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Growth Chart Questionnaire

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Building Healthy Minds: The Six Experiences
that Create Intelligence and Emotional
Growth in Babies and Young Children

By Stanley I. Greenspan, M.D.


To assess if your child has achieved a new functional milestone, the answer must be “yes” to all the questions under that milestone. If you’ve answered “no” to even one question, the child has not yet mastered the stage. Remember, this chart is simply a visual tool to draw your attention to those developmental areas where your child is progressing as expected and those where he or she may be facing some challenges.

Three Months (Stage 1 – Regulation and Attention):

  • Does your infant usually show an interest in things around him/her by looking at sights and turning towards sounds?

Susan’s thoughts and ideas…  

Dr. Greenspan is so wise …..Learn to observe your infant, as you admire and stare at the masterpiece you produced as a couple, but also to observe how smart infants are!  Watch, look and listen as well as feed, change diapers and cuddle!  The behavior of infants is amazing!   Infants are in constant motion, even when sleeping, some body part is moving!   Infants aren’t always asleep when their eyes are shut.  They could be tricking you….literally, in a light sleep state, new babies seem to be searching for sounds and sights! 

Infants come into the world, as they did in the womb, moving constantly, hiccupping, yelling and changing position… swaddle and hold for comfort, and watch how each infant wriggles and squiggles differently. But all infants shift and change position continuously! It is an excellent idea to share baby with other family members when the opportunity presents itself, so carefully “pass off” the baby from one family member to another. 

Your infant will enjoy the touch and smell and voices and sounds of family members and friends!  Infants are very social!  Remember to wash hands for a count of “happy birthday to you!” before picking up a young infant and enjoy the experience.  Change baby’s position in the crib end to end, or side to side, hold the infant up on your shoulder, lay little ones on your lap, hug and cuddle, calmly sing, and speak softly, and remember there is no need for the infant to startle if you take your time!  Change temperature, amount of light and location when it is time to feed the infant.   Sing and hum and put your face close to the baby so he can look at you and listen at the same time!   Remember when you change a diaper you are in the exact place where the infant sees you perfectly from birth…at arm’s length! 

So talk and babble and repeat sounds like clucking and hushing as you clean away urine and bowel movements….and remember babies feel the temperature change when you remove soiled diapers and they are hyper-alert to changes of air and temperature and the sound of voices!  Vocalize and create vibrations with vocal play as you change a diaper!  Change is good, but gently!   

From birth, infants demand attention!  Remember infants can’t wait for their needs to be met… crying is one way of talking and should not be discouraged but attended to promptly! Prolonged crying is tension-producing and upsetting, but crying is also the only way your infant has to get comfort and food and the basics of what we all need, attention; parents should not ignore crying for more than a brief minute or two for several weeks and even then, prompt attention is still vital to the security a young infant needs to feel! 

Five Months (Stage 2 – Engaging in Relationships):

  • Does your baby seem happy or pleased when he/she sees his/her favorite people: looking and smiling, making sounds, or some other gesture, love moving arms, that indicates pleasure or delight?


Susan’s thoughts and ideas…  

            Five-month-old babies smile, cuddle, nuzzle, scream as well as making vocal cries that cause the body to stiffen.  At this age, infants gaze, stare, gasp, release gas, and make breathing sounds as they wriggle arms and legs and squeal.  They listen to the sound of voices intently and recognize familiar faces and sounds of familiar play objects.  They are like baby birds in the nest, cooing and opening mouths for food, reaching arms and legs forward, waving arms, and engaging their family members in visual play.  They cannot be fooled at this age, as they turn away from an unfamiliar face and gaze, raptly and smile in a loving way, when familiar faces, voices and objects of interest come into view.

            Red and orange rattles and shiny objects attract infants ‘attention, watching both sights and sounds in their view.   Placed on the floor, infants will bend knees against the floor, kick and extend legs, flex the trunk of the body forward and try to roll over.  Turning their neck and searching for familiar faces, five month-olds have a full range of side-to-side vision and hearing, as well as making attempts to bat at objects dangled in front of them.  

            Five month-olds enjoy pulling up to a standing position when securely held by the trunk of the body for support.    They rock and twist, and make sounds of recognition from sitting positions when held securely.  Positions, such as sitting on laps, listening to songs and games, rocking and resting are natural ways to engage people’s faces and raise their heads with interest at sights and sounds. 

