Start
bcs_75_hi
Child Health and Education in the Seventies
Under the auspices of the University of Bristol and the National Birthday Trust Fund
Director: Professor Neville R. Butler, MD, FRCP, DCH
Research team: N. R. Butler A.F. Osborn, BA B.C. Howlett, BSc, FSS, MBCS S. F. O. Dowling, BSc, MB, BS M. C. Fraser, SRN, SCM, HV Tutor Cert.
In association with: Area Health Authorities in England and Wales Health Boards in Scotland
Co-sponsors: Health Visitors' Association
CONFIDENTIAL
HOME INTERVIEW QUESTIONNAIRE

Health District Code

Generic text

Child's Local Serial Number

Generic text

Child's Central Survey Number

Generic text
If twins use separate questionnaire for each.
Please use block capitals.

Full name of the Child

Generic text

Sex

Generic text

Singleton or twin, specify

Generic text

Date of birth

Generic date

Present home address in full

Long text

Address of child's present placement if living away from home.

Long text

Child's National Health Service Number

Generic text

N.H.S. Doctor with whom child is registered. Name

Generic text

N.H.S. Doctor with whom child is registered. Full address of practice

Long text

Full home address of mother at time she gave birth to child.

Long text

If born abroad, give approximate date child came to live in this country.

Generic text

Mother's maiden name.

Generic text
(These details are needed for matching purposes only)

Address of place of birth.

Long text
NOTES
1. Please read "Survey Notes and Information" in conjunction with this questionnaire.
2. Throughout the questionnaire the study child is designated by the letter N.
3. It is important that no question should remain unanswered without explanation.
SECTION A FAMILY COMPOSITION
People in the household
A household consists of a group of people who all live at the same address and who are all catered for by the same person.
List below all the members of this household. Include the study child, N, the present parents and others, e.g. relatives or lodgers, who are members of this household. Exclude any who are only at home for short periods; enter these in table (b) below.
Relationship to N (e.g. father, step-brother) or status in the household (e.g. lodger) Roster cs_qA1_a_X Generic text Generic text Generic text Generic date Generic text Generic text Generic date Generic text Generic text Generic text Generic date Generic text Generic date Generic text Generic text Generic text
Study child - N 1 Surname
Study child - N 1 First name(s)
Study child - N 1 Sex
Study child - N 1 Date of birth
Study child - N 2 Surname
Study child - N 2 First name(s)
Study child - N 2 Sex
Study child - N 2 Date of birth
Study child - N 3 Surname
Study child - N 3 First name(s)
Study child - N 3 Sex
Study child - N 3 Date of birth
Study child - N 4 Surname
Study child - N 4 First name(s)
Study child - N 4 Sex
Study child - N 4 Date of birth
Study child - N 5 Surname
Study child - N 5 First name(s)
Study child - N 5 Sex
Study child - N 5 Date of birth
Study child - N 6 Surname
Study child - N 6 First name(s)
Study child - N 6 Sex
Study child - N 6 Date of birth
Study child - N 7 Surname
Study child - N 7 First name(s)
Study child - N 7 Sex
Study child - N 7 Date of birth
Study child - N 8 Surname
Study child - N 8 First name(s)
Study child - N 8 Sex
Study child - N 8 Date of birth
List below any members of the family not included in the above table, for example, those who are only home for holidays or leave, and enquire or state from your own knowledge the reason for absence, for example at residential school, or working away.
Relationship to N Surname First name(s) Sex Date of birth Reason for absence from home
Generic textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric text
1
2
3
4

What is the relationship to N of the person now acting as his/her mother? Relationship to N

1
Natural mother
2
Mother by legal adoption
3
Stepmother
4
Foster mother
5
Grandmother
6
Elder sister
7
Cohabitee of father
8
Other mother figure, specify
9
No mother figure
Other

please give reason(s) for any past changes in N's situation, e.g. family changes, mother died, etc.

Generic text
If N is not now living with natural mother, i.e. 2-9 ringed,
qc_A2_b == 2 || qc_A2_b == 3 || qc_A2_b == 4 || qc_A2_b == 5 || qc_A2_b == 6 || qc_A2_b == 7 || qc_A2_b == 8 || qc_A2_b == 9

please ask when this situation began. Situation began

Generic date

What is the relationship to N of the person now acting as his/her father? Relationship to N

1
Natural father
2
Father by legal adoption
3
Stepfather
4
Foster father
5
Grandfather
6
Elder brother
7
Cohabitee of mother
8
Other father figure, specify
9
No father figure
Other

please give reason(s) for any past changes in N's situation, e.g. family changes, father died, etc.

Generic text
If N is not now living with natural father, i.e. 2-9 ringed,
qc_A3_a == 2 || qc_A3_a == 3 || qc_A3_a == 4 || qc_A3_a == 5 || qc_A3_a == 6 || qc_A3_a == 7 || qc_A3_a == 8 || qc_A3_a == 9

please ask when this situation began. Situation began

Generic date
Except in Q's B.1 to B.4 and B.23 where information is specifically required about N's natural mother or father, the terms "father" or "present father" are used to denote the present father figure identified in Q. A.3(a). The terms "mother" or "present mother" are used to denote the present mother figure identified in Q. A.2(a)
SECTION B MEDICAL HISTORY AND PRESENT HEALTH
Enter obstetric details on the study child, N, and on all liveborn and stillborn children born subsequently to N's natural mother. Include also children no longer living with their natural mother. Record each member of twin pair separately. Exclude miscarriages. (Some children in this table will be included also in table A. 1 on page opposite).
cs_qB1_Y Roster Name cs_Survival cs_Method_of_delivery cs_Gestation lbs ozs Generic text Generic text Generic date ozs cs_Survival Generic text Generic text cs_Gestation lbs cs_Method_of_delivery Generic date Generic text ozs Generic date cs_Survival Generic text lbs cs_Gestation cs_Method_of_delivery Generic date cs_Method_of_delivery cs_Gestation lbs cs_Survival ozs Generic text Generic text lbs Generic text cs_Survival cs_Gestation Generic date ozs Generic text cs_Method_of_delivery Generic date cs_Method_of_delivery cs_Survival cs_Gestation Generic text Generic text ozs lbs cs_Survival cs_Method_of_delivery lbs ozs Generic text Generic date Generic text cs_Gestation Generic date Generic text ozs lbs cs_Survival cs_Method_of_delivery cs_Gestation Generic text

1 - Alive now

2 - Died 7 days and over

3 - Died under 7 days

4 - Stillborn

0 - Not known

1 - Vertex

2 - Breech

3 - Forceps

4 - Caeserean

5 - Other

0 - Not known

1 - Over 3 weeks early

2 - At term (37-41 weeks)

3 - Over 2 weeks late

0 - Not known

1 - Alive now

2 - Died 7 days and over

3 - Died under 7 days

4 - Stillborn

0 - Not known

1 - Over 3 weeks early

2 - At term (37-41 weeks)

3 - Over 2 weeks late

0 - Not known

1 - Vertex

2 - Breech

3 - Forceps

4 - Caeserean

5 - Other

0 - Not known

1 - Alive now

2 - Died 7 days and over

3 - Died under 7 days

4 - Stillborn

0 - Not known

1 - Over 3 weeks early

2 - At term (37-41 weeks)

3 - Over 2 weeks late

0 - Not known

1 - Vertex

2 - Breech

3 - Forceps

4 - Caeserean

5 - Other

0 - Not known

1 - Vertex

2 - Breech

3 - Forceps

4 - Caeserean

5 - Other

0 - Not known

1 - Over 3 weeks early

2 - At term (37-41 weeks)

3 - Over 2 weeks late

0 - Not known

1 - Alive now

2 - Died 7 days and over

3 - Died under 7 days

4 - Stillborn

0 - Not known

1 - Alive now

2 - Died 7 days and over

3 - Died under 7 days

4 - Stillborn

0 - Not known

1 - Over 3 weeks early

2 - At term (37-41 weeks)

3 - Over 2 weeks late

0 - Not known

1 - Vertex

2 - Breech

3 - Forceps

4 - Caeserean

5 - Other

0 - Not known

1 - Vertex

2 - Breech

3 - Forceps

4 - Caeserean

5 - Other

0 - Not known

1 - Alive now

2 - Died 7 days and over

3 - Died under 7 days

4 - Stillborn

0 - Not known

1 - Over 3 weeks early

2 - At term (37-41 weeks)

3 - Over 2 weeks late

0 - Not known

1 - Alive now

2 - Died 7 days and over

3 - Died under 7 days

4 - Stillborn

0 - Not known

1 - Vertex

2 - Breech

3 - Forceps

4 - Caeserean

5 - Other

0 - Not known

1 - Over 3 weeks early

2 - At term (37-41 weeks)

3 - Over 2 weeks late

0 - Not known

1 - Alive now

2 - Died 7 days and over

3 - Died under 7 days

4 - Stillborn

0 - Not known

1 - Vertex

2 - Breech

3 - Forceps

4 - Caeserean

5 - Other

0 - Not known

1 - Over 3 weeks early

2 - At term (37-41 weeks)

3 - Over 2 weeks late

0 - Not known

N 1 Sex
N 1 Date of birth
N 1 Birthweight - lbs.
N 1 Birthweight - ozs.
N 1 Gestation
N 1 Method of delivery
N 1 Survival
N 1 If died, cause of death
N 2 Sex
N 2 Date of birth
N 2 Birthweight - lbs.
N 2 Birthweight - ozs.
N 2 Gestation
N 2 Method of delivery
N 2 Survival
N 2 If died, cause of death
N 3 Sex
N 3 Date of birth
N 3 Birthweight - lbs.
N 3 Birthweight - ozs.
N 3 Gestation
N 3 Method of delivery
N 3 Survival
N 3 If died, cause of death
N 4 Sex
N 4 Date of birth
N 4 Birthweight - lbs.
N 4 Birthweight - ozs.
N 4 Gestation
N 4 Method of delivery
N 4 Survival
N 4 If died, cause of death

How soon after N's birth did the mother first start to have regular contact with N, to hold and/or feed, not just look at?

