[Below is a transcription of the podcast]
My name’s Debra Fenton and I’m a speech-language pathologist in Denver, Colorado. I own a pediatric therapy practice called Lowry’s speech and occupational therapy. We provide services to children ages about 2 years through adolescence. We provide speech therapy and occupational therapy services as well as some academic services.
Today I’m going to talk briefly about motor skills. It’s something that we see frequently and we get a lot of questions about in our clinic: the difference between fine and gross motor skills. I am a speech-language pathologist so this is not my area of expertise but over the years I’ve learned a lot about gross and fine motor development and hopefully today I can answer just a few of your questions about general development and what skills you could expect at certain ages and maybe some things you could be looking at to see if your child is developing on track.
So, first of all, there’s a big difference between gross and fine motor skills. Gross motor skills are, really considered those movements that involve larger muscles of the body, using the arms, your legs, your trunk. Your trunk really refers to your core, your core strength which is a really important piece to make sure that your child is able to utilize their arms and legs really well. Core strength is kind of the center of your body. But let’s back up a little bit and just kind of talk about some beginning gross motor skills and some developmental milestones that you can expect at certain ages.
By age 1 we would like to see children pulling up and taking some steps and you know beginning the walking process. Most children by age 1 should be able to crawl on their hands and knees. A lot of children like to scoot at this age but we would really love to see children developing some kind of alternating movements between their arms and legs because this plays an important role in developing both sides of the body and also developing something that’s called bilateral coordination. Bilateral coordination refers to, if you think of your body as having two sides- the right side and the left side, being able to use these sides in an alternating way and in a coordinated way to perform certain tasks. Bilateral coordination at one year would just be alternating hands and legs when crawling. And we’ll talk a little bit more about the development of bilateral coordination and how that plays a role in some of the other gross motor development as children age.
If a child is not walking somewhere between 12 and 16 months, then typically we would consider them to be delayed in that milestone. A delay in that milestone, it doesn’t necessarily mean that’s going to be a delay that’s going to be persistent throughout their life but just at that point in time they’re just not quite meeting where they need to be. Some kids don’t meet these milestones because of some environmental influences and some of those can be overly helpful parents who like to carry their children and use a stroller all the time and don’t provide enough opportunities for their children to kind of learn to develop these skills on their own. Sometimes it’s hard to leave a child especially if you tend to have a clingy little toddler that doesn’t like to be down on the ground. But as hard as it is, it’s so important that you give them the room and the space to develop these skills because it will really be so much more helpful for them later on if they can get these skills into place on time.
By the second year of age, we really want to see kids beginning to be able to take some running steps in a coordinated manner. We want to make sure that they’re getting more coordinated, they’re not falling quite as much, they’re able to navigate their landscape a little bit, be able to step over a curb and you know take some small steps up stairs, maybe even starting to do some climbing. Climbing up the side of their crib or climbing down the side of their crib, being able to bend over and pick up toys and beginning to develop some ball skills. Being able to and showing interest in being able to throw and catch a ball, a large ball.
By three years of age, kids are getting really proficient. And for many parents, they can be a lot to keep up with because they’re very very active at this age and that’s a great thing. We see kids running, walking with alternating feet. They’re starting to hop. They’re able to climb. They’re becoming more and more interested in playgrounds and slides and climbing walls. All of those types of activities are great exposure for kids and really kind of help accelerate the development of these skills. Additionally, it really helps to develop some strength and endurance for kids.
By age 4 some of the skills are starting to play with a bouncing ball. One of the big ones I think to keep in mind as far as going up and down stairs is by age four we want to see kids alternating their steps. So they’re going right left right left. When we see kids that are still just leading with their right foot each time up every step we start to get a little concerned. And that kind of falls into a little bit of that bilateral coordination we talked about early on, that being able to alternate their sides of their body. So walking downstairs and upstairs using alternate feet is an important milestone for this age. And believe it or not being able to get on a swing and learning to pump a swing and get it going and keep it going is is a big milestone at this age. When you think about swinging there’s a lot going on that you need to know to be able to keep a swing going as far as developing momentum and feeling yourself in space and knowing when to pump your feet and when to lean back. There’s a lot of coordination that goes into that as well as a lot of core strength.
By age 5, we like to see kids pretty much fully proficient in jumping, hopping, skipping, skipping with alternating feet. Being able to run frontward and backward and jump rope and really navigate any type of an environment that they come across. Perhaps starting to use some scooters or little scooter boards, skateboards, bikes. When you think about using a bike and the pedals, that bilateral coordination comes back in. Being able to use your feet alternating to push the pedals up and down. Each leg is working independently of one another but in a coordinated manner and that’s that bilateral coordination.
