Fine motor skills

Definition

Fine motor skills generally refer to the small movements of the hands, wrists, fingers, feet, toes, lips, and tongue.

Description

Motor skills are actions that involve the movement of muscles in the body. They are divided into two groups: gross motor skills , which include the larger movements of arms, legs, feet, or the entire body (crawling , running, and jumping); and fine motor skills, which are smaller actions, such as grasping an object between the thumb and a finger or using the lips and tongue to taste objects. Both types of motor skills usually develop together, because many activities depend on the coordination of gross and fine motor skills.

Infancy

The hands of newborn infants are closed most of the time and, like the rest of their bodies, they have little control over them. If their palms are touched, they will make a very tight fist, but this is an unconscious reflex action called the Darwinian reflex, and it disappears within two to three months. Similarly, infants will grasp at an object placed in their hands, but without any awareness that they are doing so. At some point their hand muscles relax, and they drop the object, equally unaware that they have let it fall. Babies may begin flailing at objects that interest them by two weeks of age but cannot grasp them. By eight weeks, they begin to discover and play with their hands, at first solely by touch, and then, at about three months, by sight as well. At this age, however, the deliberate grasp remains largely undeveloped.

Hand-eye coordination begins to develop between the ages of two and four months, inaugurating a period of trial-and-error practice at sighting objects and grabbing at them. At four or five months, most infants can grasp an object that is within reach, looking only at the object and not at their hands. Referred to as "top-level reaching," this achievement is considered an important milestone in fine motor development. At the age of six months, infants can typically hold on to a small block briefly, and many have started banging objects. Although their grasp is still clumsy, they have acquired a fascination with grabbing small objects and trying to put them in their mouths. At first, babies will indiscriminately try to grasp things that cannot be grasped, such as pictures in a book, as well as those that can, such as a rattle or ball. During the latter half of the first year, they begin exploring and testing objects before grabbing, touching them with an entire hand and, eventually, poking them with an index finger.

One of the most significant fine motor accomplishments is the pincer grip, which typically appears at about 12 months. Initially, infants can only hold an object, such as a rattle, in their palm, wrapping their fingers (including the thumb) around it from one side. This awkward position is called the palmar grasp, which makes it difficult to hold on to and manipulate the object. By the age of eight to 10 months, a finger grasp begins, but objects can only be gripped with all four fingers pushing against the thumb, which still makes it awkward to grab small objects. The development of the pincer grip—the ability to hold objects between the thumb and index finger—gives the infant a more sophisticated ability to grasp and manipulate objects and also to deliberately drop them. By about the age of one, an infant can drop an object into a receptacle, compare objects held in both hands, stack objects, and nest them within each other.

Toddlerhood

Toddlers develop the ability to manipulate objects with increasing sophistication, including using their fingers to twist dials, pull strings, push levers, turn book pages, and use crayons to produce crude scribbles. Dominance of either the right or left hand usually emerges during this period as well. Toddlers also add a new dimension to touching and manipulating objects by simultaneously being able to name them. Instead of only random scribbles, their drawings include patterns, such as circles. Their play with blocks is more elaborate and purposeful than that of infants, and they can stack as many as six blocks. They are also able to fold a sheet of paper in half (with supervision), string large beads, manipulate snap toys , play with clay, unwrap small objects, and pound pegs.

Preschool

The more delicate tasks facing preschool children, such as handling silverware or tying shoelaces, represent more challenge than most of the gross motor activities learned during this period of development. The central nervous system is still in the process of maturing sufficiently for complex messages from the brain to get to the child's fingers. In addition, small muscles tire more easily than large ones, and the short, stubby fingers of preschoolers make delicate or complicated tasks more difficult. Finally, gross motor skills call for energy, which is boundless in preschoolers, while fine motor skills require patience, which is in shorter supply. Thus, there is considerable variation in fine motor development among this age group.

School age

By the age of five, most children have clearly advanced beyond the fine motor skill development of the preschool age. They can draw recognizably human figures with facial features and legs connected to a distinct trunk. Besides drawing, five-year-olds can also cut, paste, and trace shapes. They can fasten visible buttons (as opposed to those at the back of clothing), and many can tie bows, including shoelace bows. Their right- or left-handedness is well established, and they use the preferred hand for writing and drawing.

School-age children six to 12 years old should have mastered hand and eye coordination. Early school age children should be able to use eating utensils and other tools, be able to help with household chores, such as sweeping, mopping, and dusting; care for pets; draw, paint, and engage in making crafts; and begin developing writing skills. Children will continue to fine-tune their fine motor skills through adolescence with such activities as sports , crafts, hobbies, learning musical instruments, computer use, and even video games .

Helping a child succeed in fine motor tasks requires planning, time, and a variety of play materials. Fine motor development can be encouraged by activities that youngsters enjoy, including crafts, puzzles, and playing with building blocks. Helping parents with everyday domestic activities, such as baking, can be fun for the child in addition to helping the child develop fine motor skills. For example, stirring batter provides a good workout for the hand and arm muscles, and cutting and spooning out cookie dough requires hand-eye coordination. Even a computer keyboard and mouse can provide practice in finger, hand, and hand-eye coordination. Because the development of fine motor skills plays a crucial role in school readiness and cognitive development , it is considered an important part of the preschool curriculum.

KEY TERMS

Beery-Buktenica Test —A test that identifies problems with visual perception, fine motor skills (especially hand control), and hand-eye coordination.

Darwinian reflex —An unconscious action in infants in which if a palm is touched, the infant makes a very tight fist. This instinct disappears within two to three months.

Developmental coordination disorder —A disorder of motor skills.

Gross motor skills —The abilities required to control the large muscles of the body for walking, running, sitting, crawling, and other activities. The muscles required to perform gross motor skills are generally found in the arms, legs, back, abdomen, and torso.

Hand-eye coordination —The ability to grasp or touch an object while looking at it.

Lincoln-Oseretsky Motor Development Scale —A test that assesses the development of motor skills.

Palmar grasp —A young infant's primitive ability to hold an object in the palm by wrapping fingers and thumb around it from one side.

Pincer grip —The ability to hold objects between thumb and index finger, which typically develops in infants between 12 and 15 months of age.

Top-level reaching —The ability of an infant to grasp an object that is within reach, looking only at the object and not at the hands. Typically develops between four and five months of age.

Common problems

Fine motor skills can become impaired in a variety of ways, including injury, illness, stroke , and congenital deformities. An infant or child up to age five who is not developing new fine motor skills for that age may have a developmental disability. These problems can include major health conditions including cerebral palsy , mental retardation , blindness, deafness, and diabetes. Children with delays in fine motor skills development have difficulty controlling their coordinated body movements, especially with the face, hands, and fingers. Signs of fine motor skills delays include a failure to develop midline

orientation by four months, reaching by five months, transferring objects from hand to hand by six months, a raking grasp by eight months, a mature pincer grip by one year, and index finger isolation by one year.

