Overview of Milestones Between 2 and 2 and a Half Years

Motor skills: running and jumping competently; climbing onto furniture; negotiating stairs with some assistance; throwing a ball.

Cognitive development and fine motor skills: picking up small objects with care; increased dexterity with pencils and crayons; able to use a spoon and a cup at mealtimes with few spillages.

Hearing, Speech and Language Development: vocabulary of at least 50 words; putting together two-word sentences; understands simple instructions.

Social, Emotional and Behavioural Development: may have tantrums; may constantly seek attention from parents/caregivers; unlikely to understand sharing.

An In-depth Review of an Infant’s development at 2 and a Half Years

By the age of two and a half a child is likely to be running competently, stopping and starting with ease and be able to avoid obstacles as well as standing on their tiptoes. They will be very curious about their environment and may climb on furniture to look out of the window or to open doors and then get down again. Gradually they will start walking upstairs and downstairs holding on to a rail and putting two feet on each step. They may be able to sit on a small tricycle and move it along using their feet on the floor. Their skills with a ball will be increasing and they may be able to throw a ball forwards without losing their balance and kick a ball.

Their fine motor skills will continue to improve so they can easily pick up tiny objects and put them back down carefully. Their dexterity with a pencil and crayons will show increasing skill, and a preference for either their right or left hand will become more pronounced. They begin to copy others, especially adults and older children. With help, they will be able to start matching square, circular and triangular shapes in a simple jigsaw; and also build a tower using six or seven bricks. They are likely to be feeding themselves competently using a spoon and drinking well from a cup with only a few spillages.

Many children at this age will enjoy picture books, pointing to things and showing recognition of fine details in their favourite pictures. They will be able to turn the pages one at a time and also match and name pictures showing familiar objects.

Their vocabulary will be increasing, but they will be able to understand a lot more words than they can actually say; and be able to understand and carry out simple instructions. They are likely to enjoy joining in with nursery rhymes and action songs; and will also engage in make-believe play.

In terms of emotional development, tantrums are not uncommon at this age and they may demand attention from their parents and care givers. They may also begin to display defiant behaviour. They are unlikely to understand the concept of sharing and so may defend their own possessions with determination. It is common for toddlers to get excited when they are with other children and play alongside them, they may begin to join in games such as chasing games.

Potty training may start at two to two and a half years, and infants may try to verbalise their toileting needs, but this is not always successful. Nappy wearing infants may still be prone to nappy rash, and soiled nappies need to be changed frequently, with the infant’s skin kept clean and a barrier ointment used.

It is worth noting that at this age, there is a considerable variation between children in terms of when they achieve language milestones. This variation is greater than in other areas of development and is subject to a complex interplay between a range of genetic and environmental factors.

Advice which may be useful for parents

At two and half years, a toddler may: be able to run around competently, have a vocabulary of around 50 words, build a tower with six or seven bricks, enjoy picture books

• For many infants two to two and a half may be a peak time for tantrums. If you sense a tantrum is ‘brewing’ try distracting them and remove them if possible from the situation, while they calm down.
• It’s a good time to start potty training, so they get used to the idea, even if they only sit on it a couple of times a day, it’s worth trying.
• Infants wearing a nappy may still get nappy rash, so a good skincare routine including a barrier ointment continues to be essential.
• Some children enjoy playing with brightly coloured paints and crayons and this is a good time to start teaching them the names of colours.
• They will be very interested in their environment and even the simplest household task can be made into fun. So let them help you in the house, the garden and when you go shopping together.

When it comes to developmental milestones, all children are different and although they can be encouraged, they will all do things at their own pace and in their own time.

Health checks / interventions (two to two and a half years)

As part of the Healthy Child Programme (HCP) in the UK, children have a health and development review at the age of two to two and a half years, usually carried out by a health visitor. It may be done in the child's home, a baby clinic, a children's centre or nursery. This will also include a review of their immunisations to date and a discussion with their parents / care givers about their development and any concerns they may have. A child’s immunisation status should be checked, and any missing vaccinations may be offered to catch up (see milestone eight). The Ages and Stages Questionnaire (ASQ-3) may be used, so that parents/caregivers may express any concerns before the review.

Potential ‘red flag’ warnings (two and a half years)

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

• No interest in imaginary or pretend play
• Does not copy actions and words
• Little interest in toys
• Unable to build a tower of three bricks
• Speech difficult for parents/carers to understand
• Does not use 2-word phrases (for example “drink milk”)
• Does not attempt simple self-care skills like feeding and undressing
• Does not know what to do with common objects such as a brush, phone, spoon.
• Does not walk steadily
• Not able to run or jump
• Loses skills they once had

It is also worth checking the ‘red flag’ warnings highlighted in previous milestones (particularly from 18 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, Children’s Health Queensland Hospital

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

www.childrensneuropsych.com/parents-guide/milestones (accessed Oct 19)