A Therapists Guide to Fix the Developmental Delay of Baby Milestones

Poor handwriting is one of the most frequently treated issues in school based occupational therapy.

 It is very serious because handwriting problems lead to frustration, aversion to doing schoolwork and sometimes a dislike for school. Handwriting and reading are related skills. Children who cannot form letters correctly and can’t sequence correctly may have difficulty learning to read.

There are so many components that make up the handwriting skill that it is not possible to cover all aspects at one time. In previous posts I have written about the need to have good postural stability and adequate strength. Well developed visual perceptual skills and hand-eye coordination are essential. Most of all, hand strength and dexterity are the key to producing writing.

One of my favorite activities for helping to develop precision hand skills is cutting with scissors.

In order to use scissors correctly, children need sufficient finger and hand strength and stability, sufficient development of the hand arches, hand – eye coordination, bilateral integration skills (using both hands together) and the ability to cross midline. All the same skills contribute to the development of handwriting.

By the time a child is about two, you can start to work with them on scissor skills.

Most clinicians recommend that your child have a few prerequisite skills in place before attempting to teach scissor skills, but I believe that the process of learning to use scissors can aid development of the “prerequisite” skills and they can be acquired at the same time. It is helpful, but I believe not necessary, if your child can already do the following: use a fork or spoon, isolate the thumb and first two fingers (skill side of the hand), demonstrate good shoulder strength and stability, and use both hands together as in screwing/unscrewing caps, etc.

It is important before you start to work with your child that you get the right size pair of scissors.

 Most stores that cater to school supplies offer scissors specially designed for young children. I have found, however, that they are generally for ages four or older. If you are helping a younger child, you can adapt the scissors. By the way, this adaptation I am going to suggest is also good for children who are double-jointed or who have joint instability. If your child has trouble managing to open and close the scissors once their fingers are inside the handle loops, take some cotton batting or cotton balls, and tape them to the scissor loops. Use enough batting to reduce the size of the loop hole. This is a great trick. Not only does it make it easier to use the scissors, but it gives the child a point of resistance which helps weak hands open and close the scissors. It also helps to hold the fingers in the correct spot. The actual work of cutting will contribute to the development of hand and finger strength. As the skill develops, you can take out some of the batting until it is not needed anymore. If a child is very weak or has a developmental delay that impacts learning, you can purchase adaptive scissors in order to get them started. Adaptive scissors do not open and close in the traditional manner. They are on a spring and all the child has to do is grasp and squeeze in order to close the blades. The scissor blades will open automatically. These are good for helping build hand strength.

Step one of scissor skills requires the child to place their fingers in the loops. I always like to work hand over hand with children who have fine motor issues. For children who are good visual learners, show them how to insert their thumb into the top loop, and their middle and ring fingers into the bottom loop. The best position is to have the edge of the loops in contact with the finger joint. All children tend to have trouble understanding the need to use their index finger as a guide, so it helps if you position their finger for them. Place the index finger just outside the loop on the bottom.

Step two is learning how to open and close the scissors. It can be helpful to pressure their fingers with your own to give them the sense of movement direction. I will often close my fingers over a child’s fingers so they can experience what it feels like to close the scissor blades.

Step three is learning how to snip the paper. It is best to hold the paper for them, and to start with the scissors open, and then place the paper between the blades. Then just have them close the scissors. Children tend to want to flatten their hand so the palm faces the floor. This results in the paper actually sliding between the blades and the paper not getting cut. I usually tell the child to point their thumb at the ceiling. If they don’t grasp this direction, I will physically turn their hand so the thumb is up. Many children have trouble with this wrist rotation, so be patient. Keep reinforcing the proper position with physical cues. Teaching the skill with hand over hand help can speed up the process.

Step four is learning to cut and advance the scissors on the paper. At this point most children can’t manipulate the paper so that they can cut a specific shape. Rather they will move forward and approximate a straight line. Most children will tear the paper with the scissors because they get impatient. As long as they can make a few consistent sequential snips, it is fine. Be sure that your child keeps the thumb up so that the paper stays at a 90 degree angle to the scissor blades.

