Overview of Milestones Between 18 Months and 2 Years

Motor skills: walking well; starting to run; walking upstairs with help; standing on tiptoe.

Cognitive development and fine motor skills: capable of picking up small objects easily; showing a preference for using their right or left hand.

Hearing, Speech and Language Development: rapidly expanding vocabulary; putting two or three words together to make intelligible sentences.

Social, Emotional and Behavioural Development: feeding themselves using a spoon; imitates familiar routines; follows simple instructions.

An In-depth Review of an Infant’s Development at 2 Years

Between the ages of 18 months and two years, most infants will be walking well, with their feet only slightly apart, and will no longer need to hold out their arms to balance. By two years, they should be able to stand on their tiptoes and kick a ball. With a little help they may be able to walk upstairs but may find walking downstairs more difficult. They are likely to be able to climb on and off furniture unaided. A two-year-old will be able to carry a large toy like a teddy bear while walking and will explore their surroundings energetically.

Fine motor skills will be developing, and they will be capable of pointing to and picking up small objects on sight. A preference for using either the right or left hand will start to emerge, and they will be able to hold a crayon to scribble on paper. After watching how to build a tower using three or four blocks, they will start being able to do this without help. By the age of two, most infants enjoy simple picture books, often recognising and putting their index finger on boldly coloured items on the page. They are also able to imitate others in their actions and are able to use ordinary things correctly like a toothbrush or a cup.

At mealtimes, they will be able to feed themselves using a spoon and will drink from a cup.

They will try to help with dressing and undressing, such as taking off shoes and socks. Household objects will be a constant source of fascination, and familiar routines will be imitated in play, like handing out cups at a tea party.

At this age, a toddler may start giving an indication of their toilet needs by showing restlessness and vocalisation.  Most toddlers begin potty training at 18 – 24 months. They may still develop nappy rash, particularly when new foods are added to their diet, as this may lead to looser stools. Regular nappy changing and a good skincare routine using a protective barrier ointment will help prevent nappy rash.

Advice which may be useful for parents

At two years, a toddler may be: using a spoon and holding a cup to feed themselves, starting to run, pretending to feed a teddy, taking off their clothes with little help

• Their skills are improving at this age and they might enjoy scribbling with crayons on a piece of paper. You could practice drawing a straight line together.
• Talk to your child about everyday things and read out loud to them.
• Playing with blocks or bricks is fun at this age and a child may be able to stack up to six of them.
• Try doing some household chores together, to a two-year-old it will feel like playing. You could clean the floor, put clothes in the washing machine or set the table together.
• Encourage and give praise for attempts at new and routine activities.

Health checks / interventions (18 months – 2 years)

An infant will be reviewed by a health professional around the time of their second birthday. This will also include checking their immunisation status to date and a discussion with their parents / carers about their development and any concerns they may have. At 24 months a child may be offered any of the following vaccinations to catch up with the recommended schedule:

• Three doses of diphtheria, tetanus, polio, pertussis (and hepatitis B) containing vaccines.
• A single dose of Hib/MenC and PCV vaccines after the age of one year.
• Either 2 doses of MenB under the age of one and one dose after the age of one; or 2 doses of MenB after the age of one.
• A single dose of MMR vaccine after the age of one year.

Potential ‘red flag’ warnings (two years)

Any of the following could indicate a ‘red flag’ warning at two years:

• When playing with toys tends to bang, drop or throw them rather than use them for their intended purpose.
• Not learning new words.
• Not putting words together (e.g. ‘push car’).
• Does not attempt to feed themself, using a spoon.
• Does not attempt to help with dressing or undressing.
• Not able to walk independently.
• Not able to walk up and down stairs with help.

It is also worth checking the ‘red flag’ warnings highlighted in previous milestones (particularly from 12 months). Allowances need to be made for babies born prematurely, based on their gestational i.e. corrected age.

Reference sources

CF Dosman, D Andrews, KJ Goulden. Evidence-based milestone ages as a framework for developmental surveillance. Paediatr Child Health 2012;17(10):561-568.

Ajay Sharma, 2014, Mary Sheridan's From Birth to Five Years: Children's Developmental Progress 4th Edition

Morris H, The bottom line on nappy rash, British Journal of Midwifery, 2012, Vol 20, No 9

Red Flags early identification guide – birth to five years, Childrens Health Queensland hospital

Department of Health, Healthy Child Programme – The two year review, 2009