# CSBS DP Infant-Toddler Checklist

**Child’s name:**  
**Date of birth:**  
**Date filled out:**

**Was birth premature?** If yes, how many weeks premature?  
**Filled out by:**  
**Relationship to child:**

## Instructions for caregivers:
This Checklist is designed to identify different aspects of development in infants and toddlers. Many behaviors that develop before children talk may indicate whether or not a child will have difficulty learning to talk. This Checklist should be completed by a caregiver when the child is between 6 and 24 months of age to determine whether a referral for an evaluation is needed. The caregiver may be either a parent or another person who nurtures the child daily. Please check all the choices that best describe your child’s behavior. If you are not sure, please choose the closest response based on your experience. Children at your child’s age are not necessarily expected to use all the behaviors listed.

## Emotion and Eye Gaze
1. Do you know when your child is happy and when your child is upset?  
   - Not Yet  
   - Sometimes  
   - Often

2. When your child plays with toys, does he/she look at you to see if you are watching?  
   - Not Yet  
   - Sometimes  
   - Often

3. Does your child smile or laugh while looking at you?  
   - Not Yet  
   - Sometimes  
   - Often

4. When you look at and point to a toy across the room, does your child look at it?  
   - Not Yet  
   - Sometimes  
   - Often

## Communication
5. Does your child let you know that he/she needs help or wants an object out of reach?  
   - Not Yet  
   - Sometimes  
   - Often

6. When you are not paying attention to your child, does he/she try to get your attention?  
   - Not Yet  
   - Sometimes  
   - Often

7. Does your child do things just to get you to laugh?  
   - Not Yet  
   - Sometimes  
   - Often

8. Does your child try to get you to notice interesting objects—just to get you to look at the objects, not to get you to do anything with them?  
   - Not Yet  
   - Sometimes  
   - Often

## Gestures
9. Does your child pick up objects and give them to you?  
   - Not Yet  
   - Sometimes  
   - Often

10. Does your child show objects to you without giving you the object?  
   - Not Yet  
   - Sometimes  
   - Often

11. Does your child wave to greet people?  
   - Not Yet  
   - Sometimes  
   - Often

12. Does your child point to objects?  
   - Not Yet  
   - Sometimes  
   - Often

13. Does your child nod his/her head to indicate yes?  
   - Not Yet  
   - Sometimes  
   - Often

## Sounds
14. Does your child use sounds or words to get attention or help?  
   - Not Yet  
   - Sometimes  
   - Often

15. Does your child string sounds together, such as uh oh, mama, gaga, bye bye, bada?  
   - Not Yet  
   - Sometimes  
   - Often

16. About how many of the following consonant sounds does your child use: ma, na, ba, da, ga, wa, la, ya, sa, sha?  
   - None  
   - 1–2  
   - 3–4  
   - 5–8  
   - over 8

## Words
17. About how many different words does your child use meaningfully that you recognize (such as baba for bottle; gaggie for doggie)?  
   - None  
   - 1–3  
   - 4–10  
   - 11–30  
   - over 30

18. Does your child put two words together (for example, more cookie, bye bye Daddy)?  
   - Not Yet  
   - Sometimes  
   - Often

## Understanding
19. When you call your child’s name, does he/she respond by looking?  
   - Not Yet  
   - Sometimes  
   - Often

20. About how many of the following objects does your child use appropriately: cup, bottle, bowl, spoon, comb or brush, toothbrush, washcloth, ball, toy vehicle, toy telephone?  
   - None  
   - 1–2  
   - 3–4  
   - 5–8  
   - over 8

21. About how many blocks (or rings) does your child stack?  
   - None  
   - 2 blocks  
   - 3–4 blocks  
   - 5 or more

22. Does your child pretend to play with toys (for example, feed a stuffed animal, put a doll to sleep, put an animal figure in a vehicle)?  
   - Not Yet  
   - Sometimes  
   - Often

### Child's name:
 
### Date filled out:
 
### Date of birth:
 
### Chronological age:
If child is 4 or more weeks premature, use corrected age. Calculate chronological age by subtracting Date of birth from Date the Checklist was filled out.

| Predictor | Raw Score | Standard Score | Percentile Rank | Concern |
| --- | --- | --- | --- | --- |
| Emotion and Eye Gaze |  |  |  |  |
| Communication |  |  |  |  |
| Gestures |  |  |  |  |
| SOCIAL COMPOSITE |  |  |  |  |
| Sounds |  |  |  |  |
| Words |  |  |  |  |
| SPEECH COMPOSITE |  |  |  |  |
| Understanding |  |  |  |  |
| Object Use |  |  |  |  |
| SYMBOLIC COMPOSITE |  |  |  |  |
| TOTAL |  |  |  |  |

### Recommendation
Based on the information provided on the Infant-Toddler Checklist and the results shown above, the following recommendation is made at this time (check one):
- This child currently communicates as expected for his or her age. Because new skills are emerging each month, it is important to monitor this child’s development by asking the child’s caregiver to follow up if development slows or if concerns arise. A developmental evaluation will become advisable if scores remain below criterion levels.

