A Pediatric OT’s Guide to Supporting Sensory Regulation Through Movement

As a pediatric occupational therapist, one of the most common recommendations I give to families, teachers, and caregivers is to incorporate “heavy work” activities into a child’s daily routine. Whether your child is neurodivergent (such as with sensory processing differences, autism, or ADHD) or simply has big energy and big emotions, heavy work can be a powerful tool to help them feel calm, focused, and in control of their body.

In this post, I’ll walk you through:

What Is “Heavy Work”?

Heavy work refers to activities that engage the body’s muscles and joints through resistance and pressure. These movements provide proprioceptive input—a type of sensory input that tells the brain where the body is in space.

In simple terms, heavy work helps the body “wake up” or “calm down,” depending on what the nervous system needs. These activities often include pushing, pulling, lifting, squeezing, climbing, or carrying.

Examples of heavy work:

Pushing a laundry basket filled with stuffies

Carrying groceries

Doing animal walks (like crab walks or bear crawls)

Climbing on playground equipment

Wall push-ups

Jumping on a trampoline or playing hopscotch

Why Is Heavy Work Important?

Heavy work is beneficial for all children—but especially for those with sensory processing challenges, difficulty with self-regulation, or high activity levels. Here’s why it matters:

Calms the nervous system

Heavy work can be organizing and regulating, especially for kids who are feeling overstimulated or anxious. It can bring a sense of grounding and control.

Improves focus

When children get the sensory input their bodies need, they can focus better at school, during meals, or in therapy sessions.

Builds body awareness

Proprioceptive input strengthens a child’s sense of where their body is in space, which can help with coordination, balance, and motor planning.

Encourages self-regulation

Heavy work gives kids safe, productive ways to channel big emotions and energy. Over time, it helps build emotional awareness and regulation skills.

How to Incorporate Heavy Work Throughout the Day

You don’t need fancy equipment or extra time to make heavy work part of your routine. Here are a few easy ways to incorporate it naturally:

Morning Routine

Wake up the arms and legs with gentle squeezes

Pillow squishes while making bed

Animal walks out the door

 After School

Create a safe space to jump and crash

Wheelbarrow walks between rooms

Outdoor fun (ie hopscotch)

Bedtime Wind-Down

Engage in deep pressure hugs

Push or carry a sack of their toys to ‘put to bed’

Gentle massage or compressions to arms and legs

How to Use the Heavy Work Poster

To make it even easier for families, therapists, and teachers to use heavy work consistently, I created a Heavy Work Activities Poster—designed specifically for kids! I’ve included my top favorite heavy work activities that have worked well with so many children and their families including but not limited to: gentle squeezes, wheelbarrow walks, wiping surfaces and more).

Keep in mind that not all activities would be suitable for every child. Help your child engage in the activities to find the ones they enjoy best. Then, during times of stressful transitions or times of needed movement, the poster will serve as a visual reminder as to which activities to engage in. Feel free to write on the poster or circle activities to help create your own personalized sensory routine.

More on how to use it:

Hang it in a visible space

Place it somewhere your child spends time—like the playroom, sensory corner, classroom, or even on the fridge.

Use it proactively

Don’t wait until your child is dysregulated. Choose a few activities from the poster before transitions, after screen time, or whenever your child needs to refocus. The more consistent you are, the more your child’s body will start to anticipate and benefit from the input. Try building heavy work into transitions or daily rhythms.

 Let your child choose

Giving your child a sense of control helps them stay engaged. Ask: “Would you like to do crab walks or push the laundry basket today?” Although the poster offers twelve different heavy work activities, give them the option of a few (2-3) at a time.

Oral seekers

For children who tend to be oral seekers, or who enjoy added sensory input in their mouth such as biting, crunching, spitting or licking: try the heavy work activities that incorporate oral motor input (pretend marching band with an instrument or blowing bubbles while stomping).

Final Thoughts

Heavy work isn’t just a therapeutic strategy—it’s a powerful and natural way to help children feel more confident in their bodies and more regulated in their emotions. Whether you’re a parent, educator, or therapist, adding simple, consistent heavy work activities into your day can make a big difference.

The Heavy Work Poster is a great starting point to make these strategies more visual and accessible for your child. Use it daily, make it fun, and watch how it transforms your child’s ability to self-regulate.

This poster is the beginning to the sensory support products we plan to launch. Stay up to date by following our social media @seedsforspecialneeds for more product launch updates.

Hey everyone, I’m back with another back to school tip – spreading backpack awareness.

I don’t know about you guys, but when I was in grade school, I was always carrying a huge trapper planner, my lunch box, thermos, school supplies, and a few library books in my bookbag. The bag honestly was SO heavy. But it seemed normal. My shoulders would hurt, and the skin would be a little red from the weight. The only time that the weight of my bookbag came into question was at my annual pediatrician appointment, when they checked for scoliosis. While I did not have scoliosis, or an abnormal curvature of my spine, my doctor did educate us on how the weight of the bag can cause strain and poor posture.

The American occupational therapy association (AOTA) deemed the third Wednesday of September to be “Backpack Awareness Day.” As Occupational Therapists, we have knowledge about the anatomy and physiology of the body, ergonomics, and child development. Your child’s backpack should change in size and function as your child grows. But wearing the backpack incorrectly, making it too heavy, and/or wearing the wrong size can gradually affect your child’s body over time.

A child’s shoulders and neck have many muscles, nerves, and blood vessels. If restricted or compressed by a heavy backpack, it can cause numbness, tingling, and/or pain down their arms. Carrying a heavy load can also cause a compressive force on the spine, making the space between the intervertebral discs smaller, and it can distort the natural curvature of the spine.

