1

Children, Young People and Families Occupational

Therapy Team

FINE MOTOR SKILLS

Integrated Disability Service Integrated Disability Service

Lancaster House Saltisford Office Park

Exhall Grange Campus Building 1

Easter Way Ansell Way

Exhall Warwick

Coventry CV34 4UL

CV7 9HP

Tel: 02476 368 800 Tel: 01926 413 737

Fax: 02476 368 800 Fax: 01926 742 474

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 2

Contents

Page Number
Developing Early Fine Motor Skills 3-5
Finger Co-ordination 6-8
Range of Movement Exercises – Finger & Thumb 9
Fine Motor Warm Ups 10-11
Hand Strengthening Exercises 12-13
Putty Program for Strengthening Hands 14-15
Advance Putty Exercises 16-17
Wrist Movements 18-19
Range of Movement Exercises – Wrist & Forearm 20
Bilateral Integration 21-22
Crossing Mid-line 23-24
In hand Manipulation 25-28
Hand Dominance 29-30
Fine Motor Skills Program 31-33
Play dough Recipe 34

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 3

Developing Early Fine Motor Skills

Grasping

The best objects to use for a young child are toys that are easy to
pass from hand to hand such as soft rattles with handles or rings.

Banging toys

Learning to bang items down will help to

strengthen your child’s grasp and encourage controlled arm
movements. This activity can be done in a variety of positions i.e.
with the child sitting in an adult’s lap and banging on a table surface,
sitting in a high chair and banging on the tray, etc. Items that are
suitable for banging include spoons, rattles and plastic hammering
toys.

Dropping

Dropping toys is a natural stage in a child’s development and should be encouraged.

Activities to use with the child can include:

Dropping toys in the bath (rubber duck, sponge). Demonstrate dropping the toy
and making a splash and encourage your child to do the same.

Dropping toys over the edge of the high chair and watching them fall or dropping
them onto the highchair tray.

Dropping toys onto a surface to make a noise, for example, i.e. toys that squeak
when dropped, dropping toys into metal bowls, etc.

Taking items out of containers

Children generally learn to take objects out of containers before they put them back in.
This is a normal developmental stage and will help the child to develop grasp patterns
for a variety of different objects. This skill can be encouraged using activities such as:

Removing shapes from a shape sorter toy

Taking blocks/bricks out of toy buckets

Removing toy people from dolls houses/toys buses etc.

Removing pieces out of inset jigsaw puzzles

Removing shoes from a shoe cupboard

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 4

Releasing into Containers or Holes

Once the child has learned to pass a toy purposefully and can drop a toy they are ready
to learn to release into a container. This again is a normal developmental stage and will
help the child to release with accuracy. Activities to encourage this can include:

Dropping favourite toys into boxes, bags, bowls or containers.

This can be made more fun by using toys that make a noise
when they are dropped into the container or by using a
container that will encourage a noise e.g. metal bowl.

Commercially produced toys sometimes have chimneys or
openings that are fun for children to drop objects into.

Very simple shape sorters with only one opening may be
suitable but beware of making the task too difficult too early.

Placing Items Down

This skill involves being able to place objects down in an upright position on a flat
surface. Activities that encourage this skill could include:

Placing a drinking cup down on the table surface after drinking. Initially this could
be a beaker with a lid. As the child develops introduce a cup without a lid but
only put a small amount of drink in the cup to avoid excessive spills. If necessary
use a weighted cup that will right itself if not placed own flat.

At bath time encourage the child to pick up toy ducks, sponges, etc. from the
bathtub and place them on the side of the bath. Make this more fun by watching
them fall in again.

Place cars on a toy garage ramp and watch them roll down.

Practice placing toy people/cars etc. in an upright position during play.

Place toy-bowling pins in an upright position and then knock them over with a
large ball.

Palmar Grasp

Encourage your child to encircle the handle of toys with their fingers and thumbs. This
will help to strengthen the fingers and the thumb joints ready for picking up smaller
items in the future. Some objects useful for doing this are:

A cup without a handle, placing the thumb around the

cup

Toy plastic hammers and other toy tools

Small balls

Balls of playdough/plasticine

Any toy with a handle.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 5

Tripod Grasp

This involves your child beginning to isolate their thumb and first two fingers to pick up
and release objects rather than raking up the object into the palm of the hand. Some
toys and activities to help encourage this grasp include the following:

Placing and removing large pegs in/out of peg boards.

