WHEN A CHILD LACKS DEXTERITY

NEW YORK TIMES COLUMN: FAMILIES TODAY:
WHEN A CHILD LACKS DEXTERITY
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My 4-year-old son is within the chart for normal growth and development. He speaks well for his age and is fine at preschool.

But I have this nagging observation about his lack of dexterity and confidence in motor skills such as broad jumping, catching a ball or climbing. He sometimes still holds the pen with the wrong grip and finds it challenging to tear a piece of paper along a straight line.

His 20-month-old brother has shown dexterity and motor skills ahead of his age.

A. A child’s feelings can be a first tipoff to a delay. Is your son frustrated by a lack of dexterity, or does he avoid physical activities? Frustration or lack of confidence may hamper the child more than the delay itself. Comparison with a sibling is hard, too. Even the impact of a minor delay on a child’s self-esteem can be aggravated by the growing pressure on children to perform in ways that, until recently, weren’t expected so young.

You might start by talking to your pediatrician, who can check for illness and help to sort out whether it’s an issue of muscle strength, tone or coordination.

If needed, the pediatrician can refer your son to an occupational therapist for assessment. Often a minor delay shows no root cause, but treatment and time for developmental catch-up can make a big difference.

Specific exercises and activities to solve the issue can be similar to play, making a child want to join wholeheartedly. If the treatment is made to seem like it’s for a problem, a child could resist help.

Often parents, and even professionals, forget to talk with young children about the reasons for tests and treatments. Talking about problems and solutions helps children to feel less alone and afraid, and more hopeful.

The discussion can focus on issues that bother a child: “You know how sometimes you get mad at yourself when you can’t jump as far as some of the other kids?” Or a parent might ask, “What are the things you can do that you are really proud of?” Then: “What would you like to improve?”

Some children may not be able to answer, but if they’ve already noticed their delay, it’s reassuring to know you want to help.

Once a challenge has been acknowledged, put it in perspective: “It’s not a big problem, but it bothers you – and that’s a good reason to work on it, especially since it can improve.”

Progress comes when children are motivated. They may have their own reasons to hold back, such as feeling self-conscious or fearing that other children will know what’s up (though they needn’t).

Or a child may feel so badly about the delay he denies it altogether. Such a child may accept help if he is offered chances to succeed in other areas, and recognized for his strengths.

When he agrees to treatment, let the successes be his. Someday he’ll understand that even if he remains less dexterous, he deserves far more recognition for the courage to face his challenges and the tenacity to overcome them.

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.