-regulation

November 16, 2023July 13, 2022 by Victoria Wood OTR/L

In this blog, you will learn how the environment, and the feelings of those around us, directly affects behavior. You will learn simple ways to support children in calming down, while in our care, through co-regulation. This important skill is part of our emotional intelligence and one that takes fostering and nurturing. Let’s go over what coregulation means, how this skill develops, and how we can support co-regulation through practical strategies.

CoRegulation

The feelings and behavior of people in close proximity to us, directly impact how we feel, and respond to our own emotions. When children become upset, if those areound them stay calm, demonstrating how to calm down, the child can calm down quicker.

How would you feel if your neighbor was yelling at the mailman for stepping on their freshly cut grass? Do you feel annoyed? Can you feel the fear the mail man is feeling?

How would you feel while walking past someone doing yoga in the park? Do you feel calm?

In the same way adults are impacted by others actions, children pick up the moods of others around them. When people around us are behaving a certain way, we can be directly affected, responding both internally and externally.

When witnessing an uncomfortable event such as the confrontation at the mailbox, internally you might feel your heart start to pound, or clench your teeth as nervousness sets in. You might run and hide behind the window curtain to try and separate from yourself from what is making you feel uneasy (while still peeking in horror).

Once separated, you are often able to calm down using strategies to regulate your sensory system. I like to sip water and take breaths of lavender. My husband likes to go for a run and lift weights to decompress. As adults, we have learned how to adapt and overcome these intense feelings through different strategies. Children need support to separate themselves from stressful situations, and regulate their emotions. They are not able to understand the triggers and determine an acceptable calming mechanism.

What is co-regulation?

The definition of co-regulation is– the ability to regulate emotions and behaviors to soothe and manage stressing internal sensory input or external situations, with the support and direction of a connecting individual. Co-regulation is nurturing connection of another individual that supports regulation needs through the use of strategies, tools, and calming techniques in order to self-soothe or respond in times of stress.

Co-regulation and self-regulation are part of the developmental process. In order to move from a co-existing place to a place of independence, the child needs to develop emotional intelligence and social emotional learning. All of this is part of typical development.

Development of co-regulation

Co-regulation is a part of development. Before one can self-regulate, they need to co-regulate.

Co-regulation begins in infancy. Before a young child can self-soothe, they need a parent to help them. When an infant is crying a parent picks them up, holds them close, rocks, and wraps them up in a tight swaddle, and offers a pacifier. All of these strategies are tools to provide correct sensory input that calms and regulates the baby’s system. This is co-regulation; the parent is offering tools and strategies to support the infant’s needs.

As caregivers we play a huge role in helping children calm down. When children are upset or overwhelmed, they look to us for help with regulating their emotions. This article explains how to support co regulation in infants through three year olds. A caregiver needs to project calmness in order to soothe their infant. This is very difficult for an anxious or upset parent.

Co-regulation in toddlers might look similar, but with more input from the child. The toddler prefers to be active and jump, run, roll, or move, rather than be held and cuddled all the time. The caregiver offers toys and activities to get the child moving in the way they enjoy. If the toddler only does these alerting activities, they might run themselves down, and move into a meltdown state. The parent then offers a calming tool such as a cool sip of water, a slow walk, singing a song, a break from the action, or a moment to stop and look at something interesting (also known as mindfulness). All of these are co-regulation strategies for toddlers. The parent offers strategies to the young child, and hopefully, the child accepts them.

As children grow into toddlers, the most successful way to support their feelings is to calmly use words and gestures to redirect them when they are upset. When adults are feeling anxious or upset when trying to redirect the child, children respond with increased adrenaline, becoming more upset and dysregulated.

They match or mirror the energy of their caregivers. When adults stay calm, children can become calm. When children become or stay calm, they are able to listen and problem solve.

Co-regulation in preschoolers can be similar to that of a toddler. As they develop, preschoolers are able to offer more input as to their preferences, interests, and dislikes. For example; the young child can request a certain sippy cup they like. They may not know why they like certain activities or items like the long straw on their favorite cup, or the weight of a plush toy, but they know that it feels good. Similarly, adults often do not understand why they choose to run or listen calming music, they just know it helps. Parents can help young children co-regulate sensory and emotional needs through providing ideas for strategies and activities.

