Why not to push handwriting for kids

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Pushing kids into writing before they are developmentally ready happens to be one of my pet peeves. (I actually have quite a few of them, you can read all about them here. )

Experience has shown me is that children should NOT be pushed into handwriting before they’re ready. So many kids are entering Kindergarten without the basic pre-writing skills they need. Yet the Kindergarten curriculum expects them to be writing right away!

Before handwriting, children need to master pre-writing skills

Pre-writing skills are the lines, shapes, and strokes kids need to master and know before learning how to print the alphabet. They develop from 1 year to 5 years old.

Pre-writing skills ARE important.

Kids need to learn and master pre-writing lines, strokes, and shapes and strengthen their fine
motor skills before learning how to form the letters of their name or the alphabet.

Prewriting Milestones

1-2 years old:

A baby is typically scribbling and learning to make marks on a paper. They are probably holding a crayon or marker with their whole hand. This is called a palmar supinate grasp.

As they develop more control, the next step is to imitate. Maybe you make a line or shape and
then your child imitates that same line or shape.

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My Favorite Parts of #AOTA19

Last week was a complete whirlwind – whew.   I’m finally getting settled at home,  but I wanted to share my highlights of the American Occupational Therapy Association conference in New Orleans, LA.

  1. Reuniting with old friends from across the country and making new ones!

    Every year, two of my girlfriends from Utica College and I attend the conference together, and it feels like we are right back in college.  This year, I also got to hang out with my friend and fellow OT blogger Colleen Beck (From the OT Toolbox) and two other admins of my USA School Based OTs Looking for Change group (Serena Zeidler and Joan Sauvigne-Kirsch).  We had so much fun and definitely had some major brainstorming over the last few days.  It’s amazing what a bunch of OT brains can come up with!   I also attended the AOTA reception for the Communities of Practice.  I’m in the state leadership group, so I had the chance to mingle with all the ladies I work with all year long.

I also had the opportunity to meet a ton of new OTs, and I’m never disappointed!  When you go to the conference, there are literally OTs everywhere- at the restaurants, in the lobby of the hotel, walking on the street right next to you.  Meeting new people is always super fun, and getting the chance to chat with other OTs from across the country is a blast!

2.  Presenting at Conference!

This year I presented a poster and hosted a Conversations that Matter about the quest for Educational Credentialing and Equality for School OTs with my colleagues.   The Conversation that Matter went GREAT!  It was really well attended – there were actually people standing!   Serena Zeidler, Joan Sauvigne-Kirsh and I worked hard to explain what Educational Credentialing is, and WHY it’s important.  We had lots of great questions, and the members who attended seemed to leave just as excited and passionate as were are about the topic.   ( I gave out 400 USA School Based OTs Looking for Change business cards!) This movement is expanding across the country!

I also had the opportunity to be a guest speaker at one of AOTA’s courses about social media, blogging, and getting published.   Colleen Beck from the OT Toolbox and I had a great time meeting other OTs who are interested in starting their own social media following.  It was awesome!

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3) Attending other conference sessions

I attended a few really interesting conference sessions:

  • Telehealth in school-based practice
  • Applying a systems approach to school practice
  • How to get accepted for short courses for AOTA ( a goal for next year!).
  • Leadership for future OTs

I was sooooo excited that two of the sessions I attended actually mentioned the Educational Credentialing initiative – YAY!   Word is getting out!

4)  The Conference Expo

This is always one of my FAVORITE parts of the conference.  I had the chance to mingle with other OTs who are entrepreneurs and inventors.  Some of the products that are out there are just amazing!   You can see a few of the videos I made on Facebook.

5) Meeting Colleen Schneck

I literally hunted down this poor woman.  When I discovered that Colleen Schneck was going to be at the conference, I wrote down every possible spot where I could run into her, and made it my mission to meet her – and I did!  Colleen Schneck is the author of MANY articles about pencil grip and grasp.  I’ve been working on a book about Pencil Grips, Grasps, and Handwriting for quite a while now, and I’ve been relying heavily on Colleen’s research.  I was so thrilled to meet her- I think I actually scared the poor lady who was innocently standing by her poster when I practically bum-rushed her.  I was just too eager!

