Visual Motor Skills By Age

visual motor skills by age

This resource includes visual motor skills by age and lists visual motor integration developmental milestones. Visual motor development is part of hand eye coordination skills that happen from a very young age. From shaking a rattle and reaching for baby toys, to holding a pencil and writing letters, the developmental milestones are something to guide functional skill achievement! Let’s explore these visual motor developmental milestones!

Visual motor developmental milestones

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Visual Motor Skills by Age

If you’ve followed along with us here at The OT Toolbox, then you know that I love to pull my background as an occupational therapist into posts.  The crafts and activities that we do are more than just fun and cute.  There are important skills that a child develops through play.

Visual Motor Skills are needed for many functional tasks like handwriting and pencil use, scissor use clothing management, and many more tasks. 

How does Visual Motor Integration develop in kids?  We put together this list of  developmental milestones  for a general idea of development and so parents can tell when a problem might be present.  

It is important to note that every child is different and every child develops differently.  These milestones are organized by developmental stages.  Be sure to contact your pediatrician for medical advice. If occupational therapy is needed to assist with delays in visual motor integration, an assessment from a licensed occupational therapist is necessary to determine individual needs and treatment.

This hand eye coordination activities for toddlers post has more ideas.

What is visual motor integration?

Visual motor integration is often times presented a Hand eye coordination.  It is the ability to use your hands and eyes together in a coordinated manner.  

However, visual motor integration has some difference: The visual perceptual skills that are necessary for the visual component of visual motor skills play a major part in perceiving and interpreting visual information.

With skill achievement comes greater precision and finger dexterity, as well as the motor planning needed in order to accomplish more difficult tasks.

Visual motor development is needed for many functional tasks:

  • Shake a rattle
  • Reach for toys
  • Bring toys to the mouth
  • Reach for a face when held (babies)
  • Pick up food from a high chair tray
  • Reach for a bottle or cup to the mouth and putting it back down
  • Releasing objects or toys (babies dropping things from their high chair continuously and love seeing someone older pick it up and put it back so that they can drop it again reinforces this skill)
  • Coloring with crayons- progression of coloring skills happens with age along the milestone achievement
  • Scribbling
  • Playing with toys- shape sorters, puzzles, cause and effect toys, etc.
  • Holding a pencil and drawing shapes, forming letters- This level of visual processing is necessary for copying forms and identifying inconsistencies in written work. It plays a part in letter reversals and letter formation.  
  • Cutting with scissors
  • Navigating stairs
  • Throw a ball
  • Catch a ball
  • Pouring and scooping
  • Using utensils- progression from spoon, to fork, to knife- Check out this resource on how to hold a spoon and fork for specifics.
  • Riding a bike
  • So many more tasks that require visual motor skills!

In eye-hand coordination specifically, the eyes and hands work together to move the pencil, catch a ball, thread beads on a pipe cleaner, or other tasks that require the eyes and hands to fluently coordinate in actions.

You can see how, with development of both the eyes and motor skill dexterity and strength of the hands, feet, core, and legs allows for progression of skills.

The visual component and the motor skills begin working together at a very young age and continue to develop in efficiency as a child grows.  This is visual motor development!

Visual Motor integration and developmental milestones
Visual Motor and Developmental Milestones
visual motor skills by age

Developmental Milestones for Visual Motor Integration 

These visual motor developmental milestones are listed by age of typical development, however, these are general guidelines of development. There can be many other considerations impacting skill achievement. If a child hasn’t achieved a skill by the dates listed below, it’s not a huge issue. It could be that the path to skill progression is varied, and that’s ok!

If you have questions about these milestone skills and dates, especially if it seems there are many skills that aren’t being achieved within months of the dates listed below, it may be beneficial to seek out input and individualized evaluation from a pediatric occupational therapy professional.

Resources may include our parent toolbox, getting started with OT, and what you need to know about child development.


  • Tracking a rattle while lying on back                
  • Tracking a rattle to the side                


  • Infant regards their own hands
  • Tracks a ball side to side as it rolls across a table left to right and right to left
  • Tracks a rattle while lying on back side to side


  • Extends hands to reach for a rattle/toy while lying on back


  • Reaches to midline for a rattle/toy while lying on back
  • While lying on back, the infant touches both hands together.


