Fine Motor Skills, also known as dexterity, refer to the coordinated movements of the fingers and hands that require a degree of control and precision to manipulate and control objects. Fine motor skills are required for lots of everyday activities including picking up and transporting small objects, fastening buttons, tying shoelaces and handwriting.

Signs of difficulty

Children with poor fine motor skills may have difficulty when completing everyday tasks and take longer with tasks involving small movements or objects. Some examples include:

• Difficulty tying shoelaces

• Unable to manipulate and fasten buttons/zips

• Difficulty using cutlery 

• Poor handwriting - poor pencil/pen grip

• Takes a long time to pick up small objects

• Using a pair of scissors

These could be due to factors such as low muscle tone, poor grip and pinch strength or lack of experience to consolidate skills.

Activities

Activities which require the child to use both hands together are good to promote small precise movements quickly and smoothly:

• Threading - make a necklace by threading macaroni, beads, cereals, straws

• Pipe cleaner construction 

• Modelling - with clay/plasticine

• Paper tearing and pasting activities - paper mache, collages

• Spinning or flipping coins

• Card games - snap, sorting cards, fish, solitaire

• Clothes peg or tweezer/tongs - pick up pom poms or small objects with tweezers and drop them into a container

• Manipulative games - nuts and bolts, string games (cats cradle)

• Construction - lego, duplo, building blocks, k’nex

• Pencil activities - mazes, doodling, drawing, tracing

• Finger puppets

• Action songs - twinkle twinkle, incy wincy spider, wheels on the bus

• Bubbles - blow them and pop them with different fingers

Helpful strategies

• Place child’s hand in required position if the child is unable to copy

• Talk about the positions of fingers and hands as you are using them

• Use heavy and solid pieces to provide weight for improved control, avoid light toys initially

• Work at a level within the child’s frustration limit so the child remains engaged in the activity

• Encourage activities requiring hand manipulation

• Help stabilise an object while the child completes the task

• Repetition of activities helps consolidate skills

Theraputty is a useful tool used to develop the finger and hand muscles required for fine motor skills, dexterity and grip strength. Theraputty has also been found to be a calming tool and useful for boosting attention and concentration both in school and at home. 

Theraputty can be purchased online and comes in different colours which represent the level of strength/resistance in order to provide the ‘just right’ challenge. Speak with your therapist to establish the appropriate colour/strength for your child. 

Use the exercises below to work on and develop hand strength and fine motor skills.

Strengthening activities should be encouraged throughout the day. Any activity that involves gripping against resistance will increase hand strength over time. Engaging in these activities regularly helps to build the child’s endurance when completing demanding activities (e.g. handwriting for long periods).

Muscle strength of the hands and fingers increase as children grow, play and participate in everyday activities. Hand and finger strength is essential when engaging in daily activities such as fastening buttons or cutting up food.

Grip strength refers to the strength of the whole hand.

Pinch strength refers to the strength of the thumb and index finger together.

Activities

• Play with playdough, Theraputty or cookie dough; kneed, squeeze with a garlic crusher, roll or cut it with cutters

• Make a birds nest by rolling the dough or putty into a ball and then pinching the edges between the fingers and thumb - make small playdough eggs

• Construction toys - pulling them apart and pushing them together again, e.g. Lego, Duplo, K’Nex

• Squeeze softballs or sponges filled with water. Squeeze water from one bowl to another - you can make this into a game with several children

• Newspaper scrunching - scrunch up balls of newspaper and flick, roll or play finger football with them

• Tearing paper - try tearing different strengths of paper

• Tong activities - using tongs/tweezers pick up objects and transfer them from one place to another

• Hammering activities

• Spray bottle - spray water targets on the wall or help with the cleaning/watering plants

• Arts and crafts - using a stapler or sharpening pencils during crafting

• Taking lids on/off jars or Tupperware that are filled with fun objects or toys.

• Grating cheese or carrots when helping with cooking

• Pouring liquids from a container to a cup, e.g. milk or juice

• Play with toys in sand pits or water trays - spades, rakes, buckets

• Writing/drawing on a vertical surface

Hints

• Increase your child’s interest through new or novel activities 

• Encourage regular fine motor activities

• Repeat activities regularly and increase the difficulty as their hand strength improves, e.g. squeeze bottle ten times and then increase to twenty

Children with bilateral coordination difficulties will struggle with tasks that require two hands to work simultaneously. 

Bilateral coordination (also known as bilateral integration) is the skill of using both sides of the body at the same time. This can be when a child is using their arms and legs to move around such as crawling or running, or using both hands together such as stabilising a jar with one hand and using the other hand to open the lid. 

