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What does Occupational Therapy look like in the Paediatric space?

Occupational Therapist‘s use plays as a key ingredient to support children and families to meet their goals. Play is essential in childhood and drives not only learning but also social skills, and ultimately wellbeing.To give you some ideas of how we’ve helped children and families to achieve their goals, take a look at some examples of how our paediatric clients and Occupational Therapists have worked together using play. Story 1 – From Rachel Paediatric OT
Happy baby eating porridge with spoon
I work with A who has a diagnosis of Down’s Syndrome for the last 8 months.  I visit this client (A) at kindergarten every week to achieve their OT goals around improving his play skills and self-feeding skills. I use play-based therapy to develop his independence in self-feeding skills.When I first met this client (A) he had delayed fine motor skills and coordination skills which impacted on his ability in holding a spoon to further feed himself. From OT assessment, it was evident there was barriers in his environment for self-feeding therefore the first step was to assess whether assistive technology such as supported cutlery could assist achieving this goal. In collaboration with educators at the kindergarten I have been working to assist the child to achieve their set goals. In my intervention As an OT I recommended cutlery with large handles for the child to hold which assists with an appropriate grasp of the cutlery. I have focused on play in therapy, as children invest time and energy in play and creates opportunities for learning. Through water play (the action of scooping water into a cup and pouring it out which imitates the activity of using a spoon to scoop food) and object play (feeding dolls and puppets) A has been able to achieve self-feeding skills with a spoon. To further develop his self-feeding skills he uses a fork for pretend play with playdough (pretend food) and feeds dolls and puppets. A is now independently feeding himself at meal times with peers and family!!Story 2 – From Anna OTL is 5 years old and is diagnosed with ASD. Using an OT assessment, L was assessed to have delays in fine motor skills which affected his independent writing skills. He also had difficulty with concentrating, sharing with peers and interacting with others for more than 2 minutes. L is a delightful child who enjoys playing on his own and his strengths include learning new things quickly and he has a great memory. While drawing and holding crayons L initially used ‘digital pronate grasp’ This grasp is typically seen in children aged 2-3 years, which is when all fingers are used and wrist is turned down towards the bottom of a pencil along with a whole arm movement.I engaged L in activities that involved his interests and having fun to achieve his goals of improving his grasp, manipulating small objects, and increasing his concentration. I also noticed L loves being praised and recognised for his efforts and this motivates him to do better! By making OT activities engaging and enjoyable for L and by using the right tools, he is now able to hold a whiteboard marker with a more advanced grasp and is beginning to learn how to write his name. He is also now able to recognise when it is the OT’s turn in activities. With the right strategies, he can sit with the OT for at least 20 minutes before he needs a break!Story 3 – From Anna OTNoah is 4 years old and is diagnosed with ASD. To achieve Noah’s goals, OT intervention was focused on improving his fine motor skills and play skills. On observation, he initially used ‘palmar supinate’ grasp which is typically seen in children who are 12-15 months old. It is a fisted grasp with the thumb wrapped at the top of the pen. During my interaction with Noah I noted he likes toys that are colourful and toys with a pleasant or interesting texture to touch. He also enjoys listening to stories. In OT sessions with the use of colourful pompoms, colourful tongs, and a toy bus which he also plays with in speech sessions, Noah now uses an advanced grasp. In this video he is helping ‘people’ (pom poms) to board the ‘bus’. With OT supporting his play and adding variations in play by modelling using narratives.  Noah has also demonstrated improved play skills. In this photo Noah has used flowers from a threading activity to make a ‘bird’.Story 4 – From Ellen OTWhen I received the referral, this little girl had very recently been diagnosed with mild cerebral palsy. The family identified that their main goals for their daughter were for her to improve her sleep, begin to expand her food textures and tastes and be able to feed herself, and for her to be able to engage in play with her parents and other children. I used an OT model called the PEO model (Person-Environment-Occupation) to assess how we could address these goals in a family-centred way, and to understand how to best engage this little girl in play.Through conversation with the parents, it was clear the first thing we needed to address was her sleep. We all know how important sleep is, and while no one in the family was sleeping, nothing was going to change. I directed the family to a free sleep consultant available through their local maternal health service, and they have been working alongside the sleep consultant with already improved results and she is now sleeping through the night.We also worked together to get her a supportive, safe and appropriate high chair where she could use both hands to explore her food during mealtimes. I used the set up of a teddy bear’s picnic to begin exploring feeding with spoons, where we brought the teddy’s up to the table next to her and engaged in pretend play. Through involvement in mealtimes and increased exposure to a variety of different food and food textures, she started to feed herself with a spoon and with finger foods.To engage her in play, we knew her favourite place to be was outside, and her favourite people to be around were her parents. So we all took some age appropriate toys outside, and engaged in some ‘floor time’ play on the grass. We discussed the benefits of the sensory input of the grass, fresh air and sunshine, as well as engaging the little girl in an outside obstacle course, ending with a ring stacking game. Each session we increased the play task to include another step, to gradually increase her attention and concentration. We used a combination of gross motor games like crawling through tunnels and pillows, and sensory games like blowing bubbles, singing and dancing to action songs like head shoulder knees toes etc, and including a bimanual task to work on her fine motor skills such as building blocks, throwing catching a ball, cause effect toys and ring stacking to engage her in activities and work on her developmental skills.I also introduced the family to free, age appropriate social activities in the community such as the reading and song sessions for babies and toddlers at the local library, as well as kinder gym classes and swimming sessions.Over the past few months, she is sleeping through the night, eating her meals independently with finger feeding and feeding herself with a spoon, and can now engage in play activities with her parents for longer periods of time. She attends the local library weekly for story time and has started spending time with her nana and cousins each week now she isn’t too overtired. Here we used play to engage her in therapy sessions, improve her feeding skills, build rapport, capacity build for her parents and provide them with practical activities to engage their daughter and addressed the social needs of the family.If you think one of National 360’s Occupational Therapist’s might be able to help you or your child, or you just want to have a chat to explore how we can assist you, please reach out to our friendly customer service team on 1300 340 440. Or if you are ready to make a referral please visit our referrals page here.