April 19, 20215-6 Months – Developmental Questionnaire This quiz should take a maximum of 5 minutes. The final question will allow you to add comments for any questions you have not discussed or covered in the quiz. Depending on the child’s age within the range, answering “NO” isn’t necessarily a cause for concern. The difference between a 2 week old and a 2-month-old is significant. With that in mind, we will ask about your child's birthday and have a specialist look over your responses. We are happy to reach out to you if there's anything we see that the computer may have overlooked. First Name Last Name Zip Code Your Email Phone Number w/ Area Code Child's Age (e.g. '4.5 months' or '18 weeks') [Physical Developmental Skills] My child rolls from their back to their front. Yes No [Physical Developmental Skills] My child's head is steady in unsupported sitting. Yes No [Physical Developmental Skills] My child is starting to rock, roll, and twist. Yes No [Physical Developmental Skills] My child brings their feet to their mouth. Yes No [Physical Developmental Skills] My child is able to balance well when seated for increasing time. Yes No [Physical Developmental Skills] My child is pushing up onto arms, pushing through hands, when on belly. Yes No [Physical Developmental Skills] My child is able to grab my hands and pull up to sitting with head control. Yes No 1 out of 3 [Occupational Developmental Skills] My child can grab and explore objects. Yes No [Occupational Developmental Skills] My child is beginning to move objects from one hand to the other. Yes No [Occupational Developmental Skills] My child likes to play with different textures including wet textures. Yes No [Occupational Developmental Skills] My child clearly recognizes me and immediate family members. Yes No [Occupational Developmental Skills] My child expresses when they are upset or happy. Yes No [Occupational Developmental Skills] My child prefers to be held by a parent or settles easier when held by a parent. Yes No [Occupational Developmental Skills] My child turns and recognizes their name. Yes No [Occupational Developmental Skills] My child can entertain themselves for a short time. Yes No 2 out of 3 [Speech Developmental Skills] My child smiles when being spoken too. Yes No [Speech Developmental Skills] My child has different cries for different needs. Yes No [Speech Developmental Skills] My child babbles. (pa, ba, ma) Yes No [Speech Developmental Skills] My child notices items that make noise or music. Yes No [Speech Developmental Skills] My child laughs. Yes No [Speech Developmental Skills] My child makes gurgling sounds. Yes No [Speech Developmental Skills] My child is starting to respond to their own name. Yes No [Speech Developmental Skills] My child is imitating a few sounds and noises. Yes No 3 out of 3 Please fill in the comment box below. Time's up
