As occupational therapy practitioners, part of our training as clinicians is to gain a solid understanding of children’s development. We learn to identify developmental milestones and failure to achieve them by using standardized assessments and our clinical observations.
Fine motor developmental milestones are the developmental stages of fine motor skills. These are the actions or acquired abilities a child demonstrates, marking a change in their development of fine motor skills. The milestones serve as a reference guide for children’s typical development and for identifying developmental delays.
| Age | Milestones | Possible Delays |
|---|---|---|
| 0-6 Months | – Develops accurate reach. – Uses variety of palmar grasping patterns – Secures object with hand and brings to mouth. – Transfers objects hand to hand. – Plays with hands at midline. | – Limited hand exploration: Baby shows minimal interest in reaching or exploring nearby objects or toys. – Limited grasping: Baby may find it difficult to grasp and secure objects or toys within reach. – Limited hand to mouth exploration: Baby may not bring hands to mouth or mouth toys consistently. – Limited hand to hand transfer: Baby may show limited or no interest in transferring toys or objects from one hand to the other. – Limited sensory motor and visual motor development. |
| 6- 12 Months | – Baby mouthing toys. – Uses secure and direct reach for toys. – Plays with toys at midline; transfers hand to hand. – Bangs objects together to make sounds. – Waves toys in the air. – Releases toys into containers. – Rolls ball to adult. – Points to toys with index finger, uses index finger to explore toys. – Crude use of tools. | – Limited ability to reach or grasp toys or nearby objects (6 months). – Difficulty crossing midline, lack or limited ability to transfer toys from hand to hand (7- 8 months). – Limited pincer grasp development for small items (9-10 months). – Limited ability to self-feed (10- 12 months). – Difficulty holding a spoon or cup with assistance(12 months). – Limited eye- hand coordination. – Limited sensory motor skills. |
| 12- 18 Months | – Holds crayon and makes marks; scribbles. – Holds two toys in hand and toys in both hands. – Releases toys inside containers, even small containers. – Stacks blocks and fits toys into form space (places pieces in board). – Attempts puzzles. – Opens and shuts toy boxes or containers. – Points to pictures with index finger. – Uses two hands in play, one to hold or stabilize and one to manipulate. | – Limited grasp patterns. – Arm and hand weakness. – Limited voluntary release: Voluntary releasing objects from hand or handing them to others. – Difficulty stacking or handling small objects. – Difficulty holding a spoon or cup for self-feeding. – Limited pincer grasp to pick up small items. – Difficulty placing piece in a wooden puzzle. – Limited ability to imitate movements such as clapping hands. – Limited interest in holding crayons or scribbling. |
| 18- 24 Months | – Completes four to five piece puzzle. – Build towers (e.g., four blocks). – Holds crayon in fingertips and draws simple figures (straight stroke or circular stroke). – String beads. – Begins to use simple tools (e.g., play hammer). – Participates in multipart tasks. – Turns pages of book. | – Limited pincer grasp to pick up small items (e.g., puff cereal). – Difficulty stacking blocks or completing puzzles. – Limited spatial- relations awareness. – Minimum or no interest on making marks or scribbling with crayon or pencil. – Difficulty with pretend play (e.g., playing with hammer). |
| 24- 36 Months | – Snips with scissors. – Traces form, such as a cross. – Colors in large forms. – Draws circles accurately. – Builds towers and lines up objects. – Holds crayon with dexterity. – Completes puzzles of four to five pieces. – Plays with toys with moving parts. | – Weakness of intrinsic hand muscles. – Limited or no interest using scissors. – Limited or no interest in tracing or coloring. – Limited pre-writing skills. – Immature crayon or pencil grasp. – Difficulty with clothing management (e.g., buttoning shirt, zipping up jacket). – Limited self-help skills (e.g., dressing, feeding). – Limited dexterity turning individual pages of a book. – Limited eye-hand coordination (e.g., throwing and catching a ball). |
| 3- 4 Years | – Uses tripod grasp on pencil or crayon. – Colors within the lines. – Copies simple shapes; begins to copy letters. – uses scissors to cut; cuts simple shapes. – Constructs three-dimensional design (e.g., three-block bridge). | – Immature pencil grasp. – Limited or no interest in coloring or any pencil-based activities. – Limited fine motor coordination (e.g., coloring within the lines, drawing shapes accurately). – Difficulty cutting with scissors or cutting on the line. – Difficulty with self-care tasks (e.g., buttoning down shirt, zipping up jacket). – Increased frustration when playing with action figures or dolls. – Difficulty performing tasks requiring finger isolation (e.g., using one finger at a time). – Difficulty performing task requiring pincer grasp (e.g., picking up small items). |
| 4- 5 Years | – Draws using a dynamic tripod grasp. – Copies simple shapes. – Completes puzzles of up to 10 pieces. – Uses scissors to cut out squares and other simple shapes. – Colors within the lines. – Uses two hands together well, one stabilizing paper or object and other manipulating object. – Draws stick figure or may begin to draw trunk and arms. – Copies own name. – Strings 1/4-inch beads. | – Immature pencil grasp. – Difficulty managing scissors and cutting within the line. – Limited fine motor control to write own name, color, and draw simple shapes. – Frustration with pencil and paper activities. – Difficulty opening containers and with any activity requiring hand strength. – Limited bilateral hand coordination (e.g., activities requiring the use of both hands at the same time). – Limited eye-hand coordination (e.g., throwing and catching a ball). – Difficulty with self-care skills (e.g., dressing, brushing teeth, tying shoelaces). |
| 5- 6 Years | – Cuts with scissors. – Prints name from copy. – Copies triangle; traces diamond. – Completes puzzles of up to 20 pieces. – Traces letters, begins to copy letters. – Manipulates tiny objects in fingertips without dropping. – Uses two hands together in complementary movements. | – Immature pencil grasp. – Difficulty holding scissors properly and safely. – Difficulty cutting in the line and simple line-patterns. – Avoidance and frustration with pencil-paper activities. – Limited writing skills. – Prefers to color with markers than crayons or color pencils. – Difficulty completing written assignments. |
| 6- 10 Years | – Good dexterity for crafts and construction with small objects. – Bilateral coordination for building complex structures. – Precision and motor planning evident in drawing. – Motor planning evident in completion of complex puzzles. | – Difficulty performing arts and crafts activities. – Limited bilateral hand coordination (e.g., origami figures, tying shoes). – Immature pencil grasp. – Difficulty with writing components (e.g., letter formation, size, line regard). – Difficulty with paper-pencil activities. – Poor academic performance (e.g., illegible handwriting or incomplete written assignments). – Difficulty performing self-care activities (e.g., tying shoes, dressing, self- feeding). – Bilateral hand weakness. – Limited fine motor control. |
It is essential to remember that children are unique and develop at different rates. Also, children may present with other delays not mentioned in this chart. Therefore, if a parent, caregiver, or teacher notices their child or student consistently has difficulty performing everyday tasks, it is important to advise their pediatrician, who can refer them to an occupational therapist for an evaluation.
“Always remember, empowering our children goes a long way in helping them become independent and build their self-esteem.”