• I’m preparing you now – this is a long one, but with lots of good information, so if you don’t have the time (or attention span) to read the whole thing, then scan the headings for what is important to you or at least check out the activities at the bottom.
What are fine motor skills?
Fine motor skills are actions accomplished with the fingers and hands (such as cutting with scissors). They are more complicated and intricate than gross motor skills, which are large movements accomplished with larger muscle groups of parts of the body (such as kicking a ball) or even the whole body (such as running). The development of fine motor skills begins at birth when a baby grasps its parent’s finger - a reflex at first, but that movement eventually becomes controlled enough for them to open and close their hand to play with toys. The development of fine motor skills also follows a predictable sequence throughout infancy and the toddler years, each skill building upon itself to become more controlled and refined in order to accomplish more complex tasks as the child gets older. One of the major ‘building blocks’ of these fine motor skills is strength! The skills cannot be mastered correctly if there is a lack of strength in the muscles controlling the fingers and in the hands, arms, shoulders, and torso. If a certain fine motor skill in the sequence is not mastered correctly, it can have an impact on the future development of more complex fine motor skills and the activities that require the use of those skills. One very big and important example is handwriting!
The importance of fine motor skills
Yes, they really are important! Without the use of fine motor skills we wouldn’t be able to care for ourselves or others, engage in occupational activities or favorite hobbies, or even interact with our environment. Fine motor skills are required for almost every activity that we engage in on a daily basis from about the age of 6 months throughout the rest of our life. There are many activities that can be accomplished with fair to poor fine motor skills and some without hands at all, as you may have witnessed from people with amputations or injuries, but there are also many activities that require our fine motor skills to be well mastered and many school tasks and occupations that couldn’t be accomplished without them.
In the world of pediatric occupational therapy, my mother (an OT for 33 years and also co-owner of our OT clinic in Atlanta) has seen a decline in the handwriting and fine motor skills of school age children over the last decade. In most cases of poor fine motor skills (where there is not a birth defect or an obvious developmental explanation for poor fine motor skills) it is often due to a lack of strength in the upper body; the other explanation is a problem with motor planning, but that would usually also be evident in other areas of development, like gross motor skills. Ever since the AAP recommended that babies should be put to sleep on their backs and since a vast amount of contraptions to hold babies have become easily available, infants are missing out on the important developmental opportunities that sleeping on the stomach and playing on their tummies provides. A mere 10 minutes of “tummy time” a day just isn’t enough to build the necessary strength and endurance in the muscles needed for future fine motor and gross motor skills.
How does it all start in infancy?
Babies are born lacking strength in their muscles to support their own weight, which is why babies don’t particularly like tummy time at first (but they do like sleeping on their tummies because of the comfort and proximity to the thumb that it provides). Think back to when you’ve been out of shape and attempting to work out again – it’s hard right? You feel the burn almost immediately and begin to think of reasons why stopping would be a good idea. It’s the same for babies. Holding their heavy heads up against gravity with never before used little, tiny neck muscles and pushing up on their little forearms is difficult and uncomfortable and so they would prefer to stop and be cuddled. But, just like going to the gym a few times, with each session spent on the belly, every baby gains strength and over time builds enough strength to stay in and enjoy this position. (If a baby was born with low muscle tone it is even harder for them to be on their tummy and build strength – if you suspect your baby has low muscle tone, consider consulting with a pediatric occupational therapist to help your child overcome this limitation).
Being on the tummy not only builds strength in the neck, but also the back, chest, shoulders, arms, and hands (all parts of the body needed for fine motor skills). “Tummy time” is important for a great many things that affect development, which I won’t get into now, but as far as motor skills, it is the precursor to things like, rolling and crawling, and the strength built up in this position also improves a baby’s ability to bring her hands together to play with a toy, hold a bottle, clap, etc., not to mention building the strength to be able to sit up in order to bring the hands together to play. In the interest of time and space for typing, I won’t get into all the developmental details; all you have to know is that it is INCREDIBLY IMPORTANT for babies to spend LOTS OF TIME on their tummies from day 1, especially for those babies who sleep on their backs. And by this I mean, when a baby is not being held, asleep, or in the car/stroller, then he should be playing on a blanket on the floor, on a parent’s chest or lap, or even playing on his belly in the crib or pack n play. Parents can even hold their baby in their arms with the baby on her tummy (like an airplane or football hold).
