What is Pediatric Occupational Therapy?

Last updated: November 25, 2023

An occupational therapist sitting on the floor playing with blocks with a little boy

What Do Pediatric Occupational Therapists Do?

Occupational therapists (OTs) are experts in helping kids develop life independence.

To OTs, an “occupation” is any activity that provides meaning in your life or allows you to be independent. OTs can address all of a child’s occupations, from learning to play to learning to drive.

They help children who have challenges that make it hard for them to

  • Move independently
  • Develop basic life skills such as feeding and dressing
  • Overcome emotional challenges
  • Focus and concentrate
  • Develop and sustain strong relationships
  • Manage sensory processing difficulties
  • Learn how to play with toys or use their imagination
  • Develop strong thinking and problem-solving skills

OTs help children become as independent as possible as they grow. And they teach parents ways to help their children overcome challenges at home and in school.

Occupational therapists treat children with a wide variety of issues. Some of the children they treat have a history of

  • Birth defects
  • Genetic conditions like Down Syndrome
  • Injuries such as traumatic brain or spinal cord injuries
  • Prematurity
  • Developmental disabilities like ADHD or autism
  • Psychiatric disorders such as anxiety
  • Sensory Processing Disorder
  • Muscle weakness or spasticity
  • Hypertonia and hypotonia (high and low muscle tone)
  • Neuromuscular disorders like cerebral palsy
  • Burns
  • Vision or hearing loss

Many children who are referred for OT don’t have a diagnosis at all. OTs are excellent problem solvers and can help you get to the bottom of a any behavioral or motor challenges that your child may be having.

OTs can also recommend adaptive equipment for children when it is necessary. Examples of adaptive equipment include

  • Hand braces
  • Specially designed feeding devices
  • Seating systems for eating, riding in a car, or sitting at a desk
  • Special equipment for handwriting or typing
  • Equipment to help make dressing easier
  • Mobility devices like wheelchairs or walkers

How Are Occupational Therapists Trained?

All OTs must get a bachelor's degree before applying for OT school.

Most OT schools offer either a master’s degree or an entry-level Occupational Therapy Doctorate (OTD).

Therapists who graduate from an OTD program complete more coursework and research than students in a master’s degree program. Both types of programs take about 2-3.5 years to complete.

In practice, therapists with a master's degree perform the same types of evaluations and treatments as those with an OTD. Both degrees provide equal preparation for national board certification and state licensure.

Some OTs pursue a PhD in OT or in another specialty such as psychology or education. Those programs usually require the therapist to have at least a master’s degree before applying.

After graduating from an accredited OT school, OTs must pass a national board certification exam before practicing.

Most states require OTs to apply for licensure before practicing, as well.

OTs must complete a certain number of continuing education hours every year to keep their state license and national registration in good standing.

Hands-on experience

Before they graduate, OTs are required to complete “fieldwork rotations” which can be thought of as therapy internships.

During these rotations, the students evaluate, plan, and implement treatment for a variety of patients under the supervision of a practicing OT.

This hands-on experience ensures that new therapists are capable and confident with treating real patients before they start their careers.

Continuing education and specialization

While continuing education is required for maintaining state licensure and national registration, most pediatric OTs would prioritize continuing education even if it wasn’t required.

Many pediatric OTs specialize in areas such as school-based therapy, feeding therapy, NICU therapy, autism, and sensory processing disorder.

They focus their continuing education on these areas and become experts over the course of their careers.

Some therapists take it a step further and get advanced certifications.

If you see extra initials behind a therapist’s name, it’s probably because she has an advanced certification in a specialized area of pediatric therapy. Some common certifications are

However, the lack of certification credentials does not mean a lack of specialized knowledge. Most pediatric OTs take continuing education courses in a variety of specialty areas without pursuing certification.

If you are wondering if your child’s OT specializes in a specific therapy approach or diagnosis, just ask. If the answer is no, she will most likely be able to refer you to a therapist who does.

Is Pediatric Occupational Therapy Supported by Research?

