Early Intervention Support

Are My Baby’s Fine Motor Skills Typical?

“Fine motor” refers to the development of small muscle movements of the hands. Fine motor skills develop as your child’s whole body gains mobility, stability, cognitive, and emotional/social development. When most think of fine motor, skills that come to mind are shoe tying, writing, and cutting paper with scissors. However, there are several foundations before your child will acquire those skills. Those building blocks include stability, bilateral coordination, and sensation. Stability is the strength and balance control to keep one part of the body still while another part moves. Bilateral coordination is the efficient use of both hands during activities. One hand will manipulate while the other is the “helping hand.” Bilateral coordination development will lead to hand dominance (right- or left-handed). Sensation is knowing where your hands, arms, and fingers are, and how they are moving. Once the building blocks are established, your child will now develop dexterity, meaning that he or she will use small, accurate, and precise movements to open containers, pick up tiny objects, stack blocks, and many other skills. The following are fine motor developmental stages defining what your child is learning and controlling. Play activities are listed for you and your baby or toddler to help promote those all-important foundation skills.

Infants Under Three Months

At this level, your infant is learning to lift his or her head and neck. He or she is moving his or her arms together. Your infant will stare at bright objects and follow with his or her eyes. High-contrast patterns will capture his or her interest. He or she will turn head toward sounds and voices. By 3 months, the baby smiles at faces and objects that resemble faces.

Activities to promote skills:

• To attract attention, use toys with bright colors with bold strips and/or patterns, shiny objects (shiny party beads, bangles), or a bright scarf around your neck, all within 8–12 inches from your baby’s chest.
• For holding eye gaze, show your face (make expressions), hold your baby to mirror, squeak toys with faces, draw or paste large faces onto paper plates to show your baby.
• To promote active arms, hold or suspend toys about 8 inches from your baby’s chest to display excitement at seeing you and the toy before offering.
• To encourage visual tracking, use toys, a bottle, or a mobile with sounds and bright colors moving in all directions slowly. Tracking is hard work. Play for only 1-2 minutes.
• To bring hands to chest or midline, carry your baby cradled with arms forward, encourage exploring and touching your face (kiss or nibble fingers for more feedback). After a bath, massage your baby’s hand with lotion and rub hands together, place a textured toy on your baby’s chest to feel.
• To promote grasping, use rattles with slender handles, teethers, or your finger. Help your baby hold object in one hand at a time because it is difficult to hold an object in both hands at this time. Offer rattles during diaper change or small cut sponge during bath.

Infants Between Three and Six Months

At this time, discovery of hands and feet will be occurring. Your infant will be grasping objects within reach. From belly position, he or she will be rolling onto his or her back. With support, your infant can be positioned in sitting. He or she will be recognizing consistent caregivers. Babbling will begin, as will responding to high-pitched sounds.

Activities to promote skills:

• To encourage looking from one toy to another, encourage looking at floating toys during bath, tape two simple bright pictures a few inches apart on wall next to where your baby sleeps or plays.
• To promote early reaching, tap your baby’s hand with a toy to encourage reaching, swipe a dangling toy to show your baby how the toy will dance when using mobiles and crib gyms.
• To promote reaching with both arms, nuzzle your baby’s tummy with your face to encourage touching your head with both arms, use plastic sunglasses to promote your baby to reach and pull off, or place a toy between your lips for reaching and removing.
• To encourage looking at small items, items of interest may be buttons on your shirt, colored finger nails, a Band-Aid, or a refrigerator magnet.
• To encourage looking at distant objects, turn ceiling fans on and off, turn lights on and off, roll a ball past and away from your baby, or look out the window to see cars, dogs, children playing outside.
• To encourage purposeful release of objects, during a bath, drop toys in water to make a splash. While seated in a high chair, use cereal (Cheerios, Rice Crispies) to grasp a handful and release or play with ice cube (coldness may promote release).

Babies Between Four and Eight Months

Many skills are coming together at this level. Your baby is rolling over to explore and get to objects, and he or she can sit independently for brief periods of time. Objects are passed between hands. Your baby will reach for objects with both hands and bang two objects together. He or she is recognizing familiar people and likes attention.

