Why Paediatric Regulation Deserves a Re-Think: A Modern OT Perspective

Why Paediatric Regulation Needs a New Conversation in Occupational Therapy

Regulation has become one of the most commonly used words in paediatric practice. It appears in reports, NDIS goals, parent meetings and school support plans. However, when we look closely at the way the term is used across different settings, it becomes clear that we do not always mean the same thing.

For some people, regulation refers to behaviour.
For others, it means arousal.
For others, it means emotional control.
For others, it means strategy use.

This variety reveals a bigger issue.
As a profession, we are using the same word to describe many different concepts.

Regulation is not a single skill

Regulation is often spoken of as though it were a single ability that a child either has or does not have. In reality, regulation reflects a wide collection of sensory, emotional, physiological and cognitive processes that interact continuously throughout the day.

Research across sensory integration, developmental neurobiology, interoception, Polyvagal Theory and co-regulation science all point to the same idea. Regulation is not simply about staying calm. Regulation is the ability to move through internal states with support, safety and adaptability.

This includes the ability to notice sensory cues and interoceptive cues, to receive co-regulation from adults, to feel safe enough to engage and eventually to draw on more independent strategies when the child is developmentally ready.

Regulation is therefore not a static quality. It is a developmental pathway that unfolds gradually across childhood.

We often begin the conversation in the wrong place

In many settings, the focus is placed immediately on self-regulation. Children are asked to use their strategies, stay in the green zone or calm their bodies on demand. These expectations assume skills that emerge later in development.

Genuine self-regulation relies on interoception, emotional awareness, language for inner experience, impulse control, working memory and cognitive flexibility. These capacities come together slowly through the primary school years. They are not fully integrated in early childhood and are inconsistent even in the middle years.

When expectations of self-regulation are placed too early, children can feel as though they are failing. Adults can feel as though the strategies are not working. The focus shifts from understanding the child’s nervous system to compliance, which is not neuro-affirming.

Regulation begins with co-regulation and environment

Before children can regulate independently, they rely heavily on the adults around them. Co-regulation is not a step to rush through. It is a central part of how nervous systems learn to settle, organise and return to balance.

Occupational therapists already understand this intuitively. We create predictable sessions, support transitions, adjust sensory load and scaffold emotional expression. These elements form the foundation upon which independent skills are eventually built.

In this sense, regulation work is not just about teaching strategies. It is about creating the conditions in which strategies can eventually make sense.

Behaviour is communication, not the whole story

It is common for conversations about regulation to focus on behaviour. However, behaviour is only the surface-level expression of a much deeper process. When we focus only on behaviour, we risk missing what the nervous system is communicating.

A child who is overwhelmed may appear withdrawn, avoidant, oppositional or disorganised. These behaviours reflect elevated internal load rather than intentional misbehaviour.

Reframing behaviour in this way helps us shift from asking what the child is doing to asking what the child might be experiencing. This question opens the door to more thoughtful and developmentally aligned intervention.

OTs need a more explicit shared language for regulation.

One challenge in paediatric practice is that the regulation is described differently across clinicians and settings. Without shared language, it becomes harder to collaborate, harder to document clearly and harder for families to understand what regulation support actually involves.

A clearer professional conversation about regulation can help occupational therapists to:

• explain nervous system concepts without clinical jargon
• map changes in capacity throughout the day
• describe early signs of increasing load
• communicate effectively with teachers and families
• separate the child’s identity from the child’s current state
• shift away from compliance-focused language
• support trauma-aware and neuroaffirming practice

This is not about creating a new program. It is about strengthening the foundation of how we talk about the work we already do.

Where we can begin as a profession

We can start small by refining our language and aligning it more closely with development and neuroscience.

Move from a behaviour lens, to a nervous system lens
Instead of asking why a child is doing something
Ask what their body might be trying to communicate

Shift from independence expectations to pathway expectations
Instead of asking how we help a child self-regulate
Consider what supports the child needs to move toward that capacity over time

Hold co-regulation as central
Co-regulation is a core therapeutic tool rather than something children must quickly move beyond

Pay attention to environmental and sensory load
Small adjustments can create meaningful shifts in capacity

Normalise fluctuation
Children move in and out of regulated states naturally. Consistent calm is not an expected developmental baseline

These reframes honour what we know from research and allow us to approach regulation work with more compassion and clarity.

A final word for paediatric OTs

Regulation influences participation, learning, safety, relationships and well-being. When we talk about regulation as a single skill or treat it as something children must achieve on command, we miss the developmental reality of what regulation truly involves.

By shifting the conversation toward a more accurate and developmentally aligned understanding, we support children, families and educators in ways that feel more realistic and more respectful of how nervous systems actually work.

This is the beginning of a broader professional conversation about how we understand and communicate regulation within paediatric occupational therapy. Strengthening our language and conceptual clarity creates a foundation that supports more meaningful collaboration across the systems that surround children.

Watch this space for more details over the coming months…