ont an ta CSc] om PA TT eS joey CO ES Ly TEA OTE LC PHO aT Te bate Uh n Sociodemographic Profile Tadicate the complet sociodemographic profile ofthe child Child’s Name: Sex: Date of Birth: month day year Address: Barangay ‘Municipality/City Province Region Chile's Handedness (Check appropriate box) Right Left Both Not yet established ently studying? (Check appropriate box) Yes No I'Yes, write name of child's school / learning center / day care: Father's Name: Fathers Age: Father's Occupation Father's Educational Attainment: Mother's Name: Mother's Age: Mother's Occupati Mother's Educational Attainment: Child's Number of Siblings: Child's Birth Order (1st, 2nd, 3rd, etc) @==. ByIt is recommended that the Checklist be administered to the child at six intervals. Once every four months from ages 0 to 12 months; and once every six months from ages 13 to 36 months (1 year 1 month to 3.0 years). Computation of the Child’s Age After verifying the dates, compute the child’s age by subtracting his birthday from the date the test is administered. Each month is composed of 30 days. Do not round off the months or years. Write the examiner's name each time the test is administered. eu EM chs ose arom CTEM chita’s Age ERA chissoasare Cory PES LD cis a ate Ere chie's Age Introducing the Checklist Introduce the Checklist to the parent/caregiver by saying the following: We are here to help you find out how your child is developing by asking you some questions about the things he is able to do or by having your child do some activities. There is no pass or fail score. This is just a checklist. Some of the questions are for children older then your child so I do not expect him to be able to do all the things | will be asking. We plan to administer this Checklist several times until your child is 5 years and 11 months old. So please do not teach or coach him because itis important to know just what he can and cannot do at his age. Later on we will share the results with you and give suggestions on what else you can do to stimulate your child’s development, After rapport has been established, introduce the Checklist to the child aged 1.0 year or older by saying the following | will be asking you to do some things for me today. Some of them will be very easy. Some of them may be allie hard for you. Do fot worry if you cannot do them ail because some of the activities are for children who are a litle older then you. So ! do not expect you to be able to do everything | ask. Just try your best Early Childhood Care and Development (ECCD) Checklist, Child's Record 1 2How to Administer This form can be used for six separate evaluations of the same child soit will be easy for you to see how he is developing as he grows older. The “Present” portion ofthis Form has 6 columns where you will mark the child's skills and behavior each time you assess him. Ifthe child exhibits the skill or behavior, puta check (#/) in the designated column. I the child does not, puta hyphen (-) and write additional information in the “Comments” column explaining why the child was unable to demonstrate the behavior. Where to start and stop For infants ages 0 month to 1.0 year: ‘The first few items in each domain pertains to infants or children 0 to 1.0 year old. These are those in the “Infants Section.” Administer all these items. Then continue administering the rest of the items in the domain, including those in the Section labeled “Optional starting point for children ages 1 year and 1 month to 3.0 years.” ‘Stop only after five consecutive items in each domain have been marked with a hyphen (-) For children ages 1 year 1 month to 3.0 years: You may start with the section labeled “Optional starting point for children ages 1 year and 1 month to 3.0 years” if the child is 1 year and 1 month off or older and you observe that he is able to do all the items enumerated in the “Infants Section.” But if he is not yet able to do the Infant items, then always start with Item # 1 of each domain. Administer all the items in this “Optional” section. How to score Tally the number of check marks (V) in each domain and record this inthe section labeled “Total Score.” Ifyou choose to skip the Infants Section, you still have to place a check for the items in that section. Count them when you add up the scores for each domain. Early Childhood Care and Development (ECCD) Checklist, Child's Record 1eee ca Gross Motor Domain A. Infants Section (Ages 0 month - 1.0 year) eee eeu Ast | and | 3ed | ath | 5th | 6th (eee ecae 1. Infant iis head PROCEDURE: ‘when held standing | Hold the clld in an upright postion and carey emo your band from the chi's neck according this abl t Ut his head | and Keep it erect. Credit if the cbild | | ‘occasionally lifts bis bead re of suppor. | Parental report wil suffice. 