Growing up in Scotland: a study following the lives of Scotland's children

Chapter 6: Child Health and Development

6.1 Introduction

Children and young people are our investment in Scotland's future, and their health is a vital part of that investment.' (Scottish Executive, Delivering a Healthy Future 2006 p. 7)

One of the Government's key priorities is to improve health for all and reduce health inequalities. In recent years, there have been a number of consultation and guidance documents on child health. The Scottish Executive's 2004 child health consultation document, Health for all children ('Hall 4') includes a central concern with health and development in the early years, which is seen as part of a wider strategy 'to promote effective and integrated provision of universal and targeted services for children and families' (p. 2). This document suggests various universal and targeted services for early years, noting (p. 23) that the most disadvantaged children are least likely to take up routine health checks. Child health continues to be a policy priority. In April 2006, a further consultation document was published by the government, Delivering a Healthy Future: An Action Framework for Children and Young People's Health In Scotland, setting out an action framework developed by the Children and Young People's Health Support Group. Central to developing effective universal and targeted services to improve infant health is a solid evidence base about babies and toddlers' health and development. This chapter examines the health of babies and toddlers, any longer-term illnesses and disabilities they may have, illnesses and accidents which have resulted in contact with NHS services as well as presenting information on a limited number of child development milestones and parents' concerns about these.

6.2 General health of children

6.2.1 Parents' perceptions of health of children

Table 6.1 shows that the vast majority of respondents (94%) thought that the health of their baby or toddler was at least good. There was little variation between the responses of those in different household socio-economic categories and in those responding from areas of differing levels of relative deprivation.

Table 6.1 Perceptions of general health of child by sample type

Child health	Sample type (%)
	Baby	Toddler
Good/Very good	94.1	94.2
Fair to very bad	5.9	5.8
Bases
Weighted	5217	2858
Unweighted	5217	2858

6.2.2 Health problems or disabilities

Respondents were asked whether their child had any health problems or disabilities that had lasted, or were expected to last in the case of babies, for one year or longer. In total, 13% of babies and 18% toddlers were reported as having such a health problem (see Table 6.2). These longer-term health problems were more common in lone parent than couple families (20% and 17% respectively in the toddler cohort), in male compared with female babies (15% and 11%) and in those responding from households where four or more children were living.

Table 6.2 Child with health problem or disability by sample type and other factors

	% with health problem
	All sample	Family type		Sex of child		Number of children in household
		Lone parent	Couple	Boy	Girl	One	Two	Three
Baby	13.2	15.5	12.7	15.2	11.2	11.6	14.6	15.8
Toddler	17.5	19.9	16.7	17.5	17.5	17.2	17.0	24.5
Bases
Weighted
Babies	5217	1059	4158	2689	2528	2471	2510	236
Toddlers	2858	701	2157	1468	1390	971	1742	145
Unweighted
Babies	5217	978	4239	2683	2534	2445	2550	222
Toddlers	2858	655	223	1467	1391	942	1763	153

The relationship between health problems or disabilities and the birth age of the mother and the family household income can be seen in Figure 6-B and Figure 6-C. Lower proportions of both babies and toddlers with mothers aged 40 or over were reported as having longer-term health problems, although the base numbers were relatively low in the under 20 and over 40 categories. Respondents from households with lower levels of income were more likely to state that their babies or toddlers had experienced or were expected to experience a health problem or disability lasting for at least one year.

Figure 6-A Child having health problem or disability for one year by age of mother at birth of cohort child

Figure 6-B Child having health problem or disability for one year by household income quartiles

Eleven percent of babies and 16% of toddlers were said to have or to have had a longer-term health problem or disability that had a major effect on the child's ability to carry out day-to-day activities.

6.3 Health problems requiring NHS contact

6.3.1 Number and type of health problems

Respondents were asked how many times their child had experienced a health problem, excluding accidents and injuries, which had required contact with the NHS, including visits to the GP, accident and emergency or making a call to NHS 24. Table 6.3 demonstrates that babies' parents tended to have more dealings with the NHS than toddlers' parents did. Twenty-eight percent of babies had three or more problems resulting in NHS contact compared with 20% of toddlers, and only 18% of babies had no such episodes requiring NHS contact. In addition, respondents with more children in the household were much more likely to report that their child had not had any health problems requiring NHS assistance; this was true for both babies and toddlers (see Table 6.3), although the numbers of respondents with four or more children living with them was comparatively low. This may suggest that those with more children are more likely to have the experience and confidence to deal with health problems themselves or, possibly, that they do not have the time to seek help and assurance if the problem is perceived to be minor. In addition, babies or toddlers of mothers with no educational qualifications were more likely to have not required NHS contact for a health problem (Figure 6-C). This may reflect lack of access to services among this group, or an 'education effect' which leads better educated parents to seek professional help for relatively minor ailments.

Table 6.3 Number of health problems requiring NHS contact by cohort and number of children in household

Number of health problems requiring NHS contact: BABIES	% with health problem requiring NHS contract
	Sample type	Number of children in household
	Baby	One	Two or three	Four or more
None	18.3	15.9	19.8	26.8
One	30.1	29.1	31.1	29.5
Two	23.7	24.7	22.9	22.5
Three	12.9	14.3	11.9	8.5
Four or more	15.0	16.1	14.2	12.7
Number of health problems requiring NHS contact: TODDLERS	% with health problem requiring NHS contract
	Sample type	Number of children in household
	Toddler	One	Two or three	Four or more
None	28.2	20.1	31.8	39.1
One	29.9	31.6	28.6	32.4
Two	21.4	23.4	21.0	13.0
Three	9.5	11.8	8.3	9.1
Four or more	10.9	13.0	10.1	6.3
Weighted
Baby	5217	2471	2510	236
Toddler	2858	971	1742	145
Unweighted
Baby	5217	2445	2550	222
Toddler	2858	942	1763	153

Figure 6-C Child having no health problem requiring NHS contact by highest maternal educational qualification

Table 6.4 shows that the most common illness/problem that resulted in the respondent seeking NHS contact was the child having a cough, cold or fever, with half of the respondents who had sought NHS help stating that this was the underlying cause. Skin problems were the next most common problem and this was more likely to be the case in babies than in toddlers (29% versus 23%).

Table 6.4 Health problem requiring NHS contact by sample type

Nature of health problem	% of Sample type
	Baby	Toddler
Coughs, colds or fevers	49.9	49.5
Skin problems	28.9	23.1
Chest infections	21.4	19.3
Ear infections	13.5	19.6
Persistent or severe vomiting	11.4	8.0
Sight or eye problems	11.5	6.8
Persistent or severe diarrhoea	10.8	7.5
Wheezing or asthma	7.2	9.9
Weighted and Unweighted	4260	2050

6.4 Accidents and injuries requiring NHS contact

In addition to health problems which resulted in the respondent seeking NHS help, respondents were asked if the child had experienced an accident or injury which had required NHS contact. As would be expected, toddlers were much more likely to require NHS treatment or advice as a result of accidents (24%, compared with 10% of babies). A slightly higher percentage of boys than girls had experienced such accidents or injuries (in toddlers 6% versus 23%; see Figure 6-D).

Figure 6-D One or more accidents requiring NHS visit by sample type and sex of child

Table 6.5 shows that babies and toddlers of lone parent families were more likely to have had at least one accident requiring a visit to the GP or hospital than those living as part of couple families (e.g. toddlers 29% versus 23%, babies 14% versus 9%). Parents of both babies and toddlers were also more likely to say their children had been taken to the doctors or hospital after suffering an accident or injury if they lived in a household of lower socio-economic classification, the main carer was white and the mother of the child was in the lower birth age categories (see Figure 6-E). However, the base numbers for the other ethnic groups and the birth age of mother categories are relatively low and these figures should be treated with some caution.

Table 6.5 Child having accidents requiring NHS contact by sample type and other factors

	% having 1 accident or more
	All sample	Family type		Household NS-SEC		Ethnicity of main carer
		Lone parent	Couple	1	5	White	Other
Baby	10.1	13.6	9.2	8.7	12.6	10.3	6.2
Toddler	24.2	28.7	22.7	22.1	27.5	24.5	15.4
Bases
Weighted
Babies	5217	1059	4158	2517	1043	5004	209
Toddlers	2858	701	2157	1372	620	2747	108
Unweighted
Babies	5217	978	4239	2612	975	5014	199
Toddlers	2858	655	2203	1423	581	2754	101

Figure 6-E Child having accidents requiring NHS contact by age of mother at birth of cohort child

6.4.1 Type of accident or injury and consequence

For both babies and toddlers, the most common type of accident or injury requiring NHS contact involved a bang on the head; a majority of all accidents occurring in babies were of this type (see Table 6.6). There were clear differences between the nature of accidents and injuries reported for babies and toddlers. Babies were much less likely to require treatment for more serious injuries such as broken bones and cuts requiring stitches. Figure 6-F demonstrates that only about 5% of babies and toddlers were admitted as in-patients as a result of their accidents, and two-thirds of babies and three-quarters of toddlers had to visit accident and emergency departments.

