Pumpkin carving is a favorite fall tradition, but did you know it can also provide opportunities to practice important developmental and functional skills? From a pediatric occupational therapy perspective, everyday activities like pumpkin decorating can support fine-motor skills, bilateral coordination, visual-motor skills, motor planning, sensory exploration, and independence. 

Start with safety. Leave carving and sharp tools to adults. Children can help scoop, draw, and decorate with supervision. Keep seeds and small decorations away from children who may put them in their mouths.

Scoop, Squish & Strengthen 

Once an adult has opened the pumpkin, children can help scoop out the seeds and pulp using their hands or a spoon. This provides opportunities to develop hand strength, grasp and release, bilateral coordination, and tactile awareness. 

If your child doesn’t enjoy the texture, that’s okay! Try gloves, a spoon, or another way to participate. 

Design Your Pumpkin Before Carving 

Before carving, invite your child to draw a face or design. Drawing helps develop visual-motor skills—the ability to coordinate what we see with how we move our hands. 

Children can also practice planning by deciding where they want the eyes, nose, and mouth to go. 

Use Both Hands 

Holding the pumpkin steady while decorating, carrying a small pumpkin with both hands, or using one hand to stabilize an object while the other works are great ways to practice bilateral coordination. These skills are important for everyday activities like cutting, dressing, using utensils, and playing.  

Pumpkin carving also provides opportunities to practice sequencing, following directions, problem-solving, and independence. Give your child an age-appropriate job—choosing the pumpkin, drawing the design, scooping seeds, decorating, or helping clean up. 

Occupational therapy isn’t limited to the clinic. Meaningful everyday activities are opportunities for children to learn, participate, and build functional skills. Grab a pumpkin and turn a family tradition into an opportunity to play, connect, and grow!

Twice exceptional children, also known as 2e, refers to gifted children who have one or more specific learning disabilities such as dyslexia, attention deficit disorder, or autism spectrum disorder. These children often require special consideration in school because they have above average intellectual ability, as well as specific learning disability. Thus, twice exceptional children have significant strengths in some areas and deficits in other areas. Identification of these children is often complicated and requires the ability to assess and identify two areas of exceptionalism.

Common Characteristics

• Strong problems solving skills
• Higher than typical sensitivity, causing them to react strongly to sound, taste, smell, etc.
• High degree of curiosity
• Poor self-esteem due to perfectionism
• Poor social skills
• Strong ability to concentrate in areas of interest
• Difficulty with reading and writing
• Behavior challenges due to stress, boredom, and lack of motivation in subjects of little interest

Twice exceptional children need a supportive learning environment that addresses both their giftedness and their disability. They need sufficient challenges despite their learning difficulty. An individualized approach to education will help them reach their potential.

Strategies for Supporting Twice Exceptional Children

• Provide individualized education based on their interests and talents
• Give equal attention to their strengths as to their weaknesses
• Teach social skills and facilitate emotional development
• Encourage participation in enrichment programs
• Collaborate with school professionals

Additional information about twice exception children can be found at the Davidson Institute. And, check out our website to learn more about how MOSAIC can help.

Self care skills are an important part of childhood development, but they are about much more than simply teaching a child to “do things on their own.” Everyday routines such as getting dressed, eating, brushing teeth, washing hands, and using the bathroom provide children with opportunities to build confidence, problem-solving skills, coordination, and independence.

Children develop self-care skills at different rates. While developmental expectations can provide helpful guidelines, each child has their own strengths, challenges, and learning style. A child who struggles with a particular task may not be refusing to participate—they may be having difficulty with an underlying skill needed to complete the task.

What Skills Support Self Care?

Self-care routines require a combination of skills. Fine motor coordination helps children manage buttons, zippers, utensils, toothbrushes, and shoes. Strength and motor planning allow children to position and move their bodies during dressing, bathing, and toileting. Sensory processing helps children tolerate experiences such as brushing hair, wearing certain clothing, or washing their face.

