Talk to your doctor if you answer No to any of these
questions:
Yes |
No |
|
| |
|
Birth to
3 Months |
_____ |
_____ |
Reacts to loud sounds |
_____ |
_____ |
Is soothed by your voice |
_____ |
_____ |
Turns head to you when you speak |
_____ |
_____ |
Is awakened by loud voices and sounds |
_____ |
_____ |
Smiles when spoken to |
_____ |
_____ |
Seems to know your voice and quiets
down if crying |
|
|

3 to 6 Months |
_____ |
_____ |
Looks upward or turns toward a new
sound |
_____ |
_____ |
Responds to "no" and changes
in tone of voice |
_____ |
_____ |
Imitates his/her own voice |
_____ |
_____ |
Enjoys rattles and other toys that
make sounds |
_____ |
_____ |
Begins to repeat sounds (such as ooh,
aah, and ba-ba) |
_____ |
_____ |
Becomes scared by a loud voice |
| |
|

6 to 10 Months |
_____ |
_____ |
Knows words for common things (cup,
shoe) and sayings ("bye-bye") |
_____ |
_____ |
Makes babbling sounds, even when alone
|
_____ |
_____ |
Starts to respond to requests such
as "come here" |
_____ |
_____ |
Looks at things or pictures when someone
talks about them |
_____ |
_____ |
Responds to his/her own name, telephone
ringing, someone's voice, even when out loud |
|
|

10 to 15 Months |
_____ |
_____ |
Plays with own voice, enjoying the
sound and feel of it |
_____ |
_____ |
Points to or looks at familiar objects
or people when asked to do so |
_____ |
_____ |
Imitates simple words and sounds;
may use a few single words meaningfully |
_____ |
_____ |
Enjoys games like peek-a-boo and pat-a-cake |
| |
|

15 to 18 Months |
_____ |
_____ |
Follows simple directions, such as
"give me the ball" |
_____ |
_____ |
Uses words he/she has learned often
|
_____ |
_____ |
Comments, points to objects, vocalizes
or uses word approximations |
_____ |
_____ |
Understands simple "yes-no"
questions (Are you hungry?) |
_____ |
_____ |
Knows approximately 50 words (can
be approximations of adult forms) |
_____ |
_____ |
Understands simple phrases ("in
the cup", "on the table") |
_____ |
_____ |
Enjoys being read to |
_____ |
_____ |
Points to pictures when asked |
|
|

18 to 24 Months |
_____ |
_____ |
Uses 2-3 word sentences to talk about
and ask for things |
|
|

24 to 36 Months |
_____ |
_____ |
Understands "not now" and
"no more" |
_____ |
_____ |
Chooses things by size (big, little)
|
_____ |
_____ |
Follows simple directions such as
"get your shoes" and "drink your
milk" |
_____ |
_____ |
Understands many action words (run,
jump) |
_____ |
_____ |
Begins to use articles ("a",
"the") and word-endings (e.g., "-ing",
"-ed") |
_____ |
_____ |
Engages in short dialogues |
| Yes |
No |
|
| _____ |
_____ |
Do others in the family (including
brothers or sisters) have a hearing problem? |
| _____ |
_____ |
The baby was born early (premature).
Weight at birth: ______ |
| _____ |
_____ |
The baby had physical problems at
birth. |
| _____ |
_____ |
The child rubs or pulls on ear(s)
often. |
| _____ |
_____ |
The child had scarlet fever. |
| _____ |
_____ |
The child had meningitis. |
| _____ |
_____ |
The child had _____ ear infections
in the past year. |
| _____ |
_____ |
The child has colds, allergies, and
ear infections (once a month, more often) |
| _____ |
_____ |
The child's mother had medical problems
in pregnancy or delivery (serious illness or injury,
drugs or medications) |