Common Mistakes Paediatric Occupational Therapists Make When Working with Children with Hypermobility Conditions

Paediatric Occupational Therapists (OTs) play a crucial role in supporting children with Paediatric Generalised Joint Hypermobility (pGJH), Paediatric Hypermobility Spectrum Disorder (pHSD), and Loeys-Dietz Syndrome (LDS). These conditions can impact a child's ability to participate in daily activities due to joint instability, pain, fatigue, and poor proprioception. While OTs aim to promote function and independence, there are several common mistakes that can limit progress or even contribute to difficulties.

1. Underestimating the Impact on Daily Activities

Hypermobility is often seen as a musculoskeletal issue, but its effects extend to fine motor skills, handwriting, self-care, and play. Children may struggle with grip strength, hand fatigue, and postural stability, making tasks like using cutlery, tying shoelaces, or cutting with scissors challenging. OTs should assess how hypermobility affects everyday tasks.

2. Overlooking Fatigue and Pain Management

Children with hypermobility often experience chronic pain and fatigue, even if they don’t express it clearly. OTs sometimes focus on task completion without considering the energy cost and discomfort. Teaching pacing strategies, energy conservation, and joint protection techniques (e.g., using larger muscle groups, built-up handles) is essential for sustainable participation.

3. Not Addressing Proprioceptive Difficulties

Many hypermobile children have poor body awareness, affecting their ability to judge force, position, and coordination. This can lead to messy handwriting, clumsiness, or difficulty with tool use. OTs should incorporate proprioceptive input through activities like appropriately weighted tools*, resistance tasks*, and deep pressure techniques, as well as proprioceptive retraining to improve spatial awareness and control.

*with caution and continual evaluation 

4. Relying Too Much on Standard Handwriting Interventions

Traditional handwriting strategies may not be effective for hypermobile children, who struggle with finger fatigue, reduced grip strength, and unstable wrist positioning. Instead of focusing solely on letter formation, fluency and legibility, OTs should consider alternative grips, slant boards, keyboard use, or voice-to-text tools to reduce strain and support functional writing.

5. Neglecting Environmental Adaptations

Postural instability and fatigue can make sitting at a desk, holding a book, or carrying a school bag difficult. OTs should recommend seating adaptations, ergonomic writing aids, or lightweight school bags to improve comfort and endurance in learning environments.

To effectively support children with hypermobility, paediatric OTs must go beyond traditional fine motor interventions and consider the broader functional challenges, including pain, fatigue, proprioception, and environmental factors. A holistic, child-centred approach ensures that interventions are meaningful, sustainable, and empowering for the child’s everyday life.

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