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).

Newborn:

• 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.