Oral Motor Problems and Feeding

oral motor problems

Many times, OT professionals receive referrals for oral motor problems and feeding. It’s through oral motor occupational therapy interventions that kids can move from challenges biting, chewing, and moving food around inside the mouth, to success with eating and trying new foods. Let’s get started!

Oral motor problems lead to difficulty biting, chewing, and manipulating foods. They can cause difficulties with textures of foods, and can be a cause of picky eating! A good place to start is with understanding the development of oral motor skills.

Oral Motor problems

One thing is for sure; individuals can have a huge spectrum of considerations when it comes to oral motor issues. No two kiddos will be alike. That’s why it’s so important to discuss oral motor issues with a professional.

The process of eating is a complex collection of movements patterns with physical and sensory components.

When feeding is a challenge, many times individual oral structures and sensory-motor patterns are a cause. 

If you are questioning whether an eating issue is sensory or oral motor, be sure to take time to explore each consideration. There can be different interventions and strategies depending on the underlying cause of eating difficulties. For example, there are specifics when it comes to issues with sensory food aversions and sensory food issues.

What are Oral Motor Problems Occupational Therapy Addresses?

The oral motor problems listed below are just some of the issues that can impact function in feeding.  

In a small series of blog posts, I have broken down each oral motor problem that occupational therapists typically address. Each blog post includes information about the specific oral motor concern, the reasoning or underlying influences that relate to each oral motor issue, and feeding issues related to the specific oral motor problem.   

This series of blog posts should be a resource for you to find more information relating to how feeding issues are related to specific oral motor problems and how these feeding issues can be addressed in treatment.   

Click on the links below for more information on each oral motor problem area as they relate to feeding. 

  • Mouth Clamped Shut when eating- Consider the child who clamps their mouth shut during meals.  This is usually the biggest sign to a parent that the child is all done eating, is full, or is refusing to eat.  However, it might be an oral motor problem that is actually the cause of the clamped shut mouth.  The child falls back on this technique because it’s worked for them in the past in some way to provide stability, move out of the difficult oral motor exercises, or has resulted in a response from the parent.   

Other oral motor problems include:

  • Tooth Grinding
  • Tonic Bite
  • Jaw Retraction
  • Tongue Retraction  
  • Tongue Protrusion
  • Tongue Thrust      

Kids can have trouble with picky eating and difficultities in feeding when there are oral motor problems. Different types of oral motor problems.

Occupational Therapy for Oral Motor

Oral motor interventions in occupational therapy can cover a variety of intervention techniques. It is essential to begin with an evaluation and individualized assessment by a feeding professional. Occupational therapists are trained in this area, but some OTs have additional certifications.

The list of occupational therapy oral motor strategies listed below is for educational purposes only and not a replacement for therapy of any kind.

Some occupational therapy oral motor strategies that can be used are:

  1. Oral motor assessment- It is essential to start with the assessment process for safety of the individual. Addressed in more detail below.
  2. Oral motor stimulation- In occupational therapy, strategies include brushing to the lips or cheeks, towel stimulation, feeding swab, tongue mobility exercises, etc. These are explained in greater detail below.
  3. Oral Motor Exercises– We’ve listed a larger list of specific exercises to use in play and in therapy sessions.
  4. Oral motor coordination exercises– Use the oral motor cards in the deep breathing kit to improve oral motor coordination skills. Try mimicking the movements by using a mirror and visual modeling.

Oral Motor Assessment Occupational Therapy

Assessment occurs by a pediatric occupational therapist, but there are many things to be considered.

Feeding is developmental and it’s essential to consider the level, age, and abilities of the individual as this will impact all aspects of feeding and oral motor considerations.

Oral motor assessment and infants-

In infancy, oral motor skills are both a means for self-regulation (nurturing through sucking) and nutritive. Things to consider in an occupational therapy oral motor assessment for infants and babies at this age and stage:

  • Is the infant able to suck in exploration for nipple of bottle or breast?
  • Does the infant suck in bursts and have pauses to allow for breathing while eating?
  • Assessment of the physical mechanics of swallow
  • Timing of sucking and pauses- sucking should occur at a rate of about one suck per second with pausing to swallow the liquid and breathing. This should occur in a coordinated manner.
  • Lip closure
  • Jaw movements to draw liquid into the mouth and to swallow (infants)
  • Anterior tongue movement during the sucking, along with cheek movement and jaw movement as the tongue draws milk or formula to the rear of the mouth to swallow (older babies)
  • Oral reflexes and whole body primitive reflexes (root reflex, a suck reflex, a swallow reflex and then protective reflexes like gag and coughing)
  • Liquid leaking from the mouth during eating
  • Anatomy of the mouth, tongue, lips, neck, etc.
  • Positioning during feeding
  • Family educational needs
  • Sleep and timing considerations

Oral motor assessment in babies

In older babies, you begin to see certain developments. Missing these milestones can indicate oral motor problems. These considerations should be addressed in occupational therapy oral motor assessments as babies grow:

  • Hands in the mouth in exploration and play- this is normal part of exploration and supports development of tongue, lips, cheek mobility
  • Positioning and seating (high chair positioning)
  • Neck, head, and upper body control against gravity
  • Motor coordination at age appropriate levels
  • Bite reflex
  • Mouthing toys, teethers, etc.
  • Making sounds with a variety of oral motor movements
  • Mimic facial expressions (open mouth, tongue out, etc.)
  • Gag reflex present
  • Accepting variety of baby food textures, flavors
  • Accepts foods from a baby spoon
  • Lip closure
  • Tongue mobility (thrusting tongue after initial spoon offerings is normal)
  • Transverse tongue reflex- The baby/child feels stimulation on the side that tongue and the tongue moves in that lateral direction- needed for swiping foods
  • Attempts or tries a variety of flavors, textures, and softer, larger foods

Oral motor assessment in toddlers-

During the toddler years, oral motor issues can present in drinking, feeding, and other areas. Consider these aspects in OT assessments:

  • Drinking from sippy cup/open cup
  • Drinking from a straw
  • Drinking a variety of textures and thicknesses (water, juice, thick or thin smoothies
  • Eating a variety of textures and thicknesses
  • Eating fluids mixed with solids (cereal, soups)
  • Biting foods from a larger piece of food
  • Moving food around within the mouth
  • Swiping the mouth with the tongue to clear the mouth
  • Chewing with rotational movements of the jaw
  • Begins to remove food from the lips with the tongue

Oral motor stimulation

We cover specific oral motor exercises designed to support the oral motor stimulation to move the lips, tongue, and jaw to bite, move, swipe, clear the mouth of food, and swallow food in our resource on oral motor exercises. However, below you will find strategies to provide oral motor stimulation to the mouth, lips, gums, and tongue.

Oral motor stimulation in occupational therapy centers around play in order to enable function. This focuses on independence with feeding with safe ability to bite food, clear food from the mouth with the tongue so that food can be swallowed.

Tongue Stimulation-

  • Use a mouth swab– to touch, swipe, tap and swab the tongue on the sides, at the tip, and along the length, avoiding the back of the tongue to avoid activating a gag reflex.
  • Use a vibrating toothbrush- to stimulate tongue movement on the sides. This can help the tongue with lateral movements.
  • Use a gloved finger- Put on a latex or non-latex glove and use a finger to tap the sides of the tongue. The glove can be worn by either the occupational therapist or the individual themselves.
  • Use a mirror- Move the tongue by mimicking movements and watching them in a mirror. You can even have the individual touch their tongue to a clean mirror surface. Play in front of a mirror alongside the child or in front of the child above the mirror so the child can look at the therapist’s face and check their movements in the mirror at the same time.
  • Tongue movement exercises- Use the tongue and mouth exercises included in our Deep Breathing Exercise pack for ideas.
  • Tongue sounds- Make clicking sounds with the tongue on the roof of the mouth. As the child/individual to copy the sounds.
  • Push the tongue into the cheeks of the mouth to copy motions. This can help with lateral sweep of the tongue to clear foods by increasing tongue range of motion.

Lip and Cheek Stimulation

  • Washcloth oral motor simulation- this occurs with a dry wash cloth and then a wet wash cloth by rubbing the lips and cheeks. Each area can be separated so they are addressed in isolation. Use a dry washcloth or wet washcloth to wipe the face, without food use. Use a warm or cold washcloth to wipe the face.
  • Making faces- Cheeks and lips can obtain heavy work, or proprioception by puffing up the cheeks, making fish lips, sealing the lips and blowing, blowing raspberries, copying facial expressions, etc. Play “Simon Says” with facial expressions.
  • Food stimulation- Some foods (sweet, sour) are very alerting. These can be used as a frozen pop in the form of a lemonade pop, smoothie, or popsicle. Or, add fruits and frozen foods to a mesh bag that is sucked on.
  • Ice pops- Freeze an ice cube on a popsicle stick and use it as an alerting and stimulating tool to “wake up” the lips and cheeks.
  • Vibrating tools- Play with vibrating mouth toys and touch the face, mouth, lips, teeth in the way of a vibrating toothbrush (offering input through the jaw).
  • Wilbarger Brushing Protocol– Use prior to eating foods (contact a trained therapy professional)

Jaw Stimulation-

  • Vibrating toys- vibrating toys, chewing tools, or a vibrating toothbrush can offer oral motor stimulation through the jaw. This can be very alerting, so use with caution.
  • Chewing tools- biting on “chew toys” (described as heavy chewing therapy tools) or chewing tools that add heavy work through the teeth and jaws. This offers feedback to “wake up” the jaws.
Oral motor issues related to feeding in kids

    As you can see there is a lot of different areas that need to be assessed and addressed when it comes to oral motor concerns related to eating and drinking.       

