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Children with sickle cell disease (SCD) demonstrate deficits in cognitive and academic functioning. This study compared the visual motor integration (VMI) skills of children with SCD to non-SCD sibling controls.In total, 105 participants (67 patients with SCD, 38 controls) were recruited during a routine clinic visit. Each participant was administered the Grooved Pegboard Test, a test of manual dexterity and the Beery-Buktenica Developmental Test of VMI, a measure of graphomotor skills.Children with SCD demonstrated average (M=89.61, SE=3.08) fine manual dexterity and speed, but more complex fine motor functioning (graphomotor skills) (M=77.61, SE=1.65) was impaired. Relative to healthy siblings, children with SCD were not found to have different fine manual dexterity and speed (P=0.617). Patients with SCD were found to have significantly worse graphomotor skills (P=0.04).Children with SCD were found to have average basic fine motor dexterity and speed, but impaired VMI, a more complex fine motor skill. This finding is significant given the functional importance of complex fine motor skills in early academic activities.