The body often tries to compensate for the weight of the backpack, and can force kids to lean forward when they walk if they bag is too heavy. For some children, it can increase their risk of falling.

In some cases, children will wear a backpack using one strap. This creates an uneven weight distribution and can cause a child to lean to the opposite side to compensate for the uneven weight. This leaning strains neck and shoulder muscles.

The key factors to keep in mind are: the type of book bag your child has, the bookbag’s size/dimensions and how that relates to wearing the bag, and how to pack the bag.

There are many different types of backpacks and names for them. Some of the more common options are as follows:

• Standard backpack– this is the most standard type of backpack. It usually has two straps, one large opening, and potentially one smaller compartment in the front. Two straps mean that the weight of the bag is more evenly distributed.
• Sling bag/messenger bag– this usually has one single strap that goes over the shoulder, and the pockets are smaller. It is meant for lightweight items and quick trips, not books and heavy loads. By having only one strap, the weight of the backpack is not evenly distributed across your child’s upper body and torso. This is not an ideal choice of a backpack.
• Functional Backpack– similar to the standard backpack except it has more features. Features usually include more pockets, and are reinforced and have more structure. Many of the compartments have designated slots and pockets for specific items; some include a key ring for your child’s keys, pencil holders, and water bottle holders. Having two reinforced and padded straps, this is a good choice for a child’s backpack.
• Rucksack– this is also similar to a standard backpack but it can have additional straps (like a chest strap). They usually has a main compartment that closes with a buckle flap versus a zipper, and they are usually able to carry more weight comfortably.  By having extra straps that can go around your child’s chest and/or their waist, this can help to prevent the shoulder straps from slipping, and provides better weight distribution. The only potential downside is if the main compartment of the back pack closes with a buckle instead of a zipper, the contents of the bookbag may not be secure. This could be a good choice for some children.
• Drawstring backpack– lightweight bag, with one major compartment and a drawstring closure. It is not sturdy, and does not have padded straps to distribute weight. This bag is flimsy and is meant for lightweight items; this is not an ideal school bookbag.
• Rolling backpack– Similar to a functional backpack, but it has an extendable handle and wheels. It can hold heavy items and won’t put added weight on your child’s body. However, it can be difficult to pull around the school building (especially stairs), and can be a tripping hazard. This may be a good choice for some students.

Key added features to think about when choosing a backpack:

• Sternum strap– a strap that can be worn across the chest to connect shoulder straps and keep them from sliding back and off the shoulders.
• Hip strap– a strap that can be worn across the hips to provide additional support and weight distribution.
• Mesh panels– on the area of the bag that makes contact with your child’s back can provide ventilation to prevent your child’s back from getting too sweaty.
• Waterproof– to help keep your child’s belongings protected in the rain, or if their water bottle spills.
• The number of pockets-having multiple pockets can be helpful with organizing, but too many can make it easy to lose items in the bag.
• Laptop compartment– is your child carrying a tablet or laptop? Consider having a bag with a padded, separate laptop compartment to protect it.
• Fasteners– Be mindful of fasteners, can your child do these? You want to foster independence, so either ensure that their backpacks have fasteners they can manipulate and/or practice with your child so that they can become more independent with the back pack.

Size and dimensions

Ever look at a child carrying a bookbag and think to yourself that the bookbag is bigger than them?!?! Well, in some cases, you might have been right; they were wearing the wrong size.

When choosing a backpack you should be mindful of the dimensions. Backpacks should not be longer than a child’s back. There are two measurements that are important; maximum height and maximum width. To determine maximum height measure the distance between the top of your child’s shoulders and to their waist (around their belly button) then add two inches. Your child’s back will have different dimensions at different points. Therefore, you want to measure the space between your child’s shoulder blades (when they are relaxed, not when they are pulling their shoulders back), and then add an inch or two. The back pack should be able to be centered between their shoulder blades, can be a few inches below their waist (belly button area), and the shoulder straps should be snug but comfortably rest on the shoulders. You do not want the straps to be too tight and restrict their range of motion, but you also do not want them to be too loose and allow the bookbag to hang too low on the body.

Packing the bookbag

There are several important factors to consider when packing your child’s backpack.

• First off, your child’s backpack should not weigh more than approximately 10% of their body weight. In other words, if your child is 50 pounds, the backpack should not be heavier than 5 pounds.
• As often as you can, at least once a week, check your child’s backpack to ensure that they are only carrying items that they need for that day at school, and for that night to do homework. Any unnecessary items, take them out.
• Is your child allowed to have a water bottle in school? Consider having them pack an empty bottle, and fill the bottle up with water in school.
• Instead of packing their lunch box and putting it inside of their backpack, encourage your child to carry it in their hand to decrease the weight on their back.
• When packing the bag, load the heaviest items closest to your child’s back. Having heavier items closer to your child’s body helps them to maintain an optimal posture and balance when wearing the backpack. Conversely, the lighter items should be at the front of the backpack, and sharp items should also be away from the back (like scissors).
• When arranging the items in the bag try to pack it so that the items will not shift and slide around when moving.
• Once you establish the ideal way and amount of things that need to go into your child’s bag, teach your child how to pack their bag. While you can help them pack it before school, your child’s teacher may not be able to help them pack it before they leave school. If your child has difficulty remembering how to pack it, take a picture of it ideally packed and tape it to the inside of the bag. You can also try color coding and numbering the items. For example, does your child like rainbows? Put a red sticker and/ or a #1 on the item that belongs closest to their back. Put an orange sticker and or a number 2 on the next item, etc. 
• Modeling and practice should also be included for putting your child’s backpack on and taking it off. Especially practicing the fasteners! 
• Lastly, if your child’s teacher insists on your child carrying heavy items to and from school, consider talking to them about the 10% body weight rule, and see if they are open to reconsidering the daily necessary academic items.

