Department of health services state of wisconsin



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DEPARTMENT OF HEALTH SERVICES STATE OF WISCONSIN

Division of Health Care Access and Accountability



F-01067 (07/08)







HEALTHCHECK / YOUR CHILD’S SPEECH AND HEARING

Instructions: Reach each question through the child’s age group and check YES or NO. Add the total number of Nos.

If you obtain two or more Nos within an age level, or three or more Nos in all age groups through the child’s

age group, refer for audiological and communicate screening / assessment.


Check One

YES NO

Hearing and Understanding

Child’s Age

Talking

Check One

YES NO





Does your child listen to speech?

BIRTH

Does your child make happy

sounds?
















Does your child startle or cry at

noises?


When you play with your child,

does he / she look at you, look

away and then look again?













Does your child awaken at loud

sounds?






Does your child turn to you when

you speak?



BIRTH TO

THREE MONTHS

Does your child repeat the

same sounds a lot (cooing,

gooing)?










Does your child smile when

spoken to?



Does your child cry differently

for different needs?











Does your child seem to know

your voice and quiet down if

crying?


Does your child smile when

he / she sees you?












Does your child respond to “No”?

FOUR TO SIX

MONTHS

Does your child’s babbling

sound more speech-like with

lots of different sounds,

including p, b, and m?





















Does your child react to changes

in your tone of voice?



Does your child tell you (by

sound or gesture) when

he / she wants you to do

something again?



















Does your child look around for

the source of new sounds, e.g.,

the doorbell, vacuum, dog barking?


Does your child make gurgling

sounds when left alone?

When playing with you?














Does your child notice toys that

make sound?






Does your child know words for

common items like “cup”, “shoe”,

and “juice”?


SEVEN MONTHS

TO

ONE YEAR

Does your child say 1 or 2

words (bye-bye, dada, mama,

no) although they may not be

clear?










Has your child begun to answer to

requests (“come here”, “want

more?”)?


Does your child’s babbling

have both long and short

groups of sounds such as

“tata”, “upup”, “bibibibi”?











Does your child enjoy games like

peek-a-boo and pat-a-cake?



Does your child copy different

speech sounds?





















Does your child turn or look up

when you call his or her name?



Does your child use speech or

non-crying sounds to get and

keep your attention?











Does your child listen when

spoken to?





HealthCheck / Your Child’s Speech and Hearing

F-1067 (10/08)



Page 2




Check One √

YES NO

Hearing and Understanding

Child’s Age

Talking

Check One √

YES NO





Can your child point to pictures in

a book when they are named?



1 – 2 YEARS

Is your child saying more and

more words every month?











Does your child point to a few

body parts when asked?


Does your child use some 1-2

word questions (“where kitty?”

“go bye-bye?” “what’s that?”)












Can your child follow simple

commands and understand

simple questions (“Roll the ball,”

“Kiss the baby,” “Where’s your

shoe?”)?





Does your child put 2 words

together (“more cookie,” “no

juice,” “mommy block”)?














Does your child listen to simple

stories, songs, and rhymes?







Does your child listen to simple stories, songs, and rhymes?




Does your child use many

different sounds at the

beginning of words?










Does your child understand

differences in meaning (“go-stop”;

“in-on”; “big-little”; “up-down”)?


2 – 3 YEARS

Does your child have a word

for almost everything?

















Does your child continue to notice

sounds (telephone ringing,

television sound, knocking at the

door)?


Does your child use 2-3 word

“sentences” to talk about and

ask for things?














Can your child follow two

requests (“get the ball and put it

on the table”)?


Do you understand your child’s

speech most of the time?







Does your child often ask for

or direct your attention to

objects by naming them?










Does your child hear you when

you call from another room?



3 – 4 YEARS

Does your child talk about

what he/she does at school or

at friends’ homes?










Does your child hear television or

radio at the same loudness level

as other members of the family?



Does your child say most

sounds correctly except a few,

like r, l, th and s?




















Does your child answer simple

“who,” “what,” “where,” “why”

questions?


Does your child usually talk

easily without repeating

syllables or words?






Do people outside your family

usually understand your child’s

speech?






Does your child use a lot of

sentences that have 4 or more

words?










Does your child hear and

understand most of what is said

at home and in school?


4 – 5 YEARS

Does your child talk easily with

other children and adults?











Does everyone who knows your

child think he/she hears well

(teacher, baby sitter, grandparent,

etc.)?


Does your child say all sounds

correctly except maybe one or

two?














Does your child pay attention to a

story and answer simple

questions about it?


Does your child use the same

grammar as the rest of the

family?






Does your child’s voice sound

clear like other children’s?







Does your child use sentences

that give lots of details, e.g., “I

have two red balls at home.”?






Can your child tell you a story

and stick pretty much to the



topic?





     

     

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