BACKGROUND: In-hand manipulation skills (IHMS) are components of fine motor skills that are routinely used by children and adults during activities of daily living, recreation, and work. The only readily available tool to comprehensively assess in-hand manipulation (IHM) in children between the ages of three and nine is the test of in-hand manipulation (TIHM). However, like any norm-referenced test, TIHM requires normative values for accurate interpretation. Unfortunately, normative data for TIHM is not currently available. OBJECTIVE: The objective is to develop normative values of TIHM in typical children between three and nine years of age in Kerala. METHODOLOGY: This study included 793 children. The inclusion criteria included girls and boys between three and nine years of age. Cluster sampling was used for data collection. The whole activity sequence was videotaped and analyzed for manipulation skills, and scoring was done. Data was analyzed using IBM SPSS Statistics for Windows, Version 22 (Released 2013
IBM Corp., Armonk, New York, United States). RESULT: Most of the children from six to eight years of age scored the maximum range for all the components. Most of the children between three and four years of age used more than one compensatory method rather than manipulation, and they had difficulty following instructions and they took more time. There is no significant difference between the performance of girls and boys of the same age group in any of the variables observed. CONCLUSION: Normative values of TIHM in children between five and nine years have developed.