A Review of your baby’s progress depending on the age of the baby. These questions should be completed few days before your visit to doctor and should be shared with your doctor.
1-2 Weeks Review
| Question | Yes | No | Unsure |
| 1. Do you have any concerns about your baby? | |||
| 2. Is your baby startled by loud noise? | |||
| 3. Has anyone in your family had a history of early deafness (under five years of age)? | |||
| 4. Has anyone in your family had a history of early eye problems (under five years of age)? | |||
| 5. Has anyone in your family had a history of any other health problems? | |||
| 6. Is there a family history of congenital dislocation of the hip? | |||
| 7. Was your baby a breech birth? |
6-8 Weeks Review
| Question | Yes | No | Unsure |
| 1. Does your baby watch your face and follow with his/her eyes? | |||
| 2. Does your baby turn towards light? | |||
| 3. Does your baby smile at you? | |||
| 4. Do you think your baby can hear you? | |||
| 5. Is your baby startled by loud noise? | |||
| 6. How are you feeding your baby with Breast? |
6-9 Months Review
| Question | Yes | No | Unsure |
| 1. Are you concerned about your baby’s health? | |||
| 2. Is your baby being offered food other than milk? | |||
| 3. Do you have any questions about your baby’s development? | |||
| 4. Is your child’s immunization up to date? | |||
| 5. Are you concerned about your baby’s vision? | |||
| 6. Does your baby have a squint(turned eye)? | |||
| 7. Does your baby look at you and follow with his/her eyes? | |||
| 8. Does your baby look at his/her hands or objects? | |||
| 9. Does anyone in the family have vision problems? | |||
| 10. Are you concerned about your baby’s hearing? | |||
| 11. Does your baby turn to sounds or voices? | |||
| 12. Has your baby had ear infections or ear discharge? | |||
| 13. Does your baby have any hearing risk factors? | |||
| 14. Does your baby hear you and listen to your voice? | |||
| 15. Does your baby sit alone? | |||
| 16. Does your baby roll over? | |||
| 17. Does your baby reach for an object? | |||
| 18. Is your baby’s steady when sitting? | |||
| 19. Does your baby push up with his/her arms when lying on his/her stomach? | |||
| 20. Can your baby pass an object from one hand to the other? | |||
| 21. Does your baby make ‘mama’ or ‘dada’ sounds? |
18-21 Months
| Question | Yes | No | Unsure |
| 1. Are you concerned about your child’s health? | |||
| 2. Are you concerned about your child’s behavior? | |||
| 3. Are you concerned about your child’s development? | |||
| 4. Is your child’s immunisation up to date? | |||
| 5. Are you concerned about your child? | |||
| 6. Does your child have a squint (turned eye)? | |||
| 7. Does your child have difficulty seeing small objects? | |||
| 8. Does anyone in the family have eyesight problems? | |||
| 9. Are you concerned about your child’s hearing? | |||
| 10. Does your child have frequent ear infections? | |||
| 11. Is your child saying single words other than 'mama’ or ‘dada’? | |||
| 12. Can your child understand simple instructions, for example: | |||
| 1. ‘Put the ball on the table’. | |||
| 2. ‘Give the ball to me’. | |||
| 3. ‘Go and sit on the chair’. | |||
| 4. Can your child point to one body part? | |||
| 13. Can your child walk and bend down without falling over? | |||
| 14. Can your child walk up or down stairs if holding onto your hand? | |||
| 15. Can your child walk backwards? | |||
| 16. Can your child stack cubes on top of each other? | |||
| 17. Can your child pick up small objects(for example, a raisin) easily? |
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