Developmental Checklist Step 1 of 6 0% Has difficulty moving independently from one place to another Has trouble exploring and learning from the world around them Cannot do usual tasks at home, school, and in the community (like move around the house, take a bath, or go on a field trip) Cannot do things other kids of the same age can do Does not use one side of the body Has trouble using toys or other common objects Has trouble using his/her hands Has trouble using vision to help him/her move and balance Has a body that feels “floppy” or “tight” If you selected one or more of the options above, your child might benefit from working with an occupational therapist. Is slow to learn skills like sitting or standing Has tight muscles on one side of the neck Seems very "floppy" or "tight" Only uses one side of the body Will not put weight on legs after 7 months Has trouble walking or seems clumsy Falls a lot after age 3 Cannot do things they used to be able to do (such as being able to sit or walk) Gets tired faster than other children the same age Needs special equipment (Like a walker or wheelchair) If you selected one or more of the options above, your child might benefit from working with a physical therapist. Exhibits refusal of certain tastes (such as sweet, sour, or salty) Exhibits refusal of certain textures (such as crunchy foods, or smooth pureed foods) Exhibits refusal of certain temperatures of food (such as hot or cold) Has a diet limited to certain food groups or a limited number of foods Has difficulty keeping food in the mouth while chewing Has difficulty chewing or swallowing Has difficulty with drinking from a cup or straw Has difficulty using utensils Drools while eating Gags, coughs, or chokes during feeding or taking medication Has oral defensiveness Has a history of pneumonia or reflux Exhibits fatigue during feeding or meals Excessively drools If you selected one or more of the options above, your child might be having feeding difficulties and may benefit from working with an occupational therapist or speech therapist. Is too sensitive or not sensitive enough to sounds, light, or touch Has trouble paying attention Puts things in the mouth that are not food Needs to move all the time Has trouble moving from one activity to another Has trouble controlling emotions Is clumsy, weak, or uses more force than is needed Has a very high or very low activity level If you selected one or more of the options above, your child might have sensory processing problems and may benefit from working with an occupational therapist. Has difficulty pronouncing sounds like other kids his/her age, making it difficult to understand what is being said Has difficulty producing smooth and flowing speech (stuttering) Has a voice that sounds breathy, harsh, or hoarse Has difficulty naming common items Has trouble following directions, because they don’t understand what is being said to them Has trouble expressing themselves using sentences and specific vocabulary words Has trouble saying words that others can understand Has trouble saying what he/she wants to say If you selected one or more of the options above, your child might benefit from working with a speech therapist. Would you like to learn more?Name* Parent/Caregiver’s First Name Parent/Caregiver’s Last Name Child's Name* Child’s First Name Child’s Last Name Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year2022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Phone*Email*
