It is important to pick up signs of developmental delay early so that adequate management can be instituted early.  Signs of fine motor delay can be very subtle presenting later in childhood with difficulties in writing, dressing and undressing.

The following are warning signs:

1) No pincer grasp by 15-18months

2) Tremor

3) Maternal/ parental anxiety

4) Persistent fisting at 6 months- persisting primitive reflexes (moro, palmar)

5) Hand preference in a child who is less than  18 months old, and the absence of hand preference in a child aged  3-5years

6) In children more than 3years old,  fine motor delay can present with- difficulties with maturation of pencil grip, report of pain (hand hurting) when writing

7) Difficulties with cutting, use of scissors, colouring, drawing and writing

8) Some children might have chewing difficulties and a history of recurrent choking on food

9) There may also be signs of visual delay with:

a) Failure to fixate at 6 weeks
b) Fixed squint
c) Persistent squint at 6 months