Aim: This study examined the prevalence and risk factors of fine motor delay in Australian pre-school children from low-income communities. Methods: Children from the Early Start Baseline Study completed the Ages and Stages Questionnaire (3rd edn.). Age, sex, executive function and family characteristics were assessed and associations with fine motor skills analysed. Results: Data were available for 700 children (Mage 54.0 ± 8.6 months, 53.1% boys) of which 77.4% were typically developing, 12.1% at risk and 10.4% delayed for fine motor skill. Children had higher odds of being delayed if they were male (odds ratio (OR) 3.30, 95% confidence interval (CI) 2.22–4.90) or indigenous (OR 3.31, 95% CI 2.12–5.16) and had lower self-regulatory (OR 2.17, 95% CI 1.31–3.58). Higher vocabulary (OR 0.92, 95% CI 0.89–0.94), higher family income (OR 0.22, 95% CI 0.05–0.90) and family education (OR 0.25, 95% CI 0.08–0.74) were associated with lower odds of delay. Conclusion: Almost one in four children from vulnerable communities experience fine motor difficulties, highlighting the importance of early screening and targeting key child and environmental risk factors.