New Beginnings Christian Academy

New Student Development Evaluation Form

Child’s Name:                                                                        

Current feeding schedule:                                                 Length of time on current schedule                                                

Food type: (check all that apply)                 [  ] Formula      [  ] Strained       [  ] Junior      [  ] Table       [  ] Milk – specify type:           

New foods timetable / new food introduction process:                                                                                                   

How does child eat? (check all that apply)     [  ] Held in lap       [  ] In highchair       [  ] Other – Specify:                                        

Feeds self  [  ] Yes       [  ] No     If "Yes", uses:  [  ]  Spoon       [  ]  Fork       [  ] Hands

Special feeding problems?                                    Favorite foods?                           Refused foods?                                                    

SLEEP   

Current sleep schedule:                                                            Length of time on current schedule:                                                     

Falls asleep easily? [  ] Yes       [  ] No               Mood upon awakening – Describe.                                                       

Takes favorite toy(s) to bed?– child over age 1 year        [  ] Yes       [  ] No       If "Yes" – list toy(s):                                       

Sleep position – child under age 1 year (Note: Children under age 1 year must be placed to sleep on their back unless a written statement from the child's physician is attached. )

[  ]  Back for children under age 1 year               [  ] Side or stomach (physician statement attached)

Sleep position – child over age 1 year        [  ] Back       [  ] Side or stomach

DIAPERING / TOILETING

Diaper – type?                 [  ]  Cloth       [  ]  Disposable                       Plastic pants used? [  ]Always       [  ] Never        [  ] Sometimes – Specify:                                  

Highly sensitive skin  [  ]  Yes       [  ]  No        Frequent diaper rash ?   [  ]  Yes       [  ]  No         List Products used:                           

Toilet training attempted? [  ]  Yes       [  ]  No    If "Yes", describe routine.                                                           

Type of toilet seat used at home                 Potty chair        Special toilet seat                 Regular toilet seat

Regular bowel movements?   [  ]  Yes       [  ]  No                 How often.       Time(s) of day:

Toileting problems                [  ]  Yes       [  ]  No    If "Yes" – Describe.

VERBAL COMMUNICATION

Age child began talking?                    Child speaks in:                Words                     Sentences

Words used to describe special needs? – Specify.

COMFORTING

Does child have a fussy time?               [  ]  Yes       [  ]  No                 If "Yes" – Specify time.          

How is fussy time handled? (check all that apply)  Child likes to be:  [  ]  Held       [  ]  Sung to       [  ]  Rocked       [  ]  Read to     [  ] Other:                     

Special things you say or do to comfort child:                                                                                                             

SELF-EXPRESSION

What causes your child to feel angry or frustrated?                                                                                                                        

What frightens your child and how is it shown?                                                                                                       

How does your child express feelings of happiness, enjoyment, etc.?                                                                                               

PHYSICAL AND SOCIAL DEVELOPMENT

Is your child able to – (Check all that apply)  [  ]  Sit up alone       [  ] Pull up      [  ] Crawl       [  ] Walk holding on       [  ]  Walk without support

Is your child used to playmates?                 [  ]  Yes       [  ]  No    Has your child ever bitten another child? [  ]  Yes       [  ]  No                      

Child's indoor favorite toys and activities – Specify.                                                                                                                                                                                

Child's outdoor favorite toys and activities – Specify.