A a pediatric occupational therapist, I am often asked to weigh in on this debate. Not often enough, it seems. There are a lot of kids out there using pencils with wonky grasp patterns because no one has made an effort to improve the way they hold a pencil, or they doubt that it matters. Oops. Although grasp isn’t often or evn usually the biggest issue with writing problems, a really poor grasp can reduce control and increase pain and fatigue. Not every kid with poor pencil grasp is a hot mess. Some of them just need good instruction and good materials. For the others, it might be time to get an OT involved.
I thought I would drill down into the ways that OTs think about the use of pencil grips, and present a few alternatives to reflexively sending kids home with a bit of plastic on the end of a pencil:
Change the pencil. Triangular pencils give more sensory feedback during writing, and they offer a flat surface for finger pads. Thick mechanical pencils still have a standard-thickness lead, but they also are easier to hold for some children. Short pencils, including golf pencils, force more fingertip contact and can be helpful (but not if grasp is really weak or awkward).
Don’t jump into pencil use too early. Until a child can manage a mature grasp, I try very hard to keep them using crayons when they are not yet in kindergarten. I like the flip crayons from Learning Without Tears because they are so very small, but not all kids in kindergarten are ready for them. I break a toddler crayon in two so that they get the benefits of a thick shaft but they will be unable to use a fisted grasp.
Like markers? I only use them if they are the Pipsqueak markers from Crayola. Nice thick, short shafts for little fingers. Markers don’t give a child any resistance at all, so they don’t give enough sensory feedback or strengthening for my kids that need both. And they make a mess most of the time. I don’t have the time to scrub off markers.
Build strength and control with play. Yes, finemotorplay. Totally outdated (just joking) but necessary. I use the iCreate tablet stylus, bead stringing, therapy putty and lots of tiny toys like travel Connect Four games. Even baking. Utensil use counts too. How Using Utensils To Eat Prepares Your Child To Write Children are spending less time with toys and more with tablets, so I insist that they use a tablet stylus with me in sessions. They have no idea that the physical “drag” of the plastic point on the glass screen as they move objects around is creating resistance that helps their fingers get stronger.
Color with children, draw with children. A lot. Coloring is less stressful to the risk-averse child who thinks he can’t write. Drawing simple shapes is directly applicable to writing letters and numbers. Think “T” and a vertical cross, “A” and a volcano. Watching an adult and listening to their narration, such as ” I am coloring around and around to fill in the balloon, since it is a circle shape” is very helpful to young children who resist direct instruction. The child that doesn’t naturally gravitate to coloring may need downloads of their fave character or stickers to add to the picture to make it exciting. But the key is the adult interaction.
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 iCreatestylus) 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!
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!