The Development Continues
Providing lots of experiences to interact with toys, textures, and gross motor play as children develop is very important for the continued development of fine motor skills. Overall upper body and arm strength is the vital foundation for fine motor skills and crawling is a very important first step. If your child skipped crawling, then even more gross motor play that involves the arms and upper body is important, such as wheelbarrow walking and climbing. Strength: Having adequate upper body, arm strength, and hand strength are important for stability and proper posture when engaging in fine motor activities. With that strength and stability children are able to develop fine motor skills naturally and along a predictable sequence.
Grasp: Typically the progression of grasp goes from raking up small items with the whole hand into the palm to picking up small items with the finger tips and then to picking items up with a tripod grasp (two fingers and thumb; also the best pencil grasp) to then using a refined pincer grasp (thumb and index finger). Through normal every day play opportunities, such as those listed below, babies will go through this sequence naturally. Coloring with crayons comes before writing and for coloring children typically begin with a whole fist grasp, thumb side up and progress to a whole fist grasp that's rotated so the thumb is down. The best grasp for handwriting is with the crayon or pencil tip between the thumb and two or three fingers with the thumb on the writing utensil and not wrapped around the fingers. The space between the thumb and first finger should also be open and not closed. Children often need assistance with using the right grasp. To encourage a tripod pencil grasp try giving your young child crayons that are snapped in half to color with. If your child is close to 2 years old and still coloring with a whole fist grasp, then switch the crayon into a tripod grasp in their hands.
To continue to develop fine motor skills use the age appropriate activities listed below and more complex skills will develop naturally.
Activities to support the development of fine motor skills (skip to the section that corresponds with your child’s age):
Babies:
1. LOTS of time spent on the tummy!!! I really can’t stress this enough!
2. Even before a baby can reach for and pick up his own toy, he can hold something in his hand, so around 3 months of age, start placing small baby toys in your baby’s hand for him to explore (thin, cylindrical or thin plush toys are easiest for their little hands to grasp).
3. Play hand games. Even if your baby can’t bring her hands together yet, play clapping and peek a boo games with her by modeling it for her and then moving her hands. Over time she will gain the skills to do it on her own. Being able to bring the hands together to clap then opens up the ability to bring the hands together to hold a toy (this is also when thumb sucking becomes a lot easier for babies and easier for parents who get tired of dealing with the pacifier).
4. Encourage crawling on hands and knees!!! I know that some pediatricians don’t think that crawling on hands and knees (also known as creeping) is necessary for walking, and it’s not, but it is extremely important for a lot of other developmental skills – like building strength and endurance in the muscles of the neck, shoulders, torso and hands needed for fine motor skills (especially handwriting) and gross motor skills; it also plays an important role in brain development called ‘lateralization of the two hemispheres’ which is important for a great number of things (including reading and writing), but I’ll save that for another post. If you see your child not lifting their belly off the ground to crawl on hands and knees, combat crawling in a strange way, combat crawling past 9 or 10 months, or trying to skip crawling on hands and knees and go to walking – then intervening to get your child up on hands and knees would be really beneficial to their development. Consulting with a pediatric occupational therapist can be helpful if you have any concerns.
5. Encourage self feeding as soon as you introduce cheerios, Gerber Puffs, or other small finger foods. Babies will initially rake the food with the whole hand to pick it up, but over time and with plenty of practice, they refine this skill to using a tripod (thumb and first two fingers) and then a pincer grasp (the thumb and index finger) which are important for later skills like writing, tying shoes, etc.
Toddlers:
1. Playing in textures: finger paint, sand, water play (in the sink, bathtub, large bucket, kiddy pool- use squeezy toys and squirt bottles for finger and palm strength), dried beans (hide small objects in the beans for your child to pick out), play dough (roll snakes and balls, pinch of pieces, hide things in the dough, etc), and the list goes on. Get creative and please don’t shy away from these activities because they are messy – kids need to get messy. Lay down newspaper, beach towels, or a tarp; do activities in the bathtub; take it outside and hose down when done – whatever you have to do to let your kids partake in fun, messy, activities.
