The commonwealth of massachusetts department of Early Education and Care
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THE COMMONWEALTH OF MASSACHUSETTSDepartment of Early Education and CareDEVELOPMENTAL HISTORY AND BACKGROUND INFORMATION Regulations for licensed child care facilities require this information to be on file to address the needs of children while in care. CHILD'S NAME: ___________________________________ DATE OF BIRTH: __________________ Please provide information for Infants and Toddlers (marked *) as appropriate to the age of your child. DEVELOPMENTAL HISTORY Age began sitting: ____________ crawling: ____________ walking: __________ talking: ___________ *Does your child pull up? ____________ *Crawl? _____________ *Walk with support? _____________ Any speech difficulties? _______________________________________________________________ Special words to describe needs ________________________________________________________ Language spoken at home _______________________ *Any history of colic? ____________________ *Does your child use pacifier or suck thumb? _____________ *When? __________________________ *Does your child have a fussy time? ____________________ *When? __________________________ *How do you handle this time? __________________________________________________________
Any known complications at birth? _______________________________________________________ Serious illnesses and/or hospitalizations:__________________________________________________ Special physical conditions, disabilities:___________________________________________________ Allergies i.e. asthma, hay fever, insect bites, medicine, food reactions: ______________________ ___________________________________________________________________________________ ___________________________________________________________________________________ Regular medications: _________________________________________________________________ EATING HABITS Special characteristics or difficulties: _____________________________________________________ *If infant is on a special formula, describe its preparation in detail: ______________________________ ___________________________________________________________________________________ Favorite foods: ______________________________________________________________________ Foods refused: ______________________________________________________________________ * Is your child fed held in lap?__________ High chair?__________ * Does your child eat with spoon?__________ Fork?__________ Hands?__________ TOILET HABITS *Are disposable or cloth diapers used? ________*Is there a frequent occurrence of diaper rash?______ *Do you use: oil:_____ powder:_____ lotion:_____ other:_____________________________________ *Are bowel movements regular?______________________ How many per day?___________________ *Is there a problem with diarrhea?_____________________ Constipation? _______________________ *Has toilet training been attempted?______________________________________________________ *Please describe any particular procedure to be used for your child at the center: __________________ ___________________________________________________________________________________ *What is used at home? Pottychair? ________ Special child seat? _________ Regular seat? ________ *How does your child indicate bathroom needs (include special words): __________________________ Is your child ever reluctant to use the bathroom? ____________________________________________ Does your child have accidents? ________________________________________________________ Directory: edu -> docs -> eec edu -> Reflections on the 20 edu -> Did the Cold War really start in the period 1919-39? edu -> The Cold War and the Pledge of Allegiance edu -> The National Archives Learning Curve Exhibition: The Cold War Teacher Notes edu -> Scenes from the Headlines: Lessons and Ideas for Discussion Timeline edu -> Describe the scenes which show the marines landing are they being opposed? edu -> 1948 Lesson Plan Teacher Name: Valerie Schrag Grade Level: 11 Course edu -> Visualizing Devotion Student Handout Edward Curtis and Native American History eec -> Slide 1 (Presentation Title): State of Early Education in Massachusetts Presentation to the Board of Early Education and Care Download 38.5 Kb. Share with your friends:
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