Signs of difficulty

Children with poor bilateral coordination may struggle with one or more of the following activities:

• Holding paper steady whilst cutting with scissors

• Tying shoelaces

• Writing whilst other hand stabilises paper

• Stabilising an object with one hand whilst manipulating another object with the other hand

• Riding a bike

• Playing musical instruments with two hands (triangle, recorder, drums)

Helpful strategies

• Initially encourage the use of hands together in simple movements which require the same movement pattern in each hand. Do activities with both hands where possible

• Graduate to use of hands together in co-operation, where hands are doing different movements e.g. cutting, jigsaw, glueing, ruling, use of erasers, etc

• Position equipment/objects so the child has to cross the midline when reaching

• Ensure child stabilises the paper during writing tasks with a flat hand

• Encourage completion of a task with the dominant hand

Activities

Activities which require the child to use both hands together are good to promote coordinated and competent movements:

• Drawing - drawing around each hand with the other, or drawing around stencils, holding the stencil with one hand and pencil with the other

• Tearing/ripping - paper or cardboard sheets

• Threading - beads, sewing on cardboard sheets with a shoelace

• Blowing bubbles - stabilise bottle with one hand and use bubble wand with the other

• Playdough - hold rolling pin with both hands, moulding dough with both hands

• Carpet feet or dots - cut out right and left feet shapes or dots from carpet, place feet shapes in different patterns. Have the child step L-R or jump two feet together

• Swimming

• Ball games - ball games using bats or racquets which involve holding with two hands. Also catching from either side of the body

• Skipping the rope - keep both feet together

• Soldier jumps - jump, swap same arm and leg, then opposite arm and leg

• Construction toys - jumbo nuts and bolts, lego

Gross Motor Skills refer to the coordination and control of the larger muscles of our body to enable movement. 

Gross motor skills are required for many daily activities such as running, swimming, participating in P.E and moving around home or school safely. Gross motor skills are built upon various factors such as coordination, balance and motor planning. Regular engagement in gross motor games helps to improve your child’s body awareness and gross motor coordination.

Ball skills

Tip: when catching, start with a bean bag then progress to a large ball, then progress to a small ball as your child’s skills increase

• Bean bag games - relay, throwing at a target

• Throwing - underarm throwing initially, then progress to overarm

• Throwing at a target - throwing sock balls into the wash basket, throwing to a target on the wall

• Catching - straight ahead, to the side, above the head, moving side to catch the ball

• Bat and ball - balancing the ball on the bat, velcro bat and ball, swing ball, bouncing ball and hitting with a bat, throwing and hitting with a bat; rounders, tennis

• Basketball, netball, football

Animal walks

Use your body to pretend you are different animals:

• Prowl like a lion

• Flamingo walk - stop with one leg raised

• Jump like a frog

• Hop like a rabbit

• Walk with swinging arms like a gorilla

• Sprint like an ostrich

• Roll like a pig

• Move like a seal on your tummy

• Stomp with both feet like an elephant

• Waddle like a penguin

General activities

• Wall push-ups

• Chair aerobic and exercises - hands on the chair and lift bottom up

• Draw shapes in the air with your finger 

• Jumping, skipping, crawling or sliding (good on a P.E mat)

• Obstacle courses

• Hula-hoops-hop, spin, roll or hula

• Jumping - on the spot, over obstacles, backwards, bunny jumps, star jumps, eyes open/closed

• Drawing with chalk on outdoor surfaces

• Playground equipment, e.g. swings

• Treasure hunt

• Twister

Tip: when catching, start with a bean bag then progress to a large ball, then progress to a small ball as your child’s skills increase.

All about balance

Balance - is the ability to maintain equilibrium when our body in an unstable posture, or when placed in an unstable situation.

Static balance - is the ability to maintain balance when standing still.

Dynamic balance - is the ability to maintain balance whilst moving.

Activities

• Children’s yoga

• Playground equipment - e.g. seesaw

• Trampolining

• Walking on uneven surfaces - e.g. sand, a pillow, deflated ball etc.

• Stepping stones

• Hopscotch

• Walking on a line drawn on the floor - forwards, backwards, heel-to-toe

• Balance whilst crawling - lift up one arm

• Standing on one foot - hopping on one foot

All about coordination

Coordination - is the ability to use different parts of the body together in a smooth manner.

Bilateral coordination - is the ability to coordinate both sides of the body at the same time in a controlled manner.

Hand-eye coordination - is the ability to use and integrate information received from the eyes to direct the movements of the hands. 

Activities

• Connect 4

• Twister

• Card games

• Arts and crafts - using a glue stick or scissors

• Construction games - lego, duplo

• Nuts & bolts

• Swimming

• Skipping

• Hopscotch

• Obstacle courses - dribbling a ball

• Swingball

• Egg and spoon race

• Throwing and catching

Motor planning

Is the ability to plan, organise and carry out a sequence of unfamiliar movements. This may affect the upper limbs and hands (fine motor), body (gross motor), mouth and tongue movements (oral-motor), and/or eyes (oculomotor).

