Let’s be honest—emotional regulation is one of the biggest topics in paediatric occupational therapy.
There are entire textbooks dedicated to it, countless frameworks to explore and new research emerging all the time. It’s impossible to cover everything in one blog (or even one university subject!).
But here’s something we’ve noticed over the years.
Many new graduate OTs tell us they don’t feel like they learned enough about emotional regulation at university. Others have joined workplaces where the expectation is to “pick it up as you go.” Before long, you’re supporting children with complex regulation needs, trying to connect theory with practice, and wondering if everyone else knows something you don’t.
The truth is, many therapists haven’t had the opportunity to build a strong foundation in emotional regulation. And that’s not because they aren’t capable – it’s because the fundamentals are often skimmed over in favour of intervention techniques or assessment tools.
So, we thought it was the perfect time to go back to basics.
This isn’t a deep dive into every regulation model or strategy (we’ve go an on-demand course for that). Instead, consider it a refresher on the foundations that underpin so much of our work as paediatric OTs. Because when we understand the why behind a child’s behaviour, we’re in a much better position to choose the how.
The reality is that emotional regulation underpins almost everything we do as paediatric occupational therapists. It influences participation, learning, relationships, play, transitions, school success and family life. Yet it’s an area that many therapists tell us they wish had been explored in more depth during university or workplace training.
We learn about sensory processing, development and intervention planning.
But pulling those concepts together into practical, everyday clinical reasoning? That’s often something we’re expected to figure out ourselves.
So let’s go back to basics.
Emotional regulation isn’t just about getting through your OT session
It’s easy to think about regulation in the context of therapy.
“How do I help this child engage in today’s activity?”
But emotional regulation extends far beyond the clinic.
It’s what helps a child:
- transition to school without becoming overwhelmed
- cope with losing a game
- sit through family dinner
- manage homework after a long day
- navigate friendships
- recover after disappointment
- participate in everyday routines
And just as importantly, it affects families.
Parents often tell us they don’t need another behaviour chart or reward system—they want to understand why their child reacts the way they do and how they can support them in everyday life.
As occupational therapists, we’re in a unique position to help families build that understanding.
Before we can choose a strategy, we need to understand the child
One of the easiest traps to fall into is asking:
“What’s the best regulation activity?”
But that’s not really the right question.
A better question is:
“What is this child’s nervous system telling me?”
Every child processes sensory information differently. Once we understand how they’re experiencing the world, we can make far more informed decisions about the support they need.
One of the most useful ways to understand this is through Dunn’s Sensory Processing Framework.
This framework looks at two key factors:
- Neurological threshold – how much sensory input a child needs before they notice or respond to it.
- Self-regulation style – whether they respond passively or actively to sensory experiences.
Together, these create four sensory processing patterns.
It’s important to remember that these aren’t labels or boxes that children fit neatly into. Instead, they provide a helpful lens for understanding behaviour and guiding our clinical reasoning.
Low Registration
High threshold • Passive response
Children with low registration often need more sensory input before they notice what’s happening around them.
You may notice they:
- miss instructions
- seem slow to respond
- appear daydreamy
- need repeated prompts
Practical ways to support them
Rather than repeating instructions louder or assuming they’re not paying attention, consider increasing meaningful sensory input.
You might:
- pair verbal instructions with visual cues
- use movement before seated activities
- position yourself within the child’s line of sight before speaking
- make activities more engaging through novelty or movement
The goal isn’t to stimulate for the sake of it—it’s to help the child notice and engage.
Sensory Seeking
High threshold • Active response
These children actively seek extra sensory input because that’s what helps their nervous system feel organised.
You might see:
- constant movement
- climbing
- crashing
- fidgeting
- touching everything
- making noises
Practical ways to support them
Instead of constantly redirecting movement, think about how you can build it into your session.
For example:
- create movement-based learning activities
- include heavy work between tabletop tasks
- use obstacle courses with a therapeutic purpose
- schedule regular movement breaks before regulation starts to decline
Often, working with their sensory needs is much more effective than working against them.
Sensory Sensitive
Low threshold • Passive response
Children with sensory sensitivity notice sensory input very quickly but don’t always remove themselves from it.
They may appear:
- distracted
- anxious
- emotionally overwhelmed
- uncomfortable in busy environments
- tired after noisy or stimulating situations
Practical ways to support them
Sometimes the best intervention isn’t adding more sensory input—it’s reducing unnecessary demands.
This could include:
- simplifying the environment
- reducing background noise
- providing predictable routines
- allowing processing time
- checking in before moving to new activities
Small environmental changes can make a significant difference.
Sensory Avoiding
Low threshold • Active response
Children with sensory avoiding patterns actively try to reduce sensory input because it quickly becomes overwhelming.
This might look like:
- leaving activities
- covering ears
- refusing messy play
- avoiding crowds
- becoming distressed during transitions
Practical ways to support them
Think about how you can increase predictability and give the child some control.
You might:
- prepare them for transitions
- offer choices where appropriate
- create quieter therapy spaces
- gradually introduce challenging sensory experiences
- respect when a child needs a break
Feeling safe is often the first step towards successful participation.
Clinical reasoning is where it all comes together
Understanding sensory processing patterns is incredibly valuable – but it’s only one piece of the puzzle. because if we’re being honest, no child fits perfectly into one quadrant.
Children’s regulation changes throughout the day. Their responses are influenced by sleep, illness, anxiety, environment, relationships, expectations and countless other factors.
That’s why emotional regulation isn’t about memorising activities.
It’s about developing the confidence to observe what’s happening, interpret the child’s behaviour, and adapt your intervention in real time.
That’s clinical reasoning.
And it’s one of the most valuable skills you can develop as a paediatric OT.
Turning theory into everyday practice
Most therapists don’t need another printable or a longer list of sensory activities.
What you need is confidence.
Confidence to understand what’s happening beneath the behaviour. And the confidence to explain regulation to parents. While also knowing when to adapt a session- and when to stay the course.
That’s exactly why I created Ready to Regulate.
In this practical 45-minute on-demand masterclass, I draws on my more than 30 years of paediatric OT experience to unpack emotional regulation in a way that’s grounded, practical and immediately applicable.
You’ll learn:
- how emotional regulation develops
- how sensory processing influences regulation
- practical tools you can confidently use during therapy sessions
- how to strengthen your clinical reasoning
- ways to explain regulation to families in language they can understand
- strategies you can implement in your very next session
Whether you’re just starting your OT career or looking to revisit the fundamentals, Ready to Regulate is designed to help you feel more confident supporting children—and the families who rely on you.
Because when we understand emotional regulation, we don’t just improve our therapy sessions.
We help children participate more successfully in everyday life.