  

 
 
 
 
 
 
 

Colleen Beck, OTR/L is an occupational therapist with 20+ years experience, graduating from the University of Pittsburgh in 2000. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. As the creator, author, and owner of the website and its social media channels, Colleen strives to empower those serving kids of all levels and needs. Want to collaborate? Send an email to contact@theottoolbox.com.

Container Baby Syndrome

container baby syndrome

If you are a new parent, then you have probably heard that tummy time is important for your baby, but it’s so important to process the concept of container baby syndrome. In this blog post, we are covering container syndrome, what this means, and what you can do to support your most precious little one.

container baby syndrome

What is Container syndrome?

Container Syndrome is a term used to describe the lack of skill in infants who are not allowed ample movement opportunities. Container Baby Syndrome is the result of an infant being placed in a container for an excessive amount of time during the day.  This extended time leads to structural, movement, and behavioral challenges as a result. 

Baby containers include baby equipment and items such as:

  • Restrictive playpen that does not allow for movement
  • Crib
  • Car seats
  • Strollers
  • Bumbo seats
  • Bouncy seats and swings
  • Rockers
  • Nursing cushions
  • Vibrating chairs
  • Jumpers
  • Exersaucers
  • positioning pillows
  • Slings
  • Floor seats
  • Infant swings
  • Walkers
  • Jumpers

All of the time spent in these baby containers adds up! When in a positioning device such as the ones listed above, little ones are limited in the motor development that results from stretching, wiggling, turning, reaching, and otherwise moving.

Why Worry About Container Syndrome?

As a new parent, you might be wondering “why can’t I just use the wonderful bouncers, baby rockers, and other entertainment devices for infants and toddlers? After all, I got all of these amazing baby chairs, rockers, and positioners for my baby shower…can’t wait to use them!

Why should I put my baby on the floor? The biggest reason has to do with the benefits to development. Putting a baby in a container such as a jumper, positioning seat, bouncy seat lead to something called container baby syndrome.

It’s understandable why the baby seat or jumper seems like a better option than the floor for a baby. Parents and caregivers have shown a great deal of support for baby “containers” like bouncy seats, Bumbo seats, and activity centers. In fact, these baby holders have become so popular over the years, that a term has been coined; “container baby syndrome”. 

When babies are constantly keep in a space where they cannot freely move, how can they be expected to roll, crawl, or walk, when it is the developmentally appropriate timeframe?

Furthermore, babies need experiences where they can learn from their world in a physical way.

They need to discover “what happens when I move my arm and head like this”?’ Babies may fall over, and have some stumbles along the way, but this is how young children learn about gravity and develop postural stability.

Without those learning opportunities, children will only learn that their seat will catch them from falling, no matter how much they wiggle. 

With fewer movement opportunities, a delay may be seen in typical development and reflex integration. More serious issues may occur when we keep babies still, like a flattened head from lying down (positional plagiocephaly) or a tight neck that reduces head movement (torticollis). 

There is the visual component too. When babies are in a positioner such as a bouncy seat, they are positioned on their back with little to no neck movement. The neck, back, spine don’t receive the time (even minutes) to stretch, turn, and move. But the eyes are limited as well.

When placed on the back in a reclined position, the eyes are not strengthened to look and gaze based on head and neck movements. The eyes may stay in one place and are not challenged to focus on different depths and peripheral stimuli.

Neck movements are limited to turning from side to side, and they eyes tend to follow the neck. This limited eye movement can later impact other areas of development.

Where did container syndrome come from?

In 1992 the “back to sleep” campaign was introduced to lessen the likelihood of sudden infant death syndrome (SIDS).  While the rate of SIDS went down 50%, (yay!) container syndrome rose 600%, to one in seven babies! 

This is astounding. 

Parents are so nervous about SIDS, they place their babies in various containers most of the day. While this seems a safe, convenient, and supportive option, the use of too many “containers” can lead to container baby syndrome.  Babies who have not had enough tummy time may resist this at first, giving the false impression that the container is the best place for them. 

What does container syndrome look like?

  • Head Shape Flatness. The back or the side of the head is abnormally flat
  • Facial asymmetry. The sides of the baby’s face may appear unequal as a result of skull deformity and flatness
  • Torticollis. The baby has difficulty turning the head to one side, or keeping the neck and head straight due to muscle tightness on one side of the neck
  • Decreased movement, strength, and coordination -the baby may not be able to roll, sit up, crawl,  lift the head or reach with their arms while on their tummy. 
  • Delayed milestone achievement
  • Speech, sight, hearing, and cognitive problems – Visual skills can be affected such as following moving objects with the eyes and seeing toys from different distances. Hearing can be disordered, as baby does not hear from all angles. Delayed cognitive skills may arise because the infant is not able to problem solve, explore their environment, or develop language skills
  • Attention deficit hyperactivity disorder (ADHD)
  • Increased weight/obesity

How to prevent container syndrome in babies

Container baby syndrome is 100% preventable.  If you suspect your baby or a client of yours has symptoms of this syndrome, speak with their pediatrician, get a referral to a physical therapist, and begin working on exercises.

  • Allow baby plenty of supervised free time on a blanket on the floor, or in a large play yard. Encourage tummy time, reaching for toys, exploration.  Some caregivers feel unsure about putting their baby on the floor.  A blanket, sheet, or other floor covering can be placed and washed after usage
  • Limit baby’s exposure to containers. Use only when transporting the baby, or there is truly no other safe option
  • Increase supervised tummy time during the day.  Your baby may cry and resist at first, as this may be difficult or uncomfortable.  Start slowly and persevere. Colleen from the OT Toolbox has a great article on Tummy Time Myths.
  • Hold your infant in your arms, or in a sling for short periods during the day.  This will encourage movement, increased head control, and socialization
  • Rotate baby through various stations and positions during the day. Holding a baby all of the time is not healthy for a growing child either. 
  • Floor Play for Babies is another great resource from your friends at the OT Toolbox
  • Use gates and other borders to secure a safe place for baby to play, away from wandering pets, or siblings who may step on them
  • EDUCATE caregivers and other people about the danger of container baby syndrome. Encourage caregivers to provide opportunities for the baby to explore their environment freely.  Demonstrate tummy time and other appropriate movement experiences

Activities to Prevent Container Syndrome

Now that it is understood that playing on the floor is important, let’s get into the many different ways you can do it! One of the easiest ways to encourage floortime with your baby is to lay a blanket on the floor, preferably with a carpet underneath for comfort, and place a toy or two near the baby.

Depending on their age and abilities, the baby may be totally independent, rolling and playing happily. If the children are younger, or less comfortable playing by themselves, this is a great opportunity for a caregiver to step in. A fair amount of babies do not like being on their tummy for various reasons, including medical or sensory.

Babies who have gastrointestinal issues may be hesitant to engage in tummy time, as it is uncomfortable. Work through these difficulties while encouraging floor play.

How do I keep them safe down there? Prepare a safe and clean environment for movement. This may involve baby gates, barriers, or a large corral to allow freedom of movement, without risking baby falling down the stairs. Lie on the floor yourself and see what is down there at child level. You may be surprised to notice extension cords, small objects, or other unsafe objects while you are down there.

  • 2 months or younger: Talk with your baby, showing them toys, describing them, and giving them to their hand to feel and explore. Sing songs – whatever songs you know! Encourage them to wiggle their arms and kick their legs along with songs, tickles, or kisses. 
  • 3-4 months: Your baby will be able to hold tummy time for a bit longer by now. If they have trouble staying there, lay down with them! Be a part of the team, showing them how fun being on their tummy can be. Babies around this age can reach and bring toys to their mouths, so give them safe opportunities to do so.
  • 5-6 months: Rolling should be part of the baby’s physical development around this time. Encourage this movement by enticing them with something they love. Maybe it’s you, a special toy, the TV remote, or their next bottle. Try singing Five in the Bed. When the song says “Roll over!” show your baby how to roll.  During this time of development, your baby may be moving more than ever. They may even be crawling! Encourage even more floor play with these new skills. As long as the area surrounding them is safe, and you are close by, tons of fun (and important development) can be had!
  • 7-8 months: Just like rolling, encourage crawling by giving the baby lots of space on the floor (that may mean moving aside some furniture) and placing toys or books in various places. There are so many fun games to be played! Playing “Peek-a-boo” where the baby pulls a blanket or towel off to show what’s underneath, is a classic game and critical to development. This teaches baby object permanence. Scatter toys near and far to encourage looking, stretching, and moving.
  • 9-10 months: Around this age, your baby will really be on the go. Maybe a baby obstacle course is up their alley…crawl over mom’s legs, under the coffee table, around the dog, and up the step into the kitchen! Creative barriers and safety gates will likely come into play around this stage to keep young children safe.
  • 11-12 months: Almost one-year-olds may be walking, which means they will likely not tolerate being in a “container” very well anymore. Now that they are cruising on furniture, squatting to pick up toys, and participating more in play, they may likely lead the way! See what your child’s interests are during floor playtime and follow their lead. 

Need more tummy time information?  The OT Toolbox has several articles on baby play that support the development of balance and coordination through play.

Another great resource to read more on how to promote development through play is DIR Floortime as it covers strategies to support development through interest-based play.

The National Institute for Health also has a great resource on tummy time. 

Victoria Wood

Victoria Wood, OTR/L 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.

A final note on container syndrome

While the “back to sleep” campaign has certainly been successful, it is not without pitfalls. The rule of thumb for parenting is;  everything in moderation.  Not too much screen time, sweets, or containers.  Parents do not need to be laden with guilt over container baby syndrome.  Most caregivers are doing the best they can with what knowledge they have.  As they learn more, they will do more.