            The sucking reflex is strong, vigorous but pacifiers through the first five months of life should be limited to calming down and soothing themselves, and not used as a constant toy or tool.  The reason is, doctors and dentists agree, that even at this early age, the interior of the mouth needs to be wiped gently after feeding, with a clean, soft, warm cloth.   In addition to this style of gentle cleaning, parents need to start now to use a very soft brush in the mouth, gums to stimulate oral tissue and develop healthy gums and teeth. 

Assist your infant with changing positions often, holding up and over a shoulder facing infants so they can gaze outward,  supporting neck and head positions while carrying infants, lap-sitting and floor sitting between the legs of an adult, and supported sitting for feedings. 

Infants should receive solid food in a sitting position to make sucking and swallowing easy and fun.  Families soon realize infants want to be part of the family scene and they use feeding time to communicate, so talk, sing, and observe your infant’s face and its features. 

See if you can regulate the speed of eating, slowing down the movements of your baby’s tongue, ears, fingers, lips, cheeks, eyes, lids and skin, as well as the pace of sucking and inhaling.   While feeding on the bottle and breast, observe how the various motions comfort the baby.  Use the pacifier in times of distress when the infant needs the sucking reflex motion to relax and reduce tension, but avoid it just to keep an infant quiet,  it negatively affects oral development of teeth and gums by tightening muscles in the lips, throat and jaw.

Nine Months (Stage 3 – Interacts in a Purposeful Manner) :

  • Is your baby able to show what he/she wants by reaching for or pointing at something, reaching out to be picked up, or making purposeful special noises?

  • Does your baby respond to people talking or playing with him/her by making sounds, faces, initiating gestures (reaching), etc?

Susan’s thoughts and ideas…  

            Older babies are learning to fall in love with their families and flirt, wink, nod, and turn away from strangers!  They crave attention, show excitement and are aware of unfamiliar places, as well as strangers.  Older infants act and react with positive and negative reactions and a sense of determination and imitation.  Sucking and swallowing, biting and soft chewing and spitting are actions that indicate an awareness of likes and dislikes.

            The sense of touch and smell, intense staring and curiosity are strong and powerful tools babies use to become familiar with a world that is growing wider and wider.   Babies imitate many words and sounds and make all the vowel and consonant sounds of adult language and speech.  

            All babies do not crawl or rock on all fours or turn over on their own even at this stage of development, preferring to observe, play at floor level, enjoy toys, and watch family and friends.  These vicarious learners have great interest in the five senses of taste, sight, sound, smell and touch.  Most reluctant crawlers and later walkers are verbal and visual learners, seeing the world from the ground up, pushing themselves onto one leg, a knee, rocking, swaying, falling, extending their backs without fear of falling, raise up arms to be lifted, and turning to toys and games, reaching out both arms, improving ability to sit and balance on frog-like  legs. 

             Older babies do “talk” but their expressiveness language is dominated by babbling, copying actions that they observe, repeating words and phrases, making sounds, nodding and shrieking!   Generally, young toddlers are great observers, searching faces and places, toys, laughing, mouthing objects, grabbing, pulling tugging, and happy little campers, hanging out!   

            Encourage older babies to stand; encourage your toddler to walk holding your two hands, or leaning on a heavy object like a sofa or pushing a toy that has been weighted down with something heavy.  Encourage crawling and knee walking at any stage.  Pretend play is very important at this and any age, because toddlers who are not fully mobile learn imitative and observational skills.  Encourage your child to help moms and dads prepare foods, help make a bed, or do simple chores.   Help your older baby to experience frequent changes of actions like rolling balls, throwing, crawling under a card table, pretending to be a dog or a kitty, stacking blocks, turning, knocking down blocks, turning pages of cardboard books, scooting, or playing with activities to strengthen and train leg and arm muscles, as well as exercise the trunk,  joints and coordination.

            The motions of throwing, grasping, chewing on toys and following large objects with their eyes helps them to form a sense of awareness between themselves and the space they occupy.  Motor abilities develop rapidly at this stage of development, using hands and arms, legs and feet and exercising these body parts, almost entirely at the floor level.  This play is horizontal floor play, leading to the transition from a horizontal perspective to pulling to standing, holding hands while standing, taking first steps, and becoming walkers. 