1
Within 24 hours of birth
2
Between 25 and 48 hours after birth
3
On the third day or later, i.e. more than 48 hrs after birth
0
Not known
If on third day or later,
qc_B2 == 3

how many days after N's birth did regular contact start?

How many

Please give reason(s) for delay in regular contact

Generic text

After regular contact was established, was there any period of 24 hours or more during the first month of N's life when mother was not in normal contact with N, e.g. to hold and/or to feed?

1
No separation(s) of 24 hours or more
2
Mother and N out of contact for 24 hours or more
3
Cannot remember
0
Not known
If separated,
qc_B3 == 2

give total duration of separation in completed days

How many

Give reason(s) for separations(s)

Generic text

Was N breast fed partly or wholly, even for a few days?

1
Yes - for less than 1 month
2
Yes - for 1 month or more but less than 3 months
3
Yes - for 3 months or more
4
Yes but cannot remember for how long
5
No, was not breast fed at all
0
Not known
At what ages did N receive immunisation, against what diseases and where?
N's age in months Diseases immunised against Where given

1 - G.P's Surgery

2 - Child Health Clinic

3 - Other place

0 - Not known

1 - Diphtheria

2 - Tetanus

3 - Whooping-cough

4 - Poliomyelitis

5 - Smallpox*

6 - Measles

7 - B.C.G.

8 - Other

0 - Not known

How many

1 - G.P's Surgery

2 - Child Health Clinic

3 - Other place

0 - Not known

1 - Diphtheria

2 - Tetanus

3 - Whooping-cough

4 - Poliomyelitis

5 - Smallpox*

6 - Measles

7 - B.C.G.

8 - Other

0 - Not known

How many

1 - Diphtheria

2 - Tetanus

3 - Whooping-cough

4 - Poliomyelitis

5 - Smallpox*

6 - Measles

7 - B.C.G.

8 - Other

0 - Not known

How many

1 - G.P's Surgery

2 - Child Health Clinic

3 - Other place

0 - Not known

1 - G.P's Surgery

2 - Child Health Clinic

3 - Other place

0 - Not known

1 - Diphtheria

2 - Tetanus

3 - Whooping-cough

4 - Poliomyelitis

5 - Smallpox*

6 - Measles

7 - B.C.G.

8 - Other

0 - Not known

How many

1 - G.P's Surgery

2 - Child Health Clinic

3 - Other place

0 - Not known

1 - Diphtheria

2 - Tetanus

3 - Whooping-cough

4 - Poliomyelitis

5 - Smallpox*

6 - Measles

7 - B.C.G.

8 - Other

0 - Not known

How many

1 - Diphtheria

2 - Tetanus

3 - Whooping-cough

4 - Poliomyelitis

5 - Smallpox*

6 - Measles

7 - B.C.G.

8 - Other

0 - Not known

How many

1 - G.P's Surgery

2 - Child Health Clinic

3 - Other place

0 - Not known

1 - G.P's Surgery

2 - Child Health Clinic

3 - Other place

0 - Not known

1 - Diphtheria

2 - Tetanus

3 - Whooping-cough

4 - Poliomyelitis

5 - Smallpox*

6 - Measles

7 - B.C.G.

8 - Other

0 - Not known

How many

1 - G.P's Surgery

2 - Child Health Clinic

3 - Other place

0 - Not known

1 - Diphtheria

2 - Tetanus

3 - Whooping-cough

4 - Poliomyelitis

5 - Smallpox*

6 - Measles

7 - B.C.G.

8 - Other

0 - Not known

How many

1 - Diphtheria

2 - Tetanus

3 - Whooping-cough

4 - Poliomyelitis

5 - Smallpox*

6 - Measles

7 - B.C.G.

8 - Other

0 - Not known

How many

1 - G.P's Surgery

2 - Child Health Clinic

3 - Other place

0 - Not known

First att.
Second att.
Third att.
Fourth att.
Fifth att.
Sixth att.
*Please include smallpox vaccination, although now not recommended nationally
Has N ever been seen at any of the following places for reasons specified, and if so at what ages, if known.
-

1 - Never seen

2 - Seen at age: 48m+

3 - Seen at age: 36-47m

4 - Seen at age: 24-35m

5 - Seen at age: 12-23m

6 - Seen at age: 6-11m

7 - Seen at age: under 6 mth

8 - Seen at age: not known

0 - Not known if ever seen

Home by H.V. for any reason
Child Health Clinic for any reason
G.P. surgery or health centre for devel. screening
Hospital birth follow-up clinic
Assessment Centre or clinic for handicap

Has N ever been separated from his/her mother or mother substitute for one month or more? Exclude N's hospital admissions and check these are detailed in B.9.

1
Yes
2
No
0
Not known
If yes,
qc_B7 == 1

give total number of separations of one month or more, excluding N's hospital admission(s)

How many
Please give details below for all separations of one month or over. Exclude all N's hospital admissions. If more than three separations, continue on back page.
Age (years and months) Reason for separation Number of months (and weeks) separated Place of care of N?* Was the person looking after N known to him/her? Was N separated also from father?
Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text
First
Second
Third
*Place of care: State if in child's own home, other's home, instiutional placement, or specify if elsewhere.

Did the mother herself, as far as she can remember, ever spend more than a short time away from her parents as a child?

1
Yes - fostered/in care
2
Yes - other reason(s), specify
3
No, never spent more than a short time away from parents
0
Not known
Other

Has N ever been in hospital overnight or longer for any reason whatsoever? Exclude initial stay in maternity home/hospital.

1
Yes
2
No
0
Not known
If yes,
qc_B9 == 1

give total number of hospital admissions overnight or longer

How many
Please give details below for every hospital admission.
Age (years and months) Diagnosis and nature of all special procedures, including operations Number of nights in hospital Name and address of hospital in full Type of ward and specify if children only admitted
Generic textHow manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textHow manyGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric text Generic textHow manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textHow manyGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric text Generic textHow manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textHow manyGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric text Generic textHow manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textHow manyGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric text Generic textHow manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textHow manyGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric text
First
Second
Third

Has N ever attended a hospital outpatient department or any other specialist clinic?

1
Yes
2
No
0
Not known
If yes,
qc_B10 == 1
please give details below for each condition or illness resulting in attendance(s) at out-patients or specialist clinic.
Age at first attendance (years and months) Total number of attendances Diagnosis and treatment Name and address of department, hospital or clinic, in full.
How manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textHow manyGeneric textGeneric textHow manyGeneric text How manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textHow manyGeneric textGeneric textHow manyGeneric text How manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textHow manyGeneric textGeneric textHow manyGeneric text How manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textHow manyGeneric textGeneric textHow manyGeneric text
First
Second
Third

Please enquire or state from your own knowledge whether N has been seen by any of the following since the fourth birthday and/or previous to fourth birthday. Seen by a general practitioner* - at surgery/health centre

1
Yes, after 4th b'day
2
Yes, before 4th b'day
3
No never
0
Not known

Please enquire or state from your own knowledge whether N has been seen by any of the following since the fourth birthday and/or previous to fourth birthday. Seen by a general practitioner* - at home visit

1
Yes, after 4th b'day
2
Yes, before 4th b'day
3
No never
0
Not known

Please enquire or state from your own knowledge whether N has been seen by any of the following since the fourth birthday and/or previous to fourth birthday. Seen by dentist - for inspection, not therapy

1
Yes, after 4th b'day
2
Yes, before 4th b'day
3
No never
0
Not known

Please enquire or state from your own knowledge whether N has been seen by any of the following since the fourth birthday and/or previous to fourth birthday. Seen by dentist - for filling(s), extraction(s), etc.

1
Yes, after 4th b'day
2
Yes, before 4th b'day
3
No never
0
Not known

Please enquire or state from your own knowledge whether N has been seen by any of the following since the fourth birthday and/or previous to fourth birthday. Seen by doctor for routine medical exam. in nursey or school situation, specify

1
Yes, after 4th b'day
2
Yes, before 4th b'day
3
No never
0
Not known
Generic text

Please enquire or state from your own knowledge whether N has been seen by any of the following since the fourth birthday and/or previous to fourth birthday. Seen by speech therapist - age first seen ... yrs ... mths

1
Yes, after 4th b'day
2
Yes, before 4th b'day
3
No never
0
Not known
Age
Age in months

Please enquire or state from your own knowledge whether N has been seen by any of the following since the fourth birthday and/or previous to fourth birthday. Seen by child guidance clinic age first seen ... yrs ... mths Problem/diagnosis

1
Yes, after 4th b'day
2
Yes, before 4th b'day
3
No never
0
Not known
Age
Age in months
Generic text
*For medical reasons, not for developmental screening or immunisation.
Has N had any of the following in the past year and/or previous to past year?
-

1 - Yes, after 4th b'day

2 - Yes, before 4th b'day

3 - No never

0 - Not known

Tonsillectomy or T's & A's
Adenoidectomy alone
Circumcision
Hernia operation
Appendicectomy

Has N had any of the following in the past year and/or previous to past year? Any other operation, namely

1
Yes, after 4th b'day
2
Yes, before 4th b'day
3
No never
0
Not known
Other
Has N had any of the following in the past year and/or previous to past year?
-

1 - Yes, after 4th b'day

2 - Yes, before 4th b'day

3 - No never

0 - Not known

Eczema
Hay fever or sneezing attacks
Ear discharge (pus not wax)
Repeated sore throats requiring medical attention
Habitual snoring or mouth breathing
Bronchitis
Pneumonia
Meningitis or encephalitis
Hearing difficulty (suspected or confirmed)*
Any vision problem (except squint) (suspected or confirmed)*
*If any suspected or confirmed hearing or eyesight problem,
qc_B12_ii_g-p$1;9:10 == 1 || qc_B12_ii_g-p$1;9:10 == 2

please give details below.

