Holding a pencil, while missing a few finger joints

Question of the Day: My son, age 4, is missing the second knuckle of all of his fingers. How can I teach him to hold a pencil?

This is such a great question! Not all children can hold a pencil with the classic tripod grip- due to dexterity, missing joints, weakness or other problems. One in 20 children is born with a congenital hand difference, meaning that the number of children with physical challenges to having a traditional tripod grip is high. The important thing is to find a pencil grip that works for your child, and help him learn to use it.

After trying a number of pencil holds while not bending the second joint of my fingers, I found that the modified tripod felt the most comfortable to me. In this grip, the pencil balances between the index and middle fingers, and can be controlled completely by the thumb. Your child using this grip, may still need to use more wrist movement to write than other children, but it should be practical, instead of creating a less functional grip that is more like making a fist on the pencil.

Modified Tripod Grasp

I would start experimenting with this grip when he is doing an art project that is on a vertical surface- painting at an easel, using a dry erase marker or window crayon. Place the paint brush or maker between his first 2 fingers, and his thumb will naturally help hold it up against gravity. He may start with moving his entire arm still, like he would in a fist grip, which is fine at first, while he gets used to this new way of holding something. After he has gotten used to this grip, you can demonstrate holding your own marker this way, and show him how you can make the marker make small circles or such without moving your whole arm. In the early days of him trying this grip, you may need to do it too, many times, so take some time to try it out- you don't have to have great handwriting this way, but you should be able to color as well as a 4 year old.

Once he has mastered holding the marker or crayon in the vertical position, move to coloring or drawing with this grip while at a table. I highly recommend you help your son develop a confident pencil grip through art, coloring, or even scribbling before you introduce writing letters.

I hope this helps!

~Laura

PS- If there are other moms out there with a child with congenital hand differences, who would like to write and ask me about other ways to hold a pencil, feel free. I believe that an OT who can work with your child would be a better choice, but I also know that an OT consult is not available to everyone, and I am happy to help.

Cursive- Learning to write all over again

Question of the day: My fourth grader has horrible handwriting. Her teacher wants her to write in cursive, but it just isn't going well. What can I do?

Learning to write in cursive, is like learning to write all over again. For some children with poor handwriting, it can actually be a great opportunity to start again on this skill.

A sample page from Draw Write Now

Many older kids and teens who have poor handwriting, actually have weak fingers, and poor fine motor control. I suggest having your daughter start a program to strengthen her fingers- work with theraputty, color, draw, do word searches, mazes, dot-to-dots, and other pencil games, every day, as a way to strengthen her hand. Go back and read my previous post, How to improve your child's handwriting without writing letters, for more information. The ideas here work with children of all ages.

There is a series of books, Draw Write Now, which are great. They have sentences to copy and directions for learning to draw pictures. Learning some basic drawing skills helps some children a lot with the fine motor control needed for writing.

Have your child write the alphabet, in whichever form of writing she needs to use (printing or cursive), in both upper and lower case. When she is done, check to see if she formed all the letters correctly. Sometimes children with poor handwriting don't actually know how to form all the letters, perhaps they missed that lesson, or just can't remember a few. Make note of which letters are wrong. If it is more than 2 or 3, I suggest getting a Handwriting without Tears workbook. Have your child do one page each day, working with her on correct formation. Praise her efforts, and try to keep criticism to a minimum. Exclaiming "That e is the best one you ever made! Look how it sits right on the line, and is just the right size!" will make your child much more likely to keep making her e's look that way, than pointing out how all the other ones look like an i.

Using string to form cursive letters.

For some children, learning cursive is very confusing, though worthwhile. If you find your child just isn't getting the hang of how the letters are formed, try using a string to make the letters - having a 3-D example can be very effective. Other options include using a white board. You make the letter in one color, and let her trace over yours in another. Then erase both and let her try again. Or try painting the letters- sometimes making them in a different medium can help make new connections.

Copy work is another way for a child to focus on handwriting that is tried and true. Write a sentence or 2 with good handwriting, and have your child copy it as neatly as possible, focusing only on the letters and words she is copying, not on having to think of what to write. It is also possible to use this method to help your child with homework- have your child tell you her answer, you write it down, and then she can copy it neatly in her own handwriting. Sometimes, separating the act of writing from the act of thinking of what to say, can greatly improve a child's handwriting. After a while, the handwriting will improve as the child's hand becomes better able to write faster, to keep up with her thoughts.

~Laura

Making letters fun

Question of the Day: My child needs to learn to write letters, but isn't interested in workbooks. What can I do?

First, please read my post about things to do besides handwriting to help your child with being ready to write.

