Child Developmental Milestone Checklist

The purpose of this form is to gain insight into your child's development and track progress during the mineral balancing program.  Often, when the body's chemistry becomes balanced and when toxins are removed, "diagnoses", "labels" and "conditions" resolve themselves.

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Name
Parent / Guardian Name (s)
Address
Gender
Were there any complications during your pregnancy?
Were there any complications during birth?
Was your baby born either before or after term? (More than 2 weeks early or more than 10 days late)
Was your baby small for term (birth weight below 5 Lbs?
Did your baby have difficulty in the first few weeks of life: latching on, nursing or sucking a bottle?
Was / is your child extremely demanding?
Trouble sleeping, self-soothing, crying, restless, caregivers going to extraordinary lengths to calm the baby/toddler/child
Was your baby diagnosed with tongue ties?
Mention how old your baby was if treated for tongue ties and if any feeding/sucking problems were resolved.
Did your child miss out on crawling or was there atypical crawling noted?
Ex: did not crawl at all or had one leg hiked up while crawling or bear crawled only
Does your child use utensils to eat?
Describe the ability of your child to use the utensils (clumsy, no problems, won't use / only finger feeds
Would you consider your child to be a "picky eater"?
Does your child have any allergies (food/environment)?
Does your Child use crayons/pencil/paper the way peers use these items?
Grasp looks appropriate, no breakage of crayons or ripping of paper with a pencil. Teachers have not noted anything out of the ordinary.
Did your child thumb suck beyond the age of 5?
Was your child slow at learning to walk? (normally 12-16 months)
Legs turned out not typical of peers, ankles rolling in
Did your child experience speech difficulties or delayed speech?
Delays in expression or delays in comprehension or both
Was your child prone to Ear/Nose/Throat problems?
Allergies, chronic ear infections, etc.
How long did this go on and was there any resolution to the issue? PE tubes, etc.
In the first 3 years of life, did your child have any serious illness or incidents involving high temperature and/or seizures?
Did your child miss any other major milestones?
Walking, talking, eating, using utensils, potty training, self-care
Was your child vaccinated?
Does your child have any allergies? (food/environment)
Does your child color on paper and hold pen/crayon appropriately?
Displays an interest in coloring or handwriting
Did your child thumb suck beyond age 5?
Does your child suffer from travel sickness?
Did / does your child have difficulty in learning how to dress or tie shoelaces?
Did / does your child have difficulty in learning how to read a clock face?
Would you consider your child to be clumsier than their peers?
Does your child enjoy movement like swinging?
Did your child have difficulty learning to ride a bike?
Can your child catch a ball?
Is your child easily distracted or find it difficult to sit still?
If there was a sudden unexpected noise, would your child over-react or under-react?
Does your child present with an overall disheveled appearance?
Does your child experience frequent headaches?
Does your child have reading difficulties?
Does your child have writing difficulties?
Does your child have copying difficulties?
Does your child have difficulties organizing school work or completing homework?
Is there a family history of reading difficulties?
Is your child clumsier than their peers?
Does your child have issues with texture: clothing, tags, food, etc.?
Is your child sound sensitive?
Example, covers ears with vacuum cleaner noise, refusal or meltdown going into public restrooms
Is there anything else you think I should know that impacts your daily life in a challenging way?
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