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Fine Motor Skills


Fine motor skills generally refer to the small movements of the hands, wrists, fingers, feet, toes, lips, and tongue.


Motor skills are actions that involve the movement of muscles in the body. They are divided into two groups: gross motor skills , which include the larger movements of arms, legs, feet, or the entire body ( crawling , running, and jumping); and fine motor skills, which are smaller actions, such as grasping an object between the thumb and a finger or using the lips and tongue to taste objects. Both types of motor skills usually develop together, because many activities depend on the coordination of gross and fine motor skills.

The hands of newborn infants are closed most of the time and, like the rest of their bodies, they have little control over them. If their palms are touched, they will make a very tight fist, but this is an unconscious reflex action called the Darwinian reflex, and it disappears within two to three months. Similarly, infants will grasp at an object placed in their hands, but without any awareness that they are doing so. At some point their hand muscles relax, and they drop the object, equally unaware that they have let it fall. 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 that is 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 can typically hold on to a small block briefly, and many have started banging objects. Although their 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.

One of the most significant fine motor accomplishments is the pincer grip, which typically appears at about 12 months. Initially, infants can only hold an object, such as a rattle, in their palm, wrapping their fingers (including the thumb) around it from one side. This awkward position is called the palmar grasp, which makes it difficult to hold on to and manipulate the object. By the age of eight to 10 months, a finger grasp begins, but objects can only be gripped with all four fingers pushing against the thumb, which still makes it awkward to grab small objects. The development of the pincer grip—the ability to hold objects between the thumb and index finger—gives the infant a more sophisticated ability to grasp and manipulate objects and also to deliberately drop them. By about the age of one, an infant can drop an object into a receptacle, compare objects held in both hands, stack objects, and nest them within each other.

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. 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 being able to name them. Instead of only random scribbles, their drawings include patterns, such 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 more delicate tasks facing preschool children, such as handling silverware or tying shoelaces, represent more 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 is boundless in preschoolers, while fine motor skills require patience, which is in shorter supply. Thus, there is considerable variation in fine motor development among this age group.


Beery-Buktenica Test —A test that identifies problems with visual perception, fine motor skills (especially hand control), and hand-eye coordination.

Darwinian reflex —An unconscious action in infants in which if a palm is touched, the infant makes a very tight fist. This instinct disappears within two to three months.

Developmental coordination disorder —A disorder of motor skills.

Gross motor skills —The abilities required to control the large muscles of the body for walking, running, sitting, crawling, and other activities. The muscles required to perform gross motor skills are generally found in the arms, legs, back, abdomen, and torso.

Hand-eye coordination —The ability to grasp or touch an object while looking at it.

Lincoln-Oseretsky Motor Development Scale —A test that assesses the development of motor skills.

Palmar grasp —A young infant's primitive ability to hold an object in the palm by wrapping fingers and thumb around it from one side.

Pincer grip —The ability to hold objects between thumb and index finger, which typically develops in infants between 12 and 15 months of age.

Top-level reaching —The ability of an infant to grasp an object that is within reach, looking only at the object and not at the hands. Typically develops between four and five months of age.

Common problems

Fine motor skills can become impaired in a variety of ways, including injury, illness, stroke , and congenital deformities. An infant or child up to age five who is not developing new fine motor skills for that age may have a developmental disability. These problems can include major health conditions including cerebral palsy , mental retardation , blindness, deafness, and diabetes. Children with delays in fine motor skills development have difficulty controlling their coordinated body movements, especially with the face, hands, and fingers. Signs of fine motor skills delays include a failure to develop midline

Fine motor skills (Table by GGS Information Services.)
Fine motor skills
(Table by GGS Information Services.)

A toddler demonstrates his fine motor skills by grasping and munipulating building blocks. ( S. Villeger/Explorer/Photo Researchers, Inc.)
A toddler demonstrates his fine motor skills by grasping and munipulating building blocks.
(© S. Villeger/Explorer/Photo Researchers, Inc.)

orientation by four months, reaching by five months, transferring objects from hand to hand by six months, a raking grasp by eight months, a mature pincer grip by one year, and index finger isolation by one year.

Developmental coordination disorder is a disorder of motor skills. A person with this disorder has a hard time with things like riding a bike, holding a pencil, and throwing a ball. People with this disorder are often called clumsy. Their movements are slow and awkward. People with developmental coordination disorder may also have a hard time completing tasks that involve movement of muscle groups in sequence. For example, such a person might be unable to do the following in order: open a closet door, get out a jacket, and put it on. It is thought that up to 6 percent of children may have developmental coordination disorder, according to the 2002 issue of the annual journal Clinical Reference Systems . The symptoms usually go unnoticed until the early years of elementary school. It is usually diagnosed in children who are between five and 11 years old.

Parental concerns

Parents, teachers, and primary caregivers need to have a clear understanding of how young children develop fine motor skills and the timetable for development of the skills.

The Lincoln-Oseretsky Motor Development Scale is an individually administered test that assesses the development of motor skills in children and adults. Areas covered include fine and gross motor skills, finger dexterity and speed, and hand-eye coordination. The test consists of 36 tasks arranged in order of increasing difficulty. These include walking backwards, standing on one foot, touching one's nose, jumping over a rope, throwing and catching a ball, putting coins in a box, jumping and clapping, balancing on tiptoe while opening and closing one's hands, and balancing a rod vertically. Norms have been established for each part of the test for children aged six to 14.

The Beery-Buktenica Test , also known as VMI or Developmental Test of Visual-Motor Integration, is designed for individuals two years of age through adult. The text identifies problems with visual perception, fine motor skills (especially hand control), and hand-eye coordination. It is usually administered individually but can also be given in groups. The child is given a booklet containing increasingly complex geometric figures and asked to copy them without any erasures and without rotating the booklet in any direction. The test is given in two versions: the Short Test Form, containing 15 figures, is used for ages three through eight; the Long Test Form, with 24 figures, is used for older children, adolescents, and adults with developmental delay . A raw score based on the number of correct copies is converted based on norms for each age group, and results are reported as converted scores and percentiles. The test is not timed but usually takes 10 to 15 minutes to administer.

Some symptoms of impaired fine motor skills may appear up to age two. These symptoms include having a difficult time sitting up or raising the head, being unable to stand without help or having a very hard time standing without help, being unable to crawl or having a very hard time crawling, and walking very late or having a hard time walking. Other symptoms usually appear during the preschool or grade school years. These may include the child having difficulty holding a pencil or drawing, throwing a ball, riding a bicycle, playing sports, having a hard time with clothes that have buttons or zippers, having poor handwriting, and being clumsy.

Children with any one or combination of these symptoms should be seen by a pediatrician who specializes in motor skills development delays. Children who lose previously acquired motor skills should also be seen by a doctor. There are many ways to address fine motor skills impairment, such as physical therapy. This type of therapy can include treating the underlying cause, strengthening muscles, and learning how to compensate for impaired movements.

See also Gross motor skills .


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American Academy of Pediatrics. 141 Northwest Point Blvd., Elk Grove Village, IL 60007. Web site:

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