Table 6.6 Nature of accidents requiring NHS contact by sample type

Nature of accident	% of Cases
	Baby	Toddler
Bang on head	64.3	42.0
Cut or graze	8.3	13.9
Cut needing stitches	0.5	12.5
Burn or scald	9.9	7.5
Broken bone	1.5	11.2
Knock/fall (non-penetrating accident)	6.5	8.1
Ingestion of household cleaner/poison/pills	2.3	5.7
Weighted and Unweighted base	527	690

Respondents reported on up to four types of accident per child

Figure 6-F % of children requiring hospital treatment as a result of accident by sample type

6.5 Hospital inpatient admissions

The respondents were asked if their child had ever been admitted as an inpatient to hospital as a result of an illness or health problem. This was more likely to have happened to toddlers than babies (see Figure 6-G and Table 6.7; 22% versus 14%). Figure 6-G also shows that boys were more likely to have had at least one hospital admission and higher percentages of toddlers in lone parent families had been hospital inpatients. Higher percentages of respondents in the lowest household income quartile stated that their babies or toddlers had been admitted to hospital and mothers who had given birth at a younger age were much more likely to say that their child had been an inpatient (see Table 6.7).

Figure 6-G % of children having one or more hospital admissions by sex and family type

Table 6.7 Child having one or more hospital admission by age of mother at birth of cohort child

Reason	% with one or more admission
	All sample	Age of mother at birth of cohort child
		Under 20	20 - 29years	30 - 39years	40 or older
Baby	13.9	17.7	14.8	12.8	7.9
Toddler	22.0	26.9	21.7	21.9	16.6
Bases
Weighted
Babies	5217	404	2186	2440	176
Toddlers	2858	213	1206	1346	75
Unweighted
Babies	5217	350	2094	2573	189
Toddlers	2858	182	1144	1428	86

6.6 Sources of help, information and advice on child's health and behaviour

All parents were asked about the sources of help, information and advice they had used in the last year when they had concerns over the sample child's health. Parents in the toddler cohort were also asked about the sources of information or advice they had used when they had concerns about their child's behaviour. The list of sources presented to respondents included formal services such as family doctors, telephone helplines and health visitors and informal resources such as the child's grandparents, other family members or the respondent's friends. Parents could list as many sources of help as they wished. They could also indicate that they had had no concerns over the child's health and behaviour in the last year and had therefore not drawn on any person or service for help or advice on these matters.

6.6.1 Sources of help, information and advice about the child's health

Almost all parents in both samples (89% overall) said they had consulted at least one person or service for information or advice on the cohort child's health. Parents in the baby cohort were slightly more likely to have had sought health advice about their child and to have used more sources of health advice than parents in the toddler cohort.

Parents in couple families were only slightly more likely than lone parents to have sought help, information or advice about the sample child's health (in the baby cohort, 91% compared with 89%). However, parents in couple families on average had consulted a larger number of different sources than lone parents had; in the baby cohort 20% of parents in couple families had consulted five or more sources of advice compared with 9% of lone parents. A similar pattern exists among mothers of different ages. Whilst mothers in different age groups were all just as likely to have sought help or advice, those in their thirties were more likely than younger mothers and those aged 40 or older to have used a larger number of sources. As might be expected, first-time mothers were both more likely to have sought help or advice and more likely to have done so from a greater number of sources than were mothers who already had children.

Responses varied with levels of area deprivation and household income. Parents in the least deprived quintile and those in higher income households were more likely to have sought information and to have sought it from a greater number of sources. For example, 88% of parents in the highest income quartile had looked for information or advice about the sample child's health in the last year and 17% had used five or more sources compared with 84% and 5% respectively for respondents in the lowest income quartile.