NOTE* The term “they” is used instead of he/she to be inclusive.

Truths About Toddlerhood The OT Wants You To Know

toddlerhood

The toddler years can be a struggle! From the age of one year to 3 years, toddlers grow and develop immensely. But when parents are in the midst of toddlerhood, it can seem like the never-ending tantrums, meltdowns, sometimes crazed attempts at independence, and picky eating, sleep issues, etc… never end. Not to mention learning new words (with little-to-no filter), sleep changes, appetite and eating considerations, toddler years can be a real challenge to parents. But as an occupational therapist, there is a very real developmental need for these toddler antics.

Toddlerhood gets a bad rap with terms like the “terrible twos” and the “three-nager years”. But is it all bad? Here’s what your friendly OT wants you to know…

Strategies for toddlerhood

Toddlerhood Development

So, what is it about the toddler years? These cute packages of rolly, squishy, no-longer babies are little people with BIG emotions, BIG personalities, and BIG smiles. Some of the sweetest memories I have from when my kids were younger come from the toddler stage, when little voices pronounce words totally incorrectly…but in the cutest way possible. Those big teethy smiles and non-stop play was nothing but learning and developing skills.

As a mom, I loved to watch my littles learn. I loved to kiss their sweet heads to sleep each night. Oh, there were meltdowns, demanding, whining breakdowns that these cuties experienced (daily). There were messes, spills, diaper issues, and the house was in a constant state of disaster zone.

But as the occupational therapist? I knew this was all part of the stage of development and toddlerhood means messy repetition. (i.e. Yes, we will need to practice cleaning up blocks 37 times a day. Yes, we will do it again tomorrow).

But, from that perspective of a pediatric developmental professional, there is so much more to say about the toddler years. ALL of that pushing buttons, whining, changing minds, meltdowns, carrying purses full of toys, getting into the kitchen cupboards, streaking naked through the house…it’s all essential toddler development! Really!

We have a great resource on child development that covers developmental milestones. From that blog post, you’ll discover the toddler developmental stages that occur from 1-3 years.

This developmental checklist can help to define specific milestones.

Early childhood is a critical time when children develop skills they will use throughout their lives. These areas of development include:

  • physical
  • cognitive
  • communication/language
  • emotional
  • social skills

It is during the first years of life that children show a tremendous level of growth in each of these areas.

Occupational Therapy and Toddlerhood…

As a pediatric OT, there are a few sticking points that is important to remember.

The toddler years get a bad rap for behaviors, saying “no”, tantrums, going “boneless” as we used to say about sudden tantrums where the toddler flops on the floor in refusal for some task, activity, or thing like getting dressed.

But, here are a few things about the “good” of toddlerhood…

  1. Have patience with your toddler.

Because of the tremendous amount of development, it is easy to become overwhelmed by skills (running, hopping, getting dressed, manipulating toys and materials, self-feeding…the list goes on and on!) Plus, young children want to exhibit independence in these areas. They want to do what mom or dad or big siblings are doing, but they may not have the skills to do so. Frustration ensues!

Things to remember is that the child is developing in all of these areas at once. By watching routines, listening to parents talking, watching siblings, they learn to throw, carry, put away, wash, color…these are multi-faceted skills. There is sensory, motor, cognitive, visual all happening at once with daily tasks.

Plus, the cognitive development occurring at the same time means that following directions are not always on target with what the small child wants to do. They want a piece of toast for breakfast. Then they don’t. It can be easy to lose patience as the toddler has a tantrum on the floor, but they are managing emotions, thought processes, decisions, and communication challenges all at once. It can be a lot to process! Be patient as the adult in the situation.

Patience is key as your little toddler develops skills at the rate that is right for them.

That brings us to our next point.

2. Remember that each child is different.

Toddlers grow and develop at a fairly predictable course and rate. There are general developmental expectations that happen during the toddler years, called developmental milestones. However, not all child achieves these milestones at the same time. And that’s ok!

It can be easy to become upset as a parent when a friend’s child achieves skills or abilities. Remember that each child is on their course of development. From birth to three years, a child visits the pediatrician many times.

You’ll experience many questions on development during those visits, where the doctor or staff ask about milestones. If there is a concern with development, or evident delay, this is where you can explore services to support needs.

Even through each toddler is different and development occurs in different stages, it’s all part of showing independence. This can mean picky eating, throwing food, saying “NO!” or any other aspect of showing independence.

3. Development occurs through play.

Occupational therapy practitioners use play as a tool to promote more play! And it’s through play that toddlers develop skills.

It’s through play that toddlers achieve stability, build relationships with parents, siblings, and others.

They test boundaries and explore the world around them.

Play offers opportunities to use their reflexes, transform motor skills, and distinguish refined motor skills (i.e. using their arms and legs to achieve a desired action such as getting up those stairs!)

Sensorimotor skills expand and toddlers gain control in play objects and tool use; They begin to use crayons, spoons, forks, and manage clothing.

Young children are fascinated by mastering new skills and learning new things. You might see them drawn to activities or experiences that offer sensory experiences, are repetitious, or involve exploration. But even though novel opportunities support child development, routine is essential.

Read about the power of play for more ideas to support your toddler.

Physical Development during toddlerhood

Going back to the development aspect, you can generally expect to see the following skills developed during toddlerhood:

12-18 months

  • First steps
  • Walking
  • Climbing stairs

18-24 months

  • Running

24-36 months

  • Jumping
  • Begin to ride a tricycle

3 years

  • True run with both feet leaving the ground
  • Walk upstairs with alternating feet
  • Walk downstairs
  • Able to remove most clothing

Cognitive Development During Toddlerhood

From 1-3 years of age, so many cognitive skills are built and expanded upon. You’ll notice in the list below that many of these cognitive skill components are grounded in play. Remember that play builds skills! Let’s break down the skills by age:

12-18 months

  • Includes others at recipients of play behaviors
  • Imitates new behavior

18-24 months

  • Demonstrates invention by combining mental combinations
  • Finds hidden objects (separation skills)
  • Shows differed imitation
  • Uses toys or dolls in pretend play

24-36 months

  • Substitutes objects in pretend play
  • Integrates themes in play

3 years

  • Begins operational thinking
  • Counting words up to 5
  • Can solve nesting cup problems

Language Development for Toddlers

The first few years are a huge time for development of receptive language and expressive language. Here are some specifics:

12-18 months

  • Expresses self through jargon, sounds, cries

18-24 months

  • Understands multi-word phrases/sentences
  • Uses multi-word phrases to express thoughts (“Me up” to indicate a desire to be picked up; “Mommy go” to indicate that mommy has left the house)

24-36 months

  • Initiates a conversation with words or phrases
  • Uses 2 part sentences or phrases (“Me go home.”)

3 years

  • Understands positional terminology (in, on, under)
  • Uses more complex sentences
  • Distinguishes between images and words or text on paper or in books
  • Begins to generalize rules for verb tenses and using plurals

Toddler Social-Emotional Development

Social emotional development occurs even from the young age in toddler years. Social skill development occurs through interaction with others, play, and day to day tasks. Here are some milestones you may see:

12-18 months

  • Experiences peak of separation anxiety

18-24 months

  • Demonstrates less separation anxiety
  • Begins to show empathy for another person, animal, toy

24-36 months

  • Begins to respond with empathy to another person’s distress
  • Includes others in pretend play

3 years

  • Shows physical aggression over verbal aggression when distressed or upset

Toddlerhood Tips

So, how can you and your toddler thrive during these hectic years? A pinch of patience, play, play, and more play! We actually have actionable strategies over on our toddler play page, including fun ways to play with your toddler that inspire development.

Some quick tips (described in more detail over on that main toddler page) include:

  1. Meet the level of the child.
  2. Set up a toddler safe space.
  3. Be a balanced play partner.
  4. Enjoy & have fun with the play.
  5. Limit screens. (Or use in moderation.)

Transforming Toddlerhood With Play

Ask any occupational therapist and you’ll see that play is the way and the means to develop skills during these years. Looking for therapist-approved activities to inspire learning through play for toddlers? These are some of our favorite ideas:

Colleen Beck, OTR/L is an occupational therapist with 20+ years experience, graduating from the University of Pittsburgh in 2000. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. As the creator, author, and owner of the website and its social media channels, Colleen strives to empower those serving kids of all levels and needs. Want to collaborate? Send an email to contact@theottoolbox.com.

The Incredible Power of Play

child development through play

Did you ever stop and think about the power of play? There are so many ways child development progresses through every day play. We know as occupational therapists that play is the primary work of the child, but it is also through play that essential skills are developed and refined.

Play Development

We’ve covered the development of play in various places across this website, breaking areas down by age:

As well as play activities by skill area:

The Power of Play

Play is the essence of childhood and it’s the means for children to develop and grow! The incredible power of play is a tool and a means to children development.

It’s through play that kids learn. Kids delight in games, toys, and creative play while developing skills like fine and gross motor development. They learn to self-regulate. They learn to communicate, manage their emotions, and gain valuable sensory input. Play is powerful for kids!

Let’s go over the importance of children’s play

Here are 5 ways play builds child development in gross motor skills, fine motor skills, executive functioning, self-confidence, and sensory processing.

The Power of Play

Not long ago, I was asked by Radio Flyer to represent occupational therapy as an Expert Play Panelist. Such fun! As occupational therapists, we KNOW the power of play. We KNOW that kids need to move, climb, run, and experience all of their senses in order to grow and develop. Play is the means. Play is very simply, what kids do. It’s their job to play, and play is the way they develop skills they need throughout their life.

Play is powerful!

You can read the blog post over at Radio Flyer that describes the impact that play has on child development.