2. | Inf wes ok | PROCEDURE head wen yingon | Place the child on his stomach on a fat | stomach surface, Credit ifthe child at least | ‘momentary ifs his beads tha tbe chin | tsoff the surface. Parental report will | | suffice. 3.| Infanholdshead | PROCEDURE uprighton is own | Place the child on his stomach on a fat sven hing on surlace. Credit if the child lifts bis bead | : | stomach ‘and ches up s0 tba bis face makes a 90° ‘ange w/the surface for atleast several seconds Parental report wil suffice. | 4 | tnfcholds head | Parental report wil suffice. |_| seadiy 5. | Infant ros over from | pROCEDURE his back wo his Place the child on his backon at surfice. stomach with | Encourage him wo rol oer io his stomach, assistance providing some assistance to do so. Credit {f be eventually rols over. Parental ° report will suffice. | | 6.| infant cums from his | proceDuRe: | sideto his back | Rol the child from his back to his side | ‘withoutassistance Make sure he snot restricted byis clothes | | | { and his arm is not caught under his torso. | | | Credit if the cild actively turns from bis i | side to bis back. Parental report will | | suffice. {>| infansis wewih | pRocEDURE: || support teaning.on | Hold the child in a siting postion onthe | | handsifplaced on | table and slowly remove yourand from the bard sulace child making sure that he doesnot fll Cro if th child sits alone and puts is hands on bis legs or on the table for support Parental report will suffice L _— 4 Gross Motor Domain Early Chilhood Care and Development (ECCD) Checklist, Chile's Record 1eeu ee ts | and | 3rd | 4th | sth | ooh 9. | Infant sits alone PROCEDURE; stealily Hold the child in a siting postion on the table and slowly remove your hand from him making sure that he does not fll. Credi the child sts alone steadily without support, hoeping bis back fairy straight Parental report will suffice. 410 Infant moves from | MATERIAL: any toy siting to creeping’ | PROCEDURE: crawling positon | Seat the child on the Boor. Place a toy on the Hor, in front ofthe child, but not ‘within his reach. Observe how the child moves from siting o creeping position and the typeof movement fe makes to reach forthe toy. Credit i the cbild moves forward about 9 incbes or more, sing either ofthe following: bands and Anees, stomach and arms, bands and eet Parental report will suffice. 11 tofan pls sett PROCEDURE: from stig to ‘With the child in a siting positon, bold | standing position both his hands and have him pull himself vith minimal | up wth only minimal assistance from the seshianne saul Credit if be child can stand up Parental report will suffice. 12) sands with ‘MATERIAL elevated piece of furniture ‘minimum support | PROCEDURE: Credit ifthe child olds on oa piece of furiture wih both hands and bears weight | ‘onboin et Parental report will | suffice. Early Chidhood Care and Development (ECCD) Checklist, Chid's Record 1 Gross Motor Domain 5B. Optional starting point for children ages 1 year & 1 month - 3.0 years ees 13.| Holds furninre with both hands and wal sideways uence jure MATERIAL: toy | pRoceDuRE: ‘While the chilis standing, observe if he moves from one point to another by walking sideways. He may support himself byholding on to furniture. He can be encouraged to walkby placing toy on the furniture near the child but just outside his reach so he must walk to reach the toy. Credit ifthe child walls sideways while bolding on to furniture for support and balance. Parental report will suffice. eee 1st | and | 3rd | 4 | sth | 6th 14.| Walks with both brands held PROCEDURE: “Observe ifthe child walks when both hhands are eld by an adult Credit ifthe child lakes coordinated walking steps wit only light support from te adult. Automatically credit ifthe child can ‘already walk alone, Parental report will suffice. 15,| Climbs on chair or another elevated piece of furniture like abed without | help Parental report will suffice. 16.| Walksalone, rarely | fas | ‘PROCEDURE: Observe the child walks alone across the room. Gredit ifthe child walks alone with good balance without tripping and rarely falling. Parental report will suffice, 1 17,| Walks backwards PROCEDURE: Ask the child to walk backwards by demonstrating it. Credit if the cid is ‘able to walk backwards witbout falling ‘and bolding on to anything. Parental report will suffice. 