What are fine motor skills?

by Jessica Hill, COTA/L February 10, 2022

What are fine motor skills?

Fine motor describes the activities and skills that involve the small muscles of the hands and fingers, and indirectly, the muscles and coordination of the wrists and forearms. It’s important to note that for good fine motor skill development, we must also have good gross motor skill development and stability in the upper body and trunk. Without good proximal stability, we cannot have good distal control.

When talking about fine motor skills in this article, we are going to focus on several areas: hand-eye coordination, grasp development, dexterity, how fine motor skills relate to self-care, bilateral integration, and hand dominance.

Hand-eye coordination

Hand-eye coordination is the ability to coordinate vision with the hands - looking at an object and grasping it; visually tracking a ball coming towards you and catching it; playing a clapping game with your friend. This coordination is essential to development and mastering various tasks throughout the day.

Let’s take a look at the development of hand-eye coordination:

3 months

By 3 months of age, an infant’s sight has developed enough to focus on specific objects that are approximately 8 inches away. Additionally, they have “discovered” their hands and will bring their hands in front of their face to look at them. They will also begin intentionally reaching for objects within their range of vision.

6 - 12 months

By 6 months of age, the infant can visually track an object and reach for it while it’s moving through space. By 12 months of age, the infant is able to hold an object in each hand and shift their gaze between the two objects.

First 3 years

During toddlerhood, hand-eye coordination gets better and better (along with development of grasp patterns, dexterity, and bilateral integration). They begin learning how objects relate to each other (vision) and how they can manipulate objects - such as stacking blocks, placing items into containers, etc. The toddler will also begin learning to grasp writing utensils and imitate various drawing strokes. Additionally, they begin learning how to throw and catch and kick balls during play.

School ages

Hand-eye coordination continues to develop through activities such as playing on the playground, playing with peers and various toys, drawing and coloring, self-care tasks, and cause-and-effect activities. These skills are important for everyday life activities and social activities as well.

Grasp development

Grasp is the ability to coordinate the fingers to hold and manipulate an object (also dexterity, which we’ll talk about next). We are not born with efficient grasp patterns - instead, we develop them through infancy and toddlerhood, and refine them in the school age years.

Let’s take a look at the development of grasp patterns.

Infancy - grasp on toys

Once an infant discovers their hands (around 3 months) they begin reaching for objects. However, they haven’t quite mastered hand-eye coordination yet. Around 4-5 months, the infant will begin pushing themselves up on their arms and hands (during tummy time), thus beginning to place weight through their hands and fingers - this is very important! This is how their hand strength is developed (along with upper body stability).

Infant grasps

Once the infant develops more control with their hand-eye coordination, they are able to intentionally grasp toys in what is called the palmar grasp. This begins around 4-5 months of age. Typically, the thumb is not part of this grasp pattern - it is only the fingers and the palm.

As the child begins to develop their gross motor skills, they will begin crawling. This gross motor skill helps to develop effective grasp patterns, as the upper body strength and stability is being developed while the hand muscles are simultaneously being built!

By 10 months, the infant will have developed what is called the radial digital grasp where the object is no longer stabilized in the palm - instead, it is held by the fingers and the thumb.

Next, what is called an immature pincer grasp is developed, followed by the mature pincer grasp by 12 months of age. This is when precision begins to develop - the infant is able to intentionally grasp smaller objects with thumb and index finger in order to do a task - such as self feeding small pieces of food or placing small toys into containers.

Toddlerhood and up - grasp on writing utensils

Once a child reaches toddlerhood and has mastered the mature pincer grasp, they are able to manipulate objects to complete various tasks. Next, they will begin to grasp writing objects and start learning how to draw - and eventually write. Around 12 months of age, the child will use a gross palmar grasp on writing utensils - similar to their grasp on toys before they develop the pincer grasp. This palmar grasp does not involve any finger movements; instead the control comes from the upper arm and forearm.

By around 2 years of age, a more refined grasp will start to develop, in which the fingers and thumb begin to grasp the writing utensil. This is referred to as a digital pronate grasp - the fingers and thumb grasp the writing utensil, with the palm facing down, however most of the control still comes from the forearm, versus the fingers.

writing grasps

By around 3 years of age, the digital pronate grasp develops into a static quadrupod or static tripod grasp. Static refers to the fact that while the writing utensil is held with the thumb and fingers, the movement and control still comes from the forearm and wrist. A quadrupod grasp refers to grasping the writing utensil with the thumb and 3 fingers, while a tripod grasp refers to grasping the writing utensil with the thumb and two fingers. At this point, the palm is no longer facing down.

By 5-6 years of age, a dynamic grasp will have developed - it is no longer a static grasp with movement and control coming from the forearm and wrist. Instead, the fingers are now in control and moving dynamically during the writing and drawing process.


Dexterity refers to the ability to complete tasks with the hands with good skill and control. Similar to grasp development, we are not born with good dexterity; instead it is developed throughout infancy and toddlerhood as grasp patterns develop. Additionally, there needs to be good upper body stability in order to develop functional dexterity.

