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Children's Occupational Therapy

Occupational Therapy Children's Service at Pavilion House

Here at Pavilion House, we aim to empower your child and their support network (home, school, nursery etc) to access all the information needed, when needed. There are a lot of strategies and interventions you and your child can try, both at home and school, to help and support with tasks or activities that they might be struggling with.

Our Children’s Occupational Therapy service uses a tiered intervention approach (Universal, Targeted and Specialist input) in line with Royal College of Occupational Therapists' guidance. 

This means that at Universal level, on this website, you can access all the information and advice to try at home to support your child's skill development without needing to wait to see an Occupational Therapist for assessment - see the 'Getting started with the OT help!' tab to help you find the right resources for your child. 

If a referral is then required our Occupational Therapists will triage your referral to ensure you get the most appropriate level of support - see the 'Referral Information' tab below to see when we would accept a referral and how to get one for your child.

Click here to have a look around Pavilion House!

What does a Children’s Occupational Therapist do?

Occupational Therapists (OT's) support you in taking part in everyday activities, to help you lead a full and happy life, reach your goals and learn the functional skills you need during your life.

Please see here for more information about our Children's OT service:

Children's leaflet and Parent/Adult Leaflet

We aim to support you to do the things that you want and need to do as independently as possible. We do this by thinking about you, your occupation (or activity), and your environment. If these three areas are not working together, then it can be hard to do what you want or need to do. The picture below shows how these three areas all work together.

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Universal Online Offer

Our Online Support is split into 3 areas:

Foundation Skills, Play, and Leisure



These three sections are often the areas that children struggle most frequently with. You will find a range of useful and interesting information and strategies that you can try if you are experiencing any difficulties. 


How to use the online advice - a step-by-step guide:

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I’m finding this tricky…

See the section…

I also need to be good at these foundation skills…

clipart get dressed - Google Search | Get dressed, Dress ...Dressing -

Clothes and shoes



Core stability


Body awareness

Bilateral integration

Midline crossing



(buttons, zips, laces)


Bilateral integration

Midline crossing

Developing a pincer grip


Sitting for mealtimes



Core stability

Midline crossing


Using cutlery



Hand strengthening

Bilateral integration

Cartoon School Pen Royalty Free SVG, Cliparts, Vectors, And Stock  Illustration. Image 12480684.Handwriting




Core stability

Shoulder stability

Bilateral integration

Midline crossing

Developing a pincer grip

 Using scissors




Hand strengthening

Hand-eye coordination

Bilateral integration

Midline crossing

Parent and Child Doing Sportive Exercises and Sport Training Together  Having Fun Set of Scenes Stock Vector - Illustration of cycling, ball:  90481652

General coordination/clumsiness


Foundation skills, Play and Leisure

Core stability

Body awareness


Bilateral integration

Midline crossing

Lower limb coordination

Hand-eye coordination

Ball skills

Vector Illustration Of Cute Kindergarten Africanamerican Kid Boy Brushing  His Teeth Morning Hygiene For Isolated Stock Illustration - Download Image  Now - iStock

Personal Hygiene

(Bottom wiping, brushing teeth, hair)




Body awareness


Hand-eye Co-ordination

Fine Motor


Progress diary image.JPGIt can be useful to keep a diary to track your child's progress: Progress diary

Activities of Daily Living

Play is huge part of being a child; it is when you learn and practise new skills, watch and interact with friends and explore and expand your interests. Play can be broken down into different elements, all equally as important during a child’s development.

Foundation skills: Movement and Coordination

Movement and coordination are foundations skills that can be learnt during play and that will help your child develop skills needed for self-care and education.

Core stability

Animal Walks  Animal Actions

Body awareness


Ball balance games 

Shoulder stability

Leg activities

Bike riding

Bike riding 

Ball skills

Foundations skills: Hand skills

In order to play successfully your child needs to develop a range of hand skills, this enables them to play with toys as they are intended or in an imaginative way.  Developing this range of hand skills will also help them with their future functional abilities for self-care and education.

Cause and Effect

Hand-eye Coordination

Developing a pincer grip

Stacking activities

Midline crossing

Bilateral Integration

Hand strengthening

Types of Play

Explorative Play

This is often the first type of play children engage in. Also known as sensory or messy play – it’s when your child is able to interact with their world in a very hands-on way. In fact, all of your child’s senses should be stimulated during this type of play. They will examine objects by looking, smelling, touching (with hands and mouth), listening and moving them to learn about how they can influence the world around them. 

During explorative play, lots of different textures and materials can be used, including water, sand, foam, jellies and play-safe paints. You are only limited by your imagination. Baby wipes and furniture covers are advised!

Explorative play material ideas:

Messy play

Active/Energetic Play

This includes playing at the park, soft play centres, rough and tumble, jumping in puddles and sports. 

