Fine Motor Delay

Fine motor delay is when a child is not able to use their hands and fingers to hold, manipulate, and use objects when the child is at the right age to do these things. Fine motor skills require eye-hand coordination — the ability to see something and respond with the right movements in the hands and fingers. The ability to speak also uses fine motor skills because the lips, tongue, and face muscles must coordinate to make different shapes so a child can speak. Children can have a delay in fine motor skills, gross motor skills (big movements like crawling or walking), or both.

Children grow and develop on their own schedules. Some children can pick up toys or use a crayon earlier than others. Many children with a fine motor delay are able to do the activity at some point, but do it later than most children their age.

In some cases, the fine motor delay may be associated with another problem, such as autism or a developmental disability. A child’s doctor will help a parent understand if their child’s fine motor delay is something to worry about. The doctor will ask about your child’s fine motor skills and development at every visit. If there is a concern, the doctor can complete a special autism screening when your child is 18 months old and 24 months old. It is important for children to get all recommended checkups so their doctor can address any problems as soon as possible.

A child with a fine motor delay might have difficulty completing movements and activities the same way as other children. Below is a list of fine motor activities and the age a child usually does them:

• 4 months: Opens hands up from a fist; plays with fingers and brings fingers to the mouth; holds a toy and shakes it; and swings at dangling toys.
• 6 months: Reaches for blocks; moves an object from one hand to the other; and drags a small object to self using four fingers (raking grasp).
• 9 months: Picks up a small object with three fingers, claps hands with modeling
• 12 months: Puts an object inside a cup; bangs two things together; and picks up an object using a finger and thumb (pincer grasp).
• 15 months: Scribbles and dumps objects out of a bottle if you show the child first.
• 18 months: Scribbles and dumps objects out of a bottle on the child’s own, and stacks two blocks.
• 2 years: Stacks four to six blocks in a tower, and puts four to six blocks in a row.
• 2 ½ years: Can copy you drawing a horizontal or vertical line; can take off or screw on a lid; stacks eight blocks in a tower; and turns the pages of a book.
• 3 years: Can copy you drawing a circle; stacks 10 blocks in a tower; and cuts paper with child scissors.
• 4 years: Draws a person with six parts, and buttons large or medium-sized buttons.

A speech delay can sometimes be a sign of a fine motor delay because speech uses fine motor movements of the mouth, lips, and tongue. Find out more about speech and sound milestones and disorders.

Many children are healthy and have typical fine motor skills even if they don’t follow this schedule. A doctor can check a child’s muscles and fine motor movements to see if there is a problem. A doctor will also ask questions about what a child is doing or not doing at home.

Take your child to all recommended checkups so the doctor can make sure your child is developing age appropriate skills.

Call the doctor right away if your child can no longer do things that you have seen the child do before, or if their movements become either stiff or weak.

Some children reach their fine motor milestones later, and there is no problem. When fine motor delay is due to a medical problem, the problem may be related to the child’s muscles. Or, the problem may be related to a coordination problem—when the brain and hands are having trouble working together. This is called dyspraxia [dis-PRAK-see-uh].

Researchers don’t always know what causes these fine motor problems, but some possibilities include:

• Premature birth, which can cause muscles to develop more slowly.
• A genetic disorders such as Down syndrome.
• Neuromuscular (nerve and muscle) disorders such as muscular dystrophy or cerebral palsy.
• A developmental problems such as autism
• Decreased finger, arm, and core strength
• Cognitive delays
• Vision problems

To test for a fine motor delay, a doctor will watch a child move and, depending on the child’s age, ask the child to manipulate small objects and complete age appropriate functional tasks. The doctor will also check the child’s muscles.

If the doctor thinks there may be a problem, the doctor will have the child get other tests. The tests depend on the suspected problem, but may include an imaging test or a blood test to check for genetic disorders, cerebral palsy, or thyroid problems. The doctor might also refer the child to a specialist who can administer different fine motor and developmental tests such as the Peabody Developmental Motor Skills (PDMS-2) and the Bruiniks-Oseretsky Test of Motor Proficiency (BOT-2) assessments.

Some fine motor delays resolve on their own with practice of skills. A child may simply do the activity later than other children their age. The doctor may also recommend occupational or speech therapy to assess and help the child develop these skills.

If another problem is causing the delay, the doctor will likely refer the child to see a specialist—for example, a pediatric neurologist. Treatment will depend on the cause of the delay.

Fine motor delays have many causes, both known and unknown, so it is difficult to prevent them. It is always helpful to give a child opportunities to practice motor skills. Encourage children to try the skills when they are old enough to do so. Give children many chances to play, use objects, and try new skills with your help.

Autism Society

American Academy of Pediatrics. Physical Development Delays: What to Look For.

Centers for Disease Control and Prevention, “Developmental Milestones”

Understood.org: Fine Motor Skills: What You Need to Know