Fine motor skills

Development of dexterity follows development of grasp patterns. As grasp patterns mature, dexterity develops. It starts with simply holding a toy and moves to manipulating the toy to complete a specific task with it, such as rotating it to place it in a container. Dexterity continues with writing utensil grasp development, starting with static grasping and moving to dynamic grasping in order to move and control the writing utensil with the thumb and fingers.

Additionally, dexterity is required for self-care tasks such as tying laces, buttoning buttons, brushing teeth, combing hair, and more. As adults, we use dexterity during cooking and cleaning tasks, typing on a computer, texting on our phones, and more!

Bilateral Integration

Bilateral integration refers to the ability to use both sides of the body for a task. When talking about fine motor skills, bilateral integration refers more specifically to completing a task that requires both hands - catching a large ball, various self-care tasks such as buttoning, and even writing (which requires the dominant hand to write and the non-dominant hand to stabilize the paper). While bilateral integration is typically considered more of a gross motor skill, it is still very important to fine motor development.

Bilateral integration begins in infancy, when babe is learning to bring both hands to midline. This skill continues to develop when babe learns to roll to both sides and then begins to move into crawling. Then, babe will start using both hands to hold toys, transfer toys between hands, and pull toys apart as well as bang them together.


In toddlerhood, the child will learn how to use both hands together symmetrically - both hands complete the same task. This looks like pushing and pulling objects, rolling a rolling pin over playdough, and clapping. Next comes the development of asymmetrical bilateral integration - using both hands simultaneously to perform a different movement for a single task. This looks like stabilizing with one hand (typically the non-dominant hand) and performing the dexterity portion of the task with the other hand (typically the dominant hand). These tasks can be drawing and writing, buttoning and zipping, and other self-care tasks.

Check out our Top 5 Favorite Bilateral Integration Activities



Self-care refers to the ability to complete tasks to care for oneself. These can be simple tasks such as bathing and eating, as well as more complex tasks such as money management and overall healthcare. For children, self-care begins with learning the simple tasks of hygiene, self-feeding, and dressing. All of these self care tasks require fine motor skill development.

Brushing teeth

As hand-eye coordination, grasp patterns, and bilateral integration begin to develop, the infant/toddler also begins to engage in self-care tasks. This can look like taking socks off, practicing brushing teeth, and self-feeding - first with fingers and eventually utensils.

As the child ages and they begin to refine all of their fine motor skills, they can begin to engage in more complex self-care activities. This can look like independence with dressing tasks and hygiene tasks, ability to utilize a variety of silverware for meal time, and chores around the house. These self-care tasks require good development in all areas of fine motor development - hand-eye coordination, grasp development, dexterity, and bilateral integration.

Challenges with fine motor skills

There are a variety of reasons why a child might struggle to develop efficient fine motor skills.

First, if a child is struggling with gross motor skills, they may struggle to develop fine motor skills since they are dependent on one another. If a child experiences dyspraxia, a term that refers to trouble with movement and coordination, this can also impact fine motor skills development. Additionally, if a child is struggles with sensory processing - the ability to process how we feel as well as to process the world around us.

Oftentimes, all of these can result in the child receiving a diagnosis that better explains fine motor skills challenges.

For this article, we are going to look at two specific areas that can affect fine motor development - Sensory Processing Disorder (SPD) and primitive reflexes.

Sensory Processing Disorder (SPD)

SPD is when one’s body cannot take in and process the sensory information that is coming at them from their environment, causing them to have adverse reactions. 

So how does SPD affect fine motor development?

If we look at how fine motor skills begin to develop in infancy - by reaching for objects, by placing the hands on the ground to begin moving and crawling, by holding and manipulating objects, etc. - we can start to identify some sensory components to these tasks.

If a child does not process tactile information, they may struggle to tolerate holding and manipulating objects. A toy that is soft may feel scratchy. Additionally, the child may not be able to tolerate the feeling of different floor textures on their hands, thus causing them to refuse to place their hands on the ground which in turn affects their ability to weight bear through their arms to develop the upper body musculature necessary for fine motor development.

This then translates to potential challenges with self-feeding. If a child cannot process different food textures in their mouth or on their hands, they may refuse to eat those foods. This can affect their ability to learn how to manipulate silverware and drink from a variety of cups.

Then, this can move to challenges with self-care skills including dressing (tolerating certain clothing textures) and hygiene (tolerating different sounds and smells in the bathroom, just to name one example). If the child struggles to tolerate these tasks, they may not develop the necessary fine motor skills to complete self-care tasks.

Now let’s take a quick look at primitive reflexes.

Primitive reflexes

We are all born with primitive reflexes - involuntary movement patterns that help us survive in infancy. Primitive reflexes are also the building blocks for higher level movement patterns - the involuntary movements we are born with will develop into more mature movements as we progress through developmental milestones. This is called primitive reflex integration. You can read more about primitive reflexes here.