Puzzles with large knob handles

Removing and replacing lids from large marker pens

Square blocks.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 6

Finger Co-ordination

As your child develops they will need to learn to move their fingers separately from each
other. This is an important skill that will help them to achieve later skills such as using a
computer keyboard, tying shoelaces, and using a can opener.

Pointing

Pointing is the first developmental activity that prepares the child for later finger co-
ordination skills. Some children may point with the whole hand rather than the index
finger. If this happens, then gently close the rest of the hand leaving only the index
finger to point with.

Encouraging individual finger movement (Finger Isolation)

Once a child has learnt to point they will then begin to poke objects with the index
finger. Activities to encourage this include:

Pre-school books with finger holes

Finger puppets

Toy dial telephones

Holes in Duplo blocks

Poking holes in playdough/plasticine.

As your child develops, other activities that encourage individual finger movement can
be introduced. Activities to encourage this include:

Turning on and off light switches (they will need to be supervised and probably
held up to do this activity)

Pushing the doorbell button

Switching on the T.V, stereo, etc.

Pushing the buttons on touch-dial toy phones

Pushing the buttons on toy tills, cookers

Action songs and finger rhymes (e.g. round and round the garden, two little
blackbirds, one two three four five)

Books with tabs to push, pull and turn

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 7

Turning the pages of books, initially board books and then progressing to books
with paper pages

Use shaving foam or finger paint and encourage your child to freely move their
fingers about to produce different patterns (i.e. pretend to play the piano)

Musical keyboards – encourage your child to use different fingers to produce a

sound. Later on encourage playing of simple instruments such as a recorder

Card games – Picking up and holding cards can help to develop hand stability
and finger co-ordination. Start with simple matching games such as snap and
encourage the child to deal out the cards

Snacktime – give the child small objects e.g. raisins, chocolate buttons, Cheerio’s
etc. to encourage them to use their fingers to pick them up.

Pinch and Thumb Control / Finger Opposition

This is the ability to pick up very small items using the thumb and index finger in
opposition to each other (pincer grasp). Your child will first learn to bring the sides or
pads of their thumb and index finger together to grasp a small object. They will then
progress to being able to pick up an object using the tips of the thumb and index finger.

Activities to encourage development of the pincer grasp are given below:

Finger feeding – young children are often motivated to pick up small pieces of
food using this grasp. If your child has difficulty doing this you may need to start
by gently guiding their index finger and thumb towards each other.

Separating stacking/nesting cups from within each other

Releasing disc like objects into slots i.e. tops from Pringles containers into wide
horizontal slots made in boxes. Progress onto releasing coins into a moneybox
or coins into parking meters and vending machines as you child gets older.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 8

Pinching clothes pegs and attaching them around the edge of a shoebox or
similar.

For older children playing games such as Connect Four and having to pick up the
discs using a pincer grasp.

Cake decorating – using hundreds and thousands to decorate cakes will

encourage use of a pincer grasp.

Sorting activities to encourage the child to pick up small objects using a pincer
grasp e.g. beads, dry pasta shapes, coins and games such as pick up sticks.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 9

Range of Movement Exercises – Fingers and Thumb

Put your forearm on a table

Start with your fingers bent, then slowly straighten your fingers until
your hand is flat on the table

Place the palm of your hand flat on the table.

Lift your thumb and each finger off the table in turn

Place the palm of your hand flat on a table

Spread your fingers out, then bring them together

Put your elbow or the back of your hand on the table

Put your thumb against each fingertip in turn

Hold all fingers straight

Make a big circle with your thumb

IF ANY OF THE EXERCISES CAUSE SEVERE PAIN OR DISCOMFORT,

DISCONTINUE AND CONTACT YOUR THERAPIST

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 10

Fine Motor Warm Ups

Shoulder Spirals

Hold both arms out horizontally to the side and start to

circle them, initially making small circles but gradually
getting larger until the circles are as large as possible,
(this should take about 5 rotations).

When the circles have reached full size, change direction
and gradually reduce the circles, (again taking about 5
rotations) to get back to the smallest size.

Start by trying to complete 3 spiral sequences then
gradually build up the number you can do. Aim to do 10
spiral sequences comfortable. This will help improve your
stamina when writing.

