BCHC staff with child and parent image


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.



Paediatric Occupational Therapy image


Sensory processing relates to the body’s ability to take in information from the senses, organise the information within the brain and respond appropriately within the environment.


Some children have difficulties in the way in which they process sensory information. For example, some children’s systems can take in too much information so they become overwhelmed by their environment. Some children’s systems need more information to register sensory feedback so they might seek out different experiences in their environment. The ability to regulate the amount of sensory feedback our body needs is called ‘modulation’.


Possible difficulties children may experience: 

  • difficulties concentrating within certain environments e.g. noisy classroom 
  • dislike having their hands or body messy 
  • particular dislike of self-care activities such as hair washing / tooth brushing 
  • may appear always ‘on the go’ 
  • difficulty in calming after certain activities 
  • dislike of certain textures e.g. labels in clothes / socks 
  • may be a ‘picky’ eater 
  • may appear clumsy in movements / not notice when they have injured themselves


Sensory Advice Pack



Strategies to support development of this skill

Sensory strategies can be used to support children in modulating their arousal levels. It might be helpful to consider different arousal levels as the characters of Winnie the Pooh.  

  • Eeyore Zone - low energy, unable to focus on activity, low motivation, fatigued
  • Winnie Zone - ‘just right’, able to concentrate on activities, motivated, able to learn
  • Tigger Zone - high energy, distractible, moving around often, can be agitated

Children will move between each zone at various points throughout the day, however we want to try and keep them in the ‘Winnie’ zone as often as possible so that they are able to remain focused on their activities and learn new skills.  



Sensory videos













Activities to support the ‘Tigger’ child at home

When in this zone, children need activities that will be calming to their system.


Slow, rhythmical, linear (forward and back / side to side) movement:

  • swinging slowly on a swing
  • rolling slowly back and forward on an exercise ball or gentle bouncing– try using music with a slow rhythmical beat to steady the child’s movement
  • slowly playing "row, row, row your boat".


Deep touch pressure:

  • Wrapping them up, or supporting them to wrap themselves up in a blanket
  • Providing a firm hug or massage over their body, it is especially helpful to provide pressure by pushing down gently on the shoulders
  • Providing gentle but firm strokes across the body. Start from close to their body then work away e.g. from the shoulder down to the wrist. You can try using different material such as soft brushes for this
  • ‘Squishing’ them between cushions or bean bags
  • Using weighted equipment such as a weighted lap pad or shoulder snake (see sensory equipment list)
  • Wearing clothing that provides deep touch to the skin such as a lycra vest


Heavy muscle activities:

  • Any activity that requires whole body movements: yoga, swimming, climbing, obstacle courses
  • Pulling resistance bands
  • Mini exercise circuits including wall push ups, squats, chair dips, animal walks
  • Carrying heavy items e.g. helping carry a laundry basket, moving bean bags or cushions around the room or making a den, gardening
  • Weighted equipment whilst moving such as a weighted vest (see sensory equipment list) or wearing a weighted rucksack. Item must weigh no more than 5% of the child’s body weight


Creating a ‘sensory space’:

  • Identify an area within the home (preferably not the child’s bedroom) that has minimal sensory input e.g. soft lighting, minimal noise or use of calming sounds, smells they find relaxing (try lavender, camomile, vanilla) and access to blankets/cushions that they can get under
  • Encourage the child to use this space after accessing stimulating environments e.g. on return from school / after going food shopping when they are likely to be in the Tigger zone to help them regulate



Activities to support the ‘Eeyore’ child at home

When in this zonechildren will require activities that are alerting to their system. It is important not to ‘over-alert’ the system, so the following activities should often be followed by more calming activities.


Movement breaks – provide 'little but often' periods of movement around times that the child is expected to concentrate.

  • mini exercise circuits including wall push ups, squats, chair dips, animal walks
  • running ‘errands’ such as taking items from one room to another or delivering a message to a family member in another room
  • standing up and stretching, try different yoga activities designed for children such as these on the Kids' Yoga Stories website.
  • sitting or bouncing on a therapy/exercise ball during everyday activities such as watching TV
  • encourage alternative positions for activities such as lying on their tummy to play Lego, sitting on a beanbag, high kneeling to catch a ball
  • dancing games like musical statues / stop and go games such as ‘tig’
  • jumping on a trampoline


Different tactile input:

  • mix up different textures into activities to keep the child’s system guessing e.g. using sensory bins with different touch sensations, messy play, baking
  • use vibration to ‘wake’ the system – you can purchase vibrating stuffed animals/vibrating cushions from online retailers and use a vibrating toothbrush in the morning
  • having a cold drink or an ice lolly – try using homemade ice lolly moulds to make healthy options and have the child join in when making them
  • crunchy snacks such as carrot sticks

Use sound:

  • use different kinds of music and sounds with different beats
  • encourage sing-song games during activities
  • play with musical instruments

Use vision:

  • introduce bright colours into activities such as arts and crafts
  • use bright/contrasting plates and cutlery during mealtimes
  • use light up toys or sensory lighting within the environment
  • play games that require movement and following moving objects with their vision e.g. throwing and catching a ball
  • use a bright coloured table cloth during table top activities


How to keep the child in the ‘Winnie’ zone at Home

It is important that children are in a calm, well regulated state so that they can attend to and engage in their daily activities. Some childrenneed more or less feedback than others to keep them calm and alert during the day. This is called modulation. The kind of feedback a child needs will be different for each sensory system. It is important to provide a daily plan of strategies and activities that provide the regular feedback a child needs to their sensory system to allow them to stay calm, alert and engaged in their daily routine. You might have heard this referred to as a ‘sensory diet’.


Developing a ‘sensory diet’ for your child:

  • consider what ‘zone’ your child is most often in. Do they move into different zones at specific times of the day? E.g. Tigger when they arrive home from school
  • use strategies from the lists above, incorporating them throughout the child’s daily routine to ensure they get the feedback they need
  • if you notice your child’s arousal levels changing, consider introducing a new strategy to help them stay regulated
  • it is easier to keep a child in the ‘Winnie’ zone than try to get them out of the ‘Tigger’ zone – make sure they use the strategies every day even if they appear to be regulated
  • teaching the child about their own sensory needs and arousal levels can help them develop independence in self-regulation.

Here are some useful resources to support children’s understanding:

  • The ALERT® Programme – supports parents to understand a child’s sensory needs and teach self-regulation by discussing their sensory systems as an ‘engine’
  • The Kids' Guide to Staying Awesome and In Control: Simple Stuff to Help Children Regulate their Emotions and Senses
  • Sensitive Sam: Sam's Sensory Adventure Has a Happy Ending

Our patients and their carers and families are the reason we're here, so we want to hear your views about the Trust and our services.