Check out our handout for a quick and easy summary of the information above. Thanks for reading!

It is not what you do for your children, but what you have taught them to do for themselves that will make them successful human beings.”

Ann Landers

Chores – We grew up despising that word. And now our kids do? However, as Pediatric Occupational Therapists (OTs) who support children with their functional and meaningful daily tasks, we know the benefits of chores are numerous. From sensory input to sequencing – developmentally appropriate chores have it all.

This blog post will list out chores that are appropriate for each developmental age, their benefits, how to help children become more independent with chores and how to reframe the idea of chores to make them a more rewarding and positive experience for all children.

Benefits of Chores:

We wouldn’t be OT’s if we didn’t first talk about chores and how they relate to ‘Activities of Daily Living’ or ADLs. ADLs is a term commonly used by OTs which refers to the meaningful everyday tasks that a person engages in to have a successful life. These include bathing, getting dressed, feeding etc. Instrumental Activities of Daily Living or IADLs, on the other hand, are similar to ADLs, except that these tasks require more complex and higher level skills to complete. Although they may not be essential to basic survival such as eating and bathing, they are still important to have meaningful engagement in the world. Examples of IADLs are: home management, meal preparation, etc. Therefore, teaching children to become more independent with chores sets them up to have meaningful engagement in the real world.

Learning how to do age-appropriate chores not only helps to foster independence and accountability but also helps children work on many skills such as their fine, gross and visual motor skills, bilateral coordination, language development, sensory input, sustained attention, sequencing, organizational skills and more – all skills they will need to success in the school environment as well.

Now let’s break down the specific skills mentioned above and how they can be acquired by engaging in chores (you may also find the italicized words in our glossary section):

• Sensory Input  – Doing chores can provide a lot of sensory input especially for children who seek movement, touch, visual stimulation and even auditory stimulation (ex listen to the sound of a spray bottle squirting water or the rag wiping left to right). One sensory input, in particular, that is enjoyable to children who either seek and/or avoid sensory stimulation is called proprioception – and a type of proprioceptive input that can be achieved through chores is categorized as ‘heavy work activities’. Heavy work provides a calming and organizing effect on a child’s body when they receive deep pressure in their joints by carrying, lifting, pulling and/or pushing items. This can be achieved by carrying a laundry basket filled with clothes, vacuuming, and even putting groceries away.
• Gross motor skills: Lifting, transferring and coordinating the body to complete chores works on strengthening a lot of the larger muscles of the body.
• Bilateral Coordination – Using both hands to lift, manipulate and transfer items allows both sides of the body to work in a coordinated and organized manner.
• Fine motor skills: Many chores work on strengthening the finer muscles of the hands which is especially important for handwriting. Examples include pressing down on a spray bottle, wiping spills, hanging laundry with clothespin, etc.
• Visual motor skills: Seeing where the “mess” is and coordinating body movements to clean up the mess allows the eyes and body to work together, a skill that is essential for tasks like cutting.
• Tactile input/ tactile desensitization: Many household cleaning materials such as rags, mops, dusters come with various textures. Encourage your child to explore and become more normalized with touching different textures to prevent tactile sensitivities.
• Attention and Sequencing: By completing chores, children have to visually attend to the task until it’s complete and follow a sequence of steps. This helps work on increasing their attention span and sequencing skills.
• Language: Encourage your child to learn the names of various cleaning items, practice identifying the properties of the objects, practice social skills of turn taking and following directions. 

Chores by Developmental Age

Before I talk about ways to help children become more independent with chores and have a positive outlook on these tasks – here is a list of chores that are appropriate for your child based on their developmental age:

Helping Children Become More Independent with Chores:

• It is important that chores are developmentally appropriate for your child’s age (see chart above) for safety purposes and also for the just-right-challenge (a task that is not too difficult but challenging enough to promote learning).
• Children can do chores long before they can talk about it. Since children learn by first seeing, modeling how to complete the chore is important when demonstrating how to safely use the equipment and coordinate the body movements.
• There are different types of supports or cues to provide your child (ie physical, verbal, visual, etc). When providing physical support, place your hand under or over the child’s hand to guide them through the action of completing the chore. When providing visual cues you can place a sticker on the part of the broom stick, for example, where your child’s hand should be placed and/or mark the spot on the floor where they should collect the scraps of paper on the floor with their broom. Verbal cues can be given as well (ex: “Use both hands to hold the broom, move in a side to side motion etc). Gradually diminish any and all cues provided as your child learns to become more independent with the given task.
• Remember to not teach them these skills when in a rush. Practice takes time.
• Understand that there may be a cultural component to completing chores.

Making Chores More Pleasurable:

Many children view chores as a undesirable and time wasting task. Here are ways to change that perspective:

• Consider describing and engaging in chores with the “growth mindset”. In other words, children should perceive difficult tasks as something beneficial and important to their wellbeing. For example, instead of thinking “ugh, I have to clean up my room” – think “I deserve to have a clean room so I can be safe and find everything I need.”
• Consider framing chores as a way in which you are doing your job to help the family versus a punishment when doing something wrong.
• As an adult and model figure for your child, always check to make sure your own views and statements on chores are seen in a positive light. For instance, while washing the dishes, if you appear upset or bothered, this portrays the idea of washing dishes as something dreadful. However, if you verbalize in front of your child how great it feels to have clean dishes for the family, they will view this task as something important to keep the household functioning.