Half Push Ups

Lie face down on the floor and push your body up

with your arms in the same way as a normal press-
up, but keeping your tummy on the floor. (if you are
able to lift your tummy off the floor then you can do
this)

Repeat 10 times.

Wall Push Ups

Stand facing a wall about 1½ arms length away

from it.

Stretch your arms out in front (keeping them at
shoulder level) to place your hands flat on the
wall. Then bend your arms to try to bring your
face to the wall, without moving your feet.

Keeping your body straight, straighten your arms,
pushing yourself away from the wall.

Repeat 10 times.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 11

Creeping Thumbs

Use a long thin piece of material such as a

bandage. Sit at a table and stretch the
material out horizontally (as shown).

Put your writing hand at on end of the
material (right side if right handed, left side
if left handed). The palm should be on the
table with the fingers resting on the
material. Try and gather up the material,
tucking it under your hand, using only your
thumb and keeping your wrist still.

Complete 5 times; try to increase your speed each time.

Creepy Crawlies

Sitting at a table, place the material in front of

you, stretching it out vertically.

Put your writing hand on the end of the
material nearest to them to anchor it. Try to
gather up the material, using the fingers of that
hand only while keeping the wrist still.

Complete 5 times; try to increase your speed
each time.

Other Warm up Activities

Shrug shoulders

Shake arms and hands down by sides

Place palms together, fingers spread (chest height)

Press fingers together, lift elbows up and out, push heels of hands down

Interlace fingers and stretch arms out in front

Rotate hands so palms face away from body – straighten elbows and stretch

Rest hands on table – pretend piano playing to loosen fingers

Place hands flat on the table, palms face down lift fingers individually starting
with the thumb

Touch thumb tip to individual fingers tip – eyes open. Progress to eye closed

Let arms hang down by sides. Alternatively grip (fist) and release hands

Shake hands and arms loosely down by sides and relax shoulders.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 12

Hand Strengthening Exercises

Hand strengthening exercises may benefit children who have weak or immature grips
on a pencil. Extension and spreading of the hand can help to build strength and stamina
and may improve control of movement for fine motor work and in particular for pencil
control and writing.

The following are examples of exercises which would be helpful for building hand
strength. Children should shake their hands vigorously between activities.

1. Sit with the palms of hands together, fingers spread. Keeping the fingers pressed
together, push the elbows out and the heels of the hands down. Repeat a few times.

2. Sit with fingers interlaced. Stretch arms out in front of the body, pushing the palms of
the hands forward away from the body. Repeat a few times.

3. Stand an arm distance away from a wall, with the hands flat on it. Keeping the arms
straight, use fingers to push away from the wall to get to an upright position. As the
child becomes more proficient, move the feet backwards so that there is a greater
angle of lean against the wall.

4. Bunny jumps. Crouch down, place hands a shoulder width apart, and kick feet in the
air. Ask the children to keep their feet in the air as long as possible.

5. From a crouch position, with hands flat on the ground, try to touch a ball with the
forehead without moving it. The ball is placed slightly in front of the hands. Start with
a large ball, progressing to a tennis ball.

6. Cartwheels.

7. Modified crab walk.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 13

8. Modified press up, first on the hands, then on the fingertips.

9. Modified chair dips. Kneel between two chairs, one hand on each chair. Push up
with the hands to raise the body on to the toes.

10. Coffee grinder. Crouch down, with the hand used for writing on the ground to the
side of the body. The child walks round the spread hand.

11. As in 10, but the free hand guides or bounces a ball as the child moves around.

12. (In pairs) Wheelbarrows. The ‘barrow’ keeps fingers spread wide as he or she is
guided along. This should be done for only short distances.

13. (In pairs) Wheelbarrow wrestle. The child holding the ‘barrow’ tries to stand still while
the ‘barrow’ tries to hand walk around the supporter and pull him or her off balance.

14. Two handed pushing using a board or tray. Two children face each other in a
standing position, arms outstretched, hands spread, holding the board between
them. By pushing the board they try to push their partners backwards.

From: Graded Activities for Children with Motor Difficulties, James P. Russell
Programme 13, Activities for the ‘Writing’ Hand.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 14

Putty Program For Strengthening Hands

Gross Opposition

Shape dough into cone and stick base to a flat surface. Place
fingers and thumb over the top of the cone. Stick the fingers
lightly into the dough at the base. Pull up on the cone bringing
the fingers and thumb together at the peak.