  • Brings hands together to grasp a block/toy while sitting supported on an adult’s lap
  • Extends arm to reach up for a toy while laying on back


  • Transfers a block/toy from one hand to the other while sitting supported on an adult’s lap.
  • Touches a cereal piece with index finger
  • Bangs a toy on a table surface while sitting supported on an adult’s lap


  • Claps hands together




  •  Turns pages in a board book
  • Imitates stirring a spoon in a cup


  • Imitates tapping a spoon on a cup
  • Begins to places large puzzle pieces in a (Amazon affiliate link) beginner puzzle (affiliate link)


  •   Scribbles on paper


  •   Imitates building a tower of 2-3 blocks (affiliate link)


  •  Builds a block tower, stacking 4-5 blocks (affiliate link)



  • Removes a screw top lid on a bottle
  • Stacks 8 blocks (affiliate link)
  • Begins to snip with scissors


  • Imitates horizontal strokes with a marker
  • Strings 2 Beads (affiliate link) (read about fine motor skills with beads for more ideas to support this development)
  • Imitates folding a piece of paper (bending the paper and making a crease, not aligning the edges)


  • Imitates building a train with blocks
  • Strings 3-4 Beads (affiliate link)
  • Stacks 10 blocks (affiliate link)


  • Builds a “bridge” with three blocks (affiliate link)


  • Copies a circle


  • Builds a “wall” with four blocks (affiliate link)


  • Cuts a paper in half with scissors



  • Cuts within 1/2 inch of a straight line
  • Traces a horizontal line


  • Copies a square
  • Cuts a circle within 1/2 inch of the line
  • Build “steps” with blocks (affiliate link)


  • Connects two dots to make a horizontal line
  • Cuts a square within 1/2 inch of the line
  • Builds a “pyramid” with blocks (affiliate link)


  • Folds a piece of paper in half with the edges parallel
  • Colors within lines
What is Visual Motor Integration?  This blog has a lot of information on visual motor integration developmental milestones and activities for kids.
This post contains affiliate links.  You can read our full disclosure here.


Activities to help develop visual motor integration

When it comes to play, visual motor integration is part of every play activity. Some informative resources that include the sensory motor integration of visual input and motor output include the underlying skills that are all related.

These specific activities will support visual motor skills and visual motor skills play a pivotal role in these areas:


Developmental milestone achievement in children occurs through play. Use these play ideas to get you started on building skills:

Some more of our favorite OT activities for supporting development of visual motor skills includes:

Blue-Themed Sensory Play for Babies and Toddlers

Fine Motor Play with Tissue Paper

Baby Brain Building

Invitation to Scoop and Pour

Baby Ice and Bath

Playing With Color

Learning Apples and Red

Learning Colors Cup Play

Cups and Spoons

Tracing Letters: Letter Formation Handwriting Practice with Chalk

Tracing Lines with a DIY Light Box

Pencil Control Worksheets You Can Make At Home

Christmas-Themed Pencil Control Activities-DIY Worksheets for Pencil Control

Line Awareness with Beads 

Scissor Skills: Activities for Kids

Improving Scissor Skills with Play Dough

Cutting Foam Beads

Using  Stickers to Help with Scissor Skills

Finger-painting Fireworks for Scissor Use

Icicle Winter Scissor Skills Activity

Bunny Tongs Scissor Skills Activity

Color Sorting Scissor Activity

Use the fine motor kits to support development of visual motor skills and visual perception development through hands-on, play-based activities:

Working on fine motor skills, visual perception, visual motor skills, sensory tolerance, handwriting, or scissor skills? Our Fine Motor Kits cover all of these areas and more.

Check out the seasonal Fine Motor Kits that kids love:

Or, grab one of our themed Fine Motor Kits to target skills with fun themes:

Want access to all of these kits…and more being added each month? Join The OT Toolbox Member’s Club!

Sensory Brushing

sensory brushing

If you’ve looked for sensory strategies, you may have considered Sensory brushing as an option. This post will describe what sensory brushing means, why it is used, and what the potential benefits can be. 