Co-regulation in older children– Preschoolers, kindergarteners, elementary aged children and teens are able to self-regulate using skills taught to them while being supported through co-regulation at a younger age. As children grow, they have more autonomy. They have more ability to move from co-regulation to self-regulation.

The ability to self-regulate occurs through co-regulation with parents, teachers, and older peers. Typically, it’s through the first 7 years of life that children need support to regulate emotions, sensory input, and external stressors. Even after the age of 7, most kids need help!

Self-regulation development continues over time, but the ability to co-regulate begins to move from a supported mechanism, to an individual and independent ability.

Co-regulation Parenting

The above paragraph should help explain what coregulation means in young children, but how can we help support kids with co-regulation, so they can develop these self-soothing skills?

We can focus on co-regulation parenting as a tool and a means to support our children.

Many adults struggle with self-regulation. This is where we see additional problems. When young children need support to co-regulate, sometimes the adults in their lives are not offering the tools and strategies as a support person.

If a parent responds to a young child’s meltdowns or behaviors with emotional outbursts, anger, stress, and anxiety, the young child cannot soothe themselves.

It is important for adults to take a look at stressors, internal anxiety, and emotional state so they can support the young child.

How many times have you witnessed frustrated teachers/parents/caregivers yelling at children?
Does it calm them, or make them afraid and shut down?

This is why it is important for caregivers to step away from a situation where the toddler is “pushing their buttons”. Take a deep breath, get a date night out, go for a run, or some other mechanism of self-regulation. I often said, “Mommy needs a time out.”

self regulation

You have probably heard the term “self-regulation” which refers to the ability to control oneself in any given situation by balancing and calming internal sensory systems within the world around us.

Before young children can self-regulate, they need the support of adults around them to teach and help them develop the abilities to regulate on their own. They need to co-regulate, or co-exist with parents, teachers, and others, who can “show them the ropes” and learn to balance and calm their internal and external systems. Co-regulation comes before self-regulation developmentally.

Neuroscience of Co-regulation

What does co-regulation look like in the brain?

Brains are amazing machines, capable of processing the environment, including the feelings of others. Dr. Caroline Leaf, neuroscientist has stated “As you co-regulate with someone, the mirror neurons in their brain are activated, and this enables the person in the deregulated state to literally ‘mirror’ your calmness,” For long-term benefits and effective results, Johnson recommends practicing co-regulation often. “It will effectively rewire the brain so that over time, things that once were triggering or set off alarms no longer have the same effect and happen less often.”

Wow! The brain can process the feelings of others in milliseconds, directly affecting our our own moods and behaviors. No wonder all of the children in a preschool class feel overwhelmed, as soon as one child becomes dysregulated.

How do you prevent the whole room from becoming overwhelmed, when only one person is stressed? Co-regulation is the first step for a person to learn self-regulation.

According to this research article by Howard Beth, “Neuroscience shows that humans develop their abilities for emotional self-regulation through connections with reliable caregivers who soothe and model in a process called “co-regulation.” … In time, the child internalizes the expectation of a soothing response which provides a foundation for learning self-regulation. “

It is the responsibility of caregivers to support co-regulation, which directly impacts a child’s ability to self soothe as they grow. When children are upset, the most important thing for caregivers to do, is remain calm.

If caregivers become upset or overwhelmed in response to another person’s behaviors or actions, everyone will continue to feel stressed, and the situation will explode.

Co-regulation activities and strategies to help kids with emotional development of cooregulation skills.

How to help kids with co-regulation

My own regulation techniques were put to the test once, when I was teaching at a preschool that backed up to a farm. The children (all 2-5 year olds) were inside eating lunch and I was setting up their nap mats. We had a futon in the classroom for children to relax and read books on.

Out of nowhere, a humongous snake slithered out from under the futon! The initial shock wore off quickly, and my nerves set in. The snake was coming towards me, and I had 24 preschoolers eating lunch only ten feet away! I calmly helped the children walk out the door to the playground with the aide, breathing and saying “It will be okay. No need to worry.”

