SWYC: 24 months

  • SWYC: 24 months

    23 months, 0 days to 28 months, 31 days
  • Birth Date:*
     - -
  • Today's Date:*
     - -
  • Format: (000) 000-0000.

  • DEVELOPMENTAL MILESTONES

    Most children at this age will be able to do some (but not all) of the developmental tasks listed below. Please tell us how much your child is doing each of these things. PLEASE BE SURE TO ANSWER ALL THE QUESTIONS.
  • Names at least body parts - like nose, hand, or tummy*
  • Climbs up a ladder at a playground*
  • Uses words like "me" or "mine"*
  • Jumps off the ground with two feet*
  • Puts 2 or more words together - like "more water" or "go outside"*
  • Uses words to ask for help*
  • Names at least one color*
  • Tries to get you to watch by saying "Look at me"*
  • Says his or her first name when asked*
  • Draws lines*

  • PRESCHOOL PEDIATRIC SYMPTOM CHECKLIST (PPSC)

    These questions are about your child's behavior. Think about what you would expect of other children the same age, and tell us how much each statement applies to your child.
  • Does your child seem nervous or afraid?*
  • Does your child seem sad or unhappy?*
  • Does your child get upset if things are not done in a certain way?*
  • Does your child have a hard time with change?*
  • Does your child have trouble playing with other children?*
  • Does your child break things on purpose?*
  • Does your child fight with other children?*
  • Does your child have trouble paying attention?*
  • Does your child have a hard time calming down?*
  • Does your child have trouble staying with one activity?*
  • Is your child aggressive?*
  • Is your child fidgety or unable to sit still?*
  • Is your child angry?*
  • Is it hard to take your child out in public?*
  • Is it hard to comfort your child?*
  • Is it hard to know what your child needs?*
  • Is it hard to keep your child on a schedule or routine?*
  • Does your get your child to obey you?*

  • PARENT'S CONCERNS

  • Do you have any concerns about your child's learning or development?*
  • Do you have any concerns about your child's behavior?*

  • FAMILY QUESTIONS

    Because family members can have a big impact on your child's development, please answer a few questions about your family below:
  • Does anyone who lives with your child smoke tobacco?*
  • In the last year, have you ever drunk alcohol or used drugs more than you meant to?*
  • Have you felt you wanted or needed to cut down on your drinking or drug use in the last year?*
  • Has a family member's drinking or drug use ever had a bad effect on your child?*
  • Within the past 12 months, we worried whether our food would run out before we got money to buy more.*
  • Should be Empty: