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What is your baby's date of birth?
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If born premature, what is your baby's adjusted age? This assessment scores off of adjusted age.
1. My baby has mostly straight arms, legs, neck and back.
True
False
2. My baby’s arms and legs are floppy and mostly rest out to the sides when lying on their back, showing more of the inner surfaces than the top.
True
False
3. My baby’s arms and head often stay extended out or back, and they don’t bring their hands toward their mouth.
True
False
4. My baby is able to track toys and people with their eyes consistently.
True
False
5. When on their back, my baby often looks above their head or to the side instead of at the ceiling or their hands.
True
False
6. My baby's arms are stiff or tight, making diaper changes difficult.
True
False
7. My baby rests their hands on their body while laying on their back.
True
False
8. My baby is reaching up to their knees while laying on their back.
True
False
9. My baby moves one arm at a time rather than both when reaching for a toy or my face.
True
False
10. My baby's head and arm move in the same direction, involuntarily.
True
False
11. My baby kicks their legs when on their back.
True
False
12. My baby’s legs are stiff, making diaper changes, dressing, and getting in/out of carriers or the car seat difficult
True
False
13. My baby doesn’t roll from back to side with control; it seems accidental or starts after one part of their body moves.
True
False
14. My baby accidentally rolls from back to side because their body stays stiff or straight.
True
False
15. My baby has extreme difficulty with tummy time and can’t lift their head for more than a few seconds
True
False
16. My baby pushes themself up on their forearms while in tummy time.
True
False
17. While on their tummy, my baby can bring their elbows in front of their shoulders.
True
False
18. My baby's head falls back excessively when pulled to a sitting position from lying on their back
True
False
19. When sitting, my baby pushes back against me or the cushions.
True
False
20. My baby doesn’t automatically try to stand when their feet are placed on the ground in a standing position.
True
False
21. When “standing”, my baby demonstrates tiptoe posture and very straight knees.
True
False
22. My baby shows more movements using one side of their body than using both sides symmetrically.
True
False