As a pediatric OTR, I am often asked to assess and teach proper pencil grasp.  Once you start looking, you see a lot of interesting patterns out there.  When a child clearly has low muscle tone and/or hypermobile joints, the question of what to do about an atypical pencil grasp used to puzzle me.  I could spend weeks, or even months, teaching positioning and developing hand strength in a child, only to find that they simply couldn’t alter their grasp while writing.

Now I triage grasp issues by determining if it is a problem for the child now or in the future.  An atypical pencil grasp can be an acceptable functional compensation or it can be a contributor to later joint damage.  What’s the difference?  You have to know a bit about hand anatomy and function, how to adapt activities, and how to assess the ergonomics of writing.

Children aren’t aware of most of the problems that low tone and/or hypermobility create when they hold a pencil.  They just want to write or draw.  Teachers and parents don’t know what is causing issues either.  The effects of their unique physiology often results in grasp patterns that cause parents pain just to observe; fingers twisted around the shaft of the pencil, thumb joints bent backward, etc.  The kids aren’t usually complaining; their lack of sensory receptor firing at the joints and muscles gives them no clues to the strain they are inducing.  None.  Occasionally children will complain of muscular fatigue or pain after writing a few paragraphs or completing an art project.  For the most part, they are unconcerned and unaware of what is really going on.  For a more detailed explanation, please check out Hypermobility and Proprioception: Why Loose Joints Create Sensory Processing Problems for Children,

Do these funny grasp patterns reduce legibility?  Only sometimes.  There are atypical grasp patterns that are good choices for children with hypermobility.  One is to place the shaft of the pencil directly between the index and third finger, and allow the thumb to support the side of the pencil.  The knuckle joints of those fingers provide more stability than the standard tripod grasp.  This grasp pattern is illustrated at the beginning of this post.

I allow preschoolers who need to keep more than 3 fingers on the shaft of the pencil to do so, and wait to see what happens as they develop more overall hand control.  This is especially beneficial for the child with sensory discrimination issues or joint hypermobility.  Forcing a tripod grip isn’t always in their best interest now or for the future.

What can be done?  My favorite method to help children with low tone or hypermobility is to look at the problem with both a wide-angle lens and with targeted analysis.  I think about changing overall posture, altering any and all equipment, and examine the mechanics of movement.

• These kids often need better proximal support, meaning that changing their chairs and writing/drawing surfaces could result in less strain in their hands and wrists.  To understand one way your whole body is involved in writing, take a look at Better Posture and More Legible Writing With A “Helper Hand”
• Using writing tools that reduce joint force by enlarging the shaft diameter or changing out lead for gel pens or markers is another strategy.  Take a look at Child Losing Pencil Grasp During COVID-19? Flip Crayons Restore Skills, Strengthening A Child’s Pencil Grasp: Three Easy Methods That Work  and Problems With Handwriting? You Need The Best Eraser for more good ideas that actually make a difference.
• I will teach kids how to pace themselves to reduce force and fatigue throughout their bodies.  A little awareness can be a big help.  Joint protection for hypermobility is important.  Read Why Joint Protection Solutions for Hypermobility Aren’t Your Granny’s Joint Protection Strategies   to learn the difference between “ergonomics” and joint protection for hypermobility.
• Finally, I may suggest a pencil grip, but I assess this carefully in order to avoid forcing a typical grasp on a child that can’t manage it due to instability or profound weakness.  I might start with the Grotto Grip The Pencil Grip That Strengthens Your Child’s Fingers As They Write., in hopes that we can strengthen and train a stable grip, but I will move on quickly if it doesn’t work within a month or causes more difficulty/pain in writing.

Does handwriting instruction matter?  I think so.  The best writing program teaches children quickly, so that they don’t have to write 100 “A”s to learn how to write.   The only program I use is Handwriting Without Tears.  The high-quality materials and the developmental progression make learning easier and faster.  Read KickStart Kindergarten: Get Your Child Ready for Kindergarten Writing The Easy Way! to see some sample pages and understand how this particular book can work for ages 4-8.

Wondering if there are issues beyond writing that your OT can address?  Check out   Hypermobility and Music Lessons: Is Your Child Paying Too High a Price for Culture?Hypermobility and Proprioception: Why Loose Joints Create Sensory Processing Problems for Children and Three Ways To Reduce W-Sitting (And Why It Matters) for more information.

Atypical pencil grasp can be a problem, but it can also be a solution to a child who is struggling to write and draw in school.  If you have concerns, ask your OT to evaluate and explore the issue this week!

Looking for more information on raising (or treating) a hypermobile child? 

I wrote 2 books to help you!

The JointSmart Child:  Living and Thriving With Hypermobility Volume One:  The Early Years

is filled with practical strategies to help parents of children 0-5 build safety, skills, and independence.  Written in easy-to-understand language and designed with chapter summaries that help busy parents find the answers they need, this book is unique in the world of special needs resources!  Therapists will find easy ways to boost ADL skills, safety awareness, and early fine motor skills with an awareness of the sensory processing needs of the hyper mobile client.

My book is available as a PAPERBACK or a read-only download on Amazon and as a clickable and printable download on Your Therapy Source.  Worried that you don’t have a Kindle?  No problem:  Amazon’s downloads can be read on iPads and iPhones using their FREE app.

The JointSmart Child:  Living and Thriving With Hypermobility Volume Two:  The School Years

This is my newest book for parents and therapists of kids 6-12.  Older children may still need to build full ADL independence and safety, but they also need to write and keyboard, and they play sports and musical instruments.  This book is larger and more comprehensive than Volume One, filled with forms and checklists to find the right chair, desk, bike; even the best way to arrange a bedroom for sleep.  Parents and therapists will have forms and handouts they can use in CPSE and CSE meetings with the school district and information on how to become an empowered consumer in doctor’s appointments.

It is available as a PAPERBACK and as a read-only download on Amazon  and as a printable download on Your Therapy Source ,and just like Volume One, Amazon doesn’t require you to have a Kindle to download my book.  You can get their free app and read it today.  They make it easy!