The 2-year developmental review: what to expect and how to prepare

Q: What if my toddler doesn't have 50 words yet at 2?

Having fewer than 50 words at 24 months is a reason to raise it at the review, but the broader picture matters just as much as the word count. A toddler who has 30 words, points to share interest, follows two-step instructions, and is clearly understanding language is in a different position from one who has 30 words and very limited comprehension or social communication. Mention what you have noticed to the health visitor and let them assess the full picture. If they share your concern, a referral to speech and language therapy (SALT) is the usual next step, and earlier is better.

Q: Does the 2-year review check for autism?

Some areas now include a standardised autism screening questionnaire such as the M-CHAT-R at or around the 2-year review. Even where a formal tool is not used, the health visitor will ask about social communication, pointing, pretend play, eye contact, and response to name, which are all relevant to early autism identification. A positive screen does not mean a diagnosis. It means the health visitor thinks a fuller assessment would be worthwhile. Early assessment is valuable because early support, if needed, makes the most difference at this age.

Q: What should I do if I have concerns before the 2-year review?

You do not have to wait for the review. If you have concerns about your child's development at any point, contact your health visiting team or GP. You can also self-refer to speech and language therapy in many areas without needing a GP or health visitor referral first. Concerns about hearing, vision, motor development, or social communication are all valid reasons to seek advice early. The 2-year review is a scheduled checkpoint, not the only route to support.

2 years · Development · Updated July 2026 · All articles

The 2-year developmental review is the health visitor appointment most parents think of as the big toddler check. It arrives at a stage when development is moving quickly, speech is often exploding (or worrying you because it seems to be taking longer than you expected), and the differences between children of the same age can feel striking. This guide explains what the review covers, which milestones the health visitor is looking at, what to bring, and what happens if a concern is raised.

What is the 2-year developmental review?

The 2-year review is a routine check offered as part of the NHS Healthy Child Programme. It is usually carried out by a health visitor between 24 and 30 months, and some areas call it the 2 to 2.5 year review to reflect that flexibility. If you have not been contacted by the time your child is approaching two and a half, it is worth getting in touch with your health visiting team rather than waiting.

The review covers a broad range of developmental areas: speech and language, physical development (both gross motor and fine motor), social and emotional development, behaviour, vision, hearing, and your own wellbeing as a parent. Many health visiting teams now use a structured tool such as the Ages and Stages Questionnaire (ASQ-3) to structure the conversation, though practice varies across areas.

Like the 18-month check, this is a conversation and an observation, not a test your toddler can pass or fail. The health visitor is building a picture using several sources of information, and your account of what you see at home carries as much weight as anything that happens in the room during the appointment.

What milestones does the health visitor look for at 2 years?

The key developmental markers at this age draw on RCPCH guidance and the AAP 2022 milestone revision. Across all areas, the health visitor is looking at the broad pattern rather than any single item in isolation.

For language and communication, the reference points at 24 months are 50 or more words and the beginning of two-word combinations such as "more milk", "daddy go", or "big dog". The health visitor will also be interested in whether your toddler points at pictures in a book when you name them, and whether they can follow two-step instructions such as "go and get your shoes and bring them here".

For physical development, most two-year-olds are running (even if it is a fast, slightly unsteady trot), climbing, kicking a ball, and beginning to manage stairs with support. Fine motor skills include stacking blocks, scribbling with a crayon, and using a spoon at mealtimes.

For social and emotional development, the health visitor is looking at whether your toddler shows preference for certain people, beginning to show simple empathy (looking concerned when someone cries, for instance), and engaging in simple pretend play such as feeding a teddy or putting a doll to bed. Some two-year-olds begin to play alongside other children, though truly cooperative play develops later.

One thing worth knowing: what your toddler does regularly at home matters as much as what they are willing to show in an unfamiliar room with an unfamiliar adult. Come prepared with specific examples.