6) Getting Inspired 

Every year the AOTA conference fills me with new determination and initiative to keep working to achieve my goals.  This year is no exception.  The conference was super busy for me this year, but I did get a chance to hear Amy Lamb (president of AOTA)’s farewell speech.  (The new president will be Wendy Hildenbrand).   Amy showcased some really creative OTs who are thinking outside the box with really cool new inventions.  Her main message was “Be Bold”.  I love it.

7) Seeing a bit of New Orleans 

I didn’t get a chance to do much sightseeing- the conference keeps you super busy during the day and there are always networking events in the evening.  Usually, by the end of the day, you just want to put your feet up!

But I did get a chance to sneak in a few sights and bites. We did a food tour and walked around the French Quarter – the veignes were my favorite (think zepoles or funnel cake but smaller – yum).

Attending the AOTA conference for a discount is just one of MANY benefits of being an AOTA member. Check out some more here. 

Did you attend the conference?   What was your favorite part?  Are going to go next year?  I can’t wait! (Next year is in Boston!)

Related Reading:

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therapist, occupational therapist, parent guilt, teacher guilt, therapist guilt, fine motor, manipulation skills, progress monitoring, data tracking,
OT advocacy, #SchoolOTs, MissJaimeOT, #SchoolOtsmatter

Why do Occupational Therapists want Educational Credentialing?

You may have heard the buzz about Occupational Therapists advocating for Educational Credentialing. Especially if you work in the education world.

What is Educational Credentialing? 

State Education laws vary from state to state.  But in every single state in the USA (except for four), OTs and PTs are not under the “umbrella” of teachers. They do not have “educational credentials”.

Why not? 

This started in the past.  Way in the past, because OTs and PTs were considered “medical” (like the nurses).  However, educational laws have changed to a more inclusive educational community. This changed how OTs and PTs are employed.

Now, school therapists support children’s academic success.   Unfortunately,  the state education departments haven’t revised their terminology and laws to include OTs and PTs as “educators”.  YET.

OTs and PTs are not ALLOWED to address medical issues – those must be worked on outside of school in a clinic or community setting.  Everything a school therapist does must DIRECTLY relate to our kids’ academic needs.

Who IS under the “umbrella” of teachers? 
  • Teachers
  • Social Workers
  • Counselors (Guidance)
  • Speech and Language Therapists
  • Psychologists

All of these professionals who work in the school system are considered”educators” or “pedagogical”.  This means they are considered teachers, no matter what their license says (social work, guidance, etc.).   The state education system provides them with this title, which means they are “credentialed” as educators.

sometimes laws don’t keep up with the times… AND This is one of those times.

School Occupational and Physical therapists are not under the umbrella of teachers. Often this means we aren’t:

  •  observed and supervised like teachers are
  •  held to the same standards as teachers
  • included in team meetings, faculty meetings, and professional development sessions
  • provided with an appropriate work environment or room in the school
  • paid equally to other school professionals

This limits us from collaborating properly as team members to make the most successful environment for the students.  It also barrs OTs and PTs from MANY of the protections and opportunities that the “teaching” umbrella offers to other faculty.

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How are we all ALikE?

– similar job functions within the school setting.

– address educational goals on student’s Individualized Education Programs to help them access their curriculum.

  • Social workers address social-emotional and behavioral needs of students that impact a child’s ability to access the curriculum.
  • School psychologists address social-emotional needs, coping strategies, and other areas that impact a child’s ability to succeed in the classroom.
  • Speech-language therapists address expressive and receptive language deficits that impact a child’s ability to learn.
  • Occupational Therapists address impaired physical functioning which hampers the ability to perform daily life tasks, psychosocial problems which hamper the ability to function in daily life, special needs which require modification of the physical environment and/or use of specialized equipment and technologies

– We all should have equal supervision, professional development, retirement, benefits, and the ability to advance to leadership or administrative roles, but we don’t.

HOW are THE ROLES Different?

Occupational and Physical Therapists should be included in the umbrella of Pupil Personnel by their state education departments, but we are limited greatly by this archaic legislation that segregates us from our colleagues.

OT and PT professionals want education credentialing to achieve equality with our colleagues in the school system.

  1. Opportunities for Leadership – Currently, OTs who are graduating from OT programs must have a minimum of a Master’s Degree.  (This is the same as teachers, social workers, psychologists, speech and language therapists).  PTs who are graduating must have a doctorate!  We are not ALLOWED to pursue Educational Administration coursework, but we have equal or greater requirements to work in our profession.

What does that mean? 