Developmental coordination disorder is a disorder of motor skills. A person with this disorder has a hard time with things like riding a bike, holding a pencil, and throwing a ball. People with this disorder are often called clumsy. Their movements are slow and awkward. People with developmental coordination disorder may also have a hard time completing tasks that involve movement of muscle groups in sequence. For example, such a person might be unable to do the following in order: open a closet door, get out a jacket, and put it on. It is thought that up to 6 percent of children may have developmental coordination disorder, according to the 2002 issue of the annual journal Clinical Reference Systems. The symptoms usually go unnoticed until the early years of elementary school. It is usually diagnosed in children who are between five and 11 years old.

Parental concerns

Parents, teachers, and primary caregivers need to have a clear understanding of how young children develop fine motor skills and the timetable for development of the skills.

Fine motor skills development tests

The Lincoln-Oseretsky Motor Development Scale is an individually administered test that assesses the development of motor skills in children and adults. Areas covered include fine and gross motor skills, finger dexterity and speed, and hand-eye coordination. The test consists of 36 tasks arranged in order of increasing difficulty. These include walking backwards, standing on one foot, touching one's nose, jumping over a rope, throwing and catching a ball, putting coins in a box, jumping and clapping, balancing on tiptoe while opening and closing one's hands, and balancing a rod vertically. Norms have been established for each part of the test for children aged six to 14.

The Beery-Buktenica Test , also known as VMI or Developmental Test of Visual-Motor Integration, is designed for individuals two years of age through adult. The text identifies problems with visual perception, fine motor skills (especially hand control), and hand-eye coordination. It is usually administered individually but can also be given in groups. The child is given a booklet containing increasingly complex geometric figures and asked to copy them without any erasures and without rotating the booklet in any direction. The test is given in two versions: the Short Test Form, containing 15 figures, is used for ages three through eight; the Long Test Form, with 24 figures, is used for older children, adolescents, and adults with developmental delay . A raw score based on the number of correct copies is converted based on norms for each age group, and results are reported as converted scores and percentiles. The test is not timed but usually takes 10 to 15 minutes to administer.

When to call the doctor

Some symptoms of impaired fine motor skills may appear up to age two. These symptoms include having a difficult time sitting up or raising the head, being unable to stand without help or having a very hard time standing without help, being unable to crawl or having a very hard time crawling, and walking very late or having a hard time walking. Other symptoms usually appear during the preschool or grade school years. These may include the child having difficulty holding a pencil or drawing, throwing a ball, riding a bicycle, playing sports, having a hard time with clothes that have buttons or zippers, having poor handwriting, and being clumsy.

Children with any one or combination of these symptoms should be seen by a pediatrician who specializes in motor skills development delays. Children who lose previously acquired motor skills should also be seen by a doctor. There are many ways to address fine motor skills impairment, such as physical therapy. This type of therapy can include treating the underlying cause, strengthening muscles, and learning how to compensate for impaired movements.

See also Gross motor skills.

Resources

BOOKS

Bly, Lois. Motor Skills Acquisition Checklist. San Antonio, TX: Therapy Skill Builders, 2003.

Kurtz, Lisa A. How to Help a Clumsy Child: Strategies for Young Children with Developmental Motor Concerns. London, UK: Jessica Kingsley Publishing, 2003.

Liddle, Tara Losquadro, and Laura Yorke. Why Motor Skills Matter: Improving Your Child's Physical Development to Enhance Learning and Self-Esteem. New York: McGraw-Hill, 2003.

Smith, Jodene Lynn. Activities for Fine Motor Skills Development. Westminster, CA: Teacher Created Materials, 2003.

PERIODICALS

Jeansonne, Jennifer J. "Motor Skill Learning Research Looks Beyond Outcomes—Understanding the Components Needed for Skilled Performance Helps Develop Instructions and Training Methods." Biomechanics (June 1, 2004): 69.

Rink, Judith E. "It's Okay to Be a Beginner: Teach a Motor Skill, and the Skill May Be Learned. Teach How to Learn a Motor Skill, and Many Skills Can Be Learned—Even After a Student Leaves School." The Journal of Physical Education, Recreation & Dance (August 2004): 31–4.

"Should the Main Objective of Adapted Physical Education Be the Development of Motor Skills or the Development of Self-Esteem?" The Journal of Physical Education, Recreation & Dance 74 (November-December 2003): 10–12.

Vickers, Marcia. "Why Can't We Let Boys Be Boys?" Business Week (May 26, 2003): 84.

ORGANIZATIONS

American Academy of Pediatrics. 141 Northwest Point Blvd., Elk Grove Village, IL 60007. Web site: <www.aao.org>.

Developmental Research for the Effective Advancement of Memory and Motor Skills. 273 Ringwood Road, Freeville, NY 13068. Web site: <www.dreamms.org>.

WEB SITES

"How to Help Your Toddler Develop Fine Motor Skills." BabyCenter, 2004. Available online at <www.babycenter.com/refcap/toddler/toddlerdevelopment/11549.html> (accessed November 18, 2004).

"Movement, Coordination, and Your Newborn." KidsHealth, May 2001. Available online at <www.kidshealth.org/parent/growth/movement/movenewborn.html> (accessed November 18, 2004).

Ken R. Wells

Gross motor skills

Definition

Gross motor skills are the abilities required in order to control the large muscles of the body for walking, running, sitting, crawling , and other activities.

Description

Motor skills are actions that involve the movement of muscles in the body. They are divided into two groups: gross motor skills, which are the larger movements of arms, legs, feet, or the entire body (crawling, running, and jumping); and fine motor skills , which are smaller actions, such as grasping an object between the thumb and a finger or using the lips and tongue to taste objects. Motor skills usually develop together since many activities depend on the coordination of gross and fine motor skills. Gross motor skills develop over a relatively short period of time. Most development occurs during childhood. However, soldiers, some athletes, and others who engage in activities requiring high degrees of endurance may spend years improving their level of muscle and body coordination and gross motor skills.

Gross motor skills development is governed by two principles that also control physical growth. Head to toe development refers to the way the upper parts of the body develop, beginning with the head, before the lower ones. The second principle of development is trunk to extremities. Head control is gained first, followed by the shoulders, upper arms, and hands. Upper body control is developed next, followed by the hips, pelvis, and legs.

Encouraging gross motor skills requires a safe, open play space, peers to interact with, and some adult supervision. Promoting the development of gross motor abilities is considerably less complicated than developing fine motor skills. Helping a child succeed in gross motor tasks requires patience and opportunities for a child to practice desired skills. Parents and other persons must understand the child's level of development before helping him or her master gross motor skills. Children reach developmental milestones at different rates. Pushing a child to perform a task that is impossible due to development status promotes frustration and disappointment. Children should be allowed to acquire motor skills at their own paces.

There are a number of activities parents can have children do to help develop gross motor skills. These include:

• playing hopscotch and jumping rope; activities that help children learn balance
• hitting, catching, kicking, or throwing a ball, such as a baseball, football, or soccer ball; activities that help develop hand-eye or foot-eye coordination
• kangaroo hop, in which children hold something, such as a small ball or orange, between their knees and then jump with their feet together frontward, backwards, and sideways
• playing wheelbarrow, in which someone holds the children's legs while they walk on their hands along a specific route
• walking on a narrow bar or curb, while holding a bulky object in one hand, then the other hand, and then repeating the activity walking backwards and sideways
• toss and catch, in which children toss an object, such as a baseball, in the air and then catch it, while sitting or lying down and also while using alternate hands

Infancy

The first gross motor skill infants learn usually is to lift their heads and shoulders before they can sit up, which, in turn, precedes standing and walking. Lifting the head is usually followed by head control. Although they are born with virtually no head or neck control, most infants can lift their heads to a 45-degree angle by the age of four to six weeks, and they can lift both their head and chest at an average age of eight weeks. Most infants can turn their heads to both sides within 16 to 20 weeks and lift their heads while lying on their backs within 24 to 28 weeks. By about nine to 10 months, most infants can sit up unassisted for substantial periods of time with both hands free for playing.

One of the major tasks in gross motor development is locomotion, the ability to move from one place to another. Infants progress gradually from rolling (eight to 10 weeks) to creeping on their stomachs and dragging their legs behind them (six to nine months) to actual crawling (seven to 12 months). While infants are learning these temporary means of locomotion, they are gradually becoming able to support increasing amounts of weight while in a standing position. In the second half-year of life, babies begin pulling themselves up on furniture and other stationary objects. By the ages of 28 to 54 weeks, on average, they begin navigating a room in an upright position by holding on to the furniture to keep their balance. Eventually, they are able to walk while holding on to an adult with both hands and then with only one. They usually take their first uncertain steps alone between the ages of 36 and 64 weeks and are competent walkers by the ages of 12 to 18 months.

Toddlerhood

Toddlers are usually very active physically. By the age of two years, children have begun to develop a variety of gross motor skills. They can run fairly well and negotiate stairs holding on to a banister with one hand and putting both feet on each step before going on to the next one. Most infants this age climb (some very actively) and have a rudimentary ability to kick and throw a ball. By the age of three, children walk with good posture and without watching their feet. They can also walk backwards and run with enough control for sudden stops or changes of direction. They can hop, stand on one foot, and negotiate the rungs of a jungle gym. They can walk up stairs alternating feet but usually still walk down putting both feet on each step. Other achievements include riding a tricycle and throwing a ball, although they have trouble catching it because they hold their arms out in front of their bodies no matter what direction the ball comes from.

Preschool

Four-year-olds can typically balance or hop on one foot, jump forward and backward over objects, and climb and descend stairs alternating feet. They can bounce and catch balls and throw accurately. Some four-year-olds can also skip. Children this age have gained an increased degree of self-consciousness about their motor activities that leads to increased feelings of pride and success when they master a new skill. However, it can also create feelings of inadequacy when they think they have failed. This concern with success can also lead them to try daring activities beyond their abilities, so they need to be monitored especially carefully.

School age

School-age children, who are not going through the rapid, unsettling growth spurts of early childhood or adolescence , are quite skilled at controlling their bodies and are generally good at a wide variety of physical activities, although the ability varies according to the level of maturation and the physique of a child. Motor skills are mostly equal in boys and girls at this stage, except that boys have more forearm strength and girls have greater flexibility. Five-year-olds can skip, jump rope, catch a bounced ball, walk on their tiptoes, balance on one foot for over eight seconds, and engage in beginning acrobatics. Many can even ride a small two-wheel bicycle. Eight- and nine-year-olds typically can ride a bicycle, swim, roller skate, ice skate, jump rope, scale fences, use a saw, hammer, and garden tools, and play a variety of sports . However, many of the sports prized by adults, often scaled down for play by children, require higher levels of distance judgment and hand-eye coordination , as well as quicker reaction times, than are reasonable for middle childhood. Games that are well suited to the motor skills of elementary school-age children include kick ball, dodge ball, and team relay races.

In adolescence, children develop increasing coordination and motor ability. They also gain greater physical strength and prolonged endurance. Adolescents are able to develop better distance judgment and hand-eye coordination than their younger counterparts. With practice, they can master the skills necessary for adult sports.

Common problems

There are a range of diseases and disorders that affect gross motor skill development and skills. Among young persons, developmental problems such as genetic disorders, muscular dystrophy , cerebral palsy , and some neurological conditions adversely impact gross motor skill development.

Gross motor skills can become impaired in a variety of ways, including injury, illness, stroke , and congenital deformities. Developmental coordination disorder affects motor skills. A person with this disorder has a hard time with skills such as riding a bike, holding a

pencil, and throwing a ball. People with this disorder are often called clumsy. Their movements are slow and awkward. People with developmental coordination disorder may also have a hard time completing tasks that involve movement of muscle groups in sequence. For example, such a person might be unable to do the following in order: open a closet door, get out a jacket, and put it on. It is thought that up to 6 percent of children may have developmental coordination disorder, according to the 2002 issue of the annual journal Clinical Reference Systems. The symptoms usually go unnoticed until the early years of elementary school; the disorder is usually diagnosed in children who are between five and 11 years old.

Children with any one or combination of developmental coordination disorder symptoms should be seen by a pediatrician who specializes in motor skills development delays. There are many ways to address gross motor skills impairment, such as physical therapy. This type of therapy can include treating the underlying cause, strengthening muscles, and teaching ways to compensate for impaired movements.

Parental concerns

Parents, teachers, and primary caregivers need to have a clear understanding of how young children develop gross motor skills and the timetable for development of the skills. The Lincoln-Oseretsky Motor Development Scale is an individually administered test that assesses the development of motor skills in children and adults. Areas covered include fine and gross motor skills, finger dexterity and speed, and hand-eye coordination. The test consists of 36 tasks arranged in order of increasing difficulty. These include walking backwards, standing on one foot, touching one's nose, jumping over a rope, throwing and catching a ball, putting coins in a box, jumping and clapping, balancing on tiptoe while opening and closing one's hands, and balancing a rod vertically. Norms have been established for each part of the test for children aged six to 14.

When to call the doctor

Parents, who suspect that their child has a delay in developments should follow their instincts in having that child evaluated. The earliest intervention possible offers the highest response and success rate among children with special needs. Parents should call the doctor any time they have a concern about their child's motor skill development. Parents should keep in mind that children develop at different rates and try to focus on the skills their children have mastered instead of those they may have yet to master. Still, there are certain signs that may point to a problem, and these should be discussed with a pediatrician or physician. These signs include not walking by 15 months of age, not walking maturely (heel to toe) after walking for several months, walking only on the toes, and not being able to push a toy on wheels by age two. Toddlers may begin to prefer one hand to the other, the first sign of right- or left-handedness, or to use both hands equally. This preference should be allowed to develop naturally. Parents should call a doctor if the child does not seem to use one hand at all or has a strong hand preference before he or she is one year old.

KEY TERMS

Cerebral palsy —A nonprogressive movement disability caused by abnormal development of or damage to motor control centers of the brain.

Congenital malformation —A deformity present at birth.

Developmental coordination disorder —A disorder of motor skills.

Fine motor skill —The abilities required to control the smaller muscles of the body for writing, playing an instrument, artistic expression and craft work. The muscles required to perform fine motor skills are generally found in the hands, feet and head.

Lincoln-Oseretsky Motor Development Scale —A test that assesses the development of motor skills.

Locomotion —The ability to move from one place to another.

Muscular dystrophy —A group of inherited diseases characterized by progressive wasting of the muscles.

See also Fine motor skills.

Resources

BOOKS

Bly, Lois. Motor Skills Acquisition Checklist. San Antonio, TX: Therapy Skill Builders, 2003.