Isolated Opposition

Place ball of dough between thumb and index finger. Pinch

through the ball until the fingers meet. Repeat with each of
the other fingers.

Gross Finger Flexion

Place dough in palm of hand and curl fingers to make a fist.

Squeeze as hard as possible.

Flatten a ball of dough onto the table. Start with fingers and thumb
spread around the edge of the circle, then pull fingers and thumb
towards each other into the middle of the circle.

Gross Finger Extension

Make a flat disc of dough on the table.

Keep fingers straight as you push outwards spreading dough until thin.

Roll dough out into a sausage keeping the fingers straight.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 15

Isolated Finger Flexion

Hold dough in opposite hand. Push one finger into the

dough and pull the dough into the palm of the other
hand. Repeat with each of the other fingers.

Finger Adduction

Place a piece of dough between two fingers, squeeze

fingers together, try to keep fingers straight.

Thumb Extension

Shape dough into a cylinder. Rest edge of hand on the table

with thumb pointing up. Press thumb deeply into the cone,
then pull out again.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 16

Advanced Putty Exercises

These exercises will strengthen the muscles of your finger, hand and forearm.

Finger Hook

Make a hook with your fingers as

you press into the putty.

Full Grip

Squeeze your fingers into the

putty like you are making a fist.

Finger Extension

Loop the putty over the end of the finger

while it is bent. Try to straighten your finger.

Finger Spread

Spread the putty lie a pancake

over your finger and thumb. Try to
spread them apart.

Finger Scissor

Place a 1 inch piece of putty between

each pair of fingers and squeeze
together.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 17

Finger Pinch

Pinch the putty between each finger

and the thumb.

Scissor Spread

Place the putty around two

fingers at a time and try to
spread them apart.

Thumb Extension

Loop the putty at the end of your thumb while it is bent. Try
and straighten your thumb by pulling it upward.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 18

Wrist Movements

The wrist positions and stabilises our hand so that we can use it appropriately during
everyday activities.

The wrist moves from side to side, up (extension) and down (flexion), and also rotates
between supination (palm facing up) and pronation (palm facing down).

Wrist movements start to develop during play and eating, for example, the child will
rotate their wrist and forearm whilst holding something in order to see it better, or bring it
to the mouth.

Early activities to encourage rotation of the wrist include the following:

Sensory play – pouring sand, dry pasta, water, etc. into your child’s palm to
encourage them to rotate the wrist and ‘cup’ the substance.

Playdough/plasticine – Rolling out play dough and then flattening it with the
palms of the hands. This encourages the wrist to extend.

Finger rhymes such as ‘round and round the garden’ to encourage your child to
rotate at the wrist to allow the actions to take place on the palm.

Later activities

Clapping games i.e. ‘give me five.’ This fun greeting

encourages the child to rotate the wrist when offering the
palm for ‘five’.

Drawing at an upright surface such as an easel or blackboard

to encourage extension at the wrist.

Squeezing liquid soap into the child’s hands when washing

hands to encourage them to cup the liquid.

When washing hair, squeeze shampoo into the child’s cupped hands.

Cupping sweets such as Smarties in the hands before sharing out with friends.

Opening jars and lids (squash bottles, toothpaste, etc.).

Turning keys in a lock to open doors.

Turning doorknobs.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 19

Cooking activities, e.g., stirring cake mixture, sprinkling hundreds and thousands
onto iced cakes.

Shaking and rolling a dice during board games.

Throwing a Frisbee.

Tossing a bean bag from one hand to another.

Pouring water or dried pasta between assorted shapes and sizes of container.

Playing cards to encourage picking up and turning over of cards (e.g. Snap, Old
Maid, pairs).

Finding an item that is hidden under upturned cups or small containers.

Playing with musical instruments such as a tambourine and drums.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 20

Range of Movement Exercises – Wrist and Forearm

Support the forearm on a table with the hand relaxed over the
edge.

Extend the wrist up, then relax and lower the hand back down.

Support your forearms on a table with your hands over the edge.

Clasp your hands together and gently bend your wrists up and
down.

Place the palm of the hand flat on the table, holding the wrist and
fingers straight.

Bend the wrist from side to side, first towards the little finger, then
towards the thumb.

Hold your forearms horizontally in front of you and place your palms
together.

Push your palms together for approximately 5 seconds then relax.

