Parents often arrive at an occupational therapy assessment knowing that something is difficult but not necessarily knowing why.
“My child hates getting dressed.”
“Handwriting takes forever.”
“School says they can’t stay organized.”
“Haircuts are a disaster.”
“They still need help with things other children their age do themselves.”
These are exactly the kinds of real-life concerns that occupational therapists investigate.
An OT Assessment Starts With Everyday Life
Occupational therapy focuses on participation in meaningful activities.
For children, that may involve:
- Dressing
- Eating
- Writing
- Playing
- Grooming
- Learning
- Organizing
- Social participation
- School routines
The therapist will first want to understand which activities are difficult and how those difficulties affect the child and family.
Expect Questions
Parents may be asked about:
- Development
- Medical history
- School
- Home routines
- Play
- Fine motor abilities
- Sensory responses
- Independence
- Attention and organization
- Family goals
There are no “right” answers.
A child might behave completely differently at home than at school.
That difference itself can provide useful information.
Observation Through Activity
Children often show therapists more through activity than through formal questioning.
Depending on the concern, the therapist may ask the child to:
- Draw
- Write
- Cut
- Build
- Manipulate small objects
- Complete a puzzle
- Use both hands together
- Follow a sequence
- Perform self-care tasks
- Participate in play
The activities selected depend on the child’s age and reason for referral.
What Skills Might Be Assessed?
An occupational therapist may examine areas including:
Fine Motor Skills
How efficiently does the child manipulate objects with their hands?
Visual-Motor Skills
How well do visual information and hand movements work together?
Daily Living Skills
Can the child participate in dressing, grooming, feeding, or age-appropriate routines?
Handwriting
How are legibility, speed, letter formation, spacing, and physical comfort?
Sensory Processing
Are sensory responses creating barriers to everyday participation?
Organization and Task Completion
Can the child plan, begin, sequence, and complete age-appropriate activities?
Occupational therapy has a wide variety of pediatric assessment tools covering motor, sensory, developmental, adaptive, school, visual-motor, cognitive, social, and occupation-based areas.
Does Every Child Get the Same Tests?
No.
Assessment should be driven by the child’s needs.
A four-year-old having difficulty with dressing requires a very different assessment from a ten-year-old referred because handwriting is affecting school performance.
Standardized assessments may be used when they provide useful information, but observation and family input are also important.
What If Sensory Processing Is the Concern?
If sensory differences are affecting everyday life, an occupational therapist may use questionnaires, clinical observation, interviews, and other assessment approaches to understand the child’s sensory responses.
Assessment is important because sensory-based interventions should be matched to documented needs rather than automatically prescribed based on a general list of behaviours.
What Happens Afterward?
Once the assessment is complete, the therapist should explain:
- What they observed
- The child’s strengths
- Areas causing difficulty
- Whether therapy is recommended
- What goals may be appropriate
- Strategies that may help
Recommendations could involve therapy, home strategies, environmental changes, school collaboration, assistive tools, monitoring, or referral to another professional.
Your Child Is More Than a Test Score
Standardized scores can provide useful information, but they do not tell the entire story.
A child may technically be capable of an activity and still struggle to perform it in the environment where it matters.
That is why occupational therapy considers the relationship between the child, activity, and environment.
Ultimately, the assessment should answer a practical question:
What is getting in the way of this child participating successfully in everyday life—and what can we do about it?
That is the foundation for useful pediatric occupational therapy.
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Walking into your child’s first physiotherapy appointment can feel intimidating.
Will they need to perform tests?
Will the appointment hurt?
What happens if your child refuses to cooperate?
It Starts With a Conversation
Before asking your child to do anything, the physiotherapist needs to understand why you came.
Parents may be asked about:
- Their main concerns
- Pregnancy and birth history
- Developmental milestones
- Medical history
- Previous injuries
- School activities
- Sports
- Pain
- Daily routines
You do not need to remember every developmental event perfectly.
The goal is to build a useful picture of your child’s health and movement.
What Is Your Child Having Trouble Doing?
This may be the most important question.
Perhaps your toddler is not walking yet.
Maybe your six-year-old falls frequently.
Perhaps your teenager has knee pain during basketball.
A good assessment connects physical findings with the activity that matters.
The goal is not to collect measurements for their own sake.
It is to understand what is making life difficult.
Watching Your Child Move
Depending on age, the physiotherapist may observe your child:
- Sitting
- Standing
- Walking
- Running
- Jumping
- Climbing
- Reaching
- Balancing
- Playing
For an infant, the therapist may look at head control, rolling, reaching, floor movement, sitting, positioning, and how the baby uses each side of the body.
For an older child, the assessment may look more like an obstacle course or series of movement challenges.