18,| Runs without ‘ripping or fling ‘MATERIAL ball PROCEDURE: Encourage the child oro by rolinga ball across the Bloor. Credit if the cid cary fst and smoothly without tripping or faling L | 6 Gross Motor Domain Early Childhood Care and Development (ECD) Checklist, Chil’s Record 1eee acs eee iecerrecereics geeeu Comments successive step witout bolding onto ‘he handrail or wall for support. Do not | give credit i be cb places both feet on the step or uses the handrail or wall forsupport Parental report will suffice. 19.| Walks down stirs,2 | Automatically credit if tem #21 4s feetoneachstep, | passed with one hand held | Parental report will suffice. | 20.| walls up stars | MATERIAL: toy holding handrail, 2) PROCEDURE: feet oneach step | Place a toy inthe middle ofthe th or Sth step and ask the chil to walk up the stairs to get the toy. Credit ifthe cbild wal up ‘the slairs using the handrail or wallfor support and places both feet on eacb step before stepping on the next one. Automatcaly credit if tem #21 is passed. Parental report will suffice. {21.| was upstairs with | MATERIAL toy alternate fet PROCEDURE: ‘without holding on | Place a toy inthe middle of the 4th or Sth tothe handral step and ask the child wo walk upstairs to set the toy. redit if tbe child walks upstairs, alternating bs feet as be steps ‘on each successive step witout bolding_ | | om to tbe handrail or wall for support. | | Parental report will suffice. | | 22.| Walks downstairs | MATERIAL: ty | | with alternate feet | PROCEDURE: . ‘without holding Place toy atthe bottom ofthe stairs and | nin 2 handrail askthe child to walk downstairs to get the | toy Credit f the cild walks downstairs, alternating bis fet as be stepson each TOTAL SCORE Early Chitdhood Gare and Development (ECCD) Checklist, Chie’s Record 1 Gross Motor Dom:Fine Motor Domain A. Infants Section (Ages 0 month - 1.0 year) ued Sire ema Ist 1, | Handsofinfantare | PROCEDURE kept open most of | Observe the nfs hands. Credit ibis the time ‘hands are open most ofthe time. Parental report wil suffice. 2, | Infantwavesarms, | MATERIAL: dangling objecvtoy roves bodyatthe | PROCEDURE sightofa dangling | Dangle he tyi front ofthe child abjecitoy This must be elicited by the interviewer. 3, | Infantbrings both | MATERIAL: dangling objecttoy | hands together This must be elicited by the | toward dangling interciewer. abjecttoy 4, infantreaces for | MATERIAL: small toy/spoon | and holds small toy” | PROCEDURE: spoon Hold a smal iy/spoon in your hand and ‘ange the infant to get it Tois must be elicited by the interviexcer. B. Optional starting point for children ages 1 year & 1 month - 3.0 years 1st | 2nd | 3rd] ath | sin | 6c 5.| Usesall5 fingers to | MATERIAL: any small ty object setfoodtoys placed | PROCEDURE: on a surfaced Seat the child onthe parents lap with his elbows at level with the tabletop and is hhands on the table o fat surface. Drop 2 small toy in front of him and attract his tention by pointing othe toy oF upping the | | tnblelat surface. Credit the child picks up the toy, using all fingers as if raking. Automatically credit ifbe passes the next | item. | 6.| Picks up objects with | MATERIAL any small to or food thumb and index | PROCEDURE: | finger Place 2toyfod infront ofthe child and within his reach. Attract his attention by | tapping near the tooo. Credit ifthe child ses tbe pads of bis eum and index or _Soreftager to pick up the toy/food. 7. | Pulistoys with string | MATERIAL: toy with string ‘This must be elicited by the interviewer. 8 Fine Motor Domain Early Chichood Care and Development (ECCD) Checklist, Chis Record 1Pace aplece of paper and penci/erayon on the able and ask the cid to draw anything ‘he wants without showing him what to do. Credit ifthe cild uses the tips of bis thumb and any of bs otber fingertips 10 _grasp ibe peniverayon and purposefdy Scribble onthe paper (not acidentaly). ieiucen eure mments 6th 8.| Disphaysadefnite | MATERIAL: toy hhandpreference | PROCEDURE: Place the toy direct infront ofthe child st ‘midline (not his ft or his right) and ask him to reach for this. Credit if uses the ‘same hand 2 out of 3 times. Parental report will suffice. 9.) Graspsand transfers | MATERIALS: 2 small ys objet from hand | PROCEDURE to band Observe ifthe child transfers a small toy from ‘one hand to the other. Encourage this by siving the chil a toy and then presenting another oy tothe same hand. Credit ifthe bil transfers a ty from one band to the other without using bis mouth or body 10.