by Chelsea Gonzalez
It is essential to have an understanding of the major milestones of grasp and upper extremity development when working with younger kiddos so that therapy complements the changes naturally occurring in the brain at each age-level. It is important that babies and toddlers progress through each stage of hand development in a sequence so that neural pathways can be built for later in life. However, the timing of this progression can be flexible. The general progression (and timeline) of upper extremity development looks like this:
While a general understanding of developmental progression is essential, knowledge of more detailed milestones is important to have on hand for those times when a young patient schedules an evaluation. A few excellent overviews that we use:
- Gerber, Wilks & Erdie-Lalena (2010): https://pedsinreview.aappublications.org/content/31/7/267
- Children’s Hospital of Orange County: Fine Motor Skills: https://www.choc.org/userfiles/file/Rehab-Developmental%20Milestones%20final.pdf
- Centers for Disease Control and Prevention (also available in Spanish): https://www.cdc.gov/ncbddd/actearly/milestones/index.html
Assessment and treatment of pediatric patients in a hand setting requires knowledge of the developmental progression. If a stage is missed or underdeveloped because of an injury or condition, it is the therapist’s role to provide support in that area so future skills can continue to develop naturally.
If you see children in your practice, learn these milestones and become comfortable identifying them in children during the assessment process. It takes time and experience, so start practicing on kids you see in the community and in your daily life. Watching how kids move and how they use their hands is a great way to develop experience in identifying the skills and sequences of developmental milestone acquisition.
Abzug, J., Kozin, S.H., & Neiduski, R. (2020) Pediatric hand therapy. St. Louis, MO: Mosby.
Case-Smith, J. and O’Brien, J.C. (2015). Occupational therapy for children and adolescents (7th ed.). St. Louis, MO: Mosby.
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