Eliné Cloete, an Occupational Therapist at KidsAbility, outlines the foundations of handwriting and milestones in handwriting development.

When Occupational Therapists identify a child who needs intervention in the area of handwriting in collaboration with teachers and parents, what does that entail? Some children find mastering handwriting extremely difficult, and referrals to Occupational Therapy services for messy handwriting or poor fine motor skills can be common.

Research shows that handwriting plays an important role in building self-esteem and academic achievement as there’s an association between handwriting and success in school performance.(1) Despite the use of technology and devices, handwriting remains an important occupational skill to master as it is both a means of communication and a necessary life skill.(8) The development of handwriting skills may increase success in school performance in later years. (7)

Research studies on brain development in 2020 showed that handwriting allows children to recall and learn more clearly as well as build essential pathways in their brains that may increase success in school performance.(4) With this in mind it is important to consider how important it is for children to have opportunities to focus on fine motor and pre-writing skills early in their life. Practicing handwriting also builds on skills such as language use, reading and critical thinking as it activates the memory centers of our brain.(4) Handwriting is an important foundational skill and needs to be learnt and used alongside technology in an ever increasing digital world.

The Foundation of Handwriting

Children learn new skills and build on skills as a result of how their Central Nervous System processes and responds to sensory information as the foundation for other skills. Through functions of the nervous system and the senses, the child develops awareness and gains knowledge about their own body which is in turn essential for development of motor skills, visual perception, emotional stability, and appropriate responses under different circumstances.(5) Handwriting is a complex skill consisting of underlying skills such as cognitive development, motor development and visual-perceptual development which are all interconnected. From birth onwards the child is fine tuning these building blocks or underlying skills in preparation for handwriting acquisition.

In order to build towards academic learning and skills such as handwriting, other building blocks need to be developed and consolidated. For example, the vestibular system, proprioceptive system, and tactile systems are responsible for the development of pencil grasp, postural control, bilateral coordination, motor planning for a new task and so many other underlying skills of handwriting.(3) The vision system and visual perceptual foundations are again crucial building blocks for handwriting, specifically in the area of visual perception which is made up of various skills and which supports the motor tasks of writing.

Occupational Therapists will establish where difficulties lie within the foundational skills and focus on the underlying reasons why the child shows difficulties with handwriting. This will identify skills that are perhaps behind expected developmental norms.

Handwriting 1

Consider the Underlying Skills of Handwriting

1) A stable base

One important component to consider when looking at handwriting, is core strength, or the stability of the child’s body while they are writing. (11) It is important to understand the phrase: ‘proximal stability is needed for distal mobility.’ In other words, a stable base is needed from the core of the body in order for structures further away from our body, like arms and legs, to be mobile and have effective functioning in smaller movements. Therefore, intervention for handwriting could very likely include improving core strength. Upper arm stability (such as shoulder, elbow, forearm or wrist) is again necessary to secure stability for controlled fingers movements.

2) Bilateral integration

It’s important for the child to be able to use both sides of their body in a coordinated way so that the helper hand (non-dominant hand) is playing a role in holding and therefore stabilizing the page.(11)

3) Fine motor development

This skill is necessary to manipulate the writing tool and to be able to practice what is written instead of how it is written.(11) This includes in-hand manipulation or the ability to move small items around the palm of the hand, separation of the two sides of the hand, thumb opposition and hand strength.

4) Efficient pencil grip

Different pencil grasps can be appropriate during different developmental stages and ages. Pencil grips should be taught within the different pencil grasp stages in order for our children to develop different muscles and learn new patterns of movement. Before getting to the dynamic tripod grip, children need to move through the developmental stages of pencil grasps. Children start at 1 to 1 and a half years old with their palm in contact with the crayon like a fist, making scribbles. From 2-3 years children start to hold utensils with all fingers. Next from 3 and a half to 4 years children would use a grip very close to a tripod grasp, but still use wrist movements. Only after moving through all these stages do children master a tripod grasp using finger movements between the ages of 4 and a half years to 7 years efficiently.(11)

5) Hand preference

Using the same dominant hand consistently is important in order to develop one helper hand and one specialized hand. This should occur between the age of 4 years and 6 years, but if your child is still using both hands or switching, there could be an underlying cause which an Occupational Therapist can assist with. If a child cannot cross their midline, this can also impact hand dominance and therefore this needs to be established. (2)

6) Pre-writing skills

Motor skills development happens in a typical developmental sequence and children need to move through every step to learn each skill. When learning to write letters, children will start with remembering and mastering lines and strokes as a practice run for later reproducing letters. After pre-writing skills children follow the developmental sequence of learning letter formation and patterns as these are all new movements to them!(11) Children need to be able to form the expected lines/shapes/letters/number of words for their age without excessive fatigue and also with using correct pressure and small finger movements to control their pencil.

7) Attention to task

It’s important to consider that children need to be able to pay attention to tasks to be ready for learning higher levels of writing. Some children dislike handwriting because they’re fidgety or have difficulty focusing on the task or staying seated. Children need to be ready to learn handwriting and be able to follow instructions and show an eagerness to learn.(10)

8) Visual perception and ocular movements

Visual perception is required for handwriting and is made up of many subcomponents. Children struggling with spatial awareness can show errors in sizing, spacing and alignment when writing letters. New writers need to create a visual memory of each letter as well as develop a motor plan to copy that letter.(10) Children who struggle with visual perception could have difficulty with performance in reading, spelling, math, copying from the board, letter reversals or distinguishing similar letters and shapes. These higher-level skills are dependent on the ability to first form prewriting shapes.