Activities

• Obstacle courses

• Crafting with folding, cutting and pasting paper

• Colouring-in

• Jigsaw puzzles

• Animal walks - e.g. jumping like a frog

• Throwing and catching a ball - try catching above and beside the body

• Mirroring partners - get the child to copy your actions as if they were a mirror

• Simon says

• Children’s yoga

• Skipping

• Walking along a line, or hopping on paving stones

• Tying knots

• Threading beads

• Juggling

• Activity books

• Follow a string maze with your finger when your eyes are shut

Teaching strategies

• Break new tasks down into steps

• Teach one step at a time

• Give verbal prompts regarding what your arm, legs, etc. need to do

• Demonstrate the activity - make sure you have your child’s full attention

• Guide arms and legs as necessary so the child can feel the movement

• Encourage the child to go slowly, to first learn the activity

• Give plenty of opportunity for practice and praise often

Motor sequencing

Is the ability to execute orders of 2 or more movements in a smooth, coordinated manner. Ensure the child can do the first step and then progress on to the next. 

Activities

• Child catches a ball and throws back > child catches the ball, turns in a circle and throws back > child catches the ball, turns in a circle, jumps and throws back

• Child jumps with two feet together on either side of a line > child jumps with two feet together then two feet apart etc. along the line > child jumps two feet on one side, then the other and then with one foot on either side of the line

• Hop, jump, hop repeat > hop, jump, clap, hop repeat etc. (ensure your child can hop or jump before adding to a sequence)

Hypermobility is where the joints have too much movement which can occur in a few or all joints. Hypermobility is a lifelong condition and therefore ongoing management of symptoms is important. Although hypermobility does not always cause problems, some of the difficulties below may be identified.

Symptoms

Fatigue: children may complain of general fatigue because they are using extra energy to maintain joint position 
due to joint laxity. The child may experience joint or muscle fatigue.

Pain: joint pain can often be experienced due to the extra work muscles endure to stabilise the joints. If a child has 
sufficient strength to stabilise and support a hypermobile joint, they are less likely to have pain symptoms.

Poor coordination: children may appear less coordinated and clumsy and have more accidents.

Difficulties with activities of daily living: difficulty holding a writing tool, managing zips or small fastenings or 
being slower than their peers.

Joint perception: difficulties feeling and understanding where their bodies are without looking. This is because 
receptors required for body perception are located in our joints.

Factors contributing to symptoms

• Growth spurts

• Lack of exercise - being overweight

• Illness

• Repetitive activities - these should be paced and regular rest breaks scheduled

Strategies

Joint protection

• Encourage each joint to move its full range of motion once a day - slow and gently

• Encourage the child to recognise pain in a joint to learn how to avoid repeating that 
movement in the future

• Be careful not to put extra stress on the joints

• Avoid tight fists- use larger handled objects such as chunky pencils

• Try not to pinch between thumb and fingers for too long

Good body mechanics

• Avoid keeping joints in the same position for a long time

• Balance periods of rest and activity during the day

• Allow rest periods before the child becomes fatigued

• Alternate light and heavy work throughout the day

• Take regular stretch breaks

• Exercise programmes

Strengthen

• Encourage regular low impact strengthening activities such as walking/ swimming

• Avoid inactivity

• Regular gently physical activity to prevent overweight stress on the joints

Equipment

• Pen/pencil grips

• Writing slopes

• Hand/finger/wrist splints

Personal hygiene is an important element of self-care which some children find difficult with preparing the environment, sequencing the steps, initiating the task or processing sensory information. Breaking the task down into steps and providing supportive tools can promote the child’s independence when getting ready for the day. 

Chaining

Forward chaining - teach your child the first step of a task and support with the 
rest. Once the first step is mastered, teach the child the second step, and so on. 
The child gradually completes more steps until independent. 

Backward chaining - support your child with the task focusing on teaching 
the last step. Once this is mastered, teach your child the last two steps. The 
child gradually completes more steps until independent. Backwards chaining is 
beneficial for confidence boosting as the child will always be finishing the task.

Visual guide - Provide a visual timetable of the steps needed for the task- include 
pictures and talk through with the child before using. Laminate it and put it in the 
shower or in the sink. Provide a body map with names or numbers of the body 
parts needing washing. Number them in the order they are washed. Use clearly 
coloured/labelled bottles for different products (shampoo, shower gel etc.)

Routine order - Always complete the task in the same order. E.g., when 
bathing always wash the hair/body in the same order to help the child retain the 
information. If the order changes each time they have a shower, it will take them 
longer to grasp. 

Set time for the task - Provide a visual timer or musical app which provides the 
child a set time to complete the task and an understanding that the task has an 
ending point. This can also be used as a tool to prompt engagement.

Physical support - Allow the child to sit in the bath or shower to improve 
stability. Use a cup to rinse their hair, letting the child be involved- use a head 
guard to protect the eyes. 

