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Developmental Checklist (1 to 3 months)
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Child's Name
*
Child's date of birth
*
Diagnosis, if any
Full term/Preemie (how many weeks)
*
Parent(s) name
*
Phone
Email
Zip Code
Today's Date
*
Check the box next to the skills your child has mastered.
retains hold of object/rattle.
Brings hands toward center of body when lying on back.
Raises head and cheek when lying on stomach.
Supports upper body with arms when lying on stomach.
Stretches legs out when lying on stomach or back.
Opens and shuts hands.
Pushes down on his legs when his feet are placed on firm surface.
Occasionally rolls from stomach to back.
Responds to voice (i.e. turn to, wiggle, reacts)
Watches face intently.
Follows moving objects.
Recognizes familiar objects and people at a distance.
Starts using hands and eyes in coordination.
Makes sucking sounds.
Smiles at the sound of a friendly voice.
Cooing noises; vocal play.
Attends to sound.
Startles to loud noise.
Makes eye contact.
Begins to develop a social smile.
Enjoys playing with people and may cry when playing stops.
Becomes more communicative and expressive with face and body.
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)
* indicates required fields.
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