Fine motor skills (or coordination of the small muscles of the body, such as fingers, hands, and wrists) are extremely important for independent engagement in a variety of activities of daily life, even from a young age. From self-feeding to dressing to writing, we use fine motor skills all the time!

Because fine motor skills require coordination of the body’s small muscles, it is often our first instinct to look at a child’s hands if he or she is having difficulties with age-appropriate fine motor skills. “If his hands were stronger, he could hold his pencil properly.” “If her fingers practiced more, she could button her own pants.” While small muscle strength and coordination is an important component of fine motor development, it is actually one of the later steps in improving fine motor skills.

When thinking about fine motor skills, sometimes it is most helpful to imagine a pyramid of skills. When building a pyramid, it’s important to start from the bottom to establish a foundation. If we started from the top, it would simply crumble to pieces! Check out the fine motor control development pyramid below outlining the proper sequence of skill development, followed by our breakdown of these skills:

  1. Seated Posture Balance and Endurance

Before we begin worrying about the fingers, hands, or even arms, the first thing that needs to be addressed for fine motor development is having a stable seated posture. Imagine trying to cut a steak or write a letter to someone without being seated squarely in a chair. Fluid control of the distal muscles of the body requires activation of the core muscles for a stable base of support. Children need to be able to maintain sitting balance and activate their postural muscles over a prolonged period of time before they can tolerate fine motor demands. If your child is struggling with fine motor skills, check their posture. Oftentimes, children will compensate for poor balance or endurance in a seated posture by seeking out frequent position changes, standing at the table, or sliding to the end of their chair in attempt to seek out stability. In addition to working on improving their seated balance and endurance, you can help reduce this demand for your child by setting up an optimal seating environment during fine motor tasks: the tabletop should be at the nipple level, and their feet, knees, and ankles should be positioned at 90 degrees, with feet supported either on the floor or on a footrest. 

  1. Trunk, Head, and Shoulder Stability

Once a postural foundation has been established for seated balance and endurance, we can begin to work outward toward the fingertips. Next stop: stabilizing the head and shoulders in addition to the trunk. Tummy time is a great way to work on neck extension and head control at any age. Having your child in this position or a “wheelbarrow walk” position while reaching outside of their base of support can also work on their shoulder stability. Have you ever noticed that your child tends to stick out his or her elbow during writing or cutting? This is a sign that they are driving movement from their shoulder, rather than the distal muscles of their arm. To encourage stability at the shoulder and isolate more distal muscles of the arm, try having your child hold an object (i.e. bean bag, small stuffed animal, sock, etc.) between his or her upper arm and trunk during the fine motor task to encourage shoulder adduction.

  1. Proximal (Shoulder/Elbow) Stability

Proximal stability refers to the ability to stabilize the joints close to the body’s trunk. More proximal joints of the arm include the shoulder and elbow (vs. more distal joints at the wrist and fingers). It is necessary for children to be able to stabilize these joints in order to have control over more distal joints and muscles. To improve proximal stability, have your child engage in activities that require them to stabilize themself with their shoulders or elbows (including weight bearing through their hands or forearms). Practicing coloring, tracing, or drawing on a vertical surface (i.e. a piece of paper taped to a wall) can also help facilitate shoulder and elbow stability.

  1. Ulnar Stability and Radial Mobility

The radius and the ulna are the two bones that connect the elbow to the wrist. The radius  is on the thumb side of the arm, and the ulna is on the pinky side. The ulnar side works to stabilize the arm, while the radial side facilitates mobility to move the wrist and hand during fine motor tasks. If children haven’t established ulnar stability and radial mobility, you will likely see them initiating movement from their elbow or shoulder during fine motor tasks such as coloring or writing. If you notice this, you can help facilitate this by gently stabilizing their elbow for them during fine motor tasks.

  1. Wrist Extension, Supination/Pronation, Palmar Arching, Separation of Sides of Hand

As we move further up the pyramid, we can begin to focus on more complex wrist and hand movements. Once proximal stability is established, the wrist can have more control in an extended (vs. flexed) position. Supination and pronation allow the wrist to turn the palm of the hand upward (supination) or downward (pronation). The development of arches of the hand begins during crawling, but continues as children further develop their fine motor skills. This also helps separate the two sides of the hand: the pinky side of the hand serves to stabilize while the thumb and index finger work together to perform tasks requiring more manual dexterity.

  1. Thumb Mobility and Open Web Spaces

As more control begins to develop, the thumb is able to gain more mobility and precision. Children who don’t have adequate postural control for precise thumb mobility often stabilize their thumb by closing the web space between their thumb and index finger when grasping a writing utensil. This compensation does not encourage the development of precise, controlled distal movements from the thumb. If you see your child holding their writing utensil tightly in their web space, help them to move it to their fingertips to keep the web space open.

  1. Finger Isolation

Finger isolation waits all the way at the top of the pyramid! This is the ability to move each finger independently of one another. Once children develop the distal control, body awareness, and motor planning skills for finger isolation, they are able to perform much more complex fine motor tasks requiring precise manipulation, such as buttoning or even typing.