The proportions of parents using each type of source is detailed in Figure 6-H overleaf. Local doctors were by far the most popular source of information and advice about the sample child's health. Around three-quarters of respondents from both samples said they had contacted their doctor with a concern over the child's health in the last year. Health visitors were also popular sources of advice particularly, as might be expected, for parents in the baby cohort. The respondent's own parents (the child's grandparents) and their other family or friends with children were the two most common informal sources of advice on child health with the respondent's own parents being a more common option than friends and family.

Figure 6-H % of parents using each source for help, information or advice on sample child's health by sample type

Key differences existed in the range of sources used by different sets of parents. For example, lone parents were less likely than parents in couple families to have used books or leaflets, the Internet, health visitors (particularly in the baby cohort) and telephone helplines. Instead, lone parents were more likely to draw on their own parents for advice, as were younger mothers in general. Family doctors were the only source of advice that was used relatively evenly across the sample.

6.6.2 Sources of help, information and advice about the child's behaviour

In general, toddlers' parents were much less likely to have had a concern about their child's behaviour than their child's health. Half of parents in the toddler sample reported that they had had no concerns about their child's behaviour in the last year. Most of those who had had a concern used only one or two sources of information or advice. Only 1% of toddlers' parents sought information or advice about their child's behaviour from five or more sources in the last year.

There were no significant differences between lone parents and couple families in the likelihood to have sought advice and the number of sources used. Analysis did reveal however, that mothers aged 40 or older were less likely to have sought advice on this matter. There were no statistically significant differences between the other age groups. Nor were there any notable differences by area urban-rural category or neighbourhood deprivation.

The types of sources used by parents for advice about their child's behaviour are displayed in Figure 6-I. Informal sources of support featured more prominently in this instance. The respondent's own parents were the most commonly cited source of help for this matter, used by around a quarter of parents in the toddler cohort. Other friends or family with children were also a commonly mentioned source of information, used slightly more than health visitors. Local doctors, mentioned frequently in relation to concerns about child health, are not consulted as often in relation to behavioural problems. The same pattern is also true for books and leaflets. Overall, there was little notable variation in the sources used by respondents with different characteristics.

Figure 6-I Toddlers' parents using each source for help, information or advice on sample child's behaviour

6.7 Child development

6.7.1 Concerns about child's development and behaviour

Figure 6-J and Table 6.8 show that respondents were more likely to express concern about the development and behaviour of toddlers than of babies (19% versus 8%). This is not surprising given toddlers' increased capacity to demonstrate developmental milestones and express themselves behaviourally. In general, parents were more likely to have concerns about the development and behaviour of male than female toddlers (23% versus 15%). Concerns about the development of toddlers in particular also seemed to be more common among lone parent families and among respondents in households in lower income quartiles. Higher levels of concern about child development were also reported by those from non-white ethnic groups, although the small sample size means that these results need to be treated with some caution.

Figure 6-J Percentage of respondents with some concerns about child's development, learning and behaviour by sex and family type

Table 6.8 Percentage of respondents with some concerns about child's development by sample type and other factors

	% with at least some concerns
	All sample	Household income quartile		Ethnicity of main carer		Mother's highest education qualification
		Up to £14,999	£44,000and above	White	Other	Degree or equivalent	No qualifications
Babies	7.5	8.9	6.4	7.4	11.8	7.7	9.1
Toddlers	19.2	25.8	13.4	18.8	28.4	13.6	25.0
Bases
Weighted
Babies	5217	1439	805	5004	209	1392	501
Toddlers	2858	798	510	2747	108	751	308
Unweighted
Babies	5217	1352	853	5014	199	1456	471
Toddlers	2858	750	538	2754	101	789	292

6.7.2 Child weight

Table 6.9 demonstrates that the GUS sample (10.5 months) had the same median weight as the WHO figures for 11-month olds, but also tended to have lower figures for the 3rd percentile and higher figures for the 97th percentile.

Table 6.9 Comparison of weights: WHO and GUS Figures

	Weight of babies
	Weight of 10 and 11 month GIRLS in kg (percentiles)
	3rd	15th	Median	85th	97th
WHO: 10 months	6.8	7.5	8.5	9.6	10.7
WHO: 11 months	7.0	7.7	8.7	9.9	11.0
GUS	6.5	7.5	8.7	10.0	11.2
	Weight of 10 and 11 month BOYS in kg (percentiles)
WHO: 10 months	7.5	8.2	9.2	10.3	11.2
WHO: 11 months	7.7	8.4	9.4	10.5	11.5
GUS	6.6	8.1	9.4	10.7	12.1

