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.



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Productive occupations relate to activities that the child may engage in during school such as their ability to use a pencil and scissors. Occupational therapists are also interested in the child’s ability to organise themselves and process information within this environment. Productivity may also relate to a child’s ability to organise their environment such as tidying their bedroom or helping with household chores.


Productivity Advice Pack




Pre-writing skills are important for children to develop in their early years to support with their readiness for handwriting and fine motor development. During a child's development, it is important for them to move along a progression of learning, from making to scribbling to pre-writing. Children move along this journey through exploration in play and participating in multi-sensory opportunities.


Multi-sensory shapes
here are some ideas of how you can use multi-sensory experiences - for example, with sand, chalk, paint (fingers and brushes), foam on tiles, crayons, felt tips, charcoal. Use different paper, (sandpaper, cardboard, tracing paper) and alter the child's position when they are participating in these experiences. For example, your chlid can stand at an easel or lie on their tummy on the floor to carry out activities.


Concentrate on the following pre-writing shapes:


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Top tips

  • ensure activities are fun and engaging for your child, choose topics that your child is interested in;
  • use chunky crayons, fatter chalk (egg-shaped), or hands/fingers, by producing the shapes in sand or with finger paints;
  • start by making the shapes large on a big piece of paper on a fridge or a table or with chalk on an outside floor.




There are a variety of reasons as to why children may find difficulty in the important skill of handwriting. This skill requires a complex integration of the following; bilateral coordination (using both sides of the body together), postural stability, wrist stability and hand strength, finger isolation, thumb opposition (the ability of your thumb to touch the opposite side of your hand), in hand manipulation, fine motor and visual perception skills.


Possible difficulties children may experience:

  • incorrect pencil grasp
  • poor spacing of words and/or letters
  • excessive use or lack of pressure when writing 
  • hand fatigue when writing or slow handwriting for expected age 
  • poor letter formation 


Top Tips:

  • Before writing, do some quick warm up exercises so the hand muscles are warm, stretched and ready to work
  • Sit at a desk/table with feet on floor or box, knees and hips at 90 degrees, desk at elbow height
  • Carry out fun activities to practice writing, do a large maze on paper on a wall to increase shoulder strength
  • Play games that work on fine motor skills like connect 4, operation, board games where you have to move a counter and roll a dice
  • Take regular breaks between writing tasks




Cutting skills take time for children to develop. Being able to use scissors to cut well is important for many preschool and school activities including art and craft. Children may have the skills to use small scissors by 3 to 4 years of age, but scissor skills are not fully developed until 6 years of age. 


To use scissors effectively, children require skills in the following areas; sitting balance, hand strength, fine motor abilities including finger isolation, development of a preferred hand for activity, good hand eye coordination and bilateral integration (using both sides of the body together).


Possible difficulties children may experience:

  • Unable to adopt the correct sitting posture to take part in the activity 
  • Difficulty in gripping the scissors in order to use them functionally 
  • Difficulty in coordinating both hands to effectively cut around shapes 
  • Difficulty in planning and coordinating the movement of the scissors whilst cutting 
  • Ability to isolate their fingers and thumb when positioning their hand on the scissors



Fine motor skills

Developing fine motor abilities and hand strength will support the child in mastering everyday tasks such as dressing, handwriting and cutlery use independently.


Sensory exploration supports the development of a child's strength, their co-ordination and awareness of their body in space through early years activities such as tummy time, crawling and play.


As a child develops through their early years, they will start to pick up items and explore these objects with their hands and mouth, through touch and taste. Fine motor skills will contribute to a child's independence and development across all areas of their learning.


Encouraging children to engage in activities and experiences that promote large and smaller movements such as sports,  baking, gardening and fixing things will support with building foundations for holding a pencil, writing and using scissors.



Vision perception

Visual perception allows a person to process visual stimuli in order to identify what we see and understand what we are seeing. Visual perception helps to identify an object correctly including orientation, size, background and the object in relation to others.


Information received during visual perception is what is needed to successfully plan movements, for example to hit a ball, visual perception determines the speed of a ball, its direction in space and how this relates to the position of the child's arm and the applied force needed to move hands through space to successfully catch the ball. Visual perceptual skills are broken down below:

  • Visual Discrimination: children with problems in this area may have difficulty matching shapes in pictures and puzzles, and at a later stage, in discriminating between letters/words which look similar

  • Visual memory: children with problems in this area may have difficulty learning colours, shapes, letters, numerals; copying (especially from the blackboard); locating objects in the everyday environment

  • Visual sequential memory: children with problems in this area may have difficulty with remembering sequences of forms, such as letters and numbers, after seeing them

  • Visual spatial relationships: children with problems in this area may have problems differentiating objects which differ because of their direction in space; have difficulty planning actions in relation to surrounding objects; with catching a ball; reverse letters/numerals; become confused regarding the sequence of letters or numbers; be unable to space letters/words correctly when writing

  • Visual closure: may experience difficulty recognising objects which are incompletely visible, and with recognising words without orientating to each individual letter 




Effective attention is what allows us to screen out irrelevant stimulation in order to focus on the information that is important in the moment. This also means that we are able to sustain attention which then allows us to engage in a task for long enough to repeatedly practice it. Repeated practice is crucial for skill development. Difficulties in maintaining attention can be due to a variety of factors including; environment, self-regulation, sensory difficulties and motivation.

Top Tips

  • Always say how long the activity will last for. This allows children to know what is expected of them and for how long they need to maintain it for
  • Try using visual prompts such as written words, symbols, pictures and photographs.
  • Sit the child away from distractions in the classroom.
  • Ensure the child is facing the board.
  • You may wish to consider a small fidget toy the child can use in class.

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