Support your forearms on a table and clap your hands together.

Place the back of one hand on the table.

Gently turn your hands to put the back of the other hand on the
table. Ensure you elbows stay close into your sides.

IF ANY OF THE EXERCISES CAUSE SEVERE PAIN OR DISCOMFORT,

DISCONTINUE AND CONTACT YOUR THERAPIST

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 21

Bilateral Integration

These are some ideas for activities, which could be used to help encourage your child
to use both hands (bilateral integration) to carry out tasks.

For most of the activities it would be preferable to seat the child at a table or with a tray
in front, to focus their attention on the activity, for short periods of time. The list of
activities is intended to give ideas, they do not all need to be carried out and some of
them can be modified to suit your child.

Massage your child’s hands and arms to alert sensory receptors and muscles,
particularly before fine motor activities. Lotion or baby oil can be used but is not
necessary.

Rolling a large ball to and from the child encouraging them to hold it with both
hands and push it back.

Holding a ball (or other large toy) above the child’s head, encouraging the child to
reach up with both hands to take it.

Playing with toys which need two hands to operate them e.g.
accordion, posting tube, cymbals, drum with two sticks, wind up
toys, kaleidoscope.

Playing with objects that need to be pulled apart, e.g. Unicubes,

large pop apart beads, Duplo and Stickle Bricks.

Play dough, using both hands to squeeze, roll, shape, pull apart.

- Hold large piece of play dough in one hand and pass to other hand
squeezing to form a ball – continue to pass from hand to hand until a
ball shape is made.
- Take dough and roll play dough between hands to make fat sausage
shape. Remember not to press hands together too hard and to keep
sausage moving through palm of hands so that it is even in size.
- Take sausage with dominant hand and take pieces off with other hand
making them into ‘peas’.
- Place “peas” in a line in front of child with right hand squeeze each pea
between index finger and thumb. Repeat process for left hand. Then
repeat process but pinching peas simultaneously with both hands, with
right hand working from right side to middle and left hand working from
left side to middle.

Taking the top off a see-through container to get at a toy, biscuit or sweet,
encouraging the use of both hands.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 22

Clapping hands and hand rhyming games e.g. Wheels on the Bus,
Incy Wincy Spider, Twinkle Twinkle, Round & Round the Garden.

Reaching into a bag using both hands to find tactile toys or toys that
make sounds, e.g. bells, furry toys, smooth, rough, etc.

Messy play using both hands, e.g. with shaving foam, rice pudding, jelly, pasta.

Looking for toys hidden in pasta or rice (needs supervision if child tends to put
things in mouth).

Hide a scarf or hanky on one side, for example, in the child’s pocket and
encourage them to find it with the opposite hand.

Encourage the child to carry heavier toys with both hands.

Scooping, pouring, filling, emptying containers with sand or water, encouraging

both hands in play.

Putting a ribbon or yarn around the fingers of a hand and letting the child take it
off with the other hand.

Encourage the child to hold a book with one hand and turn the pages with the
other.

Paper tearing with different types of paper, e.g. newspaper, tissue paper.

Encouraging the child to release a toy from the non-dominant hand by:
- asking the child to ‘give it to Mummy/Daddy’ or to ‘put it down’.
- encouraging the child to drop the toy into a box, bag, bowl or container.
- using shape sorter toys.

Other Bilateral Activities

Lego / Duplo
Toy phone with buttons

Stickle Bricks
Soft toy with variety of

Rainbow rings fastenings, e.g. poppers,

Toy workshops with nuts zips, buttons and velcro
and bolts etc.

Snap together toys
Wind up toys, e.g. with a

Threading cotton reels key or knob to turn.

Screw toys
Unwrapping sweets!!

Billie Barrels/Russian Dolls
Open envelopes and

Brio / ELC train track unwrap presents! (A very

Early 2-4 piece jigsaws festive suggestion).

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 23

Crossing Mid-line

Crossing the midline means that one hand spontaneously moves over to the other side
of the body to work there.

Before this ability is established, you may have noticed that your young child tends to
use the left hand on the left side of the body and the right hand on the right side of the
body.

Why is midline crossing so important?

When your child spontaneously crosses the midline with the dominant hand, then the
dominant hand is going to get the practice that it needs to develop good fine motor
skills.

