Will my son learn how to use a knife and fork or tie his shoes well by the time I die?
Talking about kids who no do hand things good
When I was in college, my freshman roommate Liz and I bonded over how we both grew up with brothers. I got a giggle when she’d lament how badly her young brother Andrew handled a knife and fork. “He can’t cut!!” she’d laugh-cry, and I laughed along because: brothers.
Now, I am the mother of a brother who can’t cut, and I understand why Liz was so flummoxed. While I try to take more of an attitude of exhausted resignation, my husband is in horrified disbelief over how ineptly our older son uses silverware and somehow gets worse at it with each attempt to instruct him. Like it’s almost creative, the new ways he finds to mismanage a knife and fork.
I’ve written about this before—that teaching your child to use utensils is incredibly hard, and people are judgy about it, and then that makes us parents wonder what the hell. I’ve wondered why certain older kids who otherwise don’t seem to demonstrate development delays or significant neurological issues have such a hard time with silverware (and other related skills like shoe-tying.)
I spoke with three pediatric occupational therapists to try to learn more about what’s up with this. If you want the TL;DR version, it’s that: this is a thing, don’t feel bad/be mad at your kid, and you can either wait it out or, if you have it in you, go see an OT who can most likely help.
But here are some things I learned that might elucidate you if you, too, have stared with dismay as your older child fumbled with a knife and fork or took an achingly long time to tie their shoes despite the instructional YouTube videos. (This is not medical advice but the OTs’ observations from their work.)
It relates to motor skills and muscle tone.
Suzie Driscoll, MOT, OTR/L at Tiny and Might Therapy in Seattle told me about praxis, the ability to conceptualize, plan, organize, and execute a new action:
“When they’re learning to ride a bike, [kids] learn how to balance their body and hold onto the handles, and move their feet on the pedals, so it’s really complex if you think about it. For kids with motor praxis, somewhere along the line, there’s a little bit of disconnect in putting all those pieces together. You have to have ideation like, ‘Okay, what am I doing?’ Thinking about it and then translating that into actual movement.
Some kids have a hard time even with the idea portion. They have to plan out the motor movements. It’s like, ‘How do I move my legs left and right?’ coordinating that movement, as well as execution, the sequencing of the steps.
If I saw a kid who came to me for that concern, I would do a comprehensive physical assessment, and I would use a thing called a dynamometer. It’s like a pinch test that can see where they lie in the age-related norm. Sometimes kids do have decreased strength in their grip and pinch strength, so we can also work on strengthening the hand a little bit and coordination, too.”
Jennifer De la Rosa, a pediatric occupational therapist at the University of Chicago Medicine, told me:
“Some of my kids who have struggled with handwriting, with utensil use, tying shoes, just overall fine motor manipulation sometimes tend to be of lower tone or decreased strength. Whether that is due to something that is musculoskeletal or something hereditary, all of us are born with different muscle tone, and muscle tone doesn’t change over the course of our lives. Usually I like to work on strengthening at the core, hoping that if they are stable and more strong at their trunk, that they’re able to move their arms and their hands and their fingers better.”
Jessica Zawortny, MS,OTR/L, located in New Jersey, said, “In my previous experience [at] a private practice, [I saw] families who were looking for a set of hands and supports to help to build skills. The struggles would be limited independence in the management of shoe tying and utensil use. Upper limb coordination is how I would categorize the skill building, and then praxis. [Seeing an age range of approximately 8-15 years old,] I would do an assessment of their upper limb coordination (which is basically their ability to use their hands together and coordinate things at midline), their visual motor integration skills (which is their ability to use their eyes along with their hands simultaneously to achieve a task or skill) and grasping skill development.
Through that, I essentially got a standardized assessment score. If they were below that 50th percentile, then that would warrant me saying, ‘Hey, they have a little bit of a delay in this specific area, or what we would consider a skill deficit. Let me support you.’
There is no classification for typical or atypical. It was just honing in on, let’s say, a skill deficit that impacted their function [often relating to ] utensil use, and often shoe tying, and then riding a bike was right up with that. There was never really thought of what was the origin behind it? It’s just an identification of learning styles.
You can deep dive into the integrated reflexes. When a kiddo went through development from 0 to 24 months, were there any milestones that were skipped? Some kiddos go from crawling right to walking. That stage is connected to skill development, and that’s how we look at it. It’s teeny little things that could contribute to the big picture. There could be so many whys.