In that blog post, I discussed the power of play on fine motor skills, gross motor skills, self-confidence, sensory processing, and executive functioning skills. All of these areas (and more!) areas by play.

This play meme is perfect for sharing the immense power of play through getting dirty, playing inthe mud, jumping in puddles, and outdoor sensory play.

Play is a learning tool. Play-based learning is one way that children can learn valuable lessons through play, however it’s more than that. It’s through play that children learn about the world around them.

Kids learn how things work, move, and interact through play. Movement-based learning offers kids an opportunity to learn through gross and fine motor activities, but while they are moving, they are learning how their body works, too. They develop motor skills at the same time.

Play Development

Here’s the thing. Children develop play skills as they grow. But play also develops skills! It’s a win-win situation.

Play Develops Gross Motor Skills

Gross motor skills occur during play as kids innately practice moving in a variety of positions. Gross motor coordination, balance development, endurance, motor planning, proximal stability, and visual motor skills are all developed through play.

Whole body movements begin to develop from birth, through tummy time and play supports that. But as a baby begins to explore the world around them, they crawl, stand, and walk and all of this is rooted in play. These early gross motor milestones support development of later skills, too.

Play Develops Fine Motor Skills

Play develops fine motor skills through tool use, manipulating toys and pretend materials, and engaging in play activities. Take a look at this fine motor milestones list and see how many of the developmental milestones are rooted in play and exploration of the world using the hands and fingers.

Children can gain strength and precision in their hands through play so that coordinated and efficient use of a pencil or scissors becomes fluid and natural.

Play develops core strength and stability, refined precision skills, and endurance in the hands for managing clothing fasteners and other everyday items.

Play Develops Executive Functioning

By playing with new activities, games, or acting out pretend play situations, children can try new things, practice tasks they’ve observed grownups doing, and explore, gaining self-confidence and resilience.

Play offers experiences for developing executive functioning skills such as:

  • impulse control
  • coping skills
  • organization
  • problem solving
  • attention
  • planning and prioritization
  • task completion
  • working memory

Play is a way to practice jobs, too. Think about the child that plays house, construction worker, race car driver, or shopping. All of these occupations require executive functioning skills to plan the activity, carry out tasks, and complete the play sequence. This pretend play is a huge role in development of skills.

Play Develops Sensory Processing

Through play, children understand how their body works as they learn and integrate sensory information.

Dr. A. Jean Ayres, an occupational therapist, psychologist, and neuroscientist, developed her Ayres sensory integration theory and practice in the mid 1970s. She recognized that a child’s sensory system can greatly impact how they perceive and interact with the world around them, through play.

Play allows kids to become aware of their body awareness and body movement as they jump, roll, spin, and tumble upside down.

Play that offers a variety of movements and heavy work opportunities offer proprioceptive and vestibular input that impacts self-regulation. These sensory systems, through play are related to interoception, or internal awareness of the body’s functions.

Play also develops the visual motor system as children move through space and coordinate hand and eye information.

Play Develops Self-Confidence

By playing with new activities, games, or acting out pretend play situations, children can try new things, practice tasks they’ve observed grownups doing, and explore, gaining self-confidence and resilience.

Self-confidence allows us to try new things.

And trying new things (and trying the hard things!) is important for kids.

Self-confidence is an aspect of emotional intelligence. It’s part of social emotional skills that allow us to participate in tasks, interact with others, understand and recognize emotions, and essentially function!

All of these areas: motor skills, cognitive skills, social emotional skills, sensory processing skills…they are all founded in childhood, established at a young age through the very fun occupation of PLAY! What’s cool is we are lead as humans to do meaningful and motivating tasks, and play is just that! It makes us WANT to participate so we can learn and develop!

Play meme: Play has an extremely powerful role in child development.

The Role of Play in Child Development

Ok, you might be thinking, “Right. Kids play. That’s nothing new.”

And you’re right. Play is so natural. Some of your earliest and best memories may be of play situations in your own childhood. Play happens instinctively. But the thing is that play is suffering in kids. If you’re in an educational setting or an occupational therapist, you might be nodding your head right now. Kids are different than they were in the past. And play is at the root, once again.

Play's powerful role in child development.

But Play has Changed.

Times change. We know this. Technology advances, knowledge progresses, and the world transforms. However, play being the root of child development, learning, and pediatric skill acquisition doesn’t change.

Here are a few ways that play has changed and how that may look in kids today:

Almost all creativity involves purposeful play. Quote by Abraham Maslow on the power of play.

Play gives children a chance to practice what they are learning. A great play quote by Mr. Rogers.

Less Time for Kids in Nature

Kids spend less time outdoors- Do you remember playing outdoors for the entire day and coming home when the streetlights came on? Kids are spending more time indoors. After school hours aren’t spent outdoors or in free-play. They are spent indoors, at child care centers, or after-school programs. Sometimes, it’s the fact that kids need to complete their homework so they can dart off to sports practices or appointments. Other times, it’s not safe for children to play outside in the yard on their own. Kids miss out on the free running space, climbing, running, rolling, and motor development.

Kids are spending more time in the car, running back and forth to organized activities- There are wonderful benefits to spending time on a team or learning an instrument.

However, for children now, they are a member of several sports teams, participating in various activities, clubs, and other organized activities. Sports teams sometimes have more than one practice or game per week. Kids are being run to and from sports practices, instrument lessons, clubs, appointments, and more. All of that time spent in the car limits free and creative play.

This isn’t’ to say that sports and clubs aren’t good for kids! It’s just a point of awareness that time spent in these organized tasks limits free play, outdoor experiences, and growth in learning through the senses and motor experiences.

There are so many benefits to nature play!

Less recess time- Are you seeing this too? Kids in my district are limited in outdoor recess time by the weather. So, when it’s cold or raining, they don’t get to go outdoors to play. And that lack of monkey bar time at recess can be an issue with the afternoon learning. Students in the older grades don’t even get recess in our district.

From grades 4-6, there is a limited time for recess. In fact, recess and lunch time is shared. So if children need extra time to eat, they miss out on recess. Not cool for our kids that are “big kids”!

Kids need that outdoor play.

Are you seeing less recess time at your schools?

Play sparks learning, communication, discovery, motor development, insight, and jowy. And that's just the beginning.

Kids are spending more time on technology- The screens are taking over! So often, a child has a phone or tablet screen in front of them rather than spending time playing games, playing with friends, they are playing digital games or watching videos. They are limiting themselves in motor and sensory experiences. Movement and creative play are impacted.

Don’t take this the wrong way: Technology is awesome! It’s a way of life. We are lucky to be alive during this time of knowledge and awareness granted by technological advancements. Kids can learn from devices…some of them know more about technology than their adults. The point is that being aware of time spent in a head-down position holding that phone limits interaction with the world around them. Awareness of this time is key.

There are more changes that we’ve been seeing in kids today. This is just a short list but one to be aware of as practitioners, parents, and teachers. As the adults in the room, we need to make the change that kids need.

We need to be vigilant in making play available to kids…the power of play is essential to child development!

We need to guide children to play.

Because, the organized sports and scheduled activities are fun. It’s fun to play on a team with friends. It’s easy to fall into the day-to-day-life that daily schedules require. It’s fun and exciting to watch YouTube videos and play games with friends online.

It’s our job as parents, teachers, therapists…adults to see the impact these life changes are having on our kids.

Our kids deserve it!

Learning Through Play Quotes

In this blog post, we covered more than just the power of play. You’ll also fine learning through play quotes and memes about play. These quotes about play are just one way to advocate on the power of play.

I’m sharing great social media graphics about play that you can share online. These are importance of sensory play quotes, quotes about play, and play development memes. (Just link to this page as your source!) I’m also talking about the incredible benefits of play in kids.

There's no such thing as bad weather, only bad clothes. Outdoor play is so essential for child development!
“There’s no such thing as bad weather, only bad clothes.”
A fresh mindset about kids and how play impacts their development.
“A fresh start is not a place, it’s a mindset.”

We can take a fresh start on offering play opportunities for our kids. Let’s expose them to the power of play!

Kids are growing up in a world where play is restricted or limited. We can change that!
“I wouldn’t change you for the world. But I would change the world for you.”

We as parents, educators, and therapy professionals have the opportunity to take a stand on making the power of play more powerful! Let’s change current practices of limited recess time, lack of outside play opportunities, and busyness! Let’s change the world and its expectations and perspectives so we can promote the power of play as a means for supporting child development.

In every job that must be done, there is an element of fun. Quote by Mary Poppins
“In every job that must be done, there is an element of fun.”

This quote from the Mary Poppins book and movies equates with the through of play being the work of the child, but it’s through play that development happens and is practiced. Not only can we play to support development, we can make the process therapeutic and fun! It’s all connected!

Play and therapy looks like just playing, but it's so much more! Play is learning, growint, building skills, gaining confidence, obtaining strategies.
“Yes, we play in therapy. No, we are not just playing. We are becoming independent, growing stronger, building skills, learning, gaining confidence, obtaining coping strategies, transforming lives…”

This play quote by Colleen Beck, OTR/L at The OT Toolbox shares why play is so powerful and benefits development in children. Play offers tools that a child will use throughout their lives.

Almost all creativity involves purposeful play. quote about kids.
“Almost all creativity involves purposeful play.”

Creativity is play and play is creativity. Both are interconnected but also a way to support play development.

Childhood is a journey, not a race.
“Childhood is a journey. Not a race.”

That childhood journey involves much development; cognitively, physically, emotionally…This is a process and it’s through play that the child has the opportunity to learn and practice essential skills.

Occupational therapy uses play in practice to build essential skills.
“I play with shaving cream, toys, and a ball pit at work. I am an occupational therapist.”