Active play provides opportunities for children to develop and use their movement and co-ordination foundations skills! This type of play can also help emotional regulation and build risk awareness.

Social Play

This includes games where children are expected to follow rules, such as turn taking and sharing, or which may be pre-set, such as in a board-game.  Other games could involve developing rules with others, such as a playground game of tag.

Social play can often include opportunities for developing and using foundation skills, particularly hand skills.  It can also help build communication and relationship skills.

Pretend Play

This involves make-believe, imaginative and role play.

Pretend play can provide opportunities for children to develop and use both types of foundation skills. This type of play can also help with self-care and education skills. For example, putting on dressing up clothes, bathing dolls or ‘being a teacher’ can help children think through the steps required for each task and talk about any aspects that they find difficult.

What is Self-care?

Looking after ourselves on a daily basis is an important part of growing up and there are a number of skills to learn. Self-care activities include dressing, washing, brushing teeth, toileting, eating and drinking. Children need to be supported to develop the skills to complete these activities independently in a fun and playful environment. Practice is key to mastering any skill and the following tips might be helpful:

  • Allow plenty of time to have a go (weekends or evenings)
  • Consider how your child learns: show them, tell them and do the task with them
  • Try to let them have a go before taking over and doing it for them
  • Break the activity down into smaller steps to simplify the task
  • Practice, practice, PRACTICE!


Dressing and Undressing

Dressing is an important part of everyday life and it takes a lot of practice to be able to do it on your own successfully. Undressing comes first starting with taking off socks and then removing simple clothing without fastenings. Once this is achieved children start to learn to dress with some help and work out which way clothing should be. Finally, you can start to learn to manage fastenings such as buttons and zips.

Please see below for the Universal Online Support sheets for dressing and undressing:

Backwards Chaining

When teaching a new skill we often start at the beginning. This can be challenging for children who are struggling to master a skill. One way of learning a new task, while giving your child a sense of achievement, is to use the backward chaining technique. Backward chaining has been found to be particularly useful when learning self-care skills including getting dressed or undressed. It can also be helpful when teaching younger children and those who have difficulty learning new skills.  This technique can also be helpful for teaching any task that has a number of steps.


Eating and Drinking

Mealtimes are an important aspect of family life. Children begin to develop self-feeding skills from birth.  Self-feeding is a very complex task and it is common for children to have difficulty using cutlery to feed themselves. It takes repetition and practice before they can successfully use cutlery to feed themselves without being too messy. Practice makes perfect, practice cutting using play dough or plasticine first, progress onto ‘soft’ foods, like boiled potatoes and fish fingers. When you’ve perfected this go onto ‘tougher’ foods such as sausages.

Please see below for the Universal Online Support sheets for eating and drinking:



Toileting is a complicated skill that you develop over a number of years. This starts with knowing when you need to go to the toilet during the day and then staying dry during the night. Toileting involves skills such as managing your own clothes and wiping your own bottom, as well as being able to get on/off the potty or toilet safely.

Summary of equipment for home/ school to try:


Personal Care and Hygiene

Personal care and hygiene are important skills to develop as you get older to enable you to take care of your body, improve your wellbeing and increase social participation. 

Learning and being productive is vital for children and young people; it gives them a sense of purpose and opens up opportunities. Gaining the skills needed to participate in educational occupations typically begins in infancy, develops through childhood years to be in place by adolescence, enabling the young person to fully focus on academic learning. 

Many of the play and movement skills already mentioned, such as fine motor, crossing midline, bilateral integration and sitting well, are the foundations to effective performance in educational activities and can often be the root of difficulties in handwriting or scissor work. Therefore, the advice in those sections above may help you.

When learning any new skill having motivation and attention on the task is vital for success, this is particularly relevant to educational occupations due to the level of complexity, the potential for distraction, and the pressures of time and social expectations. Try to involve topics of interest to your child to make it more fun and start off with short bursts of activities!


Handwriting is a very complex skill involving sensory perception, visual-motor integration, motor planning, pencil control, posture and positioning. 

Multi-sensory approach

Perceptual advice

Positioning advice

It’s important to remember that if your child has a difficulty with their attention which is affecting their handwriting, this area should be addressed first - see attention section below, or input from CAMHS.

Early Skills

Development of handwriting –  It is important to recognise the order in which handwriting develops, and use this to guide the type of activity for your child.  If a child is delayed with their understanding or communication their handwriting development would be expected to show a similar level of delay.

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Pencil grasp - a child’s grasp typically develops in stages from using a whole-handed grasp to dynamic tripod grip and is complete by age 6. Though the tripod grip is seen to be the most efficient, for some children an adapted grip (if comfortable and functional) is appropriate and so this is not necessarily a cause for concern.