Generic text
Were there any of the following difficulties with N when he/she was a baby (i.e. under 6 months of age)?
-

1 - Yes

2 - No

0 - Not known

Excessive crying
Frequent feeding problems
Frequent sleeping difficulty at night

Has N ever had an accident requiring medical advice or treatment? Please include accidents in the road, home and elsewhere, accidental ingestion of medicines/poisons, burns/scalds, fractures, eye injuries, near-drowning, bad cuts and other injuries, with or without unconciousness, and non-accidental injuries.

1
Yes - accidental swallowing of medicines or poisons
2
Yes - burn(s), scald(s)
3
Yes - road traffic accident(s)
4
Yes - Accident resulting in unconciousness
5
Yes - other accidents
6
No accident
0
Not known
If yes,
qc_B14 == 1 || qc_B14 == 2 || qc_B14 == 3 || qc_B14 == 4 || qc_B14 == 5

please state total number of accidents specified above

How many
Please give details of every "accident"
Age (years and months) Where did it happen? (Road, home, school, etc.) What happened?* Description of "injuries" (e.g. burn/scald, fracture, head injury with unconciousness, etc) Part(s) of body involved (head, eyes, limbs, etc.) Where treated? (G.P., Casualty, Inpatient) Treatment, including stitches, operation(s), plaster cast(s), traction, etc. Name and address of hospital in full if attended or admitted
Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text
First
Second
Third
Fourth
*If ingestion of medicines/poisons, give name of substance.

Has N ever had one or more attacks or bouts in which he/she had wheezing on the chest, regardless of the cause?

1
Yes
2
No
0
Not known
If yes, please complete the following details.
qc_B15 == 1

Age at first or only attack in which he/she wheezed on the chest: ... years ... mths

Age
Age in months

How many attacks occurred: in first 12 months of life?

How many

How many attacks occurred: between first and fourth birthdays?

How many

How many attacks occurred: since fourth birthday?

How many

Number of times ever admitted to hospital with any wheezing in the chest, whatever the cause

How many

Please describe what the mother was told about the diagnosis in her own words

Generic text
Check whether there have been any hospital admission(s) or out-patient attendance(s) for the above, if so, make sure they are included in B.9 and B.10 respectively.

Has N ever had any form of convulsion, fit, seizure or other turn in which conciousness was lost, or any part of the body made abnormal movements?

1
Yes
2
No, never
0
Not known
If yes,
qc_B16 == 1

from health visitor's and mother's knowledge, and from records if possible, please give the most accurate diagnosis of the attack(s).

1
Epilepsy
2
Febrile convulsion(s)
3
Fainting, blackout(s)
4
Other diagnosis, namely
0
Not known
Other

please ask mother to describe the first attack form it took

Generic text

please ask mother to describe the first attack how soon seen by G.P., or admitted, if at all

Generic text

please ask mother to describe subsequent attack(s), if any. form they took if different from above

Generic text

please ask mother to describe subsequent attack(s), if any. investigations, if any

Generic text

please ask mother to describe subsequent attack(s), if any. medication and dates

Generic text
give number of convulsions, fits or seizures in each agegroup specified below.
Number of attacks
How many
First four weeks
1-12 months
Over 1 yr under 2
Over 2 under 3
Over 3 under 4
Over 4 years
Check whether there have been any hospital admission(s) or out-patient attendance(s) for the above, if so, make sure they are included in B.9 and B.10 respectively.

Has N ever worn or been prescribed glasses?

1
Yes - still has to wear them
2
Yes - but does not have to wear them now
3
No
0
Not known

Has N ever had a squint?

1
Yes - now
2
Yes - in past but not now
3
No, never
0
Not known
If yes,
qc_B18 == 1 || qc_B18 == 2

what treatment was given?

1
Medical advice - "No treatment needed"
2
Patch over one eye
3
Glasses
4
Eye exercises
5
Operation
6
Treatment advised, but not known what
7
Never attended for advice or treatment
0
Not known

Has N ever had a stammer or stutter or any other difficulty with speech? Stammer or stutter

1
Yes, at present - mild
2
Yes, at present - severe
3
Yes - in past but not now
4
No
0
Not known

Has N ever had a stammer or stutter or any other difficulty with speech? Other speech difficulty

1
Yes, at present - mild
2
Yes, at present - severe
3
Yes - in past but not now
4
No
0
Not known
If ever difficulty in speech, other than stammer or stutter,
qc_B19_ii >= 1 && qc_B19_ii <= 3

give details

Generic text

Do people outside N's household easily understand what he/she says?

1
N's main language not English
2
All or nearly all of N's speech is understood outside immediate family
3
Some of N's speech understood outside immediate family
4
Hardly any of N's speech understood outside immediate family
5
N's speech understood only by immediate family
6
Even immediate family have difficulty in understanding N's speech
7
Other answer, namely
0
Not known if others understand N
Other

From the health visitor's knowledge, observation and from records, has N ever been diagnosed as having any congenital abnormality or suspected congenital abnormality?

1
Yes - Mongol
2
Yes - Spina bifida (meningomyelocele)
3
Yes - Hydrocephalus
4
Yes - Hare-lip
5
Yes - Cleft palate
6
Yes - Congenital heart condition (diagnosed)
7
Yes - Suspected congenital heart condition (murmur, etc)
8
Yes - Skin naevus (portwine, strawberry, etc)
9
Yes - Any other congenital abnormality, specify
0
No, none of the above
Other
If yes,
qc_B21 == 1 || qc_B21 == 2 || qc_B21 == 3 || qc_B21 == 4 || qc_B21 == 5 || qc_B21 == 6 || qc_B21 == 7 || qc_B21 == 8 || qc_B21 == 9

please describe abnormalities

Generic text

From the health visitor's knowledge and observations, and where necessary from available records, does N have any physical or mental disability or handicap, or any other condition interfering with normal everyday life or which might be a problem at school?

1
Yes - but no real handicap
2
Yes - mild handicap
3
Yes - severe handicap
4
No disability or handicap
0
Not known
If yes,
qc_B22 == 1 || qc_B22 == 2 || qc_B22 == 3

please give following details Actual diagnosis

Generic text

please give following details Effect on home or school life, if any

Generic text

indicate into which of the following categories the condition, handicap or disability falls

1
Visual defect
2
Hearing defect
3
Speech defect
4
Mental handicap or disability
5
Emotional problem
6
Motor/locomotor problem
7
Respiratory problem
8
Severe congenital condition
9
Severe aquired condition (e.g. malignancy)
0
Other condition, specify
Other

Has N's natural mother or natural father or any brothers or sisters of N's ever had any of the following? Natural mother

1
Asthma
2
Hayfever
3
Eczema
4
Late reader, i.e. not reading by 7 years
5
Poor reader or non-reader at present
6
Convulsions(s) or fit(s)
7
Bedwetting, after 5 years of age
8
Late in learning to speak
9
None of above

Has N's natural mother or natural father or any brothers or sisters of N's ever had any of the following? Natural father

1
Asthma
2
Hayfever
3
Eczema
4
Late reader, i.e. not reading by 7 years
5
Poor reader or non-reader at present
6
Convulsions(s) or fit(s)
7
Bedwetting, after 5 years of age
8
Late in learning to speak
9
None of above

Has N's natural mother or natural father or any brothers or sisters of N's ever had any of the following? Sibling(s)

1
Asthma
2
Hayfever
3
Eczema
4
Late reader, i.e. not reading by 7 years
5
Poor reader or non-reader at present
6
Convulsions(s) or fit(s)
7
Bedwetting, after 5 years of age
8
Late in learning to speak
9
None of above
10
No siblings
SECTION C TELEVISION VIEWING AND READING

Does N ever watch television at home?

1
Yes - almost every day
2
Yes - occasionally
3
No, never
0
Not known
If N never watches TV proceed to C.6
qc_C1 == 3
Else
Complete the following details of N's television viewing at home in the past seven days, by ringing all appropriate numbers for each day. Start with yesterday and go back day by day through the week.
-

1 - Morning (e.g. before 1 pm)

2 - Early afternoon (e.g. 1 pm-4 pm)

3 - Late afternoon (e.g. 4 pm-6 pm)

4 - Early evening (e.g. 6 pm-9 pm)

5 - Late evening (e.g. after 9 pm)

6 - Did not watch TV that day

0 - Not known

Mon
Tue
Wed
Thur
Fri
Sat
Sun
Give total number of hours N watched each day in the past seven days
Mon Tue Wed Thur Fri Sat Sun
How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many
Enter hours watched

Is this the usual amount of TV N watches?

1
Yes
2
No
0
Not known
If no,
qc_C3_i == 2

how many hours a day on average does he/she usually watch TV?

Hours

What types of TV programmes does N watch at home?

1
Children's programmes (e.g. Playschool, Sesame Street, etc.)
2
Cartoons
3
Thriller/dramatic programmes (e.g. cowboy, gangster, science fiction, war films, etc)
4
Comedy programmes/series
5
Competition/quiz programmes (e.g. Double Your Money, Golden Shot, etc)
6
Sport
7
News programmes
8
Documentary programmes (e.g. animal, travel films, etc.)
9
Other types of programmes, please give details
Other

Which is N's favourite TV programme? Specify title or series N likes best

Generic text

Ring in column A all who have read to N at home at least once in the past 7 days. A

1
Mother
2
Father
3
Other adults, specify
4
Child(ren) 11 and over
5
Child(ren) under 11
6
Nobody read to child
0
Not known

Ring in column B the one person who reads to N most often. B

1
Mother
2
Father
3
Other adults, specify
4
Child(ren) 11 and over
5
Child(ren) under 11
6
Nobody read to child
0
Not known

On how many days has N been read to at home in the past 7 days?