Kurtz, Lisa A. How to Help a Clumsy Child: Strategies for Young Children with Developmental Motor Concerns. London: Jessica Kingsley Publishing, 2003.

Liddle, Tara Losquadro, and Laura Yorke. Why Motor Skills Matter: Improving Your Child's Physical Development to Enhance Learning and Self-Esteem. New York: McGraw-Hill, 2003.

Smith, Jodene Lynn. Activities for Gross Motor Skills Development. Westminster, CA: Teacher Created Materials, 2003.

PERIODICALS

Horsch, Karen. "Clumsy Kids." Parenting (October 1, 2003): 246.

Jeansonne, Jennifer J. "Motor Skill Learning Research Looks Beyond Outcomes—Understanding the Components Needed for Skilled Performance Helps Develop Instructions and Training Methods." Biomechanics (June 1, 2004): 69.

Rink, Judith E. "It's Okay to Be a Beginner: Teach a Motor Skill, and the Skill May Be Learned. Teach How to Learn a Motor Skill, and Many Skills Can Be Learned—Even After a Student Leaves School." The Journal of Physical Education, Recreation & Dance 75 (August 2004): 31–4.

"Should the Main Objective of Adapted Physical Education be the Development of Motor Skills or the Development of Self-Esteem?" The Journal of Physical Education, Recreation & Dance (November-December 2003): 10–2.

Vickers, Marcia. "Why Can't We Let Boys Be Boys?" Business Week (May 26, 2003): 84.

ORGANIZATIONS

American Academy of Pediatrics. 141 Northwest Point Blvd., Elk Grove Village, IL 60007. Web site: <www.aao.org>.

Developmental Research for the Effective Advancement of Memory and Motor Skills. 273 Ringwood Road, Freeville, NY 13068. Web site: <www.dreamms.org>.

WEB SITES

"Motor Skills Disorder." eMedicine, January 3, 2003. Available online at <www.emedicine.com/ped/topic2640.htm> (accessed November 19, 2004).

Ken R. Wells

Gross motor skills

Definition

Gross motor skills encompass the abilities required to control the large muscles of the body for walking, running, sitting, crawling, and other activities. The muscles required to perform gross motor skills are generally found in the arms, legs, back, abdomen, and torso.

Description

Motor skills are deliberate and controlled movements requiring both muscle development and maturation of the central nervous system . In addition, the skeletal system must be strong enough to support the movement and weight involved in any new activity. Once these conditions are met, children learn new physical skills by practicing them until each skill is mastered.

Gross motor skills involve control of the extremities (arms, legs, hands, and feet) and torso. There is an orderly sequence for development of these muscles. Although norms for motor development have been charted in great detail by researchers and clinicians over the past 50 years, the pace of development varies considerably from one child to the next. As skills become more complex, the degree of variation increases among normal children. The normal age for learning to walk has a range of several months, while the age range for turning one's head, a simpler skill that occurs much earlier, is considerably shorter. In addition to variations among children, an individual child's rate of progress varies as well, often including rapid spurts of development and frustrating periods of delay. Although rapid motor development in early childhood is often a good predictor of coordination and athletic ability later in life, no strong correlation has been demonstrated between a child's rate of motor development and intelligence. In most cases, a delay in mastering a specific motor skill is temporary and does not indicate a serious problem. However, medical advice should be sought when children lag significantly behind their peers in motor development or if they regress and lose previously acquired skills.

Function

Gross motor skills develop over a relatively short period of time. Most development occurs during childhood. However, soldiers, some athletes, and others who engage in activities requiring high degrees of endurance may spend years improving their level of muscle and body coordination and gross motor skills.

Infancy and toddler period

The sequence of gross motor development is determined by two developmental principles that also govern physical growth. The cephalo-caudal pattern, or head-totoe development, refers to the way the upper parts of the body, beginning with the head, develop before the lower ones. Thus, infants can lift their heads and shoulders before they can sit up, which, in turn, precedes standing and walking. The other pattern of both development and maturation is proximal-distal, or trunk to extremities. One of the first things an infant achieves is head control. Although they are born with virtually no head or neck control, most infants can lift their heads to a 45-degree angle by the age of four to six weeks, and they can lift both their heads and chests at an average age of eight weeks. Most infants can turn their heads to both sides within 16 to 20 weeks and lift their heads while lying on their backs within 24 to 28 weeks. By about 36 to 42 weeks, or nine to ten months, most infants can sit up unassisted for substantial periods of time with both hands free for playing.

One of the major tasks in gross motor development is locomotion, or the ability to move from one place to another. Infants progress gradually from rolling (eight to ten weeks) to creeping on their stomachs and dragging their legs behind them (six to nine months) to actual crawling (seven months to a year). While infants are learning these temporary means of locomotion, they are gradually becoming able to support increasing amounts of weight while in a standing position. In the second half year of life, babies begin pulling themselves up on furniture and other stationary objects. By the ages of 28 to 54 weeks, on average, they begin "cruising," or navigating a room in an upright position by holding on to the furniture to keep their balance. Eventually, they are able to walk while holding on to an adult with both hands, and then requiring only one adult hand. They usually take their first uncertain steps alone between the ages of 36 and 64 weeks and are competent walkers by the ages of 52 to 78 weeks. By the age of two years, children have begun to develop a variety of gross motor skills. They can run fairly well and negotiate stairs holding on to a banister with one hand and putting both feet on each step before going on to the next one. Most infants this age climb (some very actively) and have a rudimentary ability to kick and throw a ball.

Preschool

During a child's first two years, most parents consider gross motor skills a very high priority. A child's first steps are the most universally celebrated developmental milestone. By the time a child is a preschooler, however, many parents shift the majority of their attention to the child's cognitive development in preparation for school. In addition, gross motor activity at these ages requires increasing amounts of space, equipment, and supervision. However, gross motor skills remain very important to a child's development, and maintaining a youngster's instinctive love of physical activity can make an important contribution to future fitness and health.

By the age of three, children walk with good posture and without watching their feet. They can also walk backwards and run with enough control for sudden stops or changes of direction. They can hop, stand on one foot, and negotiate the rungs of a jungle gym. They can walk up stairs alternating feet but usually still walk down putting both feet on each step. Other achievements include riding a tricycle and throwing a ball, although they have trouble catching it because they hold their arms out in front of their bodies independently of the direction of the ball. Four-year-olds can typically balance or hop on one foot, jump forward and backward over objects, and climb and descend stairs alternating feet. They can bounce and catch balls and throw with accuracy. Some four-year-olds can also skip. Children this age have gained an increased degree of self-consciousness about their motor activities that leads to increased feelings of pride and success when they master a new skill. However, it can also create feelings of inadequacy when they think they have failed. This concern with success can also lead them to try daring activities beyond their abilities, so they need to be very carefully monitored.

