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Birth to Six – for Parents

MICRO QUESTIONNAIRE: YOU AND YOUR CHILD (Birth-six)

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    Description: This questionnaire, created for parents, helps them identify concerns in child development. As this questionnaire is non-submittable, no data is collected. There is however a 'Print' link at the bottom of the page which you can use to print your questionnaire results upon completion.

    Alternate languages:
    Chinese Simplified | Chinese Traditional | Farsi | Punjabi | Vietnamese | Spanish

    Introduction

    Children grow and develop very fast. It is not always easy to know whether or not they are developing appropriately and meeting developmental milestones.

    As a parent of a young child (birth to age 6), you might be worried about a certain behavior that your child is displaying -- only to find out that this kind of behavior is typical for a child who is the same age as your child.

    On the other hand, you might feel that a particular behavior that did not concern you at the time is now a problem and should be addressed right away, either by yourself or by a professional.

    If you do worry about your child's development, the following questionnaire will help you pinpoint where these concerns about your child lie. It will also guide you to the appropriate professionals and/or agencies that you should contact.

    The questionnaire will start with general questions about children's development and will then lead to questions about specific developmental areas.

    SECTION A: GENERAL

    Section description

    This questionnaire contains information about possible concerns about your child's overall development between the ages of birth to 6 years old. This questionnaire is for you to fill in, and to share it with someone of your trust.. Because is a pdf document, it must be printed and only you will know the responses to it. There is no risk for someone else looking at this questionnaire.

    We advise you to start with this set of questions. They will help you find out if you need to find out more about specific information about worries or concerns about your child's development

    Please note that this questionnaire is NOT a test of your child's abilities. It is only meant to be used as a guide that will help you determine whether or not your child is developing typically.

    This questionnaire does not replace professionals such as child psychologists, physiotherapists, occupational therapists, speech and language pathologists, early childhood teachers or physicians. If you are concerned about your child's development, we advise you to seek professional help as soon as possible. This website provides you with different agencies and resources where you can go for help in your community.

    Section instructions

    • This section contains general statements about different aspects of your child development that may be of your concern.
    • For example, you may find that you are very concerned about some aspects of your child development in one area such as motor skills. At the same time you may have a little bit of (or slight) concern for your child's language skills, and that you have no concerns about your child's emotional development.
    • Please check one of the boxes for each item. As you go through this section, check all the items that are relevant for you. To find out more on a specific area of development, click on the appropriate link next to the magnifying glass icon.

    I am (very much / somewhat / slightly / not) concerned about:

    Go to Section B: Physical Development part of questionnaire below
    Go to Section C: Motor Development part of questionnaire below
    Go to Section D: Social and Emotional part of questionnaire below
    Go to Section E: Intellectual (Cognitive) part of questionnaire below
    Go to Section F: Language and Communication part of questionnaire below
    Go to Section G: Self-help part of questionnaire below
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    SECTION B: PHYSICAL DEVELOPMENT

    Section description

    • In this section, there is specific information about your child’s physical skills. The items in this section include statements about your child’s growth and weight, as well as his/her sleeping, eating and toileting patterns.
    • Please note that the information in this section will then lead you to community resources that you can access, by clicking the icon at the end of the section.
    • About physical development

    Section instructions

    • Please indicate how much you agree to each of these statements by checking one of the boxes for each item.

    I am (very much / somewhat / slightly / not) concerned about:

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    SECTION C: MOTOR DEVELOPMENT

    Section description

    • The following questions relate to your child’s motor skills. The skills are in sequential order; for example the item that describes “sitting” is listed earlier on in the list than “walking”:
    • In this section, there is specific information about your child’s motor skills, that is, your child’s ability to use his/her hands, move around and be as independent as his/her age permits. Please note that the information in this section will then lead you to community resources that you can access, by clicking the icon at the end of the section.
    • About motor development

    Section instructions

    • Please indicate how much you agree to each of these statements by checking one of the boxes for each question:

    I am (very much / somewhat / slightly / not) concerned that my child does not:

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    SECTION D: SOCIAL AND EMOTIONAL DEVELOPMENT

    Section description

    • The following statements relate to your child’s social and emotional skills.
    • There are three mini-sections. The first one describes the overall social and emotional developmental milestones; the second one describes “social” behaviours that is, the way your child relates to others and interact with them in socially acceptable ways; the second one describes “emotional” skills, or how your child expresses his/her feelings
    • Please note that at there is an icon at the end of each sub-section for you to contact community resources specific to these developmental areas.
    • About social and emotional development

