From Patting to Pincer

A fetus's nervous system enables her to kick, push and reposition while still snug inside the womb. After birth, the baby's nervous system continues to mature and motor skills will develop in an orderly, predictable sequence. This post examines development during the first year of life as hand skills mature from patting to grasping objects using a pincer. Please read more in detail in my books From Rattles to Writing: A Parents Guide to Hand Skills and From Flapping to Function: A Parent's Guide to Autism and Hand Skills.   

Hand skills develop in the following progression from  using

• full body movement with arms kicking or extending before using intentional movement
• both arms moving at the same time before learning how to reach with only one hand
• control in the larger muscle groups such as shoulders before controlling the hands

The Grasping Reflex

Reflexes are automatic reactions to sensory stimulation. Examples are when you touch an infant's lips-she starts to seek out the nipple and once she has the nipple in her mouth, she starts to suck to receive nourishment.

When you touch an infant's palms -the stimulation will make her automatically grasp your thumbs. This grasp might be tight enough for you to lift her off the bed and protect her her from a fall! It is an example of a protective reflex. The grasping reflex also prepares a baby's hand  muscles and joints to grasp toys in the near future. The reflex only lasts for a couple of months as voluntary grasping gradually emerges.  However, this is a great time for sensory stimulation

• place objects of various textures inside the palm
• gently wrap your hand around the baby's hands to help him move them. Rattles are designed to fit perfectly and the feel of it against the palm provides the touch stimulation that prepares babies for toy play. Of course, your finger or nose will work great, also!

Bringing Hands to Midline

Between 3 and 6 months of age a baby gradually realizes that when he brings both hands to the middle of his body, they touch and can clasp. Offer different sensory experiences such as playing with leaves or patting a warm towel, while obviously supervising to prevent making a meal of them.

This is an important time to place baby in a variety of positions that provide sensory stimulation and build strength and motor control. These include

• On the tummy , perhaps propped up over a cushion, your lap or on a flat surface. Tummy Time prepares baby to crawl!

• Side-lying position enables babies to bring hands together while helping them learn to roll.  

• Suspend toys to encourage reaching

While it is highly encouraged to limit time in baby or car seats, they do provide an opportunity to dangle toys. The baby shown above is reaching in midline with both hands. Although he is looking at me, he has a great opportunity to visually examine objects directly in front of his face.

Developing Grasps Using the Palm

By 6 months of age, a baby typically will have become an expert at grasping and exploring, perhaps with one hand taking a more active lead. This is the beginning of hand control, the control required for a baby to maintain an object in one hand while she looks, tastes, pats, shakes, and examines the item from all directions. This baby is also starting to develop bilateral hand skills! 

The Ulnar Palmar Grasp 

Sometimes the ulnar palmar grasp is called a squeeze grasp because the object is squeezed tightly. The ulnar palmar grasp involves curling the ring and little fingers around an object as it presses into the palm. The object falls out easily because the baby is unable to adjust the object in the hand. You can encourage the baby to use this grasp by inserting one of your fingers inside the pinky side of his palm. Gently wrap his fingers around your finger to help him grasp it.

The Palmar Grasp

Between four and five months, a baby may start using all of the fingers to grasp the object against the palm. The fingers on the radial (thumb) side of the hand begin to apply pressure to hold the object in place. The bent thumb may slide around or rest against the object but does not yet wrap around it. The wrist continues to be in a flexed position.

You can encourage the baby to use this grasp by placing a small toy, such as a teething ring, inside his hand. Try doing this in various positions, such as while he is on his tummy, in a baby seat, or while lying on his side- he might be more successful in one position than in another.

The Radial Palmar Grasp

The radial palmar grasp involves greater use of the middle and index fingers and the thumb as they press against the object o secure it in place. The thumb wraps around cylindrical objects, such as teething rings, or presses against objects, such as blocks. Greater wrist and forearm  movement enable the baby to bring objects into her mouth. Encourage a baby to use this grasp by wrapping her thumb around the object. Gently press your hand over her thumb and fingers so that she experiences how it feels to squeeze an object while using the thumb.