Play is the work of the child, and for the pediatric occupational therapist, play is a tool to support development.

It seems that play is one of the most valuable tools for learning.
“It seems that play is one of the MOST valuable tools for learning.”

This is one of my favorites of the learning through play quotes. Learning happens through all aspects of play.

Play builds skills that kids need to build skills.
“Children have a superpower. It’s this morphing ability to take on amazing powers. If we tell them they are capable, they become capable. If we tell them they are kind, they become kind. Let’s power our kids with the tools they need!”

This play based learning quote is so powerful. We can support the development of kids through play and we can guide them to develop the skills they need!

child development through play

Free Handout on The Power of Play

Being that we as therapy professionals, teachers, or parents have this knowledge on play and child development, we can be advocates for our kids. Not only that, but by promoting play as a tool for child development, we serve other children as well. It’s an enormous ripple effect that has the power to impact a generation and generations following.

That’s why I wanted to put the information in this blog post into handout form.

Let’s share what we know about the power of play to teach others how play supports essential child development skills.

Print off this handout in either black and white, printer-friendly version or the color copy. They can be used as educational handouts to teach others on the power play has on child development skills.

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 “Educational Handouts“. 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!

FREE Handout: The Power of Play on Child Development

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    Colleen Beck, OTR/L is an occupational therapist with 20+ years experience, graduating from the University of Pittsburgh in 2000. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. As the creator, author, and owner of the website and its social media channels, Colleen strives to empower those serving kids of all levels and needs. Want to collaborate? Send an email to contact@theottoolbox.com.

    Writing with Both Hands-What you Need to Know

    Kids may write with both hands and have poor legibility or speed with handwriting.

    Writing with both hands is a common concern for parents, teachers, and therapists working with students on handwriting skills. Using both hands to write might look like switching hands while writing or even coloring as a result of hand weakness. But there could also be other considerations at play including mixed hand dominance or confusion on which hand to pick up the pencil and which hand holds the paper.

    You’ll definitely want to check out a related resource on more information on hand dominance and establishment of a preferred hand in functional activities.

    Writing with both hands- what’s going on

    Have you seen a child on your therapy caseload that writes with both hands? Writing with both hands can be a problem when it comes to handwriting legibility and efficiency.

    Have you ever wondered is my child a lefty or a righty? Or perhaps writing with both hands piqued your curiosity about whether or not your child is ambidextrous.

    Or been asked if they are a lefty or righty and unable to answer?

    Have you noticed that your child seems to use both hands equally when writing? If so, your child may be experiencing mixed hand dominance patterns or cross-dominance, and this is why you are not sure if they are a lefty or a righty. Writing with both hands can have implications that affect handwriting.

    Read on for information on using both hands to write writing and what you need to know about mixed-handedness.

    Writing with both hands, wondering what this means for kids in learning and writing? This has great information on mixed dominance and laterality in kids.

    Where to begin when kids write with Both Hands 

    First, it’s important to understand what is happening when a student uses both hands to write.

    Hand dominance

    Let’s discuss mixed dominance to begin. Here is more information about hand dominance and activities to promote laterality.

    What is mixed dominance and what does this mean in child development? Read more about hand dominance and writing with both hands.

    What is Mixed Dominance?

    Mixed dominance refers to when a child does not demonstrate a strong preference for either the left side or the right side of the body for completion of activities, or clearly utilizes both hands for specific sets of activities. For example, a kiddo might throw with his left hand, but write with his right hand.

    It should also be noted that children with mixed dominance often utilize both sides of the body equally, but poorly. When they fatigue, this leads to confusion with if they are left-side dominant or right-side dominant.

    When Does hand Dominance Develop?

    Dominance of one side of the body or the other is not expected until 5 years of age. Before the age of 5 years old, use of both hands is expected to a moderate degree. However, most children are showing a strong preference for one hand or the other by 3.5-4 years of age.

    Determining Mixed Dominance

    Dominance is typically determined through observation of the eyes, hands and feet and which one the child uses for task completion. For example, a child who is demonstrating mixed dominance may be right eye dominant, and left hand/foot dominant or left eye dominant, right hand dominant and left foot dominant, or any combination of these characteristics.

    Therapists may utilize the Jordan Left/Right Reversal Questionnaire or clinical observations to help them determine mixed dominance. In a vision screen, the therapist can have the child pretend to be a pirate, and see what eye they close when looking through a tube/rolled paper.

    The eye that the child closes is the non-dominant or “weak” eye and the dominant or “strong” eye is the open one. If the “strong” eye does not match the hand preference the child has been showing, this is mixed dominance in action.

    Be sure to watch this space, because tomorrow we’ll cover more about writing with both hands, ambidexterity, and mixed dominance.

    For more information on visual screening, check out our vision screening packet:

     

     

     

    Writing with boht hands Impacts Writing and Reading

    Children who experience mixed dominance patterns, evidenced by writing with both hands, often have challenges with left/right awareness.  This left/right confusion can impact reading and writing, as a result of delayed reading and writing skills. 

    Left Right Confusion and Handwriting

    The child that doesn’t know their left from their right side at the kindergarten to first grade stage may show challenges as they are learning letter formation.

    Poor left/right awareness can affect a student’s ability to accurately form letters and result in ‘dyslexia’ looking reversal patterns.

    The reversal patterns in letter formation and recognition may also lead to poor phonemic awareness, and later poor spelling, further delaying their reading and writing skills.

    Reading left to right may also be a significant challenge as a result of poor eye teaming, as both sides of the brain are attempting to ‘dominate’ the skill. This struggle between the two sides of the brain results in poor organization of the information and retrieval of phonemic rules. Here is more information about visual processing and the skills that impact reading and learning.

    Difficulties in these areas can be red flags of mixed dominance patterns that need to be addressed.

    Switching hands when writing means that the student holds the pencil with a different hand each time and doesn’t have the experience to create motor plans for each letter. They are looking at different angles and directions to the paper, writing  sample to copy formations, and establishing loose “muscle memory” when it comes to creating an established plan of action for letter forms. 

    Writing with different hands can impact overall organization on the paper, too. This includes use of margins, and writing in lists. Typically, when writing, we need to hold the paper with the non-dominant hand to stabilize the paper. Placing letters  

    More implications of using both hands to write

    Mixed dominance does not always seem like a big deal, but when left unaddressed your child may be left frustrated with their struggles in gross motor play, reading and writing. 

    Struggles in these areas significantly impact a child’s self-esteem and desire to participate in age appropriate activities. Fortunately, mixed dominance can be easily addressed through therapy.

    Try this pouring and scooping activity to refine hand dominance in functional tasks.

    Occupational Therapists screen for visual problems in order to determine how they may impact functional tasks. Visual screening can occur in the classroom setting, in inpatient settings, in outpatient therapy, and in early intervention or home care.  

    This visual screening tool was created by an occupational therapist and provides information on visual terms, frequently asked questions regarding visual problems, a variety of visual screening techniques, and other tools that therapists will find valuable in visual screenings.





     
    Free visual processing email lab to learn about visual skills needed in learning and reading.
    What is mixed dominance and what does this mean for kids?

    Occupational Therapy Vision Screening Tool

    Click here to read more about the Visual Screening Packet.   This is a digital file. Upon purchase, you will be able to access the 10 page file and print off to use over and over again in vision screenings and in educating therapists, teachers, parents, and other child advocates or caregivers.  

     

    For even MORE information on eye-hand coordination and activities to use in your occupational therapy practice, you will want to join our free visual processing lab email series. It’s a 3-day series of emails that covers EVERYthing about visual processing. We take a closer look at visual skills and break things down, as well as covering the big picture of visual needs.


    In the visual processing lab, you will discover how oculomotor skills like smooth pursuits make a big difference in higher level skills like learning and executive function. The best thing about this lab (besides all of the awesome info) is that it has a fun “lab” theme. I might have had too much fun with this one 🙂


    Join us in visual processing Lab! Where you won’t need Bunsen burners or safety goggles!

    Click here to learn more about Visual Processing Lab and to sign up.

    The Handwriting Book is a comprehensive resource created by experienced pediatric OTs and PTs.

    The Handwriting Book covers everything you need to know about handwriting, guided by development and focused on function. This digital resource is is the ultimate resource for tips, strategies, suggestions, and information to support handwriting development in kids.

    The Handwriting Book breaks down the functional skill of handwriting into developmental areas. These include developmental progression of pre-writing strokes, fine motor skills, gross motor development, sensory considerations, and visual perceptual skills. Each section includes strategies and tips to improve these underlying areas.

    • Strategies to address letter and number formation and reversals
    • Ideas for combining handwriting and play
    • Activities to practice handwriting skills at home
    • Tips and strategies for the reluctant writer
    • Tips to improve pencil grip
    • Tips for sizing, spacing, and alignment with overall improved legibility

    Click here to grab your copy of The Handwriting Book today.

    Colleen Beck, OTR/L is an occupational therapist with 20+ years experience, graduating from the University of Pittsburgh in 2000. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. As the creator, author, and owner of the website and its social media channels, Colleen strives to empower those serving kids of all levels and needs. Want to collaborate? Send an email to contact@theottoolbox.com.

    Ambidexterity or Mixed Dominance

    What is ambidexterity

    Many parents see their child switch hands during tasks, or show refined use of both hands and wonder if their child is ambidextrous. Maybe a child uses their left hand to throw a ball, but bats with their right hand. Maybe they kick a ball with their right foot, but hold a pencil with their left hand. Ambidexterity is a common question among parents of kids who switch hands in activities or don’t use one hand consistently.