How many

Is this the usual amount N is read to at home?

1
Yes
2
No
0
Not known
If no,
qc_C7_i == 2

how many days a week is he/she usually read to?

Days a week
SECTION D NURSERY, PLAYGROUP AND SCHOOL EXPERIENCE

Ring in the first column A any school, playgroup, or nursey placements N attends at the present (or attended last term if at present on holiday). A Present placement(s)

1
Nursery school - Local Education Authority (free)
2
Nursery school - Private (fee charged)
3
Nursery class attached to infant/primary school - Local Education Authority (free)
4
Nursery class attached to infant/primary school - Private (fee charged)
5
Normal school, full or part-time - Infant/primary school (L.E.A.)
6
Normal school, full or part-time - Independent/private
7
Playgroup
8
Special day school, nursey or unit for physically or mentally handicapped children
9
Day nursery - Local Authority
10
Day nursery - Private
11
Creche, kindergarten
12
Mother and toddler club
13
Sunday school
14
Other placement, please specify
15
Attends/attended none of these
0
Not known
Other

Ring in the second column, B all other placements attended previously for three months or longer, that he/she has since stopped attending. B Previous placement(s)

1
Nursery school - Local Education Authority (free)
2
Nursery school - Private (fee charged)
3
Nursery class attached to infant/primary school - Local Education Authority (free)
4
Nursery class attached to infant/primary school - Private (fee charged)
5
Normal school, full or part-time - Infant/primary school (L.E.A.)
6
Normal school, full or part-time - Independent/private
7
Playgroup
8
Special day school, nursey or unit for physically or mentally handicapped children
9
Day nursery - Local Authority
10
Day nursery - Private
11
Creche, kindergarten
12
Mother and toddler club
13
Sunday school
14
Other placement, please specify
15
Attends/attended none of these
0
Not known
Other
If child has attended none of the above in the past or at the present proceed to D.10.
If child is attending, or has attended any of the above, please complete D.2 onwards.
(qc_D1_A >= 1 && qc_D1_A <= 11) || qc_D1_A == 14 || (qc_D1_B >= 1 && qc_D1_B <= 11) || qc_D1_B == 14
Do not give further details of "mother and toddler club" or Sunday school.

Present placement - A Name and address in full of the place N attends at present or, if on holiday, attended last term. (If child currently attends more than one place, please give details of the main one). Designation of main place N attends now, i.e. as specified in D.1 A.

Generic text

Present placement - A Name and address in full of the place N attends at present or, if on holiday, attended last term. (If child currently attends more than one place, please give details of the main one). Name of place N attends now

Generic text

Present placement - A Name and address in full of the place N attends at present or, if on holiday, attended last term. (If child currently attends more than one place, please give details of the main one). Full postal address

Long text

Present placement - A Name and address in full of the place N attends at present or, if on holiday, attended last term. (If child currently attends more than one place, please give details of the main one). Name of head teacher, supervisor, etc

Generic text

Previous placement - B Name and address in full of place N has attended previously that he/she has since stopped attending. (If the child has attended more than once place previously for three months or longer give details of the one he/she left most recently). Designation of previous place N attended, i.e. as specified in D.1 B

Generic text

Previous placement - B Name and address in full of place N has attended previously that he/she has since stopped attending. (If the child has attended more than once place previously for three months or longer give details of the one he/she left most recently). Name of previous place N attended

Generic text

Previous placement - B Name and address in full of place N has attended previously that he/she has since stopped attending. (If the child has attended more than once place previously for three months or longer give details of the one he/she left most recently). Full postal address

Long text

Previous placement - B Name and address in full of place N has attended previously that he/she has since stopped attending. (If the child has attended more than once place previously for three months or longer give details of the one he/she left most recently). Name of head teacher, supervisor, etc.

Generic text
The following questions D.4 to D.8 refer to: A - the present placement and B - the previous placement as identified above.

Type of premises N attended for present and previous placements A Present placement

1
Normal school or nursery premises
2
Village or community hall
3
Church hall
4
Private house
5
Nursery in factory/industrial premises
6
Other kind of premises, please specify
0
Not known
Other

Type of premises N attended for present and previous placements B Previous placement

1
Normal school or nursery premises
2
Village or community hall
3
Church hall
4
Private house
5
Nursery in factory/industrial premises
6
Other kind of premises, please specify
0
Not known
Other

At what age did N start attending: A - present placement? ... years ... months

Age
Age in months

At what age did N start attending: B - previous placement? ... years ... months

Age
Age in months

At what age did N stop attending the previous placement? ... years ... months

Age
Age in months

What was the main reason he/she stopped attending the previous placement?

Generic text
Days and periods of N's attendance
- Hours attended per session ... hrs

1 - Mon

2 - Tue

3 - Wed

4 - Thu

5 - Fri

6 - Sat

7 - Sun

How many

1 - Mon

2 - Tue

3 - Wed

4 - Thu

5 - Fri

6 - Sat

7 - Sun

How many

1 - Mon

2 - Tue

3 - Wed

4 - Thu

5 - Fri

6 - Sat

7 - Sun

How many

1 - Mon

2 - Tue

3 - Wed

4 - Thu

5 - Fri

6 - Sat

7 - Sun

How many
A - Present placement Morning
A - Present placement Afternoon
B - Previous placement Morning
B - Previous placement Afternoon

Has the mother noticed any changes in N felt to be due to his/her attendance at present or previous placements? A Present placement

1
Yes, change noticed
2
No, no change
3
Not attended long enough to say
4
Cannot say
0
Not known

Has the mother noticed any changes in N felt to be due to his/her attendance at present or previous placements? B Previous placement

1
Yes, change noticed
2
No, no change
3
Not attended long enough to say
4
Cannot say
0
Not known
If yes,
qc_D7_i == 1 || qc_D7_ii == 1

what kind of changes have you noticed? A - Present placement

Generic text

what kind of changes have you noticed? B - Previous placement

Generic text

Has mother regularly taken part or helped in any way in the place(s) N attended? (e.g. looking after the children, helping with the administrative side or in other ways) A Present placement

1
Yes - at least once a week
2
Yes - 1-3 times a month
3
Yes - once or twice a term
4
Yes - less than once a term
5
No - Mother's help was not required
6
No - mother was busy doing other things
7
No - mother preferred not to take part
8
Child not attended long enough to say
9
Other reply, please give details
0
Not known
Other

Has mother regularly taken part or helped in any way in the place(s) N attended? (e.g. looking after the children, helping with the administrative side or in other ways) B - Previous placement

1
Yes - at least once a week
2
Yes - 1-3 times a month
3
Yes - once or twice a term
4
Yes - less than once a term
5
No - Mother's help was not required
6
No - mother was busy doing other things
7
No - mother preferred not to take part
8
Child not attended long enough to say
9
Other reply, please give details
0
Not known
Other
If mother has taken part,
(qc_D8_i >= 1 && qc_D8_i <= 4) || (qc_D8_ii >= 1 && qc_D8_ii <= 4)

please describe what it was she did. A - Present placement

Generic text

please describe what it was she did. B - Previous placement

Generic text
Have N's mother and/or father met the head teacher, supervisor or other staff from the present placement either before or since N started? (e.g. to discuss his/her settling down, N's school entry or anything else concerning N)
-

1 - Yes, met staff to discuss N - at school, playgroup, etc.

2 - Yes, met staff to discuss N - at parents' home

3 - Yes, met staff to discuss N - elsewhere

4 - No, never met staff

5 - No mother figure/no father figure

6 - N has no present placement

0 - Not known

Before N started: Mother
Before N started: Father
Since N started: Mother
Since N started: Father
If yes,
qc_D9 == 1 || qc_D9 == 2 || qc_D9 == 3

who initiated the meeting(s)?

1
Parents
2
Staff
3
Other reply, give details
0
Cannot say
Other
If mother does not know which infant/primary school N is to attend, put NOT KNOWN.
If N is not at present attending infant/primary school (LEA or private)
qc_D1_A != 5 && qc_D1_A != 6

please give name and address of the school mother expects him/her to attend later. Name of infant/primary school

Generic text

please give name and address of the school mother expects him/her to attend later. Full postal address

Long text

please give name and address of the school mother expects him/her to attend later. Name of head teacher

Generic text

please give name and address of the school mother expects him/her to attend later. When does the mother expect N to start attending this infant/primary school?

1
Summer term 1975
2
Autumn term (September) 1975
3
Other date, please specify
0
Cannot say
Other

Irrespective of whether or not N attended, did the mother ever have his/her name down on a waiting list to go to a playgroup, nursery school or class, or day nursery?

