Have you ever wondered how we manage everyday tasks like writing, dressing, or using utensils? It all starts with a crucial skill called 

. This involves using our thumb and fingers to 

move and control objects within a single hand

. While seemingly simple, in-hand manipulation is a foundational skill for numerous daily activities.

This blog post dives deeper into in-hand manipulation, exploring its importance, and its components, and engaging activities to support its development in your child. Stay tuned to learn how 

contributes to significant developmental 

The ability to hold an object in one hand and move it without assistance from the other hand.

Children start to develop these skills between 2-4 years old with a single object. The order of development of these skills is first finger-to-palm translation, palm-to-finger translation, rotation, and lastly shift. By the ages of 6-7, children can manipulate and stabilize more than one small object within their hand. This allows children to use these in-hand manipulation skills more purposefully and functionally to complete everyday tasks. 

A child with poor in-hand manipulation can be observed manipulating objects with both hands and/or stabilizing the object with a table or body. Children who have difficulty with in-hand manipulation may be unable to complete certain tasks, require additional time, or may appear clumsy when handling objects. Many daily tasks required these higher-level hand skills. Examples include: using a fork and knife, adjusting the grip on paper when cutting with scissors, positioning a grip when writing/drawing, manipulating clothing fasteners, and operating tools. 

Poor or delayed in-hand manipulation skills can result in difficulties with the following: 

The components of in-hand manipulation: 

 The ability to turn an object end over end. An example of this is flipping a pencil over in one hand to use the eraser instead of writing with the tip of the pencil.

Simple rotation is the ability to roll a small object between the thumb and fingertips. An example of simple rotation is using the fingertips and thumb to open a small jar. 

 Complex rotation is the ability to turn an object end over end. An example of this is flipping a pencil over in one hand to use the eraser instead of writing with the tip of the pencil.

simple or complex rotation is being performed while holding an object with the hypothenar aspect of the hand (ring and pinky finger). 

 The ability to move objects between the fingers. A couple examples of this are when you try to separate two pieces of paper that are stuck together, or when you move your fingers closer to the end of your pen/pencil to begin writing. 

the ability to move an object in a linear manner with fingertips while holding an object with the ring and pinky finger.

 Translation can be broken into two separate skills: finger-to-palm translation and palm-to-finger translation. Kids use finger-to-palm translation when they pick up small objects like pebbles, marbles, or cheerios one at a time, moving them with the fingers of only one hand into their palm. They use palm-to-finger translation when they move those small objects from their palm back to their fingertips one at a time to place them on the floor or table.

 the ability to move an object from fingertips to the palm of the hand. Ex: picking up marbles with fingers and thumb and moving them into the palm. 

 the ability to move an object from the palm of the hand to the fingertips. Ex: moving coins from the palm of the hand to the fingertips to insert them into a piggy bank.  

 holding an object with the ring and pinky finger while moving objects from palm to fingertips or fingertips to palm.

Activities that promote in-hand manipulation skills

In-hand manipulation may seem small, but it unlocks a world of possibilities for your child. Support their development with fun activities, and remember, early intervention is key.

Marshall Pediatric Therapy wants to help your family build skills for life. Take our 

evaluation with an occupational therapist

. We want to come alongside you in making growing fun for your child!

In-Hand Manipulation

As a parent or caregiver, it might be crossing your mind: "how do I help to develop a consistent routine for my child, but also make that routine actually work for my child and our family?" If you are, you are certainly not alone! The professional support from Marshall Pediatric Therapy's clinicians could make the world of difference in the dynamic of your day-to-day. 

Developing a routine for children helps to give them structure and consistency, which also greatly impacts their overall 

 These routines do not need to be strict schedules or you could be facing some resentment or a negative result. Instead, it can be done simply by creating an environment that is rather predictable so children know what to expect on a day-to-day basis. 

The neat thing about routines is that one single routine does not have to work for all families universally. Instead, families have the ability to create daily routines that cater to their specific needs, values, and schedules. This is especially helpful when there are multiple children and individuals involved with varying requirements. 