Absolutely. Evidence-based practice is the cornerstone of occupational therapy.

Evidence-based practice refers to a healthcare approach that blends scientific research, accepted standards of care, and the therapist’s own clinical expertise.

In addition to using ideas from occupational therapy and occupational science research studies, pediatric OTs pull insights from research and practice approaches from other fields such as

  • Child development
  • Education
  • Psychology
  • Orthopedic Medicine
  • Speech-Language Pathology
  • Neuroscience
  • Sociology

This multifaceted approach helps ensure that your child’s treatment is as comprehensive as possible and addresses all aspects of his development and well-being.

What Age Groups Do Pediatric Occupational Therapists Treat?

Pediatric OTs treat all ages and tailor their approaches to meet the unique developmental needs of each age group.

  • Newborns (0 - 1 month): OTs can help newborns learn to take a bottle if they are having trouble with feeding. They can also teach parents strategies for soothing their baby if self-regulation is an issue.
  • Infants (2 months - 1 year): OTs work with infants and young toddlers to meet basic developmental milestones like sitting, crawling, playing with toys, and finger-feeding.
  • Toddlers (1 year - 3 years): As children become more mobile, OTs work on fine and gross motor skills, social skills, and cognition. They also help parents learn how to help their toddlers manage big emotions.
  • Preschoolers (4 years - 5 years): OTs focus on school readiness, enhancing pre-academic skills like pencil grip and scissor use. They also guide families in incorporating sensory and behavioral strategies into daily life.
  • School-Aged Children (6 years - 11 years): OTs help school-aged kids develop executive skills like organization and mental flexibility. They help with skills like handwriting and typing. They also address motor skill deficiencies through targeted play activities. Some children in this age group go to OT to continue working on emotional regulation and sensory processing issues that were identified in early childhood.
  • Adolescents (12 years - 18 years): OTs help teens with advanced life skills, such as managing stress and emotional self-regulation. They tackle relationship challenges that can crop up during puberty and cover basic life skills like hygiene and pet care.
  • Young Adults (18 - 24 years): Some OTs specialize in the transitional phase into adulthood. They might assist in life skills training, such as budgeting, cooking, and public transportation. They may also continue to support young adults in self-regulation and managing their sensory needs in workplace settings or college life.

So, whether your child is an infant or preparing for adulthood, pediatric occupational therapists offer various treatments designed to assist with everyday activities and more specialized needs.

Where Do Pediatric Occupational Therapists Work?

You’ll find pediatric OTs throughout your community. The most common places they work are

  • Hospitals: OTs focus on recovery from illnesses like cancer, as well as rehabilitation from traumatic brain and spinal cord injuries. They also assist in rehab after surgery, such as following back surgery for scoliosis. Some hospitals have outpatient pediatric clinics, as well.
  • Outpatient Clinics: OT clinics have specialized equipment for treating more intense sensory processing or motor needs. Outpatient OT offices often look more like indoor playgrounds than stuffy health clinics.
  • Schools: OTs provide individual or group therapy either in the child's classroom or in a dedicated OT space. They work on skills that help children succeed academically and socially in school.
  • Preschools and Daycares: OTs help children in preschool adapt to the new demands of school, participate in simple routines, and develop play skills with other children.
  • Home-Based (Mobile) Therapy: Many OTs provide therapy in the child’s home. In fact, government-subsidized early intervention therapy is always provided in a child’s natural environment (home or daycare) unless there is a documented need to see the child in a clinic setting. Home-based OTs can see children of all ages at home.
  • Outdoor Therapy: Some OTs offer group or individual services provided entirely in nature. It’s not uncommon to see kids climbing trees and stomping through puddles during outdoor OT.
  • Virtual or Online Therapy: OTs can work with your child via online platforms such as Zoom. They can also consult with parents and teachers online.
  • Consultation: OTs can consult directly with parents and teachers in person or virtually. They can help problem-solve behavior issues and provide support strategies for home and school. OTs are often asked to consult with schools and community organizations about building sensory-friendly rooms and accessible playgrounds.

