Fine motor skills are the ability to make smooth, controlled movements using the small muscles in the fingers, hand, and wrist.
The hands of newborns are closed most of the time. Newborns have little control over them (or any part of the body). If the palm is touched, the newborn will make a very tight fist, but this is an unconscious action called the Darwinian reflex, and it disappears within two to three months. Similarly, the infant will grasp at an object placed in his or her hand, but without any awareness of doing so. At some point, the hand muscles will relax, and the infant will drop the object, equally unaware that it has been dropped. Babies may begin flailing at objects that interest them by two weeks of age but cannot grasp them. By eight weeks, they begin to discover and play with their hands, at first solely by touch, and then, at about three months, by sight as well. At this age, however, the deliberate grasp remains largely undeveloped.
Hand-eye coordination begins to develop between the ages of two and four months, inaugurating a period of trial-and-error practice at sighting objects and grabbing at them. At four or five months, most infants can grasp an object within reach, looking only at the object and not at their hands. Referred to as “top-level reaching,” this achievement is considered an important milestone in fine motor development. At the age of six months, infants typically can hold on to a small block briefly, and many begin banging objects. Although the grasp is still clumsy, they have acquired a fascination with grabbing small objects and trying to put them in their mouths. At first, babies will indiscriminately try to grasp things that cannot be grasped, such as pictures in a book, as well as those that can, such as a rattle or ball. During the latter half of the first year, they begin exploring and testing objects before grabbing, touching them with an entire hand and eventually poking them with an index finger.
Toddlers develop the ability to manipulate objects with increasing sophistication, including using their fingers to twist dials, pull strings, push levers, turn book pages, and use crayons to produce crude scribbles. Handedness, the dominance of either the right or left hand, usually emerges during this period as well. Toddlers also add a new dimension to touching and manipulating objects by simultaneously naming them. Instead of random scribbles, their drawings include such patterns as circles. Their play with blocks is more elaborate and purposeful than that of infants, and they can stack as many as six blocks. They are also able to fold a sheet of paper in half (with supervision), string large beads, manipulate snap toys, play with clay, unwrap small objects, and pound pegs.
The delicate tasks facing preschool children, such as handling silverware or tying shoelaces, represent more of a challenge than most of the gross motor activities learned during this period of development. The central nervous system is still in the process of maturing sufficiently for complex messages from the brain to get to the child's fingers. In addition, small muscles tire more easily than large ones, and the short stubby fingers of preschoolers make delicate or complicated tasks more difficult. Finally, gross motor skills call for energy, which often seems endless in preschoolers, while fine motor skills require patience, which is in shorter supply. Thus, there is considerable variation in fine motor development among children in this age group.
By the age of three, many children have good control of a pencil. Three year olds can often draw a circle, although their attempts at drawing people are still very primitive. It is common at four years of age to use scissors, copy geometric shapes and letters, fasten large buttons, and form clay shapes with two or three sections. Some children can print their own names in capital letters. A typical human figure drawn at age four is typically a head atop two legs, with one arm radiating from each leg.
By the age of five, most children have clearly advanced beyond the fine motor skill development of the preschool age. They can draw recognizably human figures with facial features and legs connected to a distinct trunk. They can also cut, paste, and trace shapes. Their right-or left-handedness is well established, and they use the preferred hand for writing and drawing.
By age four or five, children have begun to acquire the fine motor skills needed for daily self-care (for example, dressing, washing, toileting, and eating with utensils). They can fasten visible buttons (as opposed to those at the back of clothing), and many can tie bows, including shoelace bows. By age six, most children can spread condiments on bread with a knife and cut the bread.
School-age children who have difficulty with writing or drawing may have weakness in the shoulder girdle. In mature writing, only the person's wrist moves, while the other arm joints remain steady. Children with a weak shoulder girdle, however, must move the entire arm instead of just the wrist. As a result, they tire quickly at these tasks. A child whose problems in writing or drawing are severe enough to interfere with schoolwork should be evaluated for neurological or musculoskeletal problems that may be contributing to the difficulties with fine motor skills. In general, boys are more likely than girls to have problems with fine motor coordination. Occupational therapy is available for children with fine motor difficulties, and there are many schoolbased occupational therapists who specialize in working with children.
Encouraging gross motor skills requires a safe, open play space, peers to interact with, and some adult supervision. Nurturing the development of fine motor skills is considerably more complicated. Helping a child succeed in fine motor tasks requires planning, time, and a variety of play materials. Fine motor development can be encouraged by activities that youngsters enjoy and that involve manipulating objects or materials with the hands, including crafts, puzzles, making music on percussion instruments, and playing with building blocks. There is also considerable evidence that studying a keyboard instrument (such as piano, organ, or electric keyboard) leads to great improvement in a child's fine motor skills.
Children also can be helped to develop fine motor skills by modification of tools and writing equipment and choosing desks and chairs of the proper size and height. Large thick crayons, brushes, and pencils are easier for young artists to use than small, thin ones. A child's desk chair should allow him or her to sit with feet firmly on the floor, and hips, knees, and ankles at 90-degree angles. The surface of the desk should be about 2 in. (5 cm) above the elbows when the child's arms are resting at the side. It is easier for children to move their arms, hands, and fingers effectively and smoothly when the trunk of the body is stable.
In most cases, difficulty with certain fine motor skills is temporary and does not indicate a serious problem. Parents should seek medical help if the child is significantly behind peers in multiple aspects of fine motor development. Parents should also seek help if the child regresses, losing previously acquired skills.
See also Childhood development; Gross motor skills ; Handedness .
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American Academy of Family Physicians, PO Box 11210, Shawnee Mission, KS, 66207, (913) 906-6000, (800) 274-2237, Fax: (913) 906-6075, http://www.aafp.org .
American Academy of Pediatrics, 141 Northwest Point Blvd., Elk Grove Village, IL, 60007-1098, (847) 4344000, (800) 433-9016, Fax: (847) 434-8000, https://www.aap.org.
American Occupational Therapy Association, 4720 Montgomery Ln., Suite 200, Bethesda, MD, 20814-3449, (301) 652-6611, (800) 377-8555, Fax: (240) 762-5150, http://www.aota.org .