Engaging children in play-based therapy can be challenging, especially when they withdraw, walk away, or seem “checked out.” During one of our Play Conference interviews, Pediatric occupational therapist Katie Zelinski, founder of The Well-Balanced OT, explains that these moments are not obstacles – they’re clues. With over 11 years of pediatric OT experience, Katie shares practical strategies for adjusting the environment and using therapeutic presence to boost connection, focus, and participation.
How can we thoughtfully set up an environment for engagement?
For OTPs, the environment can make or break engagement. Before diving into play, it’s worth pausing to look at the space through the child’s eyes and sensory systems.
If you have access to standardized tools such as the Sensory Processing Measure (SPM) or Sensory Profile (SP), start there. These assessments can give you a clearer understanding of what the child needs from their environment and how best to support those needs. But even without a formal tool, simple observation and reflection can make a world of difference.
Auditory Environment
Pause and really listen to your space – the hum of lights, traffic outside, or a ticking clock. These background sounds might not bother you but can be overwhelming for a child. Use noise-reducing headphones or white noise if helpful, but remember: what calms one child may overstimulate another. Work together to find what sounds help them feel comfortable and focused.
- Visual Environment
Too much color, clutter, or movement can make engagement harder. Try clearing clutter, covering shelves, or simplifying what’s in view.
A tent or small enclosed space can act as a cozy retreat for calming or focused play – a place to reduce visual “noise” and help the nervous system re-center.
- Tactile Regulation
If you have access to lycra, katie recommends using it as a great way to connect with a child. It is a versatile tool – use it as a swing, wrap, or stretching aid to promote regulation.
- Supportive Seating
If the child’s body is well supported, this will automatically assist with better engagement. If a child has a weak core they will not be able to maintain their posture unaided for too long and this will lead to them tuning out and disengaging from the activity. If you’re working on the floor, place the activity on a small stool or low table so neither of you are hunched over.
- Incorporate Movement
Movement is regulating and organizing. Bring activities to the movement – for example, doing puzzles or fine-motor tasks on a platform swing, scooter board, or even while gently moving on your lap.This supports the vestibular system, helping the child’s body and attention find balance.
- Use Visual Supports
Some children feel calmer when they can see what’s coming next. Create visual schedules or activity boards together so the child has input and ownership. This helps build predictability and engagement. “Child-led” doesn’t mean no plan. It means using the child’s interests as your entry point. The plan flexes around the child’s engagement, not the other way around.
All Play is Functional
It’s important to remember that all play is meaningful even if it doesn’t look “typical.” If a child comes in and just wants to go and tap at the window – that is functional for them in that moment.
Sometimes, parents or therapists worry that a child doesn’t have a “preferred toy” or doesn’t know how to play. Often, the interest is there – we just haven’t learned to see it yet.
Katie encourages therapists to identify a child’s favorite item or theme and think of five different ways to use it in play. That way, you can draw on those ideas when engagement dips or transitions are tricky. As Katie reminds us, “There’s no one right way to play.” What works for one child may not work for another and that’s okay. After all, even as adults, we each have our own ways of finding joy and connection.
So after we have adjusted the environment for success, how can we really work on that engagement with the child?
Let’s start with What NOT to do. When a child leaves the activity, resist the urge to chase. If they are safe, give them space to self-regulate. Forcing them back breaks connection and increases stress. Instead, use the moment to observe and reflect:
“Our goal is not compliance – it’s connection.”
Also, limit “no” and “stop” in daily language. Save those words for safety. Instead of “No running,” say “Let’s use walking feet.” Positive phrasing keeps communication supportive and effective.
So what can we do? Therapists’ greatest tool is themselves – the therapeutic use of self. Adjusting your body language, tone, and affect helps match a child’s state:
- With low-arousal children: use big expressions, animated voice, and movement to draw interest.
- With high-arousal children: lower your voice, move slower, minimize gestures, and reduce stimulation.
Observation isn’t passive, it’s a high-level skill. By pausing and watching, we gather the information needed to adjust both our environment and approach.
Honoring the Child’s Communication
When a child leaves an activity or signals “I’m done,” they are communicating. Respecting that message fosters trust. Sometimes we can gently entice them back with curiosity like a playful sound, a surprising movement, or using a toy in a new way.
If they’re not ready, shift focus to regulation and safety. Encourage parent involvement when appropriate – co-regulation often starts with the most familiar relationship in the room.
By honoring their signals and supporting regulation, we create a space where children feel safe, understood, and ready to re-engage on their own terms. True connection and not compliance, is the foundation for meaningful participation, learning, and joy in therapy.
Curious why children sometimes withdraw in the first place? Check out Part 1: 7 Reasons Children Avoid or Withdraw from Play in Therapy
This is just a glimpse: get the full interview plus others from leading pediatric therapists inside the Play Conference
About Katie Zelinski
Katie is a pediatric Occupational Therapist specializing in sensory processing and regulation. She is founder of The Well-Balanced OT, an online platform offering mentorship, education and resources to help therapists and parents build their confidence and knowledge.
Katie’s Website: https://thewellbalancedot.com/