Playing with Cleaning Toy Sets:

Cleaning toy sets are a great way for children to associate cleaning with joy. It is also a great opportunity for parents to work on many skills required to help your child become more independent with certain tasks. Check out our Toy Review tab for recommended ways to play with a dust set:

Some examples of ways to engage with dust sets are:

• Tell your child the names of each of the objects, what they do, and on what surfaces do you use each item.
• Demonstrate their use with the toys and show them with your adult version of each item.
• Go over the properties of each item- the bristles on the dust pan broom are scratchy, the fabric on the duster is soft. What colors do you see? The mop is blue and white, the broom has green bristles. The green broom is long or tall, the red dust pan broom is short or small.
• Compare the properties of their toys and your real life items. Daddy’s mop is tall and it is red and white. Versus their mop is short, and blue and white.
• When going over the names, properties, and use of each item, if your child does not have the verbal vocabulary to participate, encourage them to point.
• Encourage your child to use the objects during play. Do they have a play kitchen, a play house? While making a fake meal in their play kitchen, pretend that they made a mess and have them use the toys to clean it up. “Aww man, I dropped crumbs on the floor, can you grab the broom and help me sweep them up?” “Woops, we spilled some milk on the floor, can you grab the mop and help me clean it up?”
• When your child makes a non food related mess, see if they can use these toys to help you clean it up. Making a valentines day card at the table with tissue paper, or cutting paper? If scraps fall on the floor, encourage them to get their broom and dust pan to clean it up. 
• Encourage the child to put each one of the items back on the stand. This helps them to learn how to clean up their toys and stay organized.
• Encourage your child to teach their siblings, friends, or relatives how to use the items.

Find the complete list in our Toy Reviews tab. And of course, always reach out for comments, questions and/or suggestions for future blog posts and toy reviews. See you in our next post!

Play is often talked about as if it were a relief from serious learning. But for children, play is serious learning. Play is really the work of childhood.”

Fred Rogers, aka Mr. Rogers

Play – the universal language of all children. The tool and means for children to learn and explore the real world.

As a Child Life Specialist who helps children cope in medical settings, I get to witness the extraordinary effect that play has on a child – whether the child is engaging in play as a distraction from a stressful or invasive procedure, playing as a way of normalizing the medical environment they are in or by engaging in medical play for the purpose of familiarizing themselves with medical tools – it is truly amazing .

As Pediatric Occupational Therapists, Christine and I also recognize play as being one of the primary occupations or meaningful daily activities for all children. Play builds confidence in children, fosters creativity and self-expression, and improves social skills, problem-solving skills, fine motor skills, gross motor skills as well as visual motor skills.

For parents or supportive adults like yourself, it is important to encourage opportunities for children to engage in free play, whether it is indoors or outdoors. This blog post will discuss the different types of play, how to play with children to enhance their motor and cognitive skills and ways to support children who may need assistance in engaging in play.

Types of Play

There are several types of play. Most of them are observed to occur at various developmental ages and stages. Some children, especially children with special needs, shy children, and/or children that do not have opportunities to play with other children, may need some support from caregivers to acquiring skills in and/or learn various types of play.

Here are some common types of play:

• Solitary play– this type of play is when children are playing with objects or toys by themselves, and do not seem to be observing or engaging in the environment around them during this play. Ex. Using a shape shifter.
• Onlooker Play – this is when a child is looking at other children playing without the desire to join them Ex a child watching children play on the playground while sitting on the bench
• Parallel play– This is when children are playing near each other, but seem to be doing their own thing, and are not engaged with each other. They may look at each other occasionally but they are not usually trying to influence their peers. Ex. One child is building a block tower at a table while another child is playing with a car on the same table.
• Associative play- This is usually when a child seems to be more interested in their peers and their play. Children are more engaged with each other, and there isn’t usually structure to their play. Ex. Two or more children are building their own block structures in the same area, sharing blocks.
• Imaginative play- Children are imagining worlds, roles, and situations, and encouraging other children to participate in their imaginary situation. Ex. One child is a veterinarian, another child has a sick stuffed animal pet.
• Cooperative play– When children work together for a common goal. Ex. Organized sports, playing board games together, building a sandcastle together.

Helping your child to get the most out of their toys:

Children may not always know how to play or engage with the toys that are given to them. Children that are young, have special needs, and/or have never seen that type of toy before may need an adult to show them how to use their toy to maximize their learning.

While some toys may seem to have limited uses, there are many ways to enhance your child’s learning by using any toy they are given. Here are some examples to do just that:

Language

Using a lot of language while playing any toy is essential in increasing your child’s vocabulary and receptive skills. Teach your child the names and various properties of the toys. For example, “this is a toy car. The colors on the car are red, black, and white. The car is small, feels hard and has a smooth surface; the paint is shiny”. It is also important to narrate your own actions as well as your child’s when playing with the toys. “I am rolling the car up a hill. Vroooom… beep beep goes the horn. I see you are stopping the car from getting across, I will drive around you”. The more language you use, the more you are encouraging your child to understand and/or use language during play.

Promoting Social Skills

Using any and all types of play is great to improve a child’s social skills. Set up situations where your child has to share, and/or ask for toys. Thank them if they let you use the toy. Drawing rainbows? After verbally going over the colors in a rainbow, hold onto the green and purple crayon, that way when they get to those colors in the rainbow, they have to ask you for the crayon.

Following Directions

Play can be a great way to teach your child how to follow one step, or multi-step directions. Whether it is during an organized game, or imaginative play. Start with giving simple, and clear one step directions, and gradually increase the complexity of the directions and number of steps. For example, while playing Simon Says, you can practice one step commands such as “touch your nose” or advance to multi-step directions such as “touch your nose then touch your ears”.  While engaging with blocks, you can have your child place the red block on top of the green block to have them practice following directions.

