Handwriting and Occupational Therapy

Writing is a highly creative and fun way to express one’s thoughts, requiring a combination of big muscles, tiny muscles, and visual skills. Today, children begin writing their letters by preschool age, but the foundational skills for writing actually begin much earlier. Keep reading to discover all the skills needed for handwriting.

Trunk Strength: The Big Muscles

In the early months of a child’s life, a common phrase you may hear is tummy time. Laying your baby on their tummy during play and interaction is important for strengthening all those trunk and neck muscles, as well as gross motor movements such as rolling, reaching, crawling, and standing. All these muscles provide children with the strength and endurance to strongly sit up in a chair while they write.

The phrase “proximal stability for distal mobility” refers to the importance of having a strong core (the proximal or center muscles of our bodies) to improve stability with fine-motor movements for muscles further from our body’s center (the distal areas). When children have poor handwriting skills, one of the first things to assess is their core strength and endurance, including the neck and shoulders. Luckily, there are plenty of fun and active ways to strengthen your child’s core muscles.

How to Know if Your Child’s Core is Weak

“W-sitting” for long periods of time past the age of two can be a red flag that there is a weak trunk. This is the position where the child’s bottom is on the ground and their legs are splayed out to each side with their knees bent. When looking at the child from above, their legs form the letter W. There are multiple concerns when it comes to children and W-sitting. Specifically related to core strength, W-sitting provides a child with a wider base of support in sitting, therefore there is much less activation of the trunk muscles in order to maintain the upright position.

These tips can help get a child out of the W-sitting habit:

• Begin with visual and verbal prompts teaching them to transition to long sitting with legs straight in front, crisscross sitting with legs crossed, and side-sitting with both legs bent to one side. Show them a visual example with yourself or a sibling.
• Tap their legs or shoulders gently with the verbal prompt, after they become familiar with the transition. The goal is for the child to eventually pull themselves out of the W-sitting position independently.
• Encourage play in other positions: tall knees while playing on an elevated surface, for example, placing a sensory bin on a chair. Laying on their stomach while propped on their elbows is a form of tummy time as well—this is a good position for coloring, playing a board game, playing with play dough, etc. Crawling on all fours or a static crawling position is also a great way to strengthen the shoulders and neck muscles. They can even sit on an exercise ball during play.

If your child is over two years old and uses the W-sitting position as their primary way to sit, an occupational therapy evaluation may be warranted. As always, early intervention is key!

Lastly, slumped posture when sitting can be a sign that your child’s core muscles are not as strong as they should be. This is where we can directly see the impact of the decreased strength at the core impacting handwriting skills. When you don't have the strength and endurance to properly maintain a sitting position in a chair, it is going to pose a major challenge to complete the fine motor tasks that need to be done. Writing, coloring, cutting, and drawing are considered bilateral hand tasks, where we use one hand to stabilize (the paper) and our dominant hand to move and work (the writing utensil).

To use both hands together while maintaining an upright sitting position, the core muscles need to be strong and activated for long periods of time. We may see kids who struggle with this using a hand to hold their head up, laying their head down on their desk, wiggling, and frequently changing their positions in their seat. Attention may also be closely impacted due to the innate desire to move and change their positions frequently. The constant movement in their seat will decrease their ability to pay attention, which can directly impact a child’s learning.

Intrinsic Strength: The Small Muscles

Intrinsic muscles are the many small muscles within our hands that help our fingers and thumbs to move in a strong and coordinated fashion, i.e., fine motor skills. There are many important tasks that we do every single day that would not be possible without our intrinsic muscles, such as brushing our teeth, holding our coffee mugs, putting in our contacts, holding utensils to eat, turning lights on and off, using our smart phones, and typing on computers, just to name a few!

Proper strength and endurance in our intrinsic muscles is vital to our handwriting skills and, like the big muscles, these also begin in the early months of life:

• Around 9 months of age, we start to observe our babies using the pincer grasp as they acquire the skill where their index finger and thumb opposition allows them to pick up small pieces of food, such as a Cheerio.
• Around 10-12 months of age, we will see our babies gaining the skills of grasping their feeding utensils. It is always good practice to introduce your baby to using a spoon to eat their yogurt, applesauce, or something easy to stick to the spoon for positive reinforcement. A messy and fun milestone!
• Around one to two years old, children will gain the skills of picking up small blocks, radial-digital grasping, stacking a tower, building, and playing. They use their new fine motor skills to begin turning the pages of a favorite book and pointing at pictures with their index finger.
• Around three to four years old, children are grasping markers and crayons to imitate simple shapes and marks on paper, such as circles, horizontal, and vertical lines. They are able to grasp a pair of scissors to snip paper and make crafts.

Of course, these age ranges are wide and unique to each child. As these skills build upon each other, we start to see our children gain the ability to trace, copy, and independently write shapes, letters, and words. When a child is having difficulty learning and acquiring these skills around these ages, it is always encouraged to practice at home and model the skills to your child. Making activities more engaging and exciting will help with participation, and there are plenty of fun ideas to try! If there are concerns with your child’s fine motor skills, an occupational therapy evaluation may be helpful!

Vision: Motor and Perceptual Skills

Vision is also a key component of handwriting. Without proper vision, we will see difficulties with tracing and copying when beginning pre-writing activities. In occupational therapy, we address visual motor skills and visual perceptual skills.

Visual motor skills are the skills that provide the ability to interpret visual stimuli and respond with an appropriate motor response. This is the skill used for copying from the board.

Visual perception is the ability to organize and interpret the information that we see. This is the skill used to form letters.

Some enjoyable activities to work on these visual skills at home include:

• Mazes (Crooked or curved)
• Hidden pictures (You can find free ones here.)
• Drawing activities (Free drawing lessons are available here.)
• Games (Operation, stacking blocks, puzzles, Mr. Potato Head, matching card games, I Spy, Connect 4, etc.)
• Coloring pages with a focus on staying within the lines (Crayola has free and printable pages)
• Scooping and dumping into containers in a sensory bin (Tons of sensory bin ideas are linked here.)

It is always recommended that if there are any concerns with your child’s trunk strength (gross motor skills), intrinsic strength (fine motor skills), or vision related to copying and writing, call for an occupational therapy assessment to determine if therapy can help your child gain and improve the skills they need to have successful handwriting skills.

To find out more or schedule a consultation with one of the experts at Trestle Therapy Group, please reach out and let’s start the conversation.