How To Tell if Your Child Needs Occupational Therapy


Does my child need Occupational TherapyKids do all kinds of crazy things, right? In response, you hear things like “boys will be boys” and “she will grow out of it” and “this too shall pass”. At many points when parenting young children we scratch our heads wondering “is this normal?” There is no guidebook to this career of parenthood and it can feel like a lonely road. 

But there is a point at which your kiddo may need more support than you can give them. As an pediatric occupational therapist, I see all sorts of kids in need of a little extra help. 

Even with their quirks, most children develop normally and don’t need any intervention along the road to their school career. Some have medical or developmental diagnoses that involve OT or PT from the few months of life. Still, others need short-term intervention to help them “catch up” to the curve and get back on track. So, what if you have concerns about your child? 

The good news

First, your pediatrician is monitoring things. Those regularly scheduled well-checks involve completing checklists about typical developmental milestones according to your child’s age. 

Also, the preschool or daycare teacher is watching. They conduct periodic assessments to monitor development and hold parent conferences to report progress and concerns. In a group/school setting they see the complex environment mixed with social demands and emerging independence in little ones. Don’t be afraid to pick their brains, and work together to get to the bottom of your concerns.

So, what is Occupational Therapy?

Occupational therapists help people improve their performance in daily occupations – at work or school, whatever is meaningful to a client. For young children, this includes making sure they are on track with development so they can be independent at home and at school. This means things like

  • helping to modify a school environment so that a student can transition between activities
  • teaching another way of putting on a coat or tying shoes to get out to the playground
  • working on hand skills to hold a crayon and use scissors efficiently to make holiday ornaments 

Occupational therapists collaborate with families and teachers to help children fully participate in life. 

How do I know if my child needs OT?

There are red flags that parents can look for that might indicate a need for OT referral. Some common ones are:

1. Fine motor difficulty – still using a “fisted” or whole-hand grasp on a crayon, avoiding coloring/art materials, difficulty cutting continuously across paper, still eating with hands vs. utensils 

2. Gross motor difficulty – can’t pedal a tricycle or jump with two feet, trouble climbing on playground equipment, avoids the swing or slide, difficulty with balance or frequent falls 

3. Sensory processing differences – can’t walk into a busy room, has meltdowns at birthday party, sensitivity to tags in clothes or messy art, picky eating, difficulty tolerating loud noises

4. Poor participation in activities of daily living (ADL) – trouble manipulating fasteners to get dressed, difficulty tooth brushing, toilet training, tolerating seasonal changes in clothing, uncooperative with hair washing, sleeping concerns 

5. Disordered attention/behavior – inability to tolerate transitions, difficulty sitting still (within reason for circle/meal time, to finish a story), needing to control things, frequent meltdowns that are unpredictable or long lasting 

What to do 

First, talk to teachers, and as well as your pediatrician to get a referral. For the birth to three population, Early Supports and Services (in NH) or “Early Intervention” can help with screenings, contact your local region provider. If your child is three or older, your local school department can help with referral to special education and developmental testing, which can include an occupational therapy evaluation. If neither of these scenarios are appropriate, health insurance may cover an evaluation with a private therapist. 

Parenting definitely takes a village. Don’t be afraid to mention concerns to doctors, teachers and other trusted adults who know your child. Keep a list of things to discuss at doctors visits, and rate your concerns over time too. Some private providers will do a phone consult for free, and many insurance carriers cover at least an initial evaluation. In regards to therapy, the basic rule is that “earlier is better” to intervene, so don’t wait. It’s very common for preschoolers to have short term therapy from speech, occupational or physical therapists.