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Children’s Occupational Therapy

Our occupational therapists and therapy assistants work with children and young people who have significant difficulties which impact on their development and/or ability to participate in everyday activities.

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What is Occupational Therapy?

Occupational Therapy offers practical support to empower children overcome barriers that are preventing them from doing the things that matter to them. We look at the practical and purposeful activities children do, or need to do, to live as independently as possible and have a sense of identity.

Occupational therapists help babies, children and young people grow, learn, have fun, socialise and play so they can develop, thrive and reach their full potential.

We will consider all of a child’s needs; physical, psychological, social and environmental.

What occupations do children and young people have?

Occupations are things we occupy ourselves with during our daily lives. As adults we tend to associate this with employment, but for children this means anything they engage in during the day, wherever they are; home, school, nursery etc.

This may include self care skills such as dressing, eating, toileting, washing and bathing. It could be more complex skills such as organisation, visual perception or fine motor development. It could mean leisure skills or in younger children it could simply be play.

Who do we work alongside?

Occupational Therapists work closely with the child, their parents, teachers and carers. We often liaise with other health professionals, including doctors, physiotherapists, speech and language therapists and specialist nurses and also with our colleagues in education and social care.

Where are we based?

The Occupational Therapy team are based in Child Development Centres in Harrogate and Northallerton. As one team, we cover two localities; Harrogate and Rural District, and Hambleton and Richmondshire.

Both Child Development Centres are open from 8.30am – 4.30pm Monday to Friday.

Whilst we are based at the centre, the therapist may arrange to see the child or young person in other locations to assess their needs. For example this could be at home, in school or at nursery.

Harrogate District Hospital
Specialist Children’s Services
Child Development Centre
Harrogate District Hospital
Lancaster Park Road
Harrogate
HG2 7SX

Hambleton and Richmondshire
Specialist Children’s Services
Child Development Centre
24 Brompton Road
Northallerton
DL6 1EA

Referral Process and Form

Referrals are accepted from most healthcare providers such as GPs, physiotherapists, nurses and speech and language therapists.

It is necessary for the referral to include 2 occupations that your child finds tricky.

The more information you can provide us with the better at the referral point. This enables us to see what you have tried to do to help and which other agencies are involved. If your child is school age it is extremely helpful for us to see what school have already implemented and whether they felt this was successful. You may wish to include information from the school SENDCO to support your referral.

We aim to see your child within 18 weeks.

Click here for the Referral Form

Once we receive a referral we triage it into one of the following categories:

  • Universal services are aimed at giving early input to all children to try and prevent difficulties
  • Targeted services are aimed at children who have had difficulties identified by health care professionals and education
  • Specialist services are provided for children with complex needs and may include advice to Education, Health and Care Plans, specialist seating, equipment, postural management

If you are concerned about your child’s motor skills (fine or gross motor) it is important that your child has completed 2 terms of activities in school as set out in this document. Without this information we will return your referral.

BOOKLET: Supporting Children and Young People with Co-ordination Difficulties

What to expect during your appointment

You or your child may have some questions about what will happen during your appointment with us. You might want to look at and share the two documents below with them to help them understand and to alleviate any worries they may have prior to coming. They will help to explain where the appointment will be, who you will see and what sort of things you might be asked to do. If you feel your child will have difficulty attending for any reason, please call us to discuss this.

Help your child at home

Welcome to our ‘Universal Service Offer’

You may be looking for some ideas of how to help your child or young person (CYP) at home or you may be waiting for an appointment and looking for some things to do whilst you wait. Schools may also be looking for extra resources and information and utilise this section.

Our universal offer is also for children aged 0-18 (19 if they are in a special school) with sensory preferences affecting everyday activities.

We aim to empower parents/carers to facilitate their CYP’s development and participation in everyday activities which they want to do and also have to do. We hope that these ideas will help you to find ways to assest your CYP.

We like to take a strengths based approach and want your CYP to enjoy engaging with you. So we woud suggest you start and end your practice sessinos with a shirt quiet, calming activity which your CYP loves to do and is good at.

