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Preemie and Young InfantDevelopmental Observation Guide

forInfants 34 Weeks Gestational Age

toFive Months Adjusted Age

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Preemie and Young Infant Developmental Observation Guidefor

Infants 34 Weeks Gestational Age to

Five Months Adjusted Age

The purpose of the Preemie and Young Infant Developmental Observation Guide is to provide service providers with a format for observing the development of very young infants in order to determine appropriate early intervention support. The goal is not to give a developmental age, but rather help guide observations throughout the early intervention process. This Observation Guide is NOT a standardized assessment.

The ability for infants to learn regulatory strategies begins to develop very early. For those infants who do not show such regulation, additional support by the caregiver is required.

The Developmental Observation Guide is divided into three parts. They include ages: 34 weeks gestation to 3 months 2-3 months corrected age 3-5 months corrected age

Each of the three parts of the Developmental Observation Guide is followed by a short section of “Red Flags.” The purpose of the red flags is to keep service providers alert to possible concerns as they develop.

The first seven pages of the Guide look at organized vs. disorganized behavior in four systems of development: physiological, motor, state (wake and sleep cycles), and behaviors of attention and interaction. Self-regulation is an on-going skill that develops as the infant matures. The Guide looks at self-regulatory behaviors as self-initiated behaviors that assist the infant to remain organized. The infant may be successful, successful for a brief period of time, or unsuccessful in using the self-regulating behavior. The goal for each infant is to move from a state of disorganization to one of organization with appropriate self-regulatory behaviors. These first seven pages may continue to be used as other parts of the Guide are completed. For some infants, the ability to become organized and self-regulated may take longer even when other developmental skills are emerging and/or maturing. This may be more obvious in babies with sensory integration challenges, babies who are beginning to show soft signs of the autistic spectrum, babies experiencing stress or trauma, and babies who have multiple impairments.

For many parents, just knowing how to interpret their infant’s behaviors can calm their fears and put them in a position to provide successful support and intervention to their infant.

Following this first section is a Summary Sheet for 34 Weeks to 3 Months. There are three copies of this summary sheet in order to track an infant’s growth over time. Date each one as it is used. The sheet is divided into the five systems of development. Following each section is a place to track the organized behavior the infant shows in each system as well as the disorganized behavior. Use a phrase or word to describe each. Not all areas may be seen in an infant at one time. Under the Self-Regulation section, identify the strategies the infant uses successfully and those in which the infant is not successful and needs outside help to accomplish.

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The second two parts of the guide are divided and scored differently. The emerging domains of development include regulatory and sensory organization, motor integration, fine motor, relationship to their surroundings, social interaction, communication, and adaptive/self help. Each item in these parts is written to give the content of the item preceded by a number. There then follows four options for responses. Letter “a” is always the skill as you want to see it. To check the “a” is to report this infant has this skill. Letters “b” and “c” indicate some deviation from the skill. Sometimes the deviation may indicate the baby is too floppy or too rigid, over responsive or under responsive, too withdrawn or too out of control, or he/she may show gradations of skill development. The letter “d” is the opportunity for the service provider to indicate a behavioral expression that does not fit into any of the above three options.

Following each age section is a Progress Notes page. This page provides a place to graph out the results of the guide for that age range. Indicate either the date or a check in each letter column. Add the number of marks in each column. Once all the items in a domain are marked with an “a” that means that the infant is developing well for that age range in that domain. If there are a number of marks in the “b” or “c” columns, that should give the service provider information as to where some of the concerns are to be found. Which domain has a number of “b”s or “c”s marked? What does the underlying issue tend to be? What variations are found by the number of items marked in the “d” column? The number of red flags in an age will also give information that will support columns “b” and “c.”

No part of this Guide should be given by an inexperienced practitioner. It is presupposed that anyone using the Guide has the skills to understand and interpret the findings.

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This Developmental Observation Guide for Premature and Young Infants was developed under a federal IDEA grant through the Michigan Department of Education to Clinton County Regional Educational Services Agency (CCRESA) through Early On® Training and Technical Assistance (EOT&TA). Revised March 2011.

Developmental Observation Guidefor Premature and Young Infants

34 Weeks to 3 Months

Baby’s Name: ___________________________Birth Date: ________ Gestational Age:_________

Current Age: ______________ Birth Weight: __________ First Contact Date:___________________

It is not an expectation that all the behaviors found in this Observation Guide will be seen in one home visit or even in one infant. When a certain behavior is seen, whether organized or disorganized, indicate that by placing the date the behavior was seen or reported. Over time it is expected that the disorganized behaviors will give way to organized behaviors. This Guide may be used for an infant/young child who is having difficulty in self-regulation or in his or her ability to remain calm and responsive to his or her environment.

You will be looking at four systems of development: physiological, motor, state, and attention/interaction. At the same time you will be attentive to the self-regulatory skills this infant has and is able to use.

Physiological/Autonomic BehaviorsSignals related to breathing, heart rate, skin color, body temperature.

Organized BehaviorSigns of stability and regulation

Disorganized BehaviorSigns of instability and stress

Date Date Date Color: Good color with pink hands/feet/nail beds.