In most states, an OT or PT professional can get a job in a school, but they have NO WAY to move up the ranks.  They can’t be a principal, CSE chairperson, Special Ed director or Superintendent.  All the other “teachers” can if they take the proper coursework, but not us.

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2) Collaboration- Many school OTs and PTs are excluded from typical staff meetings, professional development opportunities, and co-teaching situations.  We are often not directly “employed” by the school.  This enlarges the gap between the rest of the staff and the therapists.  How can we be a cohesive team when we are treated so differently?

Read a personal story by a therapist who worked in the same school for thirty years.   She was never “on the list” for simple work things like the holiday party, the super bowl pool, and more.  This kind of exclusion isn’t done on purpose, but it does impact a therapist’s ability to be a “member of the team”.   Developing a rapport with your co-workers takes time.  If you are “not on the list” for things where the other faculty are working, collaborating, or even socializing, it takes that much longer.

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So now what? 

Occupational therapists across the United States are joining together to fight the state legislation that keeps us in this “other” category.  We’ve got a long way to go, but we’ve come very far in a short time.  Multiple state associations and the American Occupational Therapy Association are supporting us!

To learn more, watch this FREE educational credentialing webinar. 

Join the Facebook group “USA School-based OTs Looking for Change”. Help us in this quest for equality.

Sign up for Miss Jaime, O.T.’s OT politics newsletter.   Stay in the loop with how we are advancing.


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“Evidence-based practice (EBP) is based on integrating critically appraised research results with the practitioner’s clinical expertise, and the client’s preferences, beliefs, and values “(AOTA). 

Primitive reflexes are often a hot topic in OT forums. 

  1. Many OTs believe that retained primitive reflexes can interfere with a child’s learning.

  2. Others feel that the minimal research that’s been done isn’t substantial enough.

Personally, I took the Integrated Learning Strategies Retained Primitive Reflex Course, and when I tested some of my students that exhibited the symptoms, I saw exactly when the course said I would.  You can see examples of retained reflexes here.

The Retained Primitive Reflex course includes: 

  • More than 40 videos of personal instruction, testing for the reflexes and exercises to integrate the reflexes
  • 85-page digital handbook with signs and symptoms of primitive reflexes, myths about primitive reflexes, testing and exercises
  • 7 charts and graphs that include parent observation sheets, exercise schedule, progress tracking sheets, learning and motor development checklists and much more
  • Private Facebook group where you can ask questions about testing or exercises, visit with other parents or OTs that have had similar experiences and receive additional instruction or training as needed.
  •   Don’t wait to join because the e-course is only available three times a year.

Research that supports the idea of working to integrate retained Primitive ReFlexes:

Retained Primitive Reflexes in ADHD and ASD among Children in an Inpatient Psychiatric Setting

Written by Occupational Therapists, this article studies 96 children with ASD and ADHD in an inpatient psychiatric setting.  The purpose of the study was to find out which primitive reflex is most common, and to what degree are the reflexes associated with ASD and ADHD symptoms and executive function deficits. They used a cross-sectional study design. 90.3% of the sample had at least one retained reflex. The most common reflex observed was the ATNR (82.4%).  ATNR was the most common reflex among children diagnosed with ADHD and ASD. ATNR. was significantly positively associated with inattention and executive function deficits.  Conclusion: ATNR and STNR are the most common retained reflexes among children diagnosed with ASD and ADHD. This article offers an evidenced-based rational in order to assess and integrate primitive reflex interventions within pediatric occupational therapy practices, especially with children diagnosed with ASD and ADHD.

Retained Primitive Reflexes and ADHD in Children

This research article studies children ADHD (ages 8-11) and primitive reflexes; specifically pertaining to the Moro and Galant reflexes.  Their study confirmed that children with ADHD have a high occurrence of primitive reflexes. Also, as a consequence, these reflexes may play a role in ADHD.  This article explains how they tested for the Moro and Galant reflex that you could potentially try with your students.  The article summarizes by stating, “these persisting primitive reflexes may play a role in ADHD.”

Retained Primitive Reflexes 

Reflexes play a vital role in survival during certain age periods but should then naturally disappear.  If the reflexes don’t integrate, developmental delays can occur.  Symptoms may be concentration, impulse control, weak balance, and poor posture.

