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Fine-Motor Skills: Everything You Need to Know

• How to Improve

When to Talk to a Doctor

Frequently asked questions.

Fine-motor skills are movements that require coordination of the fingers, hands, and wrists to complete everyday tasks. Fine-motor skills require manual dexterity and start to develop in babies and young children, improving over time with maturity. 

This article reviews examples of fine-motor skills, the typical timeline of their development, and ways to improve them.

Alexandra Jursova / Getty Images

Examples of Fine-Motor Skills

Fine-motor skills are used every day to complete self-care tasks, activities of daily living (ADLs), and school and work-related duties. Examples of fine-motor skills include:

• Brushing your teeth
• Writing with a pencil
• Using a fork or spoon
• Cutting with a knife or scissors
• Buttoning a shirt
• Zipping a zipper
• Turning a key
• Turning a doorknob
• Turning the pages of a book
• Tying shoelaces

Fine-Motor Skills vs. Gross-Motor Skills

Fine-motor skills require coordination of the small muscles and joints of the fingers, hands, and wrists. Gross-motor skills require larger muscles and joints to coordinate the movement of the arms, legs, and body.

Timeline of Development

Babies start to develop fine-motor skills at 1 or 2 months old, and they refine fine them and learn new ones as they grow. Advanced fine-motor skills take a longer time to develop, such as those used to play an instrument or create certain types of art, and can continue to develop into the adult years.

Children typically accomplish certain fine-motor skills along a predicted timeline with milestones at different ages. 

At 2 months old, a child should be able to do the following:

• Open their hand from a closed fist
• Hold their hands together
• Hold onto a rattle if placed in their hand

At 4-6 months old, a child should be able to do the following:

• Reach for objects
• Hold an object placed in the palm of the hand
• Transfer objects between the mouth and hands

At 8 months old, a child should be able to do the following:

• Grasp small objects in their fingers
• Remove an object from a cup
• Bang a spoon on a surface

10–12 Months

At 10–12 months old, a child should be able to do the following:

• Grasp or pinch an object between the thumb and index finger
• Throw objects
• Stir with a spoon

At 1–2 years old, a child should be able to do the following:

• Hold a crayon
• Attempt to stack two cubes

At 2–3 years old, a child should be able to do the following:

• Make a "train" of cubes
• Stack cubes
• Brush their teeth with assistance
• Put on a coat without assistance

At 3–4 years old, a child should be able to do the following:

• Put beads on a string
• Eat independently
• Unbutton buttons
• Pour liquid from one container to another
• Draw objects

At 4–5 years old, a child should be able to do the following:

• Cut with scissors
• Write their first name
• Dress themselves
• Wipe after going to the bathroom

At 5–6 years old, a child should be able to do the following:

• Use clothespins to transfer small objects
• Bathe independently
• Write their first and last name

6 Years and Up

At age 6 and up, a child should be able to do the following:

• Tie their shoes
• Copy drawings of a flag
• Write short sentences

Ways to Improve Fine-Motor Skills

You can improve a child's fine-motor skills by giving them opportunities to do the following:

• Put together puzzles
• Help set the table
• Draw or scribble
• Cut with child-safe scissors
• Open and close containers with lids

Adults can lose their ability to perform fine-motor skills from acquired hand and finger weakness from aging, different forms of arthritis , and neurological conditions like strokes and Parkinson’s disease . Practicing hand and finger exercises, along with attending occupational therapy , can improve fine-motor skills.

If you notice that your child isn't meeting milestones, you should talk with your healthcare provider. Certain conditions like autism spectrum disorders , cerebral palsy , Down syndrome , muscular dystrophies , and others can affect a child’s ability to perform fine-motor movements.

Aging and neurological conditions can also affect your coordination and ability to complete fine-motor tasks. If you have difficulty with the daily tasks of living, talk with your healthcare provider. Occupational therapy can be beneficial for practicing and improving fine-motor movements.

Fine-motor skills are movements that require coordination of the fingers, hands, and wrists to grab, hold, and manipulate objects in order to complete everyday tasks, such as brushing your teeth, bathing, eating, writing/drawing, and getting dressed.

Babies and young children typically follow a general timeline for developing fine-motor skills but may take longer if they have certain health conditions. If you are concerned about your child’s fine-motor skills or your own, working with an occupational therapist can help.

A Word From Verywell 

Performing fine-motor skills are crucial for maintaining independence with everyday tasks and activities of daily living. If you notice that you are losing your ability to perform fine-motor skills or if your child has difficulty with or is taking longer than expected with learning fine-motor skills, talk with your healthcare provider about starting occupational therapy.

Fine-motor skills require coordination of the small muscles and joints of the fingers, hands, and wrists, while gross-motor skills require coordination of larger muscles and joints to coordinate movement of the arms, legs, and body.

Examples of fine-motor skills include brushing your teeth, holding a pencil/pen to write, using a fork or spoon to feed yourself, cutting with a knife, buttoning a shirt, zipping a zipper, typing on a computer, cutting with scissors, turning a key in a lock, turning a doorknob, turning the pages of a book, and tying shoelaces.

Fine-motor skills can decline with age due to lack of use and acquired muscle weakness affecting coordination of the hands and fingers.

Providing different types of toys that involve pressing buttons, turning knobs, opening or closing lids, placing objects through holes, and fitting puzzle pieces together can help your child develop fine-motor skills as well as encouraging your child to participate in arts and crafts and tasks around the home, like cooking and cleaning.

Scharf RJ, Scharf GJ, Stroustrup A. Developmental milestones . Pediatr Rev (2016) 37 (1): 25–38. doi: 10.1542/pir.2014-0103

National Association for the Education of Young Children. Help your child build fine motor skills .

Moving With Hope. What does an occupational therapist do for adults?

Choo YY, Agarwal P, How CH, Yeleswarapu SP. Developmental delay: identification and management at primary care level . Singapore Med J . 2019;60(3):119-123. doi:10.11622/smedj.2019025

By Kristen Gasnick, PT, DPT Kristen Gasnick, PT, DPT, is a medical writer and a physical therapist at Holy Name Medical Center in New Jersey.

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Fine motor skills

Learn more about fine motor skills as part of the early years foundation stage (EYFS), including advice from experts and suggested activities.

Why fine motor skills are important

What the eyfs framework says, what this means in practice, suggested activities, other activities, what other nurseries and childminders are doing.

Fine motor skills involve small muscles working with the brain and nervous system to control movements in areas such as the hands, fingers, lips, tongue and eyes. Developing fine motor skills helps children do things like eating, writing, manipulating objects and getting dressed.

A baby uses their fingers and thumbs to pick things up. They will also feel and taste objects with their mouth and lips. An older child will use their fine motor skills for actions like pulling up a zip or using scissors to cut up paper. These important skills will contribute to a child’s development and independence across all areas of learning.

Research shows that the development of fine motor skills depends on the development of gross motor skills and that a joined-up approach to physical development is important. Young children need many opportunities to develop fine motor skills alongside gross motor skills so they can become confident to explore the world around them.

From a very young age, children are exploring different materials. With these materials a child will naturally start to make marks. Babies might use their whole bodies to make marks with mud, paint or cornflour in a tuff tray, or with food at mealtimes. A toddler might splash in a puddle and notice the prints they make.

Mark making is an important experience for children because over time they can attribute meaning to their marks. Combined with a child’s developing dexterity, these marks become refined and deliberate, until the point at which the young child labels their marks, either as pictures or writing.

In this video, an early years expert explains the importance of fine motor skills in the early years foundation stage framework. There are also some tips on how to support children in this area.

Gross and fine motor experiences develop incrementally throughout early childhood, starting with sensory explorations and the development of a child’s strength, co-ordination and positional awareness through tummy time, crawling and play movement with both objects and adults.

Fine motor control and precision helps with hand-eye co-ordination which is later linked to early literacy. Repeated and varied opportunities to explore and play with small world activities, puzzles, arts and crafts and the practise of using small tools, with feedback and support from adults, allow children to develop proficiency, control and confidence.

Statutory framework for the early years foundation stage , page 8, childminder EYFS, page 10, group and school-based EYFS.

You can help children develop fine motor skills by providing an environment, experiences and activities that encourage a joined-up approach to physical development.

Your environment should provide rich and varied opportunities for large and small movements. For babies this may involve providing materials that they can grasp, grip, bash, squash and poke such as crinkly paper, wooden spoons and stretchy fabric. For older children, provide activities that require small hand movements such as stirring a magic potion, pegging washing on a line or exploring wet and dry sand.

Provide interesting experiences which help children practice fine motor skills. Cooking, gardening, sewing, fixing and making things are all good examples of activities that involve using tools and small movements with accuracy and precision. The fine manipulative control skills developed in these activities will begin to provide the foundations for holding a pencil for drawing, mark-making and writing when children are developmentally ready.

You should make sure that every child is supported in developing their fine motor skills. When a child experiences difficulties, you can support them by making changes to materials or activities, or by giving gentle praise and encouragement.

You’ll need:

• materials for weaving such as ribbon, threads, string, strips of fabric, plastic tags, wool, rafia, bead strings, natural materials, such as, twigs, leaves, lichen or seed heads
• extra materials to thread through attaching with the strips such as beads, hoops, paper clips, buttons, discarded pieces from construction toys, toy wheels, paper or treasury tags, or wooden sticks
• a mesh or a weaving frame, to move different materials in and out to make a weave

There are many cheap materials that can be used for the mesh, including drain mesh, rigid garden mesh, a discarded bicycle wheel or homemade frame either out of wood or sticks.

Weaving can be done outside and inside. Arrange the materials so that they invite children to get involved. Support their natural curiosity and gently suggest how they might manipulate the materials.

This activity will help them to grasp, develop their pincer grip and to manipulate different materials. Look for high levels of involvement and note each child’s dexterity, This will inform you as to whether the materials selected are suitable and offer a degree of challenge.

How this activity links to the other areas of learning

Describing the child’s actions will support widening vocabulary within a context that is meaningful ( communication and language ). Plenty of experience manipulating materials, creating weavings develops hand eye coordination for emerging reading and writing ( literacy ). There are opportunities for children to experience shape, pattern and quantities ( mathematics ). Making weavings in different materials develops a child’s self-expression and imagination. Over time they are more able to design with intent as their familiarisation with materials and how they can manipulate them becomes embedded ( expressive arts and design ). Large meshing and weaving frames offer children the opportunity to create together ( personal, social and emotional development ). Find images of weaving with different materials to display in the setting. These images can inspire and motivate as well as complement the children’s creations ( understanding the world ).

• simple recipes
• ingredients for your recipe
• simple tools such as rolling pins, bowls, jugs and baking tins

Regularly involving young children in preparing and cooking food is a very motivating way of developing fine motor skills.

Choose simple recipes that involve combining ingredients and that use simple tools. Find out from children’s parents and carers what they like to prepare at home and make sure that the recipes you use reflect your setting’s diverse community.

Mixing, squeezing, pouring and spreading during cooking help to develop fine motor and hand-eye coordination skills. Rolling and flattening dough with the hands or with a rolling pin helps children practice using both hands in a coordinated way. Pouring ingredients into bowls and spooning batter into tins are good ways to practice hand-eye coordination.

For children who struggle to grasp and pour, provide kitchen utensils that are designed for ease of use.

Over time children are increasingly confident in talking about cooking using the correct vocabulary to describe ingredients and processes (communication and language) . Cooking involves the understanding of mathematical concepts such as counting, weighing and understanding quantity (mathematics) . Cooking relates to the children’s personal experiences (understanding the world) . Cooking is a reflection of the diverse world and gives children the opportunity to make comparisons between different types of food.

Easy cooking with kids from Cbeebies.

Making homemade playdough from the BBC’s Tiny Happy People.

Early Education has suggestions for outdoor mark-making activities .

“We try to make developing fine motor control interesting for children. An example is filling balloons with water overnight to make ice balloons. We peeled the rubber balloon off the frozen shape and put it on a big tray. Children had small pots of food colouring and plastic pipettes, small pots of salt with teaspoons, and other tools for exploring the ice. Children used a pincer grip to drip the food colouring over the ice balloons and to carefully spoon salt into the cracks that appeared. We noticed colourful patterns in the melting ice and showed children how to use the tools to chip and chisel holes and cracks. It was really motivating for children who might not choose activities that encouraged hand strength and control otherwise.”

Kate, Filton Avenue Nursery School, Bristol

• Fine motor skills help children to navigate and explore the world with confidence and independence.
• Fine motor skills depend on gross motor skills. You need a joined-up approach for developing whole body physicality and strength.
• Rich outdoor and indoor environments will provide opportunities for developing fine motor skills.
• Meaningful and real experiences like cooking are motivating for children and provide good opportunities for developing fine motor skills and coordination.
• Consider how providing small, natural materials for children to explore will support fine motor skills.
• Explore how everyday routines and experiences in your setting such as preparing snacks or tidying up could support children to practise fine motor skills.
• Review your curriculum to ensure you cover the requirements in the EYFS for this area of learning.

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Fine and Gross Motor Skills in Children

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Fine Motor Skills

Gross motor skills, motor skill delays.

Motor skills are skills that enable the movements and tasks we do every day. Learning these skills is a crucial part of child development. Fine motor skills are those that require a high degree of control and precision and use the small muscles of the hand or wrist (such as using a fork or crayon). Gross motor skills use the large muscles in the body to allow for balance, coordination, reaction time, and physical strength so that we can do bigger movements, such as walking, running, and jumping.

Motor skills enable the movements children need for everyday tasks, from playing and feeding themselves to moving from place to place. Typically, children develop certain motor skills at specific ages, but not every child will reach milestones at precisely the same time. A child with motor impairments has trouble moving in a controlled, coordinated, and efficient way. If your child seems to be delayed in developing fine or gross motor skills, they will likely undergo an assessment and may require physical or occupational therapy to catch up.