Date Date Date Color: Pale or dusky, mottled skin, pale lips; grey, dusky hands, feet and nail beds, dusky around eyes/mouth; abrupt color change.

Breathing: Regular and easy. Rate is between 40-60 breaths per minute.

Breathing: Irregular – grunty, noisy, chest retractions, nasal flaring. Rate is less than 40 or greater than 60 breaths per minute.

Can irritate infant and infant will come back to baseline.

Gasp: Strong breathing that is sustained or a burst of short breaths without exhaling.

Cough: Makes coughing sounds or has an observable cough.

Hiccough: Has more than three hiccoughs during a session.

Gastrointestinal: Digestion – stable with appropriate burping. Elimination – regular elimination

Gastrointestinal: Digestive problems – frequent spit-up and/or vomiting. Elimination –

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patterns without excessive gas. constipation, diarrhea, excessive gas, drawing up legs and crying.

Neuro-Motor Behaviors

Organized BehaviorMovements may frequently be quick and abrupt and include

normal startles, tremors and twitches.

Disorganized BehaviorExcessive frequency of startles, tremors and twitches.

Date Date Date Startle: A sudden abrupt movement of the arms and legs away from the body and a quick return to midline. The neck may extend as the arms and legs move away from the body.

Date Date Date Startle: Excessive startles without obvious external stimuli (e.g., lights, noise, movement, touch). A sudden abrupt movement of the arms and legs away from the body for more than ten seconds.

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Motor BehaviorsMuscle tone, posture, movement patterns.

Organized Behaviors Disorganized Behaviors

Date Date Date Tone: Balanced - the infant is able to lie in a well-rounded position with arms, legs and trunk softly bent. The infant does not stiffen or become rigid or limp unless irritable, crying or sleeping.

Date Date Date Tone: Hypertonic: Tone in any part of the body is stiff or rigid. The infant may be “tightly curled” or rigidly extended.

Tone: Hypotonic: Tone in any part of the body is flaccid or limp.

Posture: The infant is able to maintain a flexed, relaxed posture with arms and legs tucked in close to the body and hands near the face.

Posture: Infant maintains body in a limp, flat, flaccid posture against a firm surface.

Infant maintains body in still, extended posture against firm surface.

Examples of disorganized behavior infants may show:

Arms Salute: The infant extends the elbow and flexes the shoulder. A salute is often accompanied with a finger extension or splay.

Toe Splay: Toes are extended and spread open.

Finger Splay: Hands open and fingers are extended and separated from each other.

Fisting: The infant’s hands are tightly flexed to form a fist.

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Motor Behaviors (continued)Date Date Date Organized Behavior Date Date Date Disorganized Behavior

Extended Arms: Arms are extended over the head and/or the forearm may lay across the face in a self-protecting or shielding manner.

Sitting on Air: The infant’s knees and legs are extended and hips flexed. If the infant is lying on his back, the legs will extend off the bed. Can also be observed in side-lying position.

Movements: Well defined body movements. Arm and leg movements are fluid and stay at a close range in cycles. The infant is able to maintain arms and legs in a bent and relaxed posture with arms and legs tucked in close to the body and hands near the face. No extensions are seen. Arms and legs on both sides of the body move equally well.

Movements:a. Squirm: Small writhing, wiggling motions of trunk, often accompanying movements of the extremities.

b. Jerky: Jerky movements of arms and legs predominate.

c. Gape Face: The infant’s mouth is open limply looking exhausted.

d. Tongue Extension: The infant’s tongue protrudes beyond the lips. The extension can be maintained or repetitive.

e. Arching: Infant extends head and/or trunk pushing neck backwards.

Attention and InteractionThe ability to process and respond to the environment.

Organized Behaviors Disorganized BehaviorsDate Date Date Infant orients to visual stimuli:

Focuses and follows with eyes horizontally for at least a 30 degree arc.

Date Date Date Infant has difficulty orienting to visual stimuli; does not focus on or follow a stimulus.

Infant orients to auditory stimuli; alerts and turns eyes/head to stimulus.

Infant has difficulty orienting to auditory stimuli; no reaction or panic reaction.

Engages in social interactions without displaying stress behaviors.

Infant has difficulty engaging in social interactions or becomes easily stressed.

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Attention and Interaction (continued)Date Date Date Date Date Date

Techniques the infant uses to shut out excessive stimuli:a. Cries

b. Falls asleep

c. Other: __________________

Infant is unable to shut out excessive stimuli.

State BehaviorsSleep/wake patterns, alertness, crying – ability to change from one state to another

Organized BehaviorsSleep is organized when the infant has stable, predictable

sleep patterns with smooth transitions from sleeping to waking and is able to fall back asleep once awakened.

Disorganized BehaviorsSleep is disorganized when the baby does not have stable, predictable sleep patterns with smooth transitions from

sleeping to waking and is not able to fall back asleep once awakened.

Date Date Date Sleep States Date Date Date Sleep StatesDeep Sleep: The infant shows regular breathing, eyes closed, no rapid eye movements, relaxed facial expression and no spontaneous movements.