Your baby will soon learn that using the radial palmar grasp makes it easier to shake and manipulate objects. Encourage this by moving her hand with an object or toy inside in different directions so that she can see the toy from different angles and hear the sounds that movement creates. Help your baby grasp and bring toys to her mouth. Using this stronger palmar grasp to explore objects with the mouth will be so much fun that she will be motivated to do this independently.

I recommend offering a vibrating teether. Many babies and children love vibration sensory stimulation to hands and mouth. 

Grasping Smaller objects

Between seven and twelve months, a baby will gradually develop the coordination to pick up smaller and smaller objects. Developing more mature grasps means greater use of the radial (thumb) side of the hand using the index and middle fingers opposite the thumb. Babies typically learn to pick up tiny objects  in the following sequence;

• using fingers like a rake
• using a radial digital grasp
• using an inferior pincer grasp
• using a neat (also called mature) pincher grasp

Babies problem solve as they learn how to approach objects of different sizes in different ways. A seven-month-old child will judge when to use both hands or only one when presented with a large ball or a small cracker.  She will attempt to pick up small objects, such as cereal pieces, off the table by raking them. This means using all the fingers like a rake and curling them into the palm to hold objects.

The Radial Digital Grasp

The more mature radial digital grasp develops between seven and nine months of age and will enable the baby to more easily manipulate smaller objects. This grasp involves holding a small object between the fingers (index, middle fingers, and thumb) rather than pressing the object against the palm. A space is visible between the fingers and palm. Offer your child blocks and other small toys with close supervision as she practices this grasp.

 The Pincer Grasp

We primates are special because we have opposable thumbs. The term opposable thumbs means that the thumb is positioned opposite the fingers in order to grasp small objects. Monkeys can also do this. However, it is only the human who can learn to position the index finger opposite the thumb to perform  precise movements using the pads in order to pick up raisins, to wind up a toy, or to close a Ziploc bag.

As your baby develops greater coordination on the radial side of the hand, she will be able to pick up smaller and smaller objects, such as peas and diced carrots, between the index finger and thumb. This is called a pincer grasp. 

A seven-to-tem month-old baby will first use an inferior pincer grasp, grasping the objecteen between the sides of the index finger and thumb, close to the tis of these digits. This will be challenging, and your baby may stabilize her forearm on the table as she practices.

After a couple of months of practice, a baby typically develops a more mature type of pincer grasp called a neat pincer. This is sometimes called a superior or refined pincer grasp. This involves precise thumb and index finger opposition using the fingertips while the other fingers play a supporting role as she picks up pebbles, pennies, string, or cereal.

You can encourage your ten-to-twelve-month-old to use a pincer grasp by placing small objects inside containers, such as egg carton sections. This clever maneuver forces her to use a pincer grasp to get them out.

Finger Isolation to Poke, Point, and Push Buttons

At the same time your baby is perfecting his pincer grasp to find every crumb on the floor, she is also learning to isolate the index finger to poke and push buttons with that highly talented pointer finger. Between twelve and sixteen months of age he will show off his finger isolation abilities by pointing to everyone and everything.

Although there are lots of toys that require a baby or toddler to poke or push, it is fun to use everyday objects like a telephone that has been turned off. Look for the buttons in your life, such as on elevators, doorbells, and at crosswalks. Someday your child will be poking those computer keyboard letters, and clicking that mouse!

Children with Challenges 

I have worked with hundreds, maybe thousands of children and adults with grasp and manipulation challenges that may be due to

• Decreased hand and finger strength. Occupational therapists often recommend strengthening activities such as squeezing clothespins.
• Sensory sensitivities, especially to palms. Sensory strategies such as deep pressure may be helpful. 
• Decreased motor planning skills and eye-hand coordination.

Adapt activities to make them larger, sturdier, heavier and generally easier to use. The photo below shows a client stringing small rings that are easier to manipulate than beads.

The following video demonstrates several adaptations that were helpful when working with my very young clients. Many of these strategies are also helpful when working with older children and adults with fine- motor challenges.