A Unique Child: Integrated Review - Vital signs

Ruth Thomson
Monday, May 2, 2016

Understanding a child’s progress is particularly important in the Prime Areas. By Dr Kay Mathieson

The Integrated Review for two-year-olds is a positive opportunity to work more closely with colleagues from different agencies and traditions. This review of a two-year-old’s progress links the Progress Check at Age Two, as detailed in the Early Years Foundation Stage, with the two-and-a-half-year health review from the Healthy Child Programme. Both have existed as separate entities but are now a combined look at a child’s progress.

Parents, of course, have spent the most consistent time with their child, seeing them in a variety of contexts. From this basis, they will have built up an in-depth, detailed knowledge and understanding of their unique child. Our relationship with parents should be an opportunity to explore this knowledge and contribute our insights about the child’s response in the new situation of group care.

Health professionals, while having much less time with the child and family, bring a wealth of expertise in health and early child development. Key aspects include recognising early signs that development is not progressing as expected and raising awareness of a range of public health and well-being issues.

It sounds so simple to say that ‘parents and practitioners will share their views and observations of the child’s responses and work together to support appropriately’, so why can it get so complex in reality?

I would suggest that there are two particular reasons for the difficulties. First, parents, early years and health professionals all underestimate their specialist understanding and knowledge. Secondly, the way that we communicate our thinking about a child’s progress seldom sufficiently takes account of the listener’s perspective and specialist knowledge.

For example, an early years practitioner may mention to a parent their child’s interest in numbers. The parent may conclude from this that their child should be writing numerals, doing ‘sums’, or collecting groups of objects and counting them. However, the practitioner might actually have been referring to the child’s enjoyment of number rhymes, games and songs.

This misunderstanding arises from, first, the practitioner’s understanding of early years theory and practice and, secondly, the parent’s focus on individual rather than general child development and approaches to early learning. It is our professional responsibility to skilfully bridge this gap.

As well as being clear and explicit in our explanations, we need to listen with care, tuning into parental descriptions of their child. We can then highlight insights that can deepen the parents’ understanding of their child’s development. This is particularly important regarding a child’s progress in the EYFS Prime Areas, which are fundamental to making sense of the world.


The Prime Areas of learning are identified as such because they are:

  • universal – regardless of where a child is geographically, they will develop communicatively, socially and physically
  • time-specific – more easily acquired during the early developmental phase of life.

They are also interdependent – progress in one Prime Area will impact on the other two. Development, of course, will only occur if opportunity for experiences also exists and the basic needs of nurture and nourishment are met.

Communication and language

A specific example of this inter-relatedness is a child’s developing ability to focus attention (see EYFS Communication and Language: Listening and attention). The journey from the typical ‘fleeting attention’ of a baby to the more deliberate concentrated and focused attention of an adult is a long one. It is also a process that has implications for both social and physical responses. When the child typically:

‘pays attention to dominant stimulation’, a parent is likely to feel their child is responsive to their requests – mainly because this will be the dominant stimulus in the moment

shows ‘rigid attention and may not appear to hear’, then the adult may see them as resistant to requests, not recognising that the change has been driven by developmental progress.

These changes can be misunderstood to be purely behavioural, even ‘deliberate disobedience’, without an underpinning knowledge of child development. Most information about developmental progress gives an impression of a linear, step-by-step process. The more time you spend with children, the more you realise it is not that simple – rapid progress in one area can be followed by a period of consolidation, while other areas show significant progress.

Further, a child may periodically exhibit characteristics typical of an ‘earlier’ phase of development. So, in the case of learning to focus, an older child will be able to maintain and concentrate on an appropriate activity. However, they will also at times demonstrate the ‘fleeting attention’ and ‘rigid attention’ typical in younger children. The reverse would not be the case.

Physical development

Similar misunderstandings can arise in physical development, for example as the sense of proprioception becomes established. Proprioception is the internal ‘body map’ furnished by constant feedback from nerves to let us know where bits of our bodies are, even when we cannot see them. Children may demonstrate particular behaviours during this time, when they are not yet receiving consistent signals from the brain related to their body map.

Typical responses include leaning against an adult as they are talking to them, and being more at ease if sitting next to something solid (bookcase, wall, etc) during group storytime.

At home, finding it difficult to settle to sleep, a child may line up their cuddly toys along either side of their legs and body. As a result, when the light goes out they can still feel the ‘edges’ of their bodies and are more able to relax. Without this detailed knowledge of child development, adults may assume that a child is being deliberately fidgety and unsettled, rather than responding to a developmental change.

Another example is when young children particularly enjoy spinning or going fast on roundabouts. This activity facilitates the development of the vestibular system, enabling the brain to make sense of which way is ‘up’ and keeping our sense of balance. If opportunities for spinning or getting dizzy are ‘not allowed’ or discouraged, this balance system may not develop as efficiently as it should, potentially causing difficulties in later life.

Personal, social and emotional development

Obviously, both physical and communication/language development have an impact on a child’s personal, social and emotional development. For example, being able to move independently, a child can demonstrate preferences in whom they like to engage and what they enjoy exploring. Equally, as use of language evolves, a child’s thinking becomes more complex, including beginning to acknowledge another’s perspective on the world.

A child’s progress in communication, language for thinking and physical development is very entwined with their social understanding. All of this needs to be considered in the review, recognising that if there is a concern in communication and language, physical development or personal, social and emotional development, this is likely to have an impact on at least one of the other two Prime Areas.


Child development sources cannot be used as a checklist but can provide guidance to help us understand how each child is making sense of and interacting with their world. As we hone our skills in communicating what we are seeing, it may help to:

  • use specific examples along with reliable child development sources
  • moderate judgements with colleagues
  • share our thinking rather than just judgements with parents
  • have an open mind as we listen to others.

Successful communication, I believe, rests on developing reciprocal relationships. That is, I would like others to listen to the words I say, seek to understand what I mean, share their thoughts about my views, so that I can clarify what I mean. If this is what I want from others – and what is required to develop a deep understanding of a young child – I need to explicitly demonstrate this approach to others. Improving our own communication skills is a never-ending journey; there will always be challenges with new relationships, changes in our understanding and experience – but every day we can do it better.


Kumari, V (2015) The Integrated Review: follow-up report on practice in two local authority areas. www.ncb.org.uk

Carpendale, J and Lewis, C (2006) How Children Develop Social Understanding. Wiley-Blackwell

Early Education, (2012) Development Matters in the Early Years Foundation Stage. Early Education

www.jabadao.co.uk, Developmental Movement Play

www.ncb.org, Healthy Child Programme briefing

Moylett, H (2013) Active Learning. MA Education Practical Preschool

O’Connor, A and Daly, A (2016) Understanding Physical Development in the Early Years. Routledge

4Children, (2015). What to Expect, When? www.foundationyears.org

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