You can make two children who can be so vastly different from one another, and you didn’t do anything different with one or the other. Same household, same environment, you’re doing the same thing. It’s just our makeup is so inherently different. There are so many teeny little factors that you would imagine to be insignificant factors that can contribute to that functional outcome.”
Many kids don’t have lots of everyday practice with silverware.
The OT’s made me realize that kids may go many meals, even whole days, without using utensils. Say your older kid is eating toast or waffles for breakfast or some sort of sandwich or a Lunchable or a bento box for lunch, maybe tacos, nugs or wraps for dinner. And this is not to level any kind of judgment on parents who can’t make time or have the energy to do a sit-down family dinner consistently (we certainly don’t at my house), but that’s another aspect to it: your kid may not get a lot of time to practice or observe silverware use in action.
Silverware use is a skill that is more of a “nice to have,” than something essential, and therefore falls to the parents to teach them.
Another thing I realized: your pediatrician is not likely going to ask your kid to show them how to use a knife and fork. Your child can pass school with flying colors without knowing how to tie a shoe. I remember we had an early intervention for my younger son when he was an infant because the pediatrician had spotted low muscle tone. But the pediatrician never says, “How is her fork and knife use going? Is she tying a shoe yet? How’s her handwriting? Can she ride a bike?” I think we forget that this is a skill that’s assumed we will teach our kids well with no drama, and that’s not always the case.
There are many ways to use utensils, making it hard for parents to know how to teach how to use them. And most parents are not experts at teaching.
De La Rosa: Some cultures use their hands predominantly; some cultures use utensils, but they use it in a different way. I’m Filipino, and Filipinos definitely use forks and spoons very differently. A lot of times, we just use a spoon to cut food. It can be very culturally specific, and I want to make sure that I am being sensitive and mindful of those types of things. I [want to have] that conversation with the family early on about what are your expectations and where are you seeing these challenges occur? Is it in the home environment? Is it mostly at school? Because at school, they can also have a different set of demands.
Zawrotny: I do a lot of reassuring and validating parents’ experiences. You can do all the research and get all the cool tools and utensils that you can find to help set them up for success. But it’s harder for a parent to be the teacher because [the kids] don’t want to let mom and dad down. To teach them and to be the one that’s watching them struggle through it is just hard.
[I let parents know] if I don’t support you right now, they’ll probably figure it out eventually. But what I can do is I can help Mom and Dad alleviate the frustrating piece. I literally do this every day so I can teach it in an efficient way. And, when you’re getting information or education from Mom and Dad, it’s not as well received as it is from a stranger in an environment that’s fun.
We all have different learning styles. I don’t think everybody has sensory issues, but I think we all have sensory preferences and things that support how we exist and feel comfortable in the world, what we seek, and what we avoid to optimize our function.
Anecdotally, this motor difficulty seems to affect boys more than girls
Kids of all gender identities have these motor struggles, but the OTs I spoke with agreed with my observation that, generally boys tend to experience this type of struggle more than kids of other genders. Nobody had a definitive explanation why, although Zawrotny suspects it may have something to do with socialization and an overall desire to emulate adults. “The only thing I would identify as generalizable from a gender perspective is that I see consistently as speech. The development of speech in boys, anecdotally as an OT, is often just a little bit more behind than in girls. [It seems that] girls can be more eager to interact, where boys more often tend to sit back, and wait, and watch, and take it all in, and then react.”
The pain points of teaching these skills can create a lot of stress for parents and kids. Choose your battles.
When are you most likely to watch your child struggle with tying a shoe? Usually, when you have to be somewhere, right? How about silverware use? Dinnertime, when everyone is exhausted.
De La Rosa: I’m not going to make you sit there and work on using your utensils and have you get frustrated because you can’t spear or you can’t scoop appropriately. I usually tell families to work on three to five bites of food in the beginning and then, after that, eat your meal as you typically would because if we add this demand and we make the entire meal just about utensil use, I think that it can make mealtime a very negative experience and we don’t want that.