Activities to promote skills:

• To encourage reaching with one arm, use small toys, as large toys will encourage two-hand reach; use bubbles to encourage reach; present a cookie and wait for reach; place a toy key ring over your infant’s toes to promote reach.
• To promote banging objects for play, offer items such as spoon, rattle, squeak toy against table, tray, pot, or pans.
• To promote wrist movements, use colorful wristbands with bells attached to wrists. Banging, mouthing, and shaking objects encourages wrist movements.
• To encourage transferring toys, use a ball of masking tape to see if your infant’s other hand will attempt to pull off. During a meal, offering your baby a spoon is great for promoting transfer, or stick a Cheerio to one hand to remove with other hand.
• To promote picking up small objects, use cooked pasta or cubed Jello Jigglers placed on a highchair tray. For a fun challenge, offer finger foods toward thumb side of hand.
• Let your baby paint with food. Yogurt, soft mashed carrots, or any other type of soft, smooth food is the perfect consistency for doing some finger painting. Of course, licking your baby’s fingers is part of the fun!
• Have your baby work for his or her meal. Pulling cooled noodles apart is a fun way to practice using his or her fingers.
• Have fun in the tub. Plastic cups, pitchers, measuring cups and sponges let your baby practice holding, pouring and squeezing (not to mention making it fun to take a bath!).
• When supported, a sitting child will follow you with his or her eyes, reach and grasp for objects, drop objects, hold onto small objects, bring hands to mouth, and place both hands on bottle if bottle fed.

Eight to Twelve Months

Many skills are coming together at this level. Your baby is rolling over to explore and get to objects, and he or she can sit independently for brief periods of time. Objects are passed between hands. Your baby will reach for objects with both hands and bang two objects together. He or she is recognizing familiar people and likes attention.

Most one-year-olds can:

• Reach, grasp and put objects into mouth
• Pick things up with pincer grasp (thumb and one finger)
• Transfer objects from one hand to the other
• Drop and pick up toys
• Bang two objects together
• Release objects (purposefully)
• Put objects into and take objects out of containers with large openings
• Pinch small objects, such as a Cheerio, with thumb and pointer
• Bite and chew toys
• Hold a spoon
• Hold out an arm or leg to help with dressing

Activities to promote skills:

• To encourage reaching with one arm, use small toys, as large toys will encourage two-hand reach; use bubbles to encourage reach; present a cookie and wait for reach; place a toy key ring over your infant’s toes to promote reach.
• To promote banging objects for play, offer items such as spoon, rattle, squeak toy against table, tray, pot, or pans.
• To promote wrist movements, use colorful wristbands with bells attached to wrists. Banging, mouthing, and shaking objects encourages wrist movements.
• To encourage transferring toys, use a ball of masking tape to see if your infant’s other hand will attempt to pull off. During a meal, offering your baby a spoon is great for promoting transfer, or stick a Cheerio to one hand to remove with other hand.
• To promote picking up small objects, use cooked pasta or cubed Jello Jigglers placed on a highchair tray. For a fun challenge, offer finger foods toward thumb side of hand.
• Let your baby paint with food. Yogurt, soft mashed carrots, or any other type of soft, smooth food is the perfect consistency for doing some finger painting. Of course, licking your baby’s fingers is part of the fun!
• Have your baby work for his or her meal. Pulling cooled noodles apart is a fun way to practice using his or her fingers.
• Have fun in the tub. Plastic cups, pitchers, measuring cups and sponges let your baby practice holding, pouring and squeezing (not to mention making it fun to take a bath!).
• When supported, a sitting child will follow you with his or her eyes, reach and grasp for objects, drop objects, hold onto small objects, bring hands to mouth, and place both hands on bottle if bottle fed.
• To promote pincer grasp development, encourage pulling tissues from a box, pegs from a board, a straw from a cup.
• To promote banging objects together, use blocks, spoons, small plastic cups, plastic rings from ring stacker toy.
• To promote taking items out of containers, use these items for containers: shoe box without lid, butter tub, pots, pans, toy buckets. Use these items to fill: blocks, pop beads, bean bags, Lil’ people. At mealtime, place finger foods into empty butter cup, and at bath time, use cups filled with water to dump into tub.
• To promote more wrist movements, encourage waving “hi” and “bye,” finger paint with pudding using whole, open hand.
• To encourage voluntary release, roll a ball back and forth together. Let baby grasp and release sand, grass, pasta, etc.
• To promote poke and probe using index finger, explore holes of toy dial phone, holes of a peg board, encourage pushing buttons such as doorbells or keys of a piano.
• Babies love to clap. Help your baby bring his or her hands together and clap. Then hide baby’s hands under a blanket. Your baby will like to watch his or her hands go away and come back.
• Just call your baby a shredder. Some babies love to rip paper. If that sounds like your baby, get a big basket and some old magazines and let him or her rip, shred, and tear his or her way to happiness. (If your baby is more interested in putting wads of paper in his or her mouth, put the basket away and try again in a few weeks.)
• Learn how to twist. Let your baby watch you put Cheerios or another type of cereal into a twist top or snap-top container. Show your baby how to open it. After a few tries, your baby will be able to do this independently.
• Play catch. Make a ball out of a pair of socks. Sit close and toss it to your baby. Your baby probably cannot catch the ball, but it will enjoy trying and chasing after it.
• Read before bed. Your baby will enjoy listening to you read and looking at the pictures in simple baby books. Keep those fingers working by having your baby help you turn the pages.