Sensory strategies - Use deep pressure to massage shampoo/conditioner and 
rinse off. Decrease lighting in the bathroom, play soft music and remove any 
over-powering smells (air fresheners/ soaps). Use products with minimal smells or 
utilise ‘all-in-one’ products to reduce the number of different products needed.

STEPS OF BATHING

1. Get a towel and get undressed

2. Turn on the water and transfer into shower or tub

3. Collect shower gel, clean face and body and rinse

4. Collect shampoo/conditioner, clean hair and rinse

5. Transfer out of the shower or tub

6. Dry off with a towel and get dressed

STEPS OF TOOTH BRUSHING

1. Open the toothpaste and collect the toothbrush

2. Squeeze toothpaste onto brush (pea-sized amount)

3. Brush all teeth for 2 minutes

4. Spit out toothpaste and rinse the toothbrush

5. If chosen use mouthwash and spit out

6. Dry mouth with a towel

STEPS OF WASHING FACE

1. Put in plug and fill the sink with warm water

2. Rinse flannel and put soap on flannel 

3. Wash face, rinse flannel and wipe face clean

4. Rinse flannel and pull out the plug

Brushing teeth is an essential activity to ensure good oral health for your child, and this happens in a developmental pattern. Children will need supervision and assistance to brush safely, correctly, and thoroughly. 

Developmental timeline

6 to 24 months: a child will start to show their first teeth. Give a children’s toothbrush to explore and chew to help the feel 
of a toothbrush to be familiar.

3 to 5 years: independent brushing should be encouraged with guidance. Encourage your child to ‘spit out’ the toothpaste 
when finished.

6 to 11 years: children begin to lose teeth at age 6. Up until age 8, most children do not have the fine motor skills to 
independently brush their teeth effectively and will need help.

12 to 18 years: all permanent teeth are present. As teenagers grow, they have increased control of their diet and habits as 
self-awareness develops.

Activities to support teeth brushing

• Use a laminated picture to brush marks off

• Reaching to opposite shoulder - reaching for an object 
or peeling stickers off the shoulder

• Rotating wrist/forearm: turning cards/objects over on 
the table, playing snap

• Turning pages of a book

• Skipping rope

Teaching tips

Two minutes, twice a day. That’s the dentist-recommended brushing time to aim for, as a minimum. Yet, as any parent knows, two minutes can feel like a long time when you’re trying to convince your tiny person to brush their teeth.

• Encourage teeth brushing in play by brushing teddy’s teeth to keep them clean

• Verbal instruction and hand over hand assistance to guide movements

• Have an adult or sibling brush their teeth at the same time for a visual demonstration

• Place a mirror at the child’s height so they can see what they are doing

• Use a visual timetable or toothbrushing apps to teach steps of brushing

• Use a reward chart for brushing their teeth

• To prevent the child from swallowing toothpaste, smear toothpaste onto the brush rather than leaving the pea-sized amount on the bristles

Alternative brushes

• Electric toothbrush (some have integrated timers to inform children when to stop brushing)

• Three-sided toothbrush

• Adapted toothbrush handles

Alternative toothpaste

• Fun flavoured toothpaste: bubble gum, strawberry

• Non-flavoured toothpaste

Fine motor skills are important when fastening buttons - pinching the button, inserting into the buttonhole and pulling it through are difficult tasks for a child with poor fine motor coordination skills.

• Practice buttons at the table or on the floor before practising on their own clothing

• Start at the bottom - it’s far easier to coordinate your hands when you can see them

• Start with large buttons and buttonholes (loose or chunky cardigans are ideal)

• As the child improves, progress to smaller buttons/buttonholes

• For fastening, practice pinching the button and ‘posting’ into the buttonhole

• For unfastening, practice ‘posting’ the button back through the hole

• Snip the buttonhole to make it easier for posting through

Activities to develop fine motor skills for buttoning

• Practice ‘tripod grasp’ (thumb, index, and middle finger pinch together)

• Using tweezers/tongs to pick up and transfer small items - beads, play-doh, pom balls

• Creating different size postboxes with small, medium and large postal holes - practice posting counters, buttons, and cards into the holes

• Pinching and stretching play-doh or putty

Bilateral Coordination (using two hands together) and an established pincer grip are required to fasten a zip.

• Practice with larger zips (starting with coat zips) and progress to smaller zips

• Zip attachments (keyrings or hair bands) can be put onto zip fasteners to make them easier to grasp

• Hand over hand assistance and backwards chaining are good to build confidence

• To practice slotting the zip end into the fastener, help your child hold the end still whilst your child tries to slot the zip end in

• Reduce your hand-over-hand assistance as your child becomes more confident

Activities to develop skills required for fastening a zip

• Activities requiring two hands such as lacing cards, scissor based activities (using one hand to stabilize paper and one hand to use scissors), unscrewing/screwing lids onto jars and hiding items inside to retrieve. Lego or construction toys also are helpful

• Pinching and stretching play-doh or putty

• Spraying water bottles or wringing out wet flannels/sponges

• Create a DIY zipper board with small and large zips to practice slotting the zipper into the fasteners

Cutlery skills are an important way to increase independence at meal times.