An abstract of the book Reflexes Learning and Behavior, written by Sally Goddarth-Blythe,  is provided. Her book explains how learning can be affected if reflexes are not integrated beyond the age of 3.  Her book explains the reflexes and provides interventions.

The Correlation between Primitive Reflexes and Saccadic Eye Movements in 5th Grade Children with Teacher-Reported Reading Problems.

Abstract: This research article focused on the Moro reflex, ATNR, TLR, and the STNR. The study found that children with retained primitive reflexes had reduced saccadic accuracy and decreased reading ability. The main reflexes associated with reading problems were the TLR and STNR. The information provided in this study may further determine if vision therapy should be implemented to inhibit primitive reflexes and to improve saccadic eye movements and reading skills.

Effect of Reflex Neuromodulation on an Infant with Severe Amniotic Band Syndrome: A Case Report on the use of MNRI Techniques for Physical Therapy

Side note: MNRI stands for Masgutova neurosensorimotor reflex integration. Dr. Masgutova created the Masgutova Method, which is a set of programs that focus on motor reflex and sensory integration. She has studied how communication, cognitive, behavioral, and emotional regulation can be affected by motor reflex and sensory integration. Her website offers MNRI training.

This link is specifically to the page where you can learn about the importance of reflexes. From there you can click on other links of reflex examples, the importance of reflex integration and clinical observations.

Abstract: This research article focuses on using the MNRI method for physical therapy interventions with children born with amniotic band syndrome. Amniotic band syndrome is a rare congenital disorder that can lead to physical abnormalities, especially pertaining to an upper extremity. This article discusses how using the MNRI method can lead to new potential interventions and another tool to use in your therapy tool kit.

Reflex Based Interventions For Children with Autism and Developmental Disabilities: An Evidence-Based Practice Project

(This is a rather large document, consisting of 255 pages of information!)

Abstract: Their evidence-based PICO Question was: Are reflex-based interventions effective for improving occupational performance when treating children with autism and developmental disabilities? They focused on the MNRI method, reflex integration, and rhythmic movement training. Page 119 summarizes 5 research articles pertaining to reflex integration. Each category they focused on explains in depth a variety of articles all a part of their evidence-based practice project.

Integrated Learning Corner is a great website to learn about Primitive Reflexes.

Their reflex E-course contains 40 video lessons, a handbook, tracking sheets, reflex exercise schedule, observation materials, and the ability to join a private Facebook support group. If you aren’t sure you are ready to purchase the course, you can read some of the articles they have posted. They have three articles for you to briefly learn about Primitive Reflexes. The articles are called:

  1. Primitive Reflexes: How Retained Primitive Reflexes are Holding My Child Back in Learning and Motor Development.
  2. RED FLAGS: Are These Warning Signs and Red Flags Telling Me My Child May Have a Retained Primitive Reflex Delaying their Learning Devel
  3. MYTHS: The Myths about Retained Primitive Reflexes that could be Holding Your Child Back in their Learning and Motor Development.

Don’t forget to get your FREE handout on the signs of Retained Primitive Reflexes!primitive reflexes, retained reflexes, ATNR, Moro Reflex, Galant Reflex, STNR

Related Reading:

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primitive reflexes, Miss Jaime OT, retained reflexes, testing for retained reflexes

What do Retained Primitive Reflexes Look Like?

What are ReTAINED Primitive Reflexes? 

Primitive reflexes start to develop in utero and they actually help the baby get down the birth canal during labor. (Who knew!?) A reflex is an automatic motor response that is triggered by a stimulus.

These primitive reflexes assist the baby in their developmental milestones, helping them with things like breastfeeding, rolling and crawling. But if the reflexes don’t integrate (go away), they can hinder a child’s development. Retained reflexes can cause:

  • Sensitive to touch, sound, smell and taste
  • Balance issues, is clumsy, struggles with sports, runs into furniture
  • Freezes or is in constant fight or flight mode
  • Poor impulse control, easily distracted, severe mood swings
  • Can’t cross the midline, trouble with hand-eye coordination, struggles with fine motor
  • Has difficulty tracking when reading and writing
  • Poor posture, attention issues, wraps legs around chair, wets the bed after age 5
  • W-sitting, poor muscle control, toe walking

how Do YOU tell if your child has a retained reflex?

Get your Free Signs of Retained Reflexes:

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Get your Free Printable “Signs of Retention” Handout

The primitive reflex course from Integrated Learning Strategies teaches you how to test for each of the reflexes, as well as the exercises to do to help integrate them.

