Tag Archives: hand development

Want Your Child to Show Hand Preference (Righty/Lefty?) Where You Place Their Spoon Matters

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I get a lot of questions about this issue, based on my experience as a pediatric OTR.  Starting at 12 months, some children show a strong hand preference and never look back.  Other kids are switching hand use long after 4.  Without the existence of disorders that directly affect hand dominance such as orthopedic disorders, cerebral palsy, or untreated torticollis, hand dominance is hard-wired and emerges naturally.  But there are situations in which it is delayed or incomplete long after the typical window of skill development.

Here is what can be happening, and here is what you can do as a parent or a therapist:

Hand dominance only emerges with the development of refined hand control and the child’s awareness that they need more skilled control for an activity.  I tell parents that I can pick up my coffee cup with either hand to drink, but that doesn’t make me a lefty.  If you paid me $100, I probably couldn’t thread a needle with my left hand.

Children that aren’t practicing refined skills like feeding or assembling blocks, or even intent on picking up every darn piece of lint on the carpet…they don’t need refined grasp, and they probably will not demonstrate hand dominance on time.  Kids that are scribbling wildly but haven’t tried to draw a circle with closure ( a 36-month skill, BTW) also have no need to develop dominance.  The self-starter, the baby and toddler that watches you intently and decides to learn all these skills?  They won’t need much help.  But the child who avoids challenge or gets help because it is easier and faster for an adult to feed them or help them build a tower?  They may lag behind in hand development.

Some kids are very tuned into adult actions, and copy the hand that a parent or teacher uses.  These are the children that are great mimics.  They can see that you are using your right hand, and even if they naturally grab with their left hand, they transfer objects into the same hand you are using.  Adults are naturally inclined to assume dominance as well.  I cannot count the number of times I absent-mindedly handed a pen to a left-handed parent into their right hand.  If you do that to a child under 5 , they assume that you want them to use that hand, and will struggle on.  This is where spoon placement matters.  I encourage parents to place the utensil in the center of the placement or tray, and watch which hand (both of the child’s hands must be free) their child chooses over many trials.

If a child is inconsistent but clearly uses their left hand more often, placing their spoon on that side of the tray should boost use, and with skilled use comes more skill and awareness.  I never pull objects out of a child’s hand.  I don’t need to.  They will drop their crayon or spoon frequently enough for me to have another chance to offer it back to them.

What if I (or a parent) picked wrong?

Dominance isn’t that easy to alter.  Ask your grandmother what the nuns in Catholic school did to alter dominance in lefties (it was considered “the devil’s hand”, and what they did wasn’t pretty).  Children will eventually simply transfer their spoon over to the other hand.

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The Hypermobile Hand: More Than A Strength Problem

 

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I just received another referral for a kid with “weak’ hands.  Can’t hold a pencil correctly, can’t make a dark enough mark on paper when he writes or colors.  But his mom says he has quite a grip on an object when he doesn’t want to hand something over.  He plays soccer without problems and otherwise functions well in a regular classroom.  Could it be that hypermobility is his underlying problem?

Some children display problems with fine motor skills due to low muscle tone.  Many times, their low tone is significant enough to create poor joint alignment and stability, resulting in joint hypermobility as well as low muscle tone.  But kids can also have joint laxity with typical muscle tone.  Assessing the difference between tone, strength, alignment/stability and endurance is why you get an evaluation from a skilled therapist.  And even then, it can be tricky to determine etiology with the youngest children because they cannot follow your directions or answer questions.  Time to take out your detective hat and drill down into patient history and do a very complete assessment.

With older kids, both low tone and joint laxity can lead them over time to develop joint deformity and soft tissue damage.  Like a tire that you never rotated on your car, inappropriate wear and tear can create joint, ligament, tendon, and muscular imbalance problems that result in even worse alignment, less stability and endurance, and even pain.  And yes, weakness is often observed or reported, but it often is dependent on posture and task demands, rather than being consistent or specific to a nerve distribution or muscle/muscle group.

What does the classic hypermobile hand look like?  Here are some common presentations:

  • The small joints of the fingers and thumb look “swaybacked”, as the joint capsule is unstable and the tendons of the hand exert their pull without correct ligament support.  When they slide laterally and the joint is unable to move smoothly, people say that their fingers “lock” or they are diagnosed with “trigger finger”.
  • The arches of the hand aren’t supported, so the palm looks flat at rest.  By late preschool, the arches of the hand should be evident in both active and passive states.
  • The fleshy bases of the thumb and pinky ( the thenar and hypothenar eminences, for all you therapists out there) aren’t pronounced, due to the lack of support reducing normal muscle development during daily use.
  • Grasp and pinch patterns are immature and/or atypical.  A preschooler uses a fisted grasp to scribble, a grade-school child uses two hands to hold an object that should be held by one hand and uses a “hook” grasp on a pencil.
  • Grasp and pinch may start out looking great, and deteriorate with the need for force.  Or prehension begins looking poor and improves for a while, until fatigue sets in.  This bell-curve pattern of grasp control is often seen with kids that have poor proprioceptive discrimination.  As they use their hands they receive more input, but as fatigue sets in, they cannot maintain a mature grasp and good control.
  • The typical arches of the hand that create the “cupping” of the palm when pretending to scoop water from a stream, for example, will be somewhat flattened. Unless there is nerve damage, you won’t see the “claw hand” pattern or another atypical posture.
  • Fine grasp will often be accomplished with the thumb and third finger to achieve greater stability through the MCP (knuckle) joints and to avoid full opposition of the thumb.  Another common compensatory pattern is using digits II and III together to gain greater stability.  Some kids can even wrap one digit partially around another to do this.  Now that’s hypermobility!

