Child Immunizations Hearing and Speech
Growth & Development Milestones
CHILD’S NAME (last, first ) SEX Usual Age
___M Age Achieved
___F
Laughs and coos. Startles to loud
SSN: Date of Birth: Birth—3 mo
sounds/wakes up to noises
MOTHER’S NAME (last, first) Smiles when spoken with. Is
1—3 mo
soothed by mother’s voice
Begins to turn head or eyes to-
Mile- ward voices & sounds. Enjoys 3—6 mo
Head
Recom- Date stones
Ht Wt circum- sound-making toys
mended Age Received Reached
ference Y/ N
Begins to babble, repeating sylla-
6—12 mo
Birth bles like “ba-ba-ba”
HBV
Turns toward soft sounds or
6—12 mo
voices coming from behind
1st DPT, 2 months
1st Oral
Polio, 1st Responds to own name and the
Hib, HBV 6—12 mo
telephone ringing.
2nd DPT, 4 months
2nd Oral
Polio, 2nd Understands “no”, “bye-bye” 6—12 mo
Hib
BABY
3rd DPT, 6 months* Says 3 words (other than mama
3rd Hib, 12—21 mo
and dada)
HBV (6-18
mo.)
When asked, points to at least 3
YOUR
TB skin 12 18—24 mo
body parts.
test months**
Follows 2 requests (“get the ball
18—24 mo
and put it on the table”)
BABY
MMR, 4th 15 months
Hib
Puts 2 words together (more
18—24 mo
cookie)
4th DPT, 15 or 18
3rd Polio months Uses 3 word phrases (daddy go
immunization record for bye-bye). Child’s speech is 75% 30— 36 mo
understandable
DPT, Polio, 4-6 yrs*** __________________
MMR Uses complete 5 word sen-
4—5 yrs
Bring this card with you to each Well-Baby tences.
Check and ask your health care practitioner to
Td (Adult 14-16 yrs,
record any immunizations given to your child. Child’s speech is 90% under-
type teta- then every 10
nus and yrs. Keep the BABY YOUR BABY card in a safe standable. Understands most 4—5 yrs
diptheria) place - with your other important papers - so that conversation
you may present it when your child starts
* Schedule dependent on type of vaccine administered school. Free download for this and other forms
** Your health care practitioner will determine the need and timing for available at www.cards4life.com Source: American Academy of Pediatrics, 1999
TB testing.
*** Some private physicians give the 2nd MMR to older children.