KIDS WORKING! What's it all about?

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Occupational therapy is exactly what it says it is – it’s therapy that addresses the skills and  awareness needed to be successful in an “occupation.” The primary occupations of infants, toddlers, and young children are playing, learning, and interacting with caregivers and, eventually, their peers. For children and youth, occupations are activities that enable them to learn and develop life skills (e.g., school activities), be creative and/or derive enjoyment (e.g., play), and thrive (e.g., self-care and relationships with others) as both a means and an end.

Occupational therapy practitioners work with children of all ages and abilities and their families, caregivers, and teachers to promote active participation in activities or occupations that are meaningful to them. They have a thorough understanding of typical development, the environments in which children engage (e.g., home, school, playground) and the impact of disability, illness, and impairment on the individual child’s development, play, learning, and overall occupational performance.

Occupational therapists collaborate with parents/caregivers and other professionals to identify and meet the needs of children experiencing delays or challenges in development. They identify barriers that make it difficult for the child to participate in daily activities and develop objectives for modifying those barriers or helping the child to compensate for them. They teach and model skills and strategies for children and their families so that children can be more successful in all aspects of daily tasks, and they adapt activities, materials, and environmental conditions so that children can participate in various settings at home and in the community.

Occupational therapy interventions address developmental milestones as varied as facilitating movement to sit, crawl, or walk independently; learning to pay attention and follow simple instructions; developing the ability to eat, drink, wash, and dress independently; learning to cope with disappointment or failure; reducing extraneous environmental stimuli, such as noise for a child who is easily distracted; building skills for sharing, taking turns, and playing with peers; using toys and materials in both traditional and creative ways; and participating in age-appropriate daily routines.

The primary occupations of older children and teens are integrating educational instruction in and outside of school, forming and maintaining productive friendships, and beginning the transition to work and more independent, higher education. Occupational therapy interventions for this population often expand to include such items as adapting or modifying curricula, the environment, or activities to support participation in educational routines and learning activities; navigating more complex social relationships, including dating; assessing the skills needed to learn to drive or assisting with alternative community mobility options; strengthening self-determination and decision making skills, and enhancing overall independence; helping with vocational planning and transitions, including employer supports; and planning for transition to college, including time management, study habits and routines, and independent living skills.

Injury-Related Services
When a child experiences a serious illness or injury, medically-based or rehabilitative occupational therapy services may be provided. These services are developmentally appropriate and may emphasize physical skills to increase movement, strength, and/or coordination; and adaptive skills or equipment to address deficits in cognitive and executive function, sensory processing, visual motor and perception, and the ability to form appropriate social and interpersonal relationships, with a goal of improving the child’s functional performance and independence.

Emotional-Behavioral Needs
Occupational therapy practitioners have training in psychosocial and mental health conditions and are well suited to address children’s emotional and behavioral needs as they relate to everyday activities and social interactions. For example, occupational therapy practitioners help children develop the ability to cope with challenges and to use calming strategies to deal with frustration, defuse anger, and manage impulsivity in order to succeed at individual tasks and collaborative interactions at home, at school, and in the community.

As children grow older, skills for success in independent living become essential. Occupational therapy practitioners address self-determination and self-advocacy skills, along with the transition into adult roles.

Below you’ll find what skills you can expect your child to be developing at various ages and stages. It’s important to remember that these are just guidelines. Every child is unique. If you have concerns, it’s a good idea to talk to a professional. Ask your doctor for a referral for an assessment. If there isn’t a problem, you’ll be able to stop worrying. If there is, the sooner it’s addressed, the easier it will be for your child to improve.


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What kinds of things do I like to think about?
  • At 12 months: I like toys that make sounds and I like making them work. I know that a toy is still there even if you hide it under something. I understand how familiar objects are used and I might pretend to drink from a cup or “drive” a toy car. I might push an adult’s hand to continue a fun activity, and I anticipate certain events from familiar signs (e.g., crying when mom gets ready to go out).
  • Between 12 and 18 months: I link more objects in functional play activities (e.g., put a cup on a saucer and pretend to drink). I imitate more simple everyday actions (feeding a doll; reading a book). I like putting small objects in and out of containers. I like looking at simple picture books with you and I might point to familiar objects. I have favorite toys and I play more appropriately with them. I start experimenting with toys to see if I can use them in different ways.
  • Between 18 months and 24 months: I probably follow you around and imitate things you do (e.g., sweeping floors, talking on the phone. I’m happy playing near other children but I don’t really play with them. I play more with “make believe” activities like feeding my dolls or having my cars interact with each other.
  • Between 24 and 30 months: I play more meaningfully with toys like dolls and cars, and while I play with them I talk about what’s happening with them. I match “same” objects and pictures and I notice little details in picture books. I can do simple form boards.
  • Between 30 and 36 months: I love playing “make-believe” and even make up people and objects. I like floor-play with blocks, boxes, toy trains, dolls and doll furniture. I still like playing alone but I also play more with other children. I match colors, and shapes in puzzles and shape sorters. I count to three and maybe further and I hold up fingers to show how old I am.
  • Between 3 and 4 years: I understand concepts of big/little, fast/slow, and long/short. I can tell a simple story with beginning, middle, and end. I match more detailed pictures of “same” objects and complete a form board of 5 or more pieces
  • Between 4 and 5 years: I know how old I am! I can match and label 4 colors. I can count to 10 and answer “how many…” if you ask me. I can sequence pictures in order of occurrence and I can answer questions about a story that you read to me. I can classify objects into categories (e.g., food, toys, vehicles). I understand “yesterday”, “today”, and “tomorrow”. I can understand and complete simple analogies (e.g., “Ice is cold. Fire is “hot” and I can predict the outcome of a story.
  • At 5 years: I know my “right” from my “left” and I can tell you my home address. I can count up to 20 objects, identify some small words, say the alphabet and write some letters. I can add and subtract correctly within 5 objects. I can still be easily distracted but I like learning by doing things myself. I can make up long stories and I know the difference between telling the truth and lying.


