Official Statistics

Child development outcomes at 2 to 2 and a half years, 2023 to 2024: statistical commentary

Published 5 November 2024

Applies to England

What’s new

The following indicators have been updated with England, regional and upper tier local authority data for 2023 to 2024:

• percentage of children achieving a good level of development at 2 to 2 and a half years
• percentage of children achieving the expected level of development in communication skills at 2 to 2 and a half years
• percentage of children achieving the expected level of development in gross motor skills at 2 to 2 and a half years
• percentage of children achieving the expected level of development in fine motor skills at 2 to 2 and a half years
• percentage of children achieving the expected level of development in problem solving skills at 2 to 2 and a half years
• percentage of children achieving the expected level of development in personal social skills at 2 to 2 and a half years

Introduction

Early childhood is an important period of rapid brain growth, including during pregnancy and the first 2 years (first 1,001 days). Getting a good start in life, building emotional resilience and getting maximum benefit from education are important markers for good health and wellbeing throughout life.

Early child development is assessed at the universal health visitor review offered to all families when their child reaches 2 to 2 and a half years. This health review is a holistic review of child health, development and growth, to identify children who are not developing as expected and/or in need of additional support. The review includes the application of a recognised, validated tool for assessment of developmental progress. This is currently the Ages and Stages Questionnaire, Third Edition (ASQ-3).

The ASQ-3 assessment covers 5 domains of development, including:

• communication
• gross motor
• fine motor
• problem solving
• personal social skills

It takes 10 to 15 minutes to complete and 1 to 3 minutes to score.

Overall scores are available for each domain of development as well as thresholds for the expected age specific level of development. A child whose scores meet or exceed their age specific threshold in a domain are said to be “at or above the expected level of development” for that domain.

Children who meet or exceed their age specific thresholds in all 5 domains of development are said to be achieving a good level of development at 2 to 2 and a half years.

Coverage of universal health visitor reviews at 2 to 2 and a half years is discussed in Health visitor service delivery metrics statistical commentary, 2023 to 2024. In 2023 to 2024, 78.4% of children received their 2 to 2 and a half review and 93.3% of these children had a completed ASQ-3 as part of this review. However, some local authorities have very low levels of coverage and there is evidence that coverage of universal health visitor reviews is not evenly distributed among the population.

The health reviews, and hence development assessments, at 2 to 2 and a half years may be targeted towards children who are likely to need more support. This includes those of white ethnicity, living in the most deprived areas and children who are known to be vulnerable due to family or other circumstances. This may contribute towards a lower than expected proportion of children reported to be achieving their development outcomes in some local authorities. This particularly applies to those authorities with extreme values.

Main findings

This update shows:  

• the percentage of children at or above the expected level of development in all 5 domains of development (‘good level of development’) at 2 to 2 and a half increased to 80.4% in 2023 to 2024 compared with 79.2% in 2022 to 2023. The percentage achieving the expected level of development in communication, gross motor, fine motor, problem solving and personal social skills all increased in 2023 to 2024
• however, the proportion achieving the expected level of development in all 5 domains, and across all specific domains remains lower than the pre-pandemic level in 2019 to 2020.  Inequalities in the percentage of children achieving the expected levels of development between regions, upper tier local authorities and deprivation groups remain
• in the most deprived areas of England (2 most deprived deciles of upper tier local authorities), the percentage of children achieving the expected level of development in all 5 domains, and the specific domains of communication, fine motor skills, problem solving, and personal social skills is consistently below the England average
• however, for gross motor skills, children in the most deprived decile achieve a better level of development than the England average, and those in the second most deprived area have a percentage similar to the England average

Detailed findings

Percentage of children achieving a good level of development at 2 to 2 and a half years

In 2023 to 2024, 80.4% of children achieved the expected level of development at 2 to 2 and a half, in all 5 domains of development, an increase of 1.2 percentage points from 2022 to 2023. However, this is lower than 2019 to 2020, when 83.3% of children achieved the expected level of development in all 5 domains of development at 2 to 2 and a half.

Figure 1: percentage of children in England achieving a good level of development at 2 to 2 and a half, 2017 to 2018 to 2023 to 2024

The percentage of children achieving a good level of development varies across regions of England and across upper tier local authorities. There is an 11.0 percentage point gap between London, which has the lowest percentage at 74.7%, and Yorkshire and the Humber, which has the highest percentage at 85.7%.  

