I get a lot of questions about this issue, based on my experience as a pediatric OTR. Starting at 12 months, some children show a strong hand preference and never look back. Other kids are switching hand use long after 4. Without the existence of disorders that directly affect hand dominance such as orthopedic disorders, cerebral palsy, or untreated torticollis, hand dominance is hard-wired and emerges naturally. But there are situations in which it is delayed or incomplete long after the typical window of skill development.
Here is what can be happening, and here is what you can do as a parent or a therapist:
Hand dominance only emerges with the development of refined hand control and the child’s awareness that they need more skilled control for an activity. I tell parents that I can pick up my coffee cup with either hand to drink, but that doesn’t make me a lefty. If you paid me $100, I probably couldn’t thread a needle with my left hand.
Children that aren’t practicing refined skills like feeding or assembling blocks, or even intent on picking up every darn piece of lint on the carpet…they don’t need refined grasp, and they probably will not demonstrate hand dominance on time. Kids that are scribbling wildly but haven’t tried to draw a circle with closure ( a 36-month skill, BTW) also have no need to develop dominance. The self-starter, the baby and toddler that watches you intently and decides to learn all these skills? They won’t need much help. But the child who avoids challenge or gets help because it is easier and faster for an adult to feed them or help them build a tower? They may lag behind in hand development.
Some kids are very tuned into adult actions, and copy the hand that a parent or teacher uses. These are the children that are great mimics. They can see that you are using your right hand, and even if they naturally grab with their left hand, they transfer objects into the same hand you are using. Adults are naturally inclined to assume dominance as well. I cannot count the number of times I absent-mindedly handed a pen to a left-handed parent into their right hand. If you do that to a child under 5 , they assume that you want them to use that hand, and will struggle on. This is where spoon placement matters. I encourage parents to place the utensil in the center of the placement or tray, and watch which hand (both of the child’s hands must be free) their child chooses over many trials.
If a child is inconsistent but clearly uses their left hand more often, placing their spoon on that side of the tray should boost use, and with skilled use comes more skill and awareness. I never pull objects out of a child’s hand. I don’t need to. They will drop their crayon or spoon frequently enough for me to have another chance to offer it back to them.
What if I (or a parent) picked wrong?
Dominance isn’t that easy to alter. Ask your grandmother what the nuns in Catholic school did to alter dominance in lefties (it was considered “the devil’s hand”, and what they did wasn’t pretty). Children will eventually simply transfer their spoon over to the other hand.
