You have read the title and must be thinking, “What in the world is Dr. Lightman writing about now?” Hands? Is this about our handing over the reins of leadership from one generation to the next?
Eventually, yes. But that’s not what this is about. I am bringing to your attention something basic and fundamental that is necessary for that to eventually happen.
It is making sure that your child’s hands develop normally and optimally.
No joke here.
Normal hand development is crucial to optimal development and is interlocked into other pieces of development. Every pediatric practice has children who are diagnosed with hypotonia. Hypotonia is low muscle tone and, depending on the underlying causes of the condition, there may or may not be a cure for it. Hypotonia can be caused by conditions that affect the brain, central nervous system or muscles. In most cases, even if you cannot cure hypotonia, you can help reduce its effects on your child’s life through physical and occupational therapy.
How do you know if your child’s hands need strengthening?
During well visits, pediatricians look for developmental milestones. For our purposes now, and based on the Peabody Developmental Motor Scales – 2nd edition, your baby should have a reflexive grasp at birth and, at about 1 month of age, should be able to tightly grasp objects placed in his hands.
At about 2 months, he can briefly hold toys placed in his hands.
At about 3 months, while looking at an object, he will attempt to reach for that object (referred to as “visually directed reaching”). Some call this “global ineffective reach for objects.” There are also voluntary grasps at about this stage as well as the two-handed palmar grasp reflex – when an object is placed in the infant’s hand and the child’s palm is stroked, the fingers will close reflexively.
At about 4-5 months, the baby touches fingers together and begins reaching with both hands at the same time. Also, he touches or bangs an object on a table or hard surface. This banging is music to the ears of a pediatrician. Seriously. It means your baby is developing normally.
The one-handed palmar grasp occurs at about 5 months and then there is controlled reach at about 6 months.
At about 7-8 months, your baby begins to transfer a small object from one hand to the other hand. He will use the “interior pincer grasp,” the pads of the thumb and index finger to pick up small objects like Cheerios.
And so on.
These milestones are important to meet as each milestone is its own foundation upon which the next level of development is built. That next level becomes the new foundation.
What can you, Mommy and Daddy, to optimize development during the first year of life?
It’s important that babies get as much tummy time as possible. Tummy time is not just a position on the floor. When babies and kids are on their tummies, they push up on their hands to observe the world around them. They shift their weight from hand to hand as they reach out to grab a toy or object. This is Hand Strengthening Level 1.
After graduating from tummy time, babies move into crawling time. Until they are standing, cruising and walking, crawling time is their equivalent to Christopher Columbus’ seeing the world. All that crawling time is Hand Strengthening 2.
As you are aware, the vice of increased screen time has negative consequences, not the least of which is less outdoor, active play. The time spent outdoors in active activities like climbing ladders on the playground, climbing trees, crawling through tunnels and swinging from monkey bars is Hand Strengthening Level 3.
Hand Strengthening Level 4 is fine motor arts-and-crafts activities. What a lovely way for a family to pass time, especially when Shabbos is finished earlier rather than later. It is family bonding time. Children get significant strengthening and fine motor benefits from activities as simple as playing with play dough or snipping paper with Abba.
Afterwards, have your child clean the sponge that was used for painting. Squeezing hard strengthens hands. And squeezing sponges can be done during bath time.
These activities can be messy and not fun to clean up. So let’s segue to another way of hand strengthening. This way, too, is messy and a pain to clean up. But there are so many benefits to it.
Encourage your baby to play with food. Seriously.
Secure your baby in his hi-chair and place cooked noodles and other foods with different textures on the table. Let him choose which to hold, crumble and play with in his hands and then put in his mouth. I guarantee you a good portion of it will end up on the floor. So what? If it’s not a Persian carpet, then why worry? Playing with food is another way for your child to explore and expand his world. Let him run with it as long as possible without cleaning him up; washing his hands and face all the time will instill in him the belief that he is “dirty” and playing is a “yucky” thing. Don’t short-circuit the process. And don’t be so fast to clean him up. Let him get good and dirty. If he’s cleaned up every several minutes, he will begin to associate food with “yucky.” This could negatively impact his eating and you do not want to go anywhere near there.
If you believe your baby is not developing the way he should in this area, commence a discussion with your pediatrician. He will guide your next steps (which means the baby’s next steps).
A word (or several paragraphs) about school-age kids:
These are years which are chock full of development on every front in a child’s life. Strong hands are essential. Think about how much time during the day a child uses his hands. It is a lot of time – cutting with scissors, zipping up a zipper, getting paraphernalia in and out of a backpack, writing, and opening a combination lock on a locker. These are but a few examples. For a child with weak hands, it can be a long, frustrating day in school.
There are “red” flags you can observe to ascertain if your child’s hands may be weak.