2. Crayons, stamps, and paint: most children will follow a typical grasp pattern when using writing tools (and please start with crayons instead of markers); they will go from grasping the whole thing in their hand, thumb side up to grasping with the whole hand and thumb down to (hopefully) a tripod or quadrupod (three or four finger) grasp with the thumb down and not wrapped around the fingers, which is the optimal grasp for writing. Anything deviating from a tripod or quadrupod grasp involves writing with the hand and/or arm instead of the fingers and will cause the writer more work and fatigue. Getting the grasp right early on is vital because changing a bad grasp on a school age child is difficult; having good upper body strength to begin with is key.
To encourage the development of a correct handwriting grasp, give toddlers fat crayons or regular crayons that have been broken in half or knob crayons to color with. Model how to color and draw for your child – they are not born knowing how to do this and need your help – plus it’s a fun thing to do together. Small knob stamps are fun to play with and get the fingers in a tripod position. Painting on an easel is also fun and requires big arm movements which help to build or maintain the strength in the arms and shoulders.
3. Puzzles: Start with knob puzzles and graduate to peg puzzles and cut out puzzles as your child is ready. Moving in this order follows the natural pattern of grasp development. Puzzles (and shape sorters) are also great for working on visual processing skills.
4. Piggy bank: This requires adult supervision as it involves a choking hazard, but picking up coins and putting them in a piggy bank is something that little kids love to do and is great for improving their pincer grasp, fine motor control, and visual processing skills.
5. Use an empty food container with a plastic lid (like cool-whip or oatmeal) to create a toy. Cut different size holes in the lid. Cut different size pieces of foam and have your child push the foam through the holes. Also use materials such as cotton balls, pom poms, washcloth, etc. to push through the holes.
Pre-school and School-age:
1. Play dough, modeling clay, silly putty and other types of play materials with some type of resistance. Use cookie cutters, rolling pins, scissors, and other objects to play with the materials; hide pennies, beans, buttons, etc in it and have your child pick them out with their finger tips. To strengthen muscles for handwriting and pencil grasp, have your child tuck the fourth and fifth fingers of their dominant hand into their palm and use only their first three fingers (including thumb) to form a ball of clay, play dough, or silly putty into a cube, continuing to turn it around and push on the sides until a perfect cube is formed.
2. Use a block of Styrofoam and push 10-20 golf tees into the styrofoam (push all the way to heads of the tees until they’re firmly in) for your child to pull out. This works on strengthening the fingers and palm for handwriting and proper pencil grasp.
3. Cooking: let your child assist with cooking tasks, such as stirring and mixing, opening packages or screw top containers, measuring and pouring. This works on fine motor skills and bilateral coordination.
4. Play with Legos. Legos are tiny and involve a lot of fine motor coordination and strength to pull apart and put together. Many you g children have difficulty playing with Legos on their own at first. The process of thinking of something to build and then planning out how to build it is difficult. Spend time with your child playing with Legos and teaching him or her how to build with them; plus it’s a great way to spend quality time together.
5. Look for games that involve small parts and pieces that need to be manipulated by fingers or hands. Examples: Connect 4, Checkers, Mancala, Tricky Fingers, Fishing game, Monkeys in a Barrel, etc.
6. Crafts: Use scissors, glue, glue sticks, folding paper, coloring, painting, and other materials to create fun art projects. Cut pictures and words out of magazines to create collages. Look up art projects on the internet to do with your child. Remember that children need to be taught how to color, cut, use glue, etc and it is important to teach them how to use them appropriately from the beginning. Color in coloring books and do color by number.
7. Mazes and connect the dots: You can buy books with age appropriate mazes for your child to do, or you can draw some. Mazes and connect the dot games are useful for developing more controlled line drawing, which is important for handwriting and drawing.
8. Gross motor games that work on fine motor strength: Wheelbarrow walking, crab walking, crawling, monkey bars, zip line, climbing on rock climbing walls, etc all help to build strength in the muscles that are also necessary for fine motor skills, arm strength, and upper body strength for handwriting and good desk posture. To make it fun, have wheelbarrow walking or crab walking races, wheelbarrow walk to pick up pieces of candy laid out in a trail or pick up and place scattered puzzle pieces. Play crab soccer. Play on the playground.
9. Puzzles and parquetry: Play with simple to complex age appropriate jigsaw puzzles and parquetry designs.
10. Switch things up during mealtimes and use toothpicks, chopsticks (they do make chopsticks for kids), or tongs to eat food. All of these utensils work on grasp, hand strength, coordination, and control.
This is just a start. Be creative and look for other games and activities to build strength and coordination. Have fun!
