Paediatric Occupational Therapy

What does a Paediatric (children’s) Occupational Therapist do?

Occupational therapy (OT) is a health profession that helps children and young people do the things they need and want to do in their daily lives. These “jobs of childhood” are called occupations and include things like playing, learning at school, eating, and getting dressed. The ultimate goal is to support a child’s health, well-being, and ability to participate in family and community life.

Common Concerns and Referred Diagnoses

Families are often referred to a paediatric occupational therapist when a child faces challenges that interfere with their development or daily routine. Common diagnoses seen in OT include Autism Spectrum Disorder (ASD), ADHD, Cerebral Palsy, Down Syndrome, and general developmental delays. Occupational therapists also work with children who have sensory sensitivities, such as being over-reactive to loud noises, the feel of certain clothing, or the texture of foods. These sensory issues can make ordinary tasks like bathing or sitting in a classroom feel overwhelming or even painful.

The Occupational Therapy Process

The process is focused on the unique needs of each child and family.

Evaluation: This can be a thorough and sometimes lengthy process used to build an Occupational Profile. The therapist talks with the family to understand the child’s history and priorities while identifying strengths and barriers to their success. Evaluation involves interviewing, observing, and measuring through formal instruments how a child is interacting with the world.

Hypothesis and Planning: From this information, the therapist creates hypotheses about what is making certain tasks difficult. The therapist and family then work as partners to decide on an individual therapeutic plan.

Intervention: Therapy often includes psychoeducation to help families understand the reasoning behind certain behaviours, alongside parental coaching. This empowers parents to implement strategies at home that help the child gain independence. The therapist helps children find the right level of challenge through activities they need to perform, practising these activities in a safe and playful space, with environment modifications where appropriate. A range of evidence-based approaches is employed to meet therapeutic goals.

Case Example: Consider a student like Paul, who struggles with handwriting and following directions in a busy classroom. By analysing Paul’s needs, an OT might recommend environmental adaptations, such as moving his desk away from distracting noises or using visual schedules to break down his work into simple steps. These changes reduce the demands on Paul, allowing him to focus on learning and feel successful alongside his friends.

Occupational Therapy and Paediatric Sleep

Occupational therapy offers a unique perspective on sleep because it recognises that sleep is a foundational occupation. Unlike other approaches that focus solely on sleep hygiene or bedtime rules, OT looks at the whole picture: everything a child does during the day shapes what happens at night.

Sleep support in OT involves:

• Analysis: Looking at how daytime energy, sensory experiences, and routines affect the child’s ability to settle at night.
• Behavioural Approaches: Using evidence-based strategies to help a child feel safe, secure, and independent at bedtime.
• Family Strategies: Providing practical problem-solving strategies for families to use at home, such as adjusting the bedroom environment or creating calming sensory routines.

Early support is also available for the youngest children. This support can begin as early as 4 months of age, when a baby’s sleep starts to organise physiologically. It can even begin earlier than that, through preventive coaching for parents to help them establish healthy habits and environments from the very start.