Fine Motor Skills



Development of Fine Motor Skills in Pre-term Infants.

Arend F Bos, Koenraad N J A Van Braeckel, Marrit M Hitzert, Jozien C Tanis, Elise Roze

Fine motor skills involve the use of the smaller (fine) muscles in the hands, fingers and wrists to engage in activities such as grasping and holding items, writing, threading, cutting, fastening buttons turning pages on a book, typing on a computer keyboard and brushing teeth. A child’s hand-eye coordination involves the use of their eyes to direct their muscles towards a task and plays a supporting role in the development of a child’s fine motor skills.

Preterm infants, including thoese born moderately preterm (32 - 34 weeks gestation) can have difficulties in the development of their fine motor skills which impacts their ability to engage in age appropriate activities. As school age, between 40% and 60% of very preterm infants (born <32 weeks gestation) experience difficulties in the use of their fine motor skills.  Neonatal conditions that can increase the risk of a preterm infant experiencing difficulties in the use of fine motor skills in early childhood include intra-uterine growth restriction, inflammatory conditions and bronchopulmonary dysplasia (chronic lung disease)


Fine motor skills are essential to everyday life and support a child’s growing independence as they develop and master self-care tasks such as feeding, dressing, tying shoelaces, opening lunch boxes and pouring drinks. A child’s fine motor skills also support their developing academic skills as they participate in activities such as writing and drawing.

When a child is having difficulties using their fine motor skills to complete activities that are appropriate for their age, they may have a delay in this area of development. If you are unsure about what are age appropriate activities for your child, it can be helpful to talk to your child’s teachers or your GP.

Some signs that a child may be experiencing a delay in their fine motor skills include:

  • Holding their pencil with immature grasp for their age
  • Difficulty completing age appropriate tasks by themselves such as doing up buttons or using cutlery
  • Drawing, colouring or writing appears messy and effortful
  • Tires easily when typing, using a mouse, or completing other activities that require use of their hands
  • Struggles with age appropriate self-care tasks, such as getting dressed, putting on shoes or opening and closing zippers
  • Unable to use scissors effectively
  • May appear clumsy when handling objects and frequently drops things
  • Dislikes and avoids tasks such as Lego, puzzles or threading


As a parent, you bring a wealth of information about your child’s development and how they’re managing in different activities across their day. If you have concerns about your child’s fine motor skills, it may be helpful to speak to their classroom teacher. The teacher may have observed similar difficulties in the school environment and may have suggestions on what you and the school can both be doing to support the development of your child’s fine motor skills.

If fine motor difficulties have been observed, a referral to an Occupational Therapist (OT) who can provide a detailed assessment of your child’s development can be helpful. An OT can help identify your child’s strengths and challenges and if needed, may recommend a treatment plan that may involve some 1:1 therapy sessions.

In addition to seeking professional help, parents and caregivers can continue to support and strengthen the development of their child’s fine motor skills by engaging in a variety of play activities.  Children respond best when activities are fun, enjoyable and interactive so the more creative you can be the better.  Play can be a powerful tool in supporting a child’s development. IT provides an enriched environment and opportunities to try and practice new skills as well as building healthy connections between a parent and their child.

Play activities to strengthen fine motor skills:

  • Threading and lacing activities
  • Pick up items with a small pair of tongs or tweezers
  • Play games that require manipulation such as puzzles, Connect 4, Ker Plunk, Jenga
  • Play with playdough and clay to mould, stretch, squeeze, pound
  • Use construction toys that require pushing and pulling e.g. Lego
  • Posting activities (e.g. placing toys into holes)
  • Craft activities using scissors, sticky tape, stapler, hole punch
  • Play board games that involve rolling a dice and moving a counter e.g. Snakes and Ladders, Monopoly
  • Painting with fingers and whole hands also with brushes, thick and thin.
  • Free drawing with crayons, chalk, pencils.

Useful links:,%2C%20grasping%2C%20holding%20and%20pinching.



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Disclaimer: This publication by Miracle Babies Foundation is intended solely for general education and assistance and it is it is not medical advice or a healthcare recommendation. It should not be used for the purpose of medical diagnosis or treatment for any individual condition. This publication has been developed by our Parent Advisory Team (all who are parents of premature and sick babies) and has been reviewed and approved by a Clinical Advisory Team. This publication is not a substitute for professional medical advice. Miracle Babies Foundation recommends that professional medical advice and services be sought out from a qualified healthcare provider familiar with your personal circumstances.To the extent permitted by law, Miracle Babies Foundation excludes and disclaims any liability of any kind (directly or indirectly arising) to any reader of this publication who acts or does not act in reliance wholly or partly on the content of this general publication. If you would like to provide any feedback on the information please email [email protected].