Child development at two to two and a half years

Child development at 2 to 2 and a half years



The health and development review at 2-2.5 years is the final developmental check undertaken by the health visiting service before a child enters school at the age of 4-5 years. This is part of the mandated checks that health visitors provide to all children and gives an ideal opportunity for the health visiting service to assess the child in the context of the whole family and identify any needs or risks.

The 2-2.5 year health and development review is assessed through the Ages and Stages Questionnaire 3 (ASQ-3). This is an assessment tool that helps parents and provides information about the developmental status of their child across five areas:

  • communication

  • gross motor skills

  • fine motor skills

  • problem solving

  • personal-social


The total scores from the ASQ-3 are used to shape further referrals and access to early help partners if required.


In addition the Early Years Foundation Stage (EYFS) requires that parents and carers must be supplied with a short written summary of their childs development in the three prime learning and development areas of the EYFS: Personal, Social and Emotional Development; Physical Development; and Communication and Language; when the child is aged between 24-36 months.

The evidence base for the Healthy Child programme 0-5 (DH 2009) can be found at and a rapid review to update the evidence contained within it can be found at

The Wave Trust (2012) published an evidence based framework for commissioning prevention programmes to optimise child development at the age of two years. The areas of impact are; assessing maternal mental health in pregnancy, developing secure attachment, offering specialist parent- infant psychotherapy support, identifying risk factors during pregnancy, assessing social and emotional development and offering early help and support, reducing domestic violence, improving parenting capability, improving multi agency working and workforce capacity.


NHS England have commissioned an increased health visiting workforce and has published the 2015-16 national service specification for health visiting. This contains the full evidence base for the 0-5 healthy child programme.

Public Health England (PHE) promotes integrated two year reviews where the child is in an early years setting which aim to bring together the Early Years Foundation Stage (EYFS) Progress Check at age two with the Healthy Child Programme (HCP) 2-2½ year health and development review by September 2015. PHE has published the six high impact areas for commissioning public health programmes for children aged 0-5. These can be found at The high impact areas include the integrated two year review alongside; the transition to parenthood and the early weeks, maternal mental health, breastfeeding, healthy weight and healthy nutrition, and managing minor illnesses and reducing accidents.


A review of the pilot into integrated reviews can be found here   

The results of the Ages and Stages Questionnaire (ASQ-3) are not yet available at a local level, and cannot be generalised until full coverage is achieved, although this has recently been achieved in the wider Berkshire area.

From October 2015 the results of the Ages and Stages questionnaire will be reported within the Public Health Outcomes Framework(PHOF). This will indicate the percentage of 2-2.5 year olds who take up the offer of an assessment and the percentage of those that have a valid ASQ-3 completed. This information will be published at a national and local level. The increased ability to offer a universal screening programme will enable the mapping of needs and risks of poorer outcomes, which will provide a baseline for the development of targeted services in future.

The Public Health Outcomes Frameworkalso includes a measure of the next age specific assessment at 4-5 years old when a child reaches the end of the Early Years Foundation Stage (EYFS) and enters Year 1. As with ASQ-3, children are measured on levels of Personal, Social and Emotional Development, Physical Development and Communication and Language. This means there is a potential overlap between the two measures and collaborative working between all early years professionals would ensure consistent interpretation of results and support for childrens developmental needs.

The results of the developmental checks should inform work with children to improve their readiness for school. School readiness is measured by the Early Years Foundation Stage (EYFS) Profile and determines if a child has a Good Level of Development (GLD). More information can be found in the school life section.


PHOF profiles based on 2013/14 data showed that the Wokingham average (60.7%) for the percentage of children achieving a Good Level of Development at the end of Reception was comparable to other local authorities matched on levels of deprivation. Wokingham’s average was also comparable to the England average of 60.4%.

The percentage of pupils achieving the phonics check was 70.4%: significantly lower than the regional average of 73.2 and England average of 74.2%. This was also lower than other local authorities matched on levels of deprivation.


