Photo: BAZA Production (Shutterstock)
When a child does not meet their developmental milestones regarding manual dexterity or small muscle groups, they are said to have a fine motor delay. Rolling, walking, and jumping are all gross motor skills, while picking up a small toy, bringing a Cheerio to their mouth, buttoning a shirt, or writing with a pencil are all fine motor skills. Kids who lack fine motor skills often struggle in school and become frustrated that they cannot do what their peers can. And, if unaddressed, a fine motor delay can lead to lifelong dislike of fine motor tasks—like writing—and can impact a child’s development across the board.
Fortunately there are many ways to spot a fine motor delay and many interventions to address them early, giving your child great opportunities to manage or move through a fine motor delay before it becomes an area of distress.
How do you know if your child has a fine motor delay?
Fine motor skills include a variety of tasks:
In-hand manipulation: Turning a pencil around in one hand, sliding a playing card from one side of your hand to another.Dexterity: Typing, tying shoes, picking up a small object with fingers of the same hand that is holding something in the palm.Fine motor control: Navigating a pencil through a maze, circling a word in a word puzzle, coloring inside the lines.Fine motor integration: Drawing shapes, letters, numbers.Kids learn these skills at varying rates as they get older and some people are more manually dexterous than others either with practice or because of natural ability. By following your pediatrician’s milestone checklist, you should be able to see whether or not your child is on track to meet their fine motor skills. However, some kids compensate or have subtle signs.
“Frequently changing grasps during a task (eating, coloring)” or “using the whole hand to manipulate something small (like a Cheerio or a bead),” are all signs of a fine motor delay in a small child, says Caitlin Sanschagrin, an occupational therapist and co-founder and owner of Bright SpOT Pediatric Therapy.
For a school-aged child who is no longer doing developmental milestone checklists, you’ll often see a fine motor delay come with feelings of frustration or task avoidance. Sanschagrin says, “Sometimes, it looks like avoidance or becoming upset when they have to do small or fine motor tasks—especially writing or coloring.” Or, she says, “When writing, you might see a kiddo use too much or too little pressure.” Kids who do this get fatigued quickly when writing, so they might complain of hand or arm pain. Kids with fine motor delays who do not present until elementary school are sometimes labeled lazy or oppositional. If your child is having trouble with academics, it might be worth examining if there’s something physical going on with their fine motor skills.
How to help your child manage a fine motor delay
OTs create and recommend activities that kids both enjoy and that help build their fine motor skills. Sanschagrin says kids need to work on “hand strength, shoulder strength, core strength, dexterity, and in-hand manipulation.” Helping them do that “can be as easy as coloring a paper (or painting, chalk, etc.) taped to a window or wall.”
Part of learning to improve fine motor skills is something occupational therapists call “heavy work.” Sanschagrin says a common activity for fine motor skill development is “hide and seek with small items in Play-Doh or putty to build strength.” Having to pull out beads or gems builds strength in the little hand muscles. Another fun activity she suggests is to “tape down some action figures and play ‘rescue.’” She also recommends cooking, especially if you can incorporate “heavy work” like by kneading bread or mixing dough or batter. She says, “There are many blogs and websites that talk about ways to strengthen your hands,” which include activities for older kids and adults as well.
If adding these strategies and offering more opportunities to develop skills is not working, talk to your pediatrician and seek out an occupational therapy evaluation. In public schools and preschools linked up to an early intervention program, evaluations and recommended therapies are free. “Parents should try to access occupational therapy both from school and from private providers,” says Paulette Selman, a school psychologist and special education advocate in Oregon and Washington. Many insurances cover OT under medical coverage or mental health coverage. Some limit your yearly visits and some offer unlimited sessions, so always check with your specific plan. Make sure your private and public providers have permission to discuss and coordinate treatment with each other.
How to talk to their school about a fine motor delay
Your child’s teacher may or may not have experience with fine motor delays. Sanchagrin suggests, along with your child’s strengths, “talking about their areas of growth in conjunction with what modifications can help them be more successful and independent.” Selman says some simple modifications like a slant board or paper with bigger, bolder lines can help.
Regarding handwriting, unlike when we were kids, Selman says, “Lots of schools these days don’t actually provide direct instruction in handwriting, but your child might really benefit from it.” One program, Handwriting Without Tears, can help kids with a fine motor delay. She says, because tech tools are being used for both special ed adaptations and in the classroom around fourth grade now, “Have your child learn to type by the end of elementary school,” and use web-based programs to eliminate the “hunt and peck” method.
A fine motor delay alone, unless very severe, does not usually qualify for an Individualized Education Program (IEP) or 504 plan. However, Selman says, “schools provide occupational therapy services for fine motor skills, if the delay is impacting education,” and, if your child has another condition along with the fine motor delay, they may receive occupational therapy services to address their fine motor delay as part of an IEP or 504.
Other conditions
Some kids have a fine motor delay and no other conditions. They might even excel in gross motor or verbal skills and lag in fine motor. Fine motor skills do not necessarily signal that your child has an underlying or additional condition, such as ADHD or autism, but, Sanschagrin says, “it is not uncommon for neurodivergent children to have fine motor differences due to a multitude of factors.”
If a fine motor delay is present, Selman says to have your evaluation team look at “other areas of functioning as well such as academic progress, including the written expression part of writing, not just the handwriting part” to rule out other learning differences like reading disorders. If your child is diagnosed with another delay or condition or if you suspect the fine motor skills might be connected to another diagnosis, ask your pediatrician for advice and a potential referral for further diagnosis.