Could My Child Benefit From Occupational Therapy?

OT is important for children who are struggling with basic life skills. Some red flags to look out for are

  • Struggling with Daily Tasks: If your child has difficulty performing basic activities like getting dressed, eating, or using the toilet independently, an OT may be able to help.
  • Social Skills Challenges: Kids who have trouble making friends, understanding social cues, or regulating their emotions during play may find OT beneficial.
  • Sensory Processing Disorder: If your child is overly sensitive to lights, sounds, and textures, or has trouble with balance and spatial awareness, this could indicate sensory processing issues that an OT can address.
  • Academic Difficulties: Struggling with handwriting, attention, or organizational skills in a school setting could also be a sign that your child might benefit from OT.
  • Behavioral Concerns: Children who exhibit frequent tantrums, impulsivity, or other difficulties with self-regulation might benefit from OT.
  • Motor Skill Delays: If your child is weak, struggles with coordination, or is just having difficulty meeting their movement milestones like walking or crawling, OT can help.
  • Feeding Challenges: If your child is struggling to transition to solid foods, feed themselves, or tolerate a variety of tastes and textures, he may benefit from therapy from an OT who specializes in feeding therapy.
  • Vision or Hearing Challenges: OT may be beneficial if your child has trouble achieving independence because of their vision or hearing deficits.
  • COVID Learning Loss: If your child has motor, cognitive, social, or academic deficits related to the life disruptions that happened during the COVID-19 pandemic, OT may be beneficial.

If you think your child is struggling, trust your intuition. No one knows your child better than you.

Most pediatric OTs offer free 15-minute phone consultations, so feel free to reach out to one about your child. They can help you figure out if an evaluation is necessary and help you determine the next steps.

Talk to your child’s pediatrician as well. They can provide advice and guidance about therapy. You’ll likely need a prescription from the pediatrician before you begin therapy, especially if you are using insurance.

If your child has an Individualized Education Plan (IEP) at school, you may be able to request an OT evaluation from his special education team.

How Do I Pay for OT for My Child?

OTs accept the same payment methods as any other healthcare professional. Some examples are

  • Insurance: Most OTs accept some form of insurance, whether it's commercial insurance like Blue Cross Blue Shield or public insurance like Medicaid.
  • State Programs: Some states offer grant programs or waivers that can subsidize or completely cover the cost of therapy for children with specific diagnoses, such as autism.
  • School Districts: If your child has an Individualized Education Plan (IEP), your school district may provide occupational therapy as part of their educational program.
  • Fee-for-Service Therapists: Some OTs operate on a cash basis, meaning they don't accept insurance. These therapists won't file insurance claims for you, but they offer the flexibility of paying out-of-pocket.

Don’t be afraid to ask your child's therapist about payment options, as some therapists offer sliding-scale payment plans for families who qualify.

How Do I Find the Right OT for My Child?

Start with a prescription

In many areas, OT requires a prescription from your child's pediatrician. This is especially true if you intend to use insurance to cover the costs. Your pediatrician can often refer you to reputable therapists they've worked with before.

Early intervention services

If your child is between 0 to 3 years old, look into early intervention programs in your state. These services include OT and can assist you in setting it up.

Word-of-mouth and personal recommendations

If you know other parents whose children have participated in therapy, ask them for recommendations. Personal experience can offer valuable insights into a therapist's methods, demeanor, and effectiveness.

Ask a teacher

If you know a teacher or have a good relationship with one of your child’s teachers, ask them for recommendations.

Like therapists, teachers have seen it all. There’s a good chance they can give you the name of an OT with a good reputation in your area.

Search online

While online searches can be hit-or-miss, a specialized pediatric therapy directory can give you quick access to a list of qualified professionals where you live. This could be particularly beneficial if you're new to the world of therapy and don't have personal recommendations to lean on.

Finding a therapist who can build a solid relationship with your child is key. Most OTs offer free 15-minute phone consultations. Take advantage of that and talk to several before you commit to one.