Hand differences
Self Care Booklet

Developmental Milestones

Milestones for independence in self-care tasks, as quoted in textbooks, do not always apply to children with a hand difference. A child who has a hand difference may not be able to perform some activities, in the same way and at the same age that a child without a hand difference typically does. In order to devise alternative strategies, which are usually more complex and require greater developmental maturity, the child understandably needs to be a little older before an alternative way of performing the task can be mastered.  Therefore it is very important that the child with a hand difference is provided with ongoing assistance to perform the tasks until he/she is old enough to manage the more complex adapted method required for independence.

The following milestones may help you identify the ages when children without a hand difference typically learn independence in some self-care tasks.

2 ½  – 3 years Removes jumper or T-shirt
3 years Pulls down pants
3 – 3 ½ years Puts on pullover garment
3 ½  – 4 years Puts on open front shirt
4 years Pulls pants up
4 years Puts socks on
4 ½ – 5 years Manages shoes with Velcro
4 – 4 ½ years Buttons and unbuttons most buttons
5 ½-6 years Zips, unzips, hooks, unhooks, separates zipper
5 – 7 years Uses a knife to spread and cut soft food
6-6 ½ years Ties shoelaces with a bow
7 years Brushes teeth routinely after meals
7 years Combs hair using mirror to check style
7 – 8 years Cuts meat with knife and fork
8 years Maintains clean nails, files, clips
12 years Uses deodorant daily


Coley IL (1978). Paediatric assessment of self-care activities. St Louis, Mosby

Hayley SM, Coster WL, Ludlow LH, Haltiwanger JT, Andrellos PJ (1992). Paediatric evaluation of disability inventory. Boston, New England Medical Center Hospital and PEDI Research Group.

Henderson A (2006). Self-care and hand skill. In A Henderson and C Pehoski, editors: Hand Function in the Child: Foundations for remediation (pp 193-216). St Louis, Mosby