Twelve to Sixteen Months

At this level of development, your toddler is favoring use of one hand. While viewing books, he or she will be pointing to pictures. He or she will be gripping objects and releasing into a container. While one hand holds an object, the other hand will explore and manipulate. He or she will build block towers, climb onto furniture, and climb stairs during this time. When offered markers or crayons, he or she will scribble spontaneously.

Activities to promote skills:

• To encourage marks and scribbles, tape a large piece of paper to a table, offer crayons, demonstrating and saying “dot, dot, dot” when making marks.
• To promote putting items into a container, use pots or a coffee can that will make interesting sounds as your child drops items into the container.
• To promote stacking blocks, use a variety of stackable items such as tissue boxes, empty butter tubs, books, shoe boxes before moving to small items.
• To promote pointing with index finger, use textured book to promote poke with finger; place Playdoh balls into ice cube tray or egg carton and show your child how to poke.
• To encourage scribble, use a Magna Doodle, Aqua Doodle, sidewalk chalk on pavement, any paper taped to table and crayons.
• To promote both hands to play, use bowls and spoon for stirring, remove paper wrapper from popsicle or juice bar, hold a tambourine and hit with other hand, peel a banana.
• Toys don’t always come from stores. Make a small wad of masking tape, sticky side out. It’s very entertaining and will give your baby some good finger exercise.
• Fill and dump, again and again. Give your baby a plastic container and a mix of toys and household items. Show your baby how to fill the container, and then dump everything out. The next day, change the items to keep it fun.
• Homemade blocks. Fill saved pint and quart milk cartons with rice, and show your baby how to stack them up and knock them down.
• Squeeze those little hands. Put a sponge ball or washcloth in the bath and show your baby how to squeeze out all the water.

By 12 months:

• Frequently in a fisted position with both hands after 6 months of age
• Not bringing both hands to midline (center of body) by 10 months of age
• Not banging objects together by 10 months of age
• Not clapping their hands by 12 months of age
• Not deliberately and immediately releasing objects by 12 months of age
• Not able to tip and hold their bottle by themselves and keep it up, without lying down, by 12 months of age
• Excessive mouthing

An early childhood intervention/development therapy referral may be appropriate if your child is exhibiting any of these red flag symptoms.

Sixteen to Twenty Months

By 18 months, most babies can:

• Build a tower using 2 cubes
• Use hands together at midline (middle of the body)
• Scribble
• Point with pointer finger
• Hold cup and drink – some spilling will occur
• Remove socks
• Place hats on heads

Suggested play to help a baby between 16 and 20 months develop fine motor skills

• Let your baby be a chef! Have your baby wash its hands and show it how to tear lettuce or spinach leaves. Remember to tell the family who made the salad.
• Teach knife skills. Using a plastic knife, show your baby how to scoop and spread jelly or butter onto a piece of bread.
• Create edible art. Give your toddler a small container of Cheerios or other round cereal and a clean shoelace or piece of string with tape around the edges to make it stiff. Show your baby how to string the Cheerios, and then eat them.
• Create daily place mats. While you’re busy making dinner, your toddler can be busy making place mats. Drawing is a great activity for his/her little hands.