1
Yes - had name down on at least one waiting list for nursery school/class or playgroup
2
Yes - had name down on waiting list for day nursery
3
No, name has never been on a waiting list
0
Cannot remember

Has N ever been regularly looked after during the day in someone else's house, for three months or longer? (For this purpose "regularly" is taken as two or more hours weekly)

1
Yes - by a friend or neighbour
2
Yes - by paid child minder
3
Yes - by relative
4
Yes - by other person, please specify
5
No, never
0
Not known
Other
If yes,
qc_D12 == 1 || qc_D12 == 2 || qc_D12 == 3 || qc_D12 == 4

give age in completed years N was first regularly looked after in someone else's house

Age
SECTION E EDUCATION AND OCCUPATION OF PARENTS

Educational or occupational qualifications of present parents Mother

1
Qualifications in shorthand and/or typing, tade apprenticeships, or other vocational training, e.g. State Enrolled Nurse (SEN) or Enrolled Nurse (Scotland), hairdressing diploma, etc.
2
G.C.E. 'O' level, S.C.E. 'O' grade, Certificate of Secondary Education (CSE), City and Guilds Intermediate Technical Certificate, City and Guilds Final Craft Certificate
3
G.C.E. 'A' level, High School Certificate (HSC), Higher Grade of Scottish Leaving Certificate (SLC), Ordinary National Diploma/Certificate (OND/ONC), City and Guilds Final Technical Certificate, Higher Grade of Scottish Certificate of Education (SCE)
4
State Registered Nurse (SRN) or Registered Nurse (Scotland)
5
Certificate of Education (Teachers), Teaching Qualification (Primary/Secondary Education in Scotland)
6
Degree (e.g. BSc, BA, PhD), Higher National Diploma/Certificate (HND, HNC), Membership of Professional Institution (e.g. FCA, FRICS, MIMechE, MIEE, etc.) City and Guilds Full Technical Certificate
7
Other qualifications, please specify
8
No qualifications
9
Not applicable, no mother or no father figure
0
Qualifications not known
Other

Educational or occupational qualifications of present parents Father

1
Qualifications in shorthand and/or typing, tade apprenticeships, or other vocational training, e.g. State Enrolled Nurse (SEN) or Enrolled Nurse (Scotland), hairdressing diploma, etc.
2
G.C.E. 'O' level, S.C.E. 'O' grade, Certificate of Secondary Education (CSE), City and Guilds Intermediate Technical Certificate, City and Guilds Final Craft Certificate
3
G.C.E. 'A' level, High School Certificate (HSC), Higher Grade of Scottish Leaving Certificate (SLC), Ordinary National Diploma/Certificate (OND/ONC), City and Guilds Final Technical Certificate, Higher Grade of Scottish Certificate of Education (SCE)
4
State Registered Nurse (SRN) or Registered Nurse (Scotland)
5
Certificate of Education (Teachers), Teaching Qualification (Primary/Secondary Education in Scotland)
6
Degree (e.g. BSc, BA, PhD), Higher National Diploma/Certificate (HND, HNC), Membership of Professional Institution (e.g. FCA, FRICS, MIMechE, MIEE, etc.) City and Guilds Full Technical Certificate
7
Other qualifications, please specify
8
No qualifications
9
Not applicable, no mother or no father figure
0
Qualifications not known
Other

At what age did the present parents leave school? Age mother left school ... years

Age

At what age did the present parents leave school? Age father left school ... years

Age

How many completed years of full-time education did the present parents have after leaving school? (e.g. at college of education, at polytechnic, at university, etc.) Mother, number of years ... years

Age

How many completed years of full-time education did the present parents have after leaving school? (e.g. at college of education, at polytechnic, at university, etc.) Father, number of years ... years

Age
Occupation of present father
E.4 to E.6 refer to the father or father substitute, including foster father, adoptive father, stepfather or any other father substitute.
If N has no father or substitute father now, please ring 8 in E.4 and proceed to E.8.

What is the father's actual job, occupation, trade or profession, or the last occupation if unemployed or retired? Full and precise details of occupation are required. See "Survey notes and Information". Actual job

Generic text

What is the industry or business in which the father is engaged? Give details of goods, materials or services. see "Survey Notes and Information". Type of industry

Generic text

Father's employment status

1
Self-Employed: With 25 or more employees
2
Self-Employed: With less than 25 employees
3
Self-Employed: Without employees other than family workers
4
Employed: In managerial position
5
Employed: As foreman, supervisor, chargehand, etc.
6
Employed: Not in supervisory role
7
Other: Unemployed, sick, etc. Please describe situation
8
No father figure
0
Not known, please explain situation
Generic text
If N has no father or substitute father now, please ring 8 in E.4 and proceed to E.8.
qc_E4_c == 8
Else
Do any of the following apply?
-

1 - Never or hardly ever

2 - Sometimes

3 - Often

4 - Not known

Father away evenings until after N has gone to bed
Father away most of Saturday and/or Sunday
Father works away for long periods (i.e. a month or more at a time)
Father works overnight
Father works shifts

For how many weeks has the father been off work in the past 12 months, through illness or unemployment or for other reasons? Number of weeks off work through: Illness or accident

How many

For how many weeks has the father been off work in the past 12 months, through illness or unemployment or for other reasons? Number of weeks off work through: Unemployment

How many

For how many weeks has the father been off work in the past 12 months, through illness or unemployment or for other reasons? Number of weeks off work through: Other reasons, give details

How many
Other

When the present father left school, what was his own father's job? Actual job

Generic text

When the present father left school, what was his own father's job? Type of industry

Generic text

When the present mother left school, what was her own father's job? Actual job

Generic text

When the present mother left school, what was her own father's job? Type of industry

Generic text

Does present mother have a job, either out of the home or at home, or is she a full-time housewife?

1
Mother works out of the home - regulary full time or part-time employment, including evenings, overnight or weekends
2
Mother works out of the home - occasionally casual or freelance worker obtaining work on a day-to-day basis or seasonally, e.g. fruit picking, etc.
3
Mother works at home regularly family business, e.g. shop, farm, boarding house, clerical work for a self-employed husband, home industry i.e. working for a firm of manufacturers at home, etc.
4
Mother works at home occassionally seasonal work done at home, e.g. holiday bed and breakfast business
5
Full time housewife, no other kind of work
6
Other work situation, please give details
0
Not known
Other
If mother is now a full-time housewife or only works occassionally, (i.e. ringed 2, 4 or 5 in E.9) please proceed to E.17 on next page.
If mother works regularly at home or out of the home(i.e. ringed 1 or 3 in E.9) at the present time, please complete E.10 onwards.
qc_E9 == 1 || qc_E9 == 3

Describe mother's present job. What is her actual job? (e.g. shop assistant, teacher, assembly line worker, typist, stitcher, etc.)

Generic text

What type of industry or business does she work in? (e.g. greengrocery, infant school, tobacco, insurance, glovemaking, etc.)

Generic text

What kind of position does mother occupy at work?

1
Managerial
2
As forewoman or supervisor, etc.
3
Non-supervisory position
4
Works at home
5
Other, please specify
0
Cannot say/not known
Other

How many years has mother been doing this job? (Ignore short breaks for pregnancies or illness) Number of years

How many
Please show in the table below the times (giving a.m or p.m) the mother started and finished work and the total hours worked each day last week. If not working last week, give details of the last week worked.
Time started Time finished Total hours worked*
Generic timeHow manyGeneric timeGeneric timeHow manyGeneric timeHow manyGeneric timeGeneric time Generic timeHow manyGeneric timeGeneric timeHow manyGeneric timeHow manyGeneric timeGeneric time Generic timeHow manyGeneric timeGeneric timeHow manyGeneric timeHow manyGeneric timeGeneric time
Mon
Tues
Wed
Thurs
Fri
Sat
Sun

Does mother work these hours regulary every week?

1
Yes, every week the same
2
No, mother works a shift system
3
No set pattern of work, hours or days worked vary
4
Other reply, please give details
0
Cannot say
Other

Please give average travelling time to and from work travelling to work ... hours ... mins

Hours
Minutes

Please give average travelling time to and from work returning home ... hours ... mins

Hours
Minutes

When mother is at work, is N usually looked after at home or away from home? (If N is sometimes looked after at home and sometimes away from home ring where he/she is mainly looked after).

1
Looked after at home
2
Looked after away from home
3
Varies
0
Cannot say

Who looks after N during mother's working hours?

1
N's father
2
Mother at home
3
Accompanies mother to work
4
Adult relative e.g. grandparents, aunt, etc
5
Older sibling
6
Paid childminder
7
Friend or neighbour (not paid)
8
Local authority day nursery
9
Day nursery run by an employer or private individual(s)
10
School, nursery school or class, or playgroup
11
Some other person or place, namely
0
Not known
Other
If more than one,

who mainly looks after N during mother's working hours?

Generic text

Please ask the mother if she could say what are the main reasons she works. (If "for money" ask, "what is money mainly spent on?")

1
Financial necessity (e.g. contribution to housekeeping or rent, clothes, etc.)
2
Financial advantage (e.g. savings, holidays, household appliances, luxuries, car, to gain independence, etc.)
3
Social reasons (e.g. for company, making friends, relief of boredom, keep you young, etc.)
4
Career/enjoys the work
5
Other reasons, describe
Other
If more than one reason given,

ask, "which of these is the most important reason", and write in

Generic text

Has mother had a regular full-time or part-time job out of the home since the time of N's birth which she subsequently gave up?

1
Yes - full-time job(s)
2
Yes - part-time job(s)
3
No, never had a job out of the home since N's birth
4
Other reply, give details
0
Not known
Other
If yes,
qc_E17 == 1 || qc_E17 == 2

give total time worked since N's birth in completed years (exclude present job if any)

How many
SECTION F THE HOME AND SOCIAL ENVIRONMENT

What accommodation is occupied by this household?

1
Whole detached house or bungalow
2
Whole semi-detached house or bungalow
3
Whole terrace house (including end of terrace)
4
Flat/maisonette (self-contained)
5
Rooms (non self-contained flat)
6
Other, please give details
Other
If Flat or Rooms,
qc_F1 == 4 || qc_F1 == 5

give the lowest floor on which rooms are situated Floor

How many

Is the accommodation owned or rented by the household?

1
Owned outright
2
Being bought
3
Rented from Council
4
Privately rented - unfurnished
5
Privately rented - furnished or partly furnished
6
Tied to occupation of father
7
Other situation, please give details
Other
Does the household have sole use of, share with another household, or lack any of the following amenities?
-

1 - Sole use

2 - Shared use

3 - None available

Bathroom
Indoor lavatory
Outdoor lavoratory
Hot water supply
Garden or yard
Kitchen

How large is the kitchen and is it used for living in (e.g. for having meals in)?

1
Less than 6 feet wide - Not used for living in
2
Less than 6 feet wide - Used for living in
3
6 feet or more wide - Not used for living in
4
6 feet or more wide - Used for living in
5
No kitchen
0
Not known

How many rooms are there within the accommodation? (Include all rooms except kitchen, bathroom, toilet, and any rooms used solely for business purposes. For complete definition see "Survey notes and Information") Number of rooms

How many

Does N share a bedroom with others?

