When a child makes fast progress from a fisted grasp to a mature pencil grasp in therapy, parents notice. This isn’t easy to accomplish, but it is possible. I spent the first decade of my pediatric OT career thinking that finger exercises were the answer. Nope. Here are my three favorite strategies to see quick improvements in children ages 3-5:
- Crayons. Yes, I suggest you go old-school and use crayons, not markers, for scribbling and drawing. The tackiness of wax on paper creates slight resistance that builds strength. Feel free to provide paper with a bit of texture, such as watercolor paper; it is worth the investment! Just like when you go to the gym, all muscles will respond to resistance by recruiting more fibers and building more strength. Yeah!
- Easels. Every pediatric OT recommends an easel, and there is a good reason why. Easels work. I take if further, and make sure that the paper doesn’t slip at all, and that the target for a child’s scribbling is in the middle 1/3 of the easel surface. Why? Unless a child is very tall or very tiny, this will result in a more effective shoulder and wrist angle that allows a mature pencil grasp. How do I ensure that a child uses the target area? I color in the top and bottom 1/3’s, creating either good demos of shapes/designs, or just scribbling away, having fun. What I draw depends on the child’s needs at the moment.
- Tablet Stylus. I am well aware that some therapists are recoiling in horror at the thought of using a tablet. They might have to reconsider their stance after reading what I have to say. Children are using them daily in their homes, many have their own, and sport a newer model than I drag around for work! Tablets aren’t going away, so use them to your advantage. Using a stylus (my fave is the iCreate stylus) produces the tacky resistance that we like about crayons, but on a touchscreen. When children have to drag-and-drop objects, they are using more muscle strength and better control to maintain a stable yet mobile grasp. A few years ago, I worked with a very weak child who was dealing with a life-threatening illness. No one was going to force him to do anything, and all he wanted to do was play on a tablet. He was told to use the stylus while playing, and 6 weeks later he was eagerly coloring with crayons on paper. His improved pencil grip was amazing! As always, my apps are educational as well as fun, and tablet use in therapy is neither a reward nor the focus of my sessions. I make it clear that lots of fun can be had without it.
As with any therapeutic exercise, I monitor fatigue and adapt my set-up and activities to maximize use of a mature grasp with minimal compensation. The rule is: if it looks like a bad grip, it probably is! If your child insists on using a fisted grasp even with these strategies, you need to use some behavioral motivational tools in addition to good equipment. Your OT can help you with that!
If your therapists have mentioned that your child has low muscle tone or ligament laxity (loose joints) take a look at Does An Atypical Pencil Grasp Damage Joints or Support Function In Kids With Hypermobility? for some clarity on addressing pencil grasp with these issues.
Tried all these strategies and still seeing your child struggling? It could take more time to develop the stability and control needed, or you may have to go beyond writing tools and the surface your child is writing on, and take a look at the seating you are providing. Your occupational therapist should be able to help you figure out what an optimal seating position should be, and how to set things up for success!