Language and communication at the 2-year review

Language is the central focus at this check, as it was at the 18-month review, but the expectations are higher. By 24 months, the AAP 2022 guidance describes 50 or more words and two-word combinations as the milestone markers. The RCPCH developmental framework reflects similar expectations.

The health visitor will ask about:

How many words your toddler uses consistently and clearly (in any language if your family is bilingual)
Whether your toddler is putting two words together to make simple phrases
Whether your toddler understands simple two-step instructions
Whether your toddler points at pictures in a book when named
Whether your toddler uses pointing to share interest in things, not just to request
Whether your toddler refers back to you when something interests them (joint attention)

A toddler who has 40 clear words, combines two of them, and is pointing and making good eye contact is in a very different position from one who has 40 words with little evidence of comprehension or social communication. The word count is one data point. The health visitor is looking at all of these together.

If your toddler does not yet have 50 words or is not combining words, mention this directly. An early referral to speech and language therapy (SALT) is not alarming. It is exactly what these checks are designed to facilitate, and earlier support is more effective than later support.

What about autism screening?

Some areas now include a standardised autism screening tool at or around the 2-year review. The most widely used is the M-CHAT-R (Modified Checklist for Autism in Toddlers, Revised), a parent-completed questionnaire that takes a few minutes to complete. Not all health visiting teams use it, and practice varies significantly across England.

Whether or not a formal tool is used, the health visitor will ask about areas that are relevant to early autism identification, including social communication, pointing, eye contact, response to name, and pretend play. If any of these areas raise a question, the health visitor may ask more specifically about them.

A positive screen on the M-CHAT-R, or a health visitor who wants a closer look at social communication, does not mean your child has autism. It means a fuller assessment would give a clearer picture. Early assessment is genuinely valuable because the support that can be offered following a diagnosis is more effective when started early. If you have had your own observations about social communication and have been wondering whether to raise them, this appointment is the right time.

What to bring and how to prepare

Bring your child's Red Book. The health visitor will use it to check growth measurements over time, review immunisation records, and look at notes from earlier reviews. If your Red Book has gone missing, let the health visitor know when you arrive rather than worrying about it in advance.

Write your questions down before you go. The appointment can feel fast, and it is very easy to walk out and remember on the way home the one thing you most wanted to ask. If you have been wondering about something, write it on your phone or on a piece of paper and take it with you.

Bring something to occupy your toddler while you talk. A snack and a familiar small toy are both useful. A toddler who is hungry or bored halfway through the appointment is much less likely to cooperate with anything, and you will be calmer and more able to focus on the conversation if they have something to engage with.

In the days before the appointment, pay deliberate attention to what your toddler is doing so you arrive with recent specific examples. Note things like:

The words they use consistently (count them, including words in any language)
Whether they are starting to put two words together, and what those phrases are
Whether they follow two-step instructions without you gesturing
What pretend play you have seen (feeding a toy, pretending to sleep, making a toy talk)
Whether they point at things to share interest, not just to request
How they are with other children

Specific recent examples carry far more weight than general impressions.

What to say if your toddler won't perform on the day

This is one of the most common worries before the check, and it is worth setting your mind at rest: health visitors hear "she does it at home but won't do it now" all day. Toddlers often clam up in unfamiliar settings with unfamiliar adults, refuse to stack blocks they happily stack on the kitchen floor, and stare blankly at picture books they usually love. This is expected and well understood.

Your account of what your toddler does at home is valid clinical information, not just a parent trying to put a positive spin on things. The more specific you can be, the more useful it is. Rather than "he talks quite a bit", say "he uses about 40 words clearly and this week he started saying 'more juice' and 'daddy gone'". Rather than "she understands me", say "she can follow two instructions in a row, like 'go and get your cup and put it on the table'". These specifics are what the health visitor needs to make an accurate assessment.