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Click here to sign up for the E-Course

TESTING The Moro Reflex

The Moro Reflex is usually present in infants 3 to 4 months. The child responds to a sudden loss of support by spreading their arms, then bringing them in, and crying. This reflex should be integrated by the age of 6 months. If the reflex does NOT integrate, the child may exhibit signs of distractibility, poor balance and coordination, emotional outbursts, food sensitivities, withdrawn behavior, or frequent car sickness.


A child attempting to pigeon walk, as part of the testing for a retained Moro Reflex. The child’s awkward arm position indicates that the reflex IS NOT yet integrated. Other signs of a retained Moro Reflex may be distractibility, balance and coordination difficulties, emotional outbursts, food sensitivities, frequent car sickness.  

An Integrated Moro Reflex:


Integrated Moro Reflex- the Cross Over Test

Are you intrigued?  You can sign up for the Retained Primitive Reflex Course here. These videos are showing two ways to test for the Moro Reflex, which should be integrated (gone) by 6 months of age. Looking at these videos, it’s easy to see which child has a retained Moro reflex. The other child has a simple time performing the exercises.

The Retained Primitive Reflex Course is available for early bird discount ($99.00) until March 19th.   After that, the course goes up to $127, and is available until April 1st.

Primitive Reflexes e-Course and Handbook includes the following:

  • More than 40 videos of personal instruction, testing for the reflexes and exercises to integrate the reflexes
  • 85-page digital handbook with signs and symptoms of primitive reflexes, myths about primitive reflexes, testing, and exercises
  • 7 charts and graphs that include parent observation sheets, exercise schedule, progress tracking sheets, learning and motor development checklists and much more
  • Private Facebook group where you can ask questions about testing or exercises, visit with other parents or OTs that have had similar experiences and receive additional instruction or training as needed.


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What’s in my Therapy Bag?


I’ve been a HUGE organization kick lately. Every month or so I need to clean out my therapy bag. Inevitably, I find things out of order, things I need to change up or replace, and things that are missing pieces , etc.

I once posted a pic of the crazy amount of stuff in my bag and everyone on Facebook went crazy commenting and asking questions. I figured, why not share this “clean out” phase with all of you?

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I’m also a bit obsessed with Tiny Homes. So I love things that can be used multiple ways, are miniature, and don’t take up a lot of space.

I am in the process of moving, so I’ve also been a huge labeling kick. I am really trying to turn over a new leaf when it comes to putting things back where they belong. I don’t like to waste time in a therapy session looking through my bag for “that thing” I need (and can’t find!).

First things first, you’ve got to have a sturdy bag with a lot of compartments. I like to use a rolling backpack because:

  • It’s better for your body to pull instead of carry
  • It zippers closed so when I throw it in my trunk (which I always do) it won’t spill crayons and beads everywhere
  • I like the laptop compartment to hold my folders for each kid

One thing about the rolling backpack though, is that the fabric inside is made of a tough rayon-like material, so it’s hard to stick labels on. I’ve decided to relabel with my label maker and then cover them with packing tape. Hopefully, that will stay put. (I’m obsessed with packing tape)

My latest backpack has a bunch of compartments. This is how I organize them.

The Very Back

The “back” compartment is actually a zip-up spot where you can “hide” the straps of the backpack if you aren’t using them. I also use this spot to put my papers, dry erase board and cookie sheet (a traveling OT’s best friend).

See through packets- A Must Have!

I really like to have everything clear and see through so I can get what I need quickly, so I buy  clear zipper packets from the dollar store. I keep one in the very back section with construction paper and different kinds of writing paper. I also keep my laminated “Manipulation Dot Activity Sheets” in this spot because they are the perfect “starting” activity. I like to pull this out and keep my kiddo busy while I get out their folder and organize my materials for the session (perfect for the kid that keeps asking, “What are we doing today? What did you bring today!?”) I laminated the sheets, and they’re also perfect for keeping track of my kids’ fine motor practice.

Manipulation Dot Activity Packet

The Cookie Sheet

I use a cookie sheet 75% of the time when I work with students in their home. It’s the best dollar you’ll ever spend. It keeps messy therapy materials (like putty) in one spot and is simple to clean up glue, paint, or shaving cream. Kids LOVE tactile sensory activities like slime or shaving cream, but parents don’t want the mess. A cookie sheet is an easy fix. Just make sure that you can use the kitchen or bathroom sink to rinse it.

