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Developmental skills children need.

The following terms describe pediatric skill areas achieved during regular playtime. When needed, physical therapists can help children to develop these skills. For ways to promote these skills in your child, see Activities to Promote Development in Children.


Balance is the ability to keep the body in line under gravity with a base of support, and little to no postural sway. Sway is the horizontal movement of the center of gravity, even when a person is standing still. A person has good balance when they can sit up or stand in one position without falling. Closing your eyes and trying to stay in a sitting or standing position is a simple test of good balance.

Bilateral coordination is the use of both sides of your body at the same time. It means being able to do activities that involve using both sides of your body together. Examples include tasks like skipping, clapping your hands, riding a bike, or performing jumping jacks.

Cognitive skills are the ability of the brain to process information, apply knowledge, and change preferences. Cognitive skills are a measure of your ability to understand everything around you. This means you can observe people, objects, and places in your world and know what they are and what they do. Children with cognitive skills can plan activities to interact and play with other people, objects, and places. Examples include going to a friend’s house to play, taking a game to share, or forgetting to leave on time because they are focused on an activity they enjoy. Cognitive skills help people think, plan, organize, solve problems, remember, and take action on the things they have thought and planned.

Coordination is the combination of body movements. It uses direction and force to result in intended actions. Motor coordination is achieved when parts of the one movement or the movements of several body parts are combined in a well timed, smooth, and efficient way to reach an intended goal. It is the ability to move different parts of your body together with ease and skill. Dancing well is an example of good coordination. Children and adults can improve coordination by practicing a task in different ways and at different speeds. Activities like dropping and catching a ball while walking or picking up small objects with a spoon and placing them in a container can improve coordination.

Endurance is the ability to sustain effort without physical fatigue. It is the ability to do an activity for a long time without getting too tired. Toddlers and young children have short bouts of endurance at tasks like running. For example, they will run around at a store and then suddenly be exhausted. In a few minutes, they can run again. Older children and teens have more endurance and can play or take part in sports for long periods. Adults may lose endurance as they age.

Fine motor skills involve the coordination of small muscle movements. For example, you use the fingers in coordination with the eyes. Fine motor skills require you to use your hands for tasks, such as drawing a picture, feeding yourself, or handling small objects. People who can pick up things with their toes use the fine motor skills of the foot. Types of fine motor skills include:

  • Finger isolation is the ability to use the fingers one at a time or in groups together. Playing the piano requires isolating one finger from another. Other examples of this ability include snapping your fingers, pointing to a picture, counting using your fingers, and other finger games.
  • In-hand manipulation is the ability to move and position objects within one hand without help from the other hand. Moving objects from your fingertips to your palms or vice versa, hiding coins or candy in your palm, and then popping them out to the fingertips are examples.
  • Grasp is the ability to pick up and hold objects securely with the hand. We use grasp to pick up a cup and hold it and to hang on an overhead bar and swing. Children learn to use a pincer grasp with the thumb and first finger to pick up a small bite of food and a tripod or three-finger grasp to hold a pen for writing.

Flexibility is the range of motion of a joint, which may be increased by stretching. It is the amount of motion a joint or group of joints makes easily as far as the joint or joints are supposed to move. If muscles get tight or joints get damaged, flexibility may be lost, and stretching may help restore it. The singing game, “Head, shoulders, knees, and toes,” while touching both hands to each body part is one way to help a child stay flexible.

Gross motor skills are abilities usually gained during infancy and early childhood. By the time they reach age two, almost all children can stand up, walk and run, and walk up the stairs. These skills build, improve, and become better controlled throughout early childhood. People continue to refine these skills throughout their development and into adulthood. These gross movements come from large muscle groups and whole-body movements. They develop in order from head to toe. For example, children will typically learn head control, then trunk stability, and then how to stand up and walk. Many muscles work at the same time to allow rolling over, standing up from sitting in a chair, walking, running, climbing on playground equipment, or playing a sport.

Midline crossing means that one hand moves over to the opposite side of the body to complete a task. The ability to cross the midline of your body allows you to write on a piece of paper from left to right, read, or touch the left shoulder or foot with the right hand. Playing most sports, like kicking a soccer ball, hitting a ball with a racket, or swinging a golf club, requires midline crossing.

