Developmental Survey

This is a short survey to help parents 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?
- Yes
- No
Does your child roll front to back and back to front?
- Yes
- No
Does your child hold their head up by themselves when you hold them?
- Yes
- No
Does your child turn their head to each side easily?
- Yes
- No
Does your child tilt their head to one side more than the other?
- Yes
- No
Does your child have a flat spot on the back of their head?
- Yes
- No
Does your child squeal and babble different sounds?
- Yes
- No
Does your child enjoy playing “peek-a-boo?
- Yes
- No
Does your child bring the bottle to his/her mouth with both hands?
- Yes
- No
Does your child prop up on their forearms while on their belly?
- Yes
- No
By 12 months of age:
Does your child pull to standing at furniture?
- Yes
- No
Does your child lower his/herself to sitting on the floor, from standing, without falling?
- Yes
- No
Does your child walk sideways around furniture?
- Yes
- No
Does your child walk sideways around furniture?
- Yes
- No
Does your child stand by him/herself?
- Yes
- No
Does your child clasp their hands together well?
- Yes
- No
Does your child put 3 or more objects into a container?
- Yes
- No
Does your child stack 2 blocks?
- Yes
- No
Does your child remove rings from a stacking pole?
- Yes
- No
Does your child point with his/her index finger?
- Yes
- No
Does your child copy movements like “pat-a-cake” or “bye-bye?
- Yes
- No
Does your child repeat sounds like “baba,” “mama” or “dada?
- Yes
- No
Does your child pick up small objects with their fingers such as cheerios?
- Yes
- No
By 18 months of age:
Does your child climb into an adult chair and turn around to sit?
- Yes
- No
Does your child push/pull a large toy around the room?
- Yes
- No
Does your child use both hands, holding a toy in one hand and using the other hand to play with the toy?
- Yes
- No
Does your child stack 4-6 blocks?
- Yes
- No
Does your child scribble?
- Yes
- No
Does your child place shapes in a shape sorter?
- Yes
- No
Does your child turn 2-3 pages at a time in a thick book?
- Yes
- No
Does your child remove shoes when they are unlaced?
- Yes
- No
Does your child feed him/herself with his/her fingers?
- Yes
- No
Does your child use at least 3 words besides “mama” or “dada?
- Yes
- No
Does your child dip their spoon in food and lift it to their mouth?
- Yes
- No
Does your child hold a cup by its handle?
- Yes
- No
Does your child remove their socks?
- Yes
- No
By 24 months of age:
Does your child run without falling?
- Yes
- No
Does your child throw a tennis size ball about 3-5 ft in the direction of a person?
- Yes
- No
Does your child jump up 2 inches from the floor with both feet?
- Yes
- No
Does your child jump from a bottom step?
- Yes
- No
Does your child imitate a horizontal stroke with a pencil/crayon?
- Yes
- No
Does your child pull his/her pants down with help?
- Yes
- No
Does your child point and use words to get your attention?
- Yes
- No
Does your child say “no” a lot?
- Yes
- No
Does your child scoop food with their spoon?
- Yes
- No
Does your child use the spoon well with little spillage?
- Yes
- No
By 3 years of age:
Can your child safely make sharp turns while running?
- Yes
- No
Does your child avoid obstacles in his/her path?
- Yes
- No
Does your child catch a ball with his/her arms and hands extended?
- Yes
- No
Can your child kick a ball about 6 feet?
- Yes
- No
Can your child build a 9-10 block tower?
- Yes
- No
Can your child snip with scissors, cutting into one piece or cut 6 inches across paper (by 3 ½ years old)?
- Yes
- No
Can your child copy a cross after looking at a picture of one?
- Yes
- No
Can your child complete a 5-8 piece interlocking puzzle (by 3 ½ years old)?
- Yes
- No
Can your child self-feed with a spoon or spear with a fork with some spillage?
- Yes
- No
Can your child put his/her socks and shoes on?
- Yes
- No
Does your child comfort others when they are crying?
- Yes
- No
Does your child have at least 100 words?
- Yes
- No
Does your child combine 2 ideas in a sentence, like: “I want an apple and a banana?
- Yes
- No
Can your child walk upstairs while placing 1 foot on each step, alternating his/her feet, on 4 steps without holding your hand?
- Yes
- No
Does your child dry their hands after washing?
- Yes
- No
By 4 years of age:
Can your child hop on 1 foot forward 3 times in a row?
- Yes
- No
Does your child pedal a tricycle for a long distance and turn corners or make a U-turn?
- Yes
- No
Does your child imitate a square drawing on a piece of paper?
- Yes
- No
Can your child match 6 colors?
- Yes
- No
Can your child cut out a circle 3 inches in diameter with ¼ inch accuracy?
- Yes
- No
Can your child copy a square and diagonal stroke (/)?
- Yes
- No
Can your child trace on a 5 by ½ inch line?
- Yes
- No
Can your child button front-opening buttons?
- Yes
- No
Can your child undress daily, at designated times, without reminders?
- Yes
- No
Does your child dress self independently when asked?
- Yes
- No
Does your child quiet down after active periods and wait for instructions?
- Yes
- No
Does your child return objects to assigned places when asked?
- Yes
- No
Can your child walk downstairs while placing 1 foot on each step, alternating his/her feet, on 4 steps without falling?
- Yes
- No
Can your child throw a tennis ball 8-10 feet?
- Yes
- No
By 5 years of age:
Can your child jump, gallop and hop at least 8 consecutive times?
- Yes
- No
Can your child skip 8 steps using opposing arm and leg movements?
- Yes
- No
Can your child hit a target with a tennis ball from 12 ft away using an overhead throw?
- Yes
- No
Does your child run while pumping his/her arms?
- Yes
- No
"Can your child print his/her own name?"
- Yes
- No
Can your child cut out a small square or triangle with blunt tip scissors?
- Yes
- No
Can your child trace medium sized geometric shapes?
- Yes
- No
Can your child copy a diagonal (/) line and an X?
- Yes
- No
Can your child draw a picture of a least 3 objects?
- Yes
- No
Can your child place their shoes on the correct feet and lace the shoes?
- Yes
- No
Can your child play games with rules, like Candyland or kickball?
- Yes
- No
Can your child copy a square?
- Yes
- No
By 6 years of age:
Can your child skip 10 feet using opposing arm and leg movements?
- Yes
- No
Can your child complete 5 sit-ups in 20 seconds?
- Yes
- No
Does your child complete 8 knee push-ups in 20 seconds?
- Yes
- No
Can your child tie his/her shoes?
- Yes
- No
Can your child dress and undress without help?
- Yes
- No
Can your child accept friendly teasing?
- Yes
- No
Can your child accept friendly teasing?
- Yes
- No
Does your child pause to allow others to speak?
- Yes
- No
Does your child voluntarily offer to help others?
- Yes
- No
Can your child stand on one foot for at least 10 seconds on each leg without swaying?
- Yes
- No
Can your child copy an x?
- Yes
- No
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