Fine motor skill activities involve manual dexterity and often require coordinating movements of the hands and fingers with the eyes, which is known as hand-eye coordination.

Components of fine motor skills include being able to grip and manipulate objects, use both hands for a task, and use just the thumb and one finger to pick something up rather than the whole hand.

The following are just a few examples of fine motor skills that typically occur at different phases of child development.

Birth to 3 Months

• Uses arms to swing or "bat" at objects
• Watches hands move and brings them to the mouth

3 to 6 Months

• Begins to transfer objects from one hand to another
• Holds own hands together
• Reaches for toys using both arms

6 to 9 Months

• Begins to grasp & hold onto objects, such as a bottle or toys
• Squeezes objects
• Uses a raking grasp to move objects with fingers

9 to 12 Months

• Begins to show a preference for one hand over the other
• Puts small objects in a cup or container
• Turns pages in a book a few pages at a time
• Develops pincer grasp (using index finger and thumb to grasp objects)
• Feeds themselves finger foods

12 to 18 Months

• Builds a tower two blocks high
• Scoops objects with a spoon or small shovel
• Claps hands
• Scribbles with crayons on paper
• Waves goodbye

18 Months to 2 Years

• Begins holding a crayon with fingertips and thumb
• Builds a tower three to four blocks high
• Opens loosely wrapped packages or containers
• Turns pages in a book one page at a time
• Puts rings on pegs
• Stacks a block tower nine blocks high
• Turns doorknobs
• Washes hands independently
• Zips and unzips large zippers
• Manipulates clay or play dough
• Folds a piece of paper in half
• Draws a circle after being shown an example
• Fastens and unfastens large buttons
• Gets dressed and undressed without help
• Touches the tip of each finger to the thumb
• Uses a fork correctly
• Cuts out a circle
• Copies a triangle shape
• Grasps a pencil correctly
• Ties shoelaces
• Builds a small structure with blocks
• Puts a 16 to 20 piece puzzle together
• Cuts well with scissors
• Uses a knife to cut food

You can encourage your baby to improve their fine motor skills by laying them under a play gym, using wrist or ankle rattles, or moving a colorful toy around so they can visually track it. For toddlers, activities that might improve fine motor skills include encouraging them to pick up objects with tongs, building with blocks, and doing craft projects. You can also encourage toddlers and preschoolers to play with play-dough, sponges, pasta, or water toys.

Gross motor skills are movements that involve large muscle groups and are generally more broad and energetic than fine motor movements. These movements include walking, kicking, jumping, and climbing stairs. Some milestones for gross motor skills also involve eye-hand coordination, such as throwing or catching a ball.

The following are some examples of gross motor skills that typically occur at different phases of childhood development.

• Raises arms and legs when placed on the stomach
• Supports own head when in a sitting position

6 Months to 12 Months

• Pulls self from a sitting to a standing position
• Sits without support
• Climbs onto low furniture
• Climbs stairs with assistance
• Pulls or pushes toys with wheels
• Walks with one hand held
• Jumps using both feet simultaneously
• Runs very stiffly on toes
• Walks upstairs without a banister
• Rides tricycle using pedals, unassisted by an adult
• Runs without falling
• Throws a ball to an adult standing 5 feet away
• Catches a ball with arms and body
• Runs smoothly with changes in speed
• Walks upstairs by alternating feet
• Catches a ball with two hands
• Hops on one foot
• Performs jumping jacks and toe touches
• Walks up and down the stairs while carrying objects
• Kicks rolling ball
• Jumps over objects 10 inches high
• Rides a bicycle with training wheels
• Throws with accurate placement

Encourage your baby to work on their gross motor skills by doing lots of tummy time. Once they master that, encourage them to reach for (and later crawl towards) toys placed in front of them. To encourage your baby to walk, help them stand and take steps by holding their arms. With toddlers and preschoolers, encourage them to build forts, dance to songs like "Head, Shoulders, Knees, and Toes," play pretend, and pull their toys in wagons.

Children with  neurological conditions  or  developmental delays  may have difficulty with fine motor skills. Difficulties with fine motor skills often aren't diagnosed until preschool when it becomes more obvious that children are struggling with different school activities, such as learning to copy shapes or letters.

Some children will be diagnosed with dysgraphia , a learning difference that affects writing skills, while others might be diagnosed with developmental coordination disorder (DCD or dyspraxia), a condition that is still not widely understood. Kids with fine motor skill difficulties might need  occupational therapy , modifications, or assistive technology.

It may be easier to notice if your child isn't reaching gross motor skill milestones than fine motor milestones because gross motor skills are among the most anticipated; you're probably eagerly anticipating your baby rolling over, crawling, pulling themselves up along furniture, and taking their first steps. As a child grows, you note when they are running and playing and how well they do in physical games and sports.

Children with neurological problems, developmental delays, or disabilities will usually be diagnosed by their pediatrician if they consistently miss major milestones. Gross motor skill delays may also be a sign of dyspraxia. If children's gross motor delays affect movements, they may receive physical therapy to help with gross motor skills or they may need modifications or assistive technology to keep up with mobility or athletics.

A Word From Verywell

While each child is different, don't hesitate to discuss any concerns about your child's motor skills with your pediatrician. If your child is referred to occupational therapy or physical therapy, you will be involved in the therapy and will be given instructions on how to work with your child at home to build their motor skills.

Centers for Disease Control and Prevention. CDC's developmental milestones .

NAPA Center. Occupational therapy vs. physical therapy .

Dosman CF, Andrews D, Goulden KJ. Evidence-based milestone ages as a framework for developmental surveillance .  Paediatr Child Health . 2012;17(10):561-568. doi:10.1093/pch/17.10.561

Understood. Dysgraphia .

Understood. What is dyspraxia ?

Growing Hands-On Kids. Typical Fine Motor Developmental Milestones .

By Terri Mauro Terri Mauro is the author of "50 Ways to Support Your Child's Special Education" and contributor to the Parenting Roundabout podcast.

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Supporting Physical Development: Environments and Experiences

In this lesson, you will learn methods of supporting the physical development of school-age children. This lesson will define motor and sensory development and include appropriate activities to support each type of development in a school-age environment. This lesson will also describe "right fit" activity choices and developmentally appropriate activities for school-age children in both indoor and outdoor environments.

• Identify physical activities that are appropriate for school-age children and their physical development. 
• Plan developmentally appropriate physical activities for both indoors and outdoors.
• Discuss sensory development in school-age children.

Part of your role as a school-age staff member will be to support the physical development of the children in your care. In order to do this properly, it is important that you understand what types of physical activities are appropriate and necessary for school-age children.

Motor Development

Motor development, or the growth and improvement of muscular coordination, occurs rapidly during the first five years of a child’s life. School-age children continue to develop and strengthen their motor skills in a more slow and detailed way. Motor development involves two separate components: gross motor skills and fine motor skills. Gross motor skills are actions that use the large muscles in our bodies, such as those in our arms and legs for walking, running and jumping. Fine motor skills are actions that use smaller muscles, such as those in our hands and fingers, to perform tasks such as drawing, cutting with scissors, or writing.

Gross Motor Development

Most school-age children will have developed their basic gross motor skills, but as school-age children grow and develop physically, they continue to refine and improve coordination in their larger muscles. School-age children continue developing their large-muscle skills through practice and repetition. For example, if an 8-year-old wants to learn how to throw a baseball, he or she should practice throwing a ball repetitively over a period of time in order to develop and refine the skill.

Children who are experiencing growth sports often lack coordination and seem clumsy. They may have had a growth spurt in their torso and arms but not yet in their legs, or their feet may fully finish growing before the rest of their body. School-age children are more prone to being clumsy and uncoordinated with their movement because their brain cannot keep up with the rapid change in their body’s dimensions. Researchers in Italy, who studied the way teenagers moved, found those who had gained 3cm in height across a three-month span tended to be more awkward and less coordinated (Bisi & Stagni, 2016). Children going through these phases will have to work especially hard to excel at certain athletic skills. Later in this course, you will learn how you can support the emotional needs and challenges of school-age children who are experiencing this type of development.

You can help support the physical development of gross motor skills by including certain activities in your lesson plans. The table below provides examples of activities that support gross motor development and ideas on how to incorporate them into your program activities.

Fine Motor Development

Fine motor skills are the actions that involve using the small muscles found in our fingers, hands, and wrists. School-age children will already have a firm grasp on most fine motor skills. They will be able to use utensils, draw, tie their shoelaces, and use clasps and buttons. However, if a child’s hand-eye coordination skills are not as developed or refined, it will be difficult for them to strengthen and improve their fine motor skills. Like all developmental milestones, these tend to even out over time, and by age 12, most children will have mastered hand-eye coordination. Some examples of activities that can help strengthen fine motor skills are:

Right Fit Activities

When planning physical activities for school-age children, it is important to choose activities that are the “right fit.” This means that they are not too easy or meant for younger children while also ensuring that they are not too difficult with unachievable expectations. You want to set children up for success by giving them the opportunity to reach a goal, win a game, or achieve their personal best. Planning activities that are fun, developmentally appropriate, and designed to keep school-age children physically active will be part of your role as a school-age staff member.

The Centers for Disease Control and Prevention (CDC) recommends that school-age children be physically active for a minimum of 60 minutes each day. They also recommend a combination of aerobic activity, muscle-strengthening and bone-strengthening exercises or activities. The table below is from the CDC and lists details of activities that fall into these three categories. Because school-age children range from young children to early adolescents, the information should be used accordingly, depending on the ages of the children in your care.

Not only is it important for children to participate in the recommended amount of physical activity each day, they also need to participate in the correct types of physical activity. When planning physical activities for school-age children, you should choose fun, interactive activities that children will enjoy doing. The chart above is a great place to start to ensure a variety of activities. Keep in mind, activities need to be developmentally appropriate for school-age children. Avoid activities that are too difficult or unsafe, such as weight training or activities that are overly vigorous.

It is also important to determine the appropriate level of difficulty for your particular group of school-age children; based on their abilities. After becoming familiar with the children’s range of physical fitness levels in your care, you can begin to plan activities with their particular abilities in mind. It’s important to find a balance between activities that are too easy and activities that will be too challenging. It is OK to plan activities that children will find challenging as long as they are safe. Children and adolescents with disabilities are more likely to be inactive than those without disabilities, so it is important to consider all the children in your care. Think of ways to modify the activity to ensure equal participation.

If when you’re trying out a new activity you see that children are unable to perform the initial skills needed or are incapable of comprehending core concepts in the activity, you should choose another activity or adapt your instruction. You may need to work with children on development of initial skills and core concepts in order to accommodate children’s needs. When children continue to struggle because activities are not developmentally appropriate, they can feel inadequate, incapable, and loose self-esteem. You can modify your activities and their goals in order to allow children to test the limits of their own physical abilities and try to achieve a personal best.

Being Active: Indoor

Giving school-age children activity choices while indoors will help to support their active lifestyles. Physical activities that are planned for indoor spaces typically fall into two categories. The first are activities that are purposefully planned for physical activity, usually in a large room or gym type of environment. The other indoor activities are often called “action games.” These are activities that can be done in smaller classroom-size spaces and are often used to reinforce a lesson or concept.

Indoor Activities: Large Spaces

Many activities that are planned for outdoor spaces can be adapted to play indoors. Depending on the space available in your program, group games such as tag, soccer, flag football, dodge ball or basketball can also be played indoors as long as there is enough space to do so them safely. Other ideas for indoor spaces are:

• Group exercise class : Invite a professional trainer or use video instruction to teach school-age children specific exercise moves and routines.
• Dance : Dancing is a fun way for children to burn some energy. Have free-form dancing or instructor-led dancing for school-age children. You can also have dance offs, competitions or choreograph a dance for families to watch.
• Yoga : Yoga is a great way to relax and wind down with school-age children. It also targets core strength and flexibility, which help improve coordination and balance. If an instructor is not available, consider using books and video instruction as a guide.
• Scavenger hunts
• Relay races
• Jumping rope

It is important to note that the use of commercial DVDs or video instruction for physical fitness activities may require written consent for public viewing and use.  If you are interested in utilizing video instruction in your classroom, consult with your administrator, trainer, or coach.

Indoor Activities: Action Games

Action games are a great way to incorporate movement into school-age children’s daily routines. You can use action games as a tool for concept reinforcement or transitions. Action games are also a great option to have on hand when you need to fill a few minutes before pick-up time, or if an activity doesn’t go exactly as planned. Examples of action games are Simon Says or Charades. Attached to this lesson, you will find a resource list of web and print materials with more examples of these types of games. One of the benefits of this type of activity is that these games often require no supplies.

Being Active: Outdoor

In the Learning Environments course, you learned about a variety of outdoor spaces, as well as safety requirements. Not all outdoor spaces will be the same. Some programs have large open spaces, playground equipment, grassy areas, or paved areas. Others may utilize a shared space at a school or park. Organizing physical activities in an outdoor space is a great way to motivate children to be active. Sometimes, games and other activities will be considered free play. When school-age children engage in child-directed play to initiate a game of basketball, tag, or use their imaginations to create their own games; you should join in and participate as much as possible.  This will show that you are also committed to being active and will set a good example for the children in your care.

Other outdoor activities will be planned. Some examples are:

• Athletic games : Most types of athletic games can be adapted to play with school-age children. You should spend time going over the rules of the game. If you have an expert in your group, let her or him be the leader and share the rules of the game. Keep in mind the developmental levels of all children who want to participate, and find ways to accommodate those just beginning to acquire the skills needed to play.
• Field-day activities : Sack races, scavenger hunts, balloon tosses and other fun field day activities are a great way to add planned time to your outside schedule. Grouping peers of different skill level and age can support children by learning from a peer model, help children further mastery by teaching skills, encourage problem solving and social skills, and help to level the playing field across groups of children.
• Mock tournaments : Hold tournaments for athletic games or Olympic style competitions such as World Cup and March Madness.
• Tag : School-age children enjoy playing a variety of “tag, you’re it” games, such as freeze tag or color tag, dodgeball, and capture the flag. They will also enjoy creating their own variations of running-based competitor games.
• Fitness tests : You can contact local agencies to find information about what physical fitness tests are used for other sports training.
• Cheerleading : Cheerleading involves coordination, balance and strength. Some children enjoy writing and developing their own cheers.
• Sensory scavenger hunt : Collect items you’re sure to find around the park (wood chips, dandelions, leaves, pebbles), affix them to a piece of paper using tape, and have your children look for those items. Try to incorporate items that allow children to explore a variety of sensations along with different senses.

