Child at TableIn a pediatric setting, Occupational Therapists treat children with a variety of diagnoses and address a variety of skill areas by working with families, as well as during therapy sessions. Some of these include:

  • Fine motor skills – using the hands, eyes, lips and tongue
  • Gross motor skills – movement using the large muscles, (i.e., running, jumping, etc.)
  • Visual motor skills – using the hands and eyes together to accomplish a task
  • Visual Perceptual skills– understanding depth perception, the visual qualities of objects such as size, shape and color, seeing objects in a complex background such as finding a small item in a drawer full of things, following lines on a page
  • Self-help skills – the ability to feed, dress, and groom oneself, etc.
  • Sensory skills – Using all of the senses to learn. Regulating the senses to sleep well, concentrate on a task, eat a wide variety of foods, tolerate noisy, active environments, and much more.

These are some of the skills you may observe your child doing:

  • Moves her arms symmetrically
  • Can bring her hands to midline while on her back
  • Blinks at sudden visual stimulus
  • Grasps toy actively
  • Keeps hands open 50 percent of the time
  • Turns head to both sides while on her back
  • Lifts head while on stomach
  • Extends both legs
  • Rolls from side to her back
  • Opens and closes mouth in response to food
  • Naps frequently
  • Stays awake for longer periods without crying – usually in p.m.
  • Coordinates sucking, swallowing, and breathing
  • Follows a moving object with eyes while in supported sitting
  • Clasps hands
  • Keeps hands open most of the time
  • Reaches and grasps object
  • Drops object
  • Rolls from her back to her side
  • Bears almost all weight on legs
  • Holds head erect when leaning forward
  • Sits momentarily leaning on hands
  • Uses her tongue to move food in her mouth
  • Recognizes bottle visually, pats bottle
  • Sleeps at night, for 10-12 hours with night awakening
  • Places both hands on bottle
  • Mouths and munches solid foods
  • Bangs object on table
  • Manipulates toy actively with wrist movements
  • Reaches and grasps object with extended elbow
  • Releases object voluntarily
  • Sits without hand support for 10 minutes
  • Crawls forward/backward
  • Gets to sitting without assistance
  • Makes stepping movements
  • Pulls to standing at furniture
  • Feeds self a cracker
  • Bites and chews toys
  • Drinks from cup held for her
  • Drools less except when teething
  • Pokes with index finger
  • Bangs two cubes held in hands
  • Puts objects in and takes objects out of container
  • Uses both hands freely; may show preference for one
  • Lowers to sitting from furniture
  • Stands momentarily
  • Walks holding onto furniture
  • Pivots in sitting – twists to pick up objects
  • Finger feeds self
  • Holds spoon
  • Sleeps nights twelve to fourteen hours
  • Cooperates with dressing by extending arm or leg
  • Marks paper with crayon<
  • Puts three or more objects into container
  • Builds tower using two cubes
  • Points with index finger
  • Stands alone well
  • Falls by sitting
  • Throws underhand in sitting
  • Walks without support
  • Bends over and looks through legs
  • Brings spoon to mouth – turns spoon over
  • Holds cup handle
  • Child scribbles spontaneously
  • Turns small container upside down to obtain tiny object
  • Puts many objects into container without removing any
  • Uses both hands at midline – one holds, other manipulates
  • Builds tower using three cubes
  • Throws ball forward
  • Pulls toy behind while walking
  • Stands on one foot with help
  • Walks upstairs with one hand held
  • Carries large toy while walking
  • Indicates discomfort over soiled pants; by verbal/gesture
  • Sleeps nights ten-twelve hours
  • Naps one in afternoon one-three hours
  • Removes socks
  • Places hat on head
  • Imitates vertical stroke
  • Imitates horizontal stroke
  • Builds tower using six cubes
  • Strings three one-inch beads
  • Snips with scissors
  • Helps with simple household tasks
  • May have definite food preferences
  • Unwraps food
  • Pulls pants down with assistance
  • Unbuttons large buttons
  • Goes up and down slide
  • Stands on tiptoes
  • Walks with legs closer together
  • Catches large ball
  • Walks upstairs alone – both feet on step
  • Imitates a cross
  • Folds paper in half
  • Builds tower using eight cubes
  • Places six square pegs in pegboard
  • Walks on tip-toes a few steps
  • Jumps backwards
  • Jumps sidewards
  • Jumps on trampoline with adult holding hands
  • Dresses self with assistance
  • May reject many foods
  • Insists on doing things independently
  • Hangs clothing on hook
  • Helps with bathing self
  • Imitates cross
  • Copies a circle
  • Snips on line using scissors
  • Builds tower using nine cubes
  • Climbs jungle gyms and ladders
  • Catches eight inch ball
  • Runs on toes
  • Makes sharp turns around corners when running
  • Pours liquid from small container
  • Uses fork
  • Uses napkin
  • Buttons large buttons
  • Dries hands

Normal Sensory Integration Development Sequences


Good Sensory Integration: The baby…

  • After six weeks of age has fairly well-established sleep cycles. Sleeps all night by six months.
  • Likes to be held and molds her body to that of the adult holding her.
  • Is comfortable when being moved.
  • Easily moves from one position to another.
  • Has favorite songs or movement games, and anticipates these special interactions.
  • Explores toys by putting them in his mouth.
  • After six months accepts solid and textured foods when introduced.
  • Can attend to more than one stimulus at a time. For instance, can look at a book while listening to a story.
  • Has favorite sensory stimuli, such as certain music, finger games, flavors, etc.
  • Plays with the two hands in the middle. Transfers toys hand-to-hand.