According to one of our recent blog posts, 

suggests that a child spends a minimum of one hour outside partaking in physical activity.

 Now more than ever, children are introduced to and dependent on electronic devices to problem-solve or find some sort of connection more than ever. It is through a routine that a parent can help to define boundaries. 

10 reasons that a daily routine is important for your child:

 help to improve or restore activities that are associated with that of daily living. By doing so, OTs introduce children to independence. Each of our brains functions in a way that permits us to adapt to the behaviors being faced.  

For a simple way to start to help get your child more on track at home, we're providing you with a downloadable schedule tracker. A really great way to visually interpret and recognize a routine as it's forming and working out well. 

For more information about how Marshall Pediatric Therapy's services could benefit your family, we'd love to speak with you anytime and answer absolutely any questions you have! 

The Importance of Developing a Daily Routine 

How to use items you already have at home for your child’s sensory diet

One of our very favorite ways of addressing hot clinical topics is through a Q&A format. Learn from Occupational Therapist, Ellen Snyder, as she uncovers some of the most commonly asked questions from our parents and caregivers when it comes to establishing a sensory diet. Most, if not all of these items, can be found already laying around your house or can be purchased locally. You may also decide to conveniently take items on the go!

A: A sensory diet is a set or sequence of activities that engage multiple sensory systems. This can calm the child and help focus attention. 

Q: What sensory systems do sensory diets target?

A: The focus of the sensory diet will depend on your child's momentary needs. We have seven sensory systems (I know school only teaches us we have five, but there are two very important invisible ones). 

A: Everyone has a sensory system and can benefit from specific sensory input, however certain children may need a little extra support to get their sensory needs met. One way to think about this is with a cup analogy. If you think of each system as having an individual cup, the cup needs to be filled to meet his/her sensory needs. Until these sensory needs are met, it can be difficult for your child to attend to activities, listen to and follow directions, and keep his/her body safe. As each child and his/her sensory system is unique, the “size of the cup” will vary.  For example, a child sensitive to sound has a “small auditory system cup” and it doesn’t take much sound to fill his cup. Another child might have a “large tactile system cup” and needs a lot of tactile play to fill his cup before his sensory system is satisfied.  A few of the diagnoses that benefit from a sensory diet include:

Attention Deficit Hyperactivity Disorder (ADHD)

Q: Can I give too much sensory input to my child?

A: The only system that doesn’t become over-sensitive is the Proprioceptive system (deep pressure). All other systems can become overwhelmed and lead to increased dysfunction. Think, of becoming dizzy after spinning, or over-sensitive to loud sounds or bright lights when in a busy place. 

Q: What can I do to help regulate my child after too much sensory stimulation?

A: Input to the proprioceptive system can help the nervous system become regulated after too much of another type of sensory input. Deep squeezes on arms, hands, legs, feet, and gentle deep pressure on the head, pushing, pulling, or lifting an item with weight or resistance. 

Decreasing as much other sensory stimulation as possible, such as moving to a quiet room or smaller space, dimming lights, and reducing sound can help your child become calmer and allow his/her nervous system to not have to work as hard to filter out the external sensory stimulation. 

Q: What is a time-effective way to provide the sensory stimulation my child needs during the day? 

A: The best way to help your child get the sensory stimulation his/her body and nervous system need is to work it into their daily routine. When a child wakes up, provide deep squeezes to the head, arms, trunk, and legs

 Moving to different areas in the house, encourage your child to move like an animal 

(vestibular, proprioceptive, tactile, visual systems)

. Use of visual picture schedules for daily routine 

. Depending on your child’s needs allow for quiet or preferred music during breakfast 

. Carrying a backpack to the car and riding with it on their lap 

work with your child’s therapist to help solve how to integrate these activities into daily life. 

Q: Why does my child not become calm after 10 minutes of jumping on the trampoline? 