Self-care also requires attention, sequencing, memory, and emotional regulation. A child may know what they are need to do but have difficulty remembering all the steps or staying regulated long enough to finish the routine.

How Can Parents Encourage Independence?

One of the best ways to build independence is to give children opportunities to participate in everyday routines. It can be tempting to complete tasks for children because it is faster, but allowing them to practice is how skills develop. Try breaking routines into smaller steps. Instead of saying, “Get dressed,” try giving one step at a time. “Put your shirt on,” followed by “Now let’s put on your pants.” Visual schedules or pictures can also help children understand the sequence of familiar routines.

Give your child time to try before stepping in. Provide the least amount of assistance necessary. For example, start with a verbal cue, then demonstrate, and provide physical assistance only when needed. Remember to celebrate effort and progress—not just completion. Statements such as “You worked really hard on that zipper!” can help build confidence and motivation.

When Can Occupational Therapy Help?

Consider asking for an occupational therapy evaluation when everyday activities such as dressing, eating, hygiene, or toileting are consistently difficult for your child or cause frequent frustration. An evaluation may also help if challenges with fine motor skills, sensory experiences, motor planning, attention, or routines are limiting your child’s participation at home, at school, or in play.

You don’t have to wait for a problem to become severe. An occupational therapist can help identify what’s making an activity difficult. They will work with your family on practical ways to build confidence and independence.

In the first part of our balance development in kids series, we explored how babies and toddlers build the foundation for balance through head control, sitting, crawling, standing, and early walking. By age 3, many children are ready to use those foundational skills during faster, more complex movements—but balance development in kids continues and becomes more refined throughout childhood.

From navigating playground equipment to hopping, riding a bike, and participating in sports, balance plays an important role in how children move, play, and build confidence. In this second part of our series, we will look at how balance skills typically develop from age 3 through the school years, activities families can try at home, and signs that a child may benefit from a pediatric physical therapy evaluation.

Ages 3 to 5: Developing Single-Leg and Dynamic Balance

Preschoolers begin using balance for more coordinated and purposeful movement. Their posture becomes more controlled, their reactions become faster, and they can often adjust their bodies before they lose their balance.

Developing skills may include:

• Walking along a narrow line
• Standing briefly on one foot
• Hopping
• Jumping forward or down
• Catching and kicking balls
• Pedaling and steering a tricycle
• Climbing ladders and playground structures
• Moving through simple obstacle courses
• Beginning to skip or gallop

The CDC lists catching a large ball most of the time as a movement milestone by age 4 and hopping on one foot as a milestone by age 5.

At this age, balance also becomes closely connected to confidence. A child who feels steady may be more willing to try playground equipment, join movement games, or explore unfamiliar activities.

School Age: Refining Balance for Complex Movement

Balance continues developing well beyond the preschool years. School-age children become better at controlling their bodies while moving quickly, responding to other people, watching a ball, carrying an object, or making decisions at the same time.

These more advanced skills support:

• Riding a bicycle or scooter
• Skipping with rhythm
• Running and changing direction
• Landing after a jump
• Walking on narrow or uneven surfaces
• Throwing or catching while moving
• Participating in sports
• Maintaining balance when bumped
• Moving safely in busy environments

As children grow, the brain becomes more efficient at deciding which sensory information to trust. A child may rely on vision in one situation but need more information from the feet, joints, and inner ear in another. This process continues to mature throughout childhood.

Balance Activities for Kids

Balance practice does not need to feel like an exercise program. Many of the best opportunities happen through ordinary play.

