What are Fine Motor Milestones? And why is it important to know them?

February 22, 2021 Dr.Srinivas Gada 0 comment

What are Fine Motor Milestones? And why is it important to know them?

Evolution over millions of years has helped develop our fine motor skills. Our fine motor skills and dexterity are what makes us humans so unique. Our ability to write, draw, paint, feed, dress, compose music, thread a needle, use a keyboard, write a code for artificial intelligence all require our use of hands that differentiate humans from even our closest evolutionary cousins, the chimpanzees.

Fine motor skills involve the use of small muscles in our fingers, hands, and wrists. Fine motor skills are essential for independent living, self-care, learning and academic achievement. Also, these milestones develop on a well-established trajectory. Consequently, using this knowledge of milestones can help us identify developmental conditions such as Dyspraxia/DCD (Developmental Coordination Disorder).

Similarly, a knowledge of fine motor skills can also help us identify dyspraxic difficulties in neurodevelopmental conditions such as autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) and Learning Disabilities (LD). Hence, good knowledge of fine-motor skills milestones is crucial. Understanding fine motor milestones can avoid the delay and dither in identifying these conditions and help a child receive early and effective intervention.

Moreover, a delay or difficulties in fine motor skills can not only impact a child’s independence, learning, and academic progress, but they also cause low self-esteem and affect their morale. Therefore, checking for these fine motor milestones forms an essential part of your health visitor’s preventative development supervision visits (HV). A knowledge of these milestones, among other things, is what guides a review by a neurodevelopmental paediatrician.

In this article, I have covered ‘fine motor milestones’ in a typically developing child. But a note of caution before you read any further. While each milestone listed below is important, missing a single milestone in the absence of anything else may not be significant. Nevertheless, a delay in developing several of these milestones in a child deserves prompt attention and a thorough neurodevelopmental assessment.

0 – 3 months

An infant can reflexively grasp something placed in their hands
He/she can focus their eyes on parent/mother’s face
They are beginning to open hands occasionally
They can have voluntarily grasp at 3 months
Extensor movements of limbs cause fingers and toes to fan out

3 – 6 months

An infant is more visually alert
He/she can regard and look at their own hands when lying in supine
They can bring hands into midline over their chest or chin
He/she can clasp and unclasp hands and presses palms together.
They can hold a rattle for a few moments
An infant can visually regard a rattle at the same time as holding or moving it

6 – 9 months

An infant’s eyes move in unison to follows activities across the room
He/she can be alert for a purpose and have developed controlled reach
They can grasp toys or objects within 15-30 cm using a palmar grasp
They can put objects in their mouth
He/she can pass a toy from one hand to another

9 – 12 months

An infant can manipulate a toy by passing from one hand to another
They can explore a toy by turning it over
He/she can now start pointing with the index finger at distant objects
They can pick small objects up between index and thumb (inferior pincer grasp)
They can release a toy by dropping but are not yet able to place a toy down voluntarily

12 – 18 months

He/she can now pick-up small object such as a raisin between their tip of the index finger and thumb (pincer grasp)
They can play pushing little cars along
They can play at rolling a ball
They are developing a right- or left-hand preference
He/she can hold one cube in each hand using three fingers (tripod grasp)
He/she can bang cubes together
They can build a tower of 2-3 cubes after a demonstration
They can scribble more freely
They can throw a ball towards a person

18 – 24 months

They can use a spoon well
He/she can hold a cup and drink
He/she can do spontaneous to-and-fro scribble with either hand holding crayon/pencil in a fisted grasp
He/she can build a tower of 5-6 bricks
They can place pegs in a pegboard
They can turn pages of a book several pages at a time
Their hand preference is becoming established
He/she can turn a doorknob
They can point with the index finger to demonstrate interest or demand objects out of reach
They can help actively to dress an undress

24 – 36 months

He/she can build a tower of 6-10 bricks
They can imitate a vertical line, a horizontal line and copy a circle
He/she can do circular scribbles, holding pencil proximally with all fingers and thumb pointing downwards towards the tip of a pencil
They can pick up tiny objects accurately and quickly and place them down neatly
He/she can turn pages of book singly
They can thread large wooden beads on a shoelace
He/she can cut with toy scissors
They are beginning to use one hand consistently in most activities
They can roll, squeeze, or pull playdough
He/she can eat without assistance if food is chopped into manageable chunks

3 – 4 years

He/she can build a tower of 8-10 bricks
They can build a bridge of three cubes from a model using two hands
They can manipulate clay material to make balls or cookies
He/she can hold a pencil in their preferred hand
They can copy a cross (+)
He/she can draw a person with a head and 3- 4 body parts
They can handle scissors to snip paper
He/she can thread 6+ beads
They can undress self

4 – 5 years

Builds three steps with six cubes from a model
Holds pencil distally between first two fingers and thumb with precise opposition of pads of thumb, index, and middle fingers
They can draw a person with head, trunk, legs, arms, and usually fingers
He/she can imitate their thumb touching each finger with either hand
They can copy a ladder
He/she can copy a square
They can wash their own hands and face with some assistance
They can do up their buttons
He/she can put their socks and shoes on
They can dress and undress with minimal or no assistance

5 – 6 years

A child can now copy a triangle
He/she can draw a picture of a house
A child can copy several letters and even write a few letters spontaneously
He/she can write their first name
They can draw a person with a head, trunk, legs, arms, and features
A child can cut a thin strip edge of the paper
They can brush their teeth without assistance
A child can get a drink of water from the tap without help
He/she can wear a cardigan or topcoat unaided
They would be able to pick up and replace tiny objects carefully
They would be able to colour within the lines

6 – 8 years

A child can draw a person with features
He/she can draw a house with features
They can copy a window and a diamond
They could draw more complex and unfamiliar shapes
They can write their full name
He/she can use the dominant hand while stabilising with their non-dominant hand
They can tie their shoelaces and can tie a double bowknot
They can bath or shower and dry themselves without assistance
Posts coins into a slot quickly and accurately
Thread beads onto a string quickly and accurately using in-hand manipulation to turn beads in fingertips.

Some things you could do to help…

Children learn best through play. Giving them opportunities to practice and experiment help. Be patient. Praise their efforts. Break down the task into smaller chunks and offer them cues and feedback. Increasing the strength in their small muscles of fingers and hands through exercise and therapy is hugely beneficial.

In conclusion…

As you can see from the above, failure to acquire these milestones can occur in neurodevelopmental disorders such as DCD, ASD, or ADHD. I regularly see children with these neurodevelopmental conditions who are about to transition to secondary school but have not met the fine motor milestones for even a 6–7-year-old. If screening identifies any delays or concerns, then further prompt developmental testing or a neurodevelopmental assessment is warranted.

Because identifying and addressing these delays can prevent the development of several secondary consequences for the child, such as disengagement from learning, low self-esteem, anxiety, and poor psychological health, thus leading to sub-optimal outcomes for the child/her family and the wider society. On the other hand, earlier identification and effective interventions can help the child acquire useful qualifications, gain employment, contribute to society, and have a fulfilling life.