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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.
My baby has mostly straight arms, legs, neck and back.
True
False
My baby's arms and legs seem floppy and are mostly resting out to the sides of the body. I can see more of the “inside” of the thighs and arms rather than the “top” when laying on their backs.
True
False
My baby is not finding “midline”, arms and head are often extended back/ out, not putting their hands near their mouth.
True
False
My baby is tracking toys and/ or people consistently.
True
False
While laying on their back, my baby is often looking “up” above their head or off to one side rather than just up at ceiling or down at their hands.
True
False
My baby's arms are stiff/ tight, making diaper changes difficult.
True
False
My baby rests their hands on their body while laying on their back.
True
False
My baby is reaching up to their knees while laying on their back.
True
False
My baby is moving 1 arm at a time rather than both towards a toy or my face.
True
False
My baby's head and arm move in the same direction, involuntarily.
True
False
My baby kicks their legs when on their back.
True
False
My baby has difficulty bending their legs, makes changing diaper and onesie difficult. They seem too rigid in legs to easily move in/ out of carriers or the carseat.
True
False
My baby won’t roll from their back to side with control (seems accidental or like it is forced after one body part starts moving that way).
True
False
My baby has a tendency to accidentally roll from their back to their side because their body is extended/ straight/ erect.
True
False
My baby demonstrates extreme difficulty in tummy time/ is not lifting head their in tummy time for more than a few seconds.
True
False
My baby pushes themself up on their forearms while in tummy time.
True
False
While on their tummy, they are able to bring their elbows in front of their shoulders.
True
False
My baby demonstrates extreme head lag when they are pulled to sit (a baby situp).
True
False
My baby pushes “back” against you or cushions when sat upright.
True
False
My baby doesn’t automatically try to stand when their feet are placed on the ground in a standing position.
True
False
When “standing”, my baby demonstrates tiptoe posture and very straight knees.
True
False
My baby is demonstrating more asymmetrical movements more than symmetrical movements
True
False