When planning physical activities for school-age children, it is important to remember that not all children will have the same abilities. Don’t let a child who is not athletic feel left out of the game. Promote a team atmosphere by providing encouragement for all players. When playing team sports, it is a good idea to promote playing for fun and experience rather than winning. This will help alleviate stress for less-athletic children. If you have a few children that have well-developed skills, allow them to take the lead and be a captain or share their skills by being a trainer. This will help all children feel that they have an important part to play.

Sensory Development: What is it?

The development of our senses is an important part of physical development. In very young children, sensory development is what helps infants and toddlers gain an understanding of the world around them. As children grow, their sensory development becomes more refined and detailed.  Providing opportunities for children to actively use their senses as they explore their world through ‘sensory play’ is crucial to brain development. It helps to build nerve connections in the brain’s pathways. This leads to a child’s ability to complete more complex learning tasks and supports cognitive growth, language development, gross motor skills, social interaction, and problem-solving skills.

All children (and adults) process their surroundings differently. This is why all children do not like the same foods or listen to the same music. Each person interprets the world around them in a different way as they process through their five senses. Based on this processing, the brain makes a decision on how to proceed. If the tongue detects an extremely bitter taste, the brain will say, “let’s not try that again!” If the hands touch something extremely hot, the brain learns not to touch that spot again.

All children benefit from having planned sensory activities incorporated into their environment. Any activity that activates the senses can be considered a sensory activity. The chart below provides some examples of sensory activities that are appropriate for school-age children.

Supporting All Learners

You may find that some school-age children in your program have trouble with handwriting or perhaps organizing their school work. Others may struggle with figuring out the steps in games or with spontaneous play interaction among peers. If you have children who have these experiences, you may need to adapt your environment as well as your activities to help them succeed. If you are working with children with special learning needs, think about how your existing practices are enabling them to succeed.

Some children in your care may have conditions that affect their motor development, including physical and cognitive disabilities, neurological and perceptual disorders, and attention-deficit/hyperactivity disorders. Children with Individualized Education Programs (IEPs) have a specific plan that helps them meet their personal goals and objectives. A multidisciplinary team of specialists, including the child’s parents, teachers, therapists, and school representatives, help to outline the changes and adaptations needed in a child’s school curriculum and classroom environment for that child to succeed. Children with physical and other developmental disabilities may need related services to ensure they are able to fully access their classroom, school curriculum, activities, environments, extracurricular activities, and events. You will have to make sure that activities in your school-age program have also been adapted and changed. Something as simple as providing a left-handed mouse for left-handed children can enhance their ability to learn and develop. 

Children with physical disabilities may have difficulties with motor coordination and muscle strength. While some children may be able to engage in play and self-help activities with minimal or no help at all, other children may need significant support and may require the use of assistive technology. Equipment such as wheelchairs or braces and communication devices enable children to explore their surroundings and interact with others. Some children with physical disabilities may also have visual, hearing, or intellectual impairments that require the use of significant supports and accommodations to help preform daily classroom activities. You may be working with children who have low muscle tone, leading to their poor balance and stability, and you will assist them with supporting their access and participation in motor activities. You may also encounter children with attention deficit/hyperactivity disorder who at times may be extremely active, impulsive, or more easily distracted, and you will need to support their successful participation in your program activities.

Connecting with Nature

A busy lifestyle and increased interest in video games and technology can result in a lot of indoor time for school-age children. They might spend the majority of their day in a school setting, only going outside for their designated 60 minutes a day. Having a love and respect for the outdoors will increase the chances of children learning to make physical activity a part of their lives. Encourage as much outdoor time as possible, plan activities that include their natural surroundings, and bring the outside indoors to learn and discover.

As you will see in this video, there are a wide variety of activities that support a school-age child’s physical development.

Types of Activities

Connecting with nature is important for school-age children because being outdoors encourages healthy habits and behaviors. In this video, you will hear a program director discuss how they encourage a love for nature at their program.

• Learn . Take time to learn the differences between the main types of exercise: moderate, vigorous, bone strengthening, and muscle strengthening. Learn what types of activities aren’t appropriate for school-age children. Also, consider the skill level of each child and ways to modify activities for all the children in your care.
• Plan . Plan fun and engaging indoor and outdoor physical activities for school-age children. Take time to learn their preferences and understand their skill levels.
• Be a role model . One of the best ways you can promote an active lifestyle is to live one yourself. Join in games, learn new skills, and let children see you having fun while being active and engaged.

Resource List: Indoor Action Games

Use the information that you have learned in this lesson to think about the importance of planning activities that are a good fit for the school-age children in your program. In Right Fit Activities , reflect on what you have learned and any experiences you have had with school-age children to answer questions. Share your responses with your trainer, coach or administrator.

In the Motor Skills Observation activity, below you will observe the indoor and outdoor learning environments of school-age children to examine how they support motor skill growth and development. You may consider specific learning activity areas, equipment, materials, or upcoming program events to observe. You can refer to the motor skills section in this lesson for a reminder on activities that promote motor development. First, indicate what area, equipment, materials, and program you’re observing. Then, record how this learning environment supports development of fine and/or gross motor skills. When you are finished, share your responses with your trainer, coach, or administrator.

Motor Skills Observation

Demonstrate.

Bisi, M.C., Stagni, R. Development of gait motor control: what happens after a sudden increase in height during adolescence?. BioMed Eng OnLine 15, 47 (2016). https://doi.org/10.1186/s12938-016-0159-0

Centers For Disease Control and Prevention. (2022). Aerobic, muscle- and bone-strengthening: what counts?    http://www.cdc.gov/physicalactivity/everyone/guidelines/what_counts.html

The American Academy of Pediatrics. (2004). Caring for Your School-Age Child . New York: Bantam Books.

Angermeier, P. (2009) Learning in Motion: 101+ sensory activities for the classroom . Arlington, Texas: Future Horizons Inc.

Steinberg, D. (n.d.). Developing and Cultivating Skills Through Sensory Play. PBS Parents. 

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First grade physical development guide: Find out what you need to know

First grade is a crucial transitional year for young children, as they make the change from kindergarten to big kids’ school. This may mark the first time they are eating in the cafeteria with their friends or playing outside during recess without their teacher’s supervision.

Just as children in first grade are beginning to establish the learning and studying habits that they will rely on throughout their education and working life, they are also forming physical habits that will determine their future health and wellbeing and shape the quality of their life.

Children in first grade are usually 6 or 7 years old, and the following guidelines are aimed at children in the typical age group. However, the information here is intended only as a general guide. If your child seems to be out of step in terms of physical development, you should consult your pediatrician.

Parenting Guides 1st grade physical activity recommendations: Here's what you need to know

Gross motor skills.

Your first-grader is still developing gross motor skills, which involve whole-body movement. The include running, jumping, throwing, and catching. Physical activities at this age should include games and sports that focus on developing these fundamental skills through play, rather than competition.

Your child’s balance will improve significantly throughout this year. By the end of first grade, your child should be able to hop on one foot for up to 20 feet without stopping. Playing hopscotch helps develop this skill.

Your child should be able to walk on tip toes for up to 20 feet.

Your child should be able to skip with ease for up to 20 feet.

Your child should be able to stand on each foot for at least 10 seconds, with their hands on their waist.

Your child should be able to do several sit-ups at a time.

Your child should be able to do several push ups at a time, lifting only their chest off the ground.

Your child should be able to kick a ball with accuracy at a target 10 to 15 feet away.

Your child should be able to bounce a ball and catch it with ease.

Parenting Guides First grade physical health tips: Here's how to help your child

Fine motor skills.

Your child’s fine motor skills, which involve the coordination of small muscle movements, will be developing as quickly as their gross motor skills. These skills become especially important as the emphasis in school turns to reading and writing.

Handwriting

Your child should be able to print around 20 letters a minute.

Your child should be able to color within the lines in a coloring book.

Your child should be able to cut shapes or varying complexity out of paper.

Your child should be able to mold different shaped objects with Play-Doh or clay.

Your child should be able to tie their shoes.

Your child should be able to dress and undress, fasting and unfastening buttons and manipulating zippers, without assistance.

Parenting Guides First grade nutrition guide: Find out what you need to know for your child

Restful sleep is a fundamental requirement for a healthy child. While sleep gives a growing body time to recuperate and prepare for the day ahead, studies have also shown that well-rested children perform better academically, are less likely to act out in school, have lower rates of obesity, and are less susceptible to viral infection. It is important to prioritize sleep by ensuring that your child has a dark, quiet, and comfortable bedroom and by establishing a regular nightly routine with your child before tucking them into bed.

A well-rested child will wake up spontaneously and have energy throughout the entire day. If you notice that they are yawning at inappropriate times, or get reports from school about their hyperactivity and misbehavior, your child is most likely not getting enough sleep. Consult with your child’s health care provider about additional steps you can take to ensure your child gets a more restful night of sleep.

How much sleep?

First grade students need 10 to 11 hours of restful sleep every night. For students who need to be up at 6 AM to get ready for school, their bed-time should be between 7 and 8 PM.

Learn more about supporting your child with our first grade physical health tips and physical activity recommendations pages.

Parent Toolkit resources were developed by NBC News Learn with the help of subject-matter experts, including Dr. Jayne Greenberg, District Director, Miami-Dade County Public Schools.

Fine motor skills and motor control networking in developmental age

Affiliations.

• 1 Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy.
• 2 Department of Medicine and Aging Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy.
• 3 Department of Psychology, University of Greifswald, Germany.
• 4 Department of Psychology, University of Bremen, Bremen, Land Bremen, Germany.
• PMID: 35613316
• PMCID: PMC9541226
• DOI: 10.1002/ajhb.23758

Objectives: We investigated the relationships between fine motor skills, fitness, anthropometrics, gender and perceived motor performance in school beginners. The aim of our study was to delineate whether and to what extent fine motor control would show meaningful synchrony with other motor variables in the age of onset of handwriting in school.

Methods: A sample of N = 239 of 6-to-8-year-old children were tested with an array of tasks measuring fine motor (i.e., dexterity and speed) and grapho-motor performance (tracing on a tablet screen), anthropometric indexes, and fitness (shuttle run) measures. A subset of 95 children was also tested for perceived motor competence.

Results: In spite of an overall poor anthropometric condition, our participants were relatively fit. As expected, older children performed better in both, fine motor tasks and the shuttle test. The girls were better in fine motor skills, and an original speed-quality trade-off in the drawing was found. However, the magnitude of difference by grade was greater for boys' fine motor skills than those of girls'. A network analysis revealed three specific clusters, (1) perceived competencies, (2) fitness, and (3) fine motor skills.

Conclusions: Given the relative independence of these areas of physical performance, we suggest focusing on these three clusters as distinct areas of physical education. Fine motor skills deserve further consideration, especially at an early school age. We have demonstrated that network analysis and technology devices used to evaluate motor development are useful and meaningful tools.

© 2022 The Authors. American Journal of Human Biology published by Wiley Periodicals LLC.

Publication types

• Research Support, Non-U.S. Gov't
• Motor Skills*

• Open access
• Published: 27 March 2024

Evaluating the association between duration of breastfeeding and fine motor development among children aged 20 to 24 months in Butajira, Ethiopia: a case-control study

• Rediate Shiferaw 1 ,
• Robel Yirgu 2 &
• Yalemwork Getnet 2  

BMC Pediatrics volume  24 , Article number:  216 ( 2024 ) Cite this article

99 Accesses

Metrics details

A Suitable environment and proper child nutrition are paramount to a child’s physical and mental development. Different environmental factors contribute to proper child development. Breast milk is an important source of nutrition during the early years of life and contains essential nutrients that are the building blocks for growth and development.

To assess the association between the duration of breastfeeding and fine motor development among children aged 20 to 24 months living in Butajira, southern Ethiopia.

Community-based case-control study design was employed among mother-child dyads of children aged 20 to 24 months in Butajira Southern Ethiopia. Children were screened for fine motor delay using the Denver II developmental screening and identified as cases and controls. A repeated visit was done to gather the rest of the information and 332 samples, 83 cases, and 249 controls were available and assessed. Epi-data version 4.4.2.1 software was used to prepare a data entry template, which was later exported to and analyzed using STATA version 14 statistical software. Finally, a Multivariable logistic regression model was used to adjust for confounders and estimate the independent effect of breastfeeding duration on fine motor development.

We didn’t find a significant association between the duration of breastfeeding from 21 to 24 months and fine motor delay compared to children who were breastfed less than 18 months[AOR: 0.86, 95% CI: (0.36, 2.05)]. Children who have mothers > 35 years of age were 78% less likely than children who had mothers younger than 25 years, Children who had mothers in secondary school and above were 77% less likely than mothers who didn’t have formal education, Females were 1.86 times more likely than males, and Children who scored 20–29 on the Home score were 51% less likely than Children who scored < 20 to have fine motor delay.

Duration of breastfeeding was not significantly associated with fine motor delay for children aged 20 to 24 months old. The age of the mother, the educational status of the mother, being female, and Home score were identified to have a significant association with fine motor delay. Improving the educational status and empowerment of women is essential. Further work should be done on avoiding gender differences starting from a young age and creating a conducive environment for child development is crucial.

