Infant Social-Emotional Checklist (0-18 Months)

Record how often a baby up to 18 months old showed key social and emotional behaviors over recent weeks. A parent or caregiver fills it in during a home visit so the program can follow the child's development remotely.

Use this template

In the Claude connectors directory

Name of Home Visitor

Infant's Name

Gender

Date of Birth

Age

Name of person completing this form

Relationship to Infant

Instructions: during the past 4 weeks, how often did the child...

1. Try to do new things?

2. Respond when spoken to?

3. Imitate actions of others?

4. Enjoy interacting with others?

5. Keep trying when unsuccessful?

6. Enjoy being cuddled?

7. Show interest in what others were doing?

8. Show affection for a familiar adult?

9. Notice changes in surroundings?

10. Seek comfort from familiar adults?

11. Adjust his/her energy level to the type of play?

12. Act in a good mood?

13. Act happy when praised?

14. Make eye contact with others?

15. Explore surroundings?

16. Calm down with help from a familiar adult?

17. Express his/her dislikes?

18. Smile back at a familiar adult?

19. Reach for a familiar adult?

20. Respond to his/her name?

21. Keep trying to obtain a toy?

22. React to another child's cry?

23. Smile at familiar adults?

24. Respond positively to adult attention?

26. Act in a way that makes others smile or show interest?

27. Easily go from one activity to another?

28. Seek attention when a familiar adult is with another child?

29. Look to a familiar adult when exploring surroundings?

30. Enjoy being around other children?

31. Show pleasure when interacting with adults?

32. Act happy with familiar adults?

33. Accept comfort from a familiar adult?

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