Early Intervention

Cognitive

• Looks toward noise
• Mouths toys
• Bangs toys
• Repeats arm or leg movement to cause an action to recur
• Pulls cloth from face
• Reaches for and grasps toy

Communicative

• Looks directly at speaker
• Vocalizes in response to speaker
• Vocalizes pleasure and pain
• Laughs out loud
• Self-initiated vocal play: coos, chuckles, gurgles, and laughs
• Pitch and intonation vary

Social or Emotional

• Smiles at own reflection in mirror
• Expresses desire to be picked up
• Smiles in response to speaker

Adaptive

• Uses tongue to reject pureed foods
• Holds or supports bottle during feeding
• Sleeps through the night; takes 2-3 naps during the day

Physical

• Holds toy 10-15 seconds
• Holds small object
• Opens hand in anticipation of contact
• When pulled to sitting, holds head in line with body
• Brings hands together when lying on back
• Bounces when standing and supported by adult

Nutrition

• Do not put the baby to bed with a bottle
• Give breast milk or formula with iron (baby is not ready for cow’s milk)
• Do not add cereal to bottle

At 6 Months

• Introduce infant juice in small amount
• Iron-fortified cereal may be introduced in small amounts, using spoon
• As child progresses and shows signs of chewing motion, you may offer mashed or soft foods

Cognitive

• Drops toy without watching results
• Finds toy that is partially hidden
• Finds toy that is completely hidden (begins to understand that objects continue to exist even when they cannot be seen)
• Shakes toy
• Moves to get toy

Communicative

• Expresses facial expressions, actions, and familiar sounds
• Comprehends parental gestures
• Looks at objects, family members, and pictures when named
• Babbles /m/, /n/, /t/, /d/, /b/, /p/, and /z/
• Vocalizes to another person
• Vocalizes differently for hunger, anger and contentment

Social or Emotional

• Expresses physical states such as anger, tiredness, excitement, and hunger
• Extends arms to familiar persons
• Responds differently to caregiver and strangers
• Interacts by smiling and cooing
• Infant-to-infant interactions increase
• Responds differently to children and adults
• Recognizes self in mirror

Adaptive

• Closes lip when swallowing
• Sleeps through the night; 1-2 naps during the day
• Brings food to mouth with whole hand
• Shows definite likes and dislikes for various foods

Physical

• Rakes or scoops small objects with hand
• Transfers object from hand to hand
• Picks up objects easily
• Rolls from back to stomach
• Crawls forward on belly
• When sitting, extends arm if falling to the side
• Pulls self up to standing
• Holds a small object between thumb and index finger
• Sits alone briefly without support

Nutrition

At 6 months

• Introduce infant juice in small amount
• Iron-fortified cereal may be introduced in small amounts, using spoon
• As child progresses and shows signs of chewing motion, you may offer mashed or soft foods

At 9 months

• Encourage to feed self – messes will happen
• Give finger foods
• Cut table foods into tiny pieces – offer small amounts – watch for mouth stuffing
• Never put to bed with the bottle
• Start decreasing breast or bottle feedings as baby eats more food

Cognitive Development

• Adult starts and stops toy. After the toy’s movement stops, the infant touches the toy or adult to reactivate the toy
• Turns over the black side of a card to view picture
• Intentionally drops toy and watches it fall
• Shakes toy
• Moves to get toy

Communicative Development

• Briefly stops behavior when told “no”
• Begins to relate names and objects
• Turns when called by name
• Gives object upon request
• Claps hands and waves on command
• Articulates most speech sounds
• Gestures/vocalizes wants and needs
• Directs others physically; pats, pulls, pushes, and tugs

Social or Emotional

• Repeats actions that elicit laughter/attention from others
• Plays simple games: pat-a-cake, peek-a-boo
• Often attached to favorite toy or blanket
• Exhibits fear or reluctance toward strangers
• Expresses affection (e.g., hugging, patting)
• Expresses two or more emotions (e.g., pleasure, fear, sadness)

Adaptive

• Pulls off own socks
• Closes mouth on rim of cup but loses liquid from corners of mouth
• Feeds self finger foods
• Picks up cup and takes 4-5 swallows
• Begins to cooperate when being dressed (e.g., helps put arms in holes)
• Fusses when diaper needs to be changed
• Bowels move regularly