The cookie sheet also makes a quick magnetic surface- perfect for magnetic letters, tangrams, or puzzle pieces. Put it on the floor and have the child lay on their belly to encourage weight bearing into the upper extremities. Or, place it vertically against a wall to encourage mature grasping patterns and separation of the hand and fingers from the whole arm. I also put “chalkboard” paper on the back of mine so I could use it as a blackboard.

The Back Section of my Therapy Bag

This is the part where they think you’ll put your laptop.  It’s pretty skinny, but I fit my student’s folders in there.  I use colored folders so I can grab the one I need quickly and get right to work.

The Middle (Biggest) Section of my Therapy Bag

In this section, I put my toys, games, and “big stuff”. I like to change out these items to keep things fresh and exciting for the kids.

But, there are some things you are guaranteed to find in this section.

  1. Travel sized games: The smaller size helps me to fit more in my bag. Plus, the pieces are smaller, requiring little fingers to grasp more precisely. Win-Win. My favorite travel sized games are Connect Four, Rush Hour, Trouble, Guess Who, Perfection and Cards. For older kids, I like Battleship, Checkers, Shape by shape, and Tricky Fingers. (Heads up for my bargain hunters – 5 and Below often has imitations of these games for just 5 bucks!) You can read about the therapeutic benefits of Rush hour here.
  2. Fine Motor Toys That Require Two Hands: Many children have difficulty with fine motor skills and bilateral coordination, which is the ability to use two hands together. Toys that work on both of these things at once are a Must-Have. Some of my go-to picks are Legos, Stringing Toys, Lacing cards, Nuts and Bolts, Pop-beads, a pegboard and Bunchems
  3. Puzzles Many children struggle with spatial awareness to put puzzles together. Kids should start doing jigsaw puzzles (not inset) around the age of 4. I like the Dollar Store jigsaw puzzles with a back because the back has an outline of the shape, which is a visual cue for kids. If that outline isn’t enough, I also label each spot with a letter, shape or number, and then put a matching label on the correct piece. These puzzles also fit nicely in a zipper pocket folder (and you don’t lose the pieces).
  4. Some kind of game with letter pieces.  Such as Scrabble, Applets, Pears to Pairs, etc.  These tiny letter tiles are great for working on letter recognition, handwriting, or anything else!
  5. An ice cube tray.  Weird, I know.  But the ice cube tray is a favorite of mine. I like how it has tiny compartments for little fingers to “pinch” and put stuff in.  Use a grabber and manipulatives and the possibilities are endless – do patterns, roll dice and count to put that number in the next spot, etc.
  6. Gross Motor Supplies: Core Strength Exercise Cards, A handee band, a ball, and a beanbag. Thess are small but they are multipurpose- and can be used a ton of ways.

Front Section

My front section stays pretty consistent. This is where I keep my clear pencil cases, crayons, markers, fine motor/manipulative supplies, etc.

Pencil Case Pouches: Clear ones save time! Here’s what I have:

    • Markers, colored pencils, crayons: The smaller the better. I love Pip Squeaks from Crayola. Again, they take up less room and promote more mature grasping patterns.
    • Stickers: Big stickers, little stickers, big dot stickers, little dot stickers. Looseleaf reinforcers, too. Peeling stickers is an AWESOME fine motor and bilateral activity for kids. I like to use them as “spaces” in between words, “start spots” to show kids where to start letters, or “turn spots” when kids are trying to learn how to cut on corners. I like to use them to work on letter recognition with the Manipulation Activity Packet. And of course, they work great as rewards!
    • Playdoh and putty – Kids always love these things. I love to use it as a reward or an incentive for kids who are reluctant to begin therapy. They are also great for hand strength and sensory play. I like travel size putty because I don’t mind throwing one out if it gets boogies in it!
    • Travel size shaving cream –  A little goes a long way!
    • Manipulatives – Again, I like to keep these in little clear plastic containers so I can see what I’m grabbing.  In here you’ll find:

-magnetic bingo chips
-squeeze toys
-wind up toys
-Small pegs
-small stamps and stamp pads

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Side Pockets

My backpack has two side pockets- which I love. I found that I was kind of forgetting about them, so I made some labels and put things that I don’t need all the time.