Teaching tools

• Check your child’s posture whilst sitting at the table - their feet should be supported and the table at a height they can rest their elbows easily

• Use appropriate size and weight cutlery for your child

• Start with cutting soft foods (soft vegetables, for example, boiled potatoes) and gradually work towards firmer foods

• Non-slip mats (Dycem mat) help to keep the plate still

• Encourage the use of ‘pointy’ fingers (index finger) to guide the cutlery when cutting

• Provide visual guidance to your child - demonstrate how to hold the cutlery and ask your child to copy

Tips for using cutlery

Many children may find using cutlery difficult due to a lack of experience or difficulty coordinating two hands together.

1. Ensure there are minimal distractions e.g. phones away, TV off etc

2. Teach the child how to grasp the fork using his non-dominant hand and pick up food

3. Once the usage of the fork has been established, the child could be introduced to holding the knife and fork using the correct grips (detailed above). The knife should be held in the dominant hand

4. If they are finding it difficult to grasp, try using ‘Caring Cutlery’ as it has indentations on the handles to show your child where to place their fingers. Available in ‘adult’ and ‘junior’ sizes from online stores (e.g. Amazon)

5. Actively ‘Teach’ your child the correct technique for using a knife and fork: Firstly, ‘stab’ the food with the fork. Secondly, ‘saw’ with the knife, put the knife in front of the fork and move the knife back and forth in a ‘swing’ motion, rather than just pushing it through the food. If your child finds this difficult, place your hands over theirs and show them how to move their knife and keep their fork still. Once they start to get the hang of it, reduce your assistance to verbal prompts

6. If your child’s plate keeps slipping when cutting, place a non-slip mat underneath the plate. (E.g. Dycem mats from www.dycem-ns.com or Maplin do a multi-purpose non-slip mat)

Possible problems and solutions

Have difficulties with getting dressed? Poor orientation and balance can lead to stress when getting dressed.

Poor Balance:

• Sitting on a chair or a firm bed with their feet supported on the floor

• Sitting against a wall or in the corner of the room

• Standing against a chair or wall for support

Sock heel gets twisted to the front of the foot: 

• Don’t wear socks that are too tight 

• Wear socks with marked colours on the toes and heels 

• Tie/sew a loop of ribbon onto the edge of the socks for your child to hold when pulling the sock up

• Try with tubular socks

Sequencing - clothes are put on in the wrong order:

• Make a list showing all the steps necessary to get dressed.Use photos or pictures if it helps - pictures of the child doing each stage of the task help later recognition of steps 

• A Velcro board could be used with pictures of each clothing item under a number to indicate and prompt which order to sequence clothing. Try and get your child to place the Velcro pictures onto the board as a dressing game

• Store all items of clothing in order. (i.e Underwear in the top drawer, t-shirts in the next drawer down etc.) Remember to be consistent in your ordering

Clothes are put on back to front: 

• Lay clothes down on the table front down

• Roll clothes up slightly to give extra grip

• Put a special mark inside clothes to show your child which way is the front 

• Use patches and textures to help your child remember where the front, back, right and left sides are

• Dress your child in t-shirts and sweatshirts with a picture on the front

Arm and head holes get ‘lost’:

• Lay clothes flat out in front of your child with the arms showing

• Encourage your child to put their arms in first so they can’t be lost and then put their head in

• With a coat: Drape the coat over the back of a chair with the lining facing outwards and the sleeves hanging freely. Your child stands with their back to the lining and puts each arm, in turn, into the sleeves. The child then bends down to fit their shoulders in and then moves up and away to release the coat

• Place the coat open, with the collar nearest to your child and the lining upwards. Your child slides their arms into the sleeves and swings the coat over their head. Try using slippy, silky linings to make it easier to put the coat on and off

Orientation - clothes are put on inside-out:

• Use contrasting lining – different colours and textures from outside to inside

• Use contrasting sleeve lining from the rest of the lining 

• Use clothing that has a picture or detailing on the front 

• Daw your child’s attention to clothes that have been put on 
the wrong way round

• Put labels on the inside of clothes or write their name/symbol if they dislike labels

• Use a mirror for your child to check their clothes are all on the right way

Dressing becomes stressful at a particular time: 

• Practice dressing outside of these times, when not in a rush (e.g. weekends or evenings)

• Practice dressing with loose clothing that is a size too big or from older brothers/sisters. Stretchy materials or pyjamas often work well

• Make sure that your child has enough time to get dressed/undressed - allow them to take their time

Orientation - confusion between left and right:

• Put small ‘R’ and ‘L’ stickers inside shoes to help your child remember which shoe goes on which foot

• Cut a large sticker into two parts and place the left side in the left shoe and the right side of the sticker in the right shoe. When your child picks up their shoe prompt them to put the shoes together to complete the sticker before putting on their shoes 

• Wear shoes with fastening or pictures on the outer edge to act as a prompt

Using a cup and cutlery is an important way for children to increase their independence at mealtimes. Many children may find using cutlery difficult due to a lack of experience or difficulty using two hands together. 