Motor control is the process by which humans organize and perform actions. This skill integrates sensory information about the world and the body to determine the appropriate muscle forces and joint activations to generate a desired movement or action. Successful motor control is vital to interacting with the world. It helps to determine one's actions and also regulates balance and stability. The brain, nerves, bones, and muscles are all used for motor control. We gain motor control by practicing tasks over and over until we can do them with skill. Then we must do that task in various situations for the body to automatically recall the control. A child might learn to shoot a basketball into a hoop at home by practicing. Then she must shoot the ball into hoops at various other places, like a friend’s house, the school, and a stadium, to gain good motor control over shooting basketballs in any environment.

Motor skills are strings of movement that a person learns. They combine to produce a smooth, efficient action to enable us to master a task. There are both fine and gross motor skills. All the large and small movements we make are motor skills. People with healthy motor skills can do many kinds of tasks such as writing a sentence, combing their hair, walking up a ramp, tapping their fingers or feet in time to music, running to catch up with someone, picking up small objects, and dancing. The list is endless.

Posture refers to the ability to be stable while aligning the body in relation to spaces and objects in the environment. Postures are the positions we hold our body in throughout the day. For example, we can sit up straight in a chair (a desired posture) or slouch, which is also a posture. Children and adults need to be able to hold a variety of postures to function well. The "strike a pose” imitation game can encourage a variety of postures.

Prewriting skills lay the foundation for handwriting skills.  They are movements that children make with their fingers and hands that help them eventually learn to write. Holding a crayon and scribbling are prewriting skills. Learning to trace lines or letters, color pictures, and draw shapes are prewriting skills that best promote handwriting.

Proprioception is the sense of the position of neighboring parts of the body and the strength needed to move and hold one's posture. In other words, it is the awareness of where the entire body and its parts are in space. For example, you sense that your arm is out straight to push an object or bent at the elbow above your head to catch a ball. Most of the time, children move and play without an active awareness of proprioception. Children with motor skill problems can improve their skills through exercises and activities to help them become more aware of their body positions and movements.  

Sensory integration is the process that organizes sensations from one’s own body and the environment. This skill makes it possible to use the body in response to the environment. Sensory integration uses our senses (vision, hearing, smelling, tasting, touching, body awareness) to hold our posture, move, or change our movements. This skill even affects our speaking and thinking. If we cannot perceive sensations accurately, we might make the wrong decisions. Children who have good sensory integration understand how to wait their turn on a and how to use playground equipment safely. Children who have problems with this skill might get in line out of turn and may not understand how to step on a swinging bridge or climb a playground structure.

Social skills, sometimes called people skills, help us interact and communicate with others. We use social skills to talk and relate to other people. Each culture develops social rules about how to engage with other people. Examples include knowing how close to stand to someone, how loud or quiet to be in a conversation, how to say polite things, how much emotion to share, how to interpret the facial responses of others, and how to take turns.

Strength means having physical power, energy, and the capacity to exert force. Strong muscles and the ability to use them with control help us resist forces against the body or apply force to other objects. For example, if someone pushes us in a crowd, strength helps keep us from falling. Good strength allows us to do many tasks. Examples include pulling a sweater over our head, riding a bicycle, carrying a heavy grocery bag, or pushing a lawnmower.

Trunk (core) stability is strength in the middle of your body. It involves the postural-control muscles, including the abdominal wall, diaphragm, pelvis, and lower back. Core stability is important in the development of bilateral coordination, midline crossing, gross and fine motor, and balance skills. Core stability helps you maintain a good posture and keep your balance during activities like walking, pushing a vacuum, running and looking backward to catch a ball, or sitting and passing heavy dishes at the dinner table.

Visual-motor integration is the ability to coordinate motor output with visual input. It allows the eyes and hands or other parts of the body to work together. Finger painting, working a jigsaw puzzle, or drawing a line through a maze in a coloring book are examples of a child's ability to integrate vision and hand movements. Kicking a ball rolled to you is an example of integrating vision and movement of the leg and foot.

Visual perceptual skills are skills that help us gather visual information and use it with our other senses. When we look at something and understand what it is, we are using visual perception. We gather information with our eyes,  store the information in our brains, compare that information to other information we have stored, and use it later when needed. Children use visual perception skills to recognize that a bear from a picture book is the same animal as their stuffed bear, a small toy plastic bear, a jelly candy bear, and a real bear at the zoo.