Figure 2: percentage of children achieving a good level of development at 2 to 2 and a half, regions of England, 2023 to 2024

Children are more likely to achieve a good level of development if they live in less deprived areas than more deprived areas. For children achieving a good level of development at 2 to 2 and a half there was a 6.4 percentage point difference between the most and least deprived upper tier local authorities in 2023 to 2024. This is an increase from a 3.9 percentage point gap in 2022 to 2023.

Percentage of children achieving a good level of development in communication skills at 2 to 2 and a half years

In 2023 to 2024, 86.6% of children at 2 to 2 and a half achieved the expected level of development in communication skills, an increase of 1.3 percentage points from 2022 to 2023. However, this is a decrease from 2019 to 2020, when 88.9% of children achieved the expected level of development in communication skills at 2 to 2 and a half.

Figure 3: percentage of children at 2 to 2 and a half in England achieving the expected level of development in communication skills, 2017 to 2018 to 2023 to 2024

The percentage of children who achieved a good level of development in communication skills varies across regions of England and across upper tier local authorities. There is an 8.8 percentage point gap between London, which has the lowest percentage at 81.0%, and Yorkshire and the Humber, which has the highest percentage at 89.8%.

Figure 4: percentage of children at or above the expected level of development in communication skills at 2 to 2 and a half, regions of England, 2023 to 2024

Children are more likely to achieve the expected level of development in communication skills if they live in less deprived areas than more deprived areas. For children achieving the expected level of development in communication skills at 2 to 2 and a half years there was a gap of 4.2 percentage points between the most and least deprived upper tier  local authorities in 2023 to 2024, This is a decrease from a 4.9 percentage point gap in 2022 to 2023.

Percentage of children achieving a good level of development in gross motor skills at 2 to 2 and a half years

In 2023 to 2024, 93.3% of children achieved the expected level of development in gross motor skills at 2 to 2 and a half, an increase of 0.5 percentage points from 2022 to 2023. However, this is lower than 2019 to 2020, when 93.8% of children achieved the expected level of development.

Figure 5: percentage of children at 2 to 2 and a half in England achieving the expected level of development in gross motor skills, 2017 to 2018 to 2023 to 2024

The percentage of children achieving the expected level in gross motor skills varies across regions of England and across upper tier local authorities. There is a 3.5 percentage point gap between the South West, which is the lowest at 92.0%, and the North East, which is the highest at 95.5%.

Figure 6: percentage of children at or above the expected level of development in gross motor skills at 2 to 2 and a half, regions of England, 2023 to 2024

Children are less likely to achieve the expected level of development in gross motor skills if they live in less deprived areas than more deprived areas. This is a reverse of the pattern found in the other 4 domains of development. For children achieving the expected level of development in gross motor skills at 2 to 2 and a half years there was a gap of 1.6 percentage points between the least and most deprived upper tier local authorities in 2023 to 2024.

Percentage of children achieving a good level of development in fine motor skills at 2 to 2 and a half years

In 2023 to 2024, 93.3% of children achieved the expected level of development in fine motor skills at 2 to 2 and a half, an increase of 0.7 percentage points from 2022 to 2023. However, this is lower than 2019 to 2020, when 94.1% of children achieved the expected level of development.

Figure 7: percentage of children in England achieving the expected level of development in fine motor skills at 2 to 2 and a half, 2017 to 2018 to 2023 to 2024

The percentage of children who achieved a good level of development in fine motor skills varies across regions of England and across upper tier local authorities. There is a 5.8 percentage point gap between the South East, which is the lowest at 90.3%, and Yorkshire and the Humber, which is the highest at 96.1%.

Figure 8: percentage of children at or above the expected level of development in fine motor skills at 2 to 2 and a half, regions of England, 2023 to 2024

Children are more likely to achieve the expected level of development in fine motor skills if they live in less deprived areas than more deprived areas. For children achieving the expected level of development in fine motor skills at 2 to 2 and a half years there was a 1.6 percentage point gap between the most and least deprived upper tier local authorities in 2023 to 2024. This has decreased from a 3.2 percentage point gap in 2022 to 2023.