Side pocket #1: A tiny box with office supplies. I got this at a conference once as a “gift”, but I recently saw them at Dollar Tree! I bought four. Now I have one in every single bag and in my car. It literally has every office supply you could need in a quick fix. Even a stapler.

A tiny measuring tape. This is more useful than you’d imagine!

  1. Keep track of things like how far a kid can jump, how big are the floor tiles (because then I can calculate how far they ran, etc), how far is this spot from the target on the wall, etc.
  2. Measure how big chairs, desks, and tables are. Teachers often ask me to look at the furniture in the room, and this way I can say- “it’s too big, you need a 12-inch chair”. Then, the teacher knows exactly what to ask the custodian for.

Side pocket #2: A multipurpose tool. This little guy has a hammer, knife, pliers, file, and screwdriver. I use the hammer in therapy sometimes (my kids love to bang golf tees into a pool noodle or pushpins into a corkboard), and the other things I often need in a pinch. The screwdriver is great for loosening tight scissors and the knife opens or cuts cardboard boxes.

Pencil grips – I’ve got to have these on me!

Shoelaces – in case we need to practice tying and my kids only have velcro.

And that’s it!  You can fit a ton of stuff if you organize it right- I also keep a trunk organizer in my car with extra toys so I can swap them out when I need to.


My backpack has a tiny pocket at the top of the front section – it’s meant for keys, I think.  (or money?).  Anyway, I keep small pencils in there, and two tiny playdoh containers that I use to keep sponges and chalk.

The Very Front

My backpack also has a mesh front section in the very front.  I used to keep my scissors there, but inevitably, they end up cutting the fabric.  So now I keep hand sanitizer and a roll of packing tape in the front.  I love packing tape because it’s so sticky and strong.  Most often I use it to tape things to the wall or a sliding glass door – to add a vertical surface to our therapy session  Worksheets, pegboards, and dry erase boards tape easily to the wall.  Working on a vertical surface is great for fine motor skills and for encouraging mature grasping skills.

What do you keep in your therapy bag?

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How to Measure Progress with Your Child’s Manipulation Skills

What is in-hand manipulation, anyway?

In-hand manipulation is the ability to manipulate objects in the fingers and hand or adjust an object within the hand after grasping it.

There are three types of in-hand manipulation:

1) Translation – the ability to move an object from the fingers to the palm or from the palm to the fingers.  An example of this would be picking up a penny and moving it into the palm of the hand, and then manipulating it back to the thumb and fingers to put it in a bank. This skill starts to develop between the ages of 1.5 to 2.5 years old.

2) Rotation – the ability to rotate or turn an object in the pad of the fingers. Simple rotation could be turning a bead so you can put something through the hole. More complex rotation might be making “meatballs” with playdough within one hand using the thumb and fingers.  (This is one is always a challenge for my kids!)

3) Shift – the thumb and fingers manipulate an object in a linear movement after it’s been grasped.  Think of picking up a pencil near the eraser and then “shifting” or “walking” the fingers up toward the point.  (developing between 4 to 5 years)

What to Look For:

When you’re looking at a child’s in-hand manipulation skills, it’s important to note their speed and accuracy. I find that a lot of my kids drop things or “stumble” through in-hand manipulation tasks. Their speed and accuracy improve with natural development but lots of fine motor and manipulation activities are always helpful in pushing these skills along!

Kids who still haven’t developed in-hand manipulation often use compensatory strategies to accomplish the task in front of them. For instance, if they are trying to manipulate a peg into a pegboard, but it’s upside down, they may touch it to their chest to turn it. This is because they don’t have the higher-level manipulation skills to turn it within their hand.

Other compensatory strategies to look for:

  • -dropping the pegs or coins to pick them up in a different way
  • using their other hand to turn the object
  • picking up one object at a time

How do you know if they are making progress?

I like to use progress monitoring sheets to keep track of my kids’ manipulation skills.  These allow me to easily check off what activity I used, what goal I targeted, AND how my student did! 

Progress monitoring and keeping data are an important way to measure how and if your students are making progress. 

This printable Manipulation Activity Packet includes a simple tracking sheet that allows you to keep data while staying focused on your child and the exciting fine motor challenge at hand. 

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The Manipulation Dot Activity Packet is perfect for home or the classroom. Get 25 pages of fine motor activities and countless ways to address your goals. Use the progress monitoring sheet to track your child’s improvements.

Related Reading:

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