    Here, we are covering several aspects of ambidexterity. We’ll go over the difference between being ambidextrous and having mixed dominance. We’ll cover what it means when a child uses both hands to write or color. And, we’ll go over some activities to support a dominant hand.

    How do you know if your child is ambidextrous or if they are showing signs of mixed dominance? This post will explain a little more about ambidexterity as well as mixed dominance and what it means in motor skills.

    What is ambidexterity? Is my child ambidextrous?

    What does Ambidextrous Mean?

    The definition of ambidextrous is use of both hands with equal refined precision and motor skill. This means that each side of the body is equally able to write with natural motor planning, fine motor control, strength, and refined motor movements.

    According to the definition of ambidexterous, there is equal refinement and precision. You might think this means just the hands and fingers are involved with equal use of both sides. However, that’s not exactly the case.

    Those who are truly ambidextrous may have equal use of hands, as well as feet, eyes, and even toungue motor skills.

    An ambidextrous child will play naturally with toys using both hands. You might notice equal use of the hands and feet, or switching left to right or right to left during play, sports, school work, and other tasks.

    When it comes to someone being ambidextrous and fine motor involvement, this can refer to:

    • Writing
    • Scissor use
    • Clothing fasteners
    • Play
    • Hand strength
    • Brushing teeth and hair
    • Many other every day tasks

    Ambidextrous also refers to the feet too.

    An ambidextrous person will be able to kick equally strong and with the same amount of force with both feet. They are able to “take off” from a running stance with equal feet placement, whether they start out running on their left foot or their right foot. Gross motor ambidexterity can be seen in:

    • Jumping
    • Running
    • Skipping
    • Hopping
    • Balance
    • Kicking a ball
    • Throwing a ball
    • Catching a ball
    • Among many other every day tasks

    Ambidexterity can be observed in the eyes, too. Typically, all of us have one eye that is stronger, or a naturally dominant eye. We can complete a visual screening to identify this, or a visual exam may be in order.

    Finally, an ambidextrous individual may show motor overflow movements with the tongue to both sides of the body.

    Are you wondering about a child who uses both hands to write or perform tasks? Maybe you know a child who uses both hands equally and with equal skill. Perhaps your child uses one hand for specific tasks and their other hand for other tasks.

    Mixed Dominance or Ambidexterous?

    Just yesterday on The OT Toolbox, we discussed mixed dominance. In this post, we will cover more about true ambidexterity and what that means.

    A child with mixed dominance demonstrates clear, stronger patterns based on the side of the body they are utilizing to complete the task.

    For example, a child who is left hand dominant will develop a stronger fine motor pattern then a child who is not left side dominant but compensating for fatigue and is moderately adept at utilizing the left hand as a coping skill.

    Is my child ambidextrous

    A child who is truly ambidextrous will be equally as skilled at utilizing both sides of the body and it will look and feel natural to the child. Statistically, only 1% of the population is truly ambidextrous—it’s really very rare, and it is more likely that your child is experiencing mixed dominance patterns.

    True ambidexterity requires both hands to be used with equal precision and there is no true preference in either the right or left hand for either both fine or gross motor tasks.

    Can you make yourself ambidextrous?

    This is an interesting question. Many times there is a perceived benefit to being ambidextrous, or switching hand or foot use during a task. Some perceived benefits might be:

    • Switching hands when one is fatigued from use during a task
    • Switching dominant sides during a sport such as baseball or softball to pitch with the other arm, batting from another side, dribbling to the other side when bringing up the ball during basketball, or kicking a ball with the other foot during soccer.
    • Writing equal legibility with both hands

    Actually being ambidextrous is different than teaching yourself to become ambidextrous.

    To use both sides of the hand as a learned concept takes cognitive attention whereas natural ambidexterity occurs without thought. Because of the neuroplasticity of the brain, humans have the ability to teach themselves to use their non-dominant hand or side to complete tasks. It takes practice, practice, and more practice.

    Read here on motor planning where we cover this concept.

    Ambidexterity or Mixed Dominance?

    Is my child ambidextrous? Isn’t that what mixed dominance is? These are two questions that therapists get asked frequently when evaluating a child for the first time for mixed dominance and other concerns. The answer is no, they are not the same thing.

    This is a tricky area. Therapists recognize mixed dominance as a miscommunication or poor integration of the left and right sides of the brain and that’s how it’s explained to parents. However, there is a lot of information out there on this topic that may or may not be relevant to your child and her struggles— keep this in mind when Googling information.

    It is more likely, that your child’s brain is utilizing the left and right sides for very specific motor skills such as writing, eating and throwing a ball. This can lead to motor confusion—this is where the poor integration and lack of communication between the left and right sides of the brain comes into play.

    When the child is not utilizing one side of the brain more dominantly for motor patterns, confusion and poor motor learning occur leading to delays and deficits in motor skills.

    It is unclear why the brain develops this way, but it does happen, and it is okay. In fact, it is easily addressed by an occupational therapist.

    Ambidexterous Motor Development

    I already touched on this a little, but a child with mixed dominance may switch sides for task completion when experiencing fatigue. Due to this, their motor development and precision is typically delayed.

    The most common area that this is noted in is in fine motor development for handwriting. This is because the child is equally, but poorly skilled with both hands, and will switch hands to compensate for fatigue.

    Motor delays may also be noticed later on when it comes to the reciprocal movements needed to throw/catch or kick a ball and when skipping. A child with mixed dominance may attempt to catch and throw with the same hand, hold a bat with a backwards grip, or stand on the opposite side of the plate when hitting.

    They may also experience a moderate level of confusion, and frustration as they are unsure of how to make the two sides of their body work together leading to overall poor hand/foot-eye coordination skills.Ambidexterity or mixed dominance and what this means for kids who use both hands to complete tasks like handwriting.

    For a few fun hand dominance activities, try these ideas to help kids establish a

    Ambidextrous hands and eyes

    If you have more questions and want to learn more on a dominant eyes and understanding how the eyes and hands work together during activities, you’ll want to check out our Visual Processing Lab.

    It’s a 3-day series of emails that covers everything about visual processing, visual motor skills, and eye-hand coordination. We take a closer look at visual skills and break things down, as well as covering the big picture of visual needs and how the hands and eyes work together.  

    In the visual processing lab, you will discover how oculomotor skills like smooth pursuits make a big difference in higher level skills like learning and executive function. The best thing about this lab (besides all of the awesome info) is that it has a fun “lab” theme. I might have had too much fun with this one 🙂  

    Join us in visual processing Lab! Where you won’t need Bunsen burners or safety goggles!  

    Click here to learn more about Visual Processing Lab and to sign up.

     
    Free visual processing email lab to learn about visual skills needed in learning and reading.

    Colleen Beck, OTR/L is an occupational therapist with 20+ years experience, graduating from the University of Pittsburgh in 2000. Colleen created The OT Toolbox to inspire therapists, teachers, and parents with easy and fun tools to help children thrive. As the creator, author, and owner of the website and its social media channels, Colleen strives to empower those serving kids of all levels and needs. Want to collaborate? Send an email to contact@theottoolbox.com.

    Tips For Potty Training -Occupational Therapy & Physical Therapy

    occupational therapy potty training tips

    There are many tips on potty training out there, including many toileting methods, training strategies, and potty training charts. But, what if you could have the occupational therapy potty training strategy? What if you could get the low down on potty training from an occupational therapy or physical therapy professional, that is guided by development, focuses on underlying skills needed to use the bathroom, and addresses the whole child perspective? What if you could ask every developmental question under the sun and get tips for toileting straight from the pediatric OT and PT?

    occupational therapy potty training tips

    This blog post covers just that! I’ve joined forces with some of the best occupational therapy and physical therapy bloggers to to bring you the best potty training tips.

    Occupational therapy Potty Training

    When occupational therapists work with children, they focus on the whole perspective. We look at development, environment, and every aspect that contributes to the entire process of toileting:

    • Awareness (sensory, cognition) to know when to go to the bathroom
    • Clothing management (fine motor skills, gross motor skills, visual motor skills, bilateral coordination, crossing midline, coordination skills, executive functioning skills, cognition, sequencing)
    • Motor skills to sit, balance, stand, grasp, wipe, clean
    • Bowel movements and urination (sensory processing including interoception aspect, contributing factors such as sleep, nutrition, sensory integration)
    • Pericare
    • Hygiene– washing and drying hands (fine motor skills, gross motor skills, visual motor skills, sensory processing, executive functioning skills, attention and behavior)
    • Parent education
    • Physical adaptations and modifications– adaptive equipment, specialty toilet seats, environmental changes, visual schedule use, etc.
    • Play-based activities to support development of underlying areas that impact each of the above areas

    As you can see, occupational therapy professionals focus on the overall development and whole view of the child, the environment, and many other perspectives. This is a wider focus than your typical 3 day potty training method, or a sticker chart!

    Potty Training Tips

    Toilet training tips can look like a checklist of tasks to complete. But, when you consider all of the aspects of development that play into the process of toileting, there is much more than just a list of potty training tips to accomplish.

    Potty training is an important rite of passage for children. For most individuals, they use the toilet each day without a single thought. And it is possible for the toddler or preschooler to get to that stage. Children of all ages, including older kids can struggle with the process, which is all very typical.

    1) ROUTINES- The most valuable potty training tip for parents, no matter the age of the child and the physical or cognitive ability is consistent routine.

    Routine, whether it is practiced with a visual schedule, a potty training sticker chart, toileting adaptations, special nutrition, timers, physical exercises like yoga…all should be consistent and replicated on an ongoing basis.

    There are so many aspects of development that contribute to underlying skills and the process of toileting. Whether these factors are addressed in occupational therapy sessions or in a home program, that consistent practice and routine trial is needed to support development.

