Developmental Checklist Survey

Developmental Survey

This is a short survey to help parent’s assess if their child is hitting his/her developmental milestone at an age appropriate level. This survey is not all inclusive as each child develops at an individual rate. (Check all that apply)
By 6 months of age:

Does your child smile back at you and other family members? Does your child roll front to back and back to front? Does your child squeal and babble different sounds? Does your child sit while leaning on his/her hands? Does your child enjoy playing “peek-a-boo?” Does your child bring the bottle to his/her mouth with both hands?
By 12 months of age:

Does your child pull to standing at furniture? Does your child lower his/her self to sitting on the floor, from standing, without falling? Does your child cruise sideways around furniture? Does your child clasp hands together well? Does your child put 3 or more objects into a container? Does your child stack 2 blocks? Does your child point with his/her index finger? Does your child copy movements like “pat-a-cake” or “bye-bye. Does your child repeat sounds like “baba,” “mama” or dada.
By 18 months of age:

Does your child climb into an adult chair and turn around to sit? Does your child push/pull a large toy around the room? Does your child your both hands, holds a toy in one hand and use the other hand to play with the toy? Does your child stack 4-6 blocks? Does your child remove shoes when they are unlaced? Does your child feed him/herself with his/her fingers? Does your child use at least 3 words besides “mama” or “dada?
By 24 months of age:

Does your child run without falling? Does your child throw a tennis size ball about 3-5 ft in the direction of a target? Does your child jump up 2 inches from the floor with both feet? Does your child jump from a bottom step? Does your child imitate a horizontal stroke with a pencil/crayon? Does your child pull his/her pants down with assistance? Does your child point and use words to get your attention? Does your child say “no” a lot?
By 3 years of age:

Can your child safely make sharp turns while running? Does your child avoid obstacles in his/her path? Does your child catch a ball with his/her arms and hands extended? Can your child kick a ball about 6 feet? Can your child build a 9-10 block tower? Can your child self-feed with a spoon with some spillage? Can your child put his/her socks and shoes on? Does your child comfort others when they are crying? Does your child have at least 100 words? Does your child combine 2 ideas in a sentence, like: “I want an apple and a banana. Can your child walk up stairs while placing 1 foot on each step, alternating his/her feet, on 4 steps without holding
By 4 years of age:

Can your child hop on 1 foot forward 13 times? Does your child pedal a tricycle for a long distance and turn corners or make a u-turn? Does your child imitate a square drawing on a piece of paper? Can your child match 6 colors? Can your child cut out a small square or triangle with blunt tip scissors? Can your child button front-opening buttons? Can your child undress daily, at designated times, without reminders? Does your child dress self independently when asked? Does your child quite down after active periods and wait for instructions? Does your child return objects to assigned places when asked? Can your child walk down stairs while placing 1 foot on each step, alternating his/her feet, on 4 steps without
By 5 years of age:

Can your child jump, gallop and hop at least 8 consecutive times? Can your child skip 8 steps using opposing arm and leg movements? Can your child hit a target with a tennis ball from 12 ft away using an overhead throw? Does your child run while pumping his/her arms? Can your child print his/her own name? Can your child draw a picture of a least 3 objects? Can your child place shoes on the correct feet and lace the shoes? Can your child play games with rules, like Candyland or kickball?
By 6 years of age:

Can your child skip 10 feet using opposing arm and leg movements? Can your child complete 5 sit-ups in 20 seconds? Does your child complete 8 push-ups (lifting chest off the floor only) in 20 seconds? Can your child tie his/her shoes? Can your child dress and undress without assistance? Can your child accept friendly teasing? Does your child pause to allow others to speak? Does your child voluntarily offer to help others? Can your child stand on one foot for at least 10 seconds on each leg without swaying and with the hands on the
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Developmental Survey