Peer Review reports

The first 2 years can predict the quality of life a child can have. Appropriate connections are formed and wired in this window if this stage is passed then it is hard to rewire the brain connections [ 1 ]. Child development is a dynamic process that is a result of the interaction between biological and environmental factors [ 2 ]. Motor development is also seen as an indicator of global child development [ 3 ]. Motor development is the development of the child’s bones, muscles, and ability to move around and manipulate their environment [ 4 ]. Motor development is a critical factor in child behavior, being associated with the foundation of cognitive and social-emotional development[ 3 ]. Fine motor development is very important for the development of gross motor skills and is connected to how a child performs later on other cognitive tasks, reading and solving mathematical problems [ 5 ]. Fine motor skill is the ability to control movement through activities and coordination of the nervous system, fibril, and muscles such as fingers and hands [ 6 ]. Fine motor skills are important to do certain activities such as eating and handwriting. The United Nations has set sustainable developmental Goals to improve early child development by 2030. Goal 4 Target 4.2 supplies all children to get access to quality early childhood development so they are ready for primary education [ 7 ].

Child development is a dynamic process that is a result of the interaction between biological and environmental factors. Although infant development is influenced by several factors, The centrality of good nutrition cannot be ignored by providing the important building blocks for development [ 2 ]. Breastfeeding is the main source of important nutrients for children at this age. Breastfeeding has been identified by the World Health Organization (WHO) as an ideal source that contains important nutrients that can help for the optimal growth and development of children. WHO recommends continuing to breastfeed for up to 2 years with additional complementary foods [ 8 ]. Especially fatty acids Docosahexaenoic acid and Arachidonic acid in breast milk are important for brain growth and development and the formation of important synapses or connections in the brain. When a child is adequately nourished with important nutrients in the foundational period it creates a base for lifetime proper brain function [ 9 ]. Motor skills are also affected by factors such as caregiving practice, and stimulating environments [ 1 ]. Nutritional supplementation and psychosocial stimulation together result in greater improvements in child development than either intervention alone [ 9 ]. Determining the solo influence of breastfeeding on child development is difficult because child development is interrelated and associated with different environmental and biological factors. The complexity of child development makes it difficult to evaluate these effects [ 10 ]. The effects of environmental factors are pronounced in areas with limited access to the requirements for development [ 11 ]. Especially in developing countries, the problem can be worse due to limited resources in the environment that can aggravate the problem [ 12 ]. In resource-limited environments, limited resources such as poor stimulating environments and poor nutrition can limit the developmental potential of the children. Therefore, we need to study the effect of multiple environmental factors and nutrition on child development especially in a developing country context. To our best knowledge there are limited studies regarding developmental delays and also the practice of assessing child development in Ethiopia is low. Therefore, knowing the current status and assessing the impact is helpful for early intervention to prevent different adverse outcomes.

Materials and methods

Study design, area, and period.

Community-based Case-control study was conducted from March to May 2019 among children aged 20 to 24 months living in Butajira Health and demographic surveillance site located in Southern Nations and Nationalities (SNNP), Ethiopia. The area is located 135 km south of Addis Ababa and 50 km to the west of Zeway town in the Rift Valley, 8.2 o north latitude and 38.5 o east longitude. The climate varies from arid dry lowland areas at altitudes around 1,500 m (tropical climate) to cool mountainous areas up to 3,500 m above mean sea level (temperate climate). The livelihood of the residents is based on mixed farming. Khat (Catha edulis Forsk) and chili-peppers are the main cash crops, while maize and “false banana” or Ensete (Ensete ventricosun) are the main staples [ 13 ].

Source population

All children within the age group of 20 to 24 months living in Butajira HDSS are the Source population.

Study population

Children within the age group of 20 to 24 months living in Butajira HDSS have been identified as cases and controls based on the Denver developmental screening test.

Case definition

Cases were children who were identified as being suspect for fine motor delay and controls were children without fine motor delay.

Case (Suspect ): Two or more cautions (Item on which the age line fails or between the 75th and 90th percentile). This means 75% of the children can pass the test below the child’s age, and /or One or more delays (a child fails to perform an activity that fails completely to the left of the age line) using the Denver developmental screening test.

It is considered that a child fails to perform an item that 90% of children can perform at an earlier age.

Control (normal)

No delays and a maximum of one caution using the Denver developmental screening test.

Study variables

The outcome variable was Fine motor delay. The exposure variables were Nutritional factors (Breastfeeding duration, Dietary habits of the infant), Child characteristics (sex of the child, birth order), Socio-demographic variables (age of mother, occupation of mother, education status of mother, socioeconomic status), and Caregiving practice: (Home environment.)

Sample size calculation

The required sample size was calculated using EPI INFO 7 software using an unmatched case-control study using Proportion of Controls among those who breastfeed < 6 months P = 89.97% and Proportion of Cases among those who breastfeed < 6 months P = 76.4% and OR = 0.36 A study done in Taiwan [ 14 ].

At precision level of 5%, 95% confidence interval, and 80% power and using r = 3(ratio of cases to controls) and 10% for non-response compensation the sample size becomes 360 with 271 controls and 90 cases.

Sampling method

A survey (screening) was conducted from March to May 2019 in Butajira HDSS by obtaining a sampling frame from the Butajira HDSS. Participants were all children from 20 to 24 months living in the Butajira HDSS. The total population of children in Butajira HDSS from 20 to 24 months was 453.

After going into each Keble and household 376 children that were available were assessed using the Denver developmental screening test and identified as cases and controls. We found 85 cases and 291 controls. Then after identifying the households with cases and controls a repeated visit on the same household and on the same child was done to gather the rest of the information. After visiting the households 332 samples 332 samples 83 cases and 249 controls were available and were assessed using interviewer-administered questioners.

Operational definition

Caregiver (caretaker).

The people who look after infants and young children [ 15 ].

Breastfeeding less than 18 months

mothers while in the data collection period report that they have breastfed their babies less than 18 months.

Continue to breastfeed 18 to 20 months

mothers while in the data collection period report that they have breastfed their babies from 18 to 20 months and stopped.

Continue to breastfeed 21 to 24 months

mothers while in the data collection period report that they have breastfed their babies from 21 to 24 months.

• Fine motor development

The fine motor section of Denver II contains 33 items. Each test item on Denver II is presented on a chart by a horizontal bar partitioned into 25, 50, 75 and 90 percentile ages of passing the items. After calculating the exact age draw the age line after drawing the age line the child was asked to perform an activity to the left of the age line, this was done until the child was able to pass three or more consecutive items. Also, the child was tested for items above the age line until the child failed three or more consecutive items.

A child can pass-fail or refuse an item on which the age line fails.

By then identifying the child’s outcome using all the scores that the child has and finding the results will be carried out.

The scoring has 4 items.

“P” for pass – the child successfully performs the item or the caregiver reports (when appropriate) that the child does the item.

“F” for fail- the child does not successfully perform the item, or the caregiver reports (when appropriate) that the child does not do the item.

“N.O” for no opportunity- the child has not had the opportunity to perform the item, due to restrictions from the caregiver or other reasons. This score may only be used on “report” items.

“R” for refusal- the child refuses to attempt the item. Refusal can be minimized by telling the child what to do rather than asking. If given instruction in proper administration, the caregiver may administer the item. Report items cannot be scored as refusals.

no delays and a maximum of one caution.

Caution items are interpreted when a child fails or refuses an item on which the age line fails or between the 75th and 90th percentile. This means 75% of the children can pass the test below the child’s age. Delays are considered when a child fails to perform an activity that fails completely to the left of the age line. (Not on the item that the age line passes) It is considered that a child fails to perform an item that 90% of children can perform at an earlier age. This means 75% of the children can pass the test below the child’s age. When a child passes, fails, or refuses an item that is between the 25th and 75th percentile it is considered normal.

Delays suspect

Two or more cautions and /or one or more delays.

Caution items are interpreted when a child fails or refuses an item on which the age line fails or between the 75th and 90th percentile. This means 75% of the children can pass the test below the child’s age [ 16 ].

Adequate dietary diversity

Children who receive foods from 4 or more food groups using 24-hour recall [ 8 ].

Inadequate dietary diversity

Children who received foods less than four groups using 24-hour recall [ 8 ].

Household wealth index —is households’ living status and was constructed by using household asset data on housing conditions like the type of floor, the material of the wall, the material of roof; ownership of assets like radio, TV, telephone, vehicle; the presence of functional latrine, source of drinking water, ownership of domestic animals, ownership of farmland and amount of grain harvested in the last production year among others. After running principal components analysis (PCA) in STATA, the households’ wealth index was grouped into quintiles (lowest quintile, second quintile, middle quintile, fourth quintile, and highest quintile).

Data collection instrument and procedure

Development was assessed by the Denver developmental screening test which is designed to test the development of the child. The data collection started by Screening for a suspect for fine motor development. The fine motor was assessed using the Denver II developmental screening test. The tool contains different materials that help to examine the development of the child and a test form that contains all the developmental domains in sections. The Denver II tool was adapted in Jimma into a developing country context and was validated in Butajira Ethiopia [ 17 , 18 ]. The Denver II was assessed by a BSC nurse trained and certified for assessing children using the Denver developmental screening test.

The test was done in a natural and comfortable environment where the child could play with minimal disturbance in the presence of the caretaker. The test was started by informing the mother that the child is not expected to pass all the items.

The test contains a total of 125 items in four developmental domains: personal-social, fine motor, language, and gross motor. The fine motor section of Denver II contains 33 items. Each test item on Denver II is presented on a chart by a horizontal bar partitioned into 25, 50, 75 and 90 percentile ages of passing the items.

Draw the exact age without rounding off days, weeks, or months. Age scales are placed at the top and bottom of the page. Spaces between the age marks represent 1 month until 24 months. After carefully identifying the child’s age draw the age line using the age scales draw an age line from the top to the bottom of the form. After drawing the age line the child was asked to perform an activity to the left of the age line, this was done until the child was able to pass three or more consecutive items. Also, the child was tested for items above the age line until the child failed three or more consecutive items.

For each item, there are 25th, 50th, 75th and 90th percentile.

The age line, pass through the following tasks.

16. Dump coffee bean demonstrated.

Show the child 2 or 3 times how to dump the coffee bean out of the bottle. Then ask the child to get it out. (Do not use the word “dump.”)

Pass if the child dumps the coffee bean out of the bottle or rakes the coffee bean close to the opening and then dumps it out. Do not pass if the child removes the coffee bean with a finger.

17. Tower of cubes – 2, 4, 6, 8.

With the child sitting high enough at the table so that elbows are level with table top and hands are on the table, place the blocks on the table in front of the child. Encourage the child to stack them by demonstration and words. It may be helpful to hand the blocks to the child, one at a time. Three trials may be given.

Pass Tower of 2 cubes if the child puts one block on top of another so that it does not fall when he/she removes his/her hand.

Pass Tower of 4, 6, 8 cubes , depending upon the greatest number of blocks the child stacks in three trials.

A pass of 4, 6, or 8 cubes also passes the lower tower items (for example, passing Tower of 6 cubes also passes Tower of 2 and 4 cubes ).

“N.O” for no opportunity- the child has not had the opportunity to perform the item, due to restrictions from the caregiver or other reasons. This score may only be used on “report” items. “R” for refusal- the child refuses to attempt the item. Refusal can be minimized by telling the child what to do rather than asking. If given instruction in proper administration, the caregiver may administer the item. Report items cannot be scored as refusals.

By then identifying the child’s outcome using all the scores that the child has and finding the results were carried out.

no delays (the child successfully performs the action) and a maximum of one caution (between the 75th or 90th percentile).

two or more cautions and/or one or more delays (the child fails to perform an activity that fails completely to the left of the age line.)

refusal scores on one or more items completely to the left of the age line or on more than one item intersected by the age line in the 75-90% area.

Praise the child even for items that are failed. This will build the confidence of the child to attempt more difficult items.

Data on socio-demographic, breastfeeding, and nutritional histories were collected using interviewer-administered questions.

Total Breastfeeding duration was assessed from a study that assessed breastfeeding duration since birth [ 19 ]. It was taken by asking the mother to recall the total duration she breastfed her child. Whether she is still breastfeeding or to recall the time she stopped breastfeeding her child.

Complimentary food was assessed using WHO dietary diversity [ 8 ]. Dietary diversity was collected using dietary diversity scores adapted from the WHO standardized questionnaire for infant and young child feeding (IYCF). Mothers or caregivers were asked to recall all the food items that the child consumed during the past 24 h [ 8 ]. The home environment was assessed using the Home inventory used in different studies [ 20 ]. The Home score was assessed by interview-administered questionnaires. It was done by giving the mother a picture book and the mother will show the picture book to the child. Observation will be made on the interaction and the response the mother has towards her child. The interview was conducted in a free and friendly environment. The observation was made on the maternal and child interaction and maternal responses towards the child while asking other questions from the Home inventory.

The training was given to data collectors and supervisors regarding the objective and method of data collection and discussions were made for unclear questions in the questionnaire.

Data processing and analysis

Data were checked manually for completeness and entered into Epi-data version 4.2.2.1 statistical software and exported into STATA version 14 for data cleaning and analysis. Frequencies and summary statistics (median, interquartile range, percentage, and range) were used to describe the study population in relation to relevant variables.

Nutrition-related variables such as duration of breastfeeding were categorized based on the duration of breastfeeding in months and were grouped as breastfed less than 18 months, 18 to 20, and 21 to 24 months. Dietary diversity was also assessed using a Minimum dietary diversity score comparing children who had consumed four or more food groups and children who scored less than four groups using 24-hour recall. Socioeconomic status was analyzed based on the wealth index by using Principal component analysis (PCA). Childcare practices, maternal-child interaction were checked using the Home score.