By 18 months:

• Still using a fisted grasp to hold a crayon at 18 months of age
• Not using a mature pincer grasp (thumb and index finger, pad to pad) by 18 months of age
• Excessive mouthing

Twenty to Twenty-four Months

Fine motor skills will be refining at this level. Your toddler will be able to make circular scribbles and imitate vertical lines. Crayons will be held between thumb and fingers. During play, he or she will be manipulating shapes and large puzzle pieces, building with blocks, and scooping independently.

Most two-year-olds can:

• Build a tower of three small blocks
• Put four rings on a stick
• Place five pegs in a pegboard
• Turn pages two or three at a time
• Scribble
• Turn knobs
• Throw a small ball
• Paint with whole arm movement, shifting hands, making strokes
• Build a tower with 4-6 blocks
• Fold paper (randomly)
• Imitate a circle when scribbling (not accurate)
• Begin to use scissors and string beads
• Use zippers
• Open doors using knobs
• Help with simple household tasks

Activities to promote skills:

• To encourage drawing a line (vertical or horizontal), draw a line with finger in wet sand or finger paint, demonstrate making a line, and offer your toddler a chance to imitate.
• To promote circular scribbles, practice stirring with a bowl, make circles in wet sand with finger or stick, sit next to your toddler while you demonstrate making circles.
• Make jewelry. Stringing beads, macaroni, or large cereal will help your child learn how to use two hands at one time. Remember to put tape at the end of the shoelace or string.
• Puzzles are fun. This is a great age to introduce simple puzzles. You can even make your own by cutting a cereal box into three or four large pieces.
• Create a photo album. Make a small picture book just for your toddler with photos of family, friends, and pets. Your toddler will enjoy helping you put the book together. Later, you can look at the book and talk about the people, again and again!
• Make a fruit salad. By using a plastic picnic knife or even a popsicle stick, your baby can cut up soft fruit like bananas or peaches. He or she can sprinkle raisins on top and stir it all together.
• Write a store list. While you’re making a shopping list, give your child paper and a crayon and have him or her “write” a list.

By 24 months:

• Not imitating a drawing of a vertical line by 24 months of age
• Excessive mouthing

Twenty-four to Thirty Months

By 30 months, most babies can:

• Fold paper in half
• Imitate simple pencil markings, such as a cross
• Build a tower up to 8 cubes
• Understand common dangers, such as stairs

Suggested play to help a child between 24 and 30 months develop fine motor skills

• Fresh squeezed tastes best. You cut an orange in half and then show your toddler how to squeeze the juice from the fruit. After your toddler is done twisting back and forth, pour the juice in its cup. Yum!
• Flip fake pancakes. Give your child a small spatula, skillet and sponge. Cut the edges of the sponge so it’s shaped like a pancake. Show her how to flip the pancake and then feed it to one of her stuffed animals.
• Play “what comes next?” Draw a line on a piece of paper. Ask your toddler to continue the line and decide where it should go, alternating between straight lines, squiggly ones, zigzags and spirals.
• Create a book of favorites. Make a book by stapling together a few sheets of her favorite color of paper. Give her safety scissors to cut pictures out of magazines and glue them onto the pages. Then, decorate the pages with stickers.
• Bath time means play time. Squeezing really helps strengthen the muscles in the hands and fingers. Look for squeeze toys to add to the tub or even squeezing the water from a wash cloth can be fun.

