What developmental milestones should I assess in a child at their 2-year check-up?

A 2-year health check-up should include a comprehensive developmental assessment, particularly for children undergoing enhanced developmental surveillance ¹. This assessment should involve discussing any parental or carer concerns about the child's development ¹. Key areas to check for signs and symptoms of developmental problems and disorders as appropriate include:

• Global developmental delay and learning disability ¹.
• Speech, language, and communication problems ¹.
• Motor problems, such as delayed sitting, crawling, or walking, or unusual movements ¹,⁴.
• Autism spectrum disorder ¹.
• Visual impairment ¹.
• Hearing impairment ¹.
• Feeding problems ¹.
• Sleep problems, including sleep apnoea ¹.
• Problems with inattention, impulsivity, or hyperactivity ¹.
• Emotional and behavioural problems ¹.
• Executive function problems ¹.
• Potential special educational needs ¹.

During the assessment, physical measurements should be taken, including length or height, weight, and head circumference ¹,². These measurements should be recorded in the parent or carer-held Personal Child Health Record ²,³. For children born preterm, development should be corrected for gestational age up to 2 years ¹.

Tools that may be used include the Parent Report of Children's Abilities – Revised (PARCA-R) to identify risks of global developmental delay, learning disability, or language problems ¹. If PARCA-R is unsuitable, a suitable alternative parent questionnaire should be used ¹. If cerebral palsy has been diagnosed, the Gross Motor Function Classification System (GMFCS) score should be included ¹. Ensuring that checks of vision and hearing have been carried out in line with national recommendations is also important ¹.

Any developmental concerns reported by parents or carers, or noted during the visit, should be carefully evaluated and reviewed ¹. If a developmental problem or disorder is suspected, further investigation or referral to the appropriate local pathway should be considered ¹.