School-age

School-age children who are not going through the rapid, unsettling growth spurts of early childhood or adolescence are quite skilled at controlling their bodies and are generally good at a wide variety of physical activities, although the ability varies on the level of maturation and the physique of each child. Motor skills are approximately equal in boys and girls at this stage, except that boys have more forearm strength and girls have greater flexibility. Five-year-olds can skip, jump rope, catch a bounced ball, walk on their tiptoes, balance on one foot for more than eight seconds, and engage in beginning acrobatics. Many can even ride a small two-wheeler bicycle. Eight- and nine-year-olds typically can ride a bicycle, swim, roller-skate, ice-skate, jump rope, scale fences, use a saw, hammer, and garden tools, and play a variety of sports. However, many of the sports prized by adults, often scaled down for play by children, require higher levels of distance judgment and hand-eye coordination, as well as quicker reaction times, than are reasonable for middle childhood. Games that are well suited to the motor skills of elementary school-age children include kick ball, dodge ball, and team relay races.

In adolescence, children develop increasing coordination and motor ability. They also gain greater physical strength and prolonged endurance. Adolescents are able to develop better distance judgment and hand-eye coordination than their younger counterparts. With practice, they can master the skills necessary for adult sports.

For some persons, the development of gross motor ability and endurance continues into adulthood. Athletes and members of the military routinely engage in activities designed to further enhance their gross motor development.

Role in human health

Encouraging gross motor skills requires a safe, open play space, peers to interact with, and some adult supervision.

Promoting the development of gross motor abilities is considerably less complicated than developing fine motor skills . Helping a child succeed in gross motor tasks requires patience and opportunities for a child to practice desired skills. Parents and other persons must understand the level of development before assisting a child to master gross motor skills. Children reach developmental milestones at different rates. Pushing a child to perform a task which is impossible due to development status promotes frustration and disappointment. Children should be allowed to acquire gross motor skills at their own rates.

Common diseases and disorders

There are a range of diseases and disorders that affect gross motor skill development and skills. Among young persons, developmental problems such as genetic disorders, muscular dystrophy , cerebral palsy , and some neurological conditions adversely impact gross motor skill development. Among older persons, arthritis is a common condition. Arthritis affects the joints of the hands and feet, thus impairing the ability of muscles to perform desired movements. Stroke can impair gross motor coordination. Parkinson's disease affects motor movements. Alcoholism and drug use and withdrawal each cause motor problems.

KEY TERMS

Fine motor skill —The abilities required to control the smaller muscles of the body for writing, playing an instrument, artistic expression and craft work. The muscles required to perform fine motor skills are generally found in the hands, feet and head.

Locomotion —Movements such as walking.

Motor —A term referring to muscles and movement.

Proximal-distal —Direction from the center of a body to the tips of the extremities.

Resources

BOOKS

Hernandez, Kimberly T. Kid's Play. Laporte, PA: Quest Publishing, 2001.

Katzen-Luchenta, Jan. Awakening Your Toddler's Love of Learning. Phoenix, AZ: Emunah Publishing, 1999.

Needleman, Robert D. "Growth and development." In Nelson Textbook of Pediatrics, 16th ed., edited by Richard E. Behrman et al., Philadelphia, PA: Saunders, 2000, 23-66.

Payne, V. Gregory, and Larry D. Isaacs. Human Motor Development: A Lifespan Approach, 4th ed. New York, NY: Mayfield Publishing, 1998.

PERIODICALS

Palisano, R.J., et al. "Gross motor function of children with down syndrome: Creation of motor growth curves." Archives of Physical Medicine and Rehabilitation 82, no. 4 (2001): 494-500.

Reeves, L., et al. "Relationship of fitness and gross motor skills for five- to six-yr.-old children." Perceptual and Motor Skills 89, no. 3 Pt 1 (1999): 739-747.

Rine, R.M., et al. "Evidence of progressive delay of motor development in children with sensorineural hearing loss and concurrent vestibular dysfunction." Perceptual and Motor Skills 90, no. 3 Pt 2 (2000): 1101-1112.

Schindler, A.M., and C.C. Hausman. "Do we need to reassess normal gross motor milestones?" Archives of Pediatric and Adolescent Medicine 155, no. 1 (2001): 96-97.

Simons, C.J., et al. "Assessment of motor development in very low birth weight infants." Journal of Perinatology 20, no. 3 (2000): 172-175.

Stieh J., et al. "Gross and fine motor development is impaired in children with cyanotic congenital heart disease." Neuropediatrics 30, no. 2 (1999): 77-82.

Wiart L., and J. Darrah. "Review of four tests of gross motor development." Developmental and Medical Child Neurology 43, no. 4 (2001): 279-285.

ORGANIZATIONS

American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. (847) 434-4000. Fax: (847) 434-8000. <http://www.aap.org/default.htm>. [email protected].

American Academy of Physical Medicine and Rehabilitation, One IBM Plaza, Suite 2500, Chicago, IL 60611-3604.(312) 464-9700. (312) 464-0227. <http://www.aapmr.org/consumers/public/amputations.htm>. [email protected].

Coping.org, 6319 Chauncy Street, Tampa, FL 33647. (813) 631-5176. Fax: (813) 631-1119. <http://www.coping.org>. [email protected].

OTHER

Apraxia Kids. <http://apraxia-kids.org/links/linksot.html>.

Baby Centre (UK). <http://www.babycentre.co.uk/expert/6562.html>.

Flinders University of South Australia School of Education. <http://wwwed.sturt.flinders.edu.au/DLT/2000/FINAL/grossmotors.htm>.

Freed-Hardeman University School of Education. <http://teach.fhu.edu/technology/PSY306/grossmotor.html>.

Gallaudet University. <http://clerccenter.gallaudet.edu/SupportServices/ot/activities.html>.

Health on the Net Foundation. <http://www.hon.ch/Dossier/MotherChild/postnatal/motor_skills.html>.

Mesa (AZ) Community College. <http://www.mc.maricopa.edu/academic/psychology/dev/Spg2001/Preschool/skills.html>.

Michigan State University. <http://www.cem.msu.edu/~leej/development-prewriting.html>.

National Fragile X Foundation. <http://www.fragilex.org/characteristics/motor/motor.htm>.

Test Universe. <http://www.testuniverse.com/mothers/mothers-hdr-350.html>.

University of Scranton. <http://www.academic.uofs.edu/student/DACORTAR2/motor.html>.

Wabash University. <http://www.wabash.edu/depart/psych/Courses/Psych20/LABNET_2000/gross.html>.

L. Fleming Fallon, Jr., MD, DrPH

Gross Motor Skills

Definition

Gross motor skills encompass the abilities required to control the large muscles of the body for walking, running, sitting, crawling, and other activities. The muscles required to perform gross motor skills are generally found in the arms, legs, back, abdomen, and torso.

Description

Motor skills are deliberate and controlled movements requiring both muscle development and maturation of the central nervous system. In addition, the skeletal system must be strong enough to support the movement and weight involved in any new activity. Once these conditions are met, children learn new physical skills by practicing them until each skill is mastered.

Gross motor skills involve control of the extremities (arms, legs, hands, and feet) and torso. There is an orderly sequence for development of these muscles. Although norms for motor development have been charted in great detail by researchers and clinicians over the past 50 years, the pace of development varies considerably from one child to the next. As skills become more complex, the degree of variation increases among normal children. The normal age for learning to walk has a range of several months, while the age range for turning one's head, a simpler skill that occurs much earlier, is considerably shorter. In addition to variations among children, an individual child' rate of progress varies as well, often including rapid spurts of development and frustrating periods of delay. Although rapid motor development in early childhood is often a good predictor of coordination and athletic ability later in life, no strong correlation has been demonstrated between a child's rate of motor development and intelligence. In most cases, a delay in mastering a specific motor skill is temporary and does not indicate a serious problem. However, medical advice should be sought when children lag significantly behind their peers in motor development or if they regress and lose previously acquired skills.