If the health visitor cannot get a clear picture on the day because your toddler is not cooperating, they may suggest a follow-up appointment rather than drawing conclusions from incomplete information. This is good practice, not a sign that something is wrong.

What happens if concerns are raised?

If the health visitor thinks a closer look would be helpful, they will suggest a referral to the relevant service. The most common referrals from the 2-year review are:

Speech and language therapy (SALT): for concerns about language development, including limited vocabulary, absent two-word combinations, difficulty with comprehension, or limited pointing.
Developmental paediatrician or community paediatrician: for broader concerns across more than one developmental area, or for questions about social communication.
Audiology: if hearing is a concern, either from informal observation at the appointment or from things you have noticed at home.
Orthoptics or ophthalmology: if vision or eye alignment is a question.

An early referral is not a verdict. It is the health visitor using the check for what it was designed for: identifying anything that would benefit from specialist input while early intervention makes the most difference. Many children who are referred for assessment after the 2-year review go on to need no further support once they have been properly assessed. For those who do need ongoing support, being referred at two rather than at three or four means that support starts earlier, which is genuinely better.

If you leave the appointment feeling uncertain about what was said or what happens next, contact your health visiting team. You are entitled to understand the process and to ask questions.

Frequently asked questions

When does the 2-year developmental review happen?

The review is part of the NHS Healthy Child Programme and is offered between 24 and 30 months. Some areas call it the 2 to 2.5 year review to reflect this range. Timing varies by area and by how busy local health visiting services are. If your child is approaching 30 months and you have not been contacted, get in touch with your health visiting team to arrange an appointment. You do not have to wait to be called.

What if my toddler doesn't have 50 words yet at 2?

Having fewer than 50 words at 24 months is worth mentioning at the review, but the broader picture matters as much as the word count. A toddler with 30 words who is pointing, following two-step instructions, and combining words is in a different position from one with 30 words and very limited comprehension or social communication. Tell the health visitor what you have noticed and let them assess the full picture. If they share your concern, a referral to speech and language therapy is the usual next step. In many areas you can also self-refer to SALT without needing the health visitor or GP to do it for you.

Does the 2-year review check for autism?

Some areas include a standardised autism screening questionnaire such as the M-CHAT-R at or around the 2-year review. Even where no formal tool is used, the health visitor will ask about social communication, pointing, eye contact, pretend play, and response to name. A positive screen does not mean a diagnosis. It means the health visitor thinks a fuller assessment would give a clearer picture. If you have your own questions about social communication and have been wondering whether to raise them, this appointment is the right time to do so.

What should I do if I have concerns before the 2-year review?

You do not have to wait. Contact your health visiting team or GP at any point if something is worrying you. In many areas you can also self-refer to speech and language therapy without needing a referral. Concerns about hearing are best raised with your GP so that an audiology referral can be arranged promptly. The 2-year review is a scheduled checkpoint, not the only route into support. If something does not feel right, acting on it earlier rather than waiting for the appointment is always the right call.

What if my area doesn't offer a 2-year review?

The 2-year review is part of the NHS Healthy Child Programme, which means all areas in England should offer it. In practice, health visiting capacity is under pressure in many parts of the country, and some families are not being contacted proactively. If your child is approaching two and a half and you have not been offered the review, contact your health visiting team directly to ask. If you cannot reach a health visitor, your GP surgery can help with developmental concerns and can make referrals to the services that would otherwise be triggered by the review.

How is the 2-year review different from the 18-month check?

The 18-month check focuses particularly on early language and social communication, walking, and the broader communication picture at that stage. The 2-year review builds on this with higher language expectations (50 or more words and two-word combinations rather than around six words), a broader look at pretend play and following two-step instructions, and in some areas a structured autism screening questionnaire. The 2-year review also often uses a standardised tool such as the ASQ-3 to structure the assessment. If the 18-month check raised any concerns, the 2-year review is an important follow-up. If no concerns were raised, the 2-year review is the next routine checkpoint.

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