This is the first in a 3-part series of articles about the kinds of problems addressed by pediatric occupational therapists. This article will define occupational therapy and then focus specifically on fine motor skills challenges and provide some suggestions for what you can do if you think your child is having difficulties in this area. Later articles in the series will address eye-hand coordination and bilateral coordination (using the two sides of the body together in a coordinated fashion).
What is occupational therapy? and how can it help my child?
Occupational therapy (OT) is an allied health profession. The term occupation in this context means the ways that people enjoy spending time and the roles they occupy in their lives. The main occupation of children is play. Play is a child’s way of exploring the world and learning. Pediatric occupational therapists use play activities as a therapeutic modality to help children with illness, disability, or delayed development. OTs facilitate learning of skills and teach children and their parents how best to accommodate to deficits. The OT may suggest ways to play at home to promote development, independence and learning during play, mealtimes, or other daily activities.
Occupational therapy focuses on improving function in several areas, including fine motor, self-care, and sensory processing. Fine motor skills are skills that involve the use of the small muscles of the wrists and hands in a controlled and coordinated manner. Self-care refers to skills such as self-feeding, grooming, dressing, and for older children, organizing belongings. In many ways, acquiring independence with these skills depends on having good fine motor skills.
Sensory processing is the ability to organize and prioritize sensory information appropriately for successful functioning in the world. These skill areas overlap in terms of the child’s function. For example, the child with fine motor difficulties will probably have trouble with the self-care task of feeding, as using utensils will be problematic for her.
Occupational therapists assess how a child is doing in these areas and identify strengths and needs. Needs can often be addressed through therapy and strengths can be used to compensate for deficits.
Occupational therapists work in many settings. They work in hospitals with children who have medical issues such as injuries, strokes or burns. In the schools, OT is provided free of charge to children with qualifying disabilities, to address educationally related issues which interfere with the child’s ability to access the school program. In private clinics, such as Way to Grow, the OT may work with children who do not qualify for school-based services or need help with a specific area, such as lack of motor coordination, muscle weakness, lack of endurance, organizational challenges or problems with sensory processing.
Fine Motor Skills
A child who is having difficulty in this area will often avoid fine motor activities because they are hard. This child may shy away from coloring or writing, hate doing puzzles, eat with her hands and need more help to dress and groom than one would expect for her age. These may be kids who prefer sedentary activities such as television or video games, or they may be very active, engaging in sports and active play, but not quiet motor play.
Development of good gross (large motor) skills in infancy and during the toddler years lays the foundation for the development of hand skills and find motor skills in early childhood. In infancy, as the child develops the strength to control his head, sit up by himself, crawl, cruise on furniture, stand independently and eventually walk, he gains a stable base from which to coordinate movements of his arms and hands. Parents are not always aware of the relationship between gross motor play and later development of fine motor skills. Many children engage in these activities without being prompted, but you can help to prepare your child for fine motor skill competence by encouraging gross motor activities as a regular part of your child’s daily routine. Some examples of gross motor activities which contribute to fine motor development include:
- Basic locomotor patterns such as crawling, walking, running, walking backwards, skipping, jumping, hopping. Games such as Mother May I, Simon Says and Follow the Leader will help with development of these skills.
- Walking on curbs, lines or low walls will give children practice with balance.
- Rolling, climbing, swinging and ball play all enhance body organization and eye hand coordination.
- Push toys, riding toys, tricycle and bicycle riding, roller skates, roller blades, etc.
The foundation for fine motor skills develops long before your child picks up a crayon or a pencil. For newborns, the grasp reflex causes the hand to close automatically when the pinkie-side of the palm is pressed. After the first two months of life, this reflex pattern disappears, and the infant begins to learn to control her hands purposefully. Babies learn through trial and error and lots of practice, to accurately reach for toys and objects, and then to shape the hand appropriately to accurately grasp a desired item. Learning to release a toy is actually a separate skill which develops after the ability to grasp.
Development of fine motor skills progresses from the body midline outward. So the child needs good trunk strength before good hand skills will appear. Next comes development of good shoulder stability, which is one of the many skills being developed as a child creeps and crawls. Other essential hand skills that are developed during crawling include wrist extension and strengthening of individual muscles of the hand. As the child shifts weight from one hand to the other, there are numerous tiny adjustments made by the muscles in the arm and hand to help the child maintain balance. These adjustments act to strengthen those muscles, which give the hand its ability to move in three dimensions in a smooth and coordinated manner. Playing games where the child can pretend to be a cat or dog (or any animal that crawls on all fours) is an excellent way to reinforce and develop these skills, especially for the child who already walks but still needs to strengthen the shoulders, wrists, and hands.
Other skills that are important components of skilled fine motor control include forearm rotation and stability and wrist extension. Forearm rotation is the movement that occurs when you place your hands flat out in front of your body and alternately make the palms face up then down. Forearm stability means that you can accomplish this movement without your elbows flapping out to the side or without clamping your elbows against your ribcage for support. Wrist extension means having the ability to hold your arms straight out in front of you and bending your wrist back to raise your hand in the “stop” position. Hand clapping games which require repetitive and rhythmic slapping of the hands on the thighs first with the palms, then with the back of the hands will help children work on forearm rotation. “Miss Mary Mack” types of hand clapping games with a partner will assist with wrist extension. Other activities which will assist with all of these skills include scooting backwards on floor by sitting in long-sit position (feet straight out in front) and taking weight on your hands so you can scoot your hips backwards.
Manual dexterity means having the ability to do small motor tasks that require very precise use of the fingers in a coordinated way. Tasks such as knitting, threading needle, stringing beads, and lacing all require some level of manual dexterity. Activities which can assist your child with building dexterity include:
- Clothespin play:
- Pinch clothespins to remove from edge of a can
- If you have colors, make patterns for your child to copy
- Use clothespins to hang dress-up clothes or art projects on a line
- Take turns putting clothespins on each other’s clothing and have your child take them off
- Use sharpie to write letters or numbers and arithmetic signs on clothespins and use them to practice spelling and math problems
- Put toys in containers with screw tops to practice putting on and removing lids
- Tear heavy paper, cut heavy paper (try old playing cards or index cards)
- Crumple pieces of newspaper or tissue paper into balls
- Draw on chalkboard with small pieces of chalk or use small pieces of crayon on paper in vertical plane (use an easel or wall chalkboard or whiteboard or tape paper to the wall
- Games such as Lite Brite, Tricky Fingers, Knex, Lego
- Lacing:
- 5″ x 8″ cards, holes punched around the edges, use a shoe lace
- lace “over and over,” or “in and out,”
- lace shoes, on the foot, or in the same position as if it were on the foot
- Wrap yarn around a peg or spool
- Stringing:
- beads (large and small)
- macaroni, cheerios, large buttons, washers, plastic rings
- plastic straws cut on 1″ pieces – string onto cord, pipe cleaners, or shoe laces
- Have your child cut straws or roll play dough into snakes and cut into pieces
- Cooking activities that require stirring, pouring, rolling dough, or cutting (with supervision!!)
Children who are having difficulty with fine motor skills often avoid engaging in activities that require them. If your child is struggling with fine motor skills, try some of the suggestions provided here. OT will provide you with many more suggestions tailored to your child’s specific needs and will speed things up. We are trained to help children develop and refine skills in the fine motor area.