Lisa Dahlstrom, 42, is worried about her 3-year old son, Levi, entering preschool this fall. He has little interest in picking up a pencil or crayon, and when he does, he still holds it in a toddler’s fisted grip. He struggles with tracing lines and using scissors. He has trouble pulling shirts on and off himself and shows absolutely no desire to begin potty training.
“He wasn’t doing well with these skills when he was in daycare before the pandemic, and now, being home for months, he’s really fallen further behind,” Dahlstrom, a speech and language pathologist in Fairfield, Conn., said. “At daycare, he had other kids to motivate him and make it fun.”
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Trying to figure out if your child has a delay can be tricky even in the best of circumstances: One in four children enters kindergarten with some sort of delay in speech, gross motor skills or fine motor skills, according to a 2019 review published in the medical journal JAMA Pediatrics.
But with schools and daycare centres having closed during the pandemic, “we are now seeing many kids who have lost not just learning, but coordination and fine motor skills,” said Tanya Altmann, M.D., assistant clinical professor at the University of California, Los Angeles, Mattel Children’s Hospital and a spokesperson for the American Academy of Pediatrics. As a result, some may now need occupational therapy, or O.T., which helps children develop fine motor skills, improve eye-hand coordination and do day-to-day tasks like eating, dressing and using scissors.
It may be difficult right now to figure out if your child is actually experiencing a delay. “Previously, parents often used other kids as a gauge as to whether their own was behind, but it’s much harder to compare when your family is social distancing from others,” said Susan Cahill, Ph.D., director of evidence-based practice at the American Occupational Therapy Association.
With the pandemic, kids who already have received O.T. are also struggling. Abby Cooper, 34, a stay-at-home mother in Bergenfield, N.J., said her son Noah, 6, had received weekly private O.T. since preschool for low muscle tone, which made it difficult for him to sustain a strong pencil grip. But that stopped in mid-March when schools closed.
“As the months went by, he got slower and messier with his school work and struggled more — he couldn’t keep up with the spelling tests or writing assignments during his Zoom classes,” she said. Although his occupational therapist has provided worksheets, Noah refuses to do them. “He’s hesitant to do things that are difficult for him, and I get that,” she said. “At the same time, I personally don’t feel comfortable returning to in-person therapy.”
Delays in Motor Skills: How Parents Can Help Children
The good news is that parents can do a lot at home through simple play-based activities to strengthen their children’s fine motor skills, said Marina Scott, a pediatric occupational therapist in Old Saybrook, Conn. “In general, academic expectations for kids in preschool and kindergarten aren’t always developmentally appropriate,” she explained. Some preschools, for example, expect 4-year-olds to be able to write a full sentence when that isn’t a skill that usually emerges until around age 6 or 7.
Instead of focusing on handwriting exercises or worksheets, Scott instead suggests taking them out into the backyard or to your local playground and having them play on the monkey bars. “When children hang from them, they are strengthening their core muscles and shoulder girdle, working with both sides of the body as they move from bar to bar, and are improving hand strength and grip as they hold on,” she explained.
Or, Scott suggests, you can create an obstacle course in your backyard or living room. “Just having your child walk over an uneven surface, or putting a line of tape on the floor and have them walk heel to toe across it, builds up core strength and improves coordination and balance,” she said.
All of this will make it easier for them, when they return to the classroom, to use tools like pencils and scissors, which requires them to control paper with one hand and the tool in the other.
Liatte Lasher, a 30-year-old elementary school teacher in Stamford, Conn., spent most of her summer outside with her 3- and 4-year-old daughters, Emma and Abby, working on their fine motor skills.
“I taught second grade this past year and was struck by how many of my students didn’t have the muscle strength in their hands and fingers to use scissors or a pencil for long periods of time,” she said. “During online schooling, parents were worried about their kids being behind in their academics. But making sure they incorporate activities that use fine motor skills are just as important.”
These can be as simple as one of Lasher’s children’s favourite activities: using scissors to cut grass and look for bugs. She also sent them on “nature hunts,” where they collect weeds, leaves and flowers into a bucket, then cut them as much as they want.
Gardening is a great activity to do with your child, added Rebekah Tolin, a pediatric occupational therapist in Los Angeles. “Digging with a shovel works their trunk and shoulder muscles, and planting seeds is a good way to help your child develop and improve their pincer grasp since the seeds are so tiny and you hold them between your fingers and thumb,” she said.
Inside the home, baking can help with fine motor skills. Rolling out dough with a rolling pin or flattening it with their hands allows your child to practice using both hands together in coordination, which can help them master skills like tying shoelaces and cutting, said Tolin. Pouring ingredients into a bowl, spooning out batter, and squeezing icing on cupcakes and cookies all help improve hand strength and hand-eye coordination. Lasher keeps tweezers, pom-poms, dry pasta and fake gems around the house for her daughters’ impromptu craft projects, to help them build up finger strength.
When to seek help
If you’ve tried some of the above activities, and you feel that your child is still having significant trouble — for example, they are 4 and aren’t able to draw a person with two to four body parts, or use scissors — schedule an appointment with your paediatrician to discuss whether you need a referral for an O.T. evaluation. (Or check the C.D.C.’s guidelines for developmental milestones here.)
Almost all insurance plans offer some form of O.T., said Amy Houtrow, MD, PhD, MPH, FAAP, Chief, Division of Pediatric Rehabilitation Medicine at Children’s Hospital of Pittsburgh. But some companies only cover it for specific reasons, or in certain settings — such as in a hospital, or only with specific providers — and very few plans offer unlimited visits. So Dr Houtrow advised asking your paediatrician for the diagnostic code they are using, then checking with your insurance company to make sure it is covered. If your claim is denied, always call the insurance company to find out why.
“Some insurance simply needs a more specific diagnosis than, say, developmental delay, which is something your paediatrician can easily provide,” said Dr Houtrow. Other times, your physician will need to provide a letter of medical necessity, in which both the O.T. and the paediatrician explain why the child requires it.
Online therapy allows parents to participate in the sessions and get new ideas for activities. Rachel Winer Sticklin, 40, a communications consultant in Olney, Md., says her son Sam, 6, has been receiving weekly O.T. since preschool and switched to virtual sessions this past March.
This past June, Sam made his own Father’s Day card with coaching from his therapist. “He was able to draw, cut and glue with minimal assistance, which is huge progress for him,” she said. “He’s not where he would have been if he were still in school and attending weekly in-person sessions, but he’s definitely not sliding backwards.”
Lisa Dahlstrom recently had Levi evaluated by her local school system to see if he qualifies for O.T. services. While she’s waiting for the results, she’s been working with him on basic strategies of her own. He has trouble drawing straight lines, so she has him practice with dinosaur tracing books and place Cheerios in a straight line. “I want him to have fun with it, and not get frustrated to the point that he refuses,” she said. “But every day that he’s not in school, the gap widens.”
“How to Help a Child With Delays in Motor Skills and When to Get Support” by Hallie Levine © 2020 The New York Times Company
Hallie Levine is a health writer who lives in Fairfield, Conn., with her three children and two dogs.
This story was originally published on 21 August 2020 in NYT Parenting.