Fine motor skills refer to the coordination between your child’s small muscles, like those in their hands, wrists, and fingers in coordination with their eyes. Fine motor skills involve the small muscles of the body that enable such functions as writing, grasping small objects, and fastening clothing.

Early childhood development includes acquiring fine and gross motor skills. While both these skills involve movement, they do have differences:

• Fine motor skills involve the movement of the smaller muscle groups in your child’s hands, fingers, and wrists.
• Gross motor skills involve movements of the larger muscle groups, like the arms and legs. It’s these larger muscle groups that allow babies to sit up, turn over, crawl, and walk.

Both types of motor skills enable children to become more independent. Fine motor skills are especially crucial, however, because the ability to use the smaller muscles in the hands allows children to perform self-care tasks without assistance. This includes:

• brushing their teeth
• eating
• writing
• getting dressed

Examples of fine motor skills

Babies and toddlers develop fine and gross motor skills at their own pace. Some children develop some skills earlier than others, and that’s perfectly normal. Children usually begin to acquire these skills as early as 1 or 2 months old and continue to learn additional skills through preschool and early elementary school.

The most important fine motor skills children need to develop include the following:

• The palmar arches allow the palms to curl inward. Strengthening these helps coordinate the movement of fingers, which is needed for writing, unbuttoning clothes, and gripping.
• Wrist stability develops by early school years. It allows children to move their fingers with strength and control.
• The skilled side of the hand is the use of the thumb, index finger, and other fingers together for precision grasping.
• Intrinsic hand muscle development is the ability to perform small movements with the hand, where the tip of the thumb, index finger, and middle finger touch.
• Bilateral hand skills permit the coordination of both hands at the same time.
• Scissor skills develop by age 4 and teach hand strength and hand-eye coordination.

Here’s a brief timeline of fine motor milestones for babies and toddlers:

0 to 3 months

• places their hands in their mouth
• hands become more relaxed

3 to 6 months

• holds hands together
• moves a toy from one hand to the other
• holds and shakes a toy using both hands

6 to 9 months

• begins to grasp things by “raking” with the hand
• squeezes an item with their hands
• touches fingers together
• grasps a toy with both hands
• uses their index finger to touch things
• claps hands

9 to 12 months

• feeds themselves finger foods
• grabs small objects with thumb and index finger
• bangs things together
• holds a toy with one hand

12 month to 2 years

• builds block tower
• scribbles on paper
• eats with a spoon
• turns one page of a book at a time
• holds crayon with fingertips and thumb (pincer grasp)

2 to 3 years

• turns a doorknob
• washes hands
• uses a spoon and fork correctly
• zips and unzips clothes
• places lids and removes lids from canisters
• strings beads on yarn

3 to 4 years

• unbuttons and buttons clothes
• uses scissors to cut paper
• traces shapes on paper

Fine motor skills development

Fine motor skills develop naturally as your child gains the ability to control and coordinate their body. Keep in mind that some children might develop fine motor skills earlier and have better coordination than others.

One baby may learn to shake a rattle at 3 months, whereas a baby of the same age might not shake a rattle until a month later. This is totally normal.

Don’t be alarmed if your child isn’t developing as fast as a child of similar age. Remember, your child’s body is still growing. In a few weeks or months, they may build enough muscle strength in their hands to acquire new fine motor skills.

Fine motor skills activities

Incorporating fun activities into your child’s daily routine can help improve their fine motor skills. The ability to learn and practice fine motor skills at an early age can benefit them academically, socially, and personally.

Here are some activities you and your child can do together:

• Allow your child to assist with meal preparation, like stirring, mixing, or pouring ingredients.
• Put together a puzzle as a family.
• Play board games that involve rolling dice.
• Finger paint together.
• Let your child set the dinner table.
• Teach your child how to pour their own drinks.
• Have your child roll and flatten clay with their hands, and then use a cookie cutter to make cutouts.
• Show your child how to use a hole puncher.
• Practice placing rubber bands around a can.
• Place objects in a container and have your child remove them with tweezers

The trouble with fine motor skills

Although fine motor skills develop at different rates, see your child’s pediatrician if they struggle with these skills or gross motor skills. Delays could be a sign of developmental coordination disorder. It affects about 5 to 6 percent of school-aged children.