Deep Sleep: Irregular respirations. Occasional startles and twitches.

Active Sleep: Infant shows irregular breathing, eyes closed or partially open; rapid eye movements seen, mild sucking or low level activity may be observed.

Active Sleep: Infant shows twitches, grimaces, whimpers.

Drowsy Sleep: A transition state. The infant is trying to awaken or sleep. Breathing is irregular and eyes may be open or closed. Some movement present.

Drowsy Sleep: Semi-sleep, diffuse movements, fusses, whimpers.

The infant can fall back asleep when awakened.

Infant lacks full range of states.

The infant wants to sleep all the time and is difficult to awaken.

The infant sleeps during the day, but not at night.

The infant must be awakened to be fed.

The infant appears to squeeze his/her eyes tight to remain asleep.

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State Behaviors (continued)Sleep/wake patterns, alertness, crying – ability to change from one state to another.

Organized BehaviorsThe infant is able to achieve an alert state, maintain it and

transition smoothly into another state.

Disorganized BehaviorsThe infant is not able to achieve a calm alert state, maintain it

and transition smoothly into another state.

Date Date Date Wake States Date Date Date Wake StatesCalm Alert: Observed regular breathing, little or no body movement. Alert with eyes open and in a quiet state.

Hypo alert: This is a low level of alertness in which the infant’s eyes are slightly open and looking fatigued, but infant is quiet with little movement.

Alert & Focused: Observed regular breathing, eyes are open, and the infant appears ready for social interaction.

Hyper alert: Infant is quiet and eyes are wide open giving the impression of panic or fear. Infant appears to be intensely focusing and may be unable to break the fixation on the stimulus or look away.

Fussy: The infant is active and awake with eyes open or closed. Considerable movement and infant is restless, but not crying.

Gaze Aversion: The infant looks away from a face or object. Usually means baby is over stimulated or needs a break and is viewed as a “time out” signal or an indication from baby to stop or limit the activity

Crying: The infant’s eyes may be open or closed and has irregular breathing. Rhythmic robust crying longer than 15 seconds is present.

Floating Eyes: Eyes floating upward.

The infant comes to an alert state on his/her own.

Grimace: Face retracts and looks distorted. Infant looks uncomfortable.

The care giver is able to support the effort of the infant to remain in a calm alert state.

Active Awake: Infant has a stressed facial expression, hyper aroused, increased activity, fussing.

Techniques which may help the baby transition into and maintain a calm alert state:

Crying: Infant has a strained or weak cry lasting less than 15 seconds.

a. Swaddling

b. Cuddling

c. Use of a pacifier

d. Rocking

e. Place hand on stomach

f. Other:_______________

Fussing & Crying: Some babies cry and appear unable to calm themselves. These babies need help with learning to self-calm. Some babies have unpredictable cycles of crying and are easily upset by the environment (light, noise, activity). Some babies cry with abrupt movement and some from internally triggered arousal.

Moves rapidly between statesLacks full & clear range of states

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Self-RegulationIndicates the infant’s ability to balance the various systems.

Organized BehaviorNot all infants use all of the following behaviors.

Watch for the ones the baby is attempting to use and assist them to increase their use.

Disorganized BehaviorInability to use self-regulation behaviors.

Date Date Date Indicate the infant’s success in using these behaviors. Mark them as U – Unsuccessful; B – Brief Success; and P – Prolonged success

Date Date Date

Hands to Mouth/Face: Infant able to suck on his or her own fingers and hands.

Difficulty self-consoling.

Hand Clasping: Infant grasps own hands together and holds hands or presses them against each other.

Minimal or no self-consoling strategies.

Leg/Foot Bracing: Straightens leg or foot in attempt to connect with a boundary to inhibit movements. Once boundary is touched, infant may relax while maintaining the brace or restart active bracing again.

Ineffective use of self-consoling strategies. Attempts to self-console but is ineffective.

Sucking: Infant sucks on hand, pacifier, nipple, breast, clothing, bedding or caregiver’s finger.

Suck Search: Infant actively seeks something to suck.

Foot Clasping: Infant places one foot against the other foot or leg. Ankles may cross.

Tucking: Infant actively flexes trunk or maintains a curled trunk position. Often the infant will simultaneously tuck legs or arms into flexion.

Grasping & Holding: Infant makes grasping movements with the hand. Curls fingers around bedding, caregiver’s finger or tubing. He or she may hold on after making contact successfully.

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Self-Regulation (continued)Organized Behavior

Not all infants use all of the following behaviors. Watch for the ones the baby is attempting to use and assist

them to increase their use.

Disorganized BehaviorInability to use self-regulation behaviors.

Responds to cuddling and consoling behaviors from caregiver:a. Calms by looking at face.b. Calms by looking at face and listening to voice.c. Calms with pacifier.d. Cuddle in arm within 15-20 seconds.e. Cuddle at shoulder within 15-20 seconds.f. Calms with swaddling.g. Calms with rocking.h. Calms when caregiver places hand on infant’s stomach.

FeedingOrganized Behavior Disorganized Behavior

Date Date Date Organized suck-swallow-breathing during feeding.

Date Date Date Disorganized suck-swallow-breathing pattern during feeding.

Minimal spit up/vomiting. Excessive spit up/vomit; infant coughs, gags, drools.

Feeding length lasts less than 30 minutes.

Excessive feeding length; infant displays signs of fatigue.

Consumes the prescribed amount.

Unable to consume the prescribed amount.Stress behaviors present during feeding; back arching, fussing, crying, agitation, etc. occurring after the first few minutes of feeding.Record amount of liquid lost- from drooling, spitting up or vomiting.

Red FlagsDate Date Date Date Date Date

1. Does not startle to loud noise. 5. Cannot turn head from side-to-side when placed on tummy.

2. Does not gain weight. 6. Excessive spitting up.3. Does not grasp with equal strength in both hands.

7. Does not make eye-to-eye contact when held.

4. Gaze aversion. 8. Unable to be comforted.Based on the work of Heidelise Als.

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Some definitions taken from “Getting to Know Your Baby” by K. VandenBerg, J. Browne, et al California Department of Social Services, Oakland CA. 2003.

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Summary Sheet for 34 Weeks to 3 MonthsDate: _________

Identify the organized or disorganized behaviors in each of the four systems. If organized, indicate the behavior by a word or phrase; if disorganized, also indicate by naming the specific disorganized behavior(s) shown in each sub-part of the system. For Self-Regulation, list the behaviors the infant is able to use successfully and those with which the infant has minimal or no success. This form may be used multiple times to track changes.

System Organized Disorganized

Physiological/Autonomic Behaviors

Color

Breathing

Gastrointestinal

Neuro-Motor Behaviors – Startle

Motor BehaviorsTone

Posture

Movements

State BehaviorsSleep Behaviors

Wake Behaviors

Attention and InteractionVisual

Auditory

Social Interactions

Feeding

Self-Regulation The behaviors the infant uses successfully.

Behaviors the infant attempts with minimal or no success.

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Identify the organized or disorganized behaviors in each of the four systems. If organized, indicate the behavior by a word or phrase; if disorganized, also indicate by naming the specific disorganized behavior(s) shown in each sub-part of the system. For Self-Regulation, list the behaviors the infant is able to use successfully and those with which the infant has minimal or no success. This form may be used multiple times to track change.

System Organized Disorganized

Physiological/Autonomic Behaviors

Color

Breathing

Gastrointestinal


Motor BehaviorsTone

Posture

Movements


Wake Behaviors


Auditory

Social Interactions

Feeding

Self-Regulation The behaviors the infant uses successfully.


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Identify the organized or disorganized behaviors in each of the four systems. If organized indicate the behavior by a word or phrase; if disorganized, also indicate by naming the specific disorganized behavior(s) that are shown in each sub-part of the system. For Self-Regulation list the behaviors the infant is able to use successfully and those that the infant is unsuccessful with or has minimal success. This form may be used multiple times to track change.

System Organized DisorganizedPhysiological/Autonomic Behaviors

Color

Breathing

Gastrointestinal


Motor BehaviorsTone

Posture

Movements


Wake Behaviors


Auditory

Social Interactions

Feeding

Self-Regulation The behaviors the infant uses successfully


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2-3 Months (Corrected Age)

Indicate the skills an infant has by placing the letter under the date in which the behavior was observed or reported. This Guide may be used multiple times to document the developmental progress of the infant.

Regulatory and Sensory OrganizationDate Date Date Date Date Date

1. Baby quiets when picked up.a. Able to calm & recover from

distress.b. Rarely or weakly expresses

distress.c. Infant is usually irritable.d. _______________________

6. Baby listens to your voice.a. Easy to engage, focuses on the speaker.b. Does not respond, does not engage with

speaker.c. Easily distracted by background noise.d. ______________________________

2. Baby responds to sounds.a. Changes in expression, i.e.,

eyes widening.b. No response to sound.c. Startles, cries, winces.d. ______________________

7. Baby stays awake longer without crying.a. Has regular sleep and feeding patterns.b. Sleeps most of the time; difficult to

arouse.c. Generally fussy and irritable when awake.d. _____________________________

3. Baby enjoys being touched.a. Usually appears comfortable

with touch.b. Seems unaware of touch.c. Cries, pulls away, fusses, arches

when touched.d. ______________________

8. Baby shows active interest in person.a. Able to sustain interest and focus attention.

b. Unresponsive to most objects and people.c. Grows distressed when people are nearby.d. ______________________________

4. Baby likes to cuddle.a. Molds, relaxes.b. Eventually molds (5 min.).c. Resists being held.d. ________________________

9. Baby makes attempts to self-quiet.a. Sustained successful quieting.b. Makes no attempt to quiet self.c. Several attempts, but without success.d. _____________________________

5. Baby looks around.a. Looks calmly at things in the

environment.b. Never looks at things in the

environment.c. Overly sensitive to lights,

sounds, cries.d. ________________________

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Motor Integration10. Baby may have head lag when

pulled to sit.a. Excellent shoulder tone.b. Head lags; flops completely.c. Slight increase in shoulder tone.d. _______________________

12. Movement and tone equal on both sides.a. Shows normal movement on both sides.b. Inconsistent movement on one side.c. One side more active than the other side.d. ______________________________

11. Baby shows smooth, unrestricted movement.

a. Legs and arms move freely.b. Minimal movements.c. Primarily jerky movements.d. _______________________

13. Holds head to one side when on tummy.a. Ability to turn head to side in prone.b. Baby is slow in turning head to side, but

does manage.c. Unable to turn head to side in prone.d. ________________________________

Motor Integration Date Date Date Date Date Date

14. When held standing, makes stepping movements.

a. Clear stepping response with legs alternating.

b. Some indication of stepping (take 1 or 2 steps).

c. No stepping movements or legs stiffen.

d. ________________________

18. Baby lifts head briefly while on tummy.

a. Lifting sustained for a few seconds.b. Brief head lift once or twice.c. Little or no response.d. __________________________

15. Turns head to both sides while on back.

a. Turns head freely and completely to each side.

b. Turns head to both sides but not completely.

c. Unable to turn head or only turns in one direction.

d. _________________________

19. Baby holds head up 45 degrees while on tummy.

a. Holds head up facing forward at least 45 degrees.

b. Momentarily holds head up less than 45 degrees.

c. Unable to hold head up facing forward.d. ___________________________

16. Baby moves both legs equally well.

a. Uses both legs equally and kicks smoothly, alternating legs.

b. Uses both legs but weakly.c. Unable to move legs independent

of one another, stiff or crossed.d. __________________________

20. Baby has symmetrically shaped head.a. Head has acquired symmetrical shape.b. Head shows flattening on one side or

back.c. Head has unusual shape.d. ___________________________

17. Baby lifts head when held at shoulder.

a. Lifts head for 1 or 2 seconds from an adult’s shoulder.

b. Unable to hold head from adult’s shoulder.

c. Hyper-extends neck.d. __________________________

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Fine Motor21. Baby holds fisted hands near

face.a. Hands lay easily fisted near face.b. Hands are tightly fisted.c. Arms and hands are very tight.d. ___________________________

23. Baby moves both arms equally.a. Easily moves both arms.b. Moves both arms but only slightly.c. Arms remain flexed, stiff or floppy.d. ___________________________

22. Baby looks at colorful object momentarily.

a. Able to look at a stationary object for at least 2-3 seconds.

b. General quieting, blinking and respiratory changes.

c. No response.d. _________________________

24. Baby grasps adult finger when placed in hand.

a. Strong and sustained grasp for several seconds.

b. Short, weak grasp.c. Prolonged, excessive grasp, no

relaxation.d. ___________________________

Date Date Date Date Date Date25. Baby looks at colorful object for

a few seconds.a. Looks at colorful object 4-5

seconds.b. Inconsistently looks at colorful

object.c. Does not focus on object.d. _________________________

27. Baby’s eyes follow moving person while on back.

a. Follows someone walking a few feet away.

b. Sometimes follows moving person.c. Does not notice a moving person a few

feet away.d. ____________________________

26. Baby keeps hands loosely clenched, not tightly fisted.

a. Hands loosely clenched.b. Hands fisted, but can open with

help.c. Hands still tightly fisted.d. __________________________

Relationship to their Surroundings28. Baby quiets when picked up.

a. Soothes easily when picked up.b. Takes 2 to 3 minutes to soothe.c. Unable to be soothed.d. __________________________

31. Baby responds to a voice.a. Consistently displays one or more

defined responses after hearing a voice, i.e., stills and/or brightens.

b. Grimaces, shows disorganized response.

c. No response.d. ___________________________

29. Baby shows pleasure when touched or handled.

a. Usually appears comfortable with touch.

b. Seems unaware of touch.c. Cries, pulls away, fusses, arches

when touched.

32. Baby looks at object, follows with eyes.

a. Follows with eyes and head.b. Briefly follows object.c. Does not focus or follow object.d. ____________________________

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d. __________________________30. Baby responds to sounds.

a. Turns head to sound and/or stills and brightens.

b. Grimaces, extends arms.c. No response.d. __________________________

Social InteractionDate Date Date Date Date Date

33. Baby regards face.a. Shows interest in human face.b. Briefly looks at human face with

interest.c. Shows no interest in human face.d. ___________________________

35. Baby cries when hungry or uncomfortable.

a. Cries if distressed or uncomfortable.b. Weak cry if distressed/uncomfortable.c. Cries most of the time.d. ____________________________

34. Baby quieted by familiar soothing voice.

a. Comes to quiet state of alertness and/or stills and shifts eyes.

b. Displays discomfort.c. Not responsive to familiar voice.d.___________________________

36. Baby follows moving person with eyes.

a. Follows with eyes and head, smooth eye movements.

b. Follows briefly, jerky movements.c. Does not focus or follow.d._____________________________

Social Interaction (continued)

Date Date Date Date Date Date37. Baby establishes eye contact.

a. Establishes eye contact for at least a few seconds.

b. Occasionally establishes eye contact – not consistent.

c. Consistently resists eye contact.d. ___________________________

39. Baby enjoys physical contact.a. Baby beginning to give clear signals

when he wants physical contactb. Baby becomes fussy when heldc. Baby needs constant holding.d. _____________________________

38. Baby molds & relaxes body when held; cuddles.

a. Usually molds and relaxes body when held.

b. Usually feels or appears limp or passive when held.

c. Usually cries, fusses, arches, pulls away when held.

d. ___________________________

40. Baby draws attention to self when in distress.

a. Cries and fusses effectively to attract his caregiver’s attention.

b. Rarely cries or fusses for attention.c. Cries excessively and demands

constant holding.d. _____________________________

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CommunicationDate Date Date Date Date Date

41. Baby cries longer than 15 seconds.

a. Cry is primarily produced on exhalation; vowel-like.

b. Extremely high-pitched sound with a tense quality.

c. Absent or weak cry.d. ___________________________

43. Baby makes comfort sounds.a. Displays non-crying soft reflexive

sounds.b. Rarely makes non-crying sounds.c. Cries most of the time.d. ____________________________

42. Baby cries when hungry or uncomfortable.

a. Cries when distressed or uncomfortable.

b. Weak cry when distressed or uncomfortable.

c. Cries most of the time.d. ___________________________

44. Baby makes sucking sounds.a. When comfortable makes sucking

sounds.b. Rarely makes sucking sounds.c. Does not relax enough to make sucking

sounds.d. _____________________________

Adaptive/Self HelpDate Date Date Date Date Date

45. Baby opens and closes mouth in response to food.

a. Displays rooting reflex.b. Displays weak rooting reflex.c. Fights being fed.d. ___________________________

46. Baby coordinates sucking, swallowing and breathing.

a. Sucking, swallowing and breathing appear rhythmic and smooth.

b. Excessive choking and coughing; baby loses a lot of liquid.

c. Has a weak suck and/or displays irregular or labored breathing.

d. ___________________________


1. Does not startle to loud sounds. 3. Gaze aversion.2. Eyes do not follow moving person. 4. Does not suck or swallow easily.

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Progress Notes : Place the date or a under the letter that indicates the response the infant has for each item of the Guide.

Domain of Development a. b. c. d. CommentsRegulatory & Sensory1.2.3.4.5.6.7.8.9.Motor Integration10.11.12.13.14.15.16.17.18.19.20.Fine Motor21.22.23.24.25.26.27.Relationship to Surroundings28.29.30.31.32.Social Interaction33.34.35.36.37.38.39.40.Communication41.42.43.44.Adaptive/Self Help

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45.46.Total of each column


3 to 5 Months (Corrected Age)

Indicate the skills an infant has by placing the letter under the date on which the behavior was observed or reported. This Guide may be used multiple times to document the developmental progress of the infant.

Regulatory and Sensory OrganizationDate Date Date Date Date Date

1. Baby likes to look around.a. Looks calmly at things in his

environment.b. Overly sensitive to lights, sounds,

cries.c. Never looks at things in the

environment.d. __________________________

4. Baby shows active interest in a person.

a. Able to sustain interest and focus attention.

b. Unresponsive to most objects and people.

c. Becomes distressed when people are nearby.

d. ___________________________

2. Baby listens to your voice.a. Easy to engage, focuses on the

speaker.b. Easily distracted by background

noise.c. Does not respond, does not engage

with speaker.d. __________________________

5. Baby likes to be held.a. Likes to be held and molds to the

body.b. Arches or attempts to pull or push

away when held.c. Remains limp, no molding.d. ___________________________

3. Baby stays awake longer without crying.

a. Has regular sleep and feeding patterns.

b. Sleeps most of the time; difficult to arouse.

c. Generally fussy and irritable when awake.

d. ___________________________

6. Baby likes to be moved.a. Is comfortable being moved.b. Becomes irritable or disorganized

when passively moved.c. Appears not to notice being moved.d. ___________________________

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Motor IntegrationDate Date Date Date Date Date

7. Baby turns head to both sides while on back.

a. Turns head freely and completely to each side.

b. Turns head to both sides, but not completely.

c. Unable to turn head or only turns in one direction.

d. _________________________

9. Baby extends both legs in prone position.

a. Does not always assume a totally flexed position in prone.

b. Head appears “stuck” and bears weight rather than weight bearing on chest and forearms.

c. Maintains a frog or stiff position.d. _________________________

8. Baby holds head up 45 degrees while on tummy.

a. Holds head up facing forward at least 45 degrees.

b. Momentarily holds head up less than 45 degrees.

c. Unable to hold head up facing forward.

d. _________________________

10. Baby kicks legs alternately.a. Uses both legs equally and kicks in

smooth, alternating patterns.b. Unable to move legs independent of

one another.c. Kicks with one leg only.d. __________________________

Motor Integration Date Date Date Date Date Date

11. Baby keeps head in midline when lying on back.

a. Maintains head primarily in the midline; arms/legs symmetrical.

b. Great difficulty maintaining head in midline.

c. Unable to hold head in midline for even a few seconds.

d. __________________________

15. Baby has slight head lag when pulled to sit.

a. Head lags slightly when pulled to sit.

b. Major head lag.c. Head and body very floppy.d. _________________________

12. Baby brings hands to midline while on back.

a. Both hands move to midline.b. Only one hand moves to midline.c. Unable to bring hands to midline.d. __________________________

16. Baby holds head steady when carried.

a. Head held steady at shoulder.b. Head bobs.c. Unable to pull head up while head at

shoulder.d. _________________________

13. Baby rolls from side to back.a. Rolls from each side to back.b. Rolls by strongly arching back.c. Can roll only from one side.d. __________________________

17. Baby holds hands in midline with mutual fingering.

a. Both hands move symmetrically to midline, fingers touching.

b. Both hands move symmetrically, head not in midline or fingers do not touch.

c. Unable to move both hands to midline; may move one but not other; may not finger each hand.

d. ________________________

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Motor Integration (continued)

14. Baby holds chest up in prone – weight on forearms.

a. Holds head up, propping on forearms for at least 3-5 seconds.

b. Unable to prop on forearms.c. Unable to hold head up or prop on

forearms.d. __________________________

Fine MotorDate Date Date Date Date Date

18. Baby shows visual regard.a. Shows direct visual regard with

some stares and gazes.b. Stares and gazes most of the time,

rarely looks with visual regard.c. Always stares and gazes, never

looks directly at person.d. __________________________

20. Baby activates arms on sight of toy.

a. Arms become active upon seeing a toy, stops when toy removed.

b. Looks at toy, but does not activate arms.

c. Does not attend to toy, no arm movement for toy.

d. _________________________

19. Baby follows with eyes to midline (may be jerky).

a. Is able to follow slow moving object to midline.

b. Unable to maintain visual pursuit of object to midline.

c. Unable to focus on object.d. __________________________

21. Indwelling thumb no longer present.

a. Thumb is held open.b. Thumb tightly held against palm.c. Thumb and fingers held tightly in

fist.d. _________________________

Fine Motor (continued)Date Date Date Date Date Date

22. Baby follows with eyes 180 degrees.

a. Visually follows object moving slowly from side to side.

b. Visually follows object up to midline, loses it, then regains object past midline.

c. Unable to follow with eyes more than momentarily.

d. __________________________

26. Baby looks from one object to another.

a. Holding an object in both hands, baby will look from one object to the other.

b. Holds two objects, but does not look from one to other.

c. Can only hold one object, may drop it when another is given.

d. _________________________

23. Baby blinks at sudden bright light.

a. Blinks to sudden or bright visual stimuli.

b. Blinks frequently without stimulus.c. Never blinks to sudden visual

stimuli.d. __________________________

27. Baby reaches toward toy without grasp.

a. Touches or swipes at an object, but cannot grasp.

b. Random swiping toward object.c. Does not use arm/hand to swipe at

an object.d. _________________________

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24. Baby grasps toy when placed in hand.

a. Voluntarily holds an object for several seconds.

b. Immediately drops object.c. Holds toy involuntarily due to a

grasp reflex.d. __________________________

28. Baby’s grasp reflex is inhibited.a. Does not automatically close hand

tightly around objects.b. Hands limp; no grasp or reach.c. Strongly grasps with tight fist; grasp

reflex still strong.d. _________________________

25. Baby retains rattle in hand and looks at it.

a. Holds rattle actively and looks at it.b. Holds rattle, but does not look at it.c. Does not hold rattle.d. __________________________

29. Baby puts objects in mouth.a. Able to put objects in mouth.b. Does not try to put objects/food in

mouth.c. Does not tolerate anything close to

mouth.d. _________________________

Relationship to the Surroundings

Date Date Date Date Date Date30. Baby shows active interest in

person/object for at least a minute.

a. Actively watches a person/object for a minute.

b. Looks at a person/object for a couple of seconds.

c. shows no interest in person/r object.

d. __________________________

32. Baby reacts to disappearance of slow moving object.

a. Continues to look at the barrier after an object or person has disappeared behind it.

b. After object/person disappears, loses interest in it.

c. Is unaware of the object/person or object/person’s disappearance.

d. _________________________

31. Baby shows anticipatory excitement.

a. Shows one or more signs of anticipatory excitement in response to a familiar stimulus, i.e., kicks, waves, squeals, breathes more rapidly.

b. Shows brief or weak anticipatory excitement.

c. does not show anticipatory excitement

d. __________________________

33. Baby searches for sound with eyes.a. Shows definite eye searching,

smiling or moving head toward source of sound – does not need to find it.

b. Shows momentary interest in sound.c. Does not appear to hear sound.d. _________________________

Relationship to the Surroundings (continued)Date Date Date Date Date Date

34. Baby inspects own hands.a. Watches the movements of his

hands.b. Is unaware of his hands.c. Prefers hand watching to

interacting with people.d. _________________________

36. Baby begins playing with a rattle.a. Displays at least two simple

interactions with two different toys, e.g., holds, looks, mouths, waves or shakes.

b. Uses same interaction with all toys, i.e., mouths.

c. Does not show interest in toys.