Binary logistic regression was used to check for the association between the dependent, fine motor delay, and independent variables. Variables with P- value < 0.2 and which had clinical importance or subject matter were included in the multiple logistic regression. In the multiple logistic regressions, Variables with 95% CI of AOR which did not include 1 were considered to have significant association with the outcome variables. The goodness of fit test indicated (P = 0.0518) that the model was good enough to fit the data well.

Ethical consideration

Before data collection ethical clearance was obtained from Addis Ababa University School of Public Health Institutional Review Board (AAU-IRB). Written Informed consent was obtained from parents (legal guardians) before participating in the study. All study participants were informed about the purpose of the study, their right to deny participation, anonymity, and confidentiality of the information. All methods were carried out in accordance with relevant guidelines and regulations. The Denver II developmental screening test used in this study to measure the developmental milestone was assessed by a well-trained and certified data collector to ensure the safety of the children. It was conducted in a free and friendly environment. It was explained to the parents that the scale determines the child’s current developmental status and that it’s not an IQ test and the child is not expected to pass all the tests administered. The beneficence of the participants was assured by providing education to the participants about the benefits of breastfeeding, growth, and development. For Children identified with developmental delay, further education was given on methods of improving the motor skills of the Children. The confidentiality of the information of the participants was not disclosed.

Socio-demographic characteristics of the study participants

Mothers in the age group from 25 to 29 years were 35(42.17%) in the cases while 101(40.56%) were in the controls. The median age of the mothers was 28, IQR (25 33%). About 48(57.83%) of mothers in the cases and 93(37.65%) of mothers in the controls didn’t have any formal education. About 58(69.88%) of the cases and 185(74.60%) of mothers from the controls were Housewives. About 39(46.99%) fathers in the cases and 67(26.91%) in the controls didn’t have any formal education. About 23(27.71%) of the cases and 52(20.88%) in the controls were from the lowest quintile. About 69(83.13%) of the cases and 179(71.89%) of the controls were Rural residents (Table  1 ).

Child-related characteristics

The study included 168 male and 164 female children from the age group of 20–24 months. About 36(43.37%) males were cases while 132(53.01%) were in the controls (Table  2 ).

Delivery and nutritional characteristics of the study participants

Health facility delivery among the cases was 67(80.72%) and 213(85.54%) among the controls. Breastfeeding at least once was 81(97.59%) among the cases and 248(99.60%) among the controls. About 49(59.04%) mothers in the cases and 139(55.82%) in the controls reported that they are currently breastfeeding.

About 66(79.52%) children in the cases and 177(71.08%) children in the controls continued to be breastfed from 21 to 24 months. There was no significant variation among cases and controls by the duration of breastfeeding 95% CI (p = 0.234) (Table  3 ).

Dietary practices and nutritional characteristics of the children

About 46(55.42%) of children in the cases and 179(71.89%) in the controls started solid or semi-solid food within 6 to 8 months. There was a difference among cases and controls on children at the time of starting solids and semisolid foods (Table  4 ).

Caregiving practice

About 41(49.40%) of children in the cases and 172(69.08%) in the controls had a score between 20 and 29 on the Home score. The Home score had a minimum score of 13 and a maximum score of 32 (Table  5 ).

Association of different characteristics of children with suspect of fine motor delay

In the binary logistic regression variables with p-value < 0.2 or factors that had clinical importance were identified (Table  6 ).

After adjusting for these variables age of the mother, the educational status of the mother, the sex of the child, and the Home score were identified to have a significant association with fine motor delay.

We didn’t find a significant association between duration of breastfeeding and fine motor delay for children who were breastfed from 18 to 20 months [AOR: 0.45, 95% CI: (0.13, 1.56)] and for children who were breastfed from 21 to 24 months [AOR: 0.86, 95% CI: (0.36, 2.05)] compared to children who were breastfed less than 18 months. Children who have mothers > 35 years of age were 78% less likely to have fine motor delay than mothers who were < 25 years old [AOR: 0.22, 95% CI: (0.05, 0.87)]. Children who had mothers in primary school were 66% less likely [AOR: 0.34, 95% CI: (0.14, 0.81)] and children who had mothers in secondary school and above were 77% less likely [AOR 0. 23, 95% CI: (0.06, 0.80)] to have fine motor delay than mothers who didn’t have any formal education. Females were 1.86 times more likely to have fine motor delay than males [AOR: 1.86, 95% CI: (1.05, 3.28)]. Children who scored 20–29 on the Home score were 51% less likely to have fine motor delay than Children who scored < 20 [AOR: 0.49, 95% CI: (0.27, 0.88)] (Table  6 ).

Child development is an important aspect of human life. Development can be affected by different factors. Environmental factors and nutritional factors together play a significant role in child development. Nutritional factors have a great role in development but due to the adverse environmental and social factors, the outcome could be influenced by different factors, especially in developing countries [ 1 ].

Breastfeeding is known to have a significant effect on child growth and development [ 11 ] but in our study, We didn’t find a significant association between the duration of breastfeeding and fine motor delay for children who were breastfed from 18 to 20 and for children who were breastfed from 21 to 24 months compared to children who were breastfed less than 18 months.

Our findings are consistent with some studies that didn’t find a significant association between duration of breastfeeding and fine motor development [ 21 , 22 , 23 ]. All the studies acknowledged that breastfeeding is important for development but they suggested that other factors also have a role in influencing fine motor development. Similar to our study, A study in Singapore didn’t find a significant association between breastfeeding and fine motor development at 24 months [ 21 ]. Another study done in rural Brazil didn’t find a significant association between breastfeeding and fine motor development at 12 months and suggested home stimulation, maternal education, and income were influencing the outcome [ 22 ].

The study in Singapore suggested they have used specific research tools and have controlled for a large number of potential confounders and they didn’t find any relationship between breastfeeding on fine motor development [ 21 ]. The study in Brazil investigates the association between breastfeeding and mental and motor development, controlling for comprehensive measures of the child’s socioeconomic maternal, and environmental background, and nutritional status. They didn’t find a significant association between breastfeeding and motor development. They explained that the reason most studies have found an association between breastfeeding and development is that the studies have been done in relatively affluent populations where, in general, mothers who succeed in breastfeeding have higher socio-economic status, better educated with higher educational attainment. While In their study mothers who were breastfeeding longer had lower socioeconomic status, poorer education, and provided less stimulating home environments. They explained the reason that most studies found the association was due to incomplete adjustment for covariates, differences in methodological robustness, and types of tests used are likely to be contributory, which will result in an apparent breastfeeding benefit. To prevent this bias they controlled for different covariates. They suggested that no subgroup is differentially protected by breastfeeding, but rather that all groups benefit. The benefit of breastfeeding was an important factor that benefited all the comparison groups, while it has a beneficial effect, breastfeeding didn’t have a protective effect on fine motor development. The difference in the outcome was appreciated by other potential determinants. They found home stimulation and family income to be more important factors [ 22 ].

This is similar to our study finding that mothers who were breastfeeding longer had lower socio-economic status and poorer education. We also have found other environmental factors to be significantly associated. Similar to these studies environmental factors were playing a significant role in fine motor development.

All the studies acknowledged that breastfeeding is important for development but they suggested that other factors were influencing fine motor delay and we need to take into consideration other factors that could also affect or contribute to child development.

A systematic review also suggested that development is influenced by different environmental and psychological factors. Different factors need to be put into consideration that can affect the developmental potential of the children. Their analysis reveals that there are studies that have shown an apparent decrease in effect after multivariate analysis. Given that tight control of confounders resulted in a greater likelihood of the disappearance of the breastfeeding effect. Studies completed in middle-income and low-income countries were nearly twice as likely to find no association compared with studies set in developed countries. The fact that this relationship is less apparent in developing countries suggests that much of the observed relationship may be due to parental social advantage, confounding the choice to breastfeed [ 23 ].

In conclusion, the systematic review suggests that much of the reported effect of breastfeeding on child developmental abilities is due to maternal and socioeconomic effects. They suggested additional, future studies in this field are needed to rigorously control for all important confounders [ 23 ]. Development is not the solo effect of breastfeeding alone but a combination of different factors working together.

All these studies have used different developmental screening tools so the comparison should be done cautiously.

Contrary to our study A study in Malawi among children who breastfeed from 9 to 10 months found a small but significant protective effect on fine motor development at 12 to 18 months [ 24 ]. Studies in Western countries, a study done in Taiwan and Greece assessed the effect of duration of breastfeeding more than 6 months and fine motor assessed at 18 months. They found that any increase in the duration of breastfeeding was associated in decreasing in the odds of fine delay which persisted after controlling for different factors [ 25 , 26 ]. The Taiwan study has shown that mothers who breastfeed longer were older, had a university education, and were from a better socioeconomic class and suggested that the positive result could be due to the presence of these factors [ 25 ]. These factors were different in our setting, the majority of the mothers in this study who breastfeed for longer durations were less educated. Studies have shown that mothers who are more educated create a more favorable and stimulating environment and when breastfeeding is added to these factors there could be better results that can be helpful for child development [ 27 , 28 ]. This might be one of the reasons why we couldn’t find a significant association.

We have also found the age of the mother to have a significant association with the development of the child. We have found older mothers had more favorable outcomes than young mothers. Similar findings have suggested that older mothers tend to create a more favorable environment for child development and would also breastfeed for longer durations [ 29 – 31 ].

Also, we have found the education level of the mother to be significantly associated with fine motor delay. Children who had mothers in primary and secondary school were less likely to have fine motor delay than mothers who didn’t have formal education. Studies have shown that a mother’s education is important because as the educational level of the mother increases the level of stimuli the mother gives to her child also increases [ 27 ]. In addition to that, as the education level of the parents increases the socioeconomic status also could increase and will create a more favorable environment for the children [ 32 ].

Another factor that we found significant was the sex of the child. We have found females have greater odds of being affected by fine motor delay than males. Contrary to our study different studies have suggested females have a better score on fine motor and boys have a higher risk of having developmental delay [ 33 , 34 ]. While we cannot give a general conclusion other factors in the environment could affect the development of females. A study in India has shown that Girls are breastfed for shorter durations than boys due to the gender preferences of the mothers. Mothers will start early weaning for girls than boys to have another pregnancy and not to delay another pregnancy [ 35 ]. The gender preferences of the mother could affect the duration of breastfeeding and the care the child will have [ 36 ]. This gender preference could lead to a developmental delay in the female population.

We have found the Home score to have a significant association with fine motor development. Similarly, studies found the Home environment to have a significant association with fine motor development [ 37 , 38 ]. Motor development can be regulated critically by the home environment and maternal and child interaction [ 39 ]. The role of the mother or the caregiver has a protective role even for children growing up in limited environments such as low socioeconomic status, low levels of education, chronic illness, conflict, and mental health problems of caregivers. Mothers’ sensitivity is important because it creates a conducive environment for the development of the child [ 40 ]. A study done in Iran did not find a significant positive association between home motor affordances and motor development in their sample. They suggested that this could be due to the tool that they used was not sensitive enough to detect differences [ 3 ]. Home environment is a very important factor for childhood development a study has shown in nutrition-related interventions certain amount of stimulation from the environment was necessary and nutritional intervention alone was insufficient to bring brain development [ 40 ].

The Strengths of this study are the study was a community-based case-control study which is helpful to asses multiple exposure or risk factors. We have also used new cases that were identified at the time of collection which could prevent misclassification bias. We have used tools that are validated in our setting which can measure the case of interest in a better way.

The following limitation needs to be taken into account when interpreting the results. Most of the mothers in our study group had the practice of long-term breastfeeding durations and conducting the study where different information or different study groups are available would help to further strengthen the study finding. Our study was conducted in a rural setting but including the figure of urban mothers would further enrich the information that can be found. Even though birth weight is an important factor for development we didn’t have information on the birth weight of the children.

Conclusions

This study still supports that breastfeeding is important for child development. However, in our study, we didn’t find a significant association between the duration of breastfeeding from 18 to 20 months and for duration of breastfeeding from 21 to 24 months compared to children who were breastfed less than 18 months on fine motor development. Children from older mothers were less likely to be affected than young mothers. Children who had mothers in primary and secondary school were less likely to have fine motor delay than mothers who didn’t have formal education. Females have higher odds of being suspect of fine motor delay than males. Children who had better maternal care practices or Home scores were less likely to be affected than Children who had lower maternal care practices or lower Home scores.

Based on our findings we forward the following recommendations: Health care providers should be the first-line source of information to provide appropriate information to the mothers and the community during delivery or during any visit the mother makes to the health facility. They should educate the mothers and the community about the importance of child feeding and childcare and creating a conducive environment for child development. Older mothers tend to create more conducive environments for child development. Delaying early pregnancies is helpful to have physically and psychologically mature mothers. Since mothers are the primary caretakers improving maternal education and empowerment to improve developmental outcomes is helpful for child development. Therefore policymakers should work on improving the educational status and empowerment of women and work on avoiding gender differences starting from a young age. Assessment of Developmental delay in children should also be done routinely by Health care providers to catch delays during the early years and to have early interventions. Further studies should be done in a different setup to appreciate the difference and the effect of other environmental factors. Further follow-up studies should be done to prevent recall bias in a better way. Thus, overall, child development can be influenced by different factors in the environment, and having a holistic approach is mandatory to tackle the problem.

Data Availability

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Abbreviations

Infant and Young Child Feeding

Arachidonic acid

Docosahexaenoic acid

Ethiopian Demographic and Health Survey

Health and Demographic Surveillance site

Nationalities and Peoples Regional State

World Health Organization

Adjusted Odds Ratio

Confidence Interval

Crude Odds Ratio

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Acknowledgements

We acknowledge the data collectors, study participants, and all those who were involved in the study. We would like to extend our gratitude to Professor Frances Abound for his comment, support, and advice. We would also like to thank Dr. Teklu Gemechu for his help and guidance and Miss. Mashresa Harisgo for her help and dedication during the data collection.

