Email
*
Child Date of Birth
*
If they were premature, please identify their adjusted age. This assessment goes off of adjusted ages.
1. How would you describe your baby’s muscle tone when you hold or touch them?
Floppy or soft
Tight or stiff
in between
2. If I were to leave my child on their back in their crib or on the ground, I may walk back in to find them sitting up.
Yes
No
3. My child can move from their tummy on the ground up to sitting by themselves.
Yes
No
4. If my child is playing with 2 blocks or cubes, would they bang them together?
Yes
No
5. Is your child clapping their hands?
Yes
No
6. If your child had a small toy in each hand and you offered a third toy, would they try to grab the toy with full hands?
Yes
No
7. My child has consistently grabbed at strings (or strands of hair) and pulled them, trying to see what it attaches to.
Yes
No
8. My child will release a toy from their hand and give it to me if I ask them.
Yes
No
9. In relation to taking off their socks, what does your child typically do?
They haven't tried to take them off
They hate anything on their feet
They won't stand up unless they have something on their bare feet
They try to remove them but are unsuccessful
They can remove 1 sock after several tries
They can remove both of their socks
10. I have seen my child grab for small items with just their thumb and index finger, as opposed to their entire hand.
Yes
No
11. My child can place several small items into a cup if I show them how beforehand.
Yes
No
12. If my child were to fall backwards, would they place their arms back with palms facing down to catch themselves?
Yes
No
13. If my child is sitting and experiences a loss of balance, they can return back to sitting on their own.
Yes
No
14. I feel comfortable leaving my baby in a sitting position while playing with a toy when I leave the room.
True
False
15. When you think about your baby, or look at pictures of them, is their head usually tilted or turned to one side? Do they have a flat spot on their head?
Yes they're often looking 1 way but no flat spot
Yes and yes also a flat spot
It's hard to tell
No
16. How does your baby move around on the floor?
Rolling
Army Crawling
Butt Scooting
A Funky Thing I can't Even Name
Hands and Knees
17. My baby can move between the floor and sitting on their own.
True
False
18. My baby is starting to get onto their knees and 'revs their engine' by moving back and forth.
True
False
19. My child can crawl on their hands and knees at least 5 feet, moving their opposite sides of their body in sync.
Yes
No
They can do this in an 'army crawl' position only
20. My baby is able to scoot around on their bottom while sitting and without losing balance.
Yes, they can scoot several feet
Yes, they spin in a circle in either direction
Yes, they spin in a circle in only 1 direction
No
21. When your baby is standing with support and ready to get down, what happens?
They lower down with control most of the way
They lower down with control only at the beginning and then panic or fall
They only fall down accidentally
They scream or cry until I help them
22. Can your child maintain their balance if placed in standing for approximately 5 seconds?
Yes
No
23. If you were to hold your baby at their ribcage in a standing position, would they try to take steps?
Yes, but they would collapse after 2-3 steps
Yes, they could take at least 4 steps (even if it's just in place)
No; they seem 'frozen' in place with straight knees
No; they cannot hold their body weight up through their legs even when I am supporting them
No; their legs support their body weight, but their torso flings forward or backwards
24. My baby is starting to pull themselves up from the floor to a standing position on supportive surfaces.
True
False
25. Does your baby spend a lot of time in a bouncer, jumper, walker, car seat, or in your arms?
Yes; I need to keep them contained or held because otherwise they will cry
Yes; I have a lot to get done and this is how I manage my tasks. They probably spend a few hours in between all of these.
Yes; I have a lot to get done and this is how I manage my tasks. They probably spend 30-60 minutes in between all of these.
No; they are able to explore their environment without restraint
26. When you hold your baby in a standing position, how do they stand?
Lock out their knees and push their booty back
Stand on tiptoes
Jump nonstop
Stand upright on flat feet and sometimes even bounce
They collapse immediately
27. Does your baby show a clear preference for one side (looking, reaching, pulling up to stand).
Yes; I think they may already be showing they’re a “lefty” or a “righty”
No
Thank you for your submission. What made you decide to take our quiz, and did it bring up any other concerns you may have?