By 14 to 18 Months (Stage 4 – Organizes Chains of Interaction: Problem Solving):

  • Is your toddler (by 14 months) able to show what he/she wants or needs by using actions such a leading you by the hand to open a door or pointing to find a toy?

  • Is your toddler (by 18 months) able to orchestrate more complex chains of interactions as he/she solves problems and shows you what he/she wants, including such things as getting food, for example (does he/she take your hand, lead you to the refrigerator, tug on the handle, and point to a particular food or bottle of juice or milk?)

  • Is your toddler (by 18 months) able to use imitations, such as copying your sounds, words, or motor gestures, as part of a playful, ongoing interaction?

Susan’s thoughts and ideas…

            Once toddlers are comfortable in the vertical upright position, they are ready to change pace and enter the world of walking upright, finding a whole new view of their world.   They act like the little action-figures running loose.   At eighteen months, they are toddlers on a mission, knocking toys and throwing books and heaving objects around like a wrestler, chasing balls and generally enjoying life, as long as they have a caring adult or two standing guard! 

            At this age, the daily routine of family life needs to be down to a set of rules and channeling the energy of an over-inflated ego!  Parents need to be firm but loving and use physical actions, like holding hands, engaging them in floor play, taking walks and being active, and keeping strict schedule of activities that any toddler can learn to follow. 

            Keep your toddler’s life simple and teach good habits!  That is the key to survival….forming habits now is the best time to assure peaceful bedtimes, healthy eating, preparing for later toilet training and more!   Food and drinks in small amounts suffice for most toddlers, but snack and extra food during the off hours between lunch and supper are not helpful for toddlers, if you want them to be healthy eaters.  Vary fruits and vegetables; give milk and fruit juice with bread or crackers or more fruit at snack times. Avoid spending money at fast food venues, but do have treats at home.  Allow your busy toddler to help you in the kitchen, or doing the simple chores, like taking out the trash, or cleaning counters.  Bath time and bedtime go together. 

            Toddlers should not be carried, unless there is a reason.  “Uppy” (pick me up please!) is a toddler-type pattern of behavior left over from the infant days, to get their way and avoid following directions. Parents need to stop the heavy lifting and constant carrying, and keep working on holding hands, and playing in simple small areas until they learn the boundaries you set for them!  

            Parents are working toward cooperation more than anything!  During the day, naptime and eating times, include your toddler to help you get ready for naps or take a bath or clean up a mess.  Make a game of it; it is essential to stick to a daily routine in order to give toddlers the sense of safety and security that is necessary for learning.     

            TODDLERS LOVE TO pretend to READ TO, TO play hide and seek, to play up and down, to run away, hit bite, poke, and hug and kiss!  What a great time of life!   They are becoming, vicarious, opinionated (“no!”), and determined, with little egos running wild, grabbing, throwing toys, knocking down blocks, biting, hitting and talking all at once.   They are eager companions, but fussy eaters, sleepers, or friendly visitors,

            Toddlers are very important people, at least they think so!  They swagger, point, name toys and household objects; they run, fall and crash and cry, and retreat for comfort into the arms and safety of family and parents, siblings and grandparents.  True, toddlers have an over- inflated view of their control and power, but they do amazing things! 

            Pretend play, imitative and imaginative play, scribbling and drawing, eating with fingers and utensils and most vitally, toddlers begin the process of speech, grammar and conversational language. 

  • By 24 to 30 Months (Stage V Uses Ideas – Words or Symbols – to Convey Intentions or Feelings)

  • Does your toddler (by 24 months) ever respond to people talking with or playing with him/her by using words or sequences of sounds that are clearly an attempt to convey a word?

  • Is he/she (by 24 months) able to imitate familiar pretend-like actions, such as feeding or hugging a doll?

  • Is his/her (by 24 months) able to meet some basic needs with one or a few words (may require parent saying the word first), such as “juice,” “open,” or “kiss”?

  • Is he/she (by 24 months) able to follow simple one-step directions from caregiver to meet some basic needs, for example, “The toy is there” or “Come give Mommy a kiss.”?

  • Is he/she (by 30 months) able to engage in interactive pretend play with an adult or another child (feeding dollies, tea parties, etc.)?

