Pediatric Fine-Motor Milestones – OT / NBCOT® Exam Study Guide

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Study Guide

Birth to 2 years

  • Fist is usually clenched and strong too due to the palmar grasp reflex. 
  • Put their hands in the mouth to try and self soothe.


2-4 months

  • Begin to reach for objects but with poor motor control.
  • Unable to grasp any objects for any amount of significant time.


4-8 months

  • Pick up a small block
  • Shake a rattle
  • Trap an object between their thumb and side of the index finger (scissor grasp).
  • Using two hands, they can hold a tennis ball.


8-12 months

  • Begin to transfer objects between hands
  • Hold a baby bottle or tennis ball
  • Pick up tiny objects in order to finger feed themselves.


1-2 years

  • Pick up a small cube
  • Stack some blocks
  • Play with large puzzles
  • Scribble with a crayon.
  • Use a spoon and sippy cup.


2-3 years

  • Stack several blocks
  • Open simple containers
  • Use wind-up toys
  • String large beads together
  • Copy simple shapes
  • Snip with a scissor. 
  • Begin to learn how to use devices such as an iPad.


3-4 years

  • Simple dressing and undressing with simple fasteners such as large buttons. 
  • Use a pencil
  • Color in the lines
  • String beads
  • Cut out large shapes with scissors.


4-6 years

  • Tie shoes
  • Work with zippers and snaps
  • Use a fork and knife
  • Copy numbers, letters, and short sentences. 


7-10 years

  • Learn cursive
  • Do more craft projects involving hole punches, staplers, glue, needle and thread, and knots.
  • Proficient with eating and managing hygiene such as nail clippers and styling hair. 
  • Computer use and texting.


10 years+

  • Improve at keyboarding speed
  • Electronic devices
  • Improved fine motor skills in areas of art, music, and school projects.