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 None Physical Developmental Skills My child's head is steady in unsupported sitting. Yes No None Physical Developmental Skills My child is starting to rock, roll, and twist. Yes No None Physical Developmental Skills My child brings their feet to their mouth. Yes No None Physical Developmental Skills My child is able to balance well when seated for increasing time. Yes No None Physical Developmental Skills My child is pushing up onto arms, pushing through hands, when on belly. Yes No None Physical Developmental Skills My child is able to grab my hands and pull up to sitting with head control. Yes No None 1 out of 3 Occupational Developmental Skills My child can grab and explore objects. Yes No None Occupational Developmental Skills My child is beginning to move objects from one hand to the other. Yes No None Occupational Developmental Skills My child likes to play with different textures including wet textures. Yes No None Occupational Developmental Skills My child clearly recognizes me and immediate family members. Yes No None Occupational Developmental Skills My child expresses when they are upset or happy. Yes No None Occupational Developmental Skills My child prefers to be held by a parent or settles easier when held by a parent. Yes No None Occupational Developmental Skills My child turns and recognizes their name. Yes No None Occupational Developmental Skills My child can entertain themselves for a short time. Yes No None 2 out of 3 Speech Developmental Skills My child smiles when being spoken too. Yes No None Speech Developmental Skills My child has different cries for different needs. Yes No None Speech Developmental Skills My child babbles. (pa, ba, ma) Yes No None Speech Developmental Skills My child notices items that make noise or music. Yes No None Speech Developmental Skills My child laughs. Yes No None Speech Developmental Skills My child makes gurgling sounds. Yes No None Speech Developmental Skills My child is starting to respond to their own name. Yes No None Speech Developmental Skills My child is imitating a few sounds and noises. Yes No None 3 out of 3 Please fill in the comment box below. Time's up