6.7.3 Developmental milestones of babies

Table 6.10 shows the percentage of male and female babies able to achieve particular developmental tasks. When gross motor skills are considered there is little difference between the sexes, although slightly higher percentages of boys were reported as being able to stand with the aid of support and take a few steps on their own. Female babies tended to be more advanced in relation to specific fine motor co-ordination tasks, such as putting their hands together, as well as their ability to make gestures. For example, female babies were much more likely to wave goodbye spontaneously to someone leaving than male babies were (88% versus 76%). Overall, higher percentages of babies have achieved the developmental milestones outlined in Table 6.10 than was the case in the MCS, which is likely to reflect the slightly older age group of interest studied by GUS. However, the pattern of female babies demonstrating greater levels of communicative gestures and, to a lesser extent, more advanced fine motor skills, is a feature of both studies.

Table 6.10 Developmental milestones of babies by sex

	Boys (%)	Girls (%)
Gross Motor Coordination
S/he can sit up without being supported	98.7	99.8
If put down on floor s/he can move from one place to another	94.3	93.9
S/he can stand up while holding onto something like furniture	89.2	86.5
S/he can walk a few steps on his/her own	24.3	22.4
Fine Motor Coordination
S/he grabs objects using his/her whole hand	99.8	99.8
S/he passes a toy back and forth from one hand to another	98.6	98.8
S/he can pick up a small object using forefinger and thumb only	96.7	97.0
S/he puts his/her hands together	95.6	97.6
Fine Motor Coordination - Gestures
S/he smiles when you smile at him/her	99.9	100.0
S/he extends arms to show/he wants to be picked up	96.4	96.8
S/he reaches out and gives you a toy or some other object that s/he is holding	92.6	94.8
S/he waves bye-bye on his/her own when someone leaves	76.4	87.8
S/he nods his/her head for 'yes'	18.7	21.3
BASES: Weighted	2689	2528
Unweighted	2683	2534

The MCS also suggested that communicative gestures tended to be more advanced among those living in areas with high levels of minority ethnic populations and in areas of lower socio-economic status. As has been noted previously, the sample size for minority ethnic groups in GUS is relatively small, and the results for communicative gestures are not consistent when ethnicity is considered in any case. However, there was some evidence to support the MCS finding that those brought up in areas of greater relative deprivation might have more advanced communicative gestures with, for example, 71% of female babies from the most deprived areas reported as being able to wave goodbye often compared with 63% of female babies from other areas. In addition, babies of younger mothers tended to have more advanced abilities in relation to gestures (e.g. 56% of male babies born to under 20s were able to wave goodbye often compared with 40% of those born to mothers above the age of 40).

6.7.4 Developmental milestones of toddlers

Female toddlers tended to have attained more of the developmental milestones outlined in Table 6.11 than male toddlers. This was especially true for tasks which involved getting dressed or undressed, although arguably this might in part reflect different patterns of play or girls and boys being treated differently by their parents and carers. However, higher percentages of girls than boys also had the capacity to carry out more complicated fine motor tasks such as copying squares and circles (circles = 90% versus 80%).

Table 6.11 Developmental milestones of toddlers by sex

	Boys (%)	Girls (%)
S/he can throw a ball	99.9	99.6
S/he can grasp and handle small objects such as a pencil and scissors	99.9	99.7
S/he can hold a pencil and scribble	99.5	99.3
S/he can walk on the level without difficulties	99.5	99.1
S/he can drink from a cup	98.8	99.0
S/he can brush his/her teeth without help at least some of the time	94.7	95.3
S/he can walk up steps like an adult, one foot on each step	97.4	97.3
S/he can draw a circle	80.3	90.0
S/he can balance on one foot for at least 4 seconds	79.9	84.0
S/he can hop at least twice on one foot	72.7	76.6
S/he can undo big buttons	68.6	84.1
S/he can put on a t-shirt by his/herself	68.2	85.5
S/he can copy a square	33.2	39.6
S/he can get dressed without any help	29.1	56.0
BASES: Weighted	1468	1390
Unweighted	1467	1391

6.7.5 Speech and language development

Figure 6-K shows that female toddlers were more likely than male toddlers to be perceived as able to make themselves understood by the respondents, by other friends or family members and by strangers. For example, 73% of girls compared with 63% of boys were reported as having the ability to make themselves understood by strangers.