Don’t forget that hypermobility creates poor sensory processing feedback loops.  Reduced proprioception and kinesthesia will result in issues when children try to grade force and control movement without compensations such as visual attention and decreased speed. This can result in kids being labeled clumsy or careless.  For more on handwriting and hypermobility, read When Writing Hurts: The Hypermobile Hand

In terms of treatment, the standard strategies of strengthening and adapting equipment will be important, but I also teach joint protection to kids and parents, energy conservation and I do K-taping to hands.  It is more adaptable than splinting, parents can learn to do a taping protocol at home, and it provides the necessary proprioceptive input for learning that most splinting simply cannot deliver.  For more details on taping kids with hypermobility related to EDS, read Can You K-Tape Kids With Ehlers-Danlos and Other Connective Tissue Disorders?

Looking for more ideas to address the difficulties young children face when they have hypermobility?

I wrote an e-book for you!

The JointSmart Child:  Living and Thriving With Hypermobility Volume One: /The Early Years is my newest book, and it answers many of the questions parents of young hypermobile kids have every day!

 Filled with strategies to build control, independence and safety, it guides families in the use of seating, picking out utensils for meals, even how to make the bath and bedtime safer and easier.  It is available on Amazon.com for digital download on all platforms including iPads, and on Your Therapy Source as a click-able and printable download.  The book is designed to make parents feel empowered and to help children live happier and easier lives!

 

Here are more resources:

Take a look at For Kids With Sensory Issues and Low Tone, Add Resistance Instead of Hand-Over-Hand Assistance and Does An Atypical Pencil Grasp Damage Joints or Support Function In Kids With Hypermobility?.  Depending on the age and skill level of the child, adaptations and education can be just as important as therapeutic exercise.  Your pediatric occupational therapist can help with more than pencil grasp; we are able to help with so many real-life issues!  For toys that support a child’s grasp and control, check out Playing With Toy Food Builds Hand Skills…Faster! and DUPLO Train Set Is Affordable Safe Fun!; both of these toys are easy to hold and easy to manipulate, but allow creativity and fun while developing coordination and control.

 

Do you need help with toilet training?  My e-book will give you the support to make this less of a struggle!  Read The Practical Guide to Toilet Training Your Child With Low Muscle Tone: Potty Training Help Has Arrived! and find out what parents have to say about the only manual on the market to address potty training and low tone.

 

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Want Pincer Grasp Before Her First Birthday? Bet You’ll Be Surprised At What Moves (Hint) Build Hand Control!

The image of a baby popping cereal into her mouth and grinning is commercial genius.  But what if your child is still raking them with a fist at 8 months?  Is that late or just right?  Is there a way to promote early grasp without offering a baby something tiny that she can choke on?  Only if you know the many ways grasp is developing in those first months of life.

Motor skills do not appear out of the blue.  There isn’t a switch that goes on to suddenly release the ability to roll or the ability to hold a bottle.  That’s true for my clients in Early Intervention as well.  Some have serious medical challenges, and some have yet to be diagnosed with ASD or a genetic disorder.  But no skills just pop out without foundational abilities first.

Motor skills start developing in the womb, folks. A premature arrival has medical consequences, but it also deprives a child of the motor and sensory development that naturally occurs while floating in a very active and progressively smaller apartment.  Some children catch up quickly and some do not.   What happens after birth will make a huge impact on the way movement skills are acquired and refined every single day after birth.

If you go shopping at a baby emporium, you would think that they sell toys that are absolutely essential to development.  Reading the labels, you’d think that hand control just couldn’t happen without a Whoozit or a Taggie toy.  Guess what?  Human beings have been developing pincer grasp long before Toys R Us came along, and as far as I know, infant development did just fine without them.  What makes a difference is what exposure and encouragement a child has to build his skills.  Fun toys can motivate a child, but they aren’t the most powerful tool I know to develop grasp.

Here are the great hidden things that build early fine motor skills:

  • Crawling:  I know, there is a big internet debate about whether crawling is necessary for walking.  Here is what I do know:  it is great for developing arm strength and control through the wrist.  It is amazing for building the arches of the hand that allow a child to curve the palm and bring fingers together.  Bonus Round:  crawling with objects in the palm.  Your baby will eventually move the toy toward the thumb-side of her hand so that she can put her weight on the pinky-side while crawling.  One hand, two different uses = better refined control.
  • Reaching While in Tummy Time:  Big-time hand skills develop in this position, especially when babies have to push way up while reaching.
  • Reaching Up While Lying on the Back:  All that abdominal strength is core, core, core stabilization, plus hand control without any arm support.  I make first-graders do exercises in this position before we work on handwriting.  It works.
  • Pivoting around on the Belly.  I love the pivot!!  I took a training course from a PT about 15 years ago that transformed my understanding of this move.  Your little one will be working arms, legs, core, neck, and I saved the best for last.  As she reaches and pivots, she will be using her hand in all directions as she leans on one side of her hand first the front, then the heel of her hand, etc…  Magic can happen for so many other skills using this move, but the biggest secret is how it develops hand control!

Good luck, and have fun developing great hand control before that pincer grasp emerges!!