CD 58 Infant Evaluation Form

Name: _______________________________________  Date: ________________

_____/1pt.  Name of infant, general characteristics, where the observation took place

Physical Description - one different example in each category

_____1pt.  feeding

_____1 reaching for toys, picking them up

_____1-transferring toy from one hand to another

_____1 use of ulnar or pincer grasp

_____1  roll over, sit, crawl, stand, cruising, walking

Language Characteristics - 0ne different example in each category

_____ 1pt.  Turn head to voices, sounds heard

_____1  Make sounds, coos, babbles, gestures

_____1 imitate sounds

_____1  follow simple commands

_____1  use of simple words (holophrases)

Cognitive Development - one different example in each category

_____1pt. recognize familiar objects (name the objects)

_____1  use of the five senses

_____1  remember games, objects, such as peek a boo or where something is.

_____1  object permanence

_____1 solve simple problems

Social Emotional Development- one different example in each category

_____1pt.  smiles, recognizes parents and primary caregiver

_____1  participates, laughs

_____1   withdraws, cries, stranger anxiety

_____1 plays by him/herself or interacts with other children

_____1  offers toy to another person

_____4 pts. hand written notes, and what you learn from the observation?

Total points  _____/25

Points will be deducted for lack of good grammar, spelling, double spacing and complete sentences.

You will have 20 different situations/examples when the observation is finished