What is Pediatric Occupational Therapy?

There are two types of people in the world: those that when I tell them that I’m an occupational therapist a glossy look comes over their face, and those that nod along like they know exactly what I’m talking about.

Okay, maybe there’s a third type of person who actually does know what occupational therapy is, but they’re so rare you’re more likely to run into a unicorn in the wild.

No, by and large, the most common response I hear is “Oh, yeah! So you help people find jobs!”

Well, no. Except for in community mental health settings where that could totally be a part of an OT’s day. Or vocational rehab. Or in an work hardening/conditioning clinic…

But I’m getting off track. Still, ever since OT grad school this has been a weekly occurrence for me, so you can only imagine how people’s heads explode when I tell them I’m a pediatric occupational therapist. Cheeky child labor jokes aside, this is a setting that most people aren’t familiar with, sometimes even other therapists! I know that when I was in OT school my biggest question was always “What does occupational therapy actually look like in this setting?”

I hope this overview helps OT students as well as anyone else who would just like to learn more about our awesome profession and the field of pediatric occupational therapy.

What Kind of Clients do Pediatric Occupational Therapists See?

Pediatric OTs can work with a wide variety of children, all the way from premature newborns to 21-year-olds. While the difficulties may vary, all of these children will have some sort of diagnosed disability or other condition.

Most commonly, we see children with diagnoses like autism, cerebral palsy, Down syndrome, ADHD, etc. But practice for long enough and you’ll find conditions you didn’t even know existed – I’ve worked with children with rare genetic disorders, epidural hematomas, connective tissue disorders, and uncommon cancers.

What Kind of Skills do Pediatric Occupational Therapists Address?

Like occupational therapists in adult settings, pediatric occupational therapy treatment usually begins with ADLs. One of the biggest differences here is that very often, you will be doing habilitation instead of rehabilitation. What this means is that in a setting with older adults, you may be working on retraining the ability to put on pants.

Whereas with a 5-year-old with autism who never had the ability in the first place, you are teaching them for the first time. This is an interesting distinction and has led to battles with insurance companies and other payor sources, and has caused many states to write new laws to ensure these services are covered.

Another difference is that with older adults, you are generally attempting to help them regain all of their ADL skills, or at least return them to their prior level of function. Conversely, in pediatric practice, not all ADLs skills are age-appropriate for your patients.

That’s why it’s so important to be aware of developmental milestones – otherwise, you may be asking a child to attempt a skill that even a typical peer would struggle with.

Beyond ADLs (and IADLs for older patients), pediatric OTs work on any skill that is a barrier to participating in these tasks or other age-appropriate occupations, like play or education. Commonly, this includes fine, visual & gross motor skills, ability to transition between tasks, emotional & behavioral regulation, ability to process sensory input, attention, and ability to follow directions.

How Do Pediatric Occupational Therapists Improve Client Functioning and Performance?

Like other settings, pediatric OTs can address deficit areas in a variety of ways. Most commonly, pediatric OTs will work to improve the underlying skills to enable a child to participate in appropriate occupations. For example, a pediatric OT may work on fine motor coordination to help a child tie their shoes independently.

But for a child with severe cerebral palsy, independent shoe-tying may not be an appropriate goal, so an OT could help the family find a pair of slip-on shoes that fit over the child’s ankle foot orthotics (AFOs).

Generally, a pediatric OT will use a variety of approaches when working with a client, sometimes even choosing to use an accommodation temporarily while developing the underlying skills needed to do the task more independently.

Much of pediatric occupational therapy practice also involves caregiver training. This could be anything from teaching a parent how to appropriately transfer their child from a wheelchair to providing strategies to aid in transitioning at home, like visual timers, visual schedules, or transition warnings.

In What Settings do Pediatric OTs Practice?

Pediatric occupational therapists can practice in a wide variety of settings. Here are the most common pediatric settings:

• NICU (Neonatal Intensive Care Unit): This setting involves working with newborns (often premature but not always) who have high medical needs. Most common interventions here involve feeding, positioning, and a lot of parent/caregiver training.
• Early Intervention: This setting involves working with children birth to three years old, most commonly in their homes but also sometimes in community settings like childcare facilities or parks. There is a big emphasis on natural environment and developing skills that are valuable to the family, as well as helping with roles and routines. This area of practice is federally mandated and funded by IDEA.
• School-Based: This setting involves working in the school system with students that have been identified as having a disability that affects their education. All treatment in this setting must be educationally relevant, which means that some skills are not addressed if they aren’t interfering with their ability to participate in school. This area of practice is also federally mandated by IDEA.
• Outpatient: This setting involves working with students with a wide variety of disabilities, both in type and severity. Treatment typically takes place weekly in a special clinic that is set up to address building underlying skills in a playful way. While sensory processing disorder as a stand-alone medical diagnosis is still controversial, this is the setting where children with sensory processing differences most commonly get treatment.
• Inpatient: This setting involves working with children in the hospital. Commonly, these children are experiencing a new disabling condition, such as a spinal cord injury, burns, or cancer, but it is also possible to work with children with existing conditions who suddenly require increased medical care, such as a child with epilepsy who has been admitted to the PICU (Pediatric Intensive Care Unit).
• Home Health: In this setting, pediatric OTs work with children in their own home environment. This can be through pediatric home health agencies or with their own private practice working on the child’s specific needs and providing caregiver education and home modifications as needed.  

While less common, you will also find pediatric OTs working with children in skilled nursing settings for medically fragile children, community mental health, and foster care.

What Education/Training do You Need to Practice Pediatric Occupational Therapy?

Pediatric occupational therapy practitioners must first obtain a degree in occupational therapy, which is currently a Master’s or Doctorate degree for occupational therapists, and an Associate’s degree for occupational therapy assistants. Occupational therapy fieldwork is the next step, and while a pediatric placement is not specifically required to practice in this area after graduation, it is highly recommended.

Then, they must pass the NBCOT, a national board-certifying exam. Finally, OTs and COTAs must become licensed in any state where they intend to practice. No further training is required to practice as a pediatric occupational therapist, though it is possible to obtain specialty certifications through the American Occupational Therapy Association (AOTA).

New grads may also benefit from taking CEUs in this area to make their resumes more competitive, and it is also possible to apply for a Pediatric Fellowship after finishing grad school to increase your knowledge base even more. We also recommend finding a mentor working in pediatrics to observe and learn from, especially when you are starting out.

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I love being a pediatric occupational therapist, so I could go on for days about this area of practice, but for now, I hope this brief overview about what pediatric OT is has helped you learn a little bit more about this specialty area.

What other questions do you have about pediatric occupational therapy? If you’re a practicing pediatric occupational therapist, would you add any additional tips or information to this post for students and prospective OTs?

This post was originally published on July 15, 2019 and updated on April 5, 2023.