• Create Stepping Stones – Use flat floor markers, pieces of paper, or secured nonslip spots as pretend stepping stones. Ask your child to step from one to the next without touching the space between them. Change the distance or direction of the markers to make the activity easier or harder.
• Play Freeze Games – Freeze dance, Red Light–Green Light, and Simon Says help children practice starting, stopping, changing direction, and holding a position. These games combine balance with listening, motor planning, and body control.
• Practice Single-Leg Play – Instead of simply asking a child to stand on one foot, make it part of a game. Keep a stable surface nearby when needed. A child can:
  • Pretend to be a flamingo
  • Place one foot on a ball
  • Step over a toy
  • Tap different floor markers
  • Put on pants while standing with support
  • Kick a stationary ball toward a target
• Add Ball Play – Rolling, throwing, catching, and kicking require children to shift their weight and adjust their posture. Start with a large, lightweight ball. A larger ball moves more slowly and is often easier for young children to track and catch.
• Build an Obstacle Course – Obstacle courses can be changed frequently to keep the activity interesting. Use safe household items to create a course that includes:
  • Crawling under something
  • Stepping over a low object
  • Walking around cones
  • Moving between floor markers
  • Tossing a toy into a basket
  • Stopping in a designated spot
• Explore Outdoor Surfaces – Grass, sand, hills, playgrounds, logs, gravel paths, and packed snow provide different types of balance challenges. Outdoor play gives children opportunities to adjust their posture and foot placement in ways that smooth indoor floors do not. Stay close, choose safe environments, and match the challenge to your child’s current abilities.

How to Make Balance Activities Easier or Harder

A balance activity should be challenging enough to require effort but not so difficult that the child becomes frightened or frustrated.

To make an activity easier:

• Widen the path or space between the feet
• Allow the child to hold a hand or stable surface
• Slow the activity down
• Use a firm, level surface
• Reduce the number of steps
• Demonstrate the movement first

To increase the challenge:

• Narrow the path
• Add reaching or throwing
• Change speed or direction
• Carry a lightweight object
• Add a turn
• Use a slightly less predictable surface
• Combine two familiar movements

Balance activities should be supervised and completed in a clear area away from sharp furniture, stairs, and elevated surfaces. Stop the activity if the child experiences pain, dizziness, nausea, or unusual fatigue.

Frequently Asked Questions About Balance Development in Kids

Is it normal for toddlers to fall frequently?

Some falling is expected while toddlers learn to walk, run, turn, and navigate obstacles. Over time, families should see improved control and fewer falls. An evaluation may be helpful when falls are unusually frequent, worsening, associated with dizziness or pain, or limiting the child’s participation.

At what age should a child have good balance?

There is no single age when balance is “finished.” Balance begins developing during infancy and continues becoming more refined throughout childhood. Early skills include sitting and walking, while later skills include hopping, skipping, biking, navigating uneven surfaces, and maintaining control during sports.

Can balance improve with practice?

Many balance skills improve when children have regular opportunities to move, climb, jump, reach, and explore different environments. When an underlying strength, mobility, sensory, vestibular, coordination, or medical issue is affecting balance, individualized pediatric physical therapy may provide more targeted support.

Does poor balance always indicate a medical condition?

No. A child may temporarily appear unsteady while learning a new skill, growing quickly, or adjusting to an unfamiliar environment. Persistent, worsening, asymmetrical, or function-limiting balance problems deserve closer attention, especially when they occur with delayed milestones, pain, dizziness, or loss of previously acquired skills.

Balance continues to develop throughout childhood as kids take on more complex movements at home, on the playground, and in sports. Regular opportunities to climb, jump, run, and play can help build these skills, but if balance challenges are frequent or limit participation, a pediatric physical therapy evaluation can provide helpful guidance and support.

When a baby steadies their head, sits without support, or reaches for a toy without tipping over, they are already practicing balance. Later, balance helps that child walk, climb stairs, run across the playground, hop on one foot, ride a bike, and participate in sports. Balance development in kids is a gradual process—not one skill that suddenly appears. It grows as a child’s brain, muscles, joints, and sensory systems learn to work together. Every new movement gives the body more information and more opportunities to become steady, coordinated, and confident.

Children develop at different rates, so developmental milestones should be viewed as guideposts rather than pass-or-fail deadlines. The Centers for Disease Control and Prevention defines its listed milestones as skills that at least 75% of children can do by a particular age. Looking at a child’s overall progress is often more helpful than focusing on one isolated skill.