A: For some children, although they appear to crave constant movement, such as jumping, swinging, being upside down, and running around, their nervous system has a hard time knowing what to do with certain types of sensory stimulation. Think of a filing cabinet with no organizational system (their brain/nervous system) and the file (sensory input) doesn’t have a clear place to be filed. 

Structured sensory-based activities will be the most effective and help organize your child’s nervous system.

 Movement with a purpose or a goal will help your child from becoming dysregulated from the type of input he/she is wanting. Some examples are jumping to a song and doing a freeze dance, running to gather specific items and bringing them to a specific location, swinging and giving high fives or reaching for a puzzle piece, crawling over pillows with a straw to blow a pom-pom on the floor, or locating hidden objects in a bean bin. 

however as we exist in the world we are constantly experiencing sensory input

 from the clothes on our body, to the smells and sights, and sounds we experience. Because of this fact, it is so important to encourage our kids to play using many different sensory systems. This will naturally help them integrate their sensory systems and get the input they need. 

Q: What are some typical household items to use for a sensory diet?

Learn more about Occupational Therapy services at Marshall Pediatric Therapy and how your family can benefit, 

Creating a Sensory Diet at Home 

Parents can often feel overwhelmed sorting through medical and societal advice on how to best care for their baby. One of the most important recommendations is put your baby on his/her back to sleep. The American Academy of Pediatrics initiated the “Back to Sleep” campaign in 1994 in efforts to prevent sudden infant death syndrome (SIDS). The second part to this recommendation is to put baby on his/her tummy to play during supervised adult awake times. Research has shown supervised tummy time has a positive impact on preventing and improving torticollis. At Marshall Pediatric Therapy, our physical therapists help parents implement and carry through an individualized tummy time routine that best suits your child’s needs. 

Torticollis translates to a “tight” or “twisted” neck. This term originated back in ancient Greek times. Today it is commonly diagnosed a congenital muscular deformity. Torticollis often occurs when there is a problem with a major muscle in the neck called the sternocleidomastoid (SCM). However, torticollis can involve multiple body systems including vision, vestibular, orthopedic, respiratory, neurological, integumentary, and gastrointestinal systems. Your physical therapy team completes a thorough evaluation to screen for problems in these areas. 

Plagiocephaly, having a flat or abnormal head shape, and torticollis often happen together. Like torticollis, plagiocephaly can present at birth or develop over time. Babies heads are very vulnerable to changing shape within the first eight months of life. When a baby has a head turn or positional preference, sustained pressure on that area causes gradual flattening and abnormal facial/head shaping. Depending on the severity of flattening and facial asymmetry, your physical therapist may recommend an evaluation for a cranial helmet. Your physical therapist will discuss treatment plans, helmet wear, and provide positioning recommendations throughout your child’s plan of care. 

There are a few factors that increase a baby’s chance for developing torticollis: birth trauma/difficult delivery; intrauterine growth restriction; fetal malpositioning; first born; prematurity; breech delivery. Babies who do not receive enough tummy time or sit in a positioning device for long amounts of time are at a greater risk of developing torticollis. Positioners, such as swings, sit me ups, or bouncy seats, limit free neck movement, and do not allow babies to look both directions. 

Research indicates physical therapy intervention is highly effective in resolving torticollis when initiated in early infancy. Waiting until after one month of age prolongs the length of physical therapy needed to approximately six months of age. Waiting after six months of age can require 9-10 months of physical therapy, with few infants achieving a near normal range of motion. Early intervention requires parents to keep an eye out for the signs. It is recommended to bring up concerns to your child’s pediatrician as soon as notice any of these signs. 

If your baby is diagnosed with torticollis, it’s important to rule out other conditions that may affect how your child holds his/her head. Your physical therapist will screen for orthopedic, neurological, vision, respiratory, and gastrointestinal problems. We will also look for other diagnoses that could present with torticollis such as plagiocephaly, hip dysplasia, and early motor delays. Our physical therapists often consult with Occupational Therapists and Speech Therapists to rule out other concerns that sometimes are associated with torticollis. 

