My child is struggling with writing at school and has an unusual clamped pen grip. He can’t get started with schoolwork and only writes the minimum amount. His teacher has tried a pencil grip but there have been no changes. Can OT help?

 Yes we could definitely help. We would spend sometime trying to establish the reasons for the difficulties your child is having with handwriting. Often children develop a clamped pencil grip because they don’t have good in hand manipulation skills and so need to clamp the pencil in order to control it. That’s why giving them a pencil grip might not help.

 Some children respond well to having a visual picture, a mind map, of what they going to write about, and they struggle to start the task when they don’t have those prompts. Numerous schools are using The Big Write approach where the children don’t start writing until they have talked and talked about the topic.

 We usually start with an initial session and then decide whether your child would benefit from some individual OT sessions to develop the specific skills that they might need in order to put pen to paper. We might use a guided therapy approach where your child is part of making the decisions about the changes they’d like to make in order to write.

Could you please let me know if you could help with hair washing and nail cutting. My child becomes extremely distressed and we have to hold her down and it is always an unpleasant experience.

 We see a number of children that struggle to tolerate hair washing or nail cutting. Our sensory systems are there to protect us and so if we perceive something as dangerous we often have a flight and fight reaction. Your child maybe over sensitive to certain touch input and so would be feeling the nail cutting as painful or the water pouring over their face as dangerous.

 We start with trying to desensitize their over reactive touch sense, exposing them to different sensory input that may help to dampen down their sensitivity e.g. massage and deep firm pressure or heavy work. We might also use a Therapeutic brushing technique developed by an OT that may help to switch off their sensitive touch system and develop a better awareness of what things should be feeling like. We also introduce things like a face guard for hair washing and lots of textured scrubs and body paints in the bath to try and make bath time fun again. Practical strategies to try and overcome the unpleasant experience.

Toilet training: my child is struggling to grasp the concept of going to the toilet. We’ve been using a potty but he often refuses to go and then wets himself straight afterwards.

There are lots of things to consider when toilet training. Firstly has your child shown any signs of being interested in toileting? We often decide to do things but we often have better results if we watch the child and respond when they start to take an interest.

Start with encouraging them to come and watch when everyone in the family goes to the toilet. Talk about how Daddy stands up and how mummy sits down and show them the colour change of the water and what the bowel action product looks like in the toilet. Start labeling the steps, toilet time, lid up, pants down, sit, wipe, flush, wash hands etc. You might consider changing their nappy in or near the toilet area so that they start to develop an association with this experience and the toilet.

We use two approaches: either a gradual toilet-timed scheduled technique or an intensive toilet training approach, where your child would stop wearing a nappy and be rewarded with lots of praise and a small oral treat, every time they recognise they need to toilet. Either approach can be very effective, depending on the needs of your family.