Once your child has learned to cut and move the scissors forward consistently, development will continue until they can cut out complex shapes. The entire skill development process takes until about ages four or five years. At that point, they should have independent skills and be able to cut out almost anything.

There are some therapy “tricks” you can try which can help children who have problems learning the skill.

 Aside from the adaptive scissors and the cotton batting, you can also hold the paper up at about face level or a little higher while your child is cutting. Most people automatically rotate their arm when they reach over head. It feels a little awkward to reach with the palm facing out. When they need to reach over head, it helps them to rotate the wrist and get into the correct hand position. Also, it helps promote shoulder strength. If you feel industrious, string a clothes line over the child’s head and attach clips. I think I noticed Pottery Barn offered something like this pre-made. Then attach the paper to the clips. Let your child snip the dangling papers. This activity is very OT and really helps with hand-eye coordination and shoulder endurance and strength. If you find that your child has a weak grasp, get some construction paper to cut. It is thicker and more resistive. Once they can cut or snip the single piece of construction, either fold it or add more. The thicker the paper, the more strength is necessary to cut. If your child can’t cut through any paper, let them close the scissors as much as they can without help, and then use hand over hand to help them close the scissor blades. As they get better, have them cut snowflakes from folded paper. It is an easy task and helps them feel good about their cutting skills. Another good trick is to stick the closed scissor blades into play-doh or other soft modeling clay, and then have your child try to open the blades. You can also have them cut the modeling clay into pieces, but opening the scissors is more work and gets faster results.

If you have a child with very impaired motor skills, or who is very weak, then the adaptive scissors is the way to start. However, I think it is worth trying with a regular pair of scissors and using the taped on cotton. In my experience, it is difficult to transition children from the adaptive scissors to the regular ones. If the adaptive scissors are the only solution, then it is better to try them than avoiding the use of scissors.

One other thing to be aware of is your child’s postural alignment. Take this opportunity to have your child sit in a chair with a table top in front of them. Sitting incorrectly will affect handwriting, so now is a good time to develop proper sitting posture. If you don’t have a chair which allows your child’s feet to touch the floor, place a box or stool under their feet. This is important advice to follow for whenever your child performs a seated activity. When children’s feet dangle, they have a tendency to fidget and get distracted from the task. It is uncomfortable to sit with your feet dangling. Many children will wrap their feet around the chair legs. This results in postural misalignment. Ideally, make a box which can attach to the legs of the chair. Or find a large enough, stiff cardboard box which you can cut holes in for the chair legs. I recommend this so the child doesn’t move or fidget with the foot rest.

Learning to use scissors properly and acquiring the skill helps to develop the necessary tools for handwriting. The three fingers of the hand controlling the scissors are the ones that are needed to grip a writing tool. The act of opening and closing the scissors helps with hand arch and web space development. The web space is the area formed when the thumb tip and index finger tip touch to form the okay sign. A closed web space can indicate potential writing problems. When children can cut across a straight line, cut out a complex shape and manipulate both the paper and scissors in a controlled manner, they will have achieved precision fine motor skills and good dexterity. Handwriting should evolve nicely as a result.

P.S. I located two sites online which offer some very good cutting activities which you can print. The links are DLTK KIds and Preschoolpalace.org

3 Responses to “How scissor skills can help handwriting development”

  1. [...] This post was mentioned on Twitter by US of Autism, Liz Ditz and Lorna d'Entremont, Nancy Konigsberg. Nancy Konigsberg said: How scissor skills can help handwriting development: Poor handwriting is one of the most frequently treated issu… http://bit.ly/fWtJIm [...]

  2. Barbara, OT says:

    You covered this very well! Scissor use is a life-long-functional skill.
    http://www.therextras.com/therextras/2011/01/cut-to-the-chase-.html

  3. Thank you Barbara. That is a great compliment. I looked at your site and was very impressed.

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