Recognizing Delays in a Child's Fine Motor Development

Fine motor refers to the movements we make with the small muscles of the hands. Children start to use their hands right at birth to explore their own bodies and the world around them. Their fine motor skills develop as their whole body starts to move and become more stable. They also learn to do more things with their hands as their cognitive and social/emotional skills improve. Below are some of the typical developmental milestones for fine motor skills and “red flags” that might indicate a child is having challenges that might require the support of a pediatric occupational therapist.

Fine Motor developmental Milestones

General milestones for fine motor development for children ages 0 to 3 years

By Age 1

  • Points with index finger
  • Picks up small objects using fingers
  • Holds a crayon with fist and scribbles with whole arm movements
  • Turns pages in a board book
  • Places large pegs into a hole repeatedly
  • Places objects into an adult’s hand or an open container
  • Grasps an object with one hand and manipulates it with the other
  • Builds a tower of two to three small blocks
  • Places one or two shapes in a simple three-shape puzzle

Red flags: Does not point at objects or toys presented; does not use both hands during play; uses whole hand to pick up small, pellet-size items

By Age 2

  • Stacks large objects, or four to five small blocks
  • Strings large beads
  • Turns pages of a book, one page at a time
  • Draws and copies vertical and circular scribbles
  • Holds a crayon with thumb and fingers
  • Puts on shorts, pants, socks and shoes
  • Takes off shoes and socks
  • Uses a spoon for feeding
  • Snips paper with scissors
  • Places three shapes in a simple three-shape puzzle

Red flags: Puts lots of toys in mouth; cannot feed self with a spoon; lacks imitation skills with simple tasks at tabletop

By Age 3

  • Dresses and undresses independently; only needs help with fasteners (buttons and zippers); sometimes confuses front or back of clothes and right or left of shoes
  • Feeds self with little or no spilling
  • Drinks from a cup with one hand
  • Imitates a circle, as well as vertical and horizontal lines
  • Stacks five to seven small blocks
  • Completes simple puzzles
  • Manipulates clay or dough (pinches, rolls, balls and makes snakes)
  • May use one hand consistently in activities
  • Uses scissors to cut paper into two pieces

Red flags: Movement seems stiff or weak and lacks fluidity; grasps a crayon with whole fist; cannot stack up several blocks

The earlier a child’s sensory processing and fine motor problems are identified and treated, the less likely the problem will persist or get worse. If you think your child may have a delay in his/her fine motor skills, contact your physician for more information regarding pediatric occupational therapy services.

PVHMC’s Milestones Center for Child Development is dedicated exclusively to the developmental needs of children. Our focus is to help our patients succeed in reaching the developmental milestones that will allow them to enjoy more independence as they continue to grow. Our pediatric occupational therapists evaluate and treat children having difficulties with fine motor development and many other developmental delays and conditions. If you have any questions or concerns, feel free to contact Milestones at 909.621.7956.

Milestones Center for Child Development is located in Claremont, CA at the Pomona Valley Health Center. We will soon be opening our second location at the Pomona Valley Health Center in Chino Hills, CA.