Physical

• Cruises holding onto furniture
• Can poke with index finger
• Stands alone momentarily
• Walks with adult holding one hand
• Creeps well
• Claps hands
• Corrals ball with arms and hands when sitting with legs spread apart
• Moves body to music

Nutrition

At 9 months

• Encourage to feed self – messes will happen
• Give finger foods
• Cut table foods into tiny pieces – offer small amounts – watch for mouth stuffing
• Never put to bed with the bottle
• Start decreasing breast or bottle feedings as baby eats more food

At 12 months

• Serve liquids only in a cup
• Encourage self-feeding with spoon and cup
• Offer 3 meals a day, plus snacks
• Include baby at family meals
• Switch from formula to whole milk

Cognitive

• Manages 3-4 toys by setting one aside when given a new toy
• Pulls an object up from the floor with string
• Gives toy to someone to wind up
• Activates toy after adult demonstration
• Polls wheeled toys
• Places things in cup; dumps out contents
• Demonstrates use of everyday items (e.g., pretends to drink from cup)

Communicative

• Says “Mama” or “Dada” discriminately
• Points to objects when named
• Responds vocally to “wh” questions
• Acknowledges others’ speech by eye contact, speech, or repetition of the word said
• Uses sentence-like intonation (jargon); imitates some words
• Uses single words; says 3-20 words
• Protests by saying “no,” shaking head, moving away, or frowning
• Points to wanted object
• Says “all gone,” asks for “more”
• Teases, scolds, warns using gestures and vocalizations
• Responds to the directions “in” and “on”

Social or Emotional

• When faced with a novel situation, looks to parents for reassurance
• Shows emerging independence by moving around a familiar room in a playful, exploratory manner (still may require some supervision and encouragement)
• When playing on his or her own, may periodically return to the parent for reassurance and attention (likes to know adult is near)
• Plays alone for short periods
• Contacts with peers’ center on a toy, and adult, etc.
• Brings toy to share with caregiver

Adaptive

• Chews textured foods
• Spoon-feeds and drinks from cup independently – frequent spills
• Sleeps through the night; one nap during the day
• Cooperates when dressing and undressing
• Stirs with spoon
• Sips liquid from cup using a straw

Physical

• Squats to play
• Kicks stationary ball forward
• Drops objects into small container
• Stacks 2-4 objects on top or one another
• Starts and stops in walking
• Walks up and down stairs with assistance, placing both feet on each step
• Enjoys pushing or pulling toys while walking
• Takes independent steps
• Maintains balance while kneeling
• Walks backwards
• Creeps backward down steps
• Holds crayon with fingers, hand on top, forearm turned so thumb is directed downward

Nutrition

At 12 months

• Serve liquids only in a cup
• Encourage self-feeding with a spoon and cup
• Offer 3 meals a day, plus snacks
• Include baby at family meals
• Switch from formula to whole milk

At 15 months

• Keep encouraging self-feeding using spoon, fork and fingers
• Should be drinking only from cup
• Expect strong food preferences – offer a variety, but do not force-feed

At 18 months

• Growth is slow – appetite decreases
• Can be picky, negative behavior
• Maintain relaxed approach to eating
• Offer a variety of foods – allow the child to choose
• Avoid using food as a reward or punishment

Cognitive

• Looks at storybook pictures with adult, naming or pointing to familiar objects on request
• Uses stick to get out-of-reach toy
• Activates toy without adult demonstration
• Looks for familiar person who has left the room
• Spontaneously names objects
• Turns pages in book
• Inserts shapes into matching slots

Communicative

• Says 50 words
• Names familiar objects
• Uses ritual words “hi,” and “bye”
• Understands approximately 300 words
• Listens as pictures are named
• Points to five body parts
• Responds to yes/no questions by shaking or nodding head
• Produces words with consonant-vowel-consonant structure
• Combines words to make two-word phrases
• Mean sentence length = 1.8 words
• Uses commands (e.g., “move”), possessives (e.g., “mine”), reactions (e.g., “owee”)
• Follows a series of two related commands (e.g., “Pick up the ball and give it to me”)