Physical Assessment
The physiotherapist may assess:
- Strength
- Muscle tone
- Flexibility
- Joint movement
- Balance
- Coordination
- Posture
- Walking pattern
- Gross motor skills
Which areas are assessed depends on the reason for the appointment.
Physical therapy evaluations for developmental and coordination concerns commonly include history, participation, observation of movement, strength, tone, flexibility, balance, and age-appropriate motor skills.
What If My Child Won’t Perform?
This happens.
Young children do not care that an appointment has been scheduled for 2:00 p.m.
They may be tired, shy, hungry, nervous, distracted, or simply uninterested.
Pediatric therapists are used to adapting.
They may turn an activity into a game, give the child time to become comfortable, observe spontaneous play, or gather information from parents.
One imperfect appointment does not define the child.
Will We Get a Diagnosis?
Physiotherapists assess movement and physical function and work within their professional scope.
Sometimes an assessment identifies a clear physiotherapy concern.
Sometimes the therapist recommends monitoring.
Sometimes findings suggest that another healthcare professional should also be involved.
If further medical investigation is appropriate, the therapist may recommend that the family speak with the child’s physician or another specialist.
What Happens After the Assessment?
The physiotherapist should explain what they observed in understandable language.
Depending on the findings, recommendations may include:
- No treatment required
- Monitoring development
- Home activities
- Physiotherapy
- Changes to activity
- Collaboration with school
- Referral to another professional
If therapy is recommended, goals should relate to the child’s actual needs.
Parents Are Part of the Process
You should leave the appointment understanding what the therapist found and why the recommendations were made.
Ask questions.
Tell the therapist which goals matter to your family.
Mention what will and will not realistically work at home.
Pediatric physiotherapy is most useful when the therapist, child, and family work toward meaningful goals together.
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“My legs hurt.”
For parents, those three words can create an immediate question:
Is this just growing pains, or did my child hurt something?
Leg discomfort is common during childhood, but not every ache should automatically be blamed on growth.
Understanding the pattern can help parents know when to monitor symptoms and when to seek professional advice.
What Are “Growing Pains”?
The name is slightly misleading.
The American Academy of Pediatrics notes that growth itself is not believed to be the direct cause of growing pains. These aches may be noticed around bedtime or during the night and can sometimes follow active days.
Typical complaints are often described as aching in the legs rather than a clearly identifiable injury to one structure.
The child may have been running and playing normally earlier in the day.
What Does an Injury Look Like?
An injury is more likely when there is a clear event or a consistent relationship between pain and activity.
For example:
“I landed badly after jumping.”
“My ankle hurts every time I run.”
“I twisted my knee.”
“My heel hurts during soccer practice.”
Parents may also notice:
- Limping
- Swelling
- Bruising
- Reduced movement
- Tenderness in one specific location
- Avoidance of using one leg
That pattern is different from vague, occasional nighttime aching.
Pain During Activity Deserves Attention
One useful distinction is whether pain interferes with normal movement.
If a child repeatedly stops playing because of pain, changes the way they walk, or cannot perform an activity they normally manage comfortably, the symptom deserves attention.
Children should not need to “push through” persistent pain simply because they are young.
Red Flags
Seek medical advice when pain is accompanied by concerning features such as:
- Significant swelling
- Inability to bear weight
- Persistent limping
- Fever or illness
- Significant weakness
- Severe pain
- Pain that continues to worsen
- Repeated pain in one specific location
- Pain following substantial trauma
Parents should also seek advice when something simply feels out of character for their child.
You know their normal behaviour better than anyone.
What About Pain After Sports?
Children and teenagers can experience overuse injuries.
These occur when the demands placed on tissue repeatedly exceed its ability to recover.
Young athletes who participate in a high volume of one activity may develop pain even without one dramatic injury.
The American Academy of Pediatrics notes that many injuries in young athletes are related to overuse and recommends regular rest from organized training.
That means “there wasn’t an accident” does not automatically mean nothing is injured.
How Can Physiotherapy Help?
For musculoskeletal pain, a physiotherapist may assess:
- Joint movement
- Strength
- Flexibility
- Walking and running
- Balance
- Sport mechanics
- Training demands
- Activities that aggravate symptoms
Treatment may include exercise, education, activity modification, gradual return to sport, and collaboration with other healthcare professionals when necessary.
The great news is that assessments at a physiotherapy clinic are a great place to start.
Don’t Let the Label Replace an Assessment
“Growing pains” can sound reassuring.
Sometimes reassurance is appropriate.
But the phrase should not become a catch-all explanation for every recurring pain a child experiences.
If your child is otherwise well, active during the day, and experiences occasional generalized aches, monitoring may be reasonable.
If pain is persistent, localized, associated with swelling or limping, repeatedly triggered by activity, or simply concerns you, seek an assessment.
Determining the cause is more useful than trying to guess whether a child will eventually “grow out of it.”
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