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d. ________________________

35. Baby watches a speaker’s eyes and mouth.

a. Looks at speaker’s eyes and mouth.b. Rarely looks at speaker’s eyes or

mouth.c. Looks confused or avoids looking

at speaker.d. _________________________

Social InteractionDate Date Date Date Date Date

37. Baby responds with a smile when socially approached.

a. Smiles easily when others talk to and smile at him/her.

b. Response is vague, difficult to read.

c. Averts gaze, arches back, turns away, and has depressed expression.

d. __________________________

40. Baby distinguishes parent or caregiver from others.

a. Shows differentiated and preferential responses to parents.

b. Does not give preferential response to parent.

c. Is not soothed by parent.d. _________________________

38. Baby laughs.a. Usually laughs or chuckles at fun

interactions.b. Looks at person, may smile, but

does not laugh.c. Averts gaze, arches back, turns

away, and has depressed expression.

d. __________________________

41. Baby vocalizes responsively in a social situation.

a. Vocalizes when talked to.b. Watches speaker, but does not

vocalize.c. Turns away from speaker, does not

vocalize.d. _________________________

39. Baby smiles responsively.a. Smiles in response to another’s

smile.b. Does not respond to another’s

smile.c. Turns away from another’s smile.d. __________________________

42. Baby demands attention.a. Demands attention by fussing.b. Never demands attention.c. Unable to be quieted.d. _________________________

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Communication

Date Date Date Date Date Date43. Baby shows active interest in

person for at least one minute.a. Uses eye gaze, facial expressions

and body movements to communicate interest in a person.

b. Shows weak interest in a person.c. Avoids looking at person.d. __________________________

45. Baby vocalizes responsively in a social situation.

a. Makes sounds when talked to.b. Watches, but makes no sounds.c. Turns away from the speaker.d. _________________________

44. Baby coos and chuckles.a. Soft, amused musical sound in

response to a talking adult.b. Looks at adult, but does not make a

sound.c. Averts eyes, does not make a

sound.d. __________________________

Adaptive/Self HelpDate Date Date Date Date Date

46. Baby is able to coordinate sucking, swallowing & breathing.

a. Sucking, swallowing & breathing appear rhythmic and smooth.

b. Needs to stop after every one to two sucks or has a weak suck and/or displays irregular or labored breathing.

c. Excessive choking/coughing, loses a lot of liquid.

d. __________________________

48. Baby naps frequently.a. Can nap almost anywhere without

being overly disturbed by sound or activity

b. Cannot nap unless quiet.c. Has difficulty quieting down to nap

and must be in a place with no sounds, sights or movement.

d. _________________________

47. Baby is establishing consistent sleep-wake cycles.

a. Sleeps generally in 4 to 10 hour intervals at night.

b. Sleep problems or deviations, i.e., baby rarely sleeps more than 20 minutes at a time OR the baby sleeps excessively.

c. Takes more than 20 minutes to fall asleep and/or needs extensive external support to help fall asleep.

d. _________________________

49. Baby brings hand to mouth.a. Can easily bring both hands to

mouth.b. Has difficulty bringing one hand to

mouth.c. Never brings either hand to mouth.d. _________________________

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1. Indifferent to comforting attempts. 7. Cannot follow person/toy briefly.2. Non-organic failure to thrive. 8. Does not respond to loud sounds.3. Indifferent to social stimuli. 9. Keeps both hands fisted.4. Cannot lift head when placed in

prone position.10. Uninterested in moving.

5. Arms/legs stiff. 11. Does not locate sounds.6. Strong arching of head, back, hips. 12. Marked hypotonia; floppy.

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Progress NotesPlace the date or a under the letter that indicates the response the infant has for each item for the 3-5 Month Guide.Domain of Development a. b. c. d. CommentsRegulatory/Sensory1.2.3.4.5.6.Motor Integration7.8.9.10.11.12.13.14.15.16.17.Fine Motor18.19.2021.22.23.24.25.26.27.28.29.Relationship to Surroundings30.31.32.33.34.35.36.Social Interaction37.38.39.40.41.42.Communication43.44.45.Adaptive/Self Help46.47.48.

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49.Total Score

This document was produced and distributed through an IDEA Mandated Activities Project for CCRESA EOT&TA, awarded by the Michigan Department of Education at a cost of $.15 per brochure. The opinions expressed herein do not necessarily reflect the position or policy of the Michigan Department of Education, Michigan State Board of Education, or the U.S. Department of Education, and no endorsement is inferred. For further information or inquiries about this project, contact the Michigan Department of Education, Office of Special Education and Early Intervention Services, P.O. Box 30008, Lansing, MI 48909.

It is the policy of the Clinton County Regional Educational Service Agency (RESA) that no discriminatory practices based on gender, race, religion, color, age, national origin, disability, height, weight, marital status, sexual orientation, political affiliations and beliefs, or any other status covered by federal, state or local law be allowed in providing instructional opportunities, programs, services, job placement assistance, employment or in policies governing student conduct and attendance. Any person suspecting a discriminatory practice should contact the Associate Superintendent for Special Education, 1013 South US-27, St. Johns, MI 48879, or call 989-224-6831.

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