Hand Development

Possible delays in hand development are common reasons why a baby/child is referred to a Pediatric Occupational Therapist. While a Physical Therapist (Physiotherapist), specializes in gross motor development (skills involving the large muscles e.g walking), an Occupational Therapist specializes in Fine Motor Development (skills involving the small muscles - hands).


  • Strong grasp reflex
1-2 Months
  • Grasp reflex
  • Briefly retains object placed in the hand
  • Reflexively scratches and clutches at blanket
3-5 Months
  • Sustained voluntary grasp replaces grasp reflex
  • Uses fingers in grasp without thumb involvement
  • Progresses to palmar grasp
  • Hand begins to accommodate the shape of the object
  • Tactile awareness develops in the hand (tactile: the sense of touch on the skin)
  • Begins to transfer object hand to hand
6 Months
  • Consistent palmar grasp
  • Radial-palmar grasp emerging
  • Transfers hand to hand
  • Attempts to help with spoon feeding and cup drinking
  • Fingerfeeds
  • Shakes and bangs toys to create auditory and visual effect
7-9 Months
  • Demonstrates grip strength
  • Masters radial-palmar grasp
  • Points, and is developing pinch
  • Releases objects in space and into large container
  • Independently bottle feeds
  • Continues to fingerfeed
  • Assists with cup and spoon feeding
10-12 Months
  • Masters the three-jaw chuck grasp (thumb, index & middle fingers form this grasp)
  • Pincher grasp with finger and thumb pads
  • Progresses to finger-tip-pinch developing at 12 months
  • May develop hand preference (note: this not hand dominance which develops later)
  • Developing bimanual dexterity
  • Manipulates by pushing, pulling, squeezing, rotating
  • Combines fine motor patterns into function:
  • Removes socks and unties shoes
  • Finger feeds with minimal success
  • Attempts spoon feeding with minimal success
  • Imitates adult's use of tools (combing hair)
12-24 Months (Overview)
  • Greater control of bimanual skills: speed, accuracy, dexterity increase
  • Two hands demonstrate coordinated asymmetrical roles
12-15 Months
  • Cooperative use of two hands together: one hand holds/stabilizes, one manipulates
  • Precise controlled release into small container
  • Crayon held in fisted hand with thumb side up
15-18 Months
  • Alternating unilateral manipulation of object continues
  • Assisting hand begins to be more that just stabilizer
18-24 Months
  • Simulates hand movements involving blended combinations of alternating stability and mobility: cooperative and complimentary bimanual movements.

Compiled from Normal Development of Functional Motor Skills: The First Year of Life by R. Alexander, R. Boehme, B. Cupps and Hand Function in the Child: Foundations for Remediation by A. Henderson, C. Pehoski.


Pamela Green said...

This is SO interesting. Thank you for taking the time to share this with us. I now have a new outlook on my babies development.

Jessica said...

What a great reference guide. This is really helpful in terms of choosing appropriate aged toys for my little one. Due to my lack of understanding of development, I am sure that I was giving my little one toys that were too advanced for her age.

Success Through Play said...

Thank you for your comments. Jessica, I will be addressing the important issue of age appropriate toys in my coming posts.