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What should I be able to do with my hands?
  • By 2 years of age: I can get into all kinds of things so watch me closely!! I can unscrew the lids of jars.
  • By 2 ½ years of age: I can build with Duplo. I can complete a shape-sorter but I may need you to give me a few hints with harder pieces. I can use my hands together to put large beads on a pipe cleaner and I can complete a few puzzles with inset pieces (probably not interlocking). I can turn large pages by myself when I look at books. My coloring might still look messy to you as I color lines in all kind of directions. We can have fun playing catch now because I can catch a large ball from 2-3 feet away if you give me a few verbal cues.
  • By 3 years of age: I can pour from a small pitcher and string large beads.
  • By 4 years: I hold a pencil correctly. I can cut out a circle and other simple shapes. I can copy more shapes (square, triangle, diamond). I can draw a stick figure with up to 6 recognizable parts. I’m starting to copy letters and numbers.  I can sew a lacing card, use a key to open a small padlock, and put small pegs in a pegboard.
  • At 5 years: I can hammer a nail and use scissors carefully. I write numbers 1-to-10.


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What kind of things do I like to play with?
  • At 2 years: I like pushing and pulling things. I start to use pounding and interlocking toys. I use a cookie cutter with playdoh and I begin to enjoy painting and coloring. I like to tear paper and paste. I enjoy rocking chairs and swings. I play with dolls and stuffed animals and I act out imaginary eating and sleeping with them. I don’t share toys well and I’d rather play alone than with a friend.
  • At 3 years: I like making things from clay or mud or sand. I’m starting to paint with a brush on paper. I look at books by myself and I name pictures in books. I’m starting to draw simple shapes and I can build a tower with blocks.
  • At 4 years: I can complete a 20-piece puzzle. I play with my friends for long periods of time. I like pretend play and dressing up and I’m starting to play group games. I do puzzles and play dominoes and simple card games. I sing songs and tell stories. I draw recognizable pictures.
  • At 5 years: I like acting out with puppets. I color within the lines and I copy things.


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I like learning to do things for myself!
  • Between birth and 6 months: I communicate hunger, fear, or discomfort through crying.
  • Between 6 and 12 months: I tolerate a range of differently textured foods. I can hold my bottle independently and I start drinking from a cup. I use my tongue to move my food around in my mouth and I can self-feed small crackers or small pieces of food.
  • Between 12 and 24 months: I understand common dangers (e.g., hot objects, stairs, glass). I can settle myself to sleep at night and during the day for a nap. I try to brush my own teeth. I can take off my own shoes and socks and I cooperate in dressing by extending an arm or a leg.
  • Between 24 and 36 months: I use the toilet with help and I have daytime control. I unbutton large buttons. I feed myself simple meals using a fork or spoon.
  • Between 36 and 48 months: I unbutton large buttons. I use a napkin to wipe my face and I can put my toys away. I brush my teeth independently.
  • Between 4 and 5 years: I can choose weather-appropriate clothes and I can dress and undress myself with a little help! I tolerate different clothing textures and I know the front and back of clothes and I can button small buttons. I can lace my shoes though maybe not tie them. I can hang up my coat and put away my toys. I wash my face and blow my nose without help. I go to the toilet by myself. I can use my spoon and fork pretty well to feed myself and I can get a drink from a water-fountain.
  • Between 5 and 6 years: I dress independently and feed myself without difficulty. I can open my lunch box, zip lock bags, and food packaging. I sit at my desk at school and follow teacher instruction, and I’m independent with simple in-class assignments.
  • Between 6 and 7 years: I shower independently! I can fix simple meals (e.g., cereals). I eat a range of foods with different tastes and textures. I can pack my bag for school with very little help. I can tell time.
  • Between 7 and 8 years: I can pay attention for longer periods of time and sit still in class. I can do simple chores at home. I’m starting to use time-management skills and I understand money.


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When do I start making friends?
  • By 2 years old: I’m just beginning to develop a sense of personal identity and belonging. I can be very possessive and often show it in a negative way. I may need some adult guidance but I like playing by myself. I’m easily frustrated and I’m not yet very good at choosing between two alternatives. I’m becoming more independent and I don’t like changes very well. I respond better to humor and distraction than to discipline and reason.
  • By 3 years old: I play well next to my friends. I start to learn to take turns. I also like making new friends and trying to help my mom and dad.
  • By 4 years old: I can pay attention for longer periods of time even though I’m still easily distracted. I have favorite friends and I’d rather play with a friend than alone. I’m getting pretty good at sharing and taking turns! I talk about my feelings and I notice when you’re sad or upset. My “manners” are improving and I’m learning how to let you know I’m sad or upset without having a complete meltdown. I’m also noticing the differences between boys and girls.
  • By 5 years old: I love playing with my friends. I like simple table games with rules and “school”. I feel proud of myself when people compliment me and I like to be given special responsibilities.