Early childhood risk for Neuro-Developmental Issues
(age birth to 6 years)
Historical Risks and Indicators of Neuro-Developmental Delays and Challenges
Please check any conditions or events that apply to the pregnancy, birth and health history of your child.
Pregnancy
Constant throwing up
Threat of miscarriage
Severe viral infection during the first 12 weeks or between 26 and 36 weeks
Accident or infection
Hypertension
Severe stress
Placental insufficiency
Toxoplasmosis
Uncontrolled diabetes
Allergic reactions
Radiation
Excessive alcohol and/or drug abuse
Smoking
Birth
Prolonged labor
Very fast labor
Cord around the neck
Placenta previa
Fetal distress
Breech presentation
Forceps or vacuum extraction
Caesarian birth
Premature (more than 2 weeks early)
Post mature (more than 2 weeks late)
Newborn Disorders
Low birth weight (under 5 lbs)
APGAR under 6
Head turned to one side
Frequently turns head to one side
Required resuscitation
Swallowed meconium
Heavy bruising
Distorted skull
Required incubation
Prolonged jaundice
Problems with nursing (latch, suck, swallow, nursed on one side, pulled off while hungry)
Problems with bottle feeding if not nursing
Early Childhood (Birth to 5 years)
Inconsolable crying
Difficulties with sleeping
Difficult to calm
High need for attention
Frequent tantrums
Hyperactive
Passive or withdrawn
Hyper-sensitive (touchy)
Hypo-sensitive (low response to touch)
Thrush
Persistent cradle cap
Persistent rashes
Illnesses involving a high fever, delirium or convulsions in the first 18 months
Adverse reaction(s) to any vaccination (fever, red swollen site of shot, screaming, excessive sleep or inability to sleep, extreme passivity or agitation in 1-7 days following)
Repeated ear, nose or throat infections
Allergic reactions to:
Persistent spitting up
Projectile vomiting
Did not like being placed on tummy
Did not crawl on belly
Delayed in sitting up/down on his/her own
Did not crawl on hands and knees, or crawled very little
Unusual crawling (one legged; on feet and hands, scooted on bottom, etc.)
Late at learning to walk (later than 18 months)
Late at learning to talk (later than 18 months)
Speech problems
Difficulty learning to dress (buttoning, tying shoelaces, etc)
Thumb sucking up to age 5 years or more
Bed-wetting above age of 5
Other developmental delay ___________________________________
Full assessment includes a review of retained reflexes and sensory processing issues, as well as observation of the child. Rarely will a single factor by itself indicate neuro-developmental delay. Only when a child shows a cluster of factors may neuro-developmental delay be present. Indicators of neuro-developmental delay are not limited to the above list.
Call Catherine Burns at 612/332-7459 or e-mail at Catherine@MamaBebe.org to discuss concerns or questions you may have about your child.
Questionnaire adapted from: Institute of Neuro-Physiological Psychology; from Sally Goddard.