The kids walked out of the room curious, but not frightened. I raced to the phone and called for help (my voice was much more panicked as I talked to the janitor about the huge snake in the room)! I knew nothing about snakes, and I wasn’t about to get in its’ way. Luckily it ended up being a garter snake, removed quickly by a specialist and relocated, far away from my classroom!

At that moment, I knew that I had to “keep my cool”, so the children wouldn’t become scared. They co-regulated off of my calmness, and were able to safely follow directions and watch the situation unfold from outside.

Children learn new skills through hands-on activities. Regulation skills are learned the same way.

Regulation Strategies:

There are many more self regulation strategies than just the ones listed below. This should give you a good idea for where to start.

Deep Breathing- Deep breathing exercises for kids teaches young children how to calm down through pausing, and taking large breaths. Relaxation breathing is a great strategy for adults and kids to do together. The ones on this site use a fun and engaging strategy that introduces breathing techniques using visuals and imitation. The printables in this resource form the OT Toolbox teach kids all about breath control using fun pictures, arrows, and places to pause, and hold their breath. Print out the free PDFs, show the child the picture and the arrows, and practice deep breaths. When your child becomes upset, immediately start to “breathe like a polar bear”, or “do rainbow breaths” and watch as your preschooler starts to calm down too!

Some of the most commonly used deep breathing tools include on the OT Toolbox include:

Toys and stuffed animals- Using a preferred toy or stuffed animal integrates strategies from DIR Floortime therapy strategies. Kids gain the emotional vocabulary, and strategies to use in co-regulation, through play. I developed the Soothing Sammy (affiliate link) learning system. It is a great tool for co-regulation, because of the picture books and activities included with the emotional regulation toy.

In my book, Soothing Sammy, a golden retriever puppy, teaches children how to calm down using a variety of sensory strategies (such as jumping in place, blowing bubbles, sipping water, singing a song and squeezing a ball or play dough). First, read the Soothing Sammy story, where children visit Sammy in his dog house. He provides them with all of the tools needed to calm down. Once calm, the children are ready to play again. Use the stickers and shipping container to have your own preschoolers create a space for their own calm down items and place Sammy, the plush dog, inside! This is your child’s very own Sammy house to visit, just like the children did in the story. When children are overwhelmed, experiencing big feelings, they are easily redirected to these activities by saying “Sammy Time.” Help children co-regulate by creating your own Sammy House and using items to calm down when they are upset, modeling calm and soothing behaviors.

Go outdoors and co-regulate!

Sometimes all we need is a little bit of fresh air to help feel better. Use these outdoor sensory diet cards to discover calm down strategies to use outside with children. These cards contain outdoor play challenges to get kids moving, experiencing various sensory systems, and receiving calming input from the great outdoors. Included, are over 180 ideas on how to calm the bod through movement. The outdoors is a great place for a sensory diet. In the backyard there is a variety of movement opportunities. A playground is another great space for calming and regulating play. Check out this blog post on sensory input at the playground.

Children, especially toddlers and preschoolers, depend on adults to show them how to calm down or self-regulate.

tools for adults to learn self regulation

Being that co-regulation requires the ability to support another individual with regulation needs, it’s important to address emotional and coping needs as the adult in a parent/child (or other adult/child, peer/peer relationship). As a support person, regulating ones’ own needs can go a long way in modeling appropriate reactions, coping strategies, and following through with regulation needs.

Below are some great tools for adults to learn, or improve self-regulation so they can be models and important roles in the co-regulation relationship include:

Adult Sensory Processing Disorder– Check out this blog post for information on sensory needs in adults
Adult Executive Functioning Needs– There is a very close relationship between regulation and executive function. This blog post supports adults with executive functioning needs.
Wellness Wheel– Balance is essential to regulation. Read this blog post as a starting point to support the needs of a parent, caregiver, and all of the roles one occupies.
Family Wellness– Equally important is the overall wellness and wellbeing of the family.
Physical Exercise and Wellbeing– This is a great resource on the role physical activity has on overall wellbeing. Before helping young children regulate, caregivers need to self-regulate.

If you’ve ever flown on a plane, taken a cruise ship, you’ve heard the safety information: In the event of an emergency, adults should place the breathing mask over their faces before they attend to their child.

