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Is My Child’s Development Milestones On Track?

Updated: Jul 19, 2020

Fine motor involves movement in the small muscle groups, which include hands, fingers, face, tongue and eyes. Fine motor skills are skill sets developed over the first few years of a child’s growth. Some examples of fine motor skills include a child learning to use his/her eyes to track the things around him/her and learning to pick up cereals to self-feed. In occupational therapy, the emphasis of fine motor skill development is usually placed on the hands and fingers (i.e. grasp/grip control, pre-writing and handwriting abilities).

As children grow, they would need to utilise their fine motor skills in different activities of daily living such as feeding self, learning to write and buttoning their own shirt. Their competence level in the fine motor skills is crucial for their progression from pre-school to primary school.

A child’s self-confidence and emotional maturity get better as he/she becomes more capable in performing age-appropriate skills independently. If a child shows weakness in his/her fine motor skills, such as handwriting, he/she would face frustration and lack of motivation to continue the writing task. Many times, a smart child’s potential in academics is being masked due to the struggles and frustration he/she faces when doing the handwriting tasks. Thus, good fine motor skills are essential in helping a child perform his/her school and self-care tasks with ease, motivation and confidence.

Why Do Some Children Struggle With Their Fine Motor Skills Development?

The following fundamental skills are crucial for efficient fine motor skill development:

  • Tactile Feedback – Use of our sense of touch to learn more about the environment and the objects around us

  • Postural Stability – Use of strong and stable core muscles (i.e. muscles of the trunk and shoulder areas) to move smaller muscles of body parts such as hands, fingers and eyes

  • Bilateral Coordination – The ability to use both sides of the body at the same time in a controlled and organised manner (e.g. using both hands in cutting task with scissors)

  • Hand Function – Use of the tactile feedback and/or hand and finger muscles to manipulate objects and facilitate use of hand of motor tasks, such as holding a pencil for writing and lifting a cup off the table

If the above-mentioned areas are being compromised, such as weak tactile processing or poor core muscle strength, the child may experience delay in the development of fine motor skills.

Some studies have shown that genetic and environmental causes may also bring about fine motor skill concerns. If a pregnant mother is exposed to smoking, alcohol and drugs, the probability of having healthy development of the unborn child’s brain neurons can be greatly reduced. This probability can also be observed in premature babies. The disturbance in the development and connection of the brain neurons can cause difficulties in fine motor development and other areas such as attention and focus.

Signs Of Fine Motor Delay

Fine motor skills start developing within the first six months of life, and the pace at which each child develops his/her motor skills may differ. However if some difficulties persist or begin after the first year of development (such as poor ability in holding and drinking from cup independently, and unable to pick up small objects with thumb and one finger), parents should consider consulting a developmental pediatrician or pediatric occupational therapist for further assessment and recommended strategies to improve the child’s fine motor skills.

Some common signs of fine motor delay in children include:

  • Child is not interested in fine motor play such as playing with playdough, stringing blocks/beads and finger painting, and displays much difficulty in coordinating his hands and fingers.

  • Displays poor eye-hand coordination (e.g. catching and throwing a ball), and may appear clumsy at times compared to other peers of the same age.

  • Child loves frequent playground visits and physical activities, such as running and jumping, but dislikes tabletop tasks involving fine motor skills, such as writing, drawing and feeding self.

  • Child often shows frustration and lack of motivation to do self-care and work tasks involving fine motor, such as buttoning own shirt, using scissors for artwork and zipping up.

Children who show at least one of the signs mentioned above often face problems such as:

  • Reluctance to learn new motor skills or join friends in playing games involving fine motor skills, leading to possible weak development of problem solving and social-emotional abilities

  • Poor self-confidence and frustration in doing fine motor tasks

  • Difficulty in completing written or fine motor tasks on time

  • Affects overall learning ability and performance within school setting

Who Can Help To Diagnose And Treat Fine Motor Delay In Children?

Usually, a paediatric occupational therapist would assess and treat fine motor delay in children. The assessment can be done through clinical observations or formal standardised testing, such as the Peabody Developmental Motor Scales, Second Edition (PDMS-2).

The usual course of therapy is administered once a week. Depending on the cause(s) of fine motor delay, the focus of therapy can cover:

  • Sensory integration, particularly working on tactile perception

  • Postural work and bilateral coordination through gross motor and fine motor activities

  • Hand function through fine motor and pre-writing activities

  • Handwriting programmes and activities utilised based on the child’s needs

Fine Motor Activities Parents Can Do With Their Children

Parents can encourage their children’s fine motor development by incorporating fine motor tasks or functional activities into the daily routine (e.g. cleaning windows, watering plants, keeping the laundry and baking) – remember to make them as fun as possible!

Here are other activities that you can do with your children to put their fine motor skills to work, according to their age group:


  • Touching and exploring different textures within a box/bowl/basket

  • Playing with blocks or objects with different shapes and sizes and dropping them into a box/basket

  • Pulling pictures off from board and putting them back (with the use of Velcro and felt material)

  • Mouthing of objects/toys is encouraged but to be done in a safe way and under supervision.


  • Pick up coloured ice cream sticks and sort them into respective colours – you can make a slotted container for the sticks

  • Play with stacking blocks/cups

  • Scribbling with crayons or painting with paint brush or hands/fingers


  • Using scissors and crayons to do art work

  • Making own breakfast or snack, such as spreading jam on bread with butter knife or spoon and feeding self with own hands or using spoon/fork

  • Writing on easel with markers, chalks or crayons

  • Playing with pegs of different sizes/colours and pinning them on cardboard/string

School-aged children

  • Using spray bottles, water plants regularly or clean windows/glass panels/whiteboards (to make it more fun, water soluble paints or foam can be placed on a few spots on the surface – get your child to aim and shoot!)

  • Making own sandwich to bring to school, which involves using the butter knife and cutting the ingredients.

  • Baking session with family, which involves lots of fine motor work

  • Making friendship bracelets for friends or loved ones, consisting of colourful beads and letter blocks etc.

Article contributed by Alison Ng, Principal Occupational Therapist at MindChamps Allied Care.

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