So how do primitive reflexes affect fine motor skills?

Well first, if a primitive reflex does not integrate when it should (each reflex has a general timeline of development and integration), it may cause challenges within the child’s body and nervous system. When looking at fine motor development, we will talk specifically about the Palmar Grasp Reflex.

Palmar grasp reflex

palmar grasp

This specific reflex is one that most of us are familiar with - the iron-tight grasp that an infant has? That’s the palmar grasp reflex! This reflex is stimulated by touch to the palm, causing the infant to close their fingers around whatever is touching their hand. And then they don’t let go! At least, not until they develop the fine motor control to purposefully release, around 3-6 months of age.

However, if for some reason the palmar grasp reflex does NOT integrate around 3-6 months of age and instead lingers in the body, the child may begin to develop some challenges with tactile processing and fine motor development.

The retention of a palmar grasp reflex has been linked to:

  • Challenges with fine motor tasks, including grasp on small objects, handwriting, self-feeding, and manipulation of clothing fasteners
  • Potential challenges with speech and articulation
  • Overflow into the mouth during fine motor tasks (sticking tongue out, etc. )
  • Tactile hypersensitivity - specifically to hands
  • Challenges with directionality (left vs right)
  • Dysgraphia

Activities to help develop fine motor skills

Now let’s talk about what you can do if your child is struggling with fine motor skill development! First, we recommend identifying if these challenges are significantly impacting your child’s ability to get through their day - if so, you can chat with your child’s pediatrician about potentially getting a referral for Occupational Therapy services. An Occupational Therapist can help develop your child’s fine motor skills through a variety of therapeutic activities.

But what can you do at home to help develop your child’s fine motor skills? Let’s break it down by age!

Birth - 3 years

This age range is significant for a child’s development of fine motor skills. We want to start with simple, developmentally appropriate activities that engage the hands as well as the rest of the body. For this age, simple is best! It does not have to be complicated!

  • Tummy time.
  • Crawling, making sure the hands are open on the ground and the fingers are not curled under the palms. Try crawling through tunnels, up and down inclines, and on a variety of surfaces.
  • Climbing activities, such as climbing structures on the playground. This can help develop the upper body strength necessary for fine motor development, as well as help to strengthen the hands by grasping and holding onto different structures.
  • Fine motor toys that require some object manipulation, such as placing coins into a coin bank and peg puzzles.
  • Sensory bins. These are great to help develop tactile processing skills while simultaneously improving fine motor skills. Try edible sensory bins for younger children who are prone to put toys in their mouths. Add scoops and spoons to the sensory bin.
  • Play ball. Start with rolling a large ball back and forth. This helps to develop hand-eye coordination and bilateral integration skills.
  • Between 2 - 3 years old, start providing your child with opportunities to scribble with large crayons and markers.

3 - 6 years

This age range is perfect for practicing more complex fine motor tasks, including drawing and self-care tasks.

  • Provide a variety of different sized writing utensils. Try drawing simple lines that your child can try to imitate. Also draw on different surfaces - place the paper on the wall or an inclined surface, chalk on the sidewalk, etc.
  • Make drawing sensory bins - grab a tray and add salt or sand to cover the bottom. Using your pointer finger, draw in the material. You can also grab some writing utensils to do this, but by using your fingers you also get the added benefit of a tactile medium!
  • Continue playing games that require bilateral integration and hand-eye coordination, such as simple ball games, scooping and pouring games, and continue crawling and climbing activities (these are great for obstacle courses!).
  • Start practicing all of the self-care tasks! Buttoning large buttons, zipping up jackets, scooping with spoons and stabbing with forks, brushing teeth, etc. Practice practice practice!

6 years and up

Fine motor skills development

Once a child reaches school-age, they will likely practice a variety of fine motor tasks at school! At home, continue to practice self-care tasks and engage your child in fun activities that include fine motor tasks Using the ideas from the earlier ages is a great way to continue incorporating fine motor into your child’s day.

Again, if your child continues to struggle significantly with age-appropriate fine motor tasks, talk with your pediatrician about your options and about getting a referral for outside services with someone who is trained to help develop these skills! 


Check out our video on our Top 5 Strategies to Improve Handwriting


Be sure to check out our Fine Motor Skills Digital Activity Course

And don't miss out on these super helpful resources...

Check out our YouTube video on 5 Easy Ways and Activities to Improve Reading and Writing Skills

Jessica Hill, COTA/L
Jessica Hill, COTA/L

Jessica Hill, COTA/L, CPRCS is Harkla's in-house Certified Occupational Therapy Assistant (COTA) and Certified Primitive Reflex Clinical Specialist. She has been working with children for over 6 years in outpatient settings. Jessica specializes in creating easy-to-digest, actionable content that families can use to help their child's progress at home. Jessica is the in-house expert, content creator, and one of the podcast hosts at Harkla! To learn more about Jessica, visit the Harkla About Us Page. Make sure to listen to her weekly podcast, All Things Sensory by Harkla for actionable, fun advice on child development.

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