We have increasing evidence which shows that it can be very effective to work with families in this way.

Under 5’s

Play, Games and Daily Activities

Young children start to use their hands in daily activities as soon as they are born.

They start with sucking fingers and thumbs, grab at their bottles and cups, swipe at their toys, then they start to grab toys, shake them, bang them together, clap their hands, wave bye bye. They then progress to moving toys within their hands to manipulate and explore them and then they start to use their hands to manipulate tools such as spoons or crayons. All of the time they are using their hands in play, they are learning about their world.

Below are some examples of toys and games to use with everyday activities that help to develop the skills just described; grasping and holding, placement skills (hand eye co-ordination), using 2 hands together, manipulation skills, pre writing skills and body awareness.

Choose the activities which are appropriate for their stage of development, ie choose activities which are easy for them to start with and then progress from there.

Always use toys which are suitable for your child’s age and be aware of choking hazards, especially if your child is still mouthing toys. Do not leave your child unattended when carrying out these activities.

Washing and Bath time:

Floating bath toys are good for your baby and young child to watch as they float around. Watching toys move helps them learn to focus and track toys as they move.

They are also good to swipe at, different sizes and shapes of floating toys help develop different grasps.

Containers for pouring help with grasping and lifting. Pouring from container to container helps with hand eye co-ordination.

Hand washing games are great for all hand skills, catch the soap in a bowl of water, rub it between the hands without dropping it, then rub hands together palm to palm, spread fingers and interlace them and rub back and forth. Use a nail brush to scrub nails.

Of course all the above games can be done in a small bowl of water on the floor or table, just for play time.

Grasping different textures of sponges and flannels helps to explore texture.

If your child does not seem to like washing eg because water on their face, hands or body for washing, try this:

Choose an activity they really love first, so they are calm and happy and do this for 10 minutes first.

Use a small bowl of water for washing. Then let them choose soap products which they like the smell of, sponges or flannels which they like the feel of and just wash part of them, only do what they can tolerate, help them to wash themselves rather than you washing them, so they feel more in control. Try and make it as much fun as possible, using bath toys they really like.

Teeth Cleaning:

Use products suitable for your child’s age and stage of development.

Gently assist them with your hand over their hand, until they develop the control to do this safely by themselves.

Sitting down will help them to concentrate on the task.

Small chunky handled tooth brushes may be easier to hold.

If they seem a bit averse to this activity:

Try it without toothpaste first, is the smell or taste too strong? Try a fruity flavor rather than mint.

Is the feel of the brush a bit aversive? Try different brands of toothbrush, using a rubbery end, soft bristles, harder bristles, see what their preference is.

Try gentle face washing first, to get them used to their face being touched and then progress to tooth brushing.

Dressing:

Use backward chaining to teach these skills, whatever the age or stage of development. This means letting your child finish off the last step. As they learn to manage the last step, you can them let them do a bit more until gradually they take over the whole activity by themselves.

Choose easy garments; lightweight, large and stretchy tend to be easier.

Practice when they are not tired.

Pull off items like hats and socks

Do they help by holding out limbs for you (Put arm out for tops)

Sit to dress lower half, put legs in leg holes

Finish pulling up pyjama bottoms

Tights and socks are inevitably difficult for most under 5s!

 

Drinking:

Help your child to hold their cup / bottle with both hands.

Try different cups; integral straws, non spill lids

Try handles and no handles

Eating:

Give your child a spoon to play with when you are feeding them.

Let them dunk their spoon in their food pot.

Choose small food pots which are easy for them to hold in their small hands and help them to pull the lids off (holding it steady at the same time)

Help them to load their spoon.

Let them try and take their spoon to their mouth, let them be messy when they are practising!