    2) PATIENCE- A second and worthy toileting tip is to focus on the patience.

    Toileting is a complex process. Add in environmental considerations such as public toilets, loud hand dryers, noisy flushing toilets, and other sensory-based distractions.

    • Consider rushed schedules to get out the door in the morning.
    • Consider typical behaviors and attention spans of toddlers and preschoolers.
    • Consider day to day stressors.
    • Consider the distraction of screens and social media (“My infant is using the toilet all by themselves!”…yeah right!)

    This is just the tip of the iceberg when it comes to all the factors that play into potty training. The fact is that kids are kids! They are just learning this complex skill, and toileting is a huge developmental process! The key to this whole process is patience and persistence.

    3. BIGGER PICTURE- A third potty training tip occupational therapy professionals focus on is looking at the whole child.

    This is more on what we covered above. When you take a step back and think about ALL of the developmental areas that play into toileting, self-care, hygiene, there are SO MANY areas at play here!

    Let’s look at all of the areas that have a factor in the toileting process:

    • Balance
    • Coordination
    • Dexterity
    • Motor planning
    • Sequencing
    • Impulse control
    • Attention/focus
    • Safety awareness
    • Body awareness
    • Grasping strength and mobility
    • Postural control
    • Fine motor coordination
    • Gross motor coordination
    • Visual perceptual skills
    • Sensory processing- tactile sensitivities, proprioception, vestibular, interoception, auditory, olfactory (smell)
    • Interoception- This is worthy of a second mention- The ability to know when to go, to feel the pressure in the belly area, the sensation of having to pee or poop, the feel of pushing a bowel movement, the sensation of knowing when the process is complete, feeling hunger or thirst, sensing an upset stomach
    • Cognition
    • Communication and language
    • Social and emotional skills
    • Family perspective

    This list essentially covers all areas of development! You can see that simply potty training can take longer for some individuals, and that is completely ok!

    Occupational Therapy Toileting Strategies

    The occupational therapy professional working with families on the functional task of toileting considers all of the areas listed above. They break down the process and use skilled assessment to analyze areas contributing to challenges with toileting.

    OT professionals offer strategies and supports to develop contributing areas that impact the challenges that come up with toilet training. They offer suggestions, motivators, fun play activities, schedules, and consultancy that promotes development in the areas that will lead to success.

    Occupational therapy practitioners can support families with potty training troubles in so many ways:

    • Development of underlying areas through play
    • Adaptations and modifications to the environment
    • Establishing a routine
    • Creating a sensory diet
    • Writing appropriate toileting social stories
    • Educating parents and guardians on readiness factors
    • Supporting carryover of skills across environments
    • Medical review and ruling out considerations that should be addressed with a physician
    • Focusing on reducing anxiety
    • Supporting with schedules, motivators, and play-based games and activities
    • Creating visual cue cards or tools to support communication skills
    • Address mobility and motor skill issues
    • Supports to address dressing skills
    • Backward chaining or forward chaining methods for potty training process
    • Education on various potty training methods that work best for the individual
    • Data methods
    • Functional skill assessment
    • Address sensory sensitivities
    • Address clothing considerations
    • Educate on sensory and perceptual concepts such as wet/dry, clean/dirty, front/back
    • Body awareness considerations
    • Address physical considerations
    • Address concurrent considerations such as diagnoses and their impact on toileting: physical or cognitive considerations, sensory processing differences, mobility, balance, muscle tone, etc.

    The whole process of potty training is complex and aspects can be a challenging and difficult time for parents.  There can even be frustration at times.

    All children need to learn and finding out the best potty training tips and ways to help with teaching kids to potty train that works for their individual needs.

    To support kids in these areas, I’ve joined a team of pediatric occupational therapy professionals and physical therapists in creating the ultimate resource based on development and the whole child.

    The Toilet Training Book: A Developmental Look at Potty Training for Kids of all Abilities was created as a comprehensive resource covering every aspect of toilet training including:

    • Potty training readiness (based on development)
    • The developmental progression of toileting, perineal hygiene, self-care, and handwashing
    • Toileting for special populations including Autistic individuals, those with diagnoses such as Down Syndrome, Cerebral Palsy, Traumatic Brain Injuries, Spina Bifida, Spinal Cord Injuries, and other physical disabilities, etc.
    • Strategies and supports for those with fine motor, gross motor, visual motor, behavioral, trauma, sensory, or cognitive considerations
    • Tips and suggestions when there is trouble with toilet training
    • Equipment suggestions for toileting

    The book also includes toilet training matrix for readiness and functioning, readiness skill activities, interoception information, social stories, visual schedules, sticker charts, and other tools.

    ackling potty training is a challenge for all kids! What if you had the inside scoop on development in your back pocket? 

    What if you had the know-how of occupational therapists and physical therapists with DECADES of experience to guide you?  

    The Toilet Training Book offers a developmental look at potty training for kids of ALL needs.

    toilet training book

    More Potty Training Tips from OT and PT

    The authors of the Toilet Training Book have decades of experience working with individuals of all skills and abilities. Check out some of the potty training tips they have, coming from the OT/PT perspective:  

    Fine Motor and Toileting- Looking for fine motor considerations when it comes to toileting and potty training? There are many fine motor skill areas that impact potty training:

    • tearing toilet paper
    • wiping with enough grip and strength
    • managing clothing fasteners such as buttons, zippers, snaps, etc.
    • managing the faucet and soap
    • Motor skills to grasp and use towels
    • and even using the sticker chart!
    • Opening locks on public restroom doors
    • Flushing the toilet

    We as occupational therapists might focus on the fine motor aspect all of these areas that impact toileting. Still other contributions grasp, coordination, pinch strength, crossing midline, bilateral coordination, eye-hand coordination.

    For tips and suggestions to support development of all of theses areas, check out Potty Training, Toileting and Fine Motor Considerations by The Inspired Treehouse.

    Gross Motor and Toileting- Toileting has a considerable gross motor skill component. Consider that areas that impact potty training skills:

    • Mobility to the bathroom
    • Managing a small space
    • Getting on and off the toilet
    • For boys, standing and maintaining balance at the urinal or toilet
    • Managing clothing while sitting, standing, squatting
    • Balance
    • Coordination
    • Postural control
    • Weight shift
    • Trunk control

    Pediatric OTs and PTs can use task analysis to break down these areas into smaller steps that can be addressed through play, modifications, and activities. Check out Gross Motor Skills and Toilet Training by Your Therapy Source for more information.

    Potty Training and Sensory Processing- The potty training process has a huge sensory component. Think about these areas:

    • Tactile components to manage toilet paper, water, soap, etc.
    • Auditory consideration- sound of flushing, echo in the bathroom, sounds of others in a public restroom, hand dryers
    • Olfactory consideration- The smell of bowel movements and urination can be an issue for some, the scent of soap
    • Proprioception- understanding where the body is in space in order to squat, stand, and move with enough force
    • Vestibular- movement into different planes including an inverted head (kids will do this), standing, sitting
    • Interoception- knowing when to go, when bowel movements are completed, the feeling of a full bladder and empty bladder, huger, thirst, and even sweat
    • Sensory defensiveness, sensory seeking, sensory hypersensitivities, poor registration of sensory input all contribute to toileting
    • Body awareness
    • Fecal smearing

    For more information on the sensory aspect of potty training, check out Toileting and Sensory Processing by Miss Jaime OT.

    Adaptations and Modifications for Potty Training- Modifications to potty training can include many things:

    • adaptive equipment
    • adjustments for fine motor or gross motor
    • seating modifications
    • adaptations for fear
    • social stories
    • visual schedules
    • wiping modifications
    • sensory modifications
    • behavior modifications

    For more information on the modifications, check out Modifications For Potty Training from Therapy Fun Zone

    Developmental and Environmental Readiness for Potty Training- Readiness is more than development in some cases. Therapy can address these areas that impact successful toileting:

    • Readiness activities such as books, stories, and social stories
    • Following the lead of the child
    • Practicing hand washing
    • Practicing clothing management- removing clothing, dressing skills, buttons, zippers, snaps, buckles, etc.
    • Visual cue cards

    For more information on readiness, check out Preparing Your Child & Environment for Potty Training from Growing Hands-On Kids.

    Play-based potty training- Occupational therapy professionals use play as a tool to support development, because play is the primary occupation of children. Through play we can develop many skills. Play can be used to address activities in toileting such as:

    • Teaching wet and dry through sensory play
    • Teaching dirty and clean through sensory play
    • Teaching front/back and directional concepts through obstacle courses and doll play or other toys
    • Addressing body awareness through sensory play, obstacle courses, and toys
    • Addressing interoception, proprioception, body awareness, and sensory integration through yoga and heavy work activities
    • Addressing hand strength, gross motor skills, crossing midline, and physical considerations through pretend play, gross motor games, etc.

    For more information on using play to support potty training, check out Teaching Concepts for Potty Training Through Play from Your Kids OT.

    All of these areas are covered in detail, along with much, much more information in The Toilet Training Book, a Developmental Look at Potty Training for Kids of All Abilities.  

    Potty Training tips and ideas to help kids learn to potty train from Occupational Therapists and Physical Therapists
    Potty Training tips and ideas to help kids learn to potty train from Occupational Therapists and Physical Therapists

      Looking for more functional ideas for kids?  

    Perineal Hygiene

    perineal hygiene and pericare tips

    Here, we are covering an aspect of potty training that comes up for every parent: pericare, or perineal hygiene, and teaching kids how to wipe when toilet training. So often, a young child learns to use the toilet and other aspects of potty training, but then struggle for a long period of time with the wiping aspect. Teaching children to wipe thoroughly is a hygiene task that can be limited by many underlying areas. Here, you’ll find strategies to help wiping bottoms and interventions for perineal hygiene.