| Pushes érpullsa | MATERIAL: Interviewer’ kit or some large large object object PROCEDURE: Demonstrate pushing or pling large object. ‘This must be elicited by the inter- viewer. 11] Pussmallobjecs | MATERIALS: small objects and container in/outofconuiner | This must be elfcited by the interviewer. 12) Holdscraoowith — | MATERIAL: crayon allthe fingers ofhis | PROCEDURE: | handas tough | Present child witha crayon and have him get | making afst (ie, | this. red fbe holds it by wrapping all | palmar grasp) five fingers around as if making a fist. | ‘Automaticaly credit this item if be uses | the tips of allie fingers or the ips of bis | thumb, index, and middle fingers. | This must be elicited by the | interviewer. 13 Unscrewstid of | MATERIAL: Container with screw-on top or container or ‘wrapped candy ‘unwraps food This must be elicited by the interviewer. 14] seribles MATERIALS: paper, penciverayon spontaneously PROCEDURE: TOTAL SCORE Early Childhood Care and Development (ECCD) Checklist, Chile's Record 1 Fine Motor Domain 9Self-Help Domain A Infants Section (Ages 0 month - 1.0 year) pea Peanut Geo eae st | and | 3rd | 4th | sth | 6th 1. | Infant sucks and Parental report will suffice. swallows milk from | breastor bottle | 2.| Infant begins to take | Ask the caregiver ifthe child can ake solid foods semi-solid or mashed foods. Credit if the caregiver reports tat tbe child tolerates | these. Write “No opportunity” in the | Comments section ifthe cild bas not been introduced to solid foods. 3, | Chews solid food | Parental report will suffice. | well B. Optional starting point es 4.) Holds bottle al by | himseir for children ages 1 year & 1 month - 3.0 years Pinar eee eee | 1st | and | 3rd | ath | sth | 6th Parental report will suffice. 5. | Reads selfwith finger food (eg, biscuits, bread) using fingers MATERIALS: bread, biscuits ‘This must be elicited by the interviewer. a 6.| Helps hold a cup for MATERIALS: drinking cup, water drinking Note: The cup should not have a lid or | | spout | | This must be elicited by the | 7.| Feeds selfusing Automatically credit if child eats | [7°] tngerstoeatricer | “ttbout spitage | | sands withsilage | Parental report wil sufice Ta) panistom scp | MATERIALS dining cup, war || ith help This must be elicited by the | interviewer .| Feedssefsings | Automatically credit fbild eats 1°]. spoon wih silage | sftbouespitage | Parental report wil suffice. | To] Gesadrnkior | Parental report wl suffice. tse witout any | || help | | TOTAL SCORE Early Chishood Care and Development ECD) Checklist, Chile's Record 1Receptive Language Domain 7) a’ A. Infants Section (Ages 0 month - 1.0 year) eed Cea 1, | Infant stares to Parental report will suffice. i | oud sounas | | 2 | Infanttums eyes” | MATERIA: rate head ioward sound | PROCEDURE: ‘Cary the child on his back wth one hand and with the other shake arate out of his ‘ange of vision 6 inches fom his ea. Do this continuously for 3 seconds and observe whether he can tum oward the sound. Credit ifthe ebild widens or | | moves bis ees from side to side in search ofthe sound. | | 3. | Infant watches Parental report will suffice. smother intently 2s | she speaks to him | 4.| Infantsmiles ata | Parental report will suffice. familie woice, ke ‘when bis mother tals to him 5.| Infantstops crying | Parental report will suffice. when sung to | B. Optional starting point for children ages 1 year & 1 month - 3.0 years ee creer ed ea eee | Ist | 2nd | 3rd | 4th | Sth | 6th 6.| Tumshead when PROCEDURE: Go behind the child afew called by name, {eet away and call out his name. Observe if | | makeseyecontact | the child can look for you and smile. Parental report will suffice. 7.| Understands“no” | PROCEDURE: Shake your head and finger and say "No-no.” Then see whether the child understands this. Credit if tbe child ‘stops what be is doing. Parental report will suffice. | 8.) imitates adults" PROCEDURE: Place the child on the | | playful sounds like | caregivers ap wih you facing the child | coughing, ip ‘Then make the following sounds: cough, smacking smack ips. Gredit if the child makes the same sound orev jus be ip movements. —— = i in = aly Childhood Care and Development (ECCD) Checklist. Chis Record 1 Receptive Language Domain 11 |elec eee! ts | and | 3d ih | 5h 9. | Follows one step- | MATERIAL: spoon or any objet command (eg | PROCEDURE: | ive) when gestures | Wi the child seated infront of you, ge | aroused him a spo. Then ask or he spoon back by saying “GIVE ME TE | _(obicct) "wit your hand (palm up) | | ioward him. Credit i the cil looks at | | ‘he object and bands it over to you | even i be doesnot release this | tmmediatly 10.) Followsonesiep- | MATERIAL: ty | command without | PROCEDURE: needfor gestures | Place the toy onthe Noor and asthe child to pick his up without poining they or using any ober gesture. Credit 1f the cil picks up the ty. 11] Poinstoafanily | PROCEDURE: member when Ath child to point his mother/ askedtodoso | caregiver. Credit be does 0. TE| Points oS body | PROCEDURE: pars ofhiswhen | Have the child point to his eyes, nose, asked in do so ‘mouth hands and fet. Credit f be can point to all these. 