    D.1: Social and Emotional Development Milestones - description

    • This mini-section describes statements related to your child’s overall social and emotional developmental milestones

    D.1: Social and Emotional Development Milestones - instructions

    • Please indicate how much you agree to each of these statements by checking one of the boxes for each item

    I am (very much / somewhat / slightly / not) concerned that my child does not:

  • D.2: Social Skills - description

    • In this mini-section, there is specific information about your child’s social skills, that is, the way your child relates to others and interacts with them in socially acceptable ways.
    • Please note that items in this mini-section contain statements that apply to children with ages ranging between 2 to 6 years old. If you are not sure about what behaviours are appropriate at a certain age, please roll-over with your mouse to view typical child development information.

    D.2: Social Skills - instructions

    • Please indicate how much you agree to each of these statements by checking one of the boxes for each item

    I am (very much / somewhat / slightly / not) concerned about how my child:

  • D.3: Social Skills: Specific Concerns - description

    • In this mini-section, there is specific information about behaviours that might be of specific concern, for example, statements about hitting or biting that occur frequently or on a regular basis
    • Please note that items in this mini-section contain statements that apply to children with ages ranging between 2 to 6 years old. If you are not sure about what behaviours are appropriate at a certain age, please roll-over with your mouse to view typical child development information.

    D.3: Social Skills: Specific Concerns - instructions

    • Please indicate how much you agree to each of these statements by checking one of the boxes for each item

    I am (very much / somewhat / slightly / not) concerned about my child:

  • D.4: Emotional Skills - description

    • In this mini-section, there is specific information about your child’s emotional skills, for example, how your child expresses his/her feelings.
    • Please note that items in this mini-section contain statements that apply to children with ages ranging between 2 to 6 years old. If you are not sure about what behaviours are appropriate at a certain age, please roll-over with your mouse to view typical child development information.

    D.4: Emotional Skills - instructions

    • Please indicate how much you agree to each of these statements by checking one of the boxes for each item

    I am (very much / somewhat / slightly / not) concerned about:

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    SECTION E: INTELLECTUAL (COGNITIVE) DEVELOPMENT

    Section description

    • The following questions relate to your child’s cognitive/intellectual skills.
    • This section contains information about how your child deals with the world around him/her, how well he/she is able to solve problems and how well he/she is able to recognize and express basic information such as colors and shapes.
    • About intellectual (cognitive) development

    Section instructions

    • Please indicate how much you agree to each of these statements by checking one of the boxes for each question:

    I am (very much / somewhat / slightly / not) concerned that my child does not:

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    SECTION F: LANGUAGE AND COMMUNICATION DEVELOPMENT

    Section description

    • The following statements refer to your child’s language and communication skills.
    • This section is sub-divided into three mini-sections; the first mini-section is about your child’s understanding skills (receptive language).
    • About language and communication development

    F.1: Understanding of Language - description

    • This mini-section is about how your child understands language and whether he/she is able to show you that he/she understands language.

    F.1: Understanding of Language - instructions

    • Please indicate how much you agree to each of these statements by checking one of the boxes for each item.

    I am (very much / somewhat / slightly / not) concerned that my child does not:

  • F.2: Usage of Language - description

    • The following section contains information about how your child uses language (e.g., with a purpose).

    F.2: Usage of Language - instructions

    • Please indicate how much you agree to each of these statements by checking one of the boxes for each item.

    I am (very much / somewhat / slightly / not) concerned about how my child does not:

  • F.3: Social Communication - description

    • The following section contains information about how your child uses language for social reasons, that is to communicate with others.

    F.3: Social Communication - instructions

    • Please indicate how much you agree to each of these statements by checking one of the boxes for each item.

    I am (very much / somewhat / slightly / not) concerned about how my child does not:

  • SECTION G: SELF-HELP SKILLS

    Section description

    • The following section contains information about your child’s self help skills or how he/she takes care of him/herself.
    • About self-help skills

    Section instructions

    • Please indicate how much you agree to each of these statements by checking one of the boxes for each question:

    I am (very much / somewhat / slightly / not) concerned that my child does not:

  • SECTION H: THE WONDER THAT IS YOUR CHILD

    The following questions/statements are about the wonder that is your child. Please take the time to reflect upon the joys that your child has brought into your life and share with us your most memorable experiences:

Last updated on December 16, 2012 @6:27 pm

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