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Shiferaw, R., Yirgu, R. & Getnet, Y. Evaluating the association between duration of breastfeeding and fine motor development among children aged 20 to 24 months in Butajira, Ethiopia: a case-control study. BMC Pediatr 24 , 216 (2024). https://doi.org/10.1186/s12887-023-04391-6

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5 Important Skills Your Child Will Develop in Early Childhood Education

Many of the common concerns about early childhood Singapore -based parents have tended to revolve around education.

Some parents will wonder when it makes most sense to start sending a child to preschool, while others want to know what specific benefits their children will gain from early childhood education.

Most children enter preschool at around the age of three and remain there for two years before beginning their formal schooling at the kindergarten level.

As for the benefits, preschool is a fruitful period for children to pick up essential physical, cognitive, and socio-emotional skills that will serve them well for the rest of their lives.

The preschool years are an especially learning-rich time because a child’s brain grows faster and more extensively in those first five years of life than at any other point in their development.

A  good preschool program  helps children’s receptiveness to new experiences. Their ability to take in new information is highest in early childhood, which means there’s no better time for them to start learning new things.

The following are just a few important skills your child will take away from their time in a quality preschool program:

Gross and Fine Motor Skills

Preschool will support your child’s physical development by giving them many chances to develop and hone their motor skills. Broadly speaking, motor skills are any skills that enable people to perform everyday tasks and movements.

Gross motor skills use the large muscle groups in the arms and legs to perform big movements like walking, running, and jumping.

Fine motor skills, on the other hand, utilize the small muscles in the hands to perform tasks that require high levels of precision and control, such as cutting paper with scissors or feeding oneself.

Early childhood education programs, as well as pediatric physical therapy programs, enable children to exercise their motor skills through a range of different activities.

Outdoor play, for example, draws upon kids’ gross motor skills and helps them build strength, practice their balance, and work on their coordination.

Fine motor skills, meanwhile, come into play when drawing, finger painting, putting together puzzles, and doing other similar activities.

Social Skills

Preschool is likely to be your child’s first opportunity to interact at length with the world outside of your home.

Not only will they be meeting and forming relationships with their teachers, but they’ll also have the chance to make their first friendships with kids their own age.

The preschool setting is thus fertile ground for your child to begin developing important social and interpersonal skills, such as teamwork and empathy.

Playing and learning together every day teaches children important lessons about how to get along with others and how to work together in pursuit of a common goal.

Down the line, they’ll also gradually learn to process and resolve any conflicts that inevitably arise during play. Teachers can help kids develop a healthy approach to interpersonal conflict by mediating between them and their peers when necessary.

Emotional Recognition and Regulation

A good preschool program will help your child gain a fuller understanding of their emotions and those of others.

Beyond teaching kids to identify, describe, and name their feelings, preschool teachers can also show them how to act on these feelings in healthy ways.

A teacher who validates rather than punishes the emotions of an angry or upset child, for example, can subsequently lead that child through a constructive discussion of how they feel. Afterwards, they can begin brainstorming solutions to the child’s problem together.

Learning to recognize and consider how other people feel is another critical component of children’s socio-emotional development . To foster empathy in their young students, preschool teachers often turn to storytelling or roleplaying games.

For instance, they might describe a hypothetical situation, such as one child taking a toy from another, and then ask their students how a person involved in the situation might feel.

Such activities encourage children to engage with the feelings of others and also to consider how people’s actions might affect those around them in significant ways.

Language and Literacy Development

Communication skills refer to a series of interconnected skills that allow children to express themselves to other people and understand others in turn. Reading, writing, listening, and speaking skills tend to develop together and support each other as the child grows.

By the time they reach preschool age, for example, children are usually ready to start learning the alphabet and drawing connections between visual letters and the sounds they’re associated with. From there, they can start learning to read and write simple words.

Basic Numeracy

The skills, knowledge, dispositions, and behaviors students require to learn and utilize mathematics are known collectively as numeracy. Because mathematics is so integral to navigating everyday life, it’s crucial for children to learn basic numeracy in early childhood.

The earliest numeracy skills children can learn at preschool include recognizing numbers and counting, which will set them up for the more complex mathematical operations they’ll tackle in later years.

Early childhood education will provide your child with a wealth of learning experiences that allow them to use their rapidly developing brains and bodies to the fullest.

The important skills and knowledge they acquire at this vital point in their lives will set them up for success at higher levels of education and even beyond.

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Motor skills and cognitive benefits in children and adolescents: Relationship, mechanism and perspectives

1 School of Physical Education, Shanghai University of Sport, Shanghai, China

Xiaosu Feng

2 Physical Education College, Liaoning Normal University, Dalian, China

Associated Data

There is a strong interaction between motor skills and cognitive benefits for children and young people. The aim of this paper is to explore the relationship between motor skill types and their development and the cognitive benefits of children and adolescents. In turn, on this basis, it proposes pathways and mechanisms by which motor skills improve cognition, and provide a basis for subsequent teaching of skills that follow the laws of brain cognitive development.

This paper summarizes the research on the relationship between different types of motor skills and their development and cognitive benefits of children and adolescents. Based on these relationships, pathways, and mechanisms for motor skills to improve cognition are tentatively proposed.

There is an overall pattern of “open > closed, strategy > interception, sequence > continuous” between motor skill types and the cognitive benefits of children and adolescents. Long-term motor skill learning practice is accompanied by increased cognitive benefits as skill proficiency increases. The dynamic interaction between motor skills and physical activity exposes children and adolescents to environmental stimuli and interpersonal interactions of varying complexity, promoting the development of agility, coordination and cardiorespiratory fitness, enhancing their motor experience, which in turn improves brain structure and functional activity.

Motor skills training promote cognitive efficiency in children and adolescents. Motor skill interventions that are open-ended, strategic and sequential in nature are more effective. Environmental stimuli, interpersonal interaction, agility, coordination, and cardiorespiratory fitness can be considered as skill attribute moderators of motor skills to improve cognition.

Introduction

Cognition refers to the process in which individuals extract, process, and store information ( Bayne et al., 2019 ). It is the representation of the interconnection and interaction between objective things ( Ahmed et al., 2020 ). Cognition usually includes perception, attention, memory, thinking, and imagination ( Shao, 2019 ). It is an important indicator to measure individual survival and development. In particular, children and adolescents are the golden age of cognitive development. The level of cognitive development at this stage is of great significance to individual academic performance, mental health, and social development in adulthood ( Blakemore and Choudhury, 2006 ; Ahmed et al., 2020 ). For example, fluid intelligence and executive function are closely related to the academic performance and acquired achievement of children and adolescents ( Graham et al., 2017 ; Tikhomirova et al., 2020 ). For another example, lower executive control is associated with aggressive behavior, suicidal tendencies, anxiety and depression, Internet addiction ( Nordahl et al., 2019 ; Hu J. et al., 2022 ). Therefore, studying the cognitive development and enhancement strategies of children and adolescents is not only a prerequisite for their healthy physical and mental, but also an important guarantee for building an “Intellectual Superpower” and a “Healthy China.”

The relationship between physical activity and cognitive benefit has received increasing attention. Physical activity can improve the structural plasticity of gray matter and white matter of children and adolescents ( Xiong et al., 2018 ; Migueles et al., 2020 ), promote the change of brain activation pattern under specific tasks ( Chaddock-Heyman et al., 2013 ), improve brain structure and functional networks ( Chen et al., 2016 ), and then promote the improvement of cognitive benefits such as attention ( Moratal et al., 2020 ), memory ( Roig et al., 2013 ), thinking ( Ballester et al., 2018 ), and executive function ( Xue et al., 2019 ) in children and adolescents. With the continuous accumulation of research, researchers have gradually paid attention to the discussion on the dose-effect relationship between physical activity and cognitive benefits of children and adolescents. Most studies focus on the quantitative characteristics (intensity, period, frequency, and duration) of physical activity. A review by Chen et al. (2021) showed that moderate intensity aerobic exercise for more than 30 min has the best effect on the executive function of children and adolescents. Zhou and Jin (2021) summarized that moderate physical activity lasting at least 3 days a week, at least 60 min a day are most conducive to improving the brain function of children and adolescents.

At present, some researchers call for attention to the qualitative characteristics (e.g., energy metabolism, skill types, peer participation, etc.) of physical activity ( Tomporowski et al., 2015 ; Diamond and Ling, 2016 ). Among them, motor skills are essential for human physical activity and survival and development. On the one hand, the repetitive exercise of multi joint muscles with rich cognitive participation activates the relevant neural circuits ( Diamond, 2015 ; Lakhani et al., 2016 ). On the other hand, the stimulation of changes in the sports environment requires more individual participation in the decision-making process, and changes brain function and brain network under the interaction of individual, environment and behavior ( Nithianantharajah and Hannan, 2006 ; Sale et al., 2009 ; Tomporowski and Pesce, 2019 ). Zhou and Jin (2021) believed that motor skills have a specialization attribute on the cognitive benefits of children and adolescents. So, what are the characteristics of this specialized attribute? That is, what are the pathways and moderators by which motor skills promote cognitive benefits in children and adolescents? In addition, cognitive brain function develops to regulate the learning and control of motor skills. The dorsolateral prefrontal cortex, a brain-activated region of executive function, is closely linked to the motor system, and has an important role in motor sequence learning and monitoring behavioral execution ( Kraeutner et al., 2016 ). Selective attention and spatial working memory capacity are important for stimulus discrimination, response selection and response programming during motor decision making ( Wang, 2013 ). Therefore, it is possible to explore the pathways and moderators of motor skills to improve the cognition of children and adolescents, and then incorporate these moderators into motor skills teaching practices, thereby achieving joint improvements in motor skills and cognitive function. The purpose of this review is to review relevant study on the relationship between different types of motor skills and cognitive benefits in children and adolescents, and to explore the pathways, mechanisms and moderators of motor skills to improve cognition. On this basis, future study is envisaged, so as to inform subsequent research and teaching practice.

Cross sectional studies on motor skills and cognitive benefits

It has become a widespread consensus that physical activity promote the cognitive benefits of children and adolescents ( Fedewa and Ahn, 2011 ; García-Hermoso et al., 2021 ). At present, researchers are gradually concerned about which kind of motor skills have greater cognitive benefits ( Gu et al., 2019 ). According to the predictability of environmental changes, motor skills can be divided into open skills and closed skills ( Zhang, 2012 ). Changes in the open skills environment are unpredictable, and the quality of cognitive decision-making is the main determinant of success; the closed skills environment is predictable, and the quality of action control is the main determinant of success ( Zhang, 2012 ). A study on athletes showed that athletes who have long been engaged in open skills training show more cognitive advantages in general cognitive tasks than athletes who have been engaged in closed skills training ( Wang et al., 2016 ). Yu et al. (2017 , 2019 ) compared the performance of proactive and reactive control between badminton (open skill) and track and field (closed skill) athletes, and found that badminton athletes have a higher active control performance. Krenn et al. (2018) further divided open skills into interception skills (e.g., badminton, tennis, etc.) and strategic skills (e.g., football, ice hockey, etc.), and compared the executive function performance of interception, strategic and closed skill athletes. The results showed that compared with closed skill athletes, strategic skill athletes showed unique cognitive advantages in inhibitory control, working memory, cognitive flexibility, and interception skill athletes only performed well in inhibitory control. However, a meta-analysis ( Voss et al., 2010 ) showed that interception skill athletes have better cognitive performance than strategic skill athletes. Differences in the motor environment and the cognitive demands of interception and strategic skills may result in different changes in brain organization. Badminton players (interception skill) have significantly increased gray matter volumes in the left inferior frontal gyrus, left superior parietal lobule, and left precuneus ( Wu et al., 2015 ). These brain structures are associated with fine motor control and spatial position perception ( Macuga and Frey, 2014 ). Basketball players (strategic skill) have significantly increased gray matter volumes in the infratemporal gyrus, left middle frontal gyrus, left inferior frontal gyrus, middle cingulate gyrus, and insula ( Wu et al., 2015 ). These brain structures are related to visual information processing, response inhibition control, and perceptual motor decision-making ( Simmons et al., 2012 ).

Similarly, different types of motor skills have different associations with cognitive performance in children and adolescents. Zhang et al. (2009) used event-related potentials to compare the degree of brain activation in GO/NO-GO tasks in children involved in table tennis and swimming training. The results found that the table tennis group had higher task accuracy and lower N2 amplitude compared to the swimming group. A study ( Ji, 2014 ) compared the relationship between four open skills and executive function in pupils. The results found that the basketball and table tennis groups had the best inhibitory control; the badminton and taekwondo groups had the best cognitive flexibility. However, cross-sectional studies still need to consider more confounding factors (e.g., physical activity ( Roig et al., 2013 ; Ballester et al., 2018 ; Xue et al., 2019 ; Moratal et al., 2020 ), socio-economic status ( Duncan et al., 2017 ), sleep ( Turnbull et al., 2013 ), etc.), in order to more accurately describe the relationship between motor skills and executive function. In addition, cross-sectional studies cannot elucidate the causal relationship between the two, so a series of longitudinal intervention studies are necessary to explore this.

Interventional studies on motor skills and cognitive benefits

The advantages of real-word settings are that the equipment requirements are simpler, and easier to integrate into school physical education classes or extra-curricular sports activities ( Zhao et al., 2015 ). Therefore, this study systematically searched for studies of exercise interventions for cognitive function in children and adolescents in real-word settings, excluding intervention studies of treadmill or bicycle ergometer in laboratory settings. The focus of this study was to sort out the effects of acute or long-term interventions in different types of motor skills on the cognition of children and adolescents. This study focuses on sorting out the effects of acute and long-term interventions for different types of motor skills. Acute interventions are those in which the individual receives a brief or one-off exercise session; long-term interventions are those in which the individual receives a longer period of exercise ( De Greeff et al., 2018 ; Zhong et al., 2022 ).