Figure 6-K Toddlers mostly able to make themselves understood by respondents, friends/family and strangers by sex

Table 6.12 demonstrates that respondents were less likely to have concerns about speech and language development with female than male toddlers (90% reporting no concerns versus 81%). The major concern expressed by respondents was in relation to the pace of language development.

Table 6.12 Concerns about toddlers' speech and language by sex

	Boys (%)	Girls (%)
No concerns	80.9	89.5
Language is developing slowly	11.2	4.9
Child pronounces words poorly	6.6	3.7
Hard for others to understand child	6.3	2.2
Child stutters	1.2	0.6
Child doesn't hear well	0.8	0.7
Child doesn't seem to understand others	0.5	-
Other	3.2	2.2
BASES: Weighted	1468	1389
Unweighted	1467	1391

Figure 6-L shows that those in higher income groups and of a white ethnic background had lower levels of concern about toddlers' speech and language than those in lower income groups and of an other ethnic background. However, lower numbers means that this result does have to be treated with some caution.

Figure 6-L No concerns about toddlers' speech and language by household income quartiles, ethnic group and sex

6.8 Key points

• The vast majority of parents perceived the general health of their baby/toddler to be good or very good. In total 13% of babies and 18% of toddlers were reported as having a long-standing illness, with slightly higher rates among lone parents, those in the lowest income quartile and with male babies.
• In terms of health problems requiring NHS contact around eight in ten babies and seven in ten toddlers had experienced at least one health problem that required contact with the NHS (excluding accidents and injuries). The most common problems that resulted in the respondent seeking medical or nursing help on behalf of their baby or toddler were respiratory tract and skin infections.
• Toddlers were much more likely than babies to require NHS treatment/advice as a result of accidents (24% versus 10%). The most common type of accident or injury for both cohorts was a bang on the head (64% baby cases, 42% toddler cases). Only about 5% of babies and toddlers were admitted as in-patients as result of their accidents.
• Most parents has sought some form of help or information on their child's health in the last year. GPs and health visitors were the most common sources used. Lone parents and young mothers were less likely to have used other formal resources such as books or telephone helplines being more likely instead to seek advice from informal sources particularly their own parents.
• In regards to child development the parents were more likely to express concern about the development and behaviour of toddlers than babies (19% versus 15%) and were more likely to have concerns about male than female toddlers (23% versus 15%).
• There were few differences between the sexes in relation to gross motor skills. More pronounced differences were evident between the sexes in relation to fine motor skills and communicative gestures with girls tending to be more advanced. Respondents were more likely to express concerns about language development in relation to male than female toddlers.

6.9 Conclusion

Children's general health and development was reported by parents as good or very good overall and this assessment was fairly uniform across the population, although there was some evidence of less advanced development by children from more disadvantaged settings and by boys than girls. Against this positive backdrop of babies and toddlers good health were episodes of routine ill-health on occasion that necessitated contact with health services. The great majority of babies and toddlers were reported to have had some contact with the NHS, with more babies using services and using them more often than toddlers. Lone parents, parents of boys and parents from low income households were slightly more likely to report health problems that involved NHS contact. Of those children with longer term health problems, parents reported a major impact on their ability to carry out day-to-day activities for around a tenth of babies and around a sixth of toddlers.

A minority of parents reported that an accident or injury necessitated NHS help, more commonly involving a toddler than a baby, and slightly more often involving boys than girls and children from lone parent and lower income families. The rate of in-patient hospital admission for GUS babies is slightly lower, at 6%, than that reported by the MCS of 15% (Dex and Joshi, 2005:15). The most common type of injury involving NHS contact by far was a bang on the head, accounting for nearly two-thirds of babies' injuries and just over two-fifths of toddlers' injuries. Very few children with injuries were admitted to hospital as in-patients, the majority being treated in accident and emergency departments.

Most parents reported they had no concerns about their children's motor and linguistic development. However, more parents of toddlers than of babies, and of boys than girls, expressed concerns about their child's development, learning and behaviour. Higher levels of concern were also expressed by lone parents, by parents in lower income households and by parents from minority ethnic groups. Appropriate developmental milestones of gross and fine motor coordination and linguistic and other communication skills were achieved by the great majority of babies and toddlers, with a slightly higher proportion to that found in the MCS and with a slightly higher proportion of female than male toddlers attaining the relevant developmental milestones to that found in the MCS.