Developing pencil grip

Developing Skills

As handwriting develops the focus switches to letter formation, letter size, spacing between words, alignment on the page, and ultimately fluency. 

Pencil grip

General writing strategies

Advice for left-handers

Letter formation and spacing

Further Resources

These externally produced videos may be useful at home or in education: 

Scissor Skills

Learning to cut with scissors helps build hand strength, develops hand-eye coordination, strengthens bilateral coordination (use of both sides of the body) and can help focus attention. These factors all mean that as well as being fun and opening children up to a world of creativity, using scissors is also good for developing skills used in handwriting and other tools later in life.

Development of scissor skills begins with tearing paper, then children learn how to open/close and maintain the correct grip of scissors, before moving onto snipping, cutting lines, cutting simple shapes and then more complex shapes.

Pre-scissor skills

Scissor advice

Types of scissors


Attention is important as it helps children to listen, understand and focus on the tasks involved in learning and participating in all areas of daily life. Difficulties with attention are often noticed as fidgeting, difficulty sitting still, being easily distracted, daydreaming or appearing ‘naughty’.

Attention at home

Attention at school


Organising oneself requires the integration of skills including cognitive planning, motor planning, body awareness and timing. Children have to consider what actions are needed for a particular task, how to organise those actions and how to perform them in the right order.  

Difficulties with organisation may be noticed if children struggle with ‘personal space’, moving around the classroom or dressing themselves, in this case try activities to develop their body awareness (see Play and Leisure section). As children get older it may become apparent when they struggle to gather items needed for a task, to manage their belongings at school and with their timekeeping or homework.

Managing belongings

Time management and organisation

Additional Advice

Everybody has sensory differences which can impact their ability to take part in everyday activities; currently, at Pavilion House Children Occupational Therapy services, we do not provide sensory assessments or sensory integration therapy.

In line with the Royal College of Occupational Therapists guidance, our role is to educate and empower parents/ carers/nurseries to identify the child's sensory differences, enabling them to learn how to support their child to manage their sensory needs to be able to function in everyday life. 

We empower parents/ nurseries to do this by looking at the child's sensory environment and making changes to that, not to the child. If you feel your child has sensory differences and would like further advice, support and strategies  we have developed a series of  Sensory Processing presentations, available below,  that can be accessed freely by anyone.   

We ask that you try the strategies at home/ nursery with your child for 3 months, this will give you time to try a  few strategies to help your child. If you think you require further support or advice, and your child has not yet started school, you can request a referral for Occupational Therapy from a medical professional (GP, Health Visitor, Physio, SALT, Peaditarician etc). You will need to download and complete the Early Years Sensory Processing Questionnaire below to  send with your referral. We cannot accept referrals without the questionnaire.  If your referral is accepted you will be offerd an appointment for a telephone consultation with the Occupational Therapist.

Early Years Sensory Processing Questionnaire


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Sensory Processing Differences Presentation
The presentation is primarily aimed towards parents of preschool children and nurseries, as an introduction to what sensory processing is. This presentation aims to give you an understanding of your sensory needs and differences and helps you to start seeing your child’s behaviours through sensory specs and start to identify what their sensory differences might be. ( click on the link)

We have also developed a series of further presentations to give information and advice on the challenges children with sensory differences may experience during specific activities of daily living.  

ADLs are the every-day self-care activities that we all have to do, such as getting dressed, brushing our teeth, using the toilet, eating and going to bed. Children with sensory differences can find these activities very challenging.

These presentations will enable you to recognise why your child might find it difficult to do certain tasks from a sensory processing perspective.  ( click on the links)

You will learn about a range of strategies and compensatory techniques or equipment to help your child progress with their self-care.

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Getting dressed Presentation       

COP Bed.png

Time For Bed Presentation

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Personal Hygiene Presentation

There is a sensory service that has now been set up to support East Cheshire schools, which can be exclusively accessed by School SENDCo's. The service is called SPOTSS (Sensory Processing Occupational Therapy School Service) and can be contacted by schools.

The Sensory Processing Occupational Therapy Support Service provides support to mainstream Primary and Secondary schools to ensure the sensory processing needs of Autistic children and those who are suspected to be Autistic are accommodated.

The service delivers a core offer focusing initially on primary and secondary schools in Cheshire. Universal training is available to all local authority schools in Cheshire to educate school staff about sensory processing differences and the impact on learning. Following training, attendees will have the skills to create an individualised sensory support plan for any child in their setting.

Further targeted/specialist support is available if required, after implementation of a sensory support plan to support participation and regulation. This may include group or individual consultations and joint ​workshops with school staff and parents.

Other sensory services currently available in East Cheshire:

  • Please access CAMHS for any diagnostic assessments via your GP
  • Space 4 Autism (S4A) based here in Macclesfield, offers a wealth of support and opportunities for children and young adults with Autism, or those awaiting a diagnosis. They also support family members, friends and carers - Space 4 Autism
  • Ruby's Fund based in Congleton runs an inclusive sensory centre and social café for children and young people with additional needs and disabilities. They also support family members, friends and carers -  Ruby's Fund

Please see below for some strategies and support that might help manage and understand your child’s sensory and behaviour needs:

Please see here for some ideas to help with optimising seating for your little one, to achieve better function at home, nursery and out and about. 

Advice for early years seating 

Please see below for information on small equipment items for self-purchasing that may help with daily activities.  This equipment is not provided by NHS OT:







Theraputty may be used for hand strengthening activities, following this link to purchase from Amazon however please be aware that prices change and it can be purchased from various other online stores.

Service Information

Condition-specific Information:
  • Hypermobility: Hypermobility is a common condition, and most individuals with hypermobility maintain a normal level of activity. Hypermobility is where joints have a larger range of movement than average. Some people refer to them as having “loose joints” or being “double-jointed”. Further information about hypermobility and managing the condition can be found here: 
  • DCD (Developmental Coordination Disorder - formally Dyspraxia):

  • Down Syndrome: Downs Syndrome Association website

  • ASC (Autistic Spectrum Condition)Autism

  • Cerebral Palsy​​​​​​​​​​​​​​ScopeAlso see CP Toys as a resource of appropriate toys for Children with CP who need to develop their unimanual and bimanual skills.

Useful NHS Children's OT links:

Charities and organisations:

Before requesting a referral to our service for your child, you will need to access the Universal Online Support on this websiteYour child will need to practice strategies for at least three months before you seek a referral to the OT service.  This is to give them plenty of opportunity to practice the skill as motor skills are developed through repetition and practice, and you may find that after the three months your child does not need a referral as they are begining to develop their skills.

If your child is still struggling and has not made any progress after these 3 months of practicing strategies, please ask for referral from one of the following professionals: GP; Health visitor; SLT; Physiotherapist; or school SENDCo. Fill in the questionnaire below and pass it to the referrer to be sent with the referral form, you could ask your child's teacher to complete the questionnaire if the concern is school-based.   

Referral form (All sections to be filled in by referrer)

Questionnaire (To be filled in by Parent/Guardian/Education staff and submitted by referrer)

Referral criteria (To help referrers understand our referral criteria)

Please note - referrals will not be accepted without a completed questionnaire

*However - If your child is experiencing significant pain which affects their function, is unable to sit up by themselves, or requires specialist equipment or rehabilitation, please ask your GP/paediatrician for a referral to our service using the above referral form - this is to ensure that any other underlying medical condition has been considered before referral. In these cases you do not have to access our Universal Online Support. Please note that SENDCos cannot make referrals in these cases.

What should I do if my child is struggling with the following areas?

  • Dysgraphia

  • Dyslexia

  • Dyscalculia

  • Attention/behaviour or sleep difficulties

Please speak to the education provision, GP or CAMHS, as they are better placed to support these needs. 

What should I do if my child has long-term needs and requires equipment or adaptions to their property to support them at home?

Parents can contact the Local Authority Occupational Therapy Service directly on:

Telephone Number: 0300 123 5010 

Email: (if you live in Crewe, Nantwich, Sandbach, Middlewich, Alsager, Scholar Green, Haslington, Congleton, Holmes Chapel). (if you live in Macclesfield, Knutsford, Wilmslow, Poynton, or Handforth).

Where will my child be seen by an OT?

Your child will usually be seen in the clinic at Pavilion House, Macclesfield. But we can see your child at home, school, or nursery if appropriate. See a video walkthrough here - Pavilion House Tour

What will happen at the first appointment?

You will meet your OT and we will chat with you and your child about the difficulties they are experiencing with their everyday activities. Your child may have a formal assessment or may be observed playing with toys or completing tasks like writing, colouring and cutting. 

If we establish that your child has OT-specific needs, we will discuss functional goals and how we can help them work towards achieving their goals. 

What should I expect from Occupational Therapy?

OT’s like to work jointly with home, school and nursery to help your child achieve their goals. Your OT may provide some group or individual intervention if needed.

We may provide a report of your initial assessment and review progress reports if needed, as well as supply evidence towards your child’s EHCP if requested by the local authority.

See these useful handouts about our OT service - Children's leaflet & Parent/guardian leaflet

What if English is not my first language?

Please let us know as soon as possible before your appointment and we can arrange an interpreter, alternatively, you can choose to bring a family member to interpret for you. We can also communicate via email as well as paper if this is easier.      

When will my child be discharged from the OT service?

Your child will be discharged from the service when they have achieved their goals or have strategies in place to help support their long-term needs.

Please note - if you fail to attend your appointment or cancel 2 consecutive appointments (unless for illness) your child will be automatically discharged from the service.