If your child avoids crossing the midline, then both hands will tend to get equal practice
at developing skills, and your child’s true handedness may be apparently delayed. So,
in order for your child to do well at learning to write, there has to be a dominant, strong
hand that becomes specialised at doing the job of controlling the pencil.

“Picking apples off the tree” – reach up with one arm extended and stretch
across the body, and pretend to pick an apple off the tree, keeping elbow
straight. Return arm to position down at side of body and repeat with other arm.
Repeat full exercise 5 times.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 24

“Pegs” – Place clothes pegs on a jumper/t-shirt; one on each shoulder and knee
and either side of waist. Remove clothes pegs by using the opposite hand to the
side of the body where the peg is placed (i.e. right hand to remove peg from left
shoulder). Ensure pegs are removed using a pincer grip to squeeze the peg
rather than pull it off.

Clapping games – with partners, facing each other. Vary using different rhymes,
speeds, patterns.

Stopping a ball as it rolls down the left side of the table using right hand side and
vice versa.

“Simon Says” involving movements that encourage crossing midline.

Hitting a ball using both hands. As the ball

approaches from the side, make sure the child faces
front and is crossing the midline.

Cleaning windows, desk, blackboard.

Drawing from left to right across blackboard, large

pictures on the wall. Child keeps their body still and move their arms to draw, for
example, rainbows.

Throwing bean bags, small toys or balls into a container placed on their left side
if they are throwing with the right hand or their right if throwing with left hand.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 25

In-hand manipulation

In-hand manipulation involves manipulating an object within one hand. The fingers and
thumb are used to best position the object for the activity. For example, picking up a pen
and moving it into position with your fingers for writing. Some daily activities using in-
hand manipulation include: positioning a pencil when drawing; adjusting the paper when
cutting with scissors; doing up buttons; tying shoelaces and using a knife and fork. In-
hand manipulation is one of the most complex fine motor skills.

Helpful strategies

Show and explain to your child how to do the activity in the correct way before
your child does the activity.

Sit with your child during in-hand manipulation activities so you can give
feedback to improve awareness of finger and thumb positions.

By doing the activities in the correct way and with regular practice your child will
develop his/her in-hand manipulation skills.

General activities

Encourage your child to do these activities with his/her preferred hand and use his/her
thumb and index finger (and middle finger if required). Discourage your child from using
her other hand, chest or the table to help.

Place a small object between the tips of your child’s finger and thumb and ask
him/her to hide the object in his/her hand. Two-pence coins, buttons, marbles,
dice or small pieces of food are good objects for hiding. Practice this activity with
a variety of objects.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 26

Ask your child to pick up a small object with his/her fingers and thumb and hide it
in her hand. Then while still holding the first object, encourage him/her to pick up
another object with the same hand and hide it. If successful, try picking up a third
object. This activity could be made more interesting by asking your child to
remove coins from a purse and hide them in his/her hand.

Encourage your child to move an object placed in the palm of his/her hand to the
tips of his/her fingers and thumbs. Objects that may be useful include small
pieces of food, coins, game pieces, beads for stringing. It may be easier for your
child to hide the object in the palm of his/her hand first and then try to manipulate
it to his/her fingertips.

Try incorporating some of the above activities when playing board games, marble
race or bead threading. For example, before moving a game piece, ask your
child to hide it in his/her hand then undo a lid from a drink bottle or jar with thumb
and fingers.

Select a key, from keys on a key ring, and put it in a lock.

Hold and adjust the paper while cutting with scissors.

Do and undo buttons.

Play Connect Four, however ask your child to pick up 3 counters one at a time
and hold them in his/her hand.

When it is his/her turn, ask him/her to move one counter back to his/her fingertips
and place it into the frame.

Use a dice or place a sticker on one side of a wooden cube. Encourage your
child to hold the dice or cube between the tips of her fingers and thumb and turn
it around and over to find “the number 6” or the sticker. Ensure your child does
not use the table or other hand to help.

Practice removing small objects from a change purse, baggie or container one at
a time and hiding each within the palm. Then placing them back, one at a time.

Place coins in a piggy bank, starting with several coins in the

palm.

String beads, holding 2 or 3 beads within the palm.

Pegboard games, holding 2 or 3 pegs within the hand.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 27

Twist open or closed lids on small bottles or toothpaste tube held within the palm
of the hand.

Flip a coin from heads to tails within the fingers of one hand.

