CLNBAS
Clinical Neonatal Behavioral Assessment Scale - Training Completion Form
Exam Setting (clinic, hospital, other {specify})_____________Sex of baby ____ # Hours Old ____________
Gestational age __________ Weight ________ APGAR Scores _________Date of exam _______________
Type of feeding ________________ Parity ____________Clinician’s name _________________________
1. “Introduction to the family and Incidental Observation of the infant”

Family members present (please list)_______________________________________________________

Parents’ comments on their baby and about the birth (in their own words)
______________________________________________________________________________________

Location of the baby during the session_______________________________________________________________

Initial observation of the baby____________________________________________________________
_______________________________________________________________________
2. “The CLNBAS Exam in AIMS Format”
BEHAVIOR SYSTEM
QUALITATIVE
ASSESSMENT
ITEM
FOLLOW-UP CHECKLIST
(Please circle best description)
AUTONOMIC
Summary Assessments
INTERACTIVE
MOTOR
STATE/
SLEEP
Autonomic (color, tremors,
startles)
mild moderate extreme
___ Stress Cues
Activity
mild moderate extreme
___ Organization
Responding to face; to face and
voice
well
fairly well
not so well
___ Social readiness
Turning to voice
well
fairly well
not so well
___ Hearing
Tracking the red ball
well
fairly well
not so well
___ Vision
Turning to rattle (soft)
well
fairly well
not so well
___ Alerting to sound
weak
___ Motor Flexibility
Tone: Arms and Legs
strong
Rooting and sucking
optimal
weak
absent
___ Feeding
Hand grasp
optimal
weak
absent
___ Strength
Pull-to-sit
optimal
weak
absent
___ Strength/robustness
Crawl
optimal
weak
absent
___ Sleep positioning
average
Tunes out noxious stimuli:
Habituation to light
well
Habituation to sound
well
Crying
never
fairly well
not so well
Tunes out noxious stimuli:
fairly well
sometimes
not so well
almost always
self-consoles easily needs some support
needs a lot of support
Consolability
State regulation (transitions)
smooth
Fax completed form to:
(617) 859-7215
fairly smooth
not smooth
___ Sleep protection
___ Sleep protection
___ Crying
___ Consolability
___ State organization
2001, The BrazeltonInstitute
For CLNBAS Training Use Only