Micaela Cook, OTR/L | April 25, 2024 | Occupational Therapy

In-Hand Manipulation

Have you ever wondered how we manage everyday tasks like writing, dressing, or using utensils? It all starts with a crucial skill called in-hand manipulation. 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 in-hand manipulation contributes to significant developmental milestones!

What is in-hand manipulation?

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. 

What is the importance?

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: 

  • Self-feeding (utensil usage)

  • Dressing (clothing fasteners such as buttons, zippers, snaps)

  • Handwriting (grasping, holding/manipulating writing utensils)

  • Scissor skills 

The components of in-hand manipulation: 

Rotation: 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: 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: 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.

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

Shift: 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. 

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

Translation: 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.

Finger-to-palm translation: 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. 

Palm-to-finger translation: 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.  

Translation with stabilization: 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


  • Pick up small items (beads) one at a time and store in your palm

  • Place coins in a piggy bank that are in the palm of your hand

  • Crumble a piece of paper with one hand only

  • Lace beads onto a string while holding beads in the palm of your hand 

  • Put small objects in play-doh (coins, beads, etc.), locate them with your fingertips, and “hide” them in your palm 


  • Move your fingers up and down a pencil, using only the tips of your fingers

  • Turn pages in a book

  • Separate playing cards 

  • Hold a marker/pen and push the lid off with your thumb

  • Playing games that require you to pick up one card at a time

  • When cutting, practice turning the paper with one hand as you use scissors to cut with the other 


  • Cotton swab painting: use 2 different paint colors on each end of the cotton swab

  • Manipulate pegs for LiteBrite 

  • Playing with Legos

  • Nuts and bolts activity, screw the nuts onto the bolts 

  • Puzzles – rotate the piece to fit into the proper place 

  • Try stacking dice with the same number showing on each side, rotate to find the number 

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 free developmental assessment or consult your pediatrician for an evaluation with an occupational therapist. We want to come alongside you in making growing fun for your child!