What is the difference between occupational therapy and physical therapy?

As a parent or caregiver for a child with a delay, confirmed diagnosis, or disability, navigating the pediatric specialty world can be quite challenging. With so many therapies focused on different areas to support your child, it can quickly become overwhelming. In this post, I, Dr. Nikki Robinett, PT, DPT, will review some similarities and differences between pediatric physical and occupational therapy. This way, you can feel confident and knowledgeable about areas where your child succeeds and/ or may need additional support. On days you’re feeling overwhelmed, know that this is a normal way to feel, and we’re here to help! Take our developmental quizzes to find out more about your child's growth.

A pediatric physical therapist’s role is to help a child develop age-appropriate large body (gross motor) movements, improve balance, coordination, flexibility, and strength, and enhance posture and endurance. We also seek to reduce pain, prevent and improve independence surrounding surgeries, and select appropriate durable medical equipment (DME) needed to help a child with their standing, walking, or sitting. For example, this can include things like sitting with an upright posture for a child who is constantly leaning on tables or walls to hold themselves upright. It can consist of holding their head up in tummy time, learning how to crawl or walk independently, or changing a walking pattern from being on tiptoes to using the entire foot. More advanced skills include running, jumping, and riding a bike! 

These areas of development are helpful to address when you feel like your child fatigues more easily than their peers or is frequently irritable when placed in a position that requires them to hold themselves up against gravity. This is also helpful to note when you feel like they aren’t safe on the playground, as they often come home with scrapes and bruises. Or perhaps you are frequently packing a stroller or a chair for them in case they become too tired when running errands, or they seem to struggle to move their bodies in a way similar to their peers, often being the last one chosen for a team in PE, and possibly even bullied. Maybe they’re getting referred to as ‘skinny, weak, overweight, or lazy.’ 

The work to achieve these goals looks slightly different when working with pediatrics vs. adults, although they do have the same outcomes in mind. Some of my favorite questions that I'm asked are, “How do you get a baby to do squats?” and, “Do they make baby weights?” It is important to understand that children “work” for fun and praise. Just as adults work for money, play is the currency that children respond to best. For example, we incorporate exercises or stretches when playing games, play games while sitting or standing on a surface that requires more strength to maintain balance, or spread pieces to a game apart to require the child to move back and forth. We also sing songs, play music, and use other items that the child finds motivating to encourage more involvement in their session. This key concept is important to understand because it is where the fields of PT and OT begin to intersect. 

Occupational therapists focus on helping children engage in activities or daily living that are important for their independence, and their area of focus is on fine motor skills. They also address the strength of the upper body and smaller muscles used in the hands and neck and work on hand-eye coordination tasks. For example, eating with utensils, holding and drinking from a cup with one hand without spilling, dressing, cooking/cleaning, and handwriting. 

These everyday activities are crucial for a child to develop. Occupational therapists also help children who struggle with being present and engaged in daily tasks become more regulated, described as sensory processing interventions. Certain occupational therapists can also work with children to help them become more independent with their eating skills, particularly if the child is more averse to certain textures of foods.

As mentioned, both PTs and OTs use praise and play to help children develop. Their shared goal is to help the child reach their full potential and gain independence that may have not otherwise been attainable. Both therapies aim to be engaging, fun, and motivating for the child while targeting each child's specific needs. Another example of similarities is primitive reflex integration, as this can affect a child's physical movement patterns to move their body in a unique, rather than reflexive, pattern. These therapies can support neurodivergent children, children with disabilities, and typical children. 

Seeking the appropriate therapy for your child or creating a plan to use a combination of multiple treatments/specialists is important to meet children’s needs. Certain scenarios, examples listed below, could indicate a situation where either PT or OT would be helpful. Let’s say a child is slouched over at a school desk and not engaging in a writing assignment. A teacher may believe that they are uncompliant, behavioral, or disruptive, yet the child may struggle to hold their head up and maintain the correct posture due to back pain. 

The child may need occupational therapy to support handwriting skills or speech therapy to help with possible dyslexia. Or perhaps they have undiagnosed ASD or ADD and are seeking out the cold and smooth texture of the desk and dislike the way that the chair feels on their legs. In this example, the child would benefit from a combination of therapies. Another example would be a child demonstrating difficulty with ball play, often saying they don’t like playing catch or would rather explore the woodchips and dig in the dirt or get to a high hill to look around the playground rather than play catch with their peers. Perhaps the child feels uncoordinated or that their body doesn’t react the way they want it to, possibly indicating a lack of primitive reflex integration. Maybe they feel weak or experience pain in their shoulders when they reach up to catch the ball. In this scenario, PT and OT could address these concerns individually or separately. 

Finally, a child who walks on their tiptoes may need PT because of the tightness in their calf muscles and weakness in their abdominal and gluteal (hip) muscles. However, if they walk on their toes because they want to feel the bounce-like movement of walking this way, an OT would be appropriate to address this concern. As you can see, there are many ways PT and OT overlap and support one another while also targeting specific body systems and goals separately. 

As a parent or caregiver, remember that you are not alone. Some professionals like myself also want to see your child succeed. My practice, Moving and Grooving Pediatric Physical Therapy, focuses on seeing children thrive. We offer both physical and occupational therapy. We work with many diagnoses, including ASD, and create a tailored, 1:1 approach for each child to help them meet their goals. We offer virtual, clinic, and in-home/community-based sessions to best meet your family’s needs. We’re here to support you and guide you toward the best intervention for your child. 

Please reach out to us via email, text, or phone to schedule a free 15-minute consultation if you believe that your child may benefit from physical or occupational therapy. [email protected] and 480-269-0173.