1
Yes
2
No
0
Not known
If yes,
qc_F6 == 1

how many sleep in the same room

How many

Does N share a bed with others?

1
No
2
Yes - with one other
3
Yes - with two others
4
Yes - with more than two others
0
Not known

Which of the following does the family have?

1
Refrigerator
2
Washing machine
3
Spin dryer
4
Colour T.V.
5
Black and White T.V.
6
Van or car
7
Telephone
8
None of the above
In the past seven days has anyone helped mother at all with any of the following? (Include father, members of the household, friends, neighbours, relatives and paid help).
-

1 - Yes father

2 - Yes others

3 - No

0 - Not known

Housework/shopping
Looking after N for part of the day while mother shops, attends appointments, does housework, etc.
Babysitting in the evening
Putting N to bed
Taking N to school/nursery/playgroup, etc.
In the past 7 days has N done any of the following with others or by him/herself:
-

1 - Yes with adult(s)

2 - Yes with child(ren)

3 - Yes by self

4 - No

0 - Not known

been to a friend's or relative's house
been to a park, recreation ground, adventure playground
been on a bus or train
been to the shops, launderette, etc.
Indicate to which of the following broad ethnic catagories N and the present parents belong.
-

1 - European (U.K.)

2 - European (other)

3 - West Indian

4 - Indian/Pakistani

5 - Other Asian

6 - African

7 - Other, specify

0 - Not known

N
Mother
Father

Indicate to which of the following broad ethnic catagories N and the present parents belong. Other, specify

Other

What language is mainly used with N in the home?

1
English
2
Other language, namely
0
Not known
Other

How many times has N moved since birth? Number of moves

How many

Has N ever been in any of the following situations? Now

1
&quot;In care&quot; * (voluntary or statutory) in - fosterparents' home
2
&quot;In care&quot; * (voluntary or statutory) in - assessment centre
3
&quot;In care&quot; * (voluntary or statutory) in - family group home
4
&quot;In care&quot; * (voluntary or statutory) in - children's home
5
In &quot;Part III&quot; accommodation
6
In homeless family unit
7
None of the above
0
Not known if any of above

Has N ever been in any of the following situations? In the past but not now

1
&quot;In care&quot; * (voluntary or statutory) in - fosterparents' home
2
&quot;In care&quot; * (voluntary or statutory) in - assessment centre
3
&quot;In care&quot; * (voluntary or statutory) in - family group home
4
&quot;In care&quot; * (voluntary or statutory) in - children's home
5
In &quot;Part III&quot; accommodation
6
In homeless family unit
7
None of the above
0
Not known if any of above
*For each "in care" situation please give the following details:
Name & address of home, centre, etc., if known Local Authority or Voluntary Society Age when first entered this situation Length of stay Reason N in care
Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text
1
2
3
4

From your knowledge and anything you have learned from the interview, has anyone in the household since N's birth had contact with any statutory or voluntary social work or welfare organisations? (For example, Social Services or Social Security Departments, Probation Service, etc.)

1
Yes
2
No
0
Not known
If yes,
qc_F15 == 1

give details

Long text
SECTION G FAMILY HEALTH AND SMOKING

Has anyone in N's household since N's birth had any severe or prolonged illness (medical, surgical or psychiatric) or any handicap or disability?

1
Yes - mother
2
Yes - father
3
Yes - other adult in household
4
Yes - child in household (excluding N)
5
No, none
0
Not known
If yes,
qc_G1 == 1 || qc_G1 == 2 || qc_G1 == 3 || qc_G1 == 4

please give the following details for each member of the household concerned. Relationship to N

Generic text

please give the following details for each member of the household concerned. Diagnosis or nature of condition

Generic text

please give the following details for each member of the household concerned. Date of onset

Generic date

please give the following details for each member of the household concerned. Duration of condition (years and months)

Age
Age in months

please give the following details for each member of the household concerned. Outcome (i.e. recovered, died, condition still present)

Generic text

please give the following details for each member of the household concerned. In what way, if any, has condition caused any interference with N's everyday care?

Generic text

Do either N's mother or father smoke at all at present? (Cigarette smoking is defined as smoking an average of one or more cigarettes a day) Mother

1
No, is non-smoker
2
Yes - smokes cigarettes
3
Yes - smokes pipe or cigars
0
Not known if smokes

Do either N's mother or father smoke at all at present? (Cigarette smoking is defined as smoking an average of one or more cigarettes a day) Father

1
No, is non-smoker
2
Yes - smokes cigarettes
3
Yes - smokes pipe or cigars
0
Not known if smokes
If smokes cigarettes,
qc_G2_a_i == 2 || qc_G2_a_i == 3 || qc_G2_a_ii == 2 || qc_G2_a_ii == 3

how many are smoked per day on average? Average number smoked: Mother

How many

how many are smoked per day on average? Average number smoked: Father

How many

Irrespective of whether or not N's mother or father smoke at present, for how many years since N's birth have they smoked cigarettes, if at all? Mother

1
During the period since N's birth - Smoked all the time
2
During the period since N's birth - Smoked for more than 3 years
3
During the period since N's birth - Smoked for between 1 and 3 years
4
During the period since N's birth - Smoked for less than 1 year
5
During the period since N's birth - Smoked but not know for how long
6
During the period since N's birth - Non-smoker all the time
0
During the period since N's birth - Not known if smoked at all

Irrespective of whether or not N's mother or father smoke at present, for how many years since N's birth have they smoked cigarettes, if at all? Father

1
During the period since N's birth - Smoked all the time
2
During the period since N's birth - Smoked for more than 3 years
3
During the period since N's birth - Smoked for between 1 and 3 years
4
During the period since N's birth - Smoked for less than 1 year
5
During the period since N's birth - Smoked but not know for how long
6
During the period since N's birth - Non-smoker all the time
0
During the period since N's birth - Not known if smoked at all

From interviewer's and mother's knowledge or any other source, has N ever previously had any special test(s) of progress in connection with a follow-up of the British Births Survey or any other study of child development?

1
No
2
Yes
0
Not known
If yes,
qc_G2_b_iii == 1
please complete details below.
Age(s) of N Name of study, if known Where tested and by whom
Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric text
1
2
3
4

Relationship of informant to N

1
Mother
2
Father
3
Other, specify
Other
END OF INTERVIEW
Please thank the mother for her help in this confidential enquiry. When doing so, please mention that the study will be continued in the nurseries, playgroups, hospitals and other places already attended by the children taking part. We will also record the results of screening tests and medical examinations undergone by the children to complement the information that the mother has so kindly given.
If there are any further points the mother would care to add concerning N or the survey, we would be grateful if these could be noted on the back page.
SECTION H TO BE COMPLETED AFTER THE INTERVIEW IS OVER
Please complete H.1 to H.5 from your knowledge and any impression you have gained during the interview.

Please ring the descriptions which you feel best characterise the home and relationship of family with neighbours. Furniture/equipment in home

1
Luxurious
2
Well equipped
3
Adequate
4
Low standard
5
Very low standard
0
Can't assess

Please ring the descriptions which you feel best characterise the home and relationship of family with neighbours. Tidiness of home

1
Over-tidy
2
Very tidy
3
Average
4
Untidy
5
Chaotic
0
Can't assess

Please ring the descriptions which you feel best characterise the home and relationship of family with neighbours. Relationship of family with neighbours

1
Very good terms
2
Good terms
3
Satisfactory
4
Don't mix
5
Bad terms
0
Can't assess

In order to get some impression of the kind of district N lives in, please ring which one of the following descriptions best characterises the district.

1
In this district, houses are closely packed together and many are in poor state of repair. Multi-occupation is a common feature, and most families have low incomes
2
This district consists largely of council houses and flats or less expensive privately owned houses, for example, older terraced houses. Multi-occupation is unusual and families have average incomes. Include 'new towns' here
3
In this district houses are well spaced and the majority are well maintained. Multi-occupation is rare and most families have higher than average incomes
4
This district is part of a small market town, rural community or village. Some families may lack basic amenities but others may be fairly well-to-do. It is mainly characterised by the fact that well-to-do and poorer families live fairly close together in the community
5
If none of these descriptions seem to characterise the district N lives in, please describe in your own words what it is like:
Other

From the health visitor's knowledge and observations of the child, and where necessary from available records, what is N's intellectual development considered to be?

1
Normal or above average
2
Slightly backward
3
Definitely backward
4
Other situation, please describe
0
Insufficient information
Other
If at all backward in intellectual development,
qc_H3 == 2 || qc_H3 == 3

give any relevant diagnosis and details of assessment procedure(s) or investigations, if any.

Generic text

How well do you know this family?

1
Very well
2
Fairly well
3
Slightly
4
Never in contact before this interview
5
Other situation, please describe
Other

Were there any interruptions, distractions or other problems which made interviewing difficult?

1
No, no difficulty
2
Yes, slight difficulty
3
Yes, considerable difficulty
If yes,
qc_H5 == 2 || qc_H5 == 3

please describe any difficulty

Generic text

What procedure was adopted for the completion of the Maternal Self-completion Questionnaire?

1
Questionnaire left with mother and collected after completion
2
Mother completed it without help during the home interview
3
Mother completed it with some help from the interviewer
4
Interviewer read out all the questions for mother to respond
5
Other procedure.
If 3, 4 or 5 ringed,
qc_H6 == 3 || qc_H6 == 4 || qc_H6 == 5

please give reason(s), e.g. mother couldn't read, etc.

Generic text

Date of interview

Generic date

Name of Health Visitor conducting the interview:

Generic text

Employing Area Health Authority/Health Board

Generic text

Health District, if applicable

Generic text

Please note below: any other relevant information which you feel has not already been brought out in the interview form, any comments or observations by the General Practitioner, if he so wishes, any further details about questions if insufficient space earlier in questionnaire.