Modeling

Since most children are visual learners, it is important to model or show your child how to perform any task you want them to perform with an object or toy. It is also important to note, that you should always try to model how to use new objects, perform new tasks, or play with new toys.

For example, when attempting to brush a doll’s hair, you pick up the doll, place it in front of you, grab the brush, and show your child how you hold the doll with one hand and brush the hair with the other, moving the brush from the top of the doll’s head to the tip of their hair. Then, give the doll and brush to your child and verbally encourage them to do the same. If needed, gently place your hands over or under your child’s hands and perform the action with them. Gradually reduce the amount of help you give them, until they can brush the doll’s hair on their own.

It is also helpful to use toys to model real life activities such as potty training, wearing a mask or going to school. When kids see their favorite toys engage in certain activities with them, it can increase compliance and reduce challenging behaviors associated with those activities.

Facilitate Self-Expression:

It is always great to use play as a means for children to express themselves and showcase any suppressed feelings. For example, after a stressful doctor’s visit, you can play ‘doctor’ with your child to see how he or she may have felt during the visit. When your child is observed to aggressively insert a toy needle into her doll’s arm, that can reflect how she perceived the needle she had gotten. This type of play allows parents an opportunity to address these feelings in a safe space. “Seems like that pinch doesn’t feel too good, but I also see how quick it was to go away!”. Similarly, pretending to play a scene from your child’s day at school or an encounter they had at their friend’s house can be a great way to practice safety, social skills and develop appropriate coping strategies when needed.

Physical Support

Depending on your child’s age and abilities, they may need some physical support when learning how to play with toys. They may need assistance in holding an item, manipulating it, putting it back, and playing with it. When giving physical support to your child, it is important to gradually diminish the amount of support you give them as they become increasingly more independent with the task. Some ways to provide this support is by placing your hand over or under your child’s hand while engaging and manipulating a toy, holding the item or toy for them, verbally reminding your child what to do next with the item, pointing to the object that they need and more.

Check out our ‘Toy Reviews’ tab on more ways to help foster your child’s acquisition of developmental skills with the toys you have at home or with some of our favorite toys that we have used during our therapy sessions. A new toy review will be released each month. Join the email listing to get it straight to your inbox.

And of course, always reach out with questions on specific ways to enhance various skills with your child’s favorite toys.

It’s always a bittersweet moment for therapists, teachers and all school personnel at the end of each school year, as it is for most students as well. But although the school year is ending, the writing shouldn’t! (As all OT’s would say!

Here are 10 fun and creative end of the school year writing prompts to get your little ones reflecting on the past year as well as anticipating for the next:

Farewell Letter – A farewell letter to the teacher, therapist or any one you will truly miss. Probably the hardest thing for anyone to read!

Letter of Advice – What will you tell the future student who will be taking your seat in this class? What advice can you give them about succeeding in the coming year?

Letter to Your Future Self/Class – Are you excited about meeting your future classmates? What do you want them to know; what do you want to remind yourself on?

Favorite Memories from this Year – This can be a memory from school or from outside of school.

Summer Bucket List – Who doesn’t enjoy this one?!

One (or two) things you learned this year that you will take with you in the coming year – No explanation needed on this one.

Compliments to Your Classmates – Write one nice thing about each of your classmates on a separate page for each person. Pass them around until everyone gets all their compliments.

An Accomplishment You’re Proud of (of the many!)

A Challenge you Overcame – If the pandemic and remote learning wasn’t challenging enough!

Thank You Letter to a Parent, Teacher, (ahem Therapist) or any Adult that Supported you this Year.

Hope these are beneficial – share more writing prompt ideas in the comments!

Wishing everyone a happy, healthy and safe summer break.

Completing a puzzle can be quite an overwhelming task for some kids at first. Not knowing where to start or feeling like the puzzle pieces just don’t fit into each other is frustrating as is. However these six simple steps can make the activity of completing a puzzle a lot less challenging and a lot more enjoyable!

6 steps for teaching puzzle skills:

1. Always have the puzzle pieces facing up for ease of visibility.
2. Keep the box with the image of the completed puzzle in front of your child for reference at all times. They can even study the image first before starting the puzzle. Ask them questions about what they see which may help them remember the image better.
3. To start, first locate the 4 corner pieces. Your child can feel/look for the two straight edges that meet. You can even allow their finger to touch the pointy tip of the corner. This is important since incorporating a tactile or hands-on component may help children better grasp the concept of distinguishing between the different types of puzzle pieces. Place the corner pieces in their appropriate places using the box as a reference.
4. Complete the border by locating all the edge pieces. Edge pieces usually have one straight edge. Have your child feel and look for pieces that have just one straight edge.
5. Finally, complete the center by locating the center pieces. Usually, center pieces have ZERO straight edges.
6. Have your child group similar center pieces together and have them focus on completing one area of the center at a time. Look at the completed image on the box to make associations (ie. I see that the foot of the man is by the seashell, we should look for the seashell next!).

Important tips from an OT:

*It’s important to find the ‘just right’ challenge for your child when it comes to completing puzzles. If they’re still struggling to complete the puzzle and are starting to grow frustration with the activity, you can choose a puzzle with fewer pieces and/or a puzzle with simple, defined images with obvious contrasts. Having a puzzle that has a lot of blues and greens, for example, may make it difficulty for your child to distinguish between the pieces. Therefore, contrasting colors are important when starting simple. Then, grade up the challenge as you see fit.