Driscoll: Sometimes OTs will be like, “Hey, let’s just make it easy for everybody.” This is not a problem at all if you use an assistive device, so why bother with shoe-tying if it’s just going to take 10 extra minutes of your day that you can be spending doing something else you love? As long as the child is like, “Okay. I like that style,” there are velcros, there are slip-on shoes, there are so many options that you can do. There may be some strategies that you can make it easy on yourself so that you don’t have to beat yourself up over it.
If this motor stuff does concern you, and if you have the time/money to get to an OT, they can help your child get more proficient at these skills. Even older kids.
Driscoll: For OTs, function is a really big keyword in our field. If a child is functional, it might not be perfect the way they use it. It might not be the most graceful, but it doesn’t cause any difficulties in their daily activities or social participation, especially because eating is a social activity.
If they feel like it’s not a barrier to participating in talking with their friends while they’re trying to eat or even family meals, if those things are not a concern, that’s totally okay. But if that bothers the child or it’s impacting their social, emotional, or physical, or aspect of their well-being, then I think it’s wise to potentially get a consult.
De La Rosa: I’ve definitely had some eight, nine, 10-year-old boys that I’ve seen in the past who have struggled with these types of things. I do feel like it did affect their self-esteem. They were aware of their challenges, and they were always comparing themselves to their peers, and that’s really tough. I would always encourage them to take their time to celebrate the small wins. I know this is easier said than done, but [I would tell them] not to compare themselves to the next person. We would also spend a lot of time working on those foundational skills and just making it as fun and as playful as possible so that it didn’t seem like it was work and that it’s something that they could apply to their everyday life.
Zawrotny: These were kids that were super, super independent, successful kiddos. But Mom and Dad were just sick of it taking 30 to 90 minutes in the mornings to get ready for school. They would come to me [saying], “Everything’s looking good. Standardized tests and everything that we would do was beautiful, but this area of function...”
I’ve probably just seen a kiddo just for shoe tying because it’s a skill. I am seeing them for maybe four visits. I’m having them practice the way that I presented it at home, and then, hopefully, they’re done. I’m just trying to give them the feedback and support that they need at the moment. Especially if it’s a pediatric population, our role is to make sure that we are making it fun and patient-specific. We’re usually pairing the frustrating, hard thing that we’re doing with something super fun at the end that they get to earn to do. The OT’s role in that scope is to help to support that emotional processing as well and really instill confidence in that child that they got it. This is like, “You got this.”
I just want to live in a world where we normalize that nobody’s without the need for support. We’re modeling that it’s okay for them to need help and to ask for it in order to be better, to grow and develop, and to live in this crazy world that we live in.
Mainly, give yourself and your kids a break (and get away from judgy people IRL or online.)
De La Rosa: I know that you are balancing a million things. Just give yourself some grace, and don’t be so hard on yourself. I’m more concerned about these types of challenges when it’s interfering with overall function and participation in life. For example, I have had some older children who have struggled with handwriting to the point where they’re not able to keep up with taking notes at school, but I also keep in mind because these children are older, how much am I really going to be able to help with their handwriting? Have we reached a point where it’s more important for me to focus on your keyboarding skills? There are always other options.
I think kids have a lot of things on their plate at school. They are under pressure all day, right? They have to keep it together. They are performing under the demands of their teachers and their peers. I think keeping those things in mind when you’re speaking with your child it’s very important. Just give them the opportunity to be a kid and remember that they are still learning and they still have a lifetime of learning left to do.
And Andrew, Liz’s brother? Well, he’s a full-grown middle-aged man now with a wife, three adorable kids, a great job in healthcare and a home near his loving parents in New York. He reported to Liz that his utensil skills have greatly improved over the years. So, if it can happen for our little brothers, it can happen for anyone.
After our really delightful thread on funny tee shirts we like, witch Kristen Cox made and sent me this shirt saying “I’m Tried,” a beautiful nonsensical mix of “I tried” and “I’m tired.” I could have had my professional film/video husband guy take a flattering photo of me in it but instead got my 8-year-old to do it, making sure to capture the laundry basket and Costco boxes and cutting off the top of my head. Please visit Kristen’s Etsy shop for more good things.
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One witchy thing
“I forgive you for saying the s-word.”
—My 8-year-old, a few hours after I, in a rare moment of frustration, informed him and his brother, “I know you both think you’re hot shit but I just want you to know I do everything for you. Everything.”
“I forgive you for making me say it.”