Social or Emotional

• Has temper tantrums when frustrated
• Frequently does the opposite of what he or she is asked to do
• Curious, gets into everything
• Often defiant; says “no” to many requests
• Enjoys simple make-believe
• Has difficulty sharing
• Usually plays alone even when other children are present
• Helps put things away
• Insists on trying to do many things without help (e.g., eating with a spoon, drinking from a cup)
• Engages in make-believe and pretend play
• Plays well for brief time in groups of two or three children

Adaptive

• Begins using fork
• Squats, holds self, or verbalizes bowel and bladder needs (50% of the time)
• Brushes teeth with assistance
• Tries to wash own hands and face
• Removes loose clothing such as a jacket or shorts without assistance

Physical

• Scribbles vigorously with crayons or markers
• Imitates vertical strokes
• Walks on a straight line
• Stacks 4-6 objects
• Following demonstration, throws small ball overhand at least 3 feet

Nutrition

At 18 months

• Growth is slow – appetite decreases
• Can be picky, negative behavior
• Maintain relaxed approach to eating
• Offer a variety of foods – allow the child to choose
• Avoid using food as a reward or punishment

At 24 months

• Check portion sizes – rule of thumb: 1 Tbsp for each year of age
• Definite likes/dislikes – keep offering a variety of foods
• Provide snacks as part of the daily intake
• Expect only one good meal a day or even 2-3 days at times
• Watch milk/juice intakes. Too much fluid can decrease appetite for solid foods

Cognitive

• Understands “one,” “all” (e.g., Give me one block)
• Sequences related actions in play such as preparing food for doll, feeding it, wiping its mouth
• Matches an object to its picture
• Uses pretend objects in play
• Repeats finger play with words and actions
• Matches simple shapes such as circle, square, and triangle

Communicative

• Understands approximately 500 words
• May omit some final consonants or substitute one consonant for another (e.g., /w/ for /r/)
• Says 200 words
• Mean sentence length = 3.1 words
• Knows “big/little”
• Answers “what/where” questions (e.g., “What do you hear with?”)
• Uses some regular plurals (e.g., cats)
• Asks basic questions (“Daddy gone?”)
• Asks a simple “what/where” questions (e.g., “What’s that?”)
• Whispers

Social or Emotional

• Asks for assistance when having difficulty
• Shy with strangers, especially adults
• Claims certain articles as being his or her own
• Attempts to comfort others in distress
• Sings familiar songs with adults
• Shows pride in accomplishments
• Separates from parent in familiar surroundings without crying

Adaptive

• Takes off own shoes, socks and some pants
• Independently eats entire meal with spoon
• Tries to wash self
• Less frequent eliminations
• Site on toilet for at least 1 minute supervised
• Puts on socks, coat and shirt
• Opens door by turning handle

Physical

• Imitates circular, vertical and horizontal strokes
• Rolls, pounds and squeezes clay
• Stacks 6-7 blocks
• Walks up steps, alternating feed in adult fashion while holding on
• Jumps in place with both feet together
• Snips paper with scissors
• Catches ball from straight arm position, trapping ball against chest
• Uses one hand consistently in most activities

Cognitive

• Draws face from model
• Matches three colors
• Matches objects by color, shape and size

Communicative

• Understands approximately 900 words
• Points to pictures of common objects described by their use (e.g., “Show me what you eat with”)
• Knows third-person pronouns (e.g., he, she)
• Articulates /p/, /m/, /n/, /w/, and /h/
• Says 500 words
• Mean sentence length = 3.4 words
• Refers to self by own name
• Uses pronouns (e.g., me, you, mine)

Social or Emotional

• Says “please” and “thank you” when reminded
• Spends most group time in solitary activity, watching other children
• States whether he or she is a boy or a girl

Adaptive

• Gets drink from fountain
• Stabs food with fork and brings to mouth
• Daytime control of toileting needs with occasional accidents

Physical

• Threads four small beads on string
• Copies drawing a circle
• Stands on one foot for 3 seconds
• Can jump over a string 2 inches of the floor