Challenging Activities for Medically Fragile Children

A Teacher Asks:

I have nine medically fragile pre-k children. Three are autistic. One has a feeding tube. With the exception of one child, the group is non-verbal and have difficulty walking. One is crawling and two are in wheelchairs.

The group is functioning between a nine-month and two-year age level.

What activities would you suggest for this population?

I see wonderful activities which I am familiar with however they either have no interest or cannot participate in them.

Miss Cheryl says:

You have quite a diverse group of children with a wide range of developmental challenges and in a wide range of developmental stages.

Planning activities for preschoolers, as you know, is based on the developmental needs of the children in the group—this applies to typically developed children AND children outside the range.

As educators, we have goals for our classrooms as a whole (goals for the year for our three year old class will be different from those for our four year old class). However, we also need to consider the developmental levels and stages of the individuals in our groups each year.

This would apply to your group of children as well. To determine the most appropriate activities for your children, I would suggest that you look at each child’s IEP (Individual Education Plan).

Rather than looking at what they cannot participate in, check the IEP for the goals and objectives for each child. This information will help you determine which activities will be best for each student.

From there, you will see patterns within the IEPs. Several of your students’ goals may be to participate in group activities.

You would then want to plan group activities based on:

A. Their participatory ability now. And

B. The level of participation that their IEP goal is.


One of a child’s Motor goals is: Move safely in group activities.

You might carry this out by having small group music/movement activities where you and an assistant help the child navigate a safe space away from the other children while dancing.

You might do this by providing a soft mat or stickers/shapes taped to the floor to clearly define the personal space for each child and redirect the child to his/her space.

It would be difficult for me or other teachers to suggest specific activities that will accommodate your group’s abilities and goals without knowing their IEP, which I understand is confidential.

My suggestion would be to ask for a copy of each child’s specialist for their suggestions on how to meet the set goals. This might include occupational therapists, speech therapists, etc.

Perhaps others with experience providing activities for diverse learners will have additional suggestions? If so, please add your comments below!

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