Child development questionnaire (0-12m)

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Child's name*
First
Child's birthday*
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0-12 Months Questionnaire Instructions
Welcome to Happy Baton! We’re so excited to bring you a box of toys that are put together specific to your child’s needs. We just need to know more about your child to curate a toy box that will truly help him/her to thrive. Please scroll down to the appropriate age group and fill out this questionnaire below. Please indicate whether your child displays the following behaviors with yes/sometimes/no.
0-3 Months
Cognitive
1. Pays attention to faces?
- Yes
- Sometimes / Shows intention of doing
- Not yet
2. Begins to follow things with eyes and recognize people?
- Yes
- Sometimes / Shows intention of doing
- Not yet
3. Begins to act bored (cries, fussy) if activity doesn’t change?
- Yes
- Sometimes / Shows intention of doing
- Not yet
Language
1. Coos, makes gurgling sounds?
- Yes
- Sometimes / Shows intention of doing
- Not yet
2. Turns head toward sounds?
- Yes
- Sometimes / Shows intention of doing
- Not yet
3. Laughs at silly faces, amusing sights, favorite toy/person?/pet
- Yes
- Sometimes / Shows intention of doing
- Not yet
Physical
1. Can hold head up and begins to push up when lying on tummy?
- Yes
- Sometimes / Shows intention of doing
- Not yet
2. Makes smoother movements with arms and legs?
- Yes
- Sometimes / Shows intention of doing
- Not yet
3. Begins to reach for toys with one hand, especially sensory ones?
- Yes
- Sometimes / Shows intention of doing
- Not yet
Social & Emotional
1. Begins to smile at people?
- Yes
- Sometimes / Shows intention of doing
- Not yet
2. Can briefly calm themselves (may bring hands to mouth and suck on hand)?
- Yes
- Sometimes / Shows intention of doing
- Not yet
3. Looks at person speaking to them?
- Yes
- Sometimes / Shows intention of doing
- Not yet
4-6 Months
Cognitive
1. Responds to affection?
- Yes
- Sometimes / Shows intention of doing
- Not yet
2. Reaches for toy with one hand?
- Yes
- Sometimes / Shows intention of doing
- Not yet
3. Uses hands and eyes together, such as seeing a toy?
- Yes
- Sometimes / Shows intention of doing
- Not yet
Language
1. Begins to babble?
- Yes
- Sometimes / Shows intention of doing
- Not yet
2. Babbles with expression and copies sounds they hear?
- Yes
- Sometimes / Shows intention of doing
- Not yet
3. Cries in different ways to show hunger, pain, or being tired?
- Yes
- Sometimes / Shows intention of doing
- Not yet
Physical
1. May be able to roll over from tummy to back?
- Yes
- Sometimes / Shows intention of doing
- Not yet
2. Can hold a toy and shake it and swing at dangling toys?
- Yes
- Sometimes / Shows intention of doing
- Not yet
3. Brings hands to mouth?
- Yes
- Sometimes / Shows intention of doing
- Not yet
Social & Emotional
1. Smiles spontaneously, especially at people?
- Yes
- Sometimes / Shows intention of doing
- Not yet
2. Likes to play with people and might cry when playing stops?
- Yes
- Sometimes / Shows intention of doing
- Not yet
3. Copies some movements and facial expressions, like smiling or frowning?
- Yes
- Sometimes / Shows intention of doing
- Not yet
7-9 Months
Cognitive
1. Looks around at things nearby?
- Yes
- Sometimes / Shows intention of doing
- Not yet
2. Shows curiosity about things and tries to reach for things?
- Yes
- Sometimes / Shows intention of doing
- Not yet
3. Pass toys from one hand to the other?
- Yes
- Sometimes / Shows intention of doing
- Not yet
Language
1. Responds to sounds by making sounds?
- Yes
- Sometimes / Shows intention of doing
- Not yet
2. Responds to own name?
- Yes
- Sometimes / Shows intention of doing
- Not yet
3. Makes sounds to show joy and displeasure?
- Yes
- Sometimes / Shows intention of doing
- Not yet
Physical
1. Rolls over in both directions (front to back, back to front)?
- Yes
- Sometimes / Shows intention of doing
- Not yet
2. Sit without support?
- Yes
- Sometimes / Shows intention of doing
- Not yet
3. Rocks back and forth, sometimes crawling backward before moving forward?
- Yes
- Sometimes / Shows intention of doing
- Not yet
4. Crawl?
- Yes
- Sometimes / Shows intention of doing
- Not yet
Social & Emotional
1. Knows familiar faces and begins to know if someone is a stranger?
- Yes
- Sometimes / Shows intention of doing
- Not yet
2. Likes to play with others, especially parents?
- Yes
- Sometimes / Shows intention of doing
- Not yet
3. Responds to other people’s emotions and often seems happy?
- Yes
- Sometimes / Shows intention of doing
- Not yet
10-12 Months
Cognitive
1. Moves things smoothly from one hand to the other?
- Yes
- Sometimes / Shows intention of doing
- Not yet
2. Explores things in different ways, like shaking, banging, throwing?
- Yes
- Sometimes / Shows intention of doing
- Not yet
3. Puts things in a container, takes things out of a container?
- Yes
- Sometimes / Shows intention of doing
- Not yet
Language
1. Makes a lot of different sounds like “mamamama” and “bababababa”?
- Yes
- Sometimes / Shows intention of doing
- Not yet
2. Uses fingers to point at things?
- Yes
- Sometimes / Shows intention of doing
- Not yet
3. Uses simple gestures, like shaking head “no” or waving “bye-bye”?
- Yes
- Sometimes / Shows intention of doing
- Not yet
Physical
1. Gets to a sitting position without help?
- Yes
- Sometimes / Shows intention of doing
- Not yet
2. Pulls up to stand, walks holding on to furniture (“cruising”)?
- Yes
- Sometimes / Shows intention of doing
- Not yet
3. May take a few steps without holding on?
- Yes
- Sometimes / Shows intention of doing
- Not yet
4. May stand alone?
- Yes
- Sometimes / Shows intention of doing
- Not yet
Social & Emotional
1. Is shy or nervous with strangers?
- Yes
- Sometimes / Shows intention of doing
- Not yet
2. Cries when mom or dad leaves?
- Yes
- Sometimes / Shows intention of doing
- Not yet
3. Repeats sounds or actions to get attention?
- Yes
- Sometimes / Shows intention of doing
- Not yet

0-12 Months Questionnaire Instructions

0-3 Months

Cognitive

Language

Physical

Social & Emotional

4-6 Months

Cognitive

Language

Physical

Social & Emotional

7-9 Months

Cognitive

Language

Physical

Social & Emotional

10-12 Months

Cognitive

Language

Physical

Social & Emotional