Stages of cutlery

• Let the child play with the spoon, mouth the spoon and learn how to hold it

• Once your child has established grasping the spoon and bringing it to their mouth, put food onto the spoon and provide hand over hand assistance to guide the movement

• Giving sticky foods (porridge, rice pudding, mashed potato) help keep food on the spoon whilst the child practices independent feeding

• Once confident with the spoon, introduce a children’s fork to your child

• Allow them to practice ‘stabbing’ and picking up soft foods (fruit, boiled vegetables) with the fork

• Encourage the child to hold both spoon and fork together to get them used to holding two pieces of cutlery

• When confident with using the fork to pick up food, introduce a children’s knife to the child

Using a cup

• Start with a cup/beaker with two handles -> progress to one handle -> progress to no handles

• No-spill cups are a good tool to practice the drinking motion

• Using thicker drinks helps the child control the cup/liquids whilst learning

• Provide hand-over-hand assistance and verbal prompts/encouragements/praise throughout the learning

• Expect spillages whilst your child is learning to use an open cup

• Providing a special drink mat to place the cup down after drinking reminds the child to place it before letting go

Activity ideas

The below activities are useful to develop the skills for using an open cup:

• Blowing a whistle or bubbles

• Sipping from a straw

• Practice drinking thick fluids from an open cup

The below activities are useful to develop the skills required when using cutlery: (two hands together, tripod grip and finger/hand strength).

• Colouring with one hand whilst the other hand steadies the paper

• Construction games - lego, bead threading, K’nex

• Cooking/baking - mixing ingredients with a bowl and spoon

• Opening screw bottles and jars

• Using a dustpan and brush - keep the dustpan still whilst using the brush

• Using playdoh/modelling clay - use cutlery to cut ‘pretend food’

• Using scissors - progress from thin to firm paper/card for resistance

Alternative solutions 

1. ‘Caring Cutlery’ or ‘ Nanna’s Manners Cutlery’ are useful to prompt correct hand placement

2. Foam Tubing can provide a built-up handle for better grip

3. Angled cutlery for easier hand to mouth feeding

4. ‘Knork’ - combined cutlery for single-handed cutlery use

5. Weighted cutlery can provide better grip and control for children with motor control difficulties

Typically developing children usually learn to use the potty or toilet between the ages of 2-4 years, however, children with developmental or learning disabilities may take longer to achieve this. 

Am I ready to use the toilet?

It can be difficult to know when your child is ready to start toilet training. Looking for the common signs of readiness below can make training easier and reduce the chance of accidents: 

• Dry Nappies for 1-2 hours at a time during the day 

• They understand when they are having a wee

• They recognise when their nappy is wet or dirty, they may pull it, take it off or ask you to change it

• Visible signs that they need to go to the toilet such as fidgeting or hiding somewhere quiet 

• They can sense they need a wee and may let you know 

Preparing to use the toilet

• Sit on the potty for 1 minute per year of age (3 minutes for a 3-year-old). If the child is reluctant, start with 30 seconds and gradually increase the sitting time - don’t force sitting for extended periods

• Try using a visual timer such as a sand timer or musical app. Make it fun by singing a song with them on the toilet

• If no success, take them off the toilet and tell them we will try again later - put them back on the toilet 5-10 minutes later if they are due a wee, or leave for longer based on their toileting pattern

• Keep a diary of toilet trips to help understand their toileting pattern

1. Set the scene

Introduce the potty and always change your child’s nappy in the bathroom. Start to talk about wees and poos. Use your family words for these and make sure other people use the same words that you do. 

2. Developing skills

Make sure your child is comfortable sitting on the potty or toilet with feet supported. They will need a seat insert and stool if sitting on the toilet. Gradually introduce sitting on the potty or toilet after drinks and meals.

3. Identifying patterns

Identify your child’s toileting habits. Check their nappy every hour for wees and poos when they are awake and note in a diary if it is wet or soiled. 

4. Using the toilet

Once your child is familiar with the toilet and comfortable using it, and you are familiar with their toileting pattern, try removing the nappy when they are awake and encourage trips to the toilet. Watch their body language for indicators of needing the toilet.

Bottom wiping

Once a child has learnt how to control their bladder and bowel, they can begin to learn how to clean themselves- this is typically learnt by the time they start primary school (age 4). This can be a difficult skill to master due to the requirement of balance, reach, holding tissue and cleaning without seeing what they are doing. 

