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Developmental Checklist (48-60 months)
Leave This Blank:
Child's date of birth
Diagnosis, if any
Full term/Preemie (how many weeks)
Check the box next to the skills your child has mastered.
Stand on one foot for 10 seconds or longer.
Walks Attempts a somersault.
Independently uses a swing. ball.
Climbs on/over playground equipment independently.
May be able to skip.
Copies triangle and other geometric patterns.
Draws a person with a body.
Prints most capital letters.
Dresses and undresses independently.
Recalls at least 3 parts of a story.
Speaks in 5-6 word sentences.
Uses future tense when talking.
Can tell a longer story with a beginning and ending.
Can state name and address.
Can count ten or more objects.
Correctly names at least four colors.
Can work in a small group for 5-10 minutes.
Understands the concept of short amount of time.
Knows about things used everyday in the home (money, food, etc.).
Uses a spoon and fork independently.
Can chew food with lips closed.
Goes to the bathroom independently (may need a reminder).
Prefers to play with friends.
More likely to agree to the rules of a simple game.
Likes to sing, dance and act.
Please contact me for follow up:
Regardless if there is a concern or not
Only if there is a concern.
The best way to reach me is
By phone (listed above)
By email (listed above)
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