Girl writing

What if your Child has Difficulties with Handwriting?

If a child experiences difficulties within the nervous system, within their movement or speech and language, it can lead to a delay in development. For some children handwriting comes easy, for others it takes a huge amount of effort to learn these tasks, and this can then impact their behavior. Differences in foundational skills can result and often present as challenges with more complex skills. If a child lacks the visual-perception skills required to analyze how a letter is constructed and formed, they are going to struggle with handwriting.(3)

Learning disabilities can also affect handwriting and the various underlying skills to acquire handwriting. When children demonstrate fine motor or visual perceptual difficulties within handwriting a consultation with a healthcare provider should be considered. Occupational Therapists offer comprehensive assessments covering all aspects of visual-perceptual and motor development, and not just an occupational therapy handwriting assessment. It is their goal to establish the underlying reasons why your child is struggling with handwriting.

Boy writing

Typical Development of Handwriting

It is recommended that children be exposed to handwriting and drawing activities in school. Handwriting is beneficial for learning due to the involvement of different senses as well as different fine motor movements, which are crucial in a learning environment.(4) It is important that parents, health care workers and teachers understand the academic and emotional consequences of poor performance in handwriting. Writing as a form of communication continues to be an essential skill despite increased usage of technology.(8)

It is so important that we give our children the opportunity to develop their writing skills and all the underlying skills, and at the same time making sure it is appropriate for their age and skill level. Consider what is appropriate for your child at their age and that handwriting should progress through developmentally appropriate stages.

Occupational therapists use fun and engaging strategies that are evidence based to build children’s foundational skills in order to master legible and speed appropriate handwriting. It is important to be able to write well and to master this skill, underlying motor and visual perceptual skills need to be consolidated.

Children writing

Handwriting Development

2 years- Children at this age explore different fine motor skills activities and display pre-writing vertical and horizontal strokes. Children start to grasp a pencil in their palm and later with thumb and fingers.(6)

3 years- At this age children start becoming more aware of the written world around them.(10) Children start to grip a crayon using their thumb, index, and middle fingers.

4 years- At this age children start tracing capital letters and enjoy colouring and drawing. Later children start to grasp a pencil with the pad of their index finger and thumb as the pencil rests on the middle finger joint.(6)

5 years- At this age children are ready to print capital letters.(10) They continue playing and developing their fine motor skills by colouring, drawing and writing their name. They also start to prefer either the left or right hand.

6 years- At this age children start to foster comfortable and efficient use of pencils and pens.(6)

About the Author


Eliné received her Bachelor of Occupational Therapy in 2018 at the University of Stellenbosch in South Africa.

She is board certified with the Council for Professional Allied with Medicine in the Cayman Islands (CPAM), as well as the Health Professional Council of South Africa (HPCSA). She completed her community service year at a district hospital in South Africa where she worked within several different fields and treated a variety of patients including those with cerebral palsy, down-syndrome, autism spectrum disorder, attention deficit hyperactive disorder (ADHD) and intellectual disability within the field of paediatrics.

Eliné believes Occupational Therapy plays a pivotal role in engaging children to their full potential. She is a firm believer in working collaboratively with her clients’ families, schools, teachers, and professionals to support their development and wellbeing.

Eliné enjoys working with children to enable them to engage in their therapy by participating in meaningful everyday activities in a fun and playful way. She is committed to lifelong learning and broadening her knowledge and skills through continuous learning.


1) Graham, S., and Hebert, M. A. (2010). Writing to read: Evidence for how writing can improve reading.A Carnegie CorporationTime toAct Report.Washington,DC:Alliance for Excellent Education.

2) Drobnjak, Lauren. (August 14, 2017). Re: The Inspired Treehouse- Proximal Stability. [Web log post]. Retrieved from: https://theinspiredtreehouse.com

3) Greutman, Heather. ( March 21, 2019). Re: The Foundational Skills Needed for Handwriting Mechanics. Growinghandsonkids. [Web log post]. Retrieved from: https://www.growinghandsonkids.com/the-foundational-skills-needed-for-handwriting-mechanics.html

4) Ose Askvik E, van der Weel FR and van der Meer ALH (2020) The Importance of Cursive Handwriting Over Typewriting for Learning in the Classroom: A High-Density EEG Study of 12-Year-Old Children and Young Adults. Front. Psychol. 11:1810. doi: 10.3389/fpsyg.2020.01810

5) Witthaus, S.(2015). Enhancing your child’s development. Pro-Active publishing.

6) Beery KE (1997) The Beery-Buktenica VMI: Developmental Test of Visual-Motor Integration with Supplemental Developmental Tests of Visual Perception and Motor Coordination: Administration, Scoring, and Teaching Manual. NJ: Modern Curriculum Press.

7) Dinehart, Laura. (2014). Handwriting in early childhood education: Current research and future implications. Journal of Early Childhood Literacy. 15. 10.1177/1468798414522825.

8) Feder, K.P. and Majnemer, A. (2007), Handwriting development, competency, and intervention. Developmental Medicine & Child Neurology, 49: 312-317. https://doi.org/10.1111/j.1469-8749.2007.00312.x

10) Learning without tears TM. (August 10, 2022). Re: Handwriting and literacy development- How handwriting and literacy skills go hand in hand. [Web log post]. Retrieved from:https://www.lwtears.com/blog/how-handwriting-and-literacy-skills-go-hand-hand

11) McDougall, B. Re: The happy handwriter blog. [Web log post.] Retrieved from: https://thehappyhandwriter.co.za/handwriting-and-fine-motor-blog/