Concerns: The baby…

  • Has not developed predictable sleep/waking cycles; is frequently difficult to calm or get to sleep.
  • Arches or attempts to pull away when being held.
  • Becomes irritable when moved or position is changed.
  • Prefers to stay in one position.
  • Avoids novel play situations or interaction with others.
  • Avoids mouthing toys.
  • Has difficulty with solid or textured foods, “picky” eater.
  • “Tunes out” if more than one stimulus is presented.
  • Caregivers have difficulty determining baby’s preferences.
  • Uses just one hand at a time (after 8 months).
Good Sensory Integration: The toddler…

  • Enjoys touching textures; plays with food, textured toys, sand, play-doh, etc.
  • Enjoys bath time and accepts touch from washcloth. Accepts clothing moving against skin during diapering and dressing.
  • Plays in imaginative and unique ways.
  • Spends time exploring the various features of toys (the sights, sounds, texture, etc.)
  • Understands simple directions without gestures, listens and looks when spoken to.
  • Accepts various clothing textures. Accepts clothing that is appropriate to the weather.

Concerns: The toddler…

  • Avoids finger feeding, touching textured toys, messy hands.
  • Is excessively upset by dressing and diaper changes or by bathing.
  • Is “stuck” in play, continues to mouth, bang or throw toys repeatedly.
  • Has short attention to new toys, does not independently explore toys’ properties.
  • Has poor eye contact: Makes inconsistent responses (actions) when spoken to.
  • Is fussy about clothing textures. Avoids wearing shoes, OR insists on wearing shoes on all textured surfaces such as carpeting or grass. Insists on heavy clothing during hot weather, OR avoids clothing, even in cold weather.
  • Noises such as thunder, sirens, vacuum cleaners are frightening.
Good Sensory Integration: The toddler/child…

  • Adjusts play to the situation, active play outdoor lay vs. structured, quiet play inside.
  • Explores new play equipment, with good balance and body control
  • Can remain focused on a task despite a moderate level of activity in the room
  • Is able to participate in simple group activities: Understands the sequence of changes in group activities. Is able to understand turn taking.
  • Is comfortable with trying new things, or changes in routines.
  • Is able to tolerate moderately loud noises, and unusual environmental stimuli.
  • Accepts tooth brushing, bathing, and grooming, unless distracted by play.

Concerns: The toddler/child…

  • Has an intense need for constant movement such as jumping, rocking, swinging; Can’t sit still. OR avoids movement.
  • Has difficulty getting on and off play equipment, or is clumsy. Avoids new movement play situations. Does not want feet off the ground.
  • Is easily distracted by sights and sounds.
  • Seems to get lost in group activities. Is unable to take turns, even with adult assistance.
  • Becomes upset if routines and plans are changed.
  • Is upset by loud noises. Can hear distant sounds that others do not hear. Has unusual responses to light, smells, or other sensory experiences.
  • Has poor tolerance of grooming such as hair combing or shampooing, tooth brushing.

When to Consider Referring a Child to Occupational Therapy


Birth to 2 Months:

  • doesn’t blink
  • does not grasp objects placed near palm

3 Months

  • does not follow an object with her eyes
  • hands remain closed almost all of the time
  • frequently resists being held
  • becomes upset when moved, as when being picked up, laid down, or handed from one familiar person to another

4 Months

  • does not swipe at or reach for objects
  • does not bring hands or objects to his mouth
  • frequently irritable for no apparent reason
  • does not place both hands on her bottle while fed

5 Months

  • does not hold his own bottle
  • doesn’t smile at his image in a mirror

6 Months

  • involuntarily drops objects after only a few moments
  • does not actively grasp large finger foods such as teething cookies when they are
  • placed on the highchair tray
  • is excessively and consistently upset by leaving the home

7 Months

  • does not transfer an object from one hand to the other

Downs Child10 Months

  • not beginning to pick up small objects
  • does not poke with index finger
  • is not accepting a variety of food textures
  • is excessively upset by being dressed, diapered, bathed, or having hair groomed

12 Months

  • isn’t able to pick up a cheerio or other small object with tip of the thumb and the tip of the index finger
  • is not sleeping through the night most of the time
  • is not interested in exploring toys made for one year-olds
  • is excessively upset by sound of siren, barking dog, vacuum cleaner, or other familiar loud noise

15 Months

  • cannot put a one-inch object into a container with a slightly bigger opening
  • cannot stack two cubes
  • cannot put a round form into a round shape on a puzzle

18 Months

  • cannot point to a few of the following body parts: eyes, nose, mouth, hair, tummy, legs, feet, and hands
  • cannot turn pages of a cardboard book, or regular small book two or three pages at a time.
  • cannot stack four blocks

24 Months

  • play with toys only by tapping, shaking, or throwing
  • cannot unscrew top of a one-inch or two-inch bottle
  • cannot remove socks, untied shoes, or pull-on pants without help

30 Months

  • cannot imitate drawing a vertical line or a circular scribble on paper immediately after seeing an adult draw these lines
  • cannot stack eight to ten cubes
  • cannot imitate drawing a horizontal line immediately after seeing an adult draw a horizontal line

36 Months

  • cannot remove all pull-on clothing after fasteners have been undone
  • does not imitate the actions of adults in the home
  • does not pretend during play

HCEI dba Karen A. Fay Occupational Therapy Services

We provide occupational therapy services to individuals from infant to adult. If you think you know of an individual may qualify for our services, or if you’re just not sure, see How to Obtain Services.  Alternatively, you may visit our Occupational Therapy Services page for more information.

Do you have more questions?

Call 928-776-9285, or email us using the form below.