Hand Therapy in Early Intervention: A Guide for Parents and Providers Supporting Fine Motor Development through Early Intervention Practice

Posted in Disability Intervention

Early childhood is a time of rapid growth and development in all parts of the body including our hands. Challenges with hand use during early childhood can create difficulties when completing their daily activities, like feeding and playing. We use our hands for everything— so supporting tiny hands is essential!

Hand therapy and supporting fine motor skills can be difficult to understand for early intervention practice, as there are many different types of support. Here is what may be helpful for you to know:

Pediatric hand therapy is a specialized area in occupational therapy that addresses the development, strength, and function of a child’s hands and upper limbs. Early intervention focuses on developing these skills in a play-based and family-centered way, conducted in the child’s natural environment, such as a home or childcare setting. OTs who specialize on hand functioning will:

  • Encourage developmentally appropriate grasp and manipulation
  • Address one-sided hand use or disuse (e.g., due to brachial plexus injury or stroke)
  • Improv bilateral coordination
  • Address sensory processing (e.g., tactile defensiveness)
  • Assist with adaptive equipment or splinting if needed

After discussion with professionals in both of these fields (Pediatric Hand Therapy and Early Intervention practitioners), there appears to be a disconnect between the knowledge and confidence of assisting some more complicated hand therapy and fine motor development needs. Entry-level occupational therapy programs provide foundational knowledge of fine motor development, musculoskeletal function, and upper limb assessment. However, specific pediatric hand therapy skills, like orthotic fabrication, advanced congenital conditions, post-operative care and intervention, often require continuing education and mentorship.  Many therapists with advanced training will become a Certified Hand Therapist.

Key considerations for EI therapists:

  • Be confident in your core skills: motor learning, task adaptation, caregiver coaching, and developmentally appropriate play, and assisting families in their natural environment.
  • Seek ongoing training in pediatric upper extremity conditions when needed, such as through colleague mentorship.
  • Know when to consult or refer to a pediatric hand therapist or orthopedic team.

Remember! Your role is to assist a child when meaningfully engaging in daily life using the hands they have, with the tools and strategies that make that possible. Many young children with mild to moderate hand function concerns thrive with support from an Early Intervention practitioner. Collaboration between the Early Intervention team and a hand specialist may be appropriate if a child has:

  • A complex congenital hand difference (e.g., radial deficiency, syndactyly)
  • A brachial plexus birth injury needing structured rehab
  • Post-surgical care or splinting beyond standard positioning
  • Severe sensory-motor impairment

Resources

For Parents:

  • Ask your Early Intervention team or pediatrician when considering the support needed for your child.
  • Look for reputable sources like the American Occupational Therapy Association (AOTA) to find more helpful information.

For Practitioners:

  • Pursue continuing education in pediatric upper extremity rehab to further develop your early intervention skills related to fine motor development.
  • Partner with certified hand therapists (CHTs) for joint sessions or consultation, if applicable.
  • Stay current on evidence-based strategies in Early Intervention hand therapy

Amy Eybers-Hill, OTD (GUCEI’25)