Effects of acute interventions in motor skills on cognition

Exercise has immediate cognitive effect, and a single exercise intervention can produce certain cognitive benefits ( Tomporowski, 2003 ). This study reviewed research on the cognitive effects of acute interventions of motor skills in children and adolescents ( Table 1 ), and found that open-sequence skills, which constitute cognitive challenge and physical coordination, promoted attention ( Gallotta et al., 2015 ) and verbal working memory ( O’Brien et al., 2021 ) better than closed-sequence skills in children and adolescents. In addition, Manion and Alexander (1997) suggest that working on tasks with peers improves children’s executive functions such as strategy selection and application, and problem understanding and solving. Chen et al. (2015b) increased the unpredictability of the sport environment through peer cooperative rope skipping, further improving the effectiveness of the intervention on executive function. Ottoboni et al. (2021) compared the effects of balls (sequence skill) and obstacle running (continuous skill) with the same open attribute on verbal and visual spatial working memory in children aged 7 to 10 years and found better results for open-sequence skills. Yan et al. (2014) compared the intervention effects of obstacle running (open-continuous) and aerobics (closed-sequence) on the executive function of primary school students, and showed that there was a selective facilitation of both, without reflecting an absolute advantage of open or sequence skills. The reason for this is the interaction between the action structure (sequence and continuous) and the environmental context (open and closed). In summary, the effects of exercise interventions on children’s and adolescents’ cognition show a pattern of open skills over closed skills and sequence skills over continuous skills.

Comparative study of acute interventions of motor skills on the cognition of children and adolescents.

RCT, randomized controlled trial; E, experimental group; C, control group; y, year; HRmax, maximum heart rate; ①, attention; ②, inhibitory control; ③, working memory shifting; ④, cognitive flexibility; ⑤, visual spatial working memory; ⑥, verbal working memory; +, beneficial to experimental group; −, beneficial to control group; 0, no significant difference between the experimental and control groups; &, comparison of intervention results between experimental groups.

In addition, some studies have examined the effects of acute interventions for motor skills of varying intensity and duration on the cognition of children and adolescents. Studies have shown an “inverted U-shaped” dose–response relationship between exercise intensity and cognitive performance, with moderate intensity being more beneficial to the development of executive function ( Chang et al., 2011 ; Ludyga et al., 2016 ). Transient low activation theory ( Dietrich, 2003 ) believes that human brain resources are limited. The motor system in high-intensity exercise requires more metabolic resources to control body movements and maintain motor performance, while relatively fewer resources are available for cognitive processing, which may impair cognitive performance ( Dietrich, 2003 ; Browne et al., 2017 ). However, Chen et al. (2014) compared the effects of acute interventions with different intensities of basketball dribbling, and found that moderate intensity exercise was the most effective for executive function in primary school children, but that high intensity exercise helped to improve inhibition and refreshment functions as well. The evidence of sports experience showed that the learning and training process of complex motor skills can improve the peer relationship of children and adolescents, and it is easier to stimulate their exercise enjoyment and positive emotional experience. Some studies ( Zhang et al., 2019 ; Herbert et al., 2020 ) have shown that lower exercise enjoyment and social motivation are more likely to contribute to fatigue during exercise. Therefore, motor skills may interact with exercise intensity, but there is no study involved at present. Chen et al. (2015a) compared the effects of acute interventions of varying durations of moderate intensity basketball dribbling on the executive function of primary school students, and found that 30 min was the most effective intervention. However, no studies have investigated the time-course effects of acute intervention of complex motor skills on the cognitive function of children and adolescents, and it is unknown how long the cognitive benefits can be maintained after the intervention.

Effects of long-term interventions in motor skills on cognition

This study reviewed research on the long-term intervention effects of motor skills on children’s and adolescents’ cognition ( Table 2 ), and found that different types of motor skills improved children’s and adolescent’s cognitive functions to a certain extent, and open skills and sequence skills had better effects on attention ( Kong, 2012 ), executive function ( Schmidt et al., 2015 ) and verbal working memory ( Koutsandreou et al., 2016 ). Tse et al. (2021) similarly demonstrated a more positive effect of open motor skill learning (learning to ride a bicycle in a natural environment) than closed continuous exercise (riding a stationary bicycle) on the improvement of executive function and visual spatial working memory in children with autism spectrum disorders. However, one study ( Telles et al., 2013 ) showed that continuous skills based on jogging, sprint running and relay races were more effective than yoga (sequential skill) as an intervention for inhibitory control in school-aged children. The reason for this may be that the physical movement changes in yoga are less frequent than sequential skills such as aerobics and fitness boxing, and stimulation of the dorsolateral prefrontal cortex is lower ( Koziol and Lutz, 2013 ). A recent Meta-analysis ( Zhang et al., 2022 ) evaluated the effect of 11 motor skills on working memory in school-aged children, with an overall pattern of “open > closed, sequence > continuous.” In addition, Wu et al. (2007) compared the intervention effects of football (strategic skills) and table tennis (interception skills) on the attention qualities of primary school students. The moderate- and low-intensity football interventions were found to be more effective than table tennis in terms of attention sustainment and attention shifting, respectively; whereas the mederate-intensity table tennis intervention was more effective than football in terms of attention stability, attention breadth and attention concentration. Thus, strategic and interception skills have a selective facilitative effect on the attention qualities of children and adolescents.

Comparative study of long-term interventions of motor skills on the cognition of children and adolescents.

RCT, randomized controlled trial; non-RCCT, non-randomized concurrent control trial; NC, not clear; E, experimental group; C, control group; y, year; HRmax, maximum heart rate; RPE, rating of perceived exertion; ①, attention; ②, inhibitory control; ③, working memory shifting; ④, cognitive flexibility; ⑤, visual spatial working memory; ⑥, verbal working memory; ⑦, planning and problem solving; +, beneficial to experimental group; −, beneficial to control group; 0, no significant difference between the experimental and control groups; &, comparison of intervention results between experimental groups; ADHD, attention deficit hyperactivity disorder; ASD, autism spectrum disorder; LD, learning difficulties.

In addition, studies have demonstrated the effectiveness of interventions in open skills (basketball, orienteering) on executive function in normal pupils and children with cognitive impairment [learning difficulties ( Pan et al., 2016 ; Yin et al., 2017 ), and attention deficit hyperactivity disorder ( Song et al., 2020 ). The results found that the above exercise interventions were effective for both types of students’ executive function, and the improvement in executive function was higher in children with cognitive impairment. The cognitive load of open skills meets the cognitive memory capacity of children with cognitive impairment, and requires children to switch body movements, inhibit dominant responses and refresh memory information during movement, which can effectively improve executive function and inattention ( Song et al., 2020 ). Also, because of the developmental differences between children with cognitive impairment and normal children, the former have a greater potential for cognitive improvement. Therefore, it is more effective for children with cognitive impairment. In summary, long-term interventions in both open and sequence skills help to improve the cognitive benefits of children and adolescents, particularly in children with cognitive impairments in executive function. However, it is not clear how long this positive intervention effect can be maintained after the long-term intervention for complex motor skills has ended.

Motor skill proficiency and cognitive benefits

Motor skills play an important role in the life course of individuals. It is one of the internal mechanisms that affect the participation and persistence of physical activity ( Laukkanen et al., 2014 ; Veldman et al., 2018 ). It interacts with physical activity to jointly maintain the physical health of children and adolescents ( Stodden et al., 2008 ). Based on this, a number of policies in China put forward the goal of making teenagers “proficient in 1 ~ 2 sports skills” ( National Health Commission of the People’s Republic of China, 2019 ; Ministry of Education of the People’s Republic of China, 2021 ). So, what is the relationship between motor skill proficiency and cognitive benefits?

Brain plasticity refers to the positive changes in the physiological structure and function of molecules, synapses, and cells in the central nervous system of the brain ( Sagi et al., 2012 ). Acute or long-term motor skill learning can cause brain plasticity changes, promote brain angiogenesis, gliogenesis and synaptogenesis, and improve brain structural morphology and functional activities ( Zatorre et al., 2012 ; Vints et al., 2022 ). Neuroimaging evidence suggests that elite athletes benefit from action experience accumulated through long-term motor skill learning, and tend to increase activity in brain regions (frontal, parietal, occipital, etc.) associated with cognitive understanding ( Jacini et al., 2009 ; Huang et al., 2015 ; Yang et al., 2020 ). A meta-analysis by Voss et al. (2010) showed that proficiency in motor skill acquisition was associated with high levels of performance on visual attention processing tests, and that individuals with higher motor skills had greater inhibitory control over distracting stimuli during multi-target tracking. Bi et al. (2020) and Shi et al. (2020) also found that elite athletes who have received professional training have quick response and good accuracy in performing functional tasks. Therefore, it can be shown that long-term motor skill learning and training is accompanied by improved cognitive benefits as it increases skill proficiency.

So, are such results in the field of competitive sports reflected in the children and adolescents? The aforementioned studies have shown that after a period of motor skill learning, cognitive functions such as attention, executive function and working memory improve in children and adolescents with normal and cognitive impairments. This supports, to some extent, the idea that motor skill proficiency is associated with cognitive benefits in children and adolescents. Although the motor skills of the children and adolescents improved after the intervention, it is not clear to what extent motor skills were achieved after the intervention, so it is difficult to draw correlations between motor experience (motor control and perceptual decision-making) and cognitive benefits. Motor skill is a combination of mental and operational processes ( Ji et al., 2010 ). Although motor skills are varied in type and difficulty, whenever they are learned and practiced they necessarily involve the participation of cognitive processes. Motor skill learning processes share brain area activation with cognitive tasks such as executive function in the prefrontal cortex region ( Cao et al., 2017 ). And this region is a key region in the regulation of cognition ( Funahashi, 2001 ; Müller and Knight, 2006 ). Therefore, long-term sports skill training and competition promotes the development of individual sports cognition, and promotes the development of general cognitive function through transfer. Relevant cross-sectional studies ( Hou, 2008 ; Haapala, 2013 ; Cadoret et al., 2018 ) show that higher motor skills are associated with more effective attention, inhibitory control and working memory of children and adolescents. Verburgh et al. (2016) and Moratal et al. (2020) found that children aged 8–12 years who regularly participated in football training had more significant advantages in working memory, attention and information processing speed. Ishihara et al. (2017a , b) evaluated the relationship between tennis frequency and executive function of children and adolescents. After controlling for age, gender, BMI and tennis experience, more frequent tennis is related to higher processing speed and inhibition control of boys, and better working memory of students. Similarly, cross-sectional studies are prone to be affected by confounding factors such as physical activity, socio-economic status, and sleep, which need to be further considered in subsequent studies.

Pathways and mechanisms for motor skills to enhance cognitive benefits

The dynamic mechanism model of physical activity emphasizes that motor skills are not only the internal mechanism that affects the participation and persistence of physical activity, but also interact with physical activity to jointly maintain the physical and mental health benefits of children and adolescents ( Stodden et al., 2008 ). Available evidence ( Drollette et al., 2016 ; Escolano-Pérez and Bestué, 2021 ) also indicates a direct positive correlation between physical activity and cognition and better academic performance. Based on a review of the relationship between motor skills and the cognitive benefits of children and adolescents, this study proposes pathways and mechanisms by which motor skills enhance the cognitive benefits of children and adolescents ( Figure 1 ). The dynamic interaction between motor skills and physical activity exposes children and adolescents to environmental stimuli and interpersonal interactions of varying complexity, promoting the development of agility, coordination and cardiorespiratory fitness, enhancing their motor experience, which in turn enhances the function of molecules, cells and neural circuits in the nervous system and improves brain structure and functional activity. This is reflected in improvements in attention, executive function, and creative thinking during cognitive tasks.

Pathways and mechanisms by which motor skills enhance the cognitive benefits of children and adolescents.

Increasing the unpredictability of the environmental context, adding variable movement structures and increasing interpersonal interaction processes can increase the complexity and novelty of environmental stimuli, which will promote more physical activity and pose higher cognitive challenges ( Nithianantharajah and Hannan, 2006 ). This rich environmental stimuli increases the concentration of neurotrophins such as brain-derived neurotropic factor and nerve growth factor ( Ickes et al., 2000 ), increases the number of dendritic spines and the volume of synapses on certain neuronal populations ( Nithianantharajah and Hannan, 2006 ), and promotes neuronal activation, signaling, and brain plasticity ( Nithianantharajah and Hannan, 2006 ; Sale et al., 2009 ). Closed-continuous skills such as jogging and cycling enhance an individual’s cardiorespiratory fitness, increase the capillary density of brain tissue and activate their sensorimotor network, which is the main network regulating response inhibition ( Voelcker-Rehage et al., 2011 ; Shi et al., 2019 ). Sequence skills have a more complex movement structure and are movement sequences that combine motor coordination and aerobic fitness. The multi-limb involvement and flexibility of movements during the task require more mental manipulation processes and are more likely to induce neurogenesis in the hippocampus, cerebellum, and cerebral cortex ( Carey et al., 2005 ). Open skills such as basketball and table tennis emphasize the combined effects of cardiorespiratory fitness and rich environmental stimuli. This promotes individual perceptual-motor coordination, increases the number of Purkinje neurons and synapses, promotes prefrontal cortical vascularization and induces better neurofunctional remodeling, effectively activating sensorimotor and visual spatial networks ( Mavilidi et al., 2015 ; Moreau et al., 2015 ).

Rather than emphasizing the neurobiological mechanisms by which motor skills improve cognition, the focus of the pathway places emphasis on the pathways that guide motor skills teaching practice. By distilling the main pathways and cognitive moderators of motor skills to improve the cognition of children and adolescents, one or more of these moderators can be manipulated in subsequent motor skills teaching practices to further promote the cognitive benefits of children and adolescents. Environmental stimuli, interpersonal interaction, agility, coordination, and cardiorespiratory fitness can be considered as skill attribute moderators of motor skills to improve cognition ( Figure 1 ). In addition, there are varying degrees of overlap between these pathways. For example, the complexity of environmental stimuli can be increased through interpersonal interaction; increased environmental stimuli and improved agility, coordination and cardiorespiratory fitness contribute to motor experience. The pathways and mechanisms proposed in this study do not reveal the intrinsic correlations between the pathways, but rather point to actionable variables for teaching motor skills in order to provide guidance for subsequent practice.