When faced with a new or complicated list of symptoms and behaviors, there are several techniques that may be offered or trialed by occupational therapists.  One of the more popular and widely used programs is sensory brushing.  Therapeutic techniques are definitely not one size fits all, therefore, researching, trial and error, and professional judgment are advised when trying any new technique.

sensory brushing

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What is sensory brushing?

Sensory brushing is a layperson’s term for the Wilbarger Deep Pressure and Proprioceptive Technique (DPPT) & Oral Tactile Technique (OTT). 

In the past it was simply referred to as the Wilbarger Brushing Protocol, or the Wilbarger Protocol.  The DPPT refers to the specific sensory modulation techniques developed by Patricia Wilbarger, MEd, OTR, FAOTA. 

Patricia Wilbarger is an occupational therapist and a clinical psychologist who is also known for coining the phrase “sensory diet.”  She is a leading expert in the area of sensory defensiveness (the over-responsiveness of the protective responses of the nervous system).  

Wilbarger, P. & Wilbarger, J.  (1991).  Sensory  Defensiveness in Children Aged 2-12: An Intervention  Guide for Parents and Other Caretakers, Avanti  Educational Programs: Santa Barbara, CA.

Based on the theory of Ayres Sensory Integration, the DPPT, or sensory brushing technique, uses a prescribed method of providing stimulation through pressure touch massage, to help the mind-brain-body self-organize. 

The protocol also includes a series of joint compressions that are always used in conjunction with the brushing to enhance joint perception and feedback. This is based on proprioceptive input through the joints and deep input through the skin.

The Wilbarger Protocol is designed to be used in conjunction with an individualized sensory “diet” based on the specific needs of the child and carried out under the guidance of someone familiar with the protocol and trained in sensory integration theory and practice. 

Check out this sensory processing disorder chart on the OT Toolbox for more information on sensory processing.

 Please note: training in sensory brushing is absolutely necessary before attempting to use this technique in practice, otherwise harmful or ineffective influences may be the result.  Be sure to receive the most up to date brushing protocol training as it has changed over the years.

When to trial a sensory brushing program?

There are several situations that may be a predictor of using a sensory brush in occupational therapy as a tool to support sensory needs.

  • Tactile defensiveness – fear and discomfort of being touched, touching things, or having something touch the skin. The brushing program can reduce tactile defensiveness and oversensitive responses
  • Sensory seeking – adding extra deep pressure and sensory input can help the body regulate sensory information
  • Difficulty with self regulation – including paying attention, transitioning between activities, motor coordination, functional communication, safe behaviors

sensory brush benefits

What does a sensory brushing do?

Sensory brushing can do several things, and depending on the individual and their sensory preferences or sensory needs, there can be different results following use of a sensory brush.

  • Improved ability to transition between tasks
  • Decreased discomfort from being touched, or touching
  • Improved self regulation with less behavioral outbursts
  • Decreased picky eating
  • Ability to wear more of a variety of clothes, and engage in different textures
  • Satisfy the need to explore and touch everything
  • Self awareness, self control, handling new situations easier
  • A sensory brush may support tactile processing differences.
  • Sensory brushing can be calming or organizing when used in a sensory diet
  • Use of a sensory brush can support tactile resistiveness

The tactile system sends information into the touch receptors from our skin.  There is much to consider when thinking about touch.  Pressure (light versus heavy), texture, (rough, sticky, soft, wet, dry, silky, smooth, bumpy) temperature, (hot, warm, cold), and emotions regarding texture, (will I be able to wash my hands?) People react differently to different types of touch depending on their system. 

Children with difficulty integrating the tactile system tend to look like this:

Oversensitive (defensive):

  •  Does not like to be dirty
  • Avoids touching food
  • Fingers splayed after touching object
  • Anxious about being messy
  • Avoidant
  • Irritated by tags or types of clothing
  • Doesn’t like grooming (hair cutting, shampooing, tooth brushing, fingernail cutting)
  • React negatively to touch (pulling away, hitting, or crying)


  • Always dirty
  • Constantly touching objects or people
  • Doesn’t mind being messy
  • Doesn’t notice when hands or face are messy

wilbarger brushing protocol

What do I need to know before starting the Wilbarger brushing protocol?

Because of the ready availability of (affiliate link) sensory brushes on Amazon, it can be easy to get your hands on one (and feel the effects of a sensory brush on your hands!) But, before you start using one, it’s important to consider specific things you should know about sensory brushing or the DPPT.

