Little Green Pipsqueak - Basic Screening 0-6 Months

Helping Babies and Tots in Their Development

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Please answer all questions.
If there is an answer that you don't know, please answer "no".

Cognitive:	Yes	No
1. Responds or quiets when held or comforted
2. Listens to voices and looks toward voices or sounds
3. Mouths hands or objects
4. Beginning to hold objects
5. Watches faces when someone is talking or shows interest in object for 1-3 minutes
Speech:	Yes	No
6. Cries when hungry or for discomfort
7. Laughs and smiles
8. Coos, like: ahhh, eee, oy sounds
Gross Motor:	Yes	No
9. Turns head to both sides when on the back
10. Extends both legs
11. Rolls from side to back
12. Lifts head when on belly
13. Kicks legs
14. Rolls belly to back
15. Holds head in line with body
Fine Motor:	Yes	No
16. Moves arms symmetrically
17. Stares and gazes
18. Starts to grasp objects
19. Starts to reach for objects
20. Tracks person or objects
Social/Emotional:	Yes	No
21. Makes eye contact
22. Smiles
23. Relaxes when cuddled
24. Demands attention
25. Recognizes caregivers visually
Self Help:	Yes	No
26. Opens and closes mouth for food (bottle or breast fed)
27. Sleeps nights 4-8 hours
28. Takes naps throughout the day
29. Brings hand to mouth
30. Recognizes food source visually and responds
31. Brings hand to mouth