Here are a few ways to help prevent torticollis: 

Torticollis and Plagiocephaly

Like many OT’s I love encouraging my patients to engage in sensory play. Previous blogs have given suggestions for fun sensory play ideas for the great outdoors, but if you’re anything like me once it’s cold you’re not venturing out! I wanted to share some of my favorite sensory play activities for inside to keep your children busy while fostering cognitive, social, developmentall, and language skills. 

Sensory play is great for all kids, even those who are not currently being treated for sensory processing difficulties through occupational therapy. Sensory play helps children experience different textures, smells, sights, movements, and sounds through various play mediums. This is beneficial in so many ways. Sensory play helps the body learn to process these different sensations, it helps children learn body awareness and where they are in space, it can be calming or have an alerting effect, and it’s just fun. No matter the reason behind it sensory play is a great way to help fill your child’s day with new, fun, and engaging play activities. 

Here are six of my favorite sensory play activities for kids of all ages:  

Shaving cream is a great play activity, rub it on a mirror to practice writing letters, drawing shapes, or fun pictures! Or bury your favorite washable toys in it and dig around to find them. Add food coloring for more fun and the addition of a more intense visual stimuli. A taste safe alternative for younger children is using an electric mixer to whip the juice from a can of chickpeas into a foam. 

Shaving cream can also be a great way to incorporate self care skills such as hand washing or teeth brushing. Use a toothbrush and the bottom of a plastic pop bottle as your “tooth” and practice brushing all around it and in the crevices. Or practice brushing the teeth on a doll or other toys.

 For easy clean up do this play activity in the bathtub!

Cooked pasta is a great tactile play experience, add food coloring to the water when boiling to make fun colors. Let it cool, and add a little bit of water to make them slippery, then let the little hands dive in! Add in some of your favorite washable toys and containers to increase the imaginative play and fun. This is also a great activity for working on utensil use or cutting. Practice scoping and using a fork or snip the noodles with scissors to work on some of those self help and fine motor skills.

Water is a simple and easy sensory play activity. Fill a tub with some water, your kiddo’s favorite waterproof toys and some cups, big spoons, or measuring cups to encourage scooping, dumping, and pouring. To increase the fun, freeze water proof toys in ice cube trays or small containers of water then use dumping the water, hammers, or syringes of water to free the trapped toys. 

Sensory bins are a simple and inexpensive way to create sensory play experience. Some great sensory bin base items are rice and beans, oatmeal, easter basket grass or shredded paper, cotton balls or pom poms, sand (crush graham crackers or cheerios for a taste safe option), or water beads (use tapioca pearls for a taste safe alternative). Start with your base then add in scoops, tongs, toys, and containers. The joy of this type of play is it gives a base for your child’s imagination to run free and learn new ways to engage with everyday items. 

An obstacle course is one of the best ways to bring proprioceptive input into your child’s play, and get some of those wiggles out when we’re stuck inside. See Kelley Harlan’s ‘Let’s Make an Obstacle Course!’ blog post for some great information and ideas for your obstacle course. 

You can easily turn Kool-Aid packets into water color paints to create masterpieces with a fruity twist. Just mix the powder from a packet of kool-aid with a small amount of water to create your paint. Use the activity to talk about different scents, fruits, and colors with your kids. 

An added bonus to sensory play is that it opens an opportunity for discussion about new experiences and can help with language development. While doing all these activities talk to your child about what they are feeling, smelling, seeing, and hearing. Is it slimy, sticky, warm, or cold? Does it feel hard or soft? How does it make them feel? Help your child put language to what they are experiencing. Play is the best way for a child to learn, seize this opportunity to help them gain a new skill. Most of the time they’ll be having so much fun they won’t even realize how much work their brain and body is doing. Don’t be afraid to jump right in with them Mom and Dad, you deserve some play time too!