Cut with scissors and practice adjusting the grip on the paper with the helping
hand

Practice buttoning, zipping and snapping snaps.

Turn dice within the fingertips to see different sides.

Hold a small cup filled with water. Practice turning it with

the fingertips without spilling.

Play with construction toys such as Duplo, Lego and K'nex.

Place clothes pegs around an index card or paper plate:

encourage using only one hand to position/reposition the
card or plate.

Craft activities that require using bottles to squeeze: glue, glitter glue, puffy paint,
fabric paint, etc.

Lacing boards, sewing cards.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 28

Pencil Games

Encourage your child to do these activities without using his/her other hand, chest or
table to help.

Hold the pencil in the fingertips, ready for writing, then "walk" the fingers to the
eraser end of the pencil, then back to the tip.

Turn the pencil between the thumb and fingertips: try turning it like a windmill in
one direction, then the other.

Use a hand held pencil sharpener to sharpen your pencils.

Using a pencil with a rubber on the end, encourage your child to write a letter,
turn the pencil around to rub out and then turn it back for writing again.

Place some coloured pencils on the table in front of your child. Ask your child to
pick up a pencil and write the first letter of his name. Encourage him/her to use
his/her preferred hand only and pick up and position the pencil for writing. Repeat
using a different coloured pencil for each letter of your child’s name.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 29

Hand Dominance

When one hand is consistently used more than the other hand, and is more skilled at
tasks than the other hand, then that hand is considered to be the dominant hand.

This is also referred to as hand preference.

If your child struggles to use both hands together well, then bilateral coordination and
crossing midline activities will help develop these skills.

Once a child crosses the midline freely, hand dominance usually becomes clearer. It is
never recommended to encourage a child to use one hand over the other, unless it is
evident that the child consistently initiates an activity with the same hand. If this is the
case, switching may occur due to fatigue. Focus on strengthening to see if the child will
be able to sustain grasp to complete a task.

Activity Ideas

Presenting things at midline and encouraging the child to finish the activity with
whichever hand they started with.

Let the child choose which hand they wish to use, a rule can be established that
the hand that the child starts with is the one they have to finish with.

Screwing lids on and off jars, screwing pipe fittings together, assembling nuts
and bolts. To add interest to screwing lids off, hide small objects or stickers
inside for your child to find.

Large Lego/Duplo or other assembly toys.

Pushing a car/train around a track. You can draw “streets” on a long piece of
paper.

Tool use such as hammering or using a screwdriver. Children’s toy workbenches

are a great and safe way for children to practice their manipulative skills.

Use of other household tools such as tongs, use of clothes pegs, watching to see
which hand is more skilled.

‘Pick Up games’. Use coins, buttons, beans or other small items which require
the use of a refined pincer grasp (holding the item between the pad of the index
finger and pad of the thumb). Then try putting them into a small hole or slot
(such as a money box). Alternate hands doing the task and watch the quality of
movement.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 30

Encourage colouring on small pieces of paper. One hand has to stabilize the
paper or it slips all around.

Try to provide opportunities for your child to practice his/her ball skills. Try rolling
balls, catching, tossing balls into a container. Be sure to start with a ball large
enough that your child feels comfortable with and then moving to a smaller size
as his/her skills progress. You may also try these activities with bean bags. In
using larger balls, children learn to use their hands symmetrically, working
together. Smaller balls will encourage one hand to emerge as the dominant one.

Lacing cards, hand sewing and bead stringing encourages the use of a dominant
hand. Lacing cards can be made of thin cardboard with a hole punch. Use long
shoelaces, or wool with the end stiffened with tape.

Bowling. Go to an ally or set up objects to knock over at home with a ball in a

safe place.

Let your child play with cookie cutters and clay. Also have your child pound on
clay with one hand to flatten it.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 31

Fine Motor Skills Program

The exercises given below, when practiced on a regular basis, should help to promote
shoulder stability, the ability to cross midline, bilateral integration and to develop
pincer/precision grip for fine motor control.

Shoulder Exercises

Shrug Shoulders – raise one shoulder, then the other shoulder, then both
together - 5 times. Ensure that head remains upright in mid-line throughout and
that only one shoulder moves.

Rotate Shoulders – make circles with one shoulder – 5 forward and 5

backwards. Repeat with other shoulder. Ensure that head remains upright in
mid-line throughout.

