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Senior occupational therapist talks developmental delays in kids, from common signs to why acting early matters

Kim Cunningham, Hands On Fun OT

Today’s interview is with Kim Cunningham, a Senior Occupational Therapist with the NYC Department of Education, and the founder and owner of Hands on Fun Occupational Therapy in New Rochell, NY. She has worked in home and school settings, with several certifications, including sensory integration (SIPT certified), Therapeutic Listening, 300 Child Yoga Certification, and more. In this interview, Kim explains developmental delays, common signs for parents to look for, and how to respond. Her OT career spans 25+ years!

Disclosure: This sponsored interview focuses on the importance of identifying and getting help for developmental delays in children, and the inspiring woman who is helping kids, from infancy through the kindergarten years.

Interview with Kim Cunningham, MS OTR

The interview begins with a look at Kim Cunningham’s admirable career and education before defining “developmental delays” and why these delays are problematic. Kim is an expert in her field and helps infants, preschoolers, and kindergarten children at Hands On Fun Occupational Therapy.

Kim, how did you get into OT, and why?

When I was younger, I always wanted to be a doctor. I went to Arizona State University for my undergraduate degree in psychology and it was there during my studies that I met a colleague whose younger sibling received OT services. Immediately I was intrigued.

Then, when I finished college, I moved back home to NY, and I applied to Mercy College Master Program in Occupational Therapy. I was thrilled to be accepted and loved every second of my classes, but what really got me hooked on this field were the clinical fieldwork experiences that I had during my degree.

I was able to do hospital and school-based internships, which really showed me how rewarding it can be to provide these services to those who need them. Once I started working in pediatrics and helping children and families, I knew I [had] found the perfect job and population for me, and now I’m proud to say that I’m almost at the 30-year benchmark of my career.

What exactly are “developmental delays”?

From birth up until five years old, the AMA (American Medical Association) gives parents guidelines as to what to expect every 3 months from your child in terms of their motor development and how they use their body parts, such as arms, legs, head, eyes, etc. So, developmental delays are when a child doesn’t reach certain milestones at the expected time.

These milestones can be things like crawling, walking, talking, or other skills that are important for a child’s growth and development. If a child is 10 months old and does not lie on their stomach, roll back and forth on their backs or sit up independently they would be considered “developmentally delayed” because there is a gap between the child’s chronological age and their developmental age. They don’t match.

For example, let’s say a child is expected to start walking around their first birthday, but they’re not able to stand up on their own or take steps by themselves until they’re closer to 18 months old. That would be considered a developmental delay. Some examples of developmental delays in infants and toddlers might include not making eye contact, not responding to their names, not babbling or making other sounds, not reaching for toys or other objects, or not attempting to crawl or stand up on their own.

And likewise, in slightly older kids and toddlers, parents may notice that their child struggles with and can’t hold their bottle or hold a spoon to try to feed themselves. Sometimes the child’s preschool teacher might mention to you that your toddler has difficulty building with blocks or holding a pencil correctly, that’s why it’s so valuable to regularly check in with them.

An infant OT session with Kim Cunningham. Photo courtesy of Kim.

Why is addressing this issue in children so important?

The reason it’s so important to keep an eye on your child’s development is because early intervention really makes a difference when it’s required. Each milestone is reached in a sequential pattern, and your child’s success at completing subsequent tasks is dependent on mastering the previous ones.

So, for example, at three months old, a baby should be having a go at rolling onto their back. What this does is develop their stomach muscles as they practice rolling over and over again. Mastering this step is essential to preparing your baby to be able to sit up at six months independently without falling over.

So, these things are really contingent on each other, which is why it’s essential to introduce OT as early as possible when a child needs it. Occupational Therapy can ensure children develop the skills they need to succeed in school, play, and other activities, which ultimately prepares them for success in adulthood.

Thank you for such a clear explanation. Are there common signs for parents to look for?

Well, parents should always trust their first instincts when they think or feel something is not quite right regarding their child’s development.  I think, first and foremost, the AMA guidelines of where a child should be from birth up to 5 years old is a great reference to compare their child too, but keep in mind that no two kids will develop in an identical manner.

I think most parents are aware of the fine-motor indicators to look out for (that’s the difficulty using utensils, holding a pencil or crayon, or playing with small objects), but other things that I like to remind parents and caregivers to watch for include poor coordination, sensory processing issues, and challenges with socialization or emotional regulation. Those are some of the more social indications that OT might be beneficial.

If you do notice any of these signs, it’s important not to worry. I  really believe that Occupational Therapy can be a great way to help all children develop the skills they need to succeed in all areas of their life.

What is a good starting point for parents who aren’t sure how to support their child who has developmental delays?

First, talk to your child’s pediatrician and make an appointment for your pediatrician to physically see your child. Pediatricians know child development and are well-versed in all the areas that pertain to cognitive, physical, and emotional development. Dr’s can pinpoint the next call to action and give the appropriate referrals to specialists.

It’s also crucial to keep in mind that a parent’s job is not only to love and feed their child but to also be an advocate for their voice.  To me, being an advocate means asking questions, talking to your spouse and loved ones, and mentioning concerns is critical. Communication is key, and there is unity in community.

When is it time to seek the help of an occupational therapist (OT)?

If you have been keeping a close eye on your child’s development and you have a concern about the fact that they are struggling with reaching their milestones, having difficulty doing everyday tasks independently, or finding it challenging to form social connections with other kids their age, my recommendation is to talk to your child’s pediatrician. Because to receive OT services, a child must have a referral from their doctor.

An occupational therapy session at Hands on Fun. Photo via Kim Cunningham.

What inspired you to create Hands on Fun?

As someone with over two decades of experience as a pediatric OT and OT educator, parents of the kids I worked with, as well as some of my own friends who became first-time parents, were always asking me for suggestions and activities to do at home with their child to supplement the work they were doing with me in OT. So, with that in mind, I kind of felt like there was a gap in the market for products that could actually empower parents (and even teachers) to work on sensory and fine motor skills outside of the work I was doing with them.

So, I saw an opportunity to address this gap by developing a series of OT programs for different age groups that does two important things. First, it allows parents and caregivers to feel confident in their ability to help their child meet their milestones using science-backed therapeutic techniques in a simple and approachable format. And secondly, it also gives children who need a little extra help (or even a lot of extra help) to work on those skills in a fun way from the comfort of their own home. So, yes, our HOFOT toyboxes are fun, but it’s really about the step-by-step programs that are designed to educate and heal in a fun way.

What does a typical day at Hands on Fun look like?

Fun and busy. Hands on Fun OT is fulfilling and enriching, and dynamic because children always keep you on your toes.

Where can we connect with you, whether it’s as a parent, guardian, or anyone else?

We’re always eager to connect with like minded people who are passionate about bringing fun, educational OT services to kids who can benefit from them, so if anyone wants to reach out and discuss collaborations I’m always happy to hear from them. You can reach our team at or email me at

For updates about our current products and insights for upcoming events, product launches and promotions, I’d love to invite you to follow our Instagram account @handsonfunot and on Facebook as Hands on Fun OT to get the most up-to-date info on everything we’re doing. We’re still expanding and will have some giveaways going on in the summer so we’re excited to have everyone join us.

Check out the Hands on Fun OT website to find out more about the programs, book a workshop, at-home activity kits for preschoolers, and digital downloads.


Top photo: Kim Cunningham, owner of Hands on Fun Occupational Therapy. Photo used with Kim’s permission.

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