Signs of a problem with fine motor skills include:

• dropping items
• unable to tie shoes
• difficulty holding a spoon or toothbrush
• trouble writing, coloring, or using scissors

Some fine motor skills delays aren’t detected until a child is older. Identifying a delay early can ensure your child receives the help they need to build their skills and help them grow.

Your child’s pediatrician may diagnose a coordination disorder if your child has:

• fine motor skills below what’s expected for their age
• poor fine motor skills that make it difficult to complete everyday tasks at school and home
• developmental delays of motor skills that started at an early age

Your child may need to work one-on-one with an occupational therapist to learn techniques to improve coordination in their smaller muscle groups.

Takeaway

Fine motor skills are essential to living and learning. If your child has difficulty with day-to-day activities or you feel your child struggles with these skills, discuss the possibility of a developmental delay with their doctor.

With an early diagnosis, home activities, and the assistance of an occupational therapist, you can help your child thrive and reach developmental milestones.

What are the symptoms of uncoordinated movement?

For some, ataxia may be a slowly developing condition. For others, it may occur suddenly and without warning. The most common symptom of ataxia is loss of balance and coordination. If the condition does progress, you may experience difficulty walking and moving your arms and legs. Eventually, there can be a loss of fine motor skills, affecting activities such as writing or buttoning up your shirt.

Other common symptoms of ataxia can include:

• dizziness
• visual difficulties
• problems or changes with speech
• difficulty swallowing
• tremors

These symptoms can be very concerning because they are often similar to a stroke. Seek emergency medical attention if these symptoms suddenly appear

What causes ataxia?

There are a number of known causes for ataxia. They range from chronic conditions to sudden onset. However, most conditions will relate to damage or degeneration of the cerebellum.

Disease and injury-related causes

Coordinated movements involve the cerebellum, the peripheral nerves of the body, and the spinal cord. Diseases and injuries that damage or destroy any of these structures can lead to ataxia. These include:

• head trauma
• alcoholism
• infection
• multiple sclerosis, a chronic disease that affects the brain and spinal cord
• stroke
• transient ischemic attack (TIA), a temporary decrease of blood supply to your brain
• genetic ataxias
• cerebral palsy, a group of disorders caused by damage to a child’s brain in early development
• brain tumors
• paraneoplastic syndromes, abnormal immune responses to certain cancerous tumors
• neuropathy, disease or injury to a nerve
• spinal injuries

Examples of some inherited conditions related to ataxia are Friedreich’s ataxia and Wilson’s disease. Friedreich’s ataxia is a genetic disease that causes problems with energy production in the nervous system and the heart. Wilson’s disease is a rare inherited disorder in which excess copper damages the liver and nervous system.

Toxins

Some substances have toxic effects that can lead to ataxia. These include:

• alcohol (most common)
• seizure medications
• chemotherapy drugs
• lithium
• cocaine and heroin
• sedatives
• mercury, lead, and other heavy metals
• toluene and other types of solvents

Sometimes people have a condition known as sporadic ataxia. This causes an ataxia not related to a genetic disorder or a specific known cause.

What to expect during your doctor visit

You should schedule a doctor’s visit right away if you experience any of the following:

• a loss of balance
• trouble swallowing
• lack of coordination for more than a few minutes
• loss of coordination in one or both legs, arms, or hands
• slurred speech
• trouble walking

Seeing the doctor

Your doctor will ask you about your medical history and perform a basic physical examination. They’ll perform a detailed neurological exam that includes your muscular and nervous systems. They’ll check your ability to balance, walk, and point with your fingers and toes. Another common test is the Romberg test. It’s used to see if you can balance while closing your eyes and keeping your feet together.

Sometimes the cause of ataxia is clear, such as a brain injury, infection, or toxin. Other times your doctor will ask questions about your symptoms to narrow down the possible cause of your ataxia. These questions often include:

• When did your symptoms begin?
• Does anyone in your family have similar symptoms?
• What are you most common symptoms?
• How much do your symptoms impact your life?
• What medications do you take, including vitamins and supplements?
• What substances have you been exposed to?
• Do you use drugs or alcohol?
• Do you have other symptoms, such as visual loss, speech difficulties, or confusion?

