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

Fine Motor Milestones

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.

Further reading:

  1. Gada S. Community Paediatrics. Oxford Specialist Handbook in Paediatrics. Oxford University Press. ISBN 978 0 19 969695 6. Published Sept 2012.
  2. Aites J, Schonwald A, Augustyn M, Torchia M. Developmental-behavioural surveillance, and screening in primary care. UpToDate Inc. Wolters Kluwer. Accessed on Nov 15, 2020.
  3. National Center on Birth Defects and Developmental Disabilities (NCBDDD) Fiscal Year 2018 Annual Report. www.cdc.gov/ncbddd/aboutus/report/
  4. Weissman L et al. Autism Spectrum Disorder: Surveillance and screening in primary care. UpToDate Inc. Wolters Kluwer. Accessed on Jan 15, 2021.
Book an Appointment Email Phone