EARLY CHILDHOOD CARE AND DEVELOPMENT CHECKLIST

Childs Record 1
(Ages 0 month to 3 years)
Socio demographic Profile: Indicate the complete socio demographic profile of the
child.
Childs Name:

Sex:

Date of Birth (m/d/y):

Address:
Childs handedness:

Chronological Age:
____ Right

____ Left

Is the child presently studying: ____ yes

____ Not yet established

____ no

If yes, write the name of the childs school / learning center / day care:
Fathers Name:

Age:

Fathers Occupation:

Fathers Educational Attainment:

Mothers Name:

Age:

Mothers Occupation:

Mothers Educational Attainment:

Childs Number of Siblings:

Childs Birth Order:

GROSS MOTOR DOMAIN

A. Infant Section (Ages 0 month to 1.0 year)
_____ 1. Infant lifts head when held standing
_____ 2. Infant tries to lift head when lying on stomach
_____ 3. Infant holds head upright on his own when lying on stomach
_____ 4. Infant holds head steadily
_____ 5. Infant rolls over from his back to his stomach with assistance
_____ 6. Infant turns from his side to his back without assistance
_____ 7. Infant sits well with support, leaning on hands if placed on hard surface
_____ 8. Infant bounces when held standing, briefly bearing weight on legs
_____ 9. Infant sits alone steadily
_____ 10. Infant moves from sitting to creeping / crawling position
_____ 11. Infant pulls self from sitting to standing position with minimal assistance
_____ 12. Stands with minimum support
B. Optional Starting Point for Children Ages 1year and 1month to 3 years
_____ 13. Holds furniture with both hands and walks sideways
_____ 14. Walks with both hands held
_____ 15. Climbs on chair or another elevated piece of furniture like a bed
without help

_____ 16. Walks alone, rarely falls

_____ 17. Walks backwards
_____ 18. Runs without tripping or falling
_____ 19. Walks down stairs, 2 feet on each step, with one hand held
_____ 20. Walks upstairs holding handrail, 2 feet on each step
_____ 21. Walks upstairs with alternate feet without holding on to the handrail
_____ 22. Walks downstairs with alternate feet without holding on to the handrail
TOTAL SCORE: __________
FINE MOTOR DOMAIN
A.

Infant Section (Ages 0 month to 1.0 year)

_____ 1. Hands of infant are kept open most of the time
_____ 2. Infant waves arms, moves body at the sight of a dangling object / toy
_____ 3. Infant brings hand together toward dangling object / toy
_____ 4. Infant reaches for toy and holds small toy / spoon

B. Optional Starting Point for Children Ages 1year and 1month to 3 years
_____ 5. Uses all five fingers to get food / toys placed on flat surface
_____ 6. Picks up objects with thumb and index finger
_____ 7. Pulls toys with string
_____ 8. Displays a definite hand preference
_____ 9. Grasps and transfers objects from hand to hand
_____ 10. Pushes or pulls a large object
_____ 11. Puts small objects in / out of container
_____ 12. Holds crayon with all the fingers of his hand as though making a fist (i.e.,
palmar grasp)
_____ 13. Unscrews lid of container or unwraps food
_____ 14. Scribbles spontaneously
TOTAL SCORE: __________
SELF HELP DOMAIN
A.

Infant Section (Ages 0 month to 1.0 year)

_____ 1. Infant sucks and swallows milk from breast or bottle
_____ 2. Infant begins to take solid foods
_____ 3. Chews solid food well

B. Optional Starting Point for Children Ages 1year and 1month to 3 years
_____ 4. Holds bottle all by himself
_____ 5. Feeds self with finger food (e.g., biscuits, bread, etc.) using fingers
_____ 6. Helps hold a cup for drinking
_____ 7. Feeds self using fingers to eat rice / viands with spillage
_____ 8. Drinks from a cup without help
_____ 9. Feeds self using spoon with spillage
_____ 10. Gets a drink for himself without any help
TOTAL SCORE: __________
RECEPTIVE LANGUAGE DOMAIN
A.