What Is Balance?

Balance is the ability to keep the body steady and controlled while staying still or moving. There are two general types of balance: Static balance is the ability to stay steady in one position, such as sitting upright, standing still, or balancing on one foot. Dynamic balance is the ability to remain controlled while moving, such as walking across an uneven surface, climbing stairs, running, jumping, or changing direction. Even simple movements require several systems to work together. The brain constantly combines and adjusts information from the visual, vestibular, and somatosensory systems. The way children rely on these systems changes as they mature.

• Vision helps a child understand where they are in relation to the environment.
• The vestibular system, located in the inner ear, detects head movement and changes in position.
• Proprioception, or body awareness, provides information from the muscles and joints about where the body is and how it is moving.
• Strength and postural control help the body respond to that sensory information and remain upright.

Balance Development occurs at Different Ages

Balance development follows a general progression. Children first learn to control their head and trunk, then maintain a position, shift their weight, move between positions, stand, and eventually control their bodies during faster and more complex activities.

Infancy: The Foundation

Balance begins developing during the first months of life. Before babies can stand, they must learn how to control their head and trunk against gravity. This is the foundation of balance. During infancy, balance development can be seen as babies learn to:

• Hold their head steady
• Roll from one position to another
• Sit with and then without support
• Reach for toys without falling over
• Move in and out of sitting
• Crawl or move across the floor
• Pull to stand
• Shift weight between their feet while supported

These early skills teach babies how to respond when their body begins to tip. Sitting, crawling, supported standing, standing independently, and walking are all part of the typical progression of gross motor development. Plenty of supervised floor play gives babies opportunities to explore movement and discover how different body positions feel.

12 to 24 Months: Learning to Walk and Recover

Early walking often looks unsteady. New walkers commonly use a wide stance, hold their arms up for stability, take short steps, and fall as they test their limits. As balance improves, toddlers begin to:

• Walk with a narrower stance
• Stop and start with more control
• Bend down to pick up a toy and stand again
• Turn while walking
• Step over small objects
• Carry toys while moving
• Begin running and kicking

As physical therapists, we want to see kids walking independently by 16 months. This is because, by 18 months, most children walk without holding on, take a few steps backward, and climb on and off a couch or chair. By age 2, kids should be running, kicking a ball, walking up a few stairs with or without help, and starting to try to jump. If a child isn’t walking at 16 months, then that child won’t be able to do these more advanced movements.

Some falling is expected during this stage. What families should generally see is gradual improvement in stability, confidence, and the ability to recover after losing balance.

Ages 2 to 3: Jumping, Climbing, and Exploring

During the toddler and early preschool years, children become more adventurous. They begin moving faster, navigating obstacles, and experimenting with both feet leaving the ground. Balance skills during this stage may include:

• Running with fewer falls
• Squatting during play
• Walking sideways
• Stepping over low obstacles
• Climbing playground equipment
• Walking along a wide line or low surface
• Going up and down steps with support
• Jumping with two feet

Toddlers may look steady in a familiar room but have more difficulty on gravel, grass, snow, playground surfaces, or crowded spaces. Different environments ask the balance systems to solve different problems.

Why Do Some Kids Have More Difficulty With Balance Development?

Occasional clumsiness does not automatically mean something is wrong. Children may have temporary difficulty with balance while growing quickly, learning a new movement, recovering from an injury, or entering an unfamiliar environment. However, ongoing balance challenges can be influenced by many factors, including:

• Reduced core, hip, leg, or ankle strength
• Limited joint mobility or muscle tightness
• Low muscle tone
• Joint instability
• Differences in foot or ankle alignment
• Visual difficulties
• Vestibular or inner-ear conditions
• Reduced body awareness
• Motor-planning or coordination challenges
• Developmental, neurological, or orthopedic conditions
• Pain, injury, or fatigue
• Limited opportunities for active movement and play

Balance is a whole-body skill. A child’s feet, posture, vision, inner ear, strength, coordination, and sensory processing may all influence how steady they feel. A pediatric physical therapist looks at these systems together rather than evaluating balance as an isolated problem.

When Should Parents Consider a Balance Evaluation?

Every child trips or falls occasionally. The pattern becomes more important when balance difficulties are frequent, worsening, or limiting participation. Reach out to MOSAIC if your child:

• Is delayed in sitting, standing, or walking
• Falls much more frequently than expected
• Is not becoming steadier over time
• Has difficulty navigating stairs or playground equipment
• Avoids running, climbing, jumping, or uneven surfaces
• Struggles to keep up with children of a similar age
• Consistently needs walls, furniture, or another person for support
• Shows a clear difference between the two sides of the body
• Walks with a persistent limp or unusual pattern
• Frequently walks on their toes
• Complains of pain or excessive tiredness
• Experiences dizziness, vertigo, or motion intolerance
• Has difficulty walking in dim lighting
• Suddenly becomes less steady
• Loses a skill they previously had

A balance evaluation does not automatically mean a child has a disorder. It can provide reassurance, identify areas that need support, and give families practical ways to help their child participate more confidently. Getting help as early as possible can make it easier to address balance challenges before they begin affecting a child’s confidence, independence, or participation in play, school, and sports.

Be sure to check back next week for our blog on how balance develops from age 3 through the school years!

Starting kindergarten is an exciting milestone for children and families. It’s a time filled with curiosity, new friendships, and growing independence. But many parents wonder: Is my child really kindergarten ready? As pediatric occupational therapists, we look at kindergarten readiness as more than just knowing letters or numbers. Readiness is about the whole child—their ability to play, learn, participate, and feel confident in a classroom setting.

Key Areas For Your Child to be Kindergarten Ready

Self-Help Skills

Children thrive when they can do everyday tasks on their own. Skills to look for:

• Putting on and taking off their coat, shoes, or backpack
• Managing zippers, buttons, or Velcro
• Opening lunch containers and water bottles
• Using the bathroom independently (including hand washing)

Encourage your child to practice these skills at home. Small successes build confidence!

Fine Motor Foundations

Strong little hands are needed for writing, cutting, and classroom crafts. Skills to look for:

• Holding a crayon or pencil with control
• Cutting along a line with scissors
• Building with blocks, play dough, or Lego
• Stringing beads or completing puzzles

Activities like coloring, squeezing clothespins, or tearing paper strengthen hand muscles in fun ways.

Gross Motor Skills

Movement helps kids sit upright at their desk, move safely around the classroom, and play at recess. Skills to look for:

• Running, jumping, climbing, and balancing
• Throwing and catching a ball
• Sitting upright on the floor for story time
• Moving safely in a busy classroom space

Trips to the playground, obstacle courses, and dancing are all excellent practice.

Social and Emotional Readiness

Learning is easier when children feel secure and can manage big feelings. Social emotional learning is part of this. Skills to look for:

• Playing with peers, taking turns, and sharing
• Following simple rules or routines
• Asking for help when needed
• Starting to use words to manage frustration

Play board games, role-play “school” at home, and practice problem-solving with your child.

Early Learning Skills

Academic skills do matter—but they’re only part of the picture. Skills to look for:

• Recognizing some letters, numbers, colors, and shapes
• Listening to and retelling simple stories
• Following 2–3 step directions
• Showing curiosity and willingness to try new things

Read daily with your child, play “I Spy” games, and sing songs to support early learning naturally.

When to Seek Support

Every child develops at their own pace, but if you notice persistent challenges with motor skills, independence, or social participation, an OT can help. Occupational therapy supports children in building the skills they need to thrive in school and beyond. Kindergarten readiness isn’t about perfection—it’s about confidence. With practice, encouragement, and support, your child will be ready to take on this exciting new adventure!