## Cut-off Scores for the CSBS DP Infant-Toddler Checklist

|  | COMPOSITES |  |  | TOTAL |  |
| --- | --- | --- | --- | --- | --- |
| Social | Speech | Symbolic |  |  |  |
| 6 months | No Concern | 8 to 26 | 2 to 14 | 3 to 17 | 13 to 57 |
| Concern | 0 to 7 | 0 to 1 | 0 to 2 | 0 to 12 |  |
| 7 months | No Concern | 8 to 26 | 2 to 14 | 3 to 17 | 14 to 57 |
| Concern | 0 to 7 | 0 to 1 | 0 to 2 | 0 to 13 |  |
| 8 months | No Concern | 8 to 26 | 4 to 14 | 4 to 17 | 16 to 57 |
| Concern | 0 to 7 | 0 to 3 | 0 to 3 | 0 to 15 |  |
| 9 months | No Concern | 9 to 26 | 4 to 14 | 4 to 17 | 18 to 57 |
| Concern | 0 to 8 | 0 to 3 | 0 to 3 | 0 to 17 |  |
| 10 months | No Concern | 12 to 26 | 5 to 14 | 5 to 17 | 23 to 57 |
| Concern | 0 to 11 | 0 to 4 | 0 to 4 | 0 to 22 |  |
| 11 months | No Concern | 13 to 26 | 5 to 14 | 6 to 17 | 25 to 57 |
| Concern | 0 to 12 | 0 to 4 | 0 to 5 | 0 to 24 |  |
| 12 months | No Concern | 14 to 26 | 6 to 14 | 7 to 17 | 28 to 57 |
| Concern | 0 to 13 | 0 to 5 | 0 to 6 | 0 to 27 |  |
| 13 months | No Concern | 15 to 26 | 6 to 14 | 8 to 17 | 29 to 57 |
| Concern | 0 to 14 | 0 to 5 | 0 to 7 | 0 to 28 |  |
| 14 months | No Concern | 16 to 26 | 7 to 14 | 9 to 17 | 33 to 57 |
| Concern | 0 to 15 | 0 to 6 | 0 to 8 | 0 to 32 |  |
| 15 months | No Concern | 18 to 26 | 7 to 14 | 10 to 17 | 35 to 57 |
| Concern | 0 to 17 | 0 to 6 | 0 to 9 | 0 to 34 |  |
| 16 months | No Concern | 18 to 26 | 7 to 14 | 11 to 17 | 36 to 57 |
| Concern | 0 to 17 | 0 to 6 | 0 to 10 | 0 to 35 |  |
| 17 months | No Concern | 18 to 26 | 7 to 14 | 11 to 17 | 37 to 57 |
| Concern | 0 to 17 | 0 to 6 | 0 to 10 | 0 to 36 |  |
| 18 months | No Concern | 18 to 26 | 8 to 14 | 11 to 17 | 38 to 57 |
| Concern | 0 to 17 | 0 to 7 | 0 to 10 | 0 to 37 |  |
| 19 months | No Concern | 18 to 26 | 8 to 14 | 11 to 17 | 38 to 57 |
| Concern | 0 to 17 | 0 to 7 | 0 to 10 | 0 to 37 |  |
| 20 months | No Concern | 19 to 26 | 8 to 14 | 12 to 17 | 39 to 57 |
| Concern | 0 to 18 | 0 to 7 | 0 to 11 | 0 to 38 |  |
| 21 months | No Concern | 19 to 26 | 9 to 14 | 12 to 17 | 40 to 57 |
| Concern | 0 to 18 | 0 to 8 | 0 to 11 | 0 to 39 |  |
| 22 months | No Concern | 19 to 26 | 9 to 14 | 12 to 17 | 40 to 57 |
| Concern | 0 to 18 | 0 to 8 | 0 to 11 | 0 to 39 |  |