Worksheets are often boring for small children, and there is no reason to stick with doing them if it is miserable for all involved. Do things that are multi-sensory and fun instead! Children who hate worksheets are probably not learning best from them and need a different approach for a while.

Making letters with Wikki Stix

Explore how letters are formed by making them out of play dough, blocks or wikki stix.
Make the letter yourself and then let your child copy it. If that is too tricky, let them trace with their finger what you made. Let them feel it. Point out the places the letter is straight, curved, slanted, long or short. Make it a game, take turns with your child finding those features and making letters.

I suggest learning to make letters with the index finger first, before using a writing utensil. Even if your child has been writing for a while, if she can't seem to remember how to form the letters, backing up to this step can provide great reinforcement. Put shaving cream on a tabletop, and show your child how to draw in it. Don't start with letters. Let her explore making shapes, feeling the cream, and experiencing it. Then show her how to make a letter O. Be fun, let her try if she will. Perhaps make the O into an octopus by adding a face and 8 legs (a squiggly line in the shaving cream works for this).

Writing with shaving cream

If your child enjoys the activity, repeat it often showing her new letters each time. Just be sure you are forming the letter correctly yourself- top to bottom, lifting your finger to start a new line when appropriate. You want to set the stage for your child to learn to write the letters, not draw them. An example of drawing a letter, is when a small child makes a circle and adds a line for "a". As adults, that isn't how we write it, and if they learn to draw it first, they have to re-learn how to write later. The Handwriting Without Tears books have teacher's books that are great for explaining the proper formation. In case you aren't sure, Letters and Numbers for Me, the orange book, has detailed explanations on how to form both upper and lower case letters correctly.

If your child isn't into shaving cream, or you want to mix things up, other options include getting a large sheet pan and filling it with one of the following: dry oatmeal, corn meal, sugar, lentils, salt, or dry rice. These materials provide for the sensory experience of feeling how the letters are formed and seeing them in a different way- letting your child truly experience them. Some children respond even better if they can use a small car to form the letters in this different way. Writing in these different ways can also be a new way to practice spelling words as your child grows.

Those activities will help your child come to know how the letters are formed and how they feel. Do them in short sessions so your child doesn't become tired and bored. That way they want to play again next time!

Writing on the window

When your child is ready to use a marker, crayon or pencil, find interesting ways to make letters. I like window markers or crayons, because when a child holds the makers up to write on a vertical surface, it encourages a proper pencil grip. It also makes the letters more interesting, if he is being allowed to write on something unusual- the window, door, mirror, or even the fish tank. Novelty goes a long way with children. Bathtub crayons also have a certain appeal, for the child who enjoys a bath. And my white refrigerator has been used as a drawing and writing surface with a washable maker many, many, times.

For similar reasons, sidewalk chalk can be a great way to mix things up. However, most sidewalk chalk is very fat, causing small children to have to hold it in a fist, which is not ideal. Small chalk on a chalkboard is a better choice, for encouraging pencil grip and making easy to erase letters. For the child who is a perfectionist, writing in chalk or writing with dry erase markers on a white board, takes away some of the stress. Don't like a letter? It is gone in an instant, and the child does not have to look at it again. My daughter who struggled with math, prefers to do practice problems on the whiteboard so she can get rid of a wrong answer quickly. Make sure your dry erase markers are washable! Non-washable markers and children should never be combined. Ever.

Most children do best with a variety of activities that make learning to write letters fun and interesting. Pick and choose from above to mix things up. With my own children, I like to do a sensory activity from above with a few letters, and then work on writing those same letters on paper, making the connection of the multi sensory experience and the feel of writing the letter at a normal size on paper. However, you should feel free to do what seems to work for your own child.

I hope these ideas make learning to write more fun at your house!

~Laura

How to improve your child's handwriting, without writing letters

Question of the Day: My child [4,5 or 6 years old] is struggling to learn to write. What can I do to help?

Writing is a very complex task; it requires muscle strength in the arm, wrist and hand; it requires visual perceptual skills; it requires fine motor control and hand-eye coordination. In order for a child to learn to write it is important to address all those skills and most of them need to be developed apart from writing to reduce frustration.

The first thing to do, is work on strengthening the whole arm. If the arm isn't strong, the fingers won't be and the holding the pencil thing won't be good. So make sure your child is getting lots of time to play - ride bikes, throw and catch balls (hand-eye coordination there too), swing, climb trees, cross monkey bars, go swimming - things that strengthen the whole body, and therefore strengthen the arms. If you are stuck inside there are still things you can do. Try crawling on hands and knees or pulling yourself along on a scooter board while on your stomach. These are great child work outs that can be fun games. Chores can also be great strengthening activities - take out the trash, mop the floor, sweep, vacuum, wash the dishes - those all require some serious use of upper body strength, which is needed for writing. And my kids would rather mop the kitchen than do another page of handwriting practice.