By 30 months:

• Not able to snip with scissors by 30 months
• Excessive mouthing

Thirty to Thirty-six Months

Most three-year-olds can:

• String four large beads
• Turn single pages
• Snip with scissors
• Hold crayons with thumb and finger (not fist)
• Use one hand consistently in most activities
• Imitate circular, vertical, horizontal strokes
• Paint with some wrist action, make dots, lines, circular strokes
• Roll, pound, squeeze, and pull clay
• Build tower of up to 9 cubes
• String 1/2 inch beads
• Cut along a line
• Use a fork
• Manage large buttons
• Dress self with supervision

Suggested play to help a child between 30 and 36 months develop fine motor skills

• Bubbles are fun. First draw bubbles of all sizes on a piece of paper – big ones, little ones, green ones and purple ones. Then blow some real bubbles.
• Become a mechanic. Collect a group of large bolts with matching nuts. Show your child how to find the one that matches and then twist them together. (Supervise this activity to make sure your child doesn’t put anything in its mouth.)
• Turn tongs into toys. How many cotton balls can your child move from one container to another with a pair of kitchen tongs? This requires concentration. After the cotton balls, switch to something heavier like walnuts or small stones.
• Make a delicious puzzle. Next time you make your child a sandwich, cut it into three odd shapes and have him/her put the puzzle together before he/she eats the ‘pieces’.
• M is for Morgan. Show your child how to write the first letter of her name. Even if it doesn’t look close to the letter, clap and tell her you are proud of her.

Thirty-six to Forty-two Months

Suggested play to help a child between 36 and 42 months develop fine motor skills

• Dress the bear. Find some of your child’s old baby clothes that fit its teddy bear or another stuffed animal. Look for clothes with large buttons or snaps so your child can practice his/her small finger work. Have your child dress her animal!
• Pick peas from a pod. Buy some fresh peapods. Show your child how to find the peas hiding inside the shell. He/she can put all the peas he/she can find into a bowl, then rinse them off and eat them.
• Decorate the sidewalk. Outdoor chalk is a fun way to use hand muscles. Or, give your child a paint brush and a bucket of water. The painting will be fun and so will the magic of evaporation. “Where did your picture go?”
• Make more jewelry. Cut some circles or flowers from colored paper and punch a hole in the center. Then, cut a large plastic soda straw into pieces. Let your child string a shoelace with alternating flowers and straw pieces. Your child probably will not always alternate pieces but that doesn’t matter. Tie the ends and he/she will have a beautiful necklace.

Forty-two to Forty-eight Months

Most four-year-olds can:

• Build a tower of nine small blocks
• Drive nails and pegs
• Copy a circle
• Imitate cross
• Manipulate clay material (rolls balls, snakes, cookies)
• Hold a pencil with appropriate grasp

Suggested play to help a child between 42 and 48 months develop fine motor skills

• Play button hide-and-seek. Provide clothes for your child that have one or two large buttons. As your child is trying to fasten the button, pretend it is a hide-and-seek-game, with the button hiding at first, then “peeking out” form the hole, and then all the way through.
• Cut coupons. Give your child some coupon flyers and safety scissors. Ask your child to cut out the coupons (don’t expect them to be perfect, they might not even be usable). He/she will love the feeling that he/she is helping you.
• Make magazine puzzles. Take a colorful page from a magazine and cut it into five or six pieces. Make the pieces sturdy by gluing onto cardboard before you cut it. Save the puzzle in an envelope to use again and again.
• Play a game of pick-up. Give your child a pair of tweezers or small tongs and two cups. Put some cotton balls, large pieces of macaroni or large beans into one of the cups, and have your child pick them up with the tweezers and put them into the other cup. Once your child can do this, make it more exciting by having a race. Do it fast. Ready, set, go!
• Wind a clock. If you have a wind-up clock, show your child how to wind the alarm or turn the hands. Not only will your child get some good fine motor practice, but it will also learn something about how clocks work.

