21 month visit

Please correct the errors described below.

21 Month Questionnaire

21 months 0 days to 22 months 30 days (inclusive)

All children develop at different rates and in different ways. Please do not worry if your child is not doing all or any of the activities mentioned in the questionnaire. It is not a test. The activities are simply one way of understanding how your child is progressing

Possible answers:

  • Yes = your child does this activity (or has done it and has now progressed, e.g., crawling, but is now walking)
  • Sometimes = your child is just beginning to do this activity (but does not do it regularly)
  • Not Yet = your child has not yet started doing this

Please leave blank any activities your child has not been able to try with you.

On the following pages are questions about activities children may do. Your child may have already done some of the activities described here, and there may be some your child has not begun doing yet. For each item, please fill in the circle that indicates whether your child is doing the activity regularly (yes), sometimes, or not yet.

Important Points to Remember:

Try each activity with your child before marking a response.

Make completing this questionnaire a game that is fun for you and your child

Make sure your child is not tired or hungry.

Please bring this questionnaire with you to your child’s health and development review.

At this age, many toddlers may not be cooperative when asked to do things. You may need to try the following activities with your child more than one time. If possible, try the activities when your child is cooperative. If your child can do the activity but refuses, mark “yes” for the item.

COMMUNICATION

GROSS MOTOR

* If Gross Motor Item 6 is marked “yes” or “sometimes,” mark Gross Motor Item 1 “yes.”

FINE MOTOR

PROBLEM SOLVING

PERSONAL-SOCIAL

OVERALL

Parents and providers may use the space below for additional comments.

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