Parents should put on their life jacket before they put the life jacket on their children. This seems backwards and selfish, however these life-saving mechanisms are of no use if the adult is struggling.

If they don’t put on their own face mask or life preserver first, there is no chance to support and help the child. The same is true for regulation; parents must first self-regulate in order to help co-regulate their children’s internal and external needs.

Empathy versus Empath

Empathy is being able to understand a person’s feelings, or realize why someone might be angry or sad. It is an important social skill, especially if you are the one causing the upset. Young children do not have the capacity to understand the complexity of empathy.

An empath is a person highly attuned to the feelings and emotions of those around them. Their ability to discern what others are feeling goes beyond empathy (defined simply as the ability to understand the feelings of others) and extends to actually taking those feelings on; feeling what another person is feeling at a deep emotional level.

Try this empathy activity to teach these concepts to children.

According to this article, What we do know is that researchers have discovered what they’ve dubbed “mirror neurons” in the brain which may help us to mirror the emotions of those we come in contact with.¹ And it appears some people may have more mirror neurons than others; suggesting that empaths may exist.

The positives of being an empath are being able to offer support to others, knowing when someone is in need of assistance, and reading a person’s energy to see if they are a good fit for you.

The cons of this “ability” are that it is draining taking on the emotions of others around you, it feels like you are too sensitive, and you feel burdened taking on so much.

Being an empath can be described as feeling like a vacuum cleaner, sucking up the emotions of those around you, often before they realize how upset they are.

Empaths need to be experts at co-regulation because of the amount of sensory and emotional input they are “sucking in”.

A final note on co-regulation

Children aren’t born knowing how to manage their feelings in a positive way. As infants, they depend on their caregivers to soothe. As they grow into toddlers and preschoolers, children continue to depend on caregivers to teach them new strategies to calm down. When they sense how calm their caregiver is, they calm down also.

The best way for caregivers to help children develop their self-regulation skills, is to support them in co-regulation, by showing them calming activities they can learn to use on their own.

To learn more about sensory processing disorder and strategies, check out The Sensory Lifestyle Handbook and this resource on sensory processing disorder chart to understand all aspects of SPD.

Additionally, targeting parent and family education on co-regulation as an intervention strategy is highly effective in meeting self-regulation IEP goals so the individual can function in daily tasks.

*Note: The term caregiver has often been used instead of parent. This is to be inclusive. Caregivers can be parents, older siblings, grandparents, teachers, daycare workers, bus drivers, coaches, and many more.

Another great resource is our blog post on becoming a tech wise family.

Types of Scissors

October 17, 2023July 11, 2022 by Victoria Wood OTR/L

Did you know there are many different types of scissors to support development of scissor skills? It’s true! No matter the motor skill ability, there are different type of scissors that supports that ability or skill development. Cutting skills, like writing, are a foundational fine motor skill. Just as you would spend time selecting the right pen/pencil, makeup, hair accessory, or pair of shoes, it is important to select the correct types of scissors.

Types of scissors and why each different type is used

Why do different types of scissors matter?

What do you look for when selecting that perfect pair of shoes?

Fit
Size
Price
Durability
Reputation, reviews
Quality
Functionality

Believe it or not, the same care can be placed in selecting the correct pair of scissors. This is especially important if your learner has fine motor delays, hand weakness, difficulty with motor planning/coordination, small/large/irregular hands, or a diagnosis impacting their skills.

Here are a few real life examples:

Lula is 4 years old with dwarfism. Her hands are tiny. Her parents would be very unlikely to buy her shoes that fit a grown man. At her school, Lula was provided with regular sized scissors, thus struggling to learn this important skill.
James is 7 and has Down Syndrome. Not only are his hands weak, but they are small. While care is taken to select the right shoes and clothes for him, selecting the right scissors is just as important.
Marcy is 5 year old and has cerebral palsy, limiting her hand and arm movements. She too should have extra consideration in the type of scissors that she uses.

What are the options for types of scissors?

*Disclamer – Many of the following product recommendations are affiliate links from Amazon. This does not mean these are the best, just the easiest to find. If you prefer another vendor, check out the examples below, then type them into your Google search bar.

