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Paediatric Occupational Therapy


Paediatric occupational therapists support children and young people to carry out activities they need, want, or are expected to do, but are prevented from doing due to impairments, injuries or developmental conditions.



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Self-care skills

Self-care occupations relate to activities a child engages in to care for themselves for example, feeding, washing, dressing and toileting.


Difficulties with self-care can span across a range of environments and achieving independence in these skills can take different amounts of time and practice for each individual child.


Self-Care Skills advice pack





Washing can be a complex task for children, with lots of elements impacting on their independence for example, if your child has extra needs, sensory difficulties, global developmental delay or a diagnosed condition. 

When your child needs extra support with building their independence around washing it can be helpful to understand some strategies that you may wish to consider, or think about how you can grade this task for them. 

We have a variety of information that can support you with building your child’s independence; please view our advice sheets and videos. 

Top Tips:

  • make this a fun time, use bath and shower toys
  • ensure your child can see what they are doing in a mirror in front of them
  • use songs/fun timers as a way of them understanding how long a task will last for
  • use sequencing charts to support with sequencing of task
  • use hand over hand technique to support encourage them to wash themselves




Dressing is a complex task that involves a variety of skills.  We require planning, organisation and sequential skills to work out the order of dressing along with where we need to position ourselves for the task. Gross motor skills are required for balance and fine motor skills are required for fastening buttons and zips.  

Possible difficulties children may experience:

  • maintaining balance during dressing 
  • fine motor skills when using fastenings (zips, buttons, laces) 
  • sequencing the activity (putting on clothes in the correct order) 
  • organising the clothes on the body (putting on clothes the correct way round)
  • getting changed for PE lessons 
  • undressing their bottom half for toileting 

Top Tips:

  • practice at less stressful times
  • make it fun, play dress up
  • let them do it, you may be tempted to do it for them
  • lots of praise
  • grade it, make it ‘just right’ for them to achieve but not too hard they get frustrated


Visual Resources

Autism West Midlands are committed to providing up-to-date information about autism to people on the autism spectrum, their families and carers, and professionals. They have various information and visual resources available on their webpage; they also have examples of how to make sequencing charts.   


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Feeding / Eating

Mealtimes are an important aspect of family life. Children begin to develop self-feeding skills from birth.  Self-feeding is a very complex task and it is common for children to have difficulty using cutlery to feed themselves. It usually takes until a child is 7 years old before they can successfully use cutlery to feed themselves without being too messy. Using a knife and fork together requires bilateral co-ordination (co-ordination of left and right side of the body). 


Possible difficulties children may experience:

  • grasping cutlery 
  • holding the cutlery with a ‘functional grip’ – fingers positioned securely around the handle with index finger pointed towards the top 
  • loading food onto the cutlery 
  • bringing the food to their mouth on the cutlery 
  • using a knife and fork together 



There are many different skills and factors involved in the process of being able to go to the toilet independently. In order for a child to achieve success there needs to be cohesion between a variety of skill areas including balance, co-ordination, body awareness, hand function, dressing skills, sensory awareness and language skills.


Top Tips:

  • Make sure your child is developmentally ready to start toilet training
  • Ensure they understand the toilet/potty is a safe place, make sure their feet touch the floor or fit on a step/box
  • Do they need handles to hold onto or a ring reducer on the seat
  • Reward charts are a good way of supporting their positive behaviour and achievements
  • Use social stories with your child to understand why toileting and wiping is important 



Often children will have difficulty getting to sleep if they are not in a routine or have difficulty ‘switching off’ at night.  There can be a number of reasons why your child is experiencing difficulty getting to sleep and staying asleep. Lack of sleep can cause social and behavioural difficulties and can affect learning and development. Improving sleep patterns can improve daytime functioning and decrease stress.


Considerations for sleep

When we think about sleep we need to consider the routines, the environment, social, medications and sensory elements which may be impacting on a child’s sleep.


Possible difficulties children may experience

  • Getting into a night time routine
  • Settling to sleep
  • Going to sleep and staying asleep in their own bed
  • Bed wetting
  • Anxiety
  • Routine: it is important for children to get into a regular routine for bed in preparation for sleep. This involves having a set time to start getting ready for bed, and a time to be in bed every day. It’s important to be consistent with this routine. This will support the child’s body clock in learning when it’s time to ‘switch off’ and when its time to ‘wake up’. Use a sleep diary to record sleep problems and note any routines, activities or foods/drinks that disrupt sleep. Avoid daytime naps and oversleeping at weekends. Some children may like to have a sleep chart or record where they are rewarded for going to bed and getting up on time for a certain period of time.
  • Calm Down Time: it is important to think about ‘calm down’ within their bedtime routine. An hour before you want your child to go to bed, begin to slow the house down. Dim the lights, put on some calming music etc. There are a number of things you can think about before going up to bed, e.g. a warm milky drink, a warm relaxing bath, change into pyjamas before settling down to read a story together. [pics] Consider massaging your child, this can be done as part of a deep pressure calming activity, or using creams/lotions before bed.
  • Environment: avoid screen time (TV/iPad) before bed as this will inhibit the production of the sleep hormone (Melatonin). Make sure their room is a relaxing environment. Use calming sensory lights, night light, soft music or white noise. In cold weather, use a beanie warmer before getting into bed to warm the sheets and make it nice and cosy. In hot weather open the window prior to bed time or put a fan on to keep the room cool.
  • Sensory and sleep: please see our sensory section for more in-depth advice with strategies, but often sensory elements will need considering when it comes to children’s sleep routines.


Strategies for children with visual sensitivities

  • Avoidance of bright bedroom colours on the walls and with decoration (use pastels or light walls), avoid patterns or lots of pictures on the walls
  • Use black out blinds or curtains
  • Minimise clutter at bedtime i.e. tidying toys into box before bed
  • Consider a bed tent
  • Dim lighting / night light as getting ready for bed


Specific strategies for children with touch sensitivities:

  • High cotton count sheets for smoother surface
  • Ensure bedding is smooth e.g. no beads, iron-on prints  
  • Try different types of pyjamas, seamless (wear inside out), silky, fleecy
  • Remove any labels in sleepwear
  • Massage/back rubs/bear hugs before bed


Specific strategies for children with noise sensitivities

  • Play white noise from a special machine or electronic music device
  • Avoid ticking clocks, dripping taps, leaving devices on standby as they make a noise
  • Reduce technology before bed, and have calming story time


Examples of Deep Pressure / Calming Strategies

  • Think about layering the bedding, this can be done by using a few blankets, or a heavier blanket/double duvet or even a sleeping bag
  • Use a double sheet to place over the blankets/quilt (swaddle them) and tuck it under the mattress
  • Use a towel or blanket after the bath, wrap it around them tightly and give them a big hug
  • Onesie pyjamas, or tighter and softer pyjamas
  • Massage the child’s back, give bear hugs, play the ‘pressure sandwich’ or use a large gym ball to massage their back
  • Have cuddly toys / extra pillows in bed with the child
  • Position the bed against the wall so your child can squash themselves against the wall if desired


Further information on sleep

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