Fine motor skills encompass the abilities required to control the smaller muscles of the body for writing, playing an instrument, artistic expression, and craft work.
The muscles required to perform fine motor skills are generally found in the hands, feet, and head.
Description
Fine motor skill involves deliberate and controlled movements requiring both muscle development and maturation of the central nervous system. Although newborn infants can move their hands and arms, these motions are reflexes that a baby cannot consciously start or stop. The development of fine motor skills is crucial to an infant's ability to experience and learn about the world and thus plays a central role in the development of intelligence. Like gross motor skills, fine motor skills develop in an orderly progression, but at an uneven pace characterized by both rapid spurts and, at times, frustrating but harmless delays. In most cases, difficulty with acquiring certain fine motor skills is temporary and does not indicate a serious problem. However, medical help should be sought for children who are significantly behind their peers in multiple aspects of fine motor development; or if they regress, losing previously acquired skills.
Function
Fine motor skills develop over a long period of time, primarily during childhood. However, athletes, musicians, jewelry makers, physicians, machinists, and others who engage in activities requiring high degrees of manual dexterity and control may spend decades improving their level of muscle coordination and fine motor skills.
Infancy
The hands of newborn infants are closed most of the time and, like the rest of their bodies, are not well controlled. If its palm is touched, an infant will make a very tight fist, but this is an unconscious action called the Darwinian reflex, and it disappears within two to three months. Similarly, an infant will grasp at an object placed in the hand, but without any conscious awareness of the act. At some point, hand muscles will relax, and an infant will drop an object, equally unaware that it has fallen. Babies may begin flailing at objects that interest them by two weeks of age but cannot grasp them. By eight weeks, they begin to discover and play with their hands, at first solely by touch, and then, at about three months, by sight as well. At this age, however, the deliberate grasp remains largely undeveloped.
Hand-eye coordination begins to develop between the ages of two and four months, inaugurating a period of trial-and-error practice at sighting objects and grabbing at them. At four or five months, most infants can grasp an
object that is within reach, looking only at the object and not at their hands. Referred to as "top-level reaching," this achievement is considered an important milestone in fine motor development. At the age of six months, infants can typically hold on to a small block for a brief period, and many have started banging objects. Although their grasp is still clumsy, they have acquired a fascination with grabbing small objects and trying to put them in their mouths. At first, babies will indiscriminately try to grasp things that cannot be grasped, such as pictures in a book, as well as those that can, such as a rattle or ball. During the latter half of the first year, they begin exploring and testing objects before grabbing, touching them with an entire hand and eventually poking them with an index finger.
One of the most significant fine motor accomplishments is the pincer grip, which typically appears between the ages of 12 and 15 months. Initially, an infant can only hold an object, such as a rattle, in the palm, wrapping fingers (including the thumb) around it from one side—an awkward position called the palmar grasp, which makes it difficult to hold on to and manipulate the object. By the age of eight to ten months, a finger grasp begins, but objects can only be gripped with all four fingers pushing against the thumb, which still makes it awkward to grab small objects. The development of the pincer grip, the ability to hold objects between the thumb and index finger, gives infants a more sophisticated ability to grasp and manipulate objects, and also to drop them deliberately. By about the age of one, an infant can drop an object into a receptacle, compare objects held in both hands, stack objects, and nest them within each other.
Toddler period
Toddlers develop the ability to manipulate objects with increasing sophistication, including using their fingers to twist dials, pull strings, push levers, turn book pages, and use crayons to produce crude scribbles. Dominance of either the right or left hand usually emerges during this period as well. Toddlers also add a new dimension to touching and manipulating objects by simultaneously being able to name them. Instead of only random scribbles, their drawings include such patterns as circles. Their play with blocks is more elaborate and purposeful than that of infants, and they can stack as many as six blocks. They are also able to fold a sheet of paper in half (with supervision), string large beads, manipulate snap toys, play with clay, unwrap small objects, and pound pegs.
Preschool
The more delicate tasks facing preschool children, such as handling silverware or tying shoelaces, represent more of a challenge than most of the gross motor activities learned during this period of development. The central nervous system is still in the process of maturing sufficiently for complex messages from the brain to get to a child's fingers. In addition, small muscles tire more easily than large ones, and the short, stubby fingers of preschoolers make delicate or complicated tasks more difficult. Finally, gross motor skills call for energy, which is boundless in preschoolers, while fine motor skills require patience, which is in shorter supply. Thus, there is considerable variation in fine motor development among children of this age group.
By the age of three, many children have good control of a pencil. Three-year-olds can often draw a circle, although their attempts at drawing people are still very primitive. It is common for four-year-olds to be able to use scissors, copy geometric shapes and letters, button large buttons, and form clay shapes with two or three parts. Some can print their own names in capital letters. A human figure drawn by a four-year-old is typically a head atop two legs with one arm radiating from each leg.