Function

Gross motor skills develop over a relatively short period of time. Most development occurs during childhood. However, soldiers, some athletes, and others who engage in activities requiring high degrees of endurance may spend years improving their level of muscle and body coordination and gross motor skills.

Infancy and toddler period

The sequence of gross motor development is determined by two developmental principles that also govern physical growth. The cephalo-caudal pattern, or head-to-toe development, refers to the way the upper parts of the body, beginning with the head, develop before the lower ones. Thus, infants can lift their heads and shoulders before they can sit up, which, in turn, precedes standing and walking. The other pattern of both development and maturation is proximal-distal, or trunk to extremities. One of the first things an infant achieves is head control. Although they are born with virtually no head or neck control, most infants can lift their heads to a 45-degree angle by the age of four to six weeks, and they can lift both their heads and chests at an average age of eight weeks. Most infants can turn their heads to both sides within 16 to 20 weeks and lift their heads while lying on their backs within 24 to 28 weeks. By about 36 to 42 weeks, or nine to ten months, most infants can sit up unassisted for substantial periods of time with both hands free for playing.

One of the major tasks in gross motor development is locomotion, or the ability to move from one place to another. Infants progress gradually from rolling (eight to ten weeks) to creeping on their stomachs and dragging their legs behind them (six to nine months) to actual crawling (seven months to a year). While infants are learning these temporary means of locomotion, they are gradually becoming able to support increasing amounts of weight while in a standing position. In the second half year of life, babies begin pulling themselves up on furniture and other stationary objects. By the ages of 28 to 54 weeks, on average, they begin "cruising," or navigating a room in an upright position by holding on to the furniture to keep their balance. Eventually, they are able to walk while holding on to an adult with both hands, and then requiring only one adult hand. They usually take their first uncertain steps alone between the ages of 36 and 64 weeks and are competent walkers by the ages of 52 to 78 weeks. By the age of two years, children have begun to develop a variety of gross motor skills. They can run fairly well and negotiate stairs holding on to a banister with one hand and putting both feet on each step before going on to the next one. Most infants this age climb (some very actively) and have a rudimentary ability to kick and throw a ball.

Preschool

During a child's first two years, most parents consider gross motor skills a very high priority. A child's first steps are the most universally celebrated developmental milestone. By the time a child is a preschooler, however, many parents shift the majority of their attention to the child's cognitive development in preparation for school. In addition, gross motor activity at these ages requires increasing amounts of space, equipment, and supervision. However, gross motor skills remain very important to a child's development, and maintaining a youngster's instinctive love of physical activity can make an important contribution to future fitness and health.

By the age of three, children walk with good posture and without watching their feet. They can also walk backwards and run with enough control for sudden stops or changes of direction. They can hop, stand on one foot, and negotiate the rungs of a jungle gym. They can walk up stairs alternating feet but usually still walk down putting both feet on each step. Other achievements include riding a tricycle and throwing a ball, although they have trouble catching it because they hold their arms out in front of their bodies independently of the direction of the ball. Four-year-olds can typically balance or hop on one foot, jump forward and backward over objects, and climb and descend stairs alternating feet. They can bounce and catch balls and throw with accuracy. Some four-year-olds can also skip. Children this age have gained an increased degree of self-consciousness about their motor activities that leads to increased feelings of pride and success when they master a new skill. However, it can also create feelings of inadequacy when they think they have failed. This concern with success can also lead them to try daring activities beyond their abilities, so they need to be very carefully monitored.

School-age

School-age children who are not going through the rapid, unsettling growth spurts of early childhood or adolescence are quite skilled at controlling their bodies and are generally good at a wide variety of physical activities, although the ability varies on the level of maturation and the physique of each child. Motor skills are approximately equal in boys and girls at this stage, except that boys have more forearm strength and girls have greater flexibility. Five-year-olds can skip, jump rope, catch a bounced ball, walk on their tiptoes, balance on one foot for more than eight seconds, and engage in beginning acrobatics. Many can even ride a small two-wheeler bicycle. Eight- and nine-year-olds typically can ride a bicycle, swim, roller-skate, ice-skate, jump rope, scale fences, use a saw, hammer, and garden tools, and play a variety of sports. However, many of the sports prized by adults, often scaled down for play by children, require higher levels of distance judgment and hand-eye coordination, as well as quicker reaction times, than are reasonable for middle childhood. Games that are well suited to the motor skills of elementary school-age children include kick ball, dodge ball, and team relay races.

In adolescence, children develop increasing coordination and motor ability. They also gain greater physical strength and prolonged endurance. Adolescents are able to develop better distance judgment and hand-eye coordination than their younger counterparts. With practice, they can master the skills necessary for adult sports.

For some persons, the development of gross motor ability and endurance continues into adulthood. Athletes and members of the military routinely engage in activities designed to further enhance their gross motor development.

Role in human health

Encouraging gross motor skills requires a safe, open play space, peers to interact with, and some adult supervision.

Promoting the development of gross motor abilities is considerably less complicated than developing fine motor skills. Helping a child succeed in gross motor tasks requires patience and opportunities for a child to practice desired skills. Parents and other persons must understand the level of development before assisting a child to master gross motor skills. Children reach developmental milestones at different rates. Pushing a child to perform a task which is impossible due to development status promotes frustration and disappointment. Children should be allowed to acquire gross motor skills at their own rates.

Common diseases and disorders

There are a range of diseases and disorders that affect gross motor skill development and skills. Among young persons, developmental problems such as genetic disorders, muscular dystrophy, cerebral palsy, and some neurological conditions adversely impact gross motor skill development. Among older persons, arthritis is a common condition. Arthritis affects the joints of the hands and feet, thus impairing the ability of muscles to perform desired movements. Stroke can impair gross motor coordination. Parkinson's disease affects motor movements. Alcoholism and drug use and withdrawal each cause motor problems.

KEY TERMS

Fine motor skill— The abilities required to control the smaller muscles of the body for writing, playing an instrument, artistic expression and craft work. The muscles required to perform fine motor skills are generally found in the hands, feet and head.

Locomotion— Movements such as walking.

Motor— A term referring to muscles and movement.

Proximal-distal— Direction from the center of a body to the tips of the extremities.

Resources

BOOKS

Hernandez, Kimberly T. Kid's Play. Laporte, PA: Quest Publishing, 2001.

Katzen-Luchenta, Jan. Awakening Your Toddler's Love of Learning. Phoenix, AZ: Emunah Publishing, 1999.

Needleman, Robert D. "Growth and development." In Nelson Textbook of Pediatrics, 16th ed., edited by Richard E. Behrman et al., Philadelphia, PA: Saunders, 2000, 23-66.

Payne, V. Gregory, and Larry D. Isaacs. Human Motor Development: A Lifespan Approach, 4th ed. New York, NY: Mayfield Publishing, 1998.