1. Small Sized scissors

Beginner small-sized scissors- These scissors are all small in size. They are not just for small hands. These are great for learners with all types of fine motor issues, and hand weakness.

These beginner scissors are Amazon affiliate links.

I like these toddler sized scissors because they are very small. They are great for tiny hands, or learners with fine motor weakness.
This learning pack of scissors contains toddler sized scissors, as well as training scissors. See below for more information about training scissors.
Sewing scissors are great because they are tiny, however, they are SHARP! If you are going to use these, either dull the edges with a file, or be extra careful with your learners.
These Benbow Scissors, made by Mary Benbow are the gold standard of training scissors.

2. Training Scissors

Training scissors should be used as a stepping stone to graduating to a higher level type of scissors, once they are mastered. If training scissors are not mastered, your learner can use these indefinitely.

The training scissors listed below are Amazon affiliate links.

Self-opening scissors: many learners are able to pinch their fingers together long before they can open them during cutting at will. The key to motivation is success. While using these scissors, the hands get valuable feedback of this cutting motion. These self opening scissors fit the price and durability category, but they do not fit the functionality definition. These blunt scissors, while inherently safer than sharp scissors, do not cut well, and cause more frustration than progress.
Spring-assist scissors- This pair of self opening scissors or these soft-grip scissors fit the function, and durability categories. They are more expensive, but cut better than safety scissors. They are larger than the toddler scissors, so be sure that size is not a concern first
Double loop scissors – While I do not like that these are labeled “mother and child scissors” (because this is not inclusive), they work well. People learn by doing. Kinesthetic awareness is learning by moving. These double loop scissors give your learner the feedback needed to practice and learn the cutting motion
Trialing two kinds of scissors- This scissor pack has double loop scissors and self opening scissors to trial different kinds of scissors with your learners, or progress forward as they develop skills.

3. Scissors for Special Needs

There are times when traditional scissors do not work and a specific adaptive scissor type is required. If your learner has weakness, a hand injury, tremors, increased/decreased muscle tone, or another long term condition, various scissors for special need areas are a good option.

Scissors in this category include loop scissors, block scissors, tabletop scissors, and electric scissors.

For learners with small hands, or who are developing hand strength, I would recommend self opening scissors first, or using these adaptive scissor types for a very short period of time.

These different types of scissors designed to meet specific needs are Amazon affiliate links.

Loop scissors – These are also described as self-opening scissors. Some learners can not isolate their fingers enough to work traditional scissors, or have a sensory aversion to sticking their fingers into the little holes on the handles of the scissors. These spring open once depressed. They do take a fair amount of strength to grip for a prolonged amount of time, so these may not be the best choice for your learners with low tone or decreased strength (unless of course you are looking for a tool to increase strength).

While these mini loop scissors at 5.5 inches are smaller and take less grip strength, they also do not cut very fast, instead making small snips.
These larger loop scissors at 8 inches are a great choice for stronger hands.
These self opening loop type scissors are popular. They require less dexterity than traditional scissors, but they do not cut very well. Because the mouth of the scissors does not open wide, they do not make large cuts.

Scissors for Limited mobility – For learners missing digits, or with limited grasp, such as amputees or quadruplegic patients, use of just one upper extremity, visual challenges, or other mobility and coordination concerns, these tabletop scissors can be fastened to a table with a clamp or velcro to assist in opening containers. They are not great for intricate cutting, as they are labor intensive and can be frustrating, but more usable for self help skills.

Power option – for learners with limited mobility or fine motor dexterity, electric scissors can be a motivating option for cutting. They take some strength and coordination, but can be helpful for learners who can not use traditional scissors. These types of scissors take some practice to get used to them.

Left handed Scissors

Similar to questions on left-handed writing, teachers and parents are forever inquiring about left handed scissors and how to help with left handed cutting.

What is the left handed scissors difference?

There is definitely a difference between left-handed scissors and right-handed scissors. Right-handed scissors have the right blade positioned on top, whereas left-handed scissors have the left blade positioned on top. This prevents unnecessary bending and tearing of the paper. This difference between left and right handed scissors also allows each user to maintain a clear visual view of the cutting line.