13.| points 5 named | MATERIAL picture book 1 | picured objets | PROCEDURE: | ‘when asked odo | Show the child picure book (2 pictures, | 0 er page) and ask im to point to the | | picture by saying "Wheres the _?” | Credit ifthe child can use bis finger to | point to at least 5 pictures 14.| rolowsonestep | MATERIAL: block/oy | insinctions hat | PROCEDURE: include simple ‘kth child to pu a blockto under the | prepestions (eg, | ble; on the able; inthe bag. Do not inon, under etc) | pointor use gestures when ging the | | instruction. Credit ifthe cbild is able | | to follow at least one ofthe | Instructions 15.| Follows 2-step MATERIAL blocktoy insrvctionsthat | PROCEDURE: | include imple Ask the child to get a blocky from reposons under the able and then place ton the lable, Do not point or use gestures when ving the instruction. Credit ifthe cid {sale to follow. a a | TOTAL SCORE 12. Receptive Language Domain Early Chilghood Care and Development (ECCD) Checklist, Child's Record 1Expressive Language Domain A. Infants Section (Ages 0 month - 1.0 year) ee enue ric nnn tat [2nd 1.| Infntvocaties (eg, | Parental report will suffice. rae, coos grunts) 2, |, lnltvocatiestoexpress | Parental report will suffice. | easueodspleasie | 3, | lnfant shouts to anract | Parental report will suffice. theateton of the ce | | | 4] latat laughs outloud |” Parentat report will suffice. and squeals 5, | Infzntvocales diferent | Parental report will suffice. | vowel sounds (eg, ah, ™ 008) 6| Inamvocalzesother | PROCEDURE | sounds thatdo not mean | Ascaeper ifthe cid can make anything ‘wo dfleent sounds apart from | crying ike “go0"and er. Take note ofthe sounds, Parental | report wilt sufice. | 7. | alan’ babbies Parental report will suffice. consnvousy to amuse selforatact tention 8. | Infnt esto imitate the | Parental report wilt suffice. caregversvocaizations | | 9: | aft uses body Parental report will suffice. imorementesuresto | ‘make wants known (¢, stretches aso indicate | | | || whathewans) B. Optional stating point for children ages 1 year & 1 month - 3.0 years et Curae aoa Cons 2nd | 30d | th | 5th [ 6th 10,| Repeats vowe-consonant | Parental report wil suffice. | combinations witout | refering anyhing or anyone (eg. haba, tama, dada) 11,] Usessounds meaningfully | Parental report will suffice. wo referto specie | | objectspersns (eg “Nama fr his mother, “mama fr walt) _ Early Childhood Care and Development (ECCD) Checklist, Che's Record 1 Expressive Language Domain 13Pere i cuekare uc eu Comments 1st | and | 3rd | aah | sth | ot 12.) haters ina Parental report will suffice. conversational tone | ‘without using real words | |13.| tiiestoimitatereal | Parental report will suffice. ‘words of adalt 14] Gombinessinglewords | Parental report will suffice. and gestures to make | wanis known (eg, “ou” ||. tite poining othe door) 15,| Uses 51020 PROCEDURE: Ask he cargher ifthe recognizable words child can clearly say 5 to 6 words | aside from mama and papa. This will be the minimum number. 16.| Uses pronouns (eg 1, | Parental report will suffice. sme, ak, akin) | 17] tees2-to3.wordverb- | Parental report wil suffice. ‘oun cobitatons | (eg, bingi gatas) 18.| Names objects in “MATERIAL picture book 2 || pictures PROCEDURE: Show the child a picture book, point oan object in the book, then askhim tomname this |} (eno ito?), Credit ifthe cbild an say the correct name of at leas 4 objets: Parental report sil suffice. | | 19.| Speaksin grammatically | Parental report will suffice. | correct 2- wo 3-word sentences ‘20. | asks “what” questions | Parental report will suffice. 21. | Asks “who and“why" | Parental report will suffice. questions 22, | Gwes account ofrecent | PROCEDURE: experiences (with Aske caregiver ithe cild can | | prompting) inorder of | recountrecent experiences in correct | ‘occurrence using past | sequence and using past tenses tense ‘correct, The caregiver can prompt him so he can complete what he is talking about (eg. Tapos ano pang