PERIODICALS

Palisano, R.J., et al. "Gross motor function of children with down syndrome: Creation of motor growth curves." Archives of Physical Medicine and Rehabilitation 82, no. 4 (2001): 494-500.

Reeves, L., et al. "Relationship of fitness and gross motor skills for five- to six-yr.-old children." Perceptual and Motor Skills 89, no. 3 Pt 1 (1999): 739-747.

Rine, R.M., et al. "Evidence of progressive delay of motor development in children with sensorineural hearing loss and concurrent vestibular dysfunction." Perceptual and Motor Skills 90, no. 3 Pt 2 (2000): 1101-1112.

Schindler, A.M., and C.C. Hausman. "Do we need to reassess normal gross motor milestones?" Archives of Pediatric and Adolescent Medicine 155, no. 1 (2001): 96-97.

Simons, C.J., et al. "Assessment of motor development in very low birth weight infants." Journal of Perinatology 20, no. 3 (2000): 172-175.

Stieh J., et al. "Gross and fine motor development is impaired in children with cyanotic congenital heart disease." Neuropediatrics 30, no. 2 (1999): 77-82.

Wiart L., and J. Darrah. "Review of four tests of gross motor development." Developmental and Medical Child Neurology 43, no. 4 (2001): 279-285.

ORGANIZATIONS

American Academy of Pediatrics. 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. (847) 434-4000. Fax: (847) 434-8000. 〈http://www.aap.org/default.htm〉. [email protected].

American Academy of Physical Medicine and Rehabilitation. One IBM Plaza, Suite 2500, Chicago, IL 60611-3604. (312) 464-9700. (312) 464-0227. 〈http://www.aapmr.org/consumers/public/amputations.htm〉. [email protected].

Coping.org. 6319 Chauncy Street, Tampa, FL 33647. (813) 631-5176. Fax: (813) 631-1119. 〈http://www.coping.org〉. [email protected].

OTHER

Apraxia Kids. 〈http://apraxia-kids.org/links/linksot.html〉.

BabyCentre (UK). 〈http://www.babycentre.co.uk/expert/6562.html〉.

Flinders University of South Australia School of Education. 〈http://wwwed.sturt.flinders.edu.au/DLT/2000/FINAL/grossmotors.htm〉.

Freed-Hardeman University School of Education. 〈http://teach.fhu.edu/technology/PSY306/grossmotor.html〉.

Gallaudet University. 〈http://clerccenter.gallaudet.edu/SupportServices/ot/activities.html〉.

Health on the Net Foundation. 〈http://www.hon.ch/Dossier/MotherChild/postnatal/motor_skills.html〉.

Mesa (AZ) Community College. 〈http://www.mc.maricopa.edu/academic/psychology/dev/Spg2001/Preschool/skills.html〉.

Michigan State University. 〈http://www.cem.msu.edu/∼leej/development-prewriting.html〉.

National Fragile X Foundation. 〈http://www.fragilex.org/characteristics/motor/motor.htm〉.

Test Universe. 〈http://www.testuniverse.com/mothers/mothers-hdr-350.html〉.

University of Scranton. 〈http://www.academic.uofs.edu/student/DACORTAR2/motor.html〉.

Wabash University. 〈http://www.wabash.edu/depart/psych/Courses/Psych20/LABNET_2000/gross.html〉.

Fine Motor Skills

Definition

Fine motor skills encompass the abilities required to control the smaller muscles of the body for writing, playing an instrument, artistic expression, and craft work. The muscles required to perform fine motor skills are generally found in the hands, feet, and head.

Description

Fine motor skill involves deliberate and controlled movements requiring both muscle development and maturation of the central nervous system. Although newborn infants can move their hands and arms, these motions are reflexes that a baby cannot consciously start or stop. The development of fine motor skills is crucial to an infant's ability to experience and learn about the world and thus plays a central role in the development of intelligence. Like gross motor skills, fine motor skills develop in an orderly progression, but at an uneven pace characterized by both rapid spurts and, at times, frustrating but harmless delays. In most cases, difficulty with acquiring certain fine motor skills is temporary and does not indicate a serious problem. However, medical help should be sought for children who are significantly behind their peers in multiple aspects of fine motor development; or if they regress, losing previously acquired skills.

Function

Fine motor skills develop over a long period of time, primarily during childhood. However, athletes, musicians, jewelry makers, physicians, machinists, and others who engage in activities requiring high degrees of manual dexterity and control may spend decades improving their level of muscle coordination and fine motor skills.

Infancy

The hands of newborn infants are closed most of the time and, like the rest of their bodies, are not well controlled. If its palm is touched, an infant will make a very tight fist, but this is an unconscious action called the Darwinian reflex, and it disappears within two to three months. Similarly, an infant will grasp at an object placed in the hand, but without any conscious awareness of the act. At some point, hand muscles will relax, and an infant will drop an object, equally unaware that it has fallen. Babies may begin flailing at objects that interest them by two weeks of age but cannot grasp them. By eight weeks, they begin to discover and play with their hands, at first solely by touch, and then, at about three months, by sight as well. At this age, however, the deliberate grasp remains largely undeveloped.

Hand-eye coordination begins to develop between the ages of two and four months, inaugurating a period of trial-and-error practice at sighting objects and grabbing at them. At four or five months, most infants can grasp an object that is within reach, looking only at the object and not at their hands. Referred to as "top-level reaching," this achievement is considered an important milestone in fine motor development. At the age of six months, infants can typically hold on to a small block for a brief period, and many have started banging objects. Although their grasp is still clumsy, they have acquired a fascination with grabbing small objects and trying to put them in their mouths. At first, babies will indiscriminately try to grasp things that cannot be grasped, such as pictures in a book, as well as those that can, such as a rattle or ball. During the latter half of the first year, they begin exploring and testing objects before grabbing, touching them with an entire hand and eventually poking them with an index finger.

One of the most significant fine motor accomplishments is the pincer grip, which typically appears between the ages of 12 and 15 months. Initially, an infant can only hold an object, such as a rattle, in the palm, wrapping fingers (including the thumb) around it from one side—an awkward position called the palmar grasp, which makes it difficult to hold on to and manipulate the object. By the age of eight to 10 months, a finger grasp begins, but objects can only be gripped with all four fingers pushing against the thumb, which still makes it awkward to grab small objects. The development of the pincer grip, the ability to hold objects between the thumb and index finger, gives infants a more sophisticated ability to grasp and manipulate objects, and also to deliberately drop them. By about the age of one, an infant can drop an object into a receptacle, compare objects held in both hands, stack objects, and nest them within each other.

Toddler period

Toddlers develop the ability to manipulate objects with increasing sophistication, including using their fingers to twist dials, pull strings, push levers, turn book pages, and use crayons to produce crude scribbles. Dominance of either the right or left hand usually emerges during this period as well. Toddlers also add a new dimension to touching and manipulating objects by simultaneously being able to name them. Instead of only random scribbles, their drawings include patterns, such as circles. Their play with blocks is more elaborate and purposeful than that of infants, and they can stack as many as six blocks. They are also able to fold a sheet of paper in half (with supervision), string large beads, manipulate snap toys, play with clay, unwrap small objects, and pound pegs.

