Rooted in Regulation: The Role of Sensory Gardens in Pediatric Occupational Therapy

Jennifer Martinc, OTD

Carolyne Teixeira OTD-S

In this contemporary, rapidly evolving, screen-dominated environment, children's options for engaging in natural multimodal experiences are constrained by constant distractions. As an occupational therapy doctoral student passionate about holistic and inclusive interventions, Jen Martinc, OTD at Tampa General Hospital (Clinical Instructor for Capstone project) and I partnered with TampaWell at Tampa General Hospital, a community wellness initiative, to bring a pediatric sensory garden to life. This space allowed me to take the experience of traditional gardening into the pediatric population through sensory exploration in occupational therapy sessions. The aim was to engage the patients in immersive, hands-on opportunities to engage their senses with food exploration and engage with the natural environment while addressing meaningful therapeutic goals. 

Sensory processing challenges are prevalent among children with various developmental conditions, including autism spectrum disorder (ASD), sensory processing disorder (SPD), and physical disabilities. These issues might hinder their capacity to participate in everyday activities, manage emotions, and effectively interact in social or educational settings. An increasing body of research underscores the therapeutic advantages of nature-based settings for children. According to Hussein et al. (2013), sensory gardens, crafted to engage the senses with various components such as textures, aromas, and colors, may provide therapeutic benefits for individuals with diverse needs. Guo et al. (2024) found that horticultural activities significantly improved children’s physiological and emotional responses to stress, especially those involving real plants and nature-based materials. In addition, Nieberler-Walker et al. (2023) looked at the advantages of therapeutic gardens in hospital settings for both patients and employees, including enhanced social interaction, emotional control, and cognitive growth. They experienced better social engagement, emotional well-being, and benefits from natural settings that encourage these interactions.

Despite these benefits, many pediatric environments that I have had the opportunity to work in still lack safe, accessible, and developmentally appropriate outdoor spaces for therapeutic play. This gap allowed me to have a chance to develop the first sensory garden at Tampawell that integrates occupational therapy theoretical foundations with nature-based therapy. 

The Tampawell garden was already developed, but through our partnership, it allowed occupational therapy services to occur inside this unique setting. The garden includes raised beds filled with herbs, vegetables, flowers selected for their sensory properties, an outdoor classroom, and a small playground. In my sessions, children engaged in hands-on tasks like digging, watering, harvesting, and painting, which supported fine motor coordination in a natural setting, outside the confines of a typical clinic or classroom. Activities, including identifying produce, planning steps, and learning a plant care routine, also support cognitive development and executive functioning.  I guided children through each step, allowing them to build confidence and problem-solving abilities through active participation. The playground also provided the children with opportunities to practice sensory modulation, such as descending the slide for vestibular input or ascending the steps for proprioceptive input. When the children are exploring the garden, they are encouraged to use their senses to explore, including feeling the textures of leaves, smelling basil or mint, and listening to birds. Sensory food play sessions used the produce from the garden, providing additional opportunities for exposure and interaction. Some of this produce includes tomatoes, beets, carrots, apples, and oranges. The design of the garden placed a strong emphasis on play, relaxation, and accessibility. Some of the children with tactile defensiveness are encouraged to walk barefoot on the grass or engage in fine motor play on the ground. These activities provide alternative sensory input, as many of the children have limited exposure to diverse tactile experiences. For many of the children and the families, it was their first experience with gardening that ignited a spark of curiosity and appreciation for using nature as an occupational intervention. 

The garden provided therapy sessions, a blended intervention with structure but also exploratory play. Some of the children practiced fine motor coordination, including watering, chalk drawing, or harvesting tomatoes/peas from the garden at Tampawell. We also utilized deep breathing to link sensory input with self-regulation. In one case, a child practiced walking on different textures, including rocks, concrete, wood, and grass, to gradually address tactile defensiveness. Since the garden provided an open and calming environment that contrasted with the clinic setting, they were accustomed to for their session, the children were often more relaxed and engaged. I consistently encouraged the children to explore the garden at their own pace to allow the session to be client-centered and adaptable. For children with sensory sensitivities, the predictable rhythm of nature and the open, soothing layout helped reduce overstimulation. The environment also allowed for more social interaction and collaborative participation among family members during the session, providing opportunities for turn-taking, problem-solving, and motor planning, while also reinforcing goals from traditional indoor sessions.

After my garden sessions, many caregivers often reported noticeable changes. One parent shared, “It’s the only place my child isn’t overwhelmed. It feels safe. They’re exploring without pressure, just learning through play.” Another expressed, “I finally see my child outside, not glued to a screen — and smiling.” Improvements in focus, mood, participation and noticeable from both caregivers and therapists. Many described the environment as safe, soothing, and welcoming, and they often return energized and happy. Children were frequently more joyful and in control of their emotions and sensory needs. Some caregivers even requested and began bringing home fresh produce to their homes so they may continue the sensory exploration at home. These observations highlight the challenges children with sensory processing differences face in daily routines and social interactions, and how a sensory garden can create a supportive space for growth and regulation.

Florida’s year-round climate offers occupational therapists a unique opportunity to incorporate nature into therapeutic practice. Community wellness initiatives like TampaWell demonstrate how occupational therapy and community initiatives can be combined to improve client outcomes. The collaboration with TampaWell demonstrates how occupational therapy and community wellness initiatives may be combined. Florida is a highly multicultural state, making it essential for occupational therapy practitioners to design holistic interventions that foster inclusivity and reflect the diversity of the communities they serve. Sensory gardens offer a meaningful and accessible way to support growth, engagement, and participation across cultures. These sensory gardens provide occupational therapists in Florida more than just a diverse intervention but also the opportunity the opportunity to reestablish children's connections to play, culture, and environment in a client-centered way.

References

Hussein, H., Abidin, N. M. N. Z., & Omar, Z. (2013). Engaging research and practice in creating for outdoor multi-sensory environments: Facing future challenges. Procedia - Social and Behavioral Sciences, 105, 536–546. https://doi.org/10.1016/j.sbspro.2013.11.057

Guo, L., Xu, W., Shi, Y., Gao, S., Xiao, C., Zhang, X., Liu, X., Zhang, Q., & Zhang, Y. (2024). Which horticultural activities are more effective for children’s recovery from stress and mental fatigue? A quasi-experimental study. Frontiers in Psychology, 15, 1352186. https://doi.org/10.3389/fpsyg.2024.1352186

Nieberler-Walker, K., Desha, C., Bosman, C., Roiko, A., & Caldera, S. (2023). Therapeutic Hospital Gardens: Literature Review and Working Definition. HERD, 16(4), 260–295. https://doi.org/10.1177/19375867231187154