This article is based on the experiences of a paediatric occupational therapist who found herself in the position of helping a child with severe congenital limb deformities. She describes the initial occupational therapy assessment and the treatment programme, which was aimed at developing independence as far as possible. The equipment used is discussed, including adaptations required at home and in school. The child has now largely adapted to his physical problems, but is emotionally very dependent on stable relationships with adults.