Motor experience

Motor skill proficiency benefits from the movement experience gained during the learning of individual motor skills, including not only the joint-muscle coordination patterns developed during the learning of single technical movements, but also the procedural knowledge gained during the contextualized practice of motor skills. Firstly, according to Pavlov’s theory of conditioned reflexes, motor skills are temporary neural connections established in the relevant cortical centers of the brain with the involvement of multiple sensory organs ( Chen et al., 2021 ). In particular, multiple repetitions of multi-limb, cognitively engaging movements help to activate relevant neural pathways and promote cognitive function ( Diamond, 2015 ; Chen et al., 2021 ). The rich changes in the external environment stimuli of open skills (e.g., the tearing of offensive and defensive players and the changes in the size of empty spaces, etc.) make individuals constantly face new problems and challenges. Individuals need to coordinate and combine the original actions, coordinate the existing declarative knowledge and experience, make more reasonable coordinated responses or create more novel actions ( Kolb and Gibb, 2011 ; Chen et al., 2021 ). Therefore, this leads to the continuous connection of neural circuits in the cerebral cortex to improve the motor cognitive process ( Kolb and Gibb, 2011 ; Chen et al., 2021 ).

Environmental stimuli

The above studies show that open skills have a greater effect on improving cognitive function in children and adolescents than closed skills. This may be related to the rich environmental stimuli embedded in open skills. The changing and unpredictable sports environment is an ideal place for children and adolescents to develop their cognition ( Kolb and Gibb, 2011 ). Responding and adjusting actions in this sports environment can help to improve motor cognition and motor experience, and then promote the improvement of general cognitive explicit behavior through cognitive transfer ( Kolb and Gibb, 2011 ). Motor skill learning is cognitive and associative in nature. Individuals inhibit irrational visuomotor planning in the early stages and assess new visual stimuli and kinesthetic information through working memory refreshment, activating specific prefrontal areas ( Gentili et al., 2013 ). However, activation in prefrontal areas responsible for inhibition and refreshment decreases as motor skills reach an automated level ( Gentili et al., 2013 ). Motor skill learning consists of the cognitive, associative, and automatic stages. The automatic stage represents the end of the motor skill learning process, where the role of conscious control over the individual’s movements is reduced to a minimum ( Figure 2A ; Pesce et al., 2019 ). Therefore, Tomporowski (2003) ; Tomporowski et al. (2015) ; Tomporowski and Pesce et al. (2019) proposed to introduce more environmental perturbations in the final stages of the motor skill learning process to generate new cognitive challenges, increasing the flexibility to apply skills in changing environmental stimuli. The complexity and variability of this environmental information provides a continuous stimulus to cognition, which in turn enhances cognitive benefits to a greater extent ( Figure 2B ; Pesce et al., 2019 ).

( A and B ) Stages of motor skill acquisition and hypothesized cognitive benefits.

Interpersonal interaction

Interpersonal interaction is often the primary means of increasing the complexity of exercise situations, and motor skill learning with peer involvement is more conducive to the cognitive benefits for children and adolescents ( Chen et al., 2015b ). Wertsch (2008) proposes that higher thinking functions develop in the context of interpersonal interaction. Relevant studies have proved that parent–child interaction ( Roskam et al., 2014 ), peer social interaction ( Moriguchi et al., 2020 ), and teacher-student relationship ( Suntheimer and Wolf, 2020 ) have positive effects on executive function and attention control of children and adolescents. Conversely, social anxiety, loneliness and negative emotions can impair executive function in children and adolescents ( Frick et al., 2013 ; Ma et al., 2019 ). Sports skills, especially open sports skills such as football and basketball, have specific competition rules, and need to cooperate with peers and assume certain role responsibilities. In this interpersonal interaction process, individuals cooperate with the team to complete tasks by inhibiting irrational behavior, which helps to enhance peer relationships and social interactions, and increases the sense of team identity and honor ( Gong et al., 2020 ). In addition, positive exercise experiences and a sense of accomplishment are perceived to increase exercise confidence, enjoyment, and motivation. This leads to a more positive relationship with teachers ( Gong et al., 2020 ), which can facilitate the development of executive functioning.

Agility, coordination

The above studies show that sequence skills have a greater effect on improving cognitive function in children and adolescents than continuous skills. Sequence skills combine discrete, simple motors into more complex motors, and this complex multi-limb motor characteristic plays a key role in the development of agility and coordination ( Zhang, 2012 ; Diamond, 2015 ; Chen et al., 2021 ). Agility and coordination are more complex, integrated motor qualities. Agility refers to the body’s ability to quickly change position, switch movements and improvise during movement ( Wang and Su, 2016 ). Coordination refers to the ability of the body’s organs and systems to cooperate with each other in time and space to complete movements during exercise ( Wang and Su, 2016 ). Neural coordination is the basis of agility and coordination quality. Actions are mainly completed through the synergy and cooperation of the mutual conversion of excitation and inhibition of the neural processes ( Young and Willey, 2010 ). Therefore, the more complex the completed action, the more precise the coordination of the excitation and inhibition process of the cerebral cortex is required ( Young and Willey, 2010 ), and the transformation of this excitation and inhibition reflected in the cognitive explicit behavior is the inhibitory control process. Related studies ( Mora-Gonzalez et al., 2019 ; Xiao et al., 2021 ; Hu Q. et al., 2022 ) have also shown a strong link between agility and coordination and the degree of cognitive and brain development in children and adolescents. Open-sequence skills such as ball games, fencing and wrestling with sudden starts, sharp stops and rapid shifts in movement; closed-sequence skills such as aerobics and martial arts routines with complex and varied basic steps and manoeuvres and fast paced movements. These motor skills require the involvement of agility and coordination qualities and help to promote improved cognitive function.

Cardiorespiratory fitness

Motor skills influence the development of cardiorespiratory fitness by influencing an individual’s choice of physical activity content ( Yin, 2019 ). Motor skills based on aerobic metabolism are more conducive to the development of cardiorespiratory fitness. Some studies ( Wang et al., 2001 ; Yang et al., 2010 ) have shown that long-distance running is more conducive to improving cardiorespiratory fitness than football, dance, and Tai Chi exercises. There is a clear association between cardiorespiratory fitness and cognition in children and adolescents. Welk et al. (2010) found a significant association between cardiovascular health and academic performance after controlling for potential confounders. Niederer et al. (2011) found an association between cardiorespiratory fitness and better attention in preschoolers, with baseline cardiorespiratory fitness independently associated with improved attention after 9 months of follow-up. In neurobiology, children and adolescents with higher cardiopulmonary fitness have larger hippocampus and basal ganglia, more white matter fiber bundles, and more activation and connection in frontal, temporal, parietal and cerebellar cortex ( Erickson et al., 2015 ; Talukdar et al., 2018 ). The strength of connectivity in these areas predicts individual executive function, fluid intelligence and academic performance ( Erickson et al., 2015 ; Talukdar et al., 2018 ).

Prospects for future study

Further study on the correlation between motor skills and cognition in children and adolescents.

The variety of motor skills and the complexity of the classification system make it impossible to distinguish activity tasks effectively by a single dimension of classification through the predictability of the environmental context or the complexity of the movement structure alone. For example, there are obvious differences in the movement structure between aerobics and middle and long distance running, which belong to the same closed skills. For another example, basketball and Tai Chi, which belong to the same sequence skills, also have obvious differences in environmental context and cognitive participation. Therefore, when exploring the relationship between motor skill type and executive functioning, the interaction between open-closed skills and sequential-continuous skills should be explored in the context of the multidimensional aspects of skill classification. The relationship between motor skill type and cognitive benefits in children and adolescents should be further clarified on the basis of testing evidence from one-dimensional classification studies. Furthermore, the complexity of cognitive processes dictates that the study of motor skills and the cognitive benefits of children and adolescents is a systematic project. However, most of the current studies are fragmented, and lacks systematic integration. The main reason for this is that measures of cognition are often limited by research interests and instruments, and therefore the choice of measures is usually not a complete measure of children’s and adolescents’ cognitive performance. Cognition is a relatively large category, and motor skills are selective for cognitive development ( Zhou and Jin, 2021 ), but which cognitive indicators are more effectively promoted needs to be further explored. Cross-sectional studies are a convenient option for conducting systematic research on the relationship between motor skills and children’s and adolescents’ cognition, but more confounding factors need to be taken into account.

In addition, the relationship between exercise intensity on the treadmill / power bicycle and children’s cognition in the laboratory scenario was “inverted U-shaped” ( Chang et al., 2011 ; Ludyga et al., 2016 ). However, the relationship between exercise intensity and cognition in the natural environment is moderated by the type of motor skill, so that the relationship between the two does not satisfy the “inverted U-shaped” ( Chen et al., 2014 ). We look forward to further research exploring the interaction between motor skills and exercise intensity on the cognition of children and adolescents. Finally, there are time-course effects of exercise interventions in children’s and adolescents’ cognition. Which exercise time parameters produce the greatest cognitive benefits for different types of skills? How long do the cognitive benefits produced by acute or cyclical interventions for different types of skills last? These questions also need to be answered. Given the fragmentation of research in this area, we suggest that there is a need to clarify the association between types of motor skills and the cognitive development of children and adolescents, and a need to continue to explore the dose-effect relationship between complex motor skill-led physical activity and the cognitive performance of children and adolescents in real-word settings, to clarify the full picture of the relationship between the variables, and to provide a detailed scientific basis for the pedagogical practice of cognitive interventions in school sport.

Further testing of pathways and mechanisms for motor skills to enhance cognition in children and adolescents

This study proposes pathways and mechanisms by which motor skills enhance the cognitive benefits of children and adolescents ( Figure 1 ), and identifies environmental stimuli, interpersonal interaction, agility, coordination, and cardiorespiratory fitness as cognitive modifiers of motor skills to improve cognition. However, the above pathways and mechanisms are derived through logical reasoning based on an overview of motor skill types and their development in relation to the cognitive benefits of children and adolescents. With the exception of Chen et al. (2015b) , who validated that increased interpersonal interaction improves executive function in children and adolescents, the remaining pathways have not been effectively tested. For movement experience, the relationship between motor skill proficiency and cognitive development can be explored by drawing on the Standard Test of Sport Skill Level for Adolescents (STSSLA) ( Tang, 2018 ) and the Game Performance Assessment Instrument (GPAI) ( Oslin et al., 1998 ) to assess the quality of their technical movements and the practical operation of the game situation. For environmental stimuli, experimental studies can be conducted by selecting one motor skill and by manipulating the environmental context (predictable and unpredictable) to test the hypothesis that motor skill teaching practices enhance the cognitive benefits of children and adolescents by increasing the amount of environmental information. For agility, coordination and cardiorespiratory fitness, a cross-sectional study design can be used to examine the mediating role of agility, coordination and cardiorespiratory fitness between motor skill types and cognitive function in children and adolescents through pathway analysis. It is expected that subsequent studies will verify this separately.

Teaching motor skills in line with the cognitive development of children and adolescents

The essence of education is to use scientific and effective means to promote the cognitive and learning efficiency of the individual based on the laws of brain development. With increasing research in cognitive psychology and cognitive neuroscience, there is a growing focus on the acquisition and restructuring of internal mental representations during motor skill learning ( Ertmer and Newby, 1993 ). “Mind–body monism” also advocates that people are a unity, and the process of motor skills learning is an operational process that combines cognition and practice ( Odegard, 1970 ; Ji et al., 2010 ). The relationship between motor skills and brain cognition of children and adolescents provides a new perspective for the reform of physical education curriculum. The 2022 Physical Education and Health Standards for Compulsory Education issued by the Chinese Ministry of Education also advocate teaching contextual skills from an individual cognitive perspective, with an emphasis on improving agility and coordination. An overview found that the environmental stimulus information embedded in different types of motor skills, the level of interpersonal interaction required and the degree of effect on agility, coordination and cardiorespiratory fitness were the main factors in improving cognition. Similarly, these factors are also necessary to promote the development of motor skills. Rich environmental stimuli and interpersonal interaction information facilitate cue perception and perceptual decision-making; high levels of agility, coordination and cardiorespiratory fitness facilitate motor execution and motor control. Follow-up studies can incorporate the above factors into motor skills teaching practices to promote the development of cognitive performance and motor skills in children and adolescents. For example, properly improving the cardiorespiratory fitness of children and young people during the teaching of interceptive skills such as table tennis can boost their brain blood oxygen supply and increase the efficiency of brain activation. The teaching of strategic skills such as football emphasizes the role of the environment and people. We can design situational and practical sports games or sports competitions to enhance children’s and adolescents’ group spirit and sports interest, and promote their “awareness” or “ball IQ.” Another example is the inclusion of variable movements such as chasing changes of direction in the teaching of middle distance running skills. This promotes the development of agility and coordination to activate relevant neural pathways and improve brain structure and brain networks. But which skills are more important in teaching practice and which elements of cognitive regulation need to be supplemented? What is the most significant proportion of these elements in different types of skills teaching practice? The above questions also need to be answered through the practice of teaching motor skills, so that the educational function of physical education can be further developed.

Author contributions

PS designed the research, drafted the article and reviewed relevant literature. XF proofread manuscript and searched relevant literature. All authors participated the intellectual content of the manuscript. All authors contributed to the article and approved the submitted version.

The work was supported by the Humanities and Social Sciences youth project of Liaoning provincial department of education (WQ2020012).

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyg.2022.1017825/full#supplementary-material

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