Tests to determine the cause of ataxia

Your doctor may order the following tests:

• blood tests
• urine tests
• computed tomography (CT) scan
• magnetic resonance imaging (MRI) scan
• spinal tap
• genetic testing

Your doctor will consider the overall picture of your symptoms and test results in making a diagnosis. They may also refer you to a neurologist, a specialist in the nervous system

Living with ataxia

There’s no cure for ataxia itself. If an underlying condition is a cause, your doctor will first treat that. For example, a head trauma may eventually heal and ataxia may subside. But in other cases, such as cerebral palsy, your doctor may not be able to treat ataxia. But there are ways to manage this condition. Some medications may lessen the symptoms associated with ataxia.

In some cases, your doctor may recommend adaptive devices or therapy. Items such as canes, modified utensils, and communications aids may help to improve your quality of life. Therapies designed to help with uncoordinated movement are other options, such as:

Physical therapy: Exercises can help strengthen your body and increase your mobility.

Occupational therapy: This therapy aims to improve your skills with daily living tasks such as feeding and another fine motor movement.

Speech therapy: This can help with communication as well as swallowing or eating.

Simple changes can also make it easier for a person with ataxia to get around the house. For example:

• keep living areas clean and free of clutter
• provide wide walkways
• install handrails
• remove rugs and other items that might cause slipping and falling

Dietary therapy

Researchers at the Albany Medical Center have discovered some treatable forms of ataxia. SAVED (Ataxia with Vitamin E Deficiency) is a type of ataxia that improves with Vitamin E supplementation. Gluten ataxia improves with a gluten-free diet.

The University of London also reported that vitamin B-3, or nicotinamide, may help people with Friedreich’s ataxia. This treatment may increase frataxin levels, a protein that is low in people with this type of ataxia. But research continues as it’s unknown if this supplementation will work long-term to slow or stop the disease.

Where to find support

Symptoms of ataxia can affect a person’s independence. This can result in feelings of anxiety and depression. Talking to counselor can help. If one-on-one counseling doesn’t sound appealing, consider a support group for people with ataxia or other chronic neurological conditions. Support groups are often available online or in person. Your doctor may have a recommendation for a support group in your area.

How parallel play benefits toddlers

At first your baby watches adults and other children do things, and they will often mimic, or copy, behaviors. Then they use those observations during solitary play.

Next comes parallel play, where your child simply plays on their own while observing and being near others.

Parallel playing may seem self-centered, yet there are many benefits for your toddler.

1. Language development

As your toddler sits and minds their own playing, they will also be listening and learning words from nearby children or adults.

Sometimes they may peek and see a toy or an action being called a certain word. They’ll add to their vocabulary and surprise you with it later.

2. Gross and fine motor skill development

Play is a highly imaginative pursuit that engages body and mind. Whether toddlers simply repeat an activity or experiment with something new they picked up during parallel play, it’s all part of learning and growing.

There’s no right or wrong way of playing. Keep in mind that what looks simple to you can be a challenging thing for little hands that are learning fine-tuning moves.

Also, a simple action by a child may have a complicated imaginative component behind it.

3. Freedom to express their desires and feelings

During parallel play your little one learns more than just how a toy rolls, falls down, or moves when pushed.

They’re also using everything they can get their hands on, including toys, their own hands, and even dirt and sticks, to express feelings.

They range from joy to fear to frustration or simple silliness, and are mostly based on what they experience in real life.

By observing them play, you may get a glimpse into how their mind works at this young age and better understand their budding personality.

4. Understanding social interactions and learning about boundaries

Parallel play doesn’t mean isolation. Your child is exactly where they should be: in their own world, which is situated in the middle of the bigger world they have yet to figure out.

By observing other children interact, your child gets a glimpse into social interaction. These observations will be put to good use when the time comes where they are developmentally ready for group play.

Interactions can be positive (children being nice to each other) or negative (one child pushes another or grabs a toy). There’s something to learn from both.

5. Learning to share

Don’t expect your children of this age to sit quietly and play without ever eyeing the others’ toys. It’s the age when their minds take some big leaps in terms of development when they learn to assert themselves.

Learning the word and concept “mine” is an important step in understanding boundaries.

Allow them to say “mine” to protect what’s theirs, but help them understand that toys brought to a common area can be safely shared without fear of being taken away.

Toddlers in the parallel play stage are naturally possessive of their toys, as they do not understand sharing yet. You can practice sharing at home, but don’t be surprised if they get upset when their parallel play companion grabs their toy.