For more help on completing puzzles and/or ways to grade up or down the activity (ie. making it less or more challenging) reach out for suggestions by either emailing us or writing in the comment box. We look forward to responding!

Going back to school is anxiety provoking as is. For our kids with separation anxiety and those who have been learning remotely for some time , it can be even more challenging for parents to help transition their littles ones for the new school year.

As a school based Occupational Therapist as well as a certified Child Life Specialist trained to help children cope in stressful events, here is a compilation of eight strategies to help transition your anxious child for back to school:

1. Appropriate Prep – For kids as young as kindergarten level, it may not be helpful prepping too far in advance as they may not fully grasp the concept of time. Provide brief preps closer to the time of the school year beginning. You can try to schedule a visit to the school/classroom before the school year begins or even walk around the school with your child. You can schedule a meeting with your child’s teacher, read books/social stories about going back to school and even play ‘school’ at home. During play time, you can read stories while sitting on the rug and even practice wearing a mask if the school requires it. Helping children understand what to expect helps to ease their anxiety in novel situations.

2. Practice Separation – Provide opportunities for your child to separate from you and see you come back. Whether that means going out for a walk or stepping out during a play date, let your child learn and trust you to come back. Avoid sneaking out as that may make the child more anxious about separating from you. Allow your child to see you leave and see you return.

3. Validate their emotions – Let your child know that it is okay to feel nervous, afraid, or sad. Validate how they are feeling at the moment and let them know you are here to help them work through these emotions. Be honest with them and let them know that you will come back to pick them up at the end of the school day.

4. Comfort item – If allowed, let your child bring a comfort item from home to school. Nothing too valuable as it may get lost but something small they can keep their in their backpack.

5. Caregiver’s item – Let your child hold on to something that belongs to the parent – mom’s handkerchief, dad’s keyring, etc. That way, they can feel a sense of closeness to the caregiver at all times.

6. Consistent morning routine – Kids feel less anxious when their day is predictable. Set a morning routine and stick to it. You can create a visual schedule with images that go along with each event in the morning (ie get dressed, eat breakfast, brush teeth, put on shoes, time for school). The visual schedule should go up in an area that is easy for your child to see. It is also important to allow your child extra time in the morning to get ready, especially when they may need time to work through their emotions.

7. Share excitement – Let your child know how excited you are for them to be starting or going back to school. Let them know how excited you’ll be to pick them up and hear about their day. A little laughter can go a long way to ease the anxiety.

8. Avoid prolonging goodbyes – Don’t spend too much time saying goodbye to your child. Keep it brief and avoid lingering at the door. Your child may sense that you don’t trust they’ll be okay. Therefore, keep it short and sweet. You can even come up with a quick and fun handshake, a goodbye song or a fun dance.

For questions or comments, reach out to seedsforspecialneeds.com or write in the comment box below. Love hearing from you all!

It’s often confusing for people to hear that I pursued the career of a Child Life Specialist (CLS) around the same time I was finishing up my Master’s in Occupational Therapy (OT).

Is Child Life a subdivision of OT? Is Child Life similar to OT? Why did you become a Child Life Specialist – were you not satisfied with your OT career? – are just some of the many things I’ve been asked.

I get it.

Well to start, Child Life is not a subdivision of OT. In fact, Child Life is an entirely different certification and training. As a CLS I am trained to help children cope with the stress that comes along with any medical experience (ie. a hospital stay, Emergency Room visit, surgery, bloodwork – to just name a few). In efforts to  help children cope and deal with their anxiety in a medical setting, we provide developmentally appropriate education, procedural prep, distractions, medical play, normalization and recreational activities, sibling/family support, non-pharmacologic pain management and even bereavement and end of life support.  

As a Pediatric OT who works to help children with developmental delays gain functional skills, my Child Life training has enriched my work in so many ways. I absolutely love what I do as an OT. But after realizing the significant levels of stress my kids with Autism, ADHD and developmental challenges exhibit on a day to day basis, I wanted to become more skilled in supporting them emotionally before I can tackle any motor skills with them. And that’s exactly what the field of Child Life did for me.

Here’s a littkle break down on how the field of Child Life has enriched my work as a Pediatric OT: 

Coping in Hospitals

I knew that no matter how amazing of an OT I was meant to be or how well thought out my treatment sessions could be, if my pediatric patients are not coping well with being in a hospital setting, then in one way or another my sessions may be lacking. In order for my patients to be more receptive and engaging in a therapy session, they must feel comfortable and safe within the setting and with those they are interacting with.

OT’s who are working in a hospital setting – whether it’s outpatient, inpatient, acute or subacute – should be prepared to deal with children who associate the hospital setting with fear, anxiety and stress. This may be due in part to a past medical experience that did not go as well or perhaps an encounter with a medical staff that was not so pleasant.

A CLS can help ease the transition to medical settings in various ways. A CLS may debrief with a child regarding their past experiences or encounters, they may engage in medical play for the purpose of developing positive association to medical equipment as well as addressing fears in a safe space, they provide normalization activities to make the hospital environment less frightening, and they provide procedural prep for all events occurring during their stay.

Coping Skills during Anxious times

As a school OT, a lot of the children I work with deal with anxiety in similar ways a child at the hospital experiences anxiety. For my kids in the school setting, the anxiety may be due to a change in routine (such as the teacher being absent and thus having a substitute), unmet sensory needs, challenges in communication skills, pain, etc. I often carry my child life toolkit to help children relieve this anxiety before it escalates. Some things I have are bubbles or a pinwheel for deep breathing, sensory toys, distraction games such as iSpy, a stress ball, fidgets, and glitter wands.