Preschool

The more delicate tasks facing preschool children, such as handling silverware or tying shoelaces, represent more of a challenge than most of the gross motor activities learned during this period of development. The central nervous system is still in the process of maturing sufficiently for complex messages from the brain to get to a child's fingers. In addition, small muscles tire more easily than large ones, and the short, stubby fingers of preschoolers make delicate or complicated tasks more difficult. Finally, gross motor skills call for energy, which is boundless in preschoolers, while fine motor skills require patience, which is in shorter supply. Thus, there is considerable variation in fine motor development among children of this age group.

By the age of three, many children have good control of a pencil. Three-year-olds can often draw a circle, although their attempts at drawing people are still very primitive. It is common for four-year-olds to be able to use scissors, copy geometric shapes and letters, button large buttons, and form clay shapes with two or three parts. Some can print their own names in capital letters. A human figure drawn by a four-year-old is typically a head atop two legs with one arm radiating from each leg.

School age

By the age of five, most children have clearly advanced beyond the fine motor skill development of the preschool age. They can draw recognizably human figures with facial features and legs connected to a distinct trunk. Besides drawing, five-year-olds can also cut, paste, and trace shapes. They can fasten visible buttons (as opposed to those at the back of clothing), and many can tie bows, including shoelace bows. Their right- or left-handedness is well established, and they use the preferred hand for writing and drawing.

Role in human health

Nurturing the development of fine motor skills is considerably more complicated than developing gross motor skills. Helping a child succeed in fine motor tasks requires planning, time, and a variety of play materials. Fine motor development can be encouraged by activities that youngsters enjoy, including crafts, puzzles, and playing with building blocks. Helping parents with everyday domestic activities, such as baking, can be fun for a child in addition to developing fine motor skills. For example, stirring batter provides a good workout for hand and arm muscles, and cutting and spooning out cookie dough requires hand-eye coordination. Even a computer keyboard and mouse can provide practice in finger, hand, and hand-eye coordination. Because the development of fine motor skills plays a crucial role in school readiness and cognitive development, it is considered an important part of a preschool curriculum. Montessori schools in particular were early leaders in emphasizing the significance of fine motor tasks and the use of learning aids such as pegboards and puzzles in early childhood education. The development of fine motor skills in children of low-income parents, who often lack the time or knowledge required to foster these abilities, is a key ingredient in the success of programs such as Head Start.

Common diseases and disorders

There are a range of diseases that decrease one's ability to perform tasks that require fine motor skills. Among young persons, developmental problems such as genetic disorders, muscular dystrophy, cerebral palsy and some neurological conditions adversely impact fine motor skill development. Among older persons, arthritis is a common condition. Arthritis affects the joints of the hands and feet, thus impairing the ability of muscles to perform fine movements. Stroke can impair fine motor coordination. Parkinson's disease affects fine motor movements. Alcoholism and drug use or withdrawal all cause fine motor problems.

KEY TERMS

Darwinian reflex— An unconscious action in infants in which if a palm is touched, the infant makes a very tight fist. This instinct disappears within two to three months.

Gross motor skills— The abilities required to control the large muscles of the body for walking, running, sitting, crawling, and other activities. The muscles required to perform gross motor skills are generally found in the arms, legs, back, abdomen and torso.

Locomotion— Movements such as walking.

Motor— A term referring to muscles and movement.

Palmar grasp— A young infant's primitive ability to hold an object in the palm by wrapping fingers and thumb around it from one side.

Pincer grip— The ability to hold objects between thumb and index finger, which typically develops in infants between 12 and 15 months of age.

Top-level reaching— The ability of an infant to grasp an object that is within reach, looking only at the object and not at their hands. Typically develops between four and five months of age.

Resources

BOOKS

Hernandez, Kimberly T. Kid's Play. Laporte, PA: Quest Publishing, 2001.

Katzen-Luchenta, Jan. Awakening Your Toddler's Love of Learning. Phoenix, AZ: Emunah Publishing, 1999.

Needleman, Robert D. "Growth and development." In Nelson Textbook of Pediatrics, 16th ed. Edited by Richard E. Behrman et al. Philadelphia, PA: Saunders, 2000, 23-66.

Payne, V. Gregory, and Larry D. Isaacs. Human Motor Development: A Lifespan Approach, 4th ed. New York, NY: Mayfield Publishing, 1998.

Rosetta, Lani. Labyrinths for Kids. Medford, OR: Leihuna Enterprises, 2001.

PERIODICALS

Case-Smith, J. "Effects of occupational therapy services on fine motor and functional performance in preschool children." American Journal of Occupational Therapy 54, no. 4 (2000):372-380.

Crowe, T.K., C. McClain, and B. Provost. "Motor development of Native American children on the Peabody Developmental Motor Scales." American Journal of Occupational Therapy 3, no. 5(1999): 514-518.

Hemgren, E., and K. Persson. "A model for combined assessment of motor performance and behaviour in 3-year-old children." Uppsala Journal of Medical Science 104, no. 1(1999): 49-85.

Kumar, M., S. Hickey, and S. Shaw. "Manual dexterity and successful hearing aid use." Journal of Laryngology and Otology 114, no. 8 (2000): 593-597.

Luck, O., B. Reitemeier, and K. Scheuch. "Testing of fine motor skills in dental students." European Journal of Dental Education 4, no. 1(2000): 10-14.

Stieh, J., H.H. Kramer, P. Harding, and G. Fischer. "Gross and fine motor development is impaired in children with cyanotic congenital heart disease." Neuropediatrics 30, no. 2(1999): 77-82.

ORGANIZATIONS

American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, IL 60007-1098. (847) 434-4000. (847) 434-8000. 〈http://www.aap.org/default.htm〉. [email protected].

American Academy of Physical Medicine and Rehabilitation, One IBM Plaza, Suite 2500, Chicago, IL 60611-3604. (312) 464-9700. (312) 464-0227. 〈http://www.aapmr.org/consumers/public/amputations.htm〉. [email protected].

Coping.org, 6319 Chauncy Street, Tampa, FL 33647. (813) 631-5176. Fax: (813) 631-1119. 〈http://www.coping.org〉. [email protected]

OTHER

BabyCentre (UK). 〈http://www.babycentre.co.uk/expert/6562.html〉.

Fife School District (WA). 〈http://www.fifeschools.com/discovery/preschool/2finemotor.html〉.

Flinders University of South Australia School of Education. 〈http://wwwed.sturt.flinders.edu.au/DLT/2000/FINAL/fineint2.htm〉.

Health on the Net Foundation. 〈http://www.hon.ch/Dossier/MotherChild/postnatal/motor_skills.html〉.

MedHelp International. 〈http://medhlp.netusa.net/forums/ChildBehavior/messages/30912a.html〉.

Mesa (AZ) Community College. 〈http://www.mc.marico-pa.edu/academic/psychology/dev/Spg2001/Preschool/skills.html〉.

Michigan State University. 〈http://www.cem.msu.edu/∼leej/development-prewriting.html〉.

Nova Southeastern University. 〈http://www.nova.edu/∼pfeiffer/home.earthlink.net∼lmlk.htm〉.

Tripod. 〈http://members.tripod.com/∼imaware/fmotor.html〉.

University of Scranton. 〈http://www.academic.uofs.edu/student/DACORTAR2/motor.html〉.