#198 - A Day in the Life of a Pediatric COTA/L

Listen & Subscribe on Your Platform of Choice:

A Day in the Life of a Pediatric COTA/L

We had someone message us asking what a day in the life of a COTA looks like!

We (Rachel and Jessica) are both Certified Occupational Therapy Assistants, Licensed in the state of Idaho (COTA/L). We worked with children in an outpatient clinic setting for over 7 years and in this episode we share what a “typical” day looked like in the clinic. 

We also share some tips for fellow therapists! 

Don’t forget to listen to the end, where we answer a listener question! 

A Day In The Life Of A Pediatric COTA/L

If you've ever wondered what a Certified Occupational Therapy Assistant (COTA) really does in a pediatric setting, you're not alone. Whether you're a parent trying to understand the therapy your child receives or a new therapist entering the field, today's article will walk you through the day-to-day realities of working as a pediatric COTA—based on firsthand experiences from Harkla’s in-house experts, Rachel and Jessica.

Spoiler alert: it's a blend of creativity, chaos, compassion, and clinical expertise.

What Is A COTA?

A Certified Occupational Therapy Assistant (COTA) works under the supervision of an Occupational Therapist (OTR) to implement treatment plans for clients. In pediatric outpatient clinics, COTAs are often the friendly faces children see weekly, forming close bonds with both the child and their families.

• OTR's Role: Conducts evaluations, writes goals and treatment plans.

• COTA's Role: Delivers the hands-on therapy sessions aligned with the treatment goals.

A Typical Day In The Clinic For A Pediatric COTA

Here’s what a “typical” day might look like for a pediatric COTA in a private outpatient setting. Keep in mind that every clinic operates a bit differently, but many elements remain consistent.

1. Morning Setup

• Arrive early to review the day’s schedule.

• Set up obstacle courses, sensory paths, or themed stations for different age groups.

• Prepare individualized materials based on client goals.

“We’d set up obstacle courses on Mondays and use them all week, modifying as needed.”

2. Treatment Sessions Begin

• Back-to-back 50-minute therapy sessions with ~5–10 minutes for documentation and caregiver communication.

• Tailored sensory activities and goal-directed tasks.

• Dynamic interaction: jumping, swinging, handwriting, fine motor games, and more.

“We always tried to have fun—because if the kids weren’t enjoying it, they weren’t learning.”

3. Lunch (Maybe)

• 30–60 minutes, often used for documentation or quick brainstorming sessions with team members.

• Collaboration with OTs, speech therapists, and other COTAs is key to problem-solving complex cases.

4. Afternoon Sessions

• After-school hours typically fill with school-aged children.

• Sessions remain individualized, but energy management becomes more critical.

• As the day wears on, therapist stamina can dip—making breaks even more essential.

The Emotional Realities: Burnout & Balance

Burnout is real in pediatric therapy. Between the emotional demands of client care and the physical energy needed to stay on the floor with kids all day, COTAs often walk a tightrope of passion and fatigue.

Key Strategies To Avoid Burnout:

• Set boundaries: Know how many clients you can handle back-to-back.

• Build rapport: Sessions feel lighter when there’s trust and mutual enjoyment.

• Take time off: Even therapists need self-care days.

• Ask for help: Use your team as a support system.

• Keep learning: Confidence comes from education and experience.

“You’re constantly learning as a therapist, and that’s okay. Just be open about it.”

Real Talk: Why Some COTAs Stay COTAs

It’s common for people to ask: “Why not become an OTR?” But many choose the COTA path intentionally. 

The reasons?

• Love for hands-on therapy.

• Less paperwork.

• Daily client connection.

• Clear structure in collaborative roles.

“I wanted to do the fun stuff, not the paperwork. That’s why I stayed a COTA.”

Bonus Tips For New Or Aspiring COTAs

• Don’t worry if you don’t remember everything—bring a notebook to sessions early on.

• Collaborate often with your OTs and team.

• Take pride in building trust with clients and families.

• Use session gaps wisely (e.g., creating home programs, visual supports, laminating tools).

• Prioritize play and engagement in every session.

Listener Q&A: Winter Gloves & Sensory Challenges

Question: My autistic son won’t wear gloves but wants to play in the snow. Any suggestions?

Harkla’s Tips:

• Limit outdoor time to 5–10 minutes if gloves aren't tolerated.

• Try waterproofing comfort items (e.g., Ziploc bags).

• Use hand warmers as a novelty item.

• Experiment with indoor snow play first (e.g., snow in a bowl with dye).

• Try visual supports or timers to reduce anxiety.

• Respect the child’s boundaries, but gently stretch their tolerance with sensory-rich play.

Final Thoughts

Being a COTA in a pediatric setting is both rewarding and demanding. It's a role filled with creativity, heart, and dedication. 

If you're considering this path—or already living it—remember: your presence matters, your work is powerful, and your clients notice. Whether you’re in the clinic or in the community, your support can transform lives.

BORING, BUT NECESSARY LEGAL DISCLAIMERS

While we make every effort to share correct information, we are still learning. We will double check all of our facts but realize that medicine is a constantly changing science and art. One doctor / therapist may have a different way of doing things from another. We are simply presenting our views and opinions on how to address common sensory challenges, health related difficulties and what we have found to be beneficial that will be as evidenced based as possible. By listening to this podcast, you agree not to use this podcast as medical advice to treat any medical condition in either yourself or your children. Consult your child’s pediatrician/ therapist for any medical issues that he or she may be having. This entire disclaimer also applies to any guests or contributors to the podcast. Under no circumstances shall Rachel Harrington, Harkla, Jessica Hill, or any guests or contributors to the podcast, as well as any employees, associates, or affiliates of Harkla, be responsible for damages arising from use of the podcast.

Keep in mind that we may receive commissions when you click our links and make purchases. However, this does not impact our reviews and comparisons. We try our best to keep things fair and balanced, in order to help you make the best choice for you.

This podcast should not be used in any legal capacity whatsoever, including but not limited to establishing “standard of care” in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast.