What is Fine-Motor Coordination?

The term "fine-motor coordination" technically refers to our ability to control the small muscles in our body: hands, fingers, face, mouth and feet. Nevertheless, when teachers and therapists use this term, they are usually only referring only to the use of the small muscles in our hands and fingers.

Some examples of fine-motor skills are:

  • Pointing with an isolated index finger

  • Using utensils to feed ourselves

  • Donning/doffing clothing

  • Turning pages of a book

  • Placing pegs in pegboard

  • Building cube towers

  • Scribbling, drawing simple strokes and eventually simple shapes

  • Coloring inside the lines

  • Using scissors to cut out lines and shapes

  • Printing letters, numbers and words

  • Manipulating zipper, buttons and shoelaces

  • Opening containers (e.g. lunch boxes, food bags)

  • Playing with Legos, beads and puzzles.


The effective use of the hands is necessary to engage in a variety of important and meaningful activities. Our ability to get ready independently in the morning, manipulate utensils as we have breakfast, complete handwriting/cutting tasks and use our hands to build things during play is dependent on the appropriate development of fine-motor coordination skills. If children are unable to complete these everyday tasks, not only will their self-esteem suffer, but they will struggle developing age appropriate independence with their living skills. Their play options may be limited and they might feel different from other peers.


Poor fine-motor coordination looks different depending the age of a child. In general, there will be delayed fine-motor coordination skills:


  • Difficulty playing with objects

  • Unable to transfer objects from hand to hand

  • Struggles to manipulate small objects (e.g. raisings or cheerios)

  • Unable to point with an isolated finger

  • Difficulty inserting small objects into containers


  • Unable to turn pages in cardboard book

  • Difficulty completing a simple three-piece form board

  • Unable to scribble and/or draw simple strokes

  • Delayed dressing skills (e.g. taking off socks)

  • Difficulty learning to self-feed

Pre-School Children:

  • Unable to feed themselves

  • Cannot imitate strokes and/or simple shapes

  • Difficulty learning simple tool use (e.g. scissors)

  • Needs help to don/doff simple clothes

  • Unable to string large beads

  • Needs help to turn single pages of a book

  • Difficulty learning to write his or her own name

  • Unable to manipulate large buttons

School-Age Children:

  • Increased dependence on caregivers for assistance with activities of daily living (e.g. dressing, feeding, self-care)

  • Difficulty with higher level dressing skills (e.g. fasteners and shoelaces)

  • Frustration with tasks requiring the use of tools (e.g. pencils, scissors, etc.)

  • Difficulties with academic tasks

  • Delayed pre-writing and handwriting skills

  • Struggles to open containers (e.g. lunch boxes, food bags)

  • Unable to build with Legos or play with beads and puzzles.

Please refer to the Resource Library for more information on age-appropriate fine-motor coordination milestones for your specific child. It is up to an occupational therapist to determine whether or not your child is presenting with fine-motor coordination difficulties. A thorough evaluation with standardized assessment results is needed.


There are various reasons why your child may be having difficulties developing age-appropriate fine-motor coordination skills:

  1. Poor vision or visual skills: Vision is necessary for learning motor skills. Visual-motor coordination also has an impact on various fine-motor activities. Please refer to the “What is Visual-Motor Coordination and Visual Perception” article for more information.

  2. Poor stereognosis: Our ability to gather information about objects by means of active touch alone, instead of relying on vision, is called stereognosis or haptic perception. This skill is also necessary for the appropriate development of fine-motor coordination.

  3. Poor sensory processing: Children with poor registration of tactile input, tactile discrimination, dyspraxia and even tactile hypersensitivity will present with difficulties developing age-appropriate fine-motor coordination skills. Please refer to the “What is Sensory Processing” article for more information.

  4. Poor visual perception and cognition: A child’s ability to perceive object characteristics will affect movement and speed required to manipulate and interact with object. Please refer to the “What is Visual-Motor Coordination and Visual Perception” article for more information.

  5. Skeletal anomalies: typical joint and bone structures are needed for fine-motor coordination skills to develop.

  6. Poor muscle strength and endurance: poor finger, hand, arm, shoulder and trunk strength will affect the development of fine-motor coordination skills.

  7. Poor disassociation of movement: Our ability to perform differentiated motions with each finger, hand and arm contributes to the development of fine-motor coordination skills (e.g. difficulty isolating wrist and finger movements)

  8. Poor bilateral coordination: Some children have difficulty working with both hands at midline or are unable to dissociate arm movements.

This information was gathered from “Occupational Therapy for Children” by Case-Smith O’Brien 6th Edition, a textbook that provides evidence-based and comprehensive information for pediatric practice.