Long text
Please indicate degree of completeness of the documents.
- If not fully completed, give reason(s)

1 - Fully completed

2 - Partly completed

3 - Not completed

Generic text

1 - Fully completed

2 - Partly completed

3 - Not completed

Generic text

1 - Fully completed

2 - Partly completed

3 - Not completed

Generic text

1 - Fully completed

2 - Partly completed

3 - Not completed

Generic text
Home Interview Questionnaire
Maternal Self-completion Questionnaire
Test Booklet
We are most grateful for the time you have given. Thank you for your help.
End

bcs_75_hi

Child Health and Education in the Seventies
Under the auspices of the University of Bristol and the National Birthday Trust Fund
Director: Professor Neville R. Butler, MD, FRCP, DCH
Research team: N. R. Butler A.F. Osborn, BA B.C. Howlett, BSc, FSS, MBCS S. F. O. Dowling, BSc, MB, BS M. C. Fraser, SRN, SCM, HV Tutor Cert.
In association with: Area Health Authorities in England and Wales Health Boards in Scotland
Co-sponsors: Health Visitors' Association
CONFIDENTIAL
HOME INTERVIEW QUESTIONNAIRE
Health District Code
Generic text
Child's Local Serial Number
Generic text
Child's Central Survey Number
Generic text
If twins use separate questionnaire for each.
Please use block capitals.
Full name of the Child
Generic text
Sex
Generic text
Singleton or twin, specify
Generic text
Date of birth
Generic date
Present home address in full
Long text
Address of child's present placement if living away from home.
Long text
Child's National Health Service Number
Generic text
N.H.S. Doctor with whom child is registered. Name
Generic text
N.H.S. Doctor with whom child is registered. Full address of practice
Long text
Full home address of mother at time she gave birth to child.
Long text
If born abroad, give approximate date child came to live in this country.
Generic text
Mother's maiden name.
Generic text
(These details are needed for matching purposes only)
Address of place of birth.
Long text
1. Please read "Survey Notes and Information" in conjunction with this questionnaire.
2. Throughout the questionnaire the study child is designated by the letter N.
3. It is important that no question should remain unanswered without explanation.

SECTION A FAMILY COMPOSITION

People in the household
A household consists of a group of people who all live at the same address and who are all catered for by the same person.

List below all the members of this household. Include the study child, N, the present parents and others, e.g. relatives or lodgers, who are members of this household. Exclude any who are only at home for short periods; enter these in table (b) below.

Relationship to N (e.g. father, step-brother) or status in the household (e.g. lodger) Roster cs_qA1_a_X Generic text Generic text Generic text Generic date Generic text Generic text Generic date Generic text Generic text Generic text Generic date Generic text Generic date Generic text Generic text Generic text
Study child - N 1 Surname
Study child - N 1 First name(s)
Study child - N 1 Sex
Study child - N 1 Date of birth
Study child - N 2 Surname
Study child - N 2 First name(s)
Study child - N 2 Sex
Study child - N 2 Date of birth
Study child - N 3 Surname
Study child - N 3 First name(s)
Study child - N 3 Sex
Study child - N 3 Date of birth
Study child - N 4 Surname
Study child - N 4 First name(s)
Study child - N 4 Sex
Study child - N 4 Date of birth
Study child - N 5 Surname
Study child - N 5 First name(s)
Study child - N 5 Sex
Study child - N 5 Date of birth
Study child - N 6 Surname
Study child - N 6 First name(s)
Study child - N 6 Sex
Study child - N 6 Date of birth
Study child - N 7 Surname
Study child - N 7 First name(s)
Study child - N 7 Sex
Study child - N 7 Date of birth
Study child - N 8 Surname
Study child - N 8 First name(s)
Study child - N 8 Sex
Study child - N 8 Date of birth

List below any members of the family not included in the above table, for example, those who are only home for holidays or leave, and enquire or state from your own knowledge the reason for absence, for example at residential school, or working away.

Relationship to N Surname First name(s) Sex Date of birth Reason for absence from home
Generic textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric text
1
2
3
4
What is the relationship to N of the person now acting as his/her mother? Relationship to N
1
Natural mother
2
Mother by legal adoption
3
Stepmother
4
Foster mother
5
Grandmother
6
Elder sister
7
Cohabitee of father
8
Other mother figure, specify
9
No mother figure
Other
please give reason(s) for any past changes in N's situation, e.g. family changes, mother died, etc.
Generic text
please ask when this situation began. Situation began
Generic date
What is the relationship to N of the person now acting as his/her father? Relationship to N
1
Natural father
2
Father by legal adoption
3
Stepfather
4
Foster father
5
Grandfather
6
Elder brother
7
Cohabitee of mother
8
Other father figure, specify
9
No father figure
Other
please give reason(s) for any past changes in N's situation, e.g. family changes, father died, etc.
Generic text
please ask when this situation began. Situation began
Generic date
Except in Q's B.1 to B.4 and B.23 where information is specifically required about N's natural mother or father, the terms "father" or "present father" are used to denote the present father figure identified in Q. A.3(a). The terms "mother" or "present mother" are used to denote the present mother figure identified in Q. A.2(a)

SECTION B MEDICAL HISTORY AND PRESENT HEALTH

Enter obstetric details on the study child, N, and on all liveborn and stillborn children born subsequently to N's natural mother. Include also children no longer living with their natural mother. Record each member of twin pair separately. Exclude miscarriages. (Some children in this table will be included also in table A. 1 on page opposite).

cs_qB1_Y Roster Name cs_Survival cs_Method_of_delivery cs_Gestation lbs ozs Generic text Generic text Generic date ozs cs_Survival Generic text Generic text cs_Gestation lbs cs_Method_of_delivery Generic date Generic text ozs Generic date cs_Survival Generic text lbs cs_Gestation cs_Method_of_delivery Generic date cs_Method_of_delivery cs_Gestation lbs cs_Survival ozs Generic text Generic text lbs Generic text cs_Survival cs_Gestation Generic date ozs Generic text cs_Method_of_delivery Generic date cs_Method_of_delivery cs_Survival cs_Gestation Generic text Generic text ozs lbs cs_Survival cs_Method_of_delivery lbs ozs Generic text Generic date Generic text cs_Gestation Generic date Generic text ozs lbs cs_Survival cs_Method_of_delivery cs_Gestation Generic text

1 - Alive now

2 - Died 7 days and over

3 - Died under 7 days

4 - Stillborn

0 - Not known

1 - Vertex

2 - Breech

3 - Forceps

4 - Caeserean

5 - Other

0 - Not known

1 - Over 3 weeks early

2 - At term (37-41 weeks)

3 - Over 2 weeks late

0 - Not known

1 - Alive now

2 - Died 7 days and over

3 - Died under 7 days

4 - Stillborn

0 - Not known

1 - Over 3 weeks early

2 - At term (37-41 weeks)

3 - Over 2 weeks late

0 - Not known

1 - Vertex

2 - Breech

3 - Forceps

4 - Caeserean

5 - Other

0 - Not known

1 - Alive now

2 - Died 7 days and over

3 - Died under 7 days

4 - Stillborn

0 - Not known

1 - Over 3 weeks early

2 - At term (37-41 weeks)

3 - Over 2 weeks late

0 - Not known

1 - Vertex

2 - Breech

3 - Forceps

4 - Caeserean

5 - Other

0 - Not known

1 - Vertex

2 - Breech

3 - Forceps

4 - Caeserean

5 - Other

0 - Not known

1 - Over 3 weeks early

2 - At term (37-41 weeks)

3 - Over 2 weeks late

0 - Not known

1 - Alive now

2 - Died 7 days and over

3 - Died under 7 days

4 - Stillborn

0 - Not known

1 - Alive now

2 - Died 7 days and over

3 - Died under 7 days

4 - Stillborn

0 - Not known

1 - Over 3 weeks early

2 - At term (37-41 weeks)

3 - Over 2 weeks late

0 - Not known

1 - Vertex

2 - Breech

3 - Forceps

4 - Caeserean

5 - Other

0 - Not known

1 - Vertex

2 - Breech

3 - Forceps

4 - Caeserean

5 - Other

0 - Not known

1 - Alive now

2 - Died 7 days and over

3 - Died under 7 days

4 - Stillborn

0 - Not known

1 - Over 3 weeks early

2 - At term (37-41 weeks)

3 - Over 2 weeks late

0 - Not known

1 - Alive now

2 - Died 7 days and over

3 - Died under 7 days

4 - Stillborn

0 - Not known

1 - Vertex

2 - Breech

3 - Forceps

4 - Caeserean

5 - Other

0 - Not known

1 - Over 3 weeks early

2 - At term (37-41 weeks)

3 - Over 2 weeks late

0 - Not known

1 - Alive now

2 - Died 7 days and over

3 - Died under 7 days

4 - Stillborn

0 - Not known

1 - Vertex

2 - Breech

3 - Forceps

4 - Caeserean

5 - Other

0 - Not known

1 - Over 3 weeks early

2 - At term (37-41 weeks)

3 - Over 2 weeks late

0 - Not known

N 1 Sex
N 1 Date of birth
N 1 Birthweight - lbs.
N 1 Birthweight - ozs.
N 1 Gestation
N 1 Method of delivery
N 1 Survival
N 1 If died, cause of death
N 2 Sex
N 2 Date of birth
N 2 Birthweight - lbs.
N 2 Birthweight - ozs.
N 2 Gestation
N 2 Method of delivery
N 2 Survival
N 2 If died, cause of death
N 3 Sex
N 3 Date of birth
N 3 Birthweight - lbs.
N 3 Birthweight - ozs.
N 3 Gestation
N 3 Method of delivery
N 3 Survival
N 3 If died, cause of death
N 4 Sex
N 4 Date of birth
N 4 Birthweight - lbs.
N 4 Birthweight - ozs.
N 4 Gestation
N 4 Method of delivery
N 4 Survival
N 4 If died, cause of death
How soon after N's birth did the mother first start to have regular contact with N, to hold and/or feed, not just look at?
1
Within 24 hours of birth
2
Between 25 and 48 hours after birth
3
On the third day or later, i.e. more than 48 hrs after birth
0
Not known
how many days after N's birth did regular contact start?
How many
Please give reason(s) for delay in regular contact
Generic text
After regular contact was established, was there any period of 24 hours or more during the first month of N's life when mother was not in normal contact with N, e.g. to hold and/or to feed?
1
No separation(s) of 24 hours or more
2
Mother and N out of contact for 24 hours or more
3
Cannot remember
0
Not known
give total duration of separation in completed days
How many
Give reason(s) for separations(s)
Generic text
Was N breast fed partly or wholly, even for a few days?
1
Yes - for less than 1 month
2
Yes - for 1 month or more but less than 3 months
3
Yes - for 3 months or more
4
Yes but cannot remember for how long
5
No, was not breast fed at all
0
Not known

At what ages did N receive immunisation, against what diseases and where?