    How to teach pericare, or perineal hygiene needed to wipe completely during toileting.

    What is pericare?

    For the uninitiated, pericare (or peri-care) is short for perineal care. Perineal care refers to the hygiene and self-care of the perineal area following toileting, cleaning, and wiping of the perineal area of the body is the “private parts” area. Pericare is a term for the hygienic tasks involved in this part of the body, such as wiping one’s bottom.

    Anyone of any age may need help wiping their bottom with their perineal care, but it is especially important to teach our little ones the proper way to manage their bottoms as they become more independent. 

    This component of toileting is one that impacts overall independence and self-care with the toileting process. So often, we cheer and celebrate making it to the toilet on time, but the perineal hygiene aspect is equally as important.

    Related: Potty Training Seats for Special Needs

    You may be thinking, “Why do I need to teach my child how to wipe!?!”. For something that is such a natural task for many, it can feel odd to teach somehow how to do it.

    However, learning how to maintain a clean bottom is important for one’s health and confidence. Wiping properly, washing gently, and wearing appropriate clothing decreases the risk of yeast infections, urinary tract infections, and odors. Plus, discussing peri-care can open the door to many other conversations about the body, health, and safety – if that’s something you are interested in exploring with your child.   

    A great time to educate your child about peri-cares is while potty training. It is easier to teach the correct way first than to re-learn how to do it later. If you are stuck on potty training, we feel you there! Check out this Toliet Training Book that can help you help your children of varying needs.

    Don’t be discouraged if your child is already potty trained and they have yet to learn how to take care of their bottoms independently – it can take time and practice! 

    Development of Pericare

    An important area to cover first is the development of pericare skills. It is so important to remember that we are talking about young children who are learning a whole new skill with toileting. There are many considerations: autonomy, body awareness, interoception, self-awareness, the sensory processing and interoception aspect, family perspectives…potty training can be very overwhelming for kids.

    Then, to break it down even further, the hygiene aspect of toileting is another ball game!

    In our book, The Toilet Training Book, we cover the development of potty training and really cover what underlying skills play into potty training and independence with toileting.

    But, one important thing to remember is that a three year old child may be able to make it to the toilet in time to go, flush, and wash their hands, but the wiping aspect can developmentally, come with time.

    Developmentally, perineal hygiene, or wiping completely after toileting, may be a skill achieved during a range of 4-6 years. This range is so wide due to the underlying skills, sensory considerations, motor skills, and cognitive growth needed for perineal hygiene including knowing when and where to wipe after a bowel movement or urination, using enough pressure on the toilet paper to clean completely, wiping enough times to clean completely, and maturity to complete the task.

    The emergence of these skills takes time, but there are ways to support development of perineal hygiene.

    GET COMFORTABLE with perineal hygiene

    Everyone wants a clean bottom, let’s start there. It can be smelly and embarrassing to talk about, but it is an important step to understanding personal healthcare.

    We want to give you the confidence to discuss this in any way that you and your family feel comfortable with because it is a “touchy” subject for some. The more comfortable you are with peri cares, the more comfortable the child will be. 

    Let’s start off the potty training wiping techniques by talking about good hygiene.

    Here are some ideas to talk about perineal hygiene with kids:

    • Make it silly: Some people respond best to humor but watch out for demeaning jokes. 
    • Make the conversation about pericare hygiene scientifically accurate: It becomes less embarrassing when you hardly know what is being said! 
    • Make pericare sound similar to washing hands: We have to clean away the germs; they can make us sick! 
    • Make discussions about perineal hygiene your own: You know your family best. Think about terminology that works for the individual. In what ways can you increase trust and comfort for all? 

    GENERAL GUIDELINES for teaching perineal hygiene

    Here are some general tips for a healthy bottom that should be shared for children and adults alike. Please speak to your family physician if you have any questions or concerns related to your child’s unique needs. 

    • Wear breathable (preferably cotton) underwear that is not too tight. Change daily or when soiled. 
    • Don’t hold it in. While it is good to wait to “go” until you reach the toilet, holding in pee or poop for too long can result in a variety of issues
    • If it is comfortable, sit on the toilet with elevated feet. You may have heard of the (Amazon affiliate link) Squatty Potty – placing the legs in more of a squatting position helps bowel movements pass. More importantly, children should have access to a either a smaller potty or a footstool (or a box,etc.) near the toilet so that their feet do not dangle. 
    • Wipe from front to back to reduce bacteria entering the urethra. Talk about anatomy and why wiping front to back is effective and safe.
    • Wipe gently with 3-4 squares of folded toilet paper (each household can determine the amount – some kiddos use way too much!) until clean. I always recommend to look at what you are wiping away so that you learn about how much you need to wipe. 
    • Consider use of warm or cool wipes over toilet paper.
    • When bathing, wash the genital area gently with mild soap and rinse with clean water. No soap should be entering the body through the anus or the vagina. 
    • For bathing a uncircumsized child, refer to this article for great information and consult your family doctor for personalized advice.   

    Pericare INTERVENTION IDEAS

    Children will not know unless we lead them, so here are some fun ways to teach pericare! 

    Areas that can be broken down to increase overall self-care include:

    • Address balance
    • Pulling up and down undergarments
    • Wiping front to back
    • Wiping thoroughly
    • Wiping with enough pressure
    • Gripping the toilet paper
    • Washing hands after wiping
    • Reaching around to the back

    Each of these areas can include aspects of balance, gross motor skills, fine motor skills, strength, coordination, sensory processing, executive functioning skills, and visual motor skills. It’s important to look at each individual’s area of difficulty and then break it down into the underlying areas that are impacting success with pericare.

    First look at the area of difficulty. Then, consider how underlying areas are impacting that particular area. Come up with intervention strategies that support that need and create a “just right” challenge to build independence and pericare functioning.

    Let’s look at each of these areas of perineal hygiene…

    Pulling up and down undergarments:

    • Fine motor strength and coordination fine motor activities to the rescue! There are so many fantastically fun ways to increase this skill, but here are some that are more directly associated with potty training. 
      • Lei Obstacle Course: Grab some Hawaiian-inspired leis, hula skirts, or long necklaces and create a long pathway. As a child walks through the pathway (hopefully to another fun activity in the course), they must step inside the lei and pull it up as high as it will go. If it fits over their arms/head, they can wear it as a necklace. Pulling up the lei and wiggling their body through will strengthen the same skill as in pulling up pants. Reverse the challenge to mimic pulling pants down.
      • Silly Socks: Grab a variety of socks in fun colors and different sizes and see how many you can put on in one minute! Layering socks up the arms and legs (and removing them, too!) mimics the skill of pulling up and down undergarments. 
      • Stickers: Challenge them to peel off stickers all along the waistband of their pants. Don’t forget the backside! 

    Pericare: Wiping Activities

    Balance and reach are huge parts of perineal hygiene. Staying balanced on the potty while wiping is a big challenge for our core strength, flexibility, and range of motion. To practice this skill through play-based activities, see the ideas below! 

    Play-pretend: Place peanut butter on the back of a disposable or washable diaper and have your child wipe it off. Any familiar paste will do – sun butter, nutella, cookie butter…anything to wipe! When they think they are done wiping, show them the diaper to see if they actually cleaned it. 

    Art-based: Wipe a plastic plate with toilet paper to create an art project – the toilet paper acts as the paintbrush. They must wipe clean the whole plate! For an extra challenge, place the plate behind their backs, and the work of art in front of them. 

    Play activity: Using static electricity, tape, or velcro, have your child squat to “pick up” pom-poms or other sticky and lightweight items on their bottoms (think: window stickers, damp tissues, etc.). They carry them carefully to a container and remove them one by one. You can really make this game your own!

    Wiping Front to Back

    There are so many ways to work on perineal hygiene to cover other aspects besides the balance consideration. Consider these strategies to teach kids to wipe front to back:

    • Use toys, books, clothing, and other items to work on teaching front and back directional concepts.
    • Teach children to count to help with wiping a certain number of times.

    Reaching Back to Wipe During Perineal Hygiene

    • Clip and unclip clothes pins on the back of clothing to work on reaching back and around..
    • Use a pool noodle to reach around and through the legs to work on reach, visual attention, scanning, and eye-hand coordination. You can tap the pool noodle on a target and create a game.
    • Practice wiping the backside in the bathtub.
    • Put a handkerchief or scarf in their back pocket for the child to reach for and pull out.
    • Put stickers on the child’s back or pants for them to reach for and grab.

    Wiping with enough pressure

    • Work on tearing paper for hand strength and eye-hand coordination to pull off appropriate sizes of toilet paper.
    • Use play dough, LEGO, tong activities to develop hand strength.
    • Wipe dry erase marker off a dry erase board. Then, position the dry erase board on the ground between the feet to bend and wipe. Then, position it behind the back to reach and wipe.
    • Wipe peanut butter or washable paint from a plastic baby doll.
    • Help kids to wipe thoroughly by painting with toilet paper with having them try to wipe a blob of paint off a plastic plate and remind them to keep going until the plate was empty.

    More perineal care and potty training tips

    Looking for more information on underlying considerations that impact toileting? Need strategies, supports, and tools to facilitate independence with toileting skills? Need support strategies for potty training an older child, but not know where to begin?

    Looking for ways to help individuals with toileting skills when cognitive, behavioral, motor skills impact participation in independent toileting? Trying to initiate or progress with potty training when a diagnosis of Down Syndrome, Autism, or a motor skills challenge is at hand? Check out the Toilet Training Book: A Developmental Take on Potty Training for Kids of All Abilities.

    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.