Red Flag #1: Clothing Issues
- Difficulty holding shoes open to push a foot inside
- Unable to grasp and pull elastic of socks open to get the foot inside
- Unable to grasp and pull the waistband of pants up and down over the hips (potential bathroom accident issue)
- Difficulty with maintaining grasp on button to pull it through the buttonhole
- Zippers disconnecting mid-zip because the two sides are not held tightly to engage
- Shoelaces tied correctly but coming undone continually because they are not tied tightly
- Inability to snap/unsnap pants (another potential bathroom accident issue)
- Inability to pull with enough force to fasten or loosen a belt buckle
Red Flag #2: In the Home Kinds of Activities
- Struggling to open lids of Tupperware-style containers
- Difficulty tearing open food packages and containers
- Difficulty opening screw-top containers, i.e., water bottles
- Dropping eating utensils or finger food items
- Struggling with opening toothpaste, and other toiletry kinds of containers
- Difficulty with pushing the pump of a soap container or hand sanitizer
- Inability to turn on faucet to wash hands
Red Flag #3: The Pencil Grasp and Poor Handwriting
- Using both hands on the writing utensil at the same time
- Switching hands frequently between grasp patterns when writing, drawing or coloring
- Switching hands frequently during writing, drawing, and coloring tasks during fatigue
- Using the whole hand to grasp the writing utensil instead of the fingers
- Messy handwriting
- Difficulty controlling writing utensils
- Using light pressure on writing utensils so that marks are not dark enough to read
Red Flag #4: Scissors
- Scissors appear to “fall off” the fingers instead of being firmly held in the hand
- Scissors “getting stuck” in the paper, including unable to continuously cut across a paper with repeated open/close motion
- Attempting to hold scissors with both hands simultaneously
- Frequently changing hands during scissors tasks as hands tire
Red Flag #5: Miscellaneous
- Decreased or no interest in fine motor games and toys
- Frequently dropping small objects or manipulatives
- Decreased interest and attention – and even frustration – for crafts and art activities
- Decreased interest and engaging with climbing and other playground equipment
In this era of ubiquitous technology, whether it be the phone tablet, iPad or whatever, please do not lose sight that the pencil grip is important. Color with your children. Give them pencils to connect the dots in those books (I hope those books are not dinosaurs). Notice your child’s pencil grip starting in kindergarten. If he is not holding the pen correctly, his hands will tire quickly when writing. He will have difficulty with forming letters and note-taking.
There is plenty to be done for these children.
There are school-based occupational therapists whose sole focus is to enhance a child’s functioning in school and in all activities. Speak to your child’s teacher and /or principal(s) to begin evaluating your child and getting help.
Even if your child does not qualify for services, there is plenty and Ema and Daddy can do to help. It requires a little bit of creativity.
First, draw with chalk a large tic-tac-toe on the driveway or sidewalk. Instead of writing “X” and “O,” use objects such as gourds, bags of flour (wrapped in plastic) or stuffed bears and stuffed ducks.
Paper crumbling is another way to strengthen hands. Have your child crumple up sheets of newspaper or scrap paper in the smallest, tightest ball possible that he can manage to accomplish. As his hand strength increases, so the ball will get tighter. You can make it harder by asking your child to crumple the paper with one hand only. Afterwards, make sure your child cleans his hands thoroughly as newspaper ink can be harmful.
Do you have plants that need watering? Fill a water bottle and let your child spray away. He can also play outdoors with his spray bottle. Be sure to specify.
Help make your child the “World’s Tallest Child” by having him walk with plastic plates on his head. This requires posture and balancing. As he becomes stronger, graduate from plastic plates to bean bags or dominoes.
Making Challah from scratch? Your child can help to knead the dough. Make sure he washes his hands first. And afterwards. You can say “Amen” to each other’s Bracha for Hafrashas Challah.
Make a graffiti wall in your home by covering a wall with butchers paper and contractors tape. Get out the art supplies and let our child paint away. Try sponge painting. When the weather is nice, he can make mud pies outside from mud and rocks. So what if he’s messy? He will have fun and will become stronger. This refers back to Hand Strengthening Level 4.
I wish to emphasize that not all children “follow one handbook” for development. Each child has his own path. Part of your development, my dear fellow parents, is to accept and embrace your child as the individual person for who is. Accepting your child for the individual for who he is does not mean you have blinders on to his needs. The One Up Above has gifted you. Embrace the gift. Love him and work with him accordingly, even when he pushes (intentionally and unintentionally) your buttons. This requires time, effort and patience.
As always, daven.
Dr. Hylton I. Lightman is a senior statesman among pediatricians, an internationally-recognized authority and diagnostician, a public speaker, expert witness and go-to resource for health issues in the Orthodox Jewish community and beyond. Originally from South Africa, he started his current practice, Total Family Care of the Five Towns and Far Rockaway, PC in 1987. Dr. Lightman is a board-certified pediatrician and fellow of the American Academy of Pediatrics (FAAP). Dr. Lightman is a clinical assistant professor of pediatrics at Hofstra Northwell School of Medicine. In addition, he is actively involved in teaching pediatric and family nurse practitioners through Columbia University, Pace University, Lehmann College, and Molloy College, as well as mentoring physician assistants through Touro College. Read more here.
The words of this author reflect his/her own opinions and do not necessarily represent the official position of the Orthodox Union.