Five-Finger Breathing (Hand Tracing)
An illustrated guide to five-finger (hand-tracing) breathing, combining slow breathing with touch, with a reflection prompt and a 7-day practice log.
2-page fillable PDF · US Letter (prints on A4) · Breathwork · Grounding
- Approach / concern
- For Kids
- Technique
- Breathwork · Grounding
- Format
- Fillable PDF, 2 pages (US Letter / A4)
- Access
- Pro and Advanced plans (3-day free trial)
- For
- Licensed clinicians to use with clients
- Updated
- October 2026
Key facts
What is the Five-Finger Breathing (Hand Tracing)?
Five-finger breathing, also called hand tracing or starfish breathing, pairs slow inhalations and exhalations with tracing the outline of the hand. The visual and tactile elements make it engaging and easy to remember, especially for children.
Why it works
Slow breathing supports calm physiological states (Zaccaro et al., 2018), and concrete, multisensory coping skills are well suited to children in CBT for anxiety (Kendall & Hedtke, 2006).
When to use it
- Children with anxiety, anger or worry
- Classroom calming routines
- Adults who find breath focus hard
- Before sleep or stressful events
How to use it in session
- Demonstrate slowly on your own hand.
- Practise together once or twice.
- Encourage use at transition times.
- Track calm before and after.
- Add to the child’s calm-down plan.
Clinician tips
- Go slowly; the breath should match the tracing speed.
- Discreet for use in class or meetings.
- Make it playful: trace with a feather or crayon.
Worked example
Sharing with clients
Members can download the PDF to print or email, or copy a private client link from the download box. Your client opens the link and downloads the worksheet on any device. No client account is needed, and nothing your client writes is stored on TherapyAid.
Frequently asked questions
What age is this good for?
Most children from about age 4, and adults too.
How many times should we do it?
One or two full hands is usually enough to notice a change.
References
Kendall, P. C., & Hedtke, K. A. (2006). Cognitive-behavioral therapy for anxious children: Therapist manual (3rd ed.). Workbook Publishing.
Zaccaro, A., Piarulli, A., Laurino, M., Garbella, E., Menicucci, D., Neri, B., & Gemignani, A. (2018). How breath-control can change your life: A systematic review on psycho-physiological correlates of slow breathing. Frontiers in Human Neuroscience, 12, 353.
This worksheet is an educational tool for use by, or under the guidance of, a licensed or registered mental-health professional. It is not a diagnostic instrument or a substitute for clinical judgement. If a client is in crisis in Canada, call or text 9-8-8 or call 9-1-1.
