Written by Noémie von Kaenel, OTS and Bearfoot OT
Why are we starting with big whole-body gross motor movements when handwriting is done with your lil’ hands?
OTs love to say:
Proximal stability leads to distal mobility.
But normal people definitely DON’T talk like that, sooooooooo….
Let’s put it this way. Strength at the center of our body, like trunk control and postural stability, allows for movement and skill at the extremities. Developmentally, skills emerge from the center of our body out, so before your kid is ready to knit a sweater (distal mobility), they need to be able to sit up (proximal stability). Because that’s how development works, it’s key to address gross motor skills and establish proximal stability before we solely start working on fine motor skills.
Think about positioning and posture
Typically, writing is done at a desk/table (although if you want us to get on our nature-based soapbox we can share other cool places a kid might write). BUT, if your kid is writing at a desk while seated in a chair, the ideal posture for stability is having your elbows hips, and knees bent at 90 degrees, and both your feet flat on the floor. This is known as the 90/90/90 rule. Your body may lean towards the desk and your dominant arm may be slightly further from your body to write but you shouldn’t have to turn the paper more than 20 degrees from parallel to the desk.
(Nice picture, eh? We would like to be able to say a kid drew it......but we did. Maybe that's why we're pediatric therapists.)
Holding this position is hard for kids - and adults! The ergonomists of the world are having an absolute field day helping all our work from home set ups to be better for our bodies. Try and set your kid up for success by thinking about seated positioning and give them a break if they need it.
In addition to positioning, sitting with good posture requires a lot of:
core strength and stability
endurance
shoulder stability
hip stability
It is important to have good posture while writing. If not, your child may slouch, seek out another point of contact like resting their head on their hand or arm. This then impacts their efficiency in writing, reading and copying from the board, and visual perceptual skills.
Core strength, sustained attention and gross motor skills are needed for improved handwriting skills⁵.
So how can you support your child’s posture?
Ask your child to sit up tall as if there was a string through their back or place a pillow on top of their head and challenge them to keep it there
If your child is older, take a picture of your child and show them how they are sitting and ask (in a super nonjudgmental way) how it differs from the 90/90/90 rule
If your child seems tired and starts to melt in their chair, take a break from writing, move around, and then come back!
Figure out the right equipment for your child- a chair that fits and a desk that’s the right height
Place a pillow behind your child’s back to help support a straight back
Do some core work!
Sit-ups
Planks
Grab items between your feet
Egg roll & the Egg roll challenge
Do some back strengthening
Bird dog movements shown below
Superman pose (for a challenge: pass items behind your back from side to side)
Use a therapy ball and do walkouts like in this video
Look at shoulder and arm stability
When looking at how to help kids' handwriting, OTs also look at shoulder stability, arm movements, and crossing midline. If there isn’t shoulder stability, you’ll find your child moving their writing utensil with their BIG arm muscles and joints rather than their smaller muscles (hand and fingers). Working on gross motor skills also prepares your child for bilateral coordination tasks needed for writing like holding the paper down with one hand and writing with the other.
Establishing hand dominance is also important. By age 4-5, it’s expected to use one hand more consistently than the other. This is important because the difficulty and possible delay of using both hands or being ambidextrous can be more challenging in terms of development⁶.
Stay tuned for Part 2 of our handwriting series - fine motor skills!
Research nerds unite!
Beck, C., Chuan, C., Cooley, T., Drobnjak, L., Greutman, H., Geffron, C., Kiley, C., Meadows, An., Rice, M., Spencer, J., (2017) The Handwriting Book. OT Toolkit’s The Functional Skills for Kids Pediatric Therapist Team.
Case-Smith, J. & O’Brien, J.C. (2015). Occupational Therapy For Children And Adolescents. 7th Ed. Elsevier and Mosby Publishing.
Collette, D., Anson, K., Halabi, N., Schlierman, A., & Suriner, A. (2017). Handwriting and common core state standards: Teacher, occupational therapist, and administrator perceptions from new york state public schools. The American Journal of Occupational Therapy, 71(6), 1-9. doi:http://dx.doi.org.dominican.idm.oclc.org/10.5014/ajot.2017.021808
Feder, K., Majnemer, A., & Synnes, A., (2000). Handwriting: Current trends in occupational therapy practice. The Canadian Journal of Occupational Therapy, 67(3), 197-204. https://doi.org/10.1177/000841740006700313
Grace, N., Enticott, P. G., Johnson, B. P., & Rinehart, N. J. (2017). Do handwriting difficulties correlate with core symptomology, motor proficiency and attentional behaviours? Journal of Autism and Developmental Disorders, 47(4), 1006-1017. doi:http://dx.doi.org.dominican.idm.oclc.org/10.1007/s10803-016-3019-7
Harrington, R., & Hill, J., (2018). Handwriting and Fine Motor Skills. The Sensory Project Podcast. Season 1, Episode 17
Zwicker, J. G. (2006). Effectiveness of occupational therapy in remediating handwriting difficulties in primary students: Cognitive versus multisensory interventions (Order No. MR14673). Available from Nursing & Allied Health Database. (304984389). Retrieved from https://dominican.idm.oclc.org/login?url=https://www-proquest-com.dominican.idm.oclc.org/dissertations-theses/effectiveness-occupational-therapy-remediating/docview/304984389/se-2?accountid=25281
Handwriting without Tears Website and free resources, Retrieved from<https://www.lwtears.com/programs/distance-learning/families/packets>
American Occupational Therapy Association (AOTA) (n.d.) Handwriting. Retrieved from <https://www.aota.org/About-Occupational-Therapy/Patients-Clients/ChildrenAndYouth/Schools/Handwriting.aspx>