If you feel like your child is experiencing maybe some lags in their development, the first thing that I would recommend is really kind of take a look at how much exposure your child has had to develop some of these skills and really provide them with some practice opportunities. Sometimes it’s just a matter of getting a ball out and working with your child on some ball skills and maybe cueing them to alternate their feet on stairs and seeing how far you can push them on your own and kind of develop some of these skills. It’s not necessary to run out and get an evaluation right away. Some of these skills, it might just be that they just need a little encouragement to kind of get them into place. If after some exposure and some practice opportunities, the child is still having difficulty, at that point you might want to consider a screening by an occupational or even a physical therapist. A screening is different from a full evaluation. Usually, a screening takes maybe 20 minutes to 30 minutes. And somebody in the occupational or physical therapy field would evaluate your child’s motor skills and kind of see if they are experiencing any lags and hopefully provide you with some helpful suggestions. At the screening, a lot of times a child will just need to be monitored and supported. But there are instances where the re-screening will reveal that some more direct work with a child is indicated and at that point, you may consider working directly with an occupational therapist on developing some of these skills.
As far as the length of time for services it really is individualized. It really depends on how many skills the therapist is going to be working on with your child and how quickly they are acquiring skills with support. Some kids move pretty quickly through a motor development program and some kids take a little bit longer. The more parents can be involved in the therapy process and practicing skills at home certainly accelerates the whole process. There will be some kids where difficulty with motor skills could be something that will be with them on a lifetime basis. But for most kids you know it’s just lags in development that they will eventually overcome with some support.
For fine motor skills, these are really the skills if you think about anything that involves manipulating items using the small muscles of your body such as the hands and fingers and even your toes, although we don’t really think about toes that much, hands being the major one with development. When we look at a child who is between the ages of 1 to 2 we want to see them you know beginning to manipulate things in their environment. That could be food, it could be toys, developing a little bit of a pincer grasp or they’re able to pick up maybe some Cheerios or some small snacks from a table using a couple of fingers and being able to guide that item into their mouths. Later on around two years of age, being able to use some utensils a little spoon, feed themselves with a spoon and being able to pick up and hold their own cups and guide a straw into their mouth. We want them to be able to in their environment be able to start to think about playing with some smaller types of toys. Boys particularly, little train sets and cars require a lot of fine motor development to be able to assemble tracks so those skills really start to take off closer to three years of age between three and four.
Around that three or four age range, we also want to see some kind of the school-based skills start to develop. And that includes being able to hold a writing utensil. Early on it can be something like chalk or a fat crayon is easier for little developing hands and as they start to get older and their skills their motor skills become more developed, they’re able to hold some writing instruments that are a little bit smaller in circumference, some markers, and some regular sized crayons and pencils. We want some scissors skills to start to be developing between the ages of four and five. A lot of kids get this type of exposure at school. If your child is not at school this is something really easy and quite fun to work on with them at home. Any crafts that involve cutting and pasting and manipulating small, like pasting buttons on paper, pasta on paper are all great ways to develop fine motor skills.
If we take a look at and dissect a really pretty simple task for a child such as simply cutting out a shape from a piece of paper, we see that there are a lot of underlying foundational skills that are needed for a child to be successful with that. First of all, the child has to have adequate fine motor skills to be able to grasp and manipulate the scissors. Bilateral coordination comes into play because the child is having to cut with one hand while holding the paper with another. So we have two hands that are both doing completely different things. One hand is guiding the paper and the other hand is using the scissors to snip. So there is some bilateral coordination there. Also as far as cutting out a shape, there is what we call visual-motor integration, where the hands and eyes also need to be working together. So we have fine motor skills, we have bilateral coordination and then we have visual-motor integration. All those things need to kind of come together for the child to be able to complete this relatively simple task. When a child has a deficit in one of those areas, sometimes it’s helpful to work on those skills a little bit more in isolation so that when they do a task like this, they’re a little bit more successful. Fine motor skills and fine motor development would be working on just developing the motor skills, the strength in the hands, the endurance, the ability to really manipulate their fingers and be able to use small objects and do it with some precision and some coordination. The bilateral coordination is just making sure that the child is able to adequately use opposing sides of their body in sometimes alternating fashions or sometimes independent of one another. The visual-motor integration is making sure that their hands and their eyes are working together. When you think about visual-motor integration, a big thing that we think about is you know being able to cut and write and draw and read. Those skills are all highly dependent on visual motor integration. So ensuring those skills are in place early on really kind of sets the child up for success academically later on.
So there’s a lot of things to consider as far as gross and fine motor development in children. We know that their early skills really set the stage for later skill development. If they have some delays in some of their early skills, that will delay the development of some later skills which will be important for them for academics and self-care such as doing buttons and zippers and taking care of themselves and even things as simple as being able to open up their little lunch snacks or open up treats and being able to be more independent just at school, at home with those types of things.
So those are just some basic thoughts about gross and fine motor skills. Again if you do have concerns about your child’s skill development, your pediatrician is often able to provide you with some great guidance and there are lots of places online to get more details about ages and stages for development. On our website, Lowrystot.com, under the tab pediatric occupational therapy, we do have ages and stages available as a resource. It’s been a pleasure talking to you today. I hope I helped answer some of your questions. Thanks for listening.