Before starting

• Explain why bottom wiping is important - smell and cleanliness

• Show the child what they need to do - when they use the toilet or model with a doll

• Talk through steps from start to finish - discuss visual cues such as poo on the tissue means we need to wipe again - “we wipe until clean”

• Provide a visual timetable of the steps of bottom wiping - place this at eye level in the toilet

• Emphasise the importance of washing hands afterwards

Tips for bottom wiping 

• Be patient with the child and encourage them to participate as much as possible. If they are reluctant ask them to do the final wipe and increase wipes as tolerance increases

• Wet wipes or flushable toilet wipes provide sensory feedback and don’t require as much pressure when wiping

• Consider physical issues such as the child’s balance, ability to reach, hand function etc

• Provide a visual timetable of the steps of bottom wiping - place this at eye level in the toilet

• Verbal prompts and hand over hand assistance should be provided to allow the child to practice the movement of wiping their bottom

• Use a mirror with the child to help them identify if they are clean

• Use reward charts/stickers. Praise all attempts!

Further information

This information is informed by Bladder and Bowel UK / ERIC 

Further Information and resources for children with additional needs can be found at: 

• Bladder & Bowel UK: www.bbuk.org.uk  

• ERIC- The Children’s Bowel & Bladder Charity: www.eric.org.uk  

• National Autistic Society for advice on toilet training for children with ASD: www.autism.org.uk  

Sensory supports

• Remove strong odours (air fresheners/candles)

• Reduce lighting

• Play calming music whilst in the bathroom

• Place a toilet insert, steps and handles around the toilet 
to reduce the fear of falling

• Play with different wet textures

Activities to support wiping

• Place Post-it notes, stickers or masking tape on the child’s lower back when they are sitting down and have them pull them off

• Games involving passing toys, bean bags or scarfs backwards/forwards to someone sitting in front of/ behind them, around their waist, between their legs or overhead

• Retrieve a scarf or handkerchief tucked into the back of the waistband, with either hand. Progress to learning to tuck it back in again. Next, try retrieving the scarf from the waistband by reaching between the legs

• Practice wiping pressure by cleaning peanut butter or chocolate spread off windows and wiping tables or surfaces with a cloth. Discuss visual cues whilst doing it to reinforce wiping until clean

Activities to develop skills required for tying shoelaces

Tips to practice shoe lacing

Make or buy a shoe lacing board for the child to practice on initially. The child should try tying shoelaces with a shoe on the table, then progress to on their lap first. Once confident in this, the child can practise with shoes on their feet. When tying shoelaces, ensure your child is sitting down as this allows extra stability. Allow the child to practice shoelaces without any time demands (e.g. at weekends, in the evening). Apply a backwards chaining technique - the adult performs most of the task (steps 1-7) and the child performs the last step (8) of the sequence to receive positive reinforcement for completing the task. The practice continues with the adult doing fewer steps and the child completing additional steps. Backward chaining is particularly helpful for children with a low frustration tolerance or poor self-esteem because it gives immediate success. Visit ‘Ian’s Shoelace Site’ for various methods of tying laces to find the best one for your child.

Try this!

• Tie knots with different types of fabrics or bows with pipe cleaners. Then progress to tying bows with ribbons or laces

• Practice lacing concepts such as over, under, looping, around and through

• You can also play sequencing games

• Practice tying shoelaces on your favourite toys, dolls or teddy bears

Hand strength exercises such as:

• Ripping paper or card

• Spraying water bottles

• Squeezing out of bottles (e.g. washing liquid bottle)

• Wringing out wet cloths or sponges

Activities requiring two hands such as:

• Lacing cards

• Threading beads

• Sewing

• Construction toys

Alternatives

Tying shoelaces require the child to use both hands together, have a good pincer grip and can memorise and sequence the steps effectively.

When a child has difficulties with tying shoelaces, this could be due to physical or learning difficulties, some alternatives can be used to make this task easier:

• Velcro laces

• Magnetic laces

• Toggles

• Elastic/Silicone - no tielaces

• Coil laces

• Slip-on shoes

Keep expectations consistent

• Develop and stick to regular routines and rules. Discuss these with the child as they may have heard the words but not understood the meaning

• Some children have difficulty transitioning between tasks. Tools such as having a Now and Next board visible, using sand timers and verbal cues to help the child understand how much time is left for an activity to aid the transition. Always allow the child to move around after a seated period 

Limit distractions

• Remove any visual or noise distractions near the child such as turning off the television, radio, iPads and removing clutter. Some children like white noise or background noise. Using headphones is an option

• Sit next to your child or in front to support re-direction of attention

Provide frequent feedback

• Children benefit from frequent, instant feedback regarding their behaviour

• Praise for good behaviour should be immediate and consequences for unwanted behaviour should be prominent but not disruptive

• Rewards and incentives should always be used before punishment to motivate a child. To prevent boredom, change up the rewards frequently