School age
By the age of five, most children have clearly advanced beyond the fine motor skill development of the preschool age. They can draw recognizably human figures with facial features and legs connected to a distinct trunk. Besides drawing, five-year-olds can also cut, paste, and trace shapes. They can fasten visible buttons (as opposed to those at the back of clothing), and many can tie bows, including shoelace bows. Their right-or left-handedness is well established, and they use the preferred hand for writing and drawing.
Role in human health
Nurturing the development of fine motor skills is considerably more complicated than developing gross motor skills. Helping a child succeed in fine motor tasks requires planning, time, and a variety of play materials. Fine motor development can be encouraged by activities that youngsters enjoy, including crafts, puzzles, and playing with building blocks. Helping parents with everyday domestic activities, such as baking, can be fun for a child in addition to developing fine motor skills. For example, stirring batter provides a good workout for hand and arm muscles, and cutting and spooning out cookie dough requires hand-eye coordination. Even a computer keyboard and mouse can provide practice in finger, hand, and hand-eye coordination. Because the development of fine motor skills plays a crucial role in school readiness and cognitive development, it is considered an important part of a preschool curriculum. Montessori schools in particular were early leaders in emphasizing the significance of fine motor tasks and the use of learning aids such as pegboards and puzzles in early childhood education. The development of fine motor skills in children of low-income parents, who often lack the time or knowledge required to foster these abilities, is a key ingredient in the success of such programs as Head Start.
Common diseases and disorders
There are a range of diseases that decrease one's ability to perform tasks that require fine motor skills. Among young persons, such developmental problems as genetic disorders, muscular dystrophy, cerebral palsy and some neurological conditions adversely impact fine motor skill development. Among older persons, arthritis is a common condition. Arthritis affects the joints of the hands and feet, thus impairing the ability of muscles to perform fine movements. Stroke can impair fine motor coordination. Parkinson's disease affects fine motor movements. Alcoholism and drug use or withdrawal all cause fine motor problems.
KEY TERMS
Darwinian reflex—An unconscious action in infants in which if a palm is touched, the infant makes a very tight fist. This instinct disappears within two to three months.
Gross motor skills—The abilities required to control the large muscles of the body for walking, running, sitting, crawling, and other activities. The muscles required to perform gross motor skills are generally found in the arms, legs, back, abdomen and torso.
Locomotion—Such movements as walking.
Motor—A term referring to muscles and movement.
Palmar grasp—A young infant's primitive ability to hold an object in the palm by wrapping fingers and thumb around it from one side.
Pincer grip—The ability to hold objects between thumb and index finger, which typically develops in infants between 12 and 15 months of age.
Top-level reaching—The ability of an infant to grasp an object that is within reach, looking only at the object and not at their hands. Typically develops between four and five months of age.
BOOKS
Hernandez, Kimberly T. Kid's Play. Laporte, PA: Quest Publishing, 2001.
Katzen-Luchenta, Jan. Awakening Your Toddler's Love of Learning. Phoenix, AZ: Emunah Publishing, 1999.
Needleman, Robert D. "Growth and development." In Nelson Textbook of Pediatrics, 16th ed. edited by Richard E. Behrman et al. Philadelphia, PA: Saunders, 2000, 23-66.
Payne, V. Gregory, and Larry D. Isaacs. Human Motor Development: A Lifespan Approach, 4th ed. New York, NY: Mayfield Publishing, 1998.
Rosetta, Lani. Labyrinths for Kids. Medford, OR: Leihuna Enterprises, 2001.
PERIODICALS
Case-Smith, J. "Effects of occupational therapy services on fine motor and functional performance in preschool children." American Journal of Occupational Therapy 54, no. 4 (2000): 372-380.
Crowe, T.K., C. McClain, and B. Provost. "Motor development of Native American children on the Peabody Developmental Motor Scales." American Journal of Occupational Therapy 3, no. 5 (1999): 514-518.
Hemgren, E., and K. Persson. "A model for combined assessment of motor performance and behaviour in 3-year-old children." Uppsala Journal of Medical Science 104, no. 1(1999): 49-85.
Kumar, M., S. Hickey, and S. Shaw. "Manual dexterity and successful hearing aid use." Journal of Laryngology and Otology 114, no. 8 (2000): 593-597.
Luck, O., B. Reitemeier, and K. Scheuch. "Testing of fine motor skills in dental students." European Journal of Dental Education 4, no. 1 (2000): 10-14.
Stieh, J., H.H. Kramer, P. Harding, and G. Fischer. "Gross and fine motor development is impaired in children with cyanotic congenital heart disease." Neuropediatrics 30, no. 2 (1999): 77-82.
ORGANIZATIONS
American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. (847) 434-4000. (847) 434-8000. <http://www.aap.org/default.htm>. kidsdoc@aap.org.
American Academy of Physical Medicine and Rehabilitation. One IBM Plaza, Suite 2500, Chicago, IL 60611-3604. (312) 464-9700. (312) 464-0227. <http://www.aapmr.org/consumers/public/amputations.htm>. info@aapmr.org.