Education

As an OT, part of our essential role during treatment sessions is to provide patient education on how to appropriately and effectively continue treatment at home. How we implement that education for the different age ranges is not something I was give extensive training in as an OT student.

However, as a CLS we are certified and trained in providing education that is developmentally appropriate for each pediatric age group while knowing how to assess which developmental level the child belongs to. Having this training makes it easier to connect with that child and ensure they are understanding the information in a way that best meets their developmental level. 

A child is more likely to continue therapy at home if the education is provided in a way that best suits their understanding through developmentally appropriate language and visual supports (ie dolls, images, videos etc).

Trauma

Stress in inevitable in all children. I’ve had students during my OT sessions who were completely distraught and unable to focus on their work due to what’s happening at home – ie. parents getting a divorce, the loss of a parent/grandparent, the loss of a pet,  moving, etc. This inevitably affects a child’s performance at school and should not be overlooked.

One of my students, who was unfortunately mourning the passing of her dog, was unable to work on her OT goal of writing. Our typical OT session involves writing 2-3 age appropriate sentences with a focus on her letter formation, spacing and alignment in addition to an activity working on her fine motor development (ie. strengthening the small muscles of her hands). Keeping those goals in mind while acknowledging her need to cope, I realized it was more therapeutic for her to write a memoir of her dog as a writing task, or creating a memory box with popsicle sticks for a fine motor activity. That way, although she no longer had her dog, she can still hold on to something tangible indefinitely. These activities not only became a motivating factor for this student to continue working on her OT goals, but they had a huge therapeutic component which was most important of all.

Restoring Family Bonds

As a CLS, we restore the parent- child bond or sibling-child bond when family dynamics change.  Parents often feel guilt from their child’s condition or may even struggle coping with their own stresses. A CLS makes sure to work on the family-child relationship as it affects all aspects of the child’s life.

I had a student for OT who unfortunately did not know her father had passed away a year ago. As any young six year old child, she was eagerly awaiting her father’s return from his ‘travels’. I soon found out that it was mom’s personal decision to keep this secret from her daughter in fear of how she may react. The student, who started to grow worrisome of her dad’s absence and may have gotten an idea of his reason for not returning home from older siblings, started to grow resentment towards her mother.

I spoke to the mother about the importance of telling her daughter the truth and the negative impact this can have on the parent-child trust. The concerned mom knew she had to break the news to her daughter but was struggling with the ‘how’. That’s where my CLS side was able to help. I was able to provide her with appropriate resources as well as information for support groups, leaving the mother full of gratitude and relief.

Had I not had that training as a CLS, I may not have felt comfortable having this conversation with the mom, let alone have those resources at hand.

Coping Skills for Family Members

As mentioned before, a family’s way of coping with a stressful life event inevitably affects the child’s own coping skills as well as their perception of the situation. Since a family’s style of coping is an influential factor to a child’s coping skills, a CLS can help families develop appropriate coping skills to better support themselves and their children.

Play

Play is the natural language of all children and an essential occupation for kids as well. It’s always great to be able to use play as a means to not only achieve pediatric goals as a CLS but as an OT as well. Having a background in Child Life has made me more creative in providing playful ideas when working with the pediatric population in addition to giving me more training in play based therapy approaches.

Whether I’m helping a child learn to manage fasteners, buttons and zippers on a toy doll in my OT session or teaching an IV prep on a similar doll during my Child Life session, I’m always appreciative of the fact that I can use this natural medium to help children learn and understand the world.

Creating Sensory Environments

As a means to help children cope in medical settings, a CLS aims to provide a calming sensory environment in what can be a highly overstimulating scenario. With that additional training in creating optimal sensory environments, I am more equipped at helping my children with sensory challenges during my OT sessions as well.

The extensive training in creating optimal sensory environments has helped me tremendously as a CLS as well. As a CLS and advocate for our Pediatric Emergency Department, I am now on the team to create the very first sensory room for our Pediatric ER! I’ve had the pleasure to use my training from both fields to come up with an amazing design for the sensory room that will help destress an anxious child before and/or after their ER visit.

With that being said, I also have the pleasure to be an ongoing guest lecturer for a Child Development Course where I teach Graduate Students of Education on how to create an optimal sensory classroom for their special needs students. Giving my graduate students strategies from both a CLS and OT perspective has been greatly insightful and well received.

Helping Children of Adult Patients  

Although I do not work with the adult population, CLS are also needed there. Not only does a CLS get called to support an adult who has developmental delays but they support an adult patient who may have children that are not coping well with the parent’s illness. Whether the parent has had a traumatic injury, a chronic illness, are in a coma or are preparing for end of life, the CLS can provide developmentally appropriate prep for the children as well as facilitate appropriate bonding activities specific to that child’s coping needs.

End of Life

End of life and bereavement support has always been the most challenging area to address even as a Child Life Specialist – making it that much more vital to our skillset. Having a pediatric patient who may be approaching end of life is something any pediatric healthcare worker should be ready to face. A CLS is trained to support a child and their family during this time and facilitate memory making activities for the families and their loved ones.

Questions?

If you’re a Child Life Specialist, Occupational Therapist, student in either field or someone who is interested in pursuing either career (or hey, both!) please feel free to reach out with questions. I will be sure to respond!

Most parents must brace themselves before taking their child to the doctor’s office. As terrifying as it is for the child, it is even more anxiety provoking for the parent, especially when you don’t know how to best support your child during such high levels of stress.

When it comes to our kids with autism, who are anxious at baseline, may be non-verbal and/or have sensory needs, it does not take much for them to reach high levels of anxiety. As a Child Life Specialist trained to support children in medical settings, I wanted to share tips on how best to support your child with Autism before, during and after their doctor’s visit.