Percentage of children achieving a good level of development in problem solving skills at 2 to 2 and a half years

In 2023 to 2024, 92.5% of children achieved the expected level of development in problem solving skills at 2 to 2 and a half, an increase of 0.7 percentage points from 2022 to 2023. However, this is lower than 2019 to 2020, when 93.9% of children achieved the expected level of development.

Figure 9: percentage of children in England achieving the expected level of development in problem solving skills at 2 to 2and a half, 2017 to 2018 to 2023 to 2024

The percentage of children who achieved a good level of development in problem solving skills varies across regions of England and across upper tier local authorities. There is a 3.0 percentage point gap between the West Midlands, which is the lowest at 90.7%, and Yorkshire and the Humber, which is the highest at 93.7%.

Figure 10: percentage of children at or above the expected level of development in problem solving skills at 2 to 2 and a half, regions of England, 2023 to 2024

Children are more likely to achieve the expected level of development in problem solving skills if they live in less deprived areas than more deprived areas. For children achieving the expected level of development in problem solving skills at 2 to 2 and a half years there was a 1.0 percentage point gap between the most and least deprived local authorities in 2023 to 2024. This is a decrease from a 3.2 percentage point gap in 2022 to 2023.

Percentage of children achieving a good level of development in personal social skills at 2 to 2 and a half years

In 2023 to 2024, 91.2% of children achieved the expected level of development in personal social skills at 2 to 2 and a half, an increase of 0.9 percentage points from 2022 to 2023. However, this is lower than 2019 to 2020, when 92.9% of children achieved the expected level of development.

Figure 11: percentage of children in England achieving the expected level of development in personal social skills at 2 to 2 and a half, 2017 to 2018 to 2023 to 2024

The percentage of children who achieved a good level of development in personal social skills varies across regions of England and across upper tier local authorities. There is a 4.1 percentage point gap between the West Midlands, which is the lowest at 89.6%, and Yorkshire and the Humber, which is the highest at 93.7%.

Figure 12: percentage of children at or above the expected level of development in personal social skills at 2 to 2 and a half, regions of England, 2023 to 2024

Children are more likely to achieve the expected level of development in personal social skills if they live in less deprived areas than more deprived areas. For children achieving the expected level of development in personal social skills at 2 to 2 and a half years there was a 1.8 percentage point gap between the most and least deprived upper tier local authorities in 2023 to 2024. This is a decrease from a 3.2 percentage point gap in 2022 to 2023.

Background

The information within this publication relates to child development outcomes for children aged 2 to 2 and a half. These are assessed at the universal health visitor review at this age, which is funded from the local authority public health grant for children’s public health 0 to 5 years. All pregnant women and children are eligible for a schedule of 5 mandated health reviews (universal health visitor reviews), and this publication covers child development outcomes.

The ASQ-3 has been applied as a standard part of the Healthy Child Programme 2 to 2 and a half year review since 2015. The questionnaire is administered by health visitors and community nursery nurses and completed in collaboration with parents and carers.

ASQ-3 questionnaires for different ages are available, allowing for the most appropriate one to be applied. The 2 to 2 and a half year review uses the 24, 27 and 30 month questionnaires.

The data has been obtained via OHID’s interim reporting system for children’s public health 0 to 5 years which collects health visiting activity and related outcomes, breastfeeding at 6 to 8 weeks and child development outcomes aged 2, at a local authority level.

Caution should be exercised when interpreting these figures as it is a voluntary data collection. Any figures shown at a region or England level are based on an aggregate total of local authorities within those areas who supplied data items which complied with validation criteria for each indicator.

In the longer term, reporting on health visitor activity and related outcomes (breastfeeding and child development outcomes) will increasingly draw data from NHS England’s Community Services Data Set (CSDS). This solution will allow more flexibility in reporting, including options for metrics at lower geographical levels, and for inequalities to be described and monitored. Reporting from a record-level data set enforces standard definitions in a way that was not previously possible.

The technical guidance contains full details of the health visiting, breastfeeding and child development indicators, including definitions and methodology.

Previous related publications are available on the Child and maternal health statistics page for:

• breastfeeding at 6 to 8 weeks
• health visitor service delivery metrics

Indicators are also available on Fingertips.

Contact information

For media enquiries please contact the Department of Health and Social Care media team.

For all other enquiries relating to the statistics or to offer feedback on the publication please contact us at interimreporting@dhsc.gov.uk.