Forty-eight to Fifty-four Months

Suggested play to help a child between 48 and 54 months develop fine motor skills

• Play with pudding. Make a batch of pudding (your child will be good at stirring the ingredients). Place a few spoonfuls on a cookie sheet or a large plate. (You may want to cover the table with newspaper first.) Have your child wash its hands and then finger-paint in the pudding. Your child can practice letters and shapes or draw pictures. The best part is cleaning up!
• Give him/her the mail. When the mail comes, let your child open the junk mail. He/she can exercise his/her fingers opening the mail, and may find some little surprises inside. Help your child write and mail letters to family members or to a favorite performer or athlete.
• Make paper chains. Paper chains can be made by cutting any type of paper into strips about 1 inch by 5 inches. Show your child how to make a loop by gluing or taping the ends together. Create a chain by inserting the next strop through the first loop and so forth. See how long you can make the chain.
• Homemade books are fun! Staple, tape, glue or sew together a few pieces of paper. On the pages, your child can draw pictures or paste in cut-out pictures from magazines to illustrate a story. Encourage your child to tell you its story. Help your child by writing down its words on each page.
• Artists always sign their masterpieces. After your child makes you a picture with paint or crayons, ask him/her to sign his/her name. Show your child how to do it, and watch him/her make the marks on the paper. It won’t look just right but letting your child do things on his/her own is how he/she will learn.

Fifty-four to Sixty Months

Most five-year-olds can:

• Cut on a line continuously
• Copy a cross
• Copy a square
• Print some capital letters

Suggested play to help a child between 54 and 60 months develop fine motor skills

• Make a family portrait. Encourage your child to draw a picture of the family. When he/she is done, ask him/her to tell you about the picture.
• Wrap it up. Give your child a small sturdy box, some newspaper or wrapping paper tape and ribbon. Let your child practice wrapping the box. Later he/she can wrap a real present for a friend in his/her very own way.
• Color the sidewalks. Decorate your sidewalks with beautiful chalk drawings. Colorful chalk can be found at any toy store and some supermarkets. Don’t forget to remind your child to sign its name!
• Make lacing cards. Using safety scissors, your child can cut out simple pictures of familiar things from magazines and glue the pictures onto the cardboard. With a paper punch, punch several holes around the outside of the picture. Tie a shoestring or heavy piece of yarn through one of the holes. Make sure the other end of the string has tape wrapped around it to make a firm tip. Your child can sew in and out around the edges of the card.
• Make a map. Draw a large square for your child. Ask your child to make a map of its room, showing where the bed, dresser, etc. are located. After making a map of the room, your child can make one of the entire house.

Techniques for Engaging in Play

Sometimes, despite the back flips and cartwheels we try, kids just don’t seem terribly interested in our attempts at engaging them in play. Before stepping up your efforts to even more outrageous antics, make sure that all of your child’s basic needs are met. As adults, if we are hungry or tired, we’re not usually in the mood to play either. If they seem to be well rested, well fed and have a clean diaper, here are some strategies to attempt:

• Change the type of play. If you’d been trying to engage in rough and tumble play, switch to quiet activities like books, puzzles or blocks. If quiet activities aren’t doing the trick, try motor games like airplane flying, climbing on sofa cushions, or jumping jacks.
• Engage in play that requires reciprocal interaction, like rolling a ball back and forth or building a tower of blocks for your child to then knock over.
• Deliberately establish eye contact and wait for reciprocation before initiating interactions.
• Model the appropriate way to play with a particular toy while commenting on your actions. (“I put the circle in the hole. In. Your turn!”)
• Use hand-over-hand assistance to help your child use a toy appropriately.
• Follow your child’s lead and then build on what it shows interest in. For example, if your child’s only interested in lining his/her cars up, line them up with him/her and then model pushing a car along a “road”.
• Eliminate distractions from the environment. Some children become over-stimulated very easily. If there is a lot of noise or overly stimulating activity happening in the environment, your child may not be able to focus on what you’re presenting.
• Start with just one or two simple items, and as your child is able to tolerate those, gradually add more.

Your child’s temperament plays a large role in how he or she responds to play initiations. Some kids will always prefer to sit back and watch rather than be in the middle of the excitement. If you feel that your child is excessively passive in his or her interactions or doesn’t seem to be motivated to interact with you or presented toys, talk to your pediatrician about your concerns.

References

Case-Smith, J., Allen, A.S., and Pratt, P. (1996). Occupational Therapy for Children. St. Louis: Mosby-Year Book, Inc.

Furuno, S. (1994). Hawaii Early Learning Profile. USA: VORT Corp.