Before the Visit

Social Stories
It is always important to talk to your child about their upcoming doctor’s visit, what to expect and why they will be going. Since most kids with Autism are visual learners, you can prep them using a story book or a social story. A social story is a short narrative that helps walk your child through a social scenario. If your child is non-verbal, try using images and language that is familiar to them and adapting the social story to their understanding. A social story can use the following phrases:

–  Mommy is taking me to see a doctor so he can help me with my tummy ache
– When we get there, mommy must sign my name, so the doctor knows I am here
–   I may have to wait with mommy in a special waiting area before it’s my turn to see the doctor. I can play iSpy with mommy while I wait.

The social story can be in first person, like the example above, or in third person using your child’s first name: Matthew is going to see a doctor. This helps them better relate to the scenario.

Incorporating actual images of the doctor’s office into the social story can be helpful so that your child knows what to expect when they get there. When showing images of the doctor’s office and/or reading a book about going to the doctor’s office, avoid pictures or illustrations of children with worrisome or fearful expressions as your child with Autism may pick up on those expressions. Kids with smiling faces are preferred to ensure that they will be okay.

Medical play

Playing ‘doctor’ using items that the child will most likely be seeing in the doctor’s office is a great way to familiarize your child before their visit, leading to a less stressful encounter with their doctor. Some things to incorporate during medical play can include a stethoscope (letting your child feel the coolness of the bell or diaphragm on their skin), a blood pressure cuff  (pretending to squeeze their arm), a thermometer to check their temperature, a scale to check weight, a tongue depressor to look inside their mouth and an otoscope to check inside their ears.

Having toys that resemble the actual tools are ideal in helping your child better make the association when encountering them in the doctor’s office. Playing with these items beforehand not onlyhelps them to be familiar with the tools and their purpose but also helps them associate these items with joy and comfort.

Medical play also gives you an insight as to how your child may be feeling about the visit. When your daughter tells her toy doll that the ‘thermometer won’t hurt’, that reflects her own understanding of the instrument. On the flip side, if she’s stabbing a needle in her doll’s arm, that too can reflect how she thinks needles feel. At that point it is best to address her concern during the play session, letting her doll know ‘you will feel a pinch but it’s quick to go away!’.

Be honest
Be honest when communicating to your child about their doctor’s visit. Avoid lying to your child by saying ‘we are going to the ice cream store’ instead of saying doctor’s office to avoid a stressful car ride. This can result in mistrust between the parent and child and may lead to an even more difficult transition to the doctor’s office the next time. Rather, be honest and let them know why it is important to go. “We will go see a doctor so he can let mommy know how to better take care of the tummy ache that’s been bothering you”.

Validate their feelings
It is important to let your child know that she is allowed to feel the emotions she is feeling saying things like: ‘it is okay to feel nervous or scared’. Avoid phrases like: ‘don’t be afraid’ since that may prevent them from opening up to you about their emotions. Validating their emotions helps them to feel understood which will lead them to be more transparent when talking to you about their concerns. This also builds trust between the parent and child.

Explain their role
Let your child know exactly what their role would be at the doctor’s office. Avoid saying: ‘don’t cry’ since crying is a natural and healthy coping mechanism for all children. Rather, validate their emotions and give them explicit instructions on what to do: “it is okay to be scared, but it’s important that you hold still so the doctor can listen to your heart and understand how best to help you”.  

During the Visit

Bring comfort items
Make sure to bring your child’s favorite toys, any sensory item that can help calm them downor a familiar item that helps to destress them. If there was a social story or book that was used to prep them for their visit, you can bring that along and continue to read it to your child as he or she goes through each step of the visit.
 
Communication Device
It is very important that your child is able to let you know exactly how he or she is feeling before, during and after their doctor’s visit so you know how best to support them and which concerns to address. If your child requires a communication device, make sure to bring it to their visit and use it intermittently to assess their feelings.

Give choices
Children cope better when they have more control over a situation. Whenever possible, give your child choices during their doctor’s visit: let them decide which chair to sit on, which arm to let the nurse take their blood pressure on, or which snack they will earn when they are all done with their visit.

Use language that sounds less frightening to your child
Using honest yet appropriate language with your child is key in helping your child feel more comfortable at their doctor’s office. Language that sounds less frightening will help you child better cope with the experience. For example, if your child is about to have her blood pressure taken, you can tell her that the machine will give her arm a nice tight hug rather than saying the machine will squeeze her arm.

After the Visit

Reward
Give your child a reward for their bravery! Regardless of how the visit went, they got through it and a prize is well deserved. It is best to let them know beforehand that they will earn a reward at the end of the visit, even giving them choices as to what they would like. The prize should be novel and exciting to them to encourage motivation.

Debrief
Always talk with your child afterwards, asking them how they felt the visit went. For our kids with autism, using a visual emotion scale is helpful in assessing how they feel after the visit. It is important to know what they liked and did not like to better support them the next time. This is also a great time to address any concerns and answer any questions they may have. You can even have your child explain to someone else (perhaps a sibling or friend) as to how their doctor’s visit went, to better understand their perspective of the experience.  

More Medical Play
You can always follow up with more medical play when you get home. If your child is non-verbal or is not as expressive with their words when telling you how they felt, they will be sure to express their emotions though play, the natural language of all children. Through medical play, you can have the childre-enact the visit, observing how they think the visit went. Your child may say things like ‘it’s okay to be scared, you just have to hold still’ which tells you they were able to internalize what was expected of them. If your child continues to show aggression, then they may still have fears that need to be addressed. That would be great opportunity to address concerns that may still be bothering your child for a smoother visit the next time.