Windmills – make 5 forward and 5 backward circles in the air, first one arm and
then the other arm, then both arms together, one arm following the other in a
consecutive manner. Ensure that the arm is stretched above the head and the
elbow remains straight, the head remaining upright and in mid-line.

Advanced Exercise

Shoulder Girdle Spirals – Lift both arms to shoulder height and extend arms out
to the side. Begin by making small circles with wrists then gradually make circles
larger until using whole of arm (5 or more rotations). When circles are as large
as possible, change direction and gradually reduce the size until only the wrist is
moving. Aim to build up to 10 repetitions. This exercise is hard on the shoulders
so it is important to build up slowly. Keep arms raised to shoulder height and
arms extended throughout.

Crossing Mid-line Exercises/Bilateral Integration

“Picking apples off the tree” – reach up with one arm extended and stretch
across the body, and pretend to pick an apple off the tree, keeping elbow
straight. Return arm to position down at side of body and repeat with other arm.
Repeat full exercise 5 times.

“Pegs” – Place clothes pegs on a jumper/t-shirt; one on each shoulder and knee
and either side of waist. Remove clothes pegs by using the opposite hand to the
side of the body where the peg is placed (i.e. right hand to remove peg from left
shoulder). Ensure pegs are removed using a pincer grip to squeeze the peg
rather than pull it off.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 32

Advanced Exercise

Clapping games – with partners, facing each other. Vary using different rhymes,
speeds, patterns.

Table Top Activities

Promote good sitting posture by ensuring the child is sitting with bottom back in the
chair, chair tucked in, arms resting lightly on the table top and feet placed flat on the
floor.

Putty / Playdough Exercises

Roll a sausage – use both hands together to gradually roll an even sized length
of dough approx. 30 – 40 cms long. Ensure the body remains still, the shoulders
relaxed and the arms move from shoulders.

Finger isolation – isolate thumb and each individual finger consecutively to

press down on the sausage of dough. First one hand then the other.

Opposition – pinch/squeeze sausage between thumb and individual finger tips

consecutively. One hand and then the other.

Roll sausage into a ball on the tabletop with one hand. Pick up and squeeze as
hard as possible with one hand. Roll dough into a ball between two hands and
squeeze as hard as possible using the other hand.

Bilateral Integration & Fine Motor Activities

Unicubes – create a tower of up to 10 cubes using the tabletop as the base and
one hand to stabilise the tower. Ensure that the tower is properly aligned. Pull
tower apart one cube at a time, holding the tower between both hands.

Stack 2 towers using both hands simultaneously.

Paper balls – tear paper into thin strips and scrunch into balls using fingertips.
Flick balls using individual fingertips with thumb into a “goal”.

Paper plate and pegs – place numbers, dots, marks around the edge of a paper
plate. Use non-dominant hand to turn the plate whilst placing pegs with
dominant hand. (Move plate in an anti-clockwise direction for right-handers and
clockwise direction for left-handers).

Pegs and Pegboard – pour a number of pegs into a small container and place in
the mid-line above the pegboard. Use dominant hand to pick up pegs one at a

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 33

time and place in the board, using a mature pincer grip (thumb tip to index finger
tip) and stabilising the board with the non-dominant hand. Vary the activity by
placing pegs by colour/pattern sequences. Remove pegs one at a time and
return to container.

Threading – use buttons, beads, reels, pasta tubes. Ensure that the lace tip is
appropriate for threading the chosen object, i.e. longer, stable lace tip with larger
objects, ordinary shoelace tip with large holed buttons.

Advanced activity

Use tweezers or pegs to transfer small objects (pasta, balls of crumpled paper,
dried peas/beans) from one container to another.

Finale to session

Stand up. Lift arms above head and stretch through body from toes upwards to
outstretched fingers. Lower arms in front of body.

Clap hands – 2 fast, 2 slow, 2 fast. (Vary according to level of ability)

Stamp feet several times.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team
 34

Play dough Recipe

1 teacup of flour

½ teacup salt

1 teacup of hot water

1 tablespoon cold water

1 tablespoon cooking oil

1 tablespoon cream of tartar

Food colouring (few drops)

Mix all ingredients together in a non-stick saucepan, over a gentle heat, stirring
constantly until it forms into a lump of dough. When cool enough to touch, knead dough
and place in an airtight container.

South Warwickshire Foundation Trust – Children, Young People and Families Occupational Therapy Team