Bilateral coordination is one of those behind-the-scenes skills that quietly powers so much of what kids do every day. From tying shoes to riding a bike, from cutting with scissors to catching a ball—using both sides of the body together in a smooth, organized way is essential. In pediatric occupational therapy, bilateral coordination is a foundational skill we often target to help children participate more confidently and independently in daily activities.
Bilateral coordination is the ability to use both sides of the body together in a coordinated way. Sometimes both sides are doing the same thing (like clapping), and sometimes each side is doing something different but complementary (like holding paper with one hand while cutting with the other).
This skill relies on strong communication between the two hemispheres of the brain, allowing movements to be timed, sequenced, and adjusted smoothly. As children grow, they move from symmetrical movements (using both hands the same way) to more complex, asymmetrical tasks that require one hand to stabilize while the other manipulates.
From an occupational therapy perspective, bilateral coordination supports:
Bilateral coordination begins developing in infancy. Babies use both hands together to hold a bottle or bang toys. As they grow, they start to differentiate roles for each hand. Around preschool age, most children begin to show a hand preference, with one hand becoming more skilled at fine motor tasks while the other supports and stabilizes.
By early elementary school, children are expected to manage more complex tasks requiring refined bilateral skills—like cutting detailed shapes, tying shoelaces, and writing or typing for longer periods.
Some common signs of bilateral coordination difficulties include:
Occupational therapists look at the “whole child”—not just the motor skill itself, but how it impacts daily participation. During an evaluation, an OT may assess fine motor skills, visual-motor integration, core strength, and motor planning to understand the underlying factors affecting bilateral coordination.
Strong core muscles provide the stability needed for coordinated arm and hand movements. Activities like animal walks, wheelbarrow walking, and climbing can build this foundation.
Clapping games, jumping jacks, rolling a ball back and forth, or using a rolling pin help children coordinate both sides of the body together.
Tasks like stringing beads (one hand holds the string, the other threads), cutting shapes, and building with blocks encourage one hand to stabilize while the other manipulates.
Parents and caregivers can support bilateral coordination at home with simple, playful activities:
The key is repetition in a fun, low-pressure environment.
Bilateral coordination is more than a motor skill—it’s a gateway to independence. When children can confidently use both sides of their body together, they engage more fully in school, play, and self-care. By strengthening bilateral coordination through playful, purposeful activities, we empower kids to build skills, confidence, and joy in everyday occupations.
If you’re noticing challenges in this area, early support can make a meaningful difference. With the right strategies and encouragement, children can develop the coordination they need to thrive—one two-handed task at a time.
