Developmental History And Background Information Form (Page 2 of 2) in pdf

Developmental History And Background Information Form Page 2

SLEEPING HABITS

*Does your child sleep in a crib? ________ Bed? ________

Does your child become tired or nap during the day (include when and how long)? ______________

_________________________________________________________________________________

Please note: The American Academy of Pediatrics has determined that placing a baby on his/her

back to sleep reduces the risk of Sudden Infant Death Syndrome (SIDS). SIDS is the sudden and

unexplained death of a baby under one year of age. If your child does not usually sleep on his/her

back, please contact your pediatrician immediately to discuss the best sleeping position for your

baby. Please also take the time to discuss your child’s sleeping position with your caregiver

When does your child go to bed at night? ______ and get up in the morning? __________________

Describe any special characteristics or needs (stuffed animal, story, mood on walking etc) ________

SOCIAL RELATIONSHIPS

How would you describe your child:

Previous experience with other children/day care:

Reaction to strangers:

Able to play alone:

Favorite toys and activities:

Fears (the dark, animals, etc):

How do you comfort your child:

What is the method of behavior management/discipline at home:

What would you like your child to gain from this childcare experience?

DAILY SCHEDULE: Please describe your child's schedule on a typical day.

*For infants, please include awakening, eating, time out of crib/bed, napping, toilet habits, fussy time,

night bedtime, etc.

Is there anything else we should know about your child?

Parent/Guardian Signature:

Date:

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GCCDevelopmentalHistotry20050701

Developmental History And Background Information Form Page 2