Points for Concern: Two Years to Three Years

Notice if children are walking differently, such as walking on their toes, walking with a broad-based gait, or with knock knees, or if children have poor transition skills from sitting to standing and back, and refer for motor assessment. Refer to Disabled Village Children, Chapter 6: “Guide for Identifying Disabilities” for assessment and resource suggestions.  Children who don’t enjoy walking, running or movement or those who fall frequently or have difficulty avoiding obstacles could have difficulties either in their motor skills, motor planning or in visual capacity. Please ensure complete clinical assessment and refer to “Motor Planning” in the and Helping Children who are Blind, Chapter 4 “Finding out what your child can see” and Chapter 10: “Movement” for ideas.
 
Children with surprisingly high levels of constant activity – always running, jumping, tapping – seem unable to stay in one place or attend to a task, may have sensory issues or issues with attention or impulse control. Please refer Sensory Processing Checklist and send for further evaluation as needed.
 
Clumsiness in handling small objects, manipulative tasks or atypical grasp patterns are all indicators of delay or impairment in hand function development or possible signs of a vision impairment. Please send for clinical vision evaluation and refer to Developing Grasp for activity ideas. 
 
Unclear speech and mis-articulation could be due to some degree of hearing loss, including frequent ear infections or issues with the oro-motor structure. Ensure that clinical evaluations of hearing and speech are carried out. Also refer to Helping Children who are Deaf, Chapter 5: What can your child hear? for testing suggestions and Chapter 3: Guidelines for Teaching Language, for some activity ideas. Refer also CommDeall Intervention Manuals for Toddlers and Preschoolers, AYJNIHH Speech and Language Stimulation and NIMH Manual on Early Intervention Series.
 
When children have only a few word vocabulary, don’t express themselves easily through speech, do not use sentences of three or more words, there may be issues in comprehension of language or relationships and social interaction. Look for other signs of problems in comprehension such as inability to follow simple instructions or remember sequences. Children who have trouble with relationships and social interactions may spend a lot of time by themselves, be unable or unwilling to play in a small group with other children, cannot tolerate sharing beyond what is normal in children of this age and may have behaviours unusual in such young children such as solving their own problems rather than turning to known adults for help. This may be the result of a social situation such as a child largely left alone or could indicate issues within the Autism spectrum. Such children may show other signs such as dislike of eye contact, stereotypical play and strong sensory preferences or dislikes. Please refer the “Autism Information and Resource Centre” on the National Trust website http://autismresourcecenter.in/Default.aspx# for resources and ideas and refer for further professional evaluation and guidance.  All children need ways to express themselves effectively so please refer to “Communication Assessment” to make a beginning in understanding the child’s needs and to consider ways including sign language, pictures and other systems that effectively augment speech. Refer to CommDeall Intervention Manuals for Toddlers and Preschoolers, AYJNIHH Speech and Language Stimulation and NIMH Manual on Early Intervention Series 3 (Speech, language and communication) for activity suggestions. Please consider referral to Speech and Language Therapists as needed.
 
By three, children should be able to understand two step directions, name body parts, show actions in pictures, recite rhymes, match and sort objects and pictures and show understanding of concepts like big and small, few and many. Delays in these areas could point to lack of exposure and opportunities in the early years, and enriched play activities will allow the child to quickly catch up. Delays could also be a sign of lack of comprehension. Also refer to NIMH Manual on Early Intervention Series 1 (Cognition, Audition and Fine Motor), and to Disabled Village Children page 318. 
 
By this age, children should be quite independent in eating and assist in bathing and dressing and enjoy and even demand this independence. Children must have attained toilet control. Delays in these areas could be due to poor opportunities or trouble mastering these tasks due to delays in any area of development. Drooling, not noticing a runny nose, resisting walking barefoot or oversensitivity to these sensations point to issues in sensory tolerance and reception. Please refer to Sensory Processing Checklist and send for further evaluation as needed.  Refer to Disabled Village Children, Chapter 36 - 39 for detailed suggestions on teaching independence in self-care.  Problems in eating such as excessive or very poor appetite, poor chewing, and poor tolerance of certain textures, should be referred for further clinical consultation. Remember that children with vision impairment or sensory issues often have problems with eating.