  • The sensory brushing program, when performed correctly, can have some great benefits.  If performed incorrectly, there may be negative effects, or be ineffective
  • There is a specific brush to use for the brushing program – in order to be consistent and effective, look for a (Affiliate link) Willbarger approved brush.  There is a basic and a (affiliate link) deluxe model.  The deluxe model has a larger handle for comfort and control, but is not necessary.  Other brushes, hair brushes, paint brushes, etc. are not consistent in the pressure they provide
  • Apply firm consistent pressure – light pressure will disorganize the system or cause increased arousal
  • Do not brush the stomach or chest.  Brushing the stomach may affect digestion, and the chest may affect respiration.  
  • Stay away from the face when brushing.  It is too sensitive an area.  Instead use a washcloth, or warmed lotion
  • Sensory brushing is more effective over bare skin, however if brushing over clothing pull the clothing tight and eliminate bumps
  • Follow brushing with joint compressions
  • Sensory brushing should not cause pain. It might take some practice and effort to complete the cycles, but it will be worth it!
  • Use the most updated sensory brushing protocol
  • Best practice is to brush every 90 minutes to 2 hours, stopping at least 2-3 hours before bedtime, as brushing can increase arousal level.  Aim for at least six brushes daily
  • Include brushing into daily routines such as diapering, toileting, dressing, transitions between activities
  • Complete two to three weeks of this intense brushing, then discuss fading with a therapist

What to watch for when using a sensory brush:

Sensory brushes, like any sensory tool can have detrimental side effects. For this reason, it’s important to consult an occupational therapy professional trained in use of these tools.

  • Negative side effects such as difficulty eating, sleeping, worsening of behavior, digestive issues, moodiness, etc.  If these occur, advise spreading out the brushing until the learner’s system accommodates to it
  • Positive behavioral changes – encourage caregivers to keep a record or chart to track behaviors

A word about evidenced based practice

Governing agencies strive to produce techniques that are backed by evidence and research.  While there is evidence that the brushing program can be effective, it is inconsistent.  All sensory treatment is, unfortunately, based on trial and error. 

Because the treatment does not occur in a bubble, it is difficult to get definitive results and research.  What works one day, may not work the next.  Much like the use of weighted blankets and compression garments, there is evidence found in the literature, and there is skilled experience from professionals.

A treatment protocol that seems to be working may be influenced by diet, the weather, mood, concurrent techniques, and 57 other variables.  Because the program (generally) does not cause harm, it is worth trying.  

Personal Therapeutic Experience with Sensory Brushing:

I have used the brushing program personally, and in practice during the past 25 years.  It has worked for some, but not all.  Personally I found it difficult to keep up with regimen of brushing. 

Even though it was only 3-5 minutes each cycle, remembering to do it every 90 minutes was tough.  In addition, when I was feeling better, I could not be sure it was the brushing that was affecting me.  It could have been a sunny day, my mood was elevated, I had a good night’s rest, and had a good breakfast.  It did not harm me, and even if it was a placebo, it was worth it to feel better. 

Give parents some leeway as they incorporate this into their busy lives.  Remind them it is only for a couple of weeks.  Like adding an antibiotic, it is tough at first, but will be over soon.  If caregivers can only get four cycles in a day, that is better than nothing.  If they are not doing it consistently enough to gauge progress, it might be better to wait until they are able to commit to this program before starting. 

Sensory brushing, as with any other techniques is definitely not one size fits all.  My philosophy is to offer the least restrictive or invasive option first.  Start with a sensory diet, play based activities, and therapeutic activity before jumping straight into sensory brushing or DPPT.

Victoria Wood, OTR/L is a contributor to The OT Toolbox and has been providing Occupational Therapy treatment in pediatrics for more than 25 years. She has practiced in hospital settings (inpatient, outpatient, NICU, PICU), school systems, and outpatient clinics in several states. She has treated hundreds of children with various sensory processing dysfunction in the areas of behavior, gross/fine motor skills, social skills and self-care. Ms. Wood has also been a featured speaker at seminars, webinars, and school staff development training. She is the author of Seeing your Home and Community with Sensory Eyes.