What is Paediatric Occupational Therapy?
The origins of occupational therapy
Occupational therapy dates back to the 1700s when physicians started to challenge the lack of treatment for people who were mentally ill. The introduction of purposeful daily activities to treat patients began, but it wasn’t until 1929 that this form of therapy was introduced to the U.K by Elizabeth Casson. Dr Casson, the first woman to be awarded a medical degree, recognised that occupation – daily activities that bring meaning and purpose – was integral to the treatment of patients. She borrowed funds to enable her to set up an occupational therapy school.
Since then, occupational therapy has evolved as a practice to help both children and adults develop or regain skills needed to perform activities in their daily lives.
Today, in the UK, there is a British Association and College of Occupational Therapists and a professional body for occupational therapy professionals.
Over 30 UK universities offer occupational therapy qualifications at degree, postgraduate diploma, or master’s level.
How can a child benefit from occupational therapy?
Occupational therapists look at how the whole body functions as a unit, but there are specific areas they may focus on:
- Self Help – These are skills required for independence such as dressing, feeding, and toileting.
- Balance and Coordination – The ability to maintain a balanced body position during activities, and coordinate movement (rolling, crawling, walking, running, hopping) and sitting still.
- Body Awareness and Movement – This is also known as spatial awareness: having a sense of your own body and a sense of objects around you to organise your movements. For example, a young child will learn how far they need to stretch to reach a toy.
- Fine Motor Skills – These are the small movements of the hands which enable children to grip, release and manipulate objects and toys.
- Gross Motor Skills – Also known as physical skills, they are the foundation of whole body movement and enable the large muscles of the body to perform everyday activities, e.g. rolling, sitting upright, walking, running, jumping, hopping.
- Low Muscle Tone – Also known as hypotonia, where the muscles in the body can appear loose or floppy.
- Visual Perception Skills – The ability to look at an object and make sense of it by identifying if it is big or small, near or far, the right way up or upside-down, and similar or different to other objects. By processing what they see, children are then able to respond with appropriate movement, e.g. picking out an object from cluttered space.
- Sensory Processing – The ability to understand, process and organise the five senses, sight, hearing, touch, taste and smell, and respond appropriately to them in the environment.
If a child is having difficulties in one or more of these areas, this can have an impact on other areas of their development, including their self-esteem, confidence, and independence. Occupational therapists, therefore, offer children broad support that extends beyond assistance with physical skills.
An occupational therapist can also assess children with complex needs who may require specialist equipment at home or in the nursery/school environment, e.g. seating, hoists, splinting, and equipment to ensure safety at bath time.
What does a child’s assessment involve?
Assessment includes information gathering from parents, families and others involved in the child’s life. Occupational therapists also build on what is already known about the child from other professionals in health, education and social care.
There is no standard assessment for occupational therapy, but each establishes a baseline of how the child or young person uses their functional skills in their daily life. Occupational therapists combine clinical observation with a standardised or non-standardised assessment to gather this information. They commonly observe a child or young person at nursery/school or in their home environment and within their practice.
Following observation and assessment, therapists write a report of their findings and, if the input is considered appropriate, they develop a plan to meet the needs of the child.
What happens next?
The primary goal of paediatric occupational therapists is to enable children to participate as fully as possible in everyday activities. Support is varied and may include:
- direct therapy in their clinic, health centre, or at the child’s home, nursery or school
- individual programmes designed to be implemented at home, nursery or school
- training and advice for parents/carers and other professionals involved
- specialist equipment recommendations to support functional skills and learning
- contributions to Education, Health and Care Plans
- support for any transitions, e.g. starting nursery or school
Parents and carers, key-workers and teachers play a critical role in the child’s therapy as they implement the occupational therapist’s suggestions at home and at nursery/school.
After an agreed time period, occupational therapists review the child’s progress and offer further recommendations. If the child is reaching their potential or the child or family no longer wish to continue with the service they are discharged.
Who can be seen by an occupational therapist?
Occupational therapists treat and manage children with a wide range of needs and conditions that may be present from birth or become apparent with age. They commonly work with children who have a diagnosis of:
- spina bifida
- down syndrome
- global developmental delay
- cerebral palsy
- other chronic illnesses
They also work with children who have:
- orthopaedic injuries
- traumatic injuries
- post-surgical conditions
This list is not exhaustive.
A diagnosis of a specific need or condition, e.g. autism, does not automatically entitle children to therapy on the NHS. They will require a full assessment from an occupational therapist first.
Is a referral required?
Occupational therapy can be offered through the NHS although there may be quite a wait for an initial assessment. Referrals are most commonly made by health professionals, including paediatricians, GPs, health visitors, speech and language therapists, physiotherapists and school nurses, or through social workers. Information about your local occupational therapy service can be obtained from your GP practice or school.
Private occupational therapy
There are a large number of private therapists who can be contacted directly. However, it is important to check that a therapist is a fully qualified member of a recognised body such as the Royal College of Occupational Therapists (RCOT). The RCOT website has a helpful search field for occupational therapists by area. The NHS advises that ‘Only healthcare professionals registered with the Health and Care Professions Council (HCPC) are allowed to use the title of “occupational therapist”’. You can check if an occupational therapist is registered with the HCPC on the home page of their website.
What to do if you have concerns about your child’s development
It is always a good idea to have a chat with your health visitor, GP or another health professional if you have any concerns about your child’s development, no matter what they might be. Professionals will be able to give you advice and information and signpost you to services that could help.
It is also important to remember that every child is unique and different: all children acquire skills at different times from one another. It can be so easy to compare your child to others, so having a better understanding of individual development and expectations can really help. In this way, you ensure professional support for your child when it is needed, but also personal guidance for yourself so you can help your child to play and learn to the best of their ability.