Scissor handles are often molded to accommodate either the left or right hand. When manufacturers claim they have created a pair of ambidextrous scissors, be aware that such a thing does not exist. They have simply created a “neutral” handle accessible for the both left and right hand. The blades are still right-hand oriented. Thus, left-handed users should not be given scissors marketed as being appropriate for both left-handers and right-handers.

True left handed scissors have the cutting blade positioned on the top. Neutral scissors or scissors that can fit both left and right hands may cause additional frustrations.

Read more on the term ambidextrous and what this means for functional tasks such as cutting with scissors.

There are several types of scissors for lefty’s available, but what are the best left handed scissors?

These basic lefty scissors (affiliate link) are ideal. If it wasn’t such a right handed world, I would recommend these to all lefties.

Being a lefty myself, I understand the benefit and fit of left handed scissors. The majority of scissors your learner will encounter will be right handed, so it is better to learn and adapt to traditional scissors. There are only a few left handed items that are necessary (can opener, ice cream scoop, binder, ladle, vegetable peeler.)

Tips for Left handed cutting:

Use sharp scissors – this way the blade has less chance of just bending the paper instead of neatly slicing through it
Don right handed scissors upside down – for some reason putting the thumb in the fingers hole changes the blade position, and makes cutting easier.
Lefties cut CLOCKWISE. Righties cut COUNTERCLOCKWISE. This is important. If your learner cuts in the wrong direction, this leaves them without the ability to hold onto and turn the piece of paper that is being cut. Try it!

time to learn to cut

Now that you have selected the right fit, durability, functionality, and quality of scissors for your learner, it is time to learn to cut! The OT Toolbox has multiple posts and products available for practicing scissor skills. There is a comprehensive scissor skills guide available also.

The key to cutting skills –

Thumb and middle finger in the scissor loops. You can add ring finger into the loops if they are large. Pointer finger stays out and points the way. This adds to hand stability and opens the arches of the hand further.
Thumbs up! The helper hand grips the object being cut, with their thumb facing up. This gives the object being held greater stability, and ease of movement. All of the various types of scissors could have a sticker added as an additional adaptation to help with positioning.
How to hold scissors – check out this helpful post on the OT Toolbox
Steps of scissor skill development
Scissor Skills
Scissor Skills Crash Course

Guide to Types of Scissors

Want a printable guide to the various types of scissors? You are in luck. We have a one page printable guide that shows images of the different versions of scissors on the market. These are the different scissor types you might see in a therapists’ therapy bag!

Now you can quickly share information on why each type of scissor might be used and determine which type of scissor to use based on the individual needs of the learner.

To get your copy, just enter your email into the form below.

This handout set is also available in our OT Toolbox Member’s Club.

Current Membership Club members can log into your account and head to the dashboard toolbox labeled “Scissor Skills Downloads“. Print off the handouts without the need to enter an email address.

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!

a final note on selecting the correct types of scissors

Pamper your learner with a great pair of scissors, just like you do when you purchase those amazing shoes. Fit and function over price. Quality always wins. Fiskars are the gold standard for traditional scissors, and the one type almost every therapy provider has in their OT bag of tricks. They cut paper well and come in tons of sizes and designs.

So…what are the worst scissors? Most therapists agree that those “safety scissors” that don’t cut anything except maybe playdough are absolutely the worst. Save those for playdough, and upgrade when it comes to cutting anything else.

*The term, “learner” is used throughout this post for readability, however this information is relevant for students, patients, clients, children of all ages and stages, or whomever could benefit from these resources. The term “they” is used instead of he/she to be inclusive.

Looking for tips, strategies, and activities to support development of scissor skills? Grab a copy of The Scissor Skills Book!

The Scissor Skills Book breaks the functional skill of cutting with scissors into several developmental areas including:

Developmental progression of scissor use
Fine motor skill involvement
Gross motor development
Sensory considerations and visual perceptual skills

Each section includes strategies and tips to improve these underlying areas.

Help for kids who struggle with cutting accurately
Creative tips to keep things interesting for kids who lose interest easily
Quick, practical strategies that can be put into action today!
Ideas for kids who cut too fast or too slow
Support for kids who can’t grasp scissors efficiently
Strategies for right-handed and left-handed children

Click here to get your copy today.

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