Occupational therapy is a health care service designed to help individuals engage in the activities they need and want to do in their daily lives. For a toddler, these daily activities, or “occupations,” center on self-care, learning, socializing, and play. When a toddler experiences developmental delays or struggles to perform age-appropriate tasks, a pediatric occupational therapist (OT) evaluates the underlying physical, cognitive, or sensory reasons. The goal of this support is to remove barriers that prevent a child from achieving independence and participating fully in their world. This article explores the common functional challenges that lead to a toddler being referred for occupational therapy services.
Difficulties with Movement and Coordination
Delays in developing motor skills are a common reason for referral. Occupational therapists distinguish between fine motor skills, involving the small muscles of the hands and wrists, and gross motor skills, involving the larger muscle groups. Both sets of skills are necessary for functional tasks like self-feeding and playing.
Fine motor delays manifest as difficulty with precise hand movements, such as grasping small objects or manipulating toys. A two-year-old should be able to stack four to six blocks and scribble, while a three-year-old is expected to string large beads and begin holding a crayon with their fingers rather than a full fist. When a toddler struggles to turn single pages in a book, use a spoon, or complete a simple shape sorter, these difficulties indicate a need for targeted hand-eye coordination and dexterity work. The OT focuses on improving the strength and coordination needed for these hands-on activities, ensuring the child can use movement to perform functional tasks.
Gross motor skill delays involve challenges with balance, strength, and coordination of the arms, legs, and torso. By age three, a child learns to run well, jump in place with both feet, and walk up and down stairs using an alternating foot pattern. A toddler who frequently falls, struggles to climb playground structures, or cannot sustain a controlled run may need therapy to develop core stability and motor planning. OT addresses these larger movements to ensure the child can safely and efficiently navigate their home and play environments.
Navigating Sensory Input
Difficulty with sensory processing occurs when the brain incorrectly interprets information received from the senses. It affects how a child reacts to sights, sounds, textures, and movement, which can disrupt daily functioning and behavior. The goal of OT in this area is to help the child regulate their responses so they can focus on learning and play rather than constantly reacting to environmental stimuli.
Some toddlers are over-responsive, or hypersensitive, meaning they experience ordinary sensations as overwhelming or painful. This may result in extreme reactions to loud noises, or a refusal to wear certain types of clothing due to the texture. Hypersensitivity can also cause a child to be an extremely picky eater who refuses entire food groups based on texture, leading to significant mealtime stress.
Other toddlers are under-responsive, or hyposensitive, and may seek intense sensory input to feel grounded or regulated. These children might crave intense movement, such as constant spinning or jumping, or they may not register pain or injury as easily as their peers. OT uses specialized techniques like sensory integration therapy, which involves controlled exposure to stimuli through play, to help the nervous system process information more comfortably and efficiently.
Challenges with Daily Routines and Self-Care
Difficulties with daily self-care tasks are often the result of underlying motor or sensory processing issues that prevent independence. A child may have trouble cooperating with bathing or grooming because they are highly sensitive to the temperature of the water or the feel of a brush on their skin.
Feeding difficulties are common, especially when the issue goes beyond typical toddler pickiness. This can include problems with oral-motor skills, such as chewing and swallowing, or an extreme aversion to food textures due to sensory sensitivities. Therapists work to improve the child’s acceptance of different foods by gradually introducing textures and supporting the development of self-feeding skills using appropriate utensils.
Self-regulation and play skills are crucial, and challenges here can impact socialization. A child may struggle with prolonged tantrums, an inability to transition smoothly between activities, or difficulty engaging in focused, purposeful play. OT helps toddlers develop better coping mechanisms and social engagement skills, which rely on the foundation of being able to process the environment and control their body movements.
The Evaluation Process
When concerns arise about a toddler’s development, the first step is a consultation with a pediatrician, who can provide a referral for an occupational therapy evaluation. The evaluation involves a thorough collection of background and developmental information from the parents or caregivers.
During the evaluation, the therapist uses direct observation during play and standardized assessments. The OT assesses the child’s skills across domains, including motor coordination, visual-motor skills, and sensory processing. The parent interview identifies the family’s priorities and specific concerns about the child’s habits and routines.
The occupational therapist discusses the findings and determines if therapeutic intervention is recommended. If therapy is needed, the OT develops a personalized treatment plan with specific, measurable goals tailored to the child’s needs. This plan aims to build the skills necessary for the child to participate successfully in their daily activities and achieve greater independence.