  • Is he/she (by 30 months) able to use ideas – words or symbols- to share his/her delight or interest? (See truck!”, for example)

  • Is he she able to use symbols (words, pictures, organized games) while enjoying and interacting with one or more peers?

Susan’s thoughts and ideas…

This stage is called symbolic pretend play or role-playing, in which older toddlers and young preschoolers engage in very obvious and very playful imitation of parents, They “act out” what they see and hear; this time period allows for huge social and intellectual growth and self awareness, playful humor, testing  of limits, and repeating what  they see others say and do!  Monkey see…..monkey do!  This is when it shocks parent’s to realize that adults are running around falling into the older toddler trap of running your household, giving orders, acting like parents and you are left wondering just who is in charge here?

Your child has discovered that you can be imitated and thinking logically, he or she purposefully imitates YOU and tests YOU and speaks as you speak and looks the way you look!   This age child is discovering how to think with logic and purpose.  “Purposeful actions” are the name of the game for children 24 to 36 months of age and at three years of age many have found themselves in power! 

Parents beware!  It is crucial to social, mental and physical development to be good role models who set boundaries and show love and affection and use humor and engage in pretending as a way to act out good and bad behavior, set the rules and show children you are in charge!  

It is never too soon to recognize your child’s developmental talents and strengths and help them progress on the level of what each child is able to do well, and try, but don’t push, new things at the same time!  You are HUGE and a role model whether you like it or not…not preschool teachers, not grandparents, not child minders or day care providers….no!   YOU!!!!!!!

In fact, you will hold that prominent position through all of childhood, the teen years and beyond!  Children are the products of their parents and parents have the responsibility to revert to their own childhoods, after all, all human beings start out the same way!  First, infancy, then childhood, then teenage years… … parents are teachers and preachers!  YOU teach family rules, good behavior or not-so—good behavior and YOU are the molders of the clay YOU gave life to!  …

By 36 to 48 Months (Stage 6 – Creates Logical Bridges between Ideas)

  • Is your toddler (by 36 months) able to use words or other symbols (for example, pictures) to show what he/she likes or dislikes, such as “want that” or  “no want that”?

  • Is your toddler (by 36 months) able to engage in pretend play with another person in whom the story or drama makes sense? (For example, does he/she have the bears go visit grandmother and then have a big lunch?)

  • Is your toddler (by 36 months) able to begin to explain wishes or needs (“Mommy, go out.” ”What are you going to do outside?” ”Play”)? May need multiple choice help from you (“What will you do, play or sleep?”)

  • Can your preschooler (by 48 months) explain reasons why he/she wants something or wants to do something (“Why do you want the juice?)”…”Because I’m thirsty”).

  • Is your preschooler (by 48 months) able occasionally to use feelings to explain reasons for a wish or behavior (because I’m happy/excited/sad)?

  • Is your preschooler (by 48 months) able to engage in interactive pretend dramas with both peers as well as adults in which there are a number of elements that logically fit together (The children go to school, do work, have lunch, and meet an elephant on the way home)?:

  • Is your preschooler (by 48 months) able to make a logical conversation with four or more give-and-take sequences about a variety of topics, ranging from negotiating foods and bedtimes to talking about friends or school?

Susan’s thoughts and ideas…

      Stress listening to your child, really listening and having conversations with your children, rather than setting too many demands, good habits, good food, good health, firm support and understanding mistakes and plenty of rest and sleep! 

      These are the years of greatest nutritional need since infancy and these years are often wasted on denial, discipline and punishment, or harsh treatment and demands that most children are not ready for!  Children are your legacy in life, and their behavior reflects your attitudes, prejudices and even your temperaments!  Sure, parents should stay in charge, set family rules, of course, but control adult tempers and take a “kinder-we-all make mistakes” type of discipline and setting too long or two extreme consequences!  I have seen far too much harsh treatment of children at this preschool stage that has resulted in schools and childcare centers literally "kicking" children out of programs, the very children who need the consistency and attention they lack at home.  

      So moms and dads, GET WISE TO HOW YOU TREAT OTHERS!   With your child in mind, think out ahead of time the limits and boundaries you feel fit your child’s and your personalities and practice with each other how certain situations will be handled when a child or YOU gets out of control!  Yes PRACTICE YOUR PARENTING, so you know in advanced how to handle specific situations!  

Ask Dr. Susan