Using Hands to Play:

Baby gym (encourages eyes looking and following, swiping and grasping)

Rattles

Shakers

Musical instruments, shaking bells, shaking maracas

Mirrors

Pull along toys to watch

Bubbles to watch

Finger puppets

Cause and effect toys eg pop up toys, musical toys

Activity centres with push buttons, sliders, twist action buttons

Sensory toys, with different textures, brushes, sponges

Water play, pouring buckets and containers, ducks to grasp and watch float around

Hand rhymes / action rhymes eg ‘Round and round the garden’, ‘Wind the bobbin up’, ‘Peter Pointer’

Put toys in boxes, start with big boxes and progress to smaller ones

Stacking rings

Shape sorters

Bricks, stacking cubes, stacking cups

Inset puzzle boards with chunky handles

Inset puzzles with small peg handles

Board books, turning pages

Paper books, when they are good with board books, progress to paper books, turning pages

Finger painting, with child friendly paints

Messy play with food, hands in bowls of jelly

Other sites that you might like to visit for more information:

EI SMART

Motor and Co-ordinations Skills Affecting Everyday Activities:

Practising the actual everyday activity is the best way to get better at it. Practice every day, at a time of the day when your child is most alert and motivated.

Choose activities which are appropriate for their stage of development, ie choose activities which are easy for them to start with and then progress from there.

Always use toys which are suitable for your child’s age and be aware of choking hazards.

Dressing / Fastenings:

Use backward chaining to teach these skills, whatever the age or stage of development. This means letting your child finish off the last step. As they learn to manage the last step, you can then let them do a bit more until gradually they take over the whole activity by themselves.

Sit to do this, so they can focus on the activity.

Choose easy garments eg chunky buttons with generous button holes, zips with novelty zippers added to then which are easy to get hold of. Buttons and zips which are different colours to the garment are easy to see, put some coloured stitching around the button hole to help visually define it.

Give plenty of time, eg early evening put pyjamas on before getting too tired, also pyjamas are generally easier garments to manage.

Choose easy garments, light large and stretchy tend to be easier.

Put the garment on the table in front of them, don’t actually put it on as they can see the fastenings more easily.

Talk about ‘posting the button through the hole and ‘catching it’ on the other side.

Source (or make?) pencil case with different fasteners (buttons/zips) so they can practice skills at other times too.

Washing and Bath time:

Bath toys are a fun way to develop hand skills, manipulation skills and using 2 hand together.

Different sizes and shapes of containers for pouring help with grasping and hand eye co-ordination.

Hand washing games are great for all hand skills, catch the soap in a bowl of water, rub it between the hands without dropping it, then rub hands together palm to palm, spread fingers and interlace them and rub back and forth. Use a nail brush to scrub nails.

Use different textures of sponges and flannels helps to explore texture.

Use a mirror to help wash their faces and see where the flannel is.

Teeth Cleaning:

Use products suitable for your child’s age and stage of development.

Gently assist them with your hand over their hand, until they develop the control to do this safely by themselves.

Sitting down will help them to concentrate on the task.

Using a mirror will help them see what they are doing even though it will be ‘backwards’

Small chunky handled tooth brushes may be easier to hold

If they seem a bit averse to this activity:

Try it without toothpaste first, is the smell or taste too strong? Try a fruity flavour rather than mint.

Is the feel of the brush a bit aversive? Try different brands of toothbrush, using a rubbery end, soft bristles, harder bristles, see what their preference is

Try gentle face washing first, to get them used to their face being touched and then progress to tooth brushing.

Drinking:

Choose a cup which is easy to hold, eg smaller, with 2 handles

To help prevent spilling, half fill a cup, use a non spill cup, integral straw etc.

Using Cutlery:

Used shaped cutlery which helps to train how to have the correct hand posture for easier use of spoons, forks and knives (Caring cutlery and Nana’s Mana’s cutlery is easy to use, or just smaller, chunky handled cutlery).

Offer food which is easy to load onto a spoon and does not fall off eg thick yoghurt or mashed potato.

Offer food which is easy to stab with a fork.

When they are the correct age and ready to use a knife to cut food, use hand over hand assistance to help model the cutting action.

