Emerging Fine Motor Manipulation

by Denise Jefferson

There are four important fine motor skills that are prerequisites to more refined hand tasks. These include, grasping, reaching, releasing and rotating.  The first three skills are learned during the child’s first year and the last one closer to age two. Babies with visual impairments will acquire these same skills but the sequence may be different from typical developing children (Ferrell, 2011).

Babies and toddlers with visual impairments may need extra prompting to encourage the development of fine motor skills. Something to keep in mind is the importance of positioning yourself behind the child when using physical prompts to model these movements (Ferrell, 2011). Another good technique described in more detail by Trief and Shaw (2009) is hand-under-hand instruction. During this technique a child places his or her hands on top of the adults so they can manipulate and touch the object together. The adult then gradually fades their hands away so the child is exploring independently (Shaw & Trief, 2009). Some children with visual impairments are tactually sensitive and the hand-under-hand technique helps facilitate exploration while still allowing the child control of their own hands. I think our natural tendency is to pull the child’s hand forward when we are asking them to locate an object. This is good information to model and emphasize to the parents.

Positioning of the child is also another important consideration for promoting hand skills. The prone position, sometimes referred to as “tummy time”, is essential for developing grasp and manipulation. This can be a more challenging position for babies with visual impairments if they can’t see objects in front of them to motivate them to hold this position. There is a direct correlation between kinesthetic feedback, weight bearing on the arms and hands and the development of fine motor movements such as grasping. When babies bear weight on their hands and forearms they are innately becoming aware of these upper body parts and how they can use them. They are also learning to weight shift as they develop a more refined reach and grasp. The early intervention visual impairment (EIVI) professional can consult with the occupational and physical therapist on the child’s team to help give parents information on exercises and techniques they can use to encourage awareness of the hands and arms.

Providing practice opportunities is essential for fine motor development. The EIVI professional can help parents adapt these activities for their children with visual impairments to optimize their success. It is important to share with parents that their child with a visual impairment may not follow the same sequence of motor development as a child without a disability. This will help keep them from getting discouraged and continue to try new activities. Some activities to promote the emerging skills of reaching and grasping include: provide toys and objects with sounds to promote reaching, place the baby in front of dangling objects on the floor, in car seat etc. preferably in a prone position, use a variety of objects with textures to place in the babies hand to encourage a more purposeful grasp, play games involving filling and dumping to help develop a voluntary release and daily activities such as eating and dressing practice the skill of wrist rotation (Ferrell, 2011).



Ferrell, K. A. (2011). Reach out and teach: Helping your child who is visually impaired learn and grow. New York, NY: AFB Press.

Pogrund, R.L. & Fazzi, D. L. (Eds.). (2002). Early focus: Working with young blind and visually impaired children and their families. New York: AFB Press.

Trief, E. & Shaw, R. (2009). Everyday activities to promote visual efficiency: A handbook for working with young children with visual impairments. New York: AFB Press.