Why Paediatric Home Modifications Require a Different Approach
Home modifications play a critical role in supporting children with disabilities to participate fully and safely in everyday life. For occupational therapists (OTs), prescribing home modifications for children is a complex but rewarding area of practice that requires consideration of development, family systems, equipment, and the environment over time.
What Home Modifications Offer Children
Well-designed home modifications provide children with far more than physical access. They offer protection and freedom, enabling children to move safely within their home while reducing injury risk. Modifications can increase a child’s sense of control, support connection to daily roles and routines, and enable meaningful participation in self-care, play, leisure, and family life. Importantly, the home environment can also present opportunities for skill acquisition and mastery, allowing children to practise emerging skills in real contexts rather than being passively assisted. Accessible play spaces, bathrooms, and entry points can significantly enhance inclusion and quality of life.
The Role of the Occupational Therapist
The OT’s role is to assist families in considering both short- and long-term needs, recognising that children’s abilities, equipment, and routines are constantly changing. This includes anticipating developmental milestones, fostering inclusion within the family, and balancing a child’s independence with care needs. Unlike adult home modifications, paediatric practice requires forward planning for growth, changing carer roles, and evolving participation goals. OTs also play a key role in advocacy, collaboration with builders or designers, and ensuring modifications align with safety standards and funding guidelines.
Assessment Process: Child, Carer, Equipment and Tasks
A thorough assessment underpins effective home modification outcomes, which involves:
- Interviewing the child and parents, considering ages and stages (infancy through adolescence), family expectations, and level of acceptance of the child’s disability.
- Exploring whether the disability was hereditary or acquired, and how this impacts routines, coping, and planning.
- Observing the child and carers completing everyday tasks to identify functional barriers and risks.
- Measuring the child, carers, and equipment, recognising that equipment type and use will change over time. Effective measurement requires sound knowledge of anthropometrics, biomechanics, ergonomics, and manual handling.
- Identifying environmental barriers and measuring the home accurately, including access points, circulation spaces, and wet areas.
The OT then determines a range of possible solutions, considering alternative interventions such as task adaptations, strategies, equipment, or supports.
Typical Barriers and Practical Solutions
Common barriers include narrow doorways, steps at entrances, poor internal circulation, inaccessible bathrooms, lack of automation, and unsafe outdoor or play spaces. Additional challenges include unstable housing, limited budgets, cultural considerations, and carer capacity.
Solutions often involve a staged approach that prioritises health, safety, independence, and play. Modifications may be permanent, adjustable, or designed to be replaced as the child grows. Failure to tailor modifications appropriately can result in non-use, safety risks, and wasted resources, highlighting the importance of careful planning and review.
Resources to Assist Practice
OTs should draw on relevant Australian Standards (e.g. AS 1428), evidence-based frameworks, and collaboration with architects, builders, and equipment suppliers. Ongoing plan review and post-completion evaluation are essential to ensure modifications remain functional and relevant. Professional networks, webinars, and specialist home modification resources can further support clinical reasoning and best practice.
In paediatric home modifications, the OT’s expertise ensures that the home evolves alongside the child—supporting participation, dignity, and family life now and into the future.
About the author
Stacey is a Clinical Excellence Lead at KEO Care. With over 5 years experience working predominately in the Home Modifications space, Stacey supports and mentors KEO therapists in the area of Home Modifications and other clinical outcomes. Stacey is passionate about sharing knowledge to upskill the KEO team and achieving great outcomes for the participants that the KEO team supports.