Use tools and flexible rules

• Children who present as restless may be able to attend better if able to stand whilst working

• For children who tend to fidget, holding a small stress ball or something tactile to manipulate (like Therapy Putty) provides a little stimulation without disrupting the task

• For children who have difficulty with organisation, help them to write a checklist for items they need for the task and collect them together

Give them a break

• Children who tend to struggle with sitting still for long periods of time, try giving them frequent opportunities to get up and move around 

• You can provide them with a functional movement break by letting them take an item upstairs or give something to another family member

• Movement breaks can be useful for the whole family to improve attention e.g. jumping activities, children’s yoga, table gym activities

Don’t overload them

• Children may become overwhelmed. It can be helpful to reduce the task by breaking it down into smaller sections 

• Most children are in the ‘rest and digest’ state after lunchtime, try to do activities when they are most alert

Encourage support

• Practising an activity with a family or siblings can encourage support between each other

• Discuss with your child that it is okay to find something difficult and praise their efforts. Remind them that you are there for support 

• Discuss strategies with the schoolteacher to identify what methods help your child’s attention/concentration

Use tools and flexible rules

• Children who present as restless may be able to attend better if able to stand whilst working

• For children who tend to fidget, holding a small stress ball or something tactile to manipulate (like Therapy Putty) provides a little stimulation without disrupting the task

• For children who have difficulty with organisation, help them to write a checklist for items they need for the task and collect them together

Guide their attention and concentration

• Before you start explaining a task, ensure that the child is not moving and paying attention 

• When giving direct instructions, get the child’s attention by calling their name and making eye contact 

• Show or explain an example of the finished product so the child understands what they are trying to accomplish 

• Demonstrate first and then tell the child what you want them to do 

• Check-in with the child before a task to ensure they understand what they need to do; concentration often decreases when a child is unsure of what they need to do next 

What are planning and organisational skills?

There is a collection of cognitive or thinking skills called ‘executive functions’ which include planning and organisation

• Planning: is the process of thinking about the activities required to reach the desired goal

• Organisation: refers to the ability to direct and bring order to the task at hand

Examples of difficulties with planning and organisational skills

• Not starting tasks because they don’t know where to begin

• Starting a task impulsively, without planning what steps are necessary

• Attempting tasks in haphazard ways and finishing things slowly or inefficiently 

• Having trouble coping with anything complicated

• Jumping from one topic to another or going off on tangents in conversation, oral presentations or written tasks 

• Completing a task but not meeting the goal that was set

• Understanding parts of a task or subject but not being able to join all the parts effectively

• Not knowing where things are and forgetting appointments

• Difficulty learning new information

• Difficulty prioritising work and organising homework

Strategies

1. Keep a family calendar or planner

Place all activities on a visually accessible calendar, encouraging your child to write their own entries and reference the calendar when making plans.

2. Introduce checklists

Whether it’s as simple as “3 Things To Do Before Bed, creating and referring to lists together will develop your child’s ability to plan and organise their time. 

3. Assign chores that involve organising

Grocery shopping, emptying the dishwasher, sorting photos, cleaning out a closet, and other tasks that involve pre-planning, making lists, or arranging things are great choices.

4. Get ready the night before

This may take time but try to create a habit through verbal prompts and assistance if needed. 

5. Use containers and organising boxes

If there’s a place for everything your child will manage to find items, keep them neat, and clean up. 

6. Organise schoolwork

Make sure your child’s keeping notes, homework, handouts, and graded assignments in separate folders. Try to check their backpack nightly and set a time aside each week to get things sorted. 

7. Establish a homework routine

Help your child make a “study hour” schedule and set up a comfortable workspace. Encourage your child to stick to the schedule even when they don’t have homework (They can read, review notes, or even do a crossword puzzle.) 

8. Create a homework supply box

Fill a box with office supplies and encourage your child to store pens, paper, measurement tools, and a calculator in it so they’ll have what they need on hand. 

9. Cook together

Cooking teaches measuring, following directions, sorting ingredients, and managing time — all key elements in organisation. Involve your child in meal planning too, challenging them to help you put together a shopping list.

10. Cultivate an interest in collecting

If your child has a particular interest, encourage them to create and organise the collection. It can even be something free — such as rocks or cancelled stamps — that he can sort, classify, and arrange.

11. Demonstrate the skills and tools you use

Your child benefits from seeing behaviours and mirroring them. Explain and demonstrate planning and organising tools that parents/teachers use to help children visualise how organisation looks. 

12. Reward and provide support with organisational tasks

Your child may find organising a challenge, so help them develop their routine and give them a treat for jobs well done!

Occupational Developmental Milestones 

There are several charities which can help to provide services to families who need extra support. We are currently gathering information around this.

Contact A Family

Wipe Away Those Tears

The Boparan Charitable Trust

Tree of Hope

Newlife Charity

Muscular Dystrophy UK