If a child does not receive a good start in life their health and wellbeing can be negatively affected. A baby’s early experiences are influential in determining their future emotional, intellectual and physical development. From early infancy, children naturally reach out to create bonds, and they develop best when caring adults respond in warm, stimulating and consistent ways. This secure attachment with those close to them leads to the development of empathy, trust and well-being; however, parental skills and confidence can be affected by a range of risk factors which can also affect the child’s social and emotional and behavioural outcomes. 


Training in the promotion of attachment and the measures used to assess attachment would be beneficial for all professionals in the early years sector.

Health visiting teams are trained to promote attachment but as yet do not have a commissioned perinatal mental health service that meets national best practice into which they can refer women who are anxious and depressed. About 50% of women who are assessed as needing emotional support and physical help and who are referred to Improving Access to Psychological Therapies (IAPT) ante or postnatally, do not attend these services unless supported by the voluntary sector. This is a gap that is echoed across Berkshire. There is a gap too in perinatal mental health training for early years staff and volunteers who work with families. This requires multi agency action and has been set as an outcome within the voluntary sector strategy.


Speech and language delay is a major contributor to poor school readiness and collaborative working is recommended to identify commonalities between the ASQ-3 and EYFS communication and language criteria.


Promotion of on line checking of child development is essential. Parents concerned about their child’s communication can go to the local Berkshire Healthcare Foundation Trust integrated therapies website and self assess their child’s progress using the early years toolkit. This can be found at


A focus on avoiding child maltreatment (whether by neglect, physical or emotional abuse) and wider safeguarding is essential. Referrals to the early help team are supported by programmes that aim to reduce the risk of a child being taken into care. The early help process offers self help programmes to parents coping with the impact of domestic abuse, alcohol or drug misuse or low levels of parental mental health that do not meet the criteria for referral to adult mental health services.


Strategies for reducing barriers to uptake of the 2-2.5 year review include offering improved drop-in and bookable sessions for working parents through commercial settings and evening and weekend access. This is now a quality indicator in the health visiting service contract.


The purpose of the 6 High Impact Area early years documents is to articulate the contribution of health visitors to the 0-5 agenda and describe areas where health visitors have a significant impact on health and wellbeing and improving outcomes for children, families and communities:


Improved data sharing would benefit how progress is tracked in early years and thus enable timely and developmentally appropriate interventions to be implemented.


Parents can be assured that the health visiting services have been trained in motivational interviewing; a technique used to support lifestyle/behaviour change and an optimum way to assess child development.


School readiness (Good Level of Development) is poorer in those who are eligible for free school meals.


In order to achieve an improvement in child development and school readiness developments need to focus on;

  • Improved accessibility for vulnerable groups
  • Integrated  IT systems and information sharing across agencies
  • The development and use of integrated pathways
  • Systematic collection of user experience e.g. Friends and Family Test to inform action
  • Increased use of evidence-based and multi-agency interventions to improve parenting and attachment
  • Improved partnership working e.g. maternity, school nursing and early years settings
  • Consistent information for parents and carers
  • Improved coverage
  • Agreed common assessment tool across agencies (ASQ3 and ASQ SE)
  • Appropriate services to support identified needs through the assessment
  • Reduction of the percentage of children with unknown needs identified at 2 years
  • Uptake of free early learning places for 2 year olds
  • To support access to IAPT services for women who require mental health support
  • For the Clinical Commissioning Group (CCG to commission a perinatal mental health service
  • Child development at 2-2.5 years can be improved through delivery of evidence-based parenting programmes and through close working with Children’s Centres and Local Authority Early Years teams.
  • Integrated working of health visiting services within existing Local Authority arrangements to improve services for children, parents and families through a holistic approach
  • Effective delivery of universal prevention and early intervention programmes
  • Identification of skills and competence to inform integrated working and skill mix

This section links to:

 Perinatal mental health