Infant Section (Ages 0 month to 1.0 year)

_____ 1. Infant startles to loud sounds
_____ 2. Infant turns eyes / head towards sound
_____ 3. Infant watches mother intently as she speaks to him
_____ 4. Infant smiles at a familiar voice, like when his mother talks to him
_____ 5. Infant stops crying when sung to

B. Optional Starting Point for Children Ages 1year and 1month to 3 years
_____ 6. Turns head when called by name
_____ 7. Understands no
_____ 8. Imitates adults playful sounds like coughing or lip smacking
_____ 9. Follows one-step command (e.g., give) when gestures are used
_____ 10. Follows one-step command without need for gestures
_____ 11. Points to a family member when asked to do so
_____ 12. points to 5 body parts of his when asked to do so
_____ 13. Points to five named pictured objects when asked to do so
_____ 14. Follows one-step instructions that include simple prepositions (e.g., in,
on, under)
_____ 15. Follows 2-step instructions that include simple prepositions
TOTAL SCORE: __________

EXPRESSIVE LANGUAGE DOMAIN

A. Infant Section (Ages 0 month to 1.0 year)
_____ 1. Infant vocalizes (e.g., gurgles, coos, grunts)
_____ 2. Infant vocalizes to express pleasure or displeasure
_____ 3. Infant shouts to attract the attention of the caregiver
_____ 4. Infant laughs out loud and squeals
_____ 5. infant vocalizes different vowel sounds (e.g., aaah, oooh)
_____ 6. Infant vocalizes other sounds that do not mean anything
_____ 7. Infant babbles continuously to amaze self or attract attention
_____ 8. Infant tries to imitate caregivers vocalizations
_____ 9. Infant uses body movements / gestures to make wants known (e.g, stretches
arm to indicate what he wants)
B. Optional Starting Point for Children Ages 1year and 1month to 3 years
_____ 10. Repeats vowel-consonant combinations without referring to anything or
anyone
_____ 11. Uses sounds meaningfully to refer to specific objects / persons
_____ 12. Chatters in a conversational tone without using real words
_____ 13. Tries to imitate real words of adults
_____ 14. Combines single words and gestures to make wants known
_____ 15. Uses 5 20 recognizable words
_____ 16. Uses pronouns
_____ 17. Uses 2- to 3-word-verb-noun combination
_____ 18. Names objects in pictures
_____ 19. Speaks in grammatically correct 2- to 3-words sentences
_____ 20. Asks what questions
_____ 21. Asks who and why questions
_____ 22. Gives account of recent experiences (with prompting) in order of
occurrence using past tense
TOTAL SCORE: __________
COGNITIVE DOMAIN
A. Infant Section (Ages 0 month to 1.0 year)
_____ 1. Infant inspects surroundings
_____ 2. Infant gazes slowly at moving objects / people
_____ 3. Infant turns head to bright colored objects

_____ 4. Infant changes face when he does not like the taste of his food
_____ 5. Infant explores and manipulates objects by biting, holding and looking at
them
_____ 6. Infant shakes toy deliberately to make this sound
_____ 7. Infant eventually gets used to irritating or bothersome familiar sounds
_____ 8. Infant reacts to cloth placed over his face
B. Optional Starting Point for Children Ages 1year and 1month to 3 years
_____ 9. Looks in the direction of a fallen object
_____ 10. Displays for a preference for certain objects by reaching for these more
readily than others
_____ 11. Pushes the ball to make it roll
_____ 12. Repeatedly drops or throws objects
_____ 13. Looks for partially hidden object
_____ 14. Imitates behavior just seen a few minutes earlier
_____ 15. Offers an object but may not release it
_____ 16. Looks for completely hidden object
_____ 17. Exhibits simple pretend play
_____ 18. Matches objects

TOTAL SCORE: __________

SOCIO-EMOTIONAL DEVELOPMENT
A. Infant Section (Ages 0 month to 1.0 year)
_____ 1. Infant stops crying when mother picks him
_____ 2. Infant smiles in response to the caregiver
_____ 3. Infant reacts to familiar situations like bathing or feeding
_____ 4. Infant lifts arms to greet familiar people
B. Optional Starting Point for Children Ages 1year and 1month to 3 years
_____ 5. Cries when caregiver leaves
_____ 6. Enjoys watching activities of nearby people or animals
_____ 7. Smiles playfully at mirror image
_____ 8. Friendly with strangers but initially may show slight anxiety or shyness
_____ 9. Plays alone but likes to be near familiar adults or brothers or sisters
_____ 10. Laughs or squeals aloud in play
_____ 11. Plays peek-a-boo

_____ 12. Rolls ball interactively with caregiver / examiner

_____ 13. Hugs or cuddles toys
_____ 14. Responds with pleasure to friendly people

TOTAL SCORE: __________

___________________________________
EXAMINER