This list is created based on items you check. Please print it and use it when you talk with your child’s pediatrician. If you’re waiting until your child’s next well-child visit, put it on your bulletin board or refrigerator so you don’t forget.

Note: This website won’t save your information. Once you close your browser, your information may be cleared. This information is not sent to the American Academy of Pediatrics or any third party organizations.

Use the spaces below each item to write down specific information for the pediatrician. This may include:

  • When you first started noticing the sign
  • If the sign has gotten better or worse over time
  • Other worries you have about your child’s development

I will call the pediatrician later today or tomorrow and ask about these signs of physical developmental delays:

I will bring up these concerns with my child’s pediatrician at the next well-child visit:

Did you know?

According to research from the National Center for Medical Home Implementation, 8 out of 10 parent concerns are correct and accurate.

If you feel like your worries aren’t being taken seriously, don’t be afraid to bring it up again or ask the pediatrician to take another look. Many signs of developmental delays aren’t obvious. Trust your gut.