 

‘Building block’ fine motor skills that may need practice:

Sometimes there are ‘building block’ skills which are a bit tricky for some children and they need help to develop, in order to manage the everyday tasks.

Great toys and activities for assisting with these building blocks of general motor control:

  • Play with peg games and use clothes pegs (which need to be squeezed) on washing line, ‘peg up’ their pictures, this can help to develop pincer grasps.
  • Water squirters
  • Try 2 handed skills, pass small items from hand to hand, threading
  • Construction toys such as Lego and Meccano
  • Sewing, baking
  • Fidget toys

More Handouts for Ideas:

Below are links to helpful advice sheets with activities you can complete at home with your child.

 

Also look at the North Yorkshire Council (NYC) website for activities to assist with co-ordination difficulties called ‘Supporting Children and Young People with Co-ordination Difficulties’. This was co-produced by the NHS OT Team and The NYC Inclusion Team.

Link to NYC

38093 C&YP SUPPORTING CHILDREN – CO-ORDINATION:30482J (northyorks.gov.uk)

Sensory Preferences Affecting Everyday Activities:

This area will be helpful for all ages.

Sensory preferences are the choices that children make about the sensations that they like and dislike.

We all have sensory preferences that help us to function in daily activities optimally, eg some people like it quiet to work and some like the radio on in the background. Neither is right or wrong, it is just different.

Some children have very obvious choices and strong needs for some sensory choices and if these needs are not met, it really affects their everyday activities in a negative way. We try to help them to get these sensory preferences met, in a safe and age appropriate way.

It is also helpful to know that getting these preferences met little and often, can help a child stay well regulated. When a child is well regulated, they can play and learn. Which supports their wellbeing.

Their choices of activity and behavioural responses to sensory cues around them, tell us what they need to develop and grow.

How do they show us their choices? We watch their behaviour and we think, what does this tell us about the sensory preferences that they have?

Sometimes children are very sensitive to some sensations and do not like them and sometimes they needs lots of a particular sensation.

Here are some things to think about when you watch your child. See your child with ‘sensory eyes’:

Do they love lots of movement, eg running around, turning in circles, turning themselves upside down to do roly polys?

Do they dislike movement, eg are easily car sick, like to sit still?

Do they like to jump, bounce, are heavy handed or heavy footed?

Do they like to make noise or put music or TV on very loud?

Do they cover their ears when there is noise?

Do they dislike the feel of their clothes, or haircuts?

Do they like the room to be dark, close the curtains, turn the lights off?

Do they dislike strong smells, or seek out strong smells?

Do they dislike strong tastes or seek out strong flavours?

Whatever their preference is, let them have it, in a safe and age appropriate way, little and often and see if they are calmer and more settled afterwards. If they are, keep doing this, it is what they need.

When you help your child to get these needs met, they will then be more ready to engage in the other everyday activities which they need to do or would like to do eg getting washed and dressed, brushing teeth.

If you would like to learn more about this, you may find the links below useful:

locala.org.uk/services/sensory-occupational-therapy-service/information-for-parents

locala.org.uk/services/sensory-occupational-therapy-service/talking-sense-training

 

Sensory Integration Education – Transform Lives

Sensory Integration Education offer free advice to parents, run free courses for parents and schools and have lots of useful advice on their website.

 

More Information for home and school coming soon.

Useful links

We often use external companies to assess for and provide equipment like seating for our children.

If you have a problem with your piece of equipment and it was provided by the NHS, please call Medequip on 01423 226240

Some of the equipment companies we use are listed below with contact details:

Wheelchair services are provided by NRS Healthcare and they are based in York.

01904 654052

NYCC (Social Services) Occupational Therapists can help you to make large adaptations to your property or provide equipment to make things easier at home like bathing aids, stairlifts, etc. You can contact them on 0300 1312131

The William Merrit Centre in Leeds offers children’s car seat clinics if you are concerned about your child travelling safely in a car seat because of their disability. This is a self referral service.

0113 3508989

SMS 07858 224510

https://wmdlc.org