CSBS DP Infant-Toddler Checklist

CSBS DP Infant-Toddler Checklist
Access Code*
Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Date
Parent's Name*

First NameLast Name
Email*
example@example.com
Was birth premature?

YesNo
How many weeks premature?*
Instructions for caregiver: This checklist is designed to identify different aspects of development in infants and toddlers. Many behaviors that develop before children talk may indicate whether or not a child will have difficulty learning to talk. This checklist should be completed by a caregiver when the child is bettwen 6 and 24 months of age to determinewhether a referral for an evaluation is needed. The caregiver may be either a parent or another person who nurtures the child daily. Please check all the choices that best describe your child's behavior. If you are not sure, please choose the closest response based on your experience. Children at your child's age are not necessarily expected to use all the behaviors listed.

	Not yet	Sometimes	Often
18. Does your child put two words together (for example, more cookie, bye bye Daddy)?

	Not yet	Sometimes	Often
19. When you call your child's name, does he/she respond by looking or turning toward you?

	Not yet	Sometimes	Often
21. Does your child show interest in playing with a variety of objects?

	None	2 blocks	3-4 blocks	5 or more
23. About how many blocks (or rings) does your child stack?

	Not yet	Sometimes	Often
24. Does your child pretend to play with toys (for example, feed a stuffed animal, put a doll to sleep, put an animal figure in a vehicle)?

	Not yet	Sometimes	Often
1. Do you know when your child is happy and when your child is upset?
2. When your child plays with toys, does he/she look at you to see if you are watching?
3. Does your child smile or laugh while looking at you?
4. When you look at and point to a toy across the room, does your child look at it?

	Not yet	Sometimes	Often
5. Does your child let you know that he/she needs help or wants an object out of reach?
6. When you are not paying attention to your child, does he/she try to get your attention?
7. Does your child do things just to get you to laugh?
8. Does your child try to get you to notice interesting objects - just to get you to look at the objects, not to get you to do anything with them?

	Not yet	Sometimes	Often
9. Does your child pick up objects and give them to you?
10. Does your child show objects to you without giving you the object?
11. Does your child wave to greet people?
12. Does your child point to objects?
13. Does your child nod his/her head to indicate yes?

	Not yet	Sometimes	Often
14. Does your child use sounds or words to get attention or help?
15. Does your child string sounds together, such as uh oh, mama, gaga, bye bye, bada?