Next, work on the muscles of the hand. Those small muscles get very tired when a child starts writing if they aren't strengthened properly. Kneading dough, playing with play dough, putting pennies in a bank, sewing, knitting, crocheting, using a knitting loom, and stringing beads all work those small hand muscles.

As an OT, my secret weapon, is theraputty.

Practicing her pinching with theraputty.

Theraputty has a non-sticky, smooth texture that makes it more appealing than play dough and it never dries out. I hide about 20 pony beads in a cup of it, and have the child spend about 5 minutes digging out the beads and then have the child hide them again by pinching the putty over them. Two exercises for the price of one! There is something kids just love about this stuff so they don't realize it is an exercise. However, be warned. It is self-leveling, which means it will slowly ooze as flat as it can get, running off of tables and into carpet fibers, if it isn't in its cup. It also stains, both clothes and furniture, if left on them. My personal nightmare involved my children stringing out a cup of the stuff ALL OVER my house and leaving it there over night. Not good, not good at all. So if you decide to get some, just be sure it always goes back in the cup with a lid when you are done, and have your child work with it on a table top, not the couch.

Pencil grip is the next thing on my list. Please, please, please, if your child is just beginning to write make sure they are holding their pencil correctly. The way a 5 year old learns to hold the pencil can last a life time! And not all grips are created equal.

Tripod Grip

The grip I teach most often is a "tripod grip", which means you grip the pencil with 3 fingers: the thumb, first or index finger and middle finger. An ideal grip involves the child pinching the pencil between the thumb and first finger, and using the middle finger as a stabilizer, under the pencil. The other 2 fingers of the hand should not be touching the pencil. If they seem to constantly be grasping the pencil try having your child hold a very small object, like a tiny pencil eraser, with the ring and smallest finger while writing. This reinforces the habit of not using these fingers to help hold the pencil. The picture here also links to more information about pencil grips. If your child cannot seem to develop a functional pencil grasp, I recommend seeking an OT to work with your child. I had to swallow all my pride and have my oldest see another OT when she was 6 for just this reason. It worked, she learned to hold a pencil, and did things for the therapist that she just would not do for mom.

Amazing Mazes (Kumon Practice Books)

I recommend that as part of a warm up to writing everyday have your child do a non-writing activity where you focus on making sure she is holding the pencil correctly. Coloring is a wonderful finger exercise, though many kids who hate handwriting, also hate coloring. I can generally encourage a child to color a very small picture, or piece of a picture, instead of a whole page. I try to make coloring a once a week activity with my own children, even the ones who hate it. Other days of the week, we do mazes or dot-to-dots, which both focus on pencil skills and gives me an opportunity to correct or reinforce their grip while working on hand eye coordination and visual perceptual skills, all needed for good handwriting. Learning to look carefully at what they are doing while holding a pencil sets the stage to look carefully at the difference between b and d, for example, which are both made with a curve and a straight line and can be difficult for the early writer to recognize correctly. Doing mazes and dot-to-dots work on being careful with the pencil - even if your child is being silly about going down every wrong path in the maze. Personally, I love the maze books made by Kumon. The mazes start simple and get gradually more challenging. Pictured above is one of the first mazes in the Amazing Mazes book. Their cutting book is also excellent and a great fine motor activity to strengthen hands.

Highlights Hidden
Pictures Sticker Fun

Visual perceptual skills are a problem for many children struggling with handwriting. The brain has to be able to look at the letter, see it, process it, and understand the parts of each letter- the curves and lines- to be able to copy it. I believe every child should have time each week doing those activities that strengthen that skill- puzzles and hidden pictures are some of my favorites for this. I have many wooden puzzles around the house, but for on-the-go, I love the Hidden Picture Playground books made by Highlights. My kids like the stickers (and placing stickers does work on that pincher grip needed to grab the pencil), and it is easy to take along in my bag for waiting on sister's dance class.

Doing all these things - strengthening the arms, and hands, learning a functional pencil grip, developing the finger control for other activities, and strengthening the eyes and brain to work together - will help your child's handwriting improve. And they help with many other life skills. I recommend a variety of the activities above be done every day. I alternate things for my daughter (who hates it all). My son wants to complete things as quickly as possible. So we work through a single Kumon book start to finish, doing a few pages a day. Find what works for your child, and go with it.

For actually teaching handwriting, I love the Handwriting Without Tears program. It simplifies the letters and has a simple workbook to use with instructions on how to form the letter correctly. We do lots of the activities above, but only 1 page in our handwriting book each day, that way learning to write isn't frustrating, or exhausting.

~Laura