N's age in months Diseases immunised against Where given

1 - G.P's Surgery

2 - Child Health Clinic

3 - Other place

0 - Not known

1 - Diphtheria

2 - Tetanus

3 - Whooping-cough

4 - Poliomyelitis

5 - Smallpox*

6 - Measles

7 - B.C.G.

8 - Other

0 - Not known

How many

1 - G.P's Surgery

2 - Child Health Clinic

3 - Other place

0 - Not known

1 - Diphtheria

2 - Tetanus

3 - Whooping-cough

4 - Poliomyelitis

5 - Smallpox*

6 - Measles

7 - B.C.G.

8 - Other

0 - Not known

How many

1 - Diphtheria

2 - Tetanus

3 - Whooping-cough

4 - Poliomyelitis

5 - Smallpox*

6 - Measles

7 - B.C.G.

8 - Other

0 - Not known

How many

1 - G.P's Surgery

2 - Child Health Clinic

3 - Other place

0 - Not known

1 - G.P's Surgery

2 - Child Health Clinic

3 - Other place

0 - Not known

1 - Diphtheria

2 - Tetanus

3 - Whooping-cough

4 - Poliomyelitis

5 - Smallpox*

6 - Measles

7 - B.C.G.

8 - Other

0 - Not known

How many

1 - G.P's Surgery

2 - Child Health Clinic

3 - Other place

0 - Not known

1 - Diphtheria

2 - Tetanus

3 - Whooping-cough

4 - Poliomyelitis

5 - Smallpox*

6 - Measles

7 - B.C.G.

8 - Other

0 - Not known

How many

1 - Diphtheria

2 - Tetanus

3 - Whooping-cough

4 - Poliomyelitis

5 - Smallpox*

6 - Measles

7 - B.C.G.

8 - Other

0 - Not known

How many

1 - G.P's Surgery

2 - Child Health Clinic

3 - Other place

0 - Not known

1 - G.P's Surgery

2 - Child Health Clinic

3 - Other place

0 - Not known

1 - Diphtheria

2 - Tetanus

3 - Whooping-cough

4 - Poliomyelitis

5 - Smallpox*

6 - Measles

7 - B.C.G.

8 - Other

0 - Not known

How many

1 - G.P's Surgery

2 - Child Health Clinic

3 - Other place

0 - Not known

1 - Diphtheria

2 - Tetanus

3 - Whooping-cough

4 - Poliomyelitis

5 - Smallpox*

6 - Measles

7 - B.C.G.

8 - Other

0 - Not known

How many

1 - Diphtheria

2 - Tetanus

3 - Whooping-cough

4 - Poliomyelitis

5 - Smallpox*

6 - Measles

7 - B.C.G.

8 - Other

0 - Not known

How many

1 - G.P's Surgery

2 - Child Health Clinic

3 - Other place

0 - Not known

First att.
Second att.
Third att.
Fourth att.
Fifth att.
Sixth att.
*Please include smallpox vaccination, although now not recommended nationally

Has N ever been seen at any of the following places for reasons specified, and if so at what ages, if known.

-

1 - Never seen

2 - Seen at age: 48m+

3 - Seen at age: 36-47m

4 - Seen at age: 24-35m

5 - Seen at age: 12-23m

6 - Seen at age: 6-11m

7 - Seen at age: under 6 mth

8 - Seen at age: not known

0 - Not known if ever seen

Home by H.V. for any reason
Child Health Clinic for any reason
G.P. surgery or health centre for devel. screening
Hospital birth follow-up clinic
Assessment Centre or clinic for handicap
Has N ever been separated from his/her mother or mother substitute for one month or more? Exclude N's hospital admissions and check these are detailed in B.9.
1
Yes
2
No
0
Not known
give total number of separations of one month or more, excluding N's hospital admission(s)
How many

Please give details below for all separations of one month or over. Exclude all N's hospital admissions. If more than three separations, continue on back page.

Age (years and months) Reason for separation Number of months (and weeks) separated Place of care of N?* Was the person looking after N known to him/her? Was N separated also from father?
Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text
First
Second
Third
*Place of care: State if in child's own home, other's home, instiutional placement, or specify if elsewhere.
Did the mother herself, as far as she can remember, ever spend more than a short time away from her parents as a child?
1
Yes - fostered/in care
2
Yes - other reason(s), specify
3
No, never spent more than a short time away from parents
0
Not known
Other
Has N ever been in hospital overnight or longer for any reason whatsoever? Exclude initial stay in maternity home/hospital.
1
Yes
2
No
0
Not known
give total number of hospital admissions overnight or longer
How many

Please give details below for every hospital admission.

Age (years and months) Diagnosis and nature of all special procedures, including operations Number of nights in hospital Name and address of hospital in full Type of ward and specify if children only admitted
Generic textHow manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textHow manyGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric text Generic textHow manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textHow manyGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric text Generic textHow manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textHow manyGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric text Generic textHow manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textHow manyGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric text Generic textHow manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textHow manyGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric text
First
Second
Third
Has N ever attended a hospital outpatient department or any other specialist clinic?
1
Yes
2
No
0
Not known

please give details below for each condition or illness resulting in attendance(s) at out-patients or specialist clinic.

Age at first attendance (years and months) Total number of attendances Diagnosis and treatment Name and address of department, hospital or clinic, in full.
How manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textHow manyGeneric textGeneric textHow manyGeneric text How manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textHow manyGeneric textGeneric textHow manyGeneric text How manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textHow manyGeneric textGeneric textHow manyGeneric text How manyGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textHow manyGeneric textGeneric textGeneric textHow manyGeneric textGeneric textHow manyGeneric text
First
Second
Third
Please enquire or state from your own knowledge whether N has been seen by any of the following since the fourth birthday and/or previous to fourth birthday. Seen by a general practitioner* - at surgery/health centre
1
Yes, after 4th b'day
2
Yes, before 4th b'day
3
No never
0
Not known
Please enquire or state from your own knowledge whether N has been seen by any of the following since the fourth birthday and/or previous to fourth birthday. Seen by a general practitioner* - at home visit
1
Yes, after 4th b'day
2
Yes, before 4th b'day
3
No never
0
Not known
Please enquire or state from your own knowledge whether N has been seen by any of the following since the fourth birthday and/or previous to fourth birthday. Seen by dentist - for inspection, not therapy
1
Yes, after 4th b'day
2
Yes, before 4th b'day
3
No never
0
Not known
Please enquire or state from your own knowledge whether N has been seen by any of the following since the fourth birthday and/or previous to fourth birthday. Seen by dentist - for filling(s), extraction(s), etc.
1
Yes, after 4th b'day
2
Yes, before 4th b'day
3
No never
0
Not known
Please enquire or state from your own knowledge whether N has been seen by any of the following since the fourth birthday and/or previous to fourth birthday. Seen by doctor for routine medical exam. in nursey or school situation, specify
1
Yes, after 4th b'day
2
Yes, before 4th b'day
3
No never
0
Not known
Generic text
Please enquire or state from your own knowledge whether N has been seen by any of the following since the fourth birthday and/or previous to fourth birthday. Seen by speech therapist - age first seen ... yrs ... mths
1
Yes, after 4th b'day
2
Yes, before 4th b'day
3
No never
0
Not known
Age
Age in months
Please enquire or state from your own knowledge whether N has been seen by any of the following since the fourth birthday and/or previous to fourth birthday. Seen by child guidance clinic age first seen ... yrs ... mths Problem/diagnosis
1
Yes, after 4th b'day
2
Yes, before 4th b'day
3
No never
0
Not known
Age
Age in months
Generic text
*For medical reasons, not for developmental screening or immunisation.

Has N had any of the following in the past year and/or previous to past year?

-

1 - Yes, after 4th b'day

2 - Yes, before 4th b'day

3 - No never

0 - Not known

Tonsillectomy or T's & A's
Adenoidectomy alone
Circumcision
Hernia operation
Appendicectomy
Has N had any of the following in the past year and/or previous to past year? Any other operation, namely
1
Yes, after 4th b'day
2
Yes, before 4th b'day
3
No never
0
Not known
Other

Has N had any of the following in the past year and/or previous to past year?

-

1 - Yes, after 4th b'day

2 - Yes, before 4th b'day

3 - No never

0 - Not known

Eczema
Hay fever or sneezing attacks
Ear discharge (pus not wax)
Repeated sore throats requiring medical attention
Habitual snoring or mouth breathing
Bronchitis
Pneumonia
Meningitis or encephalitis
Hearing difficulty (suspected or confirmed)*
Any vision problem (except squint) (suspected or confirmed)*
please give details below.
Generic text

Were there any of the following difficulties with N when he/she was a baby (i.e. under 6 months of age)?

-

1 - Yes

2 - No

0 - Not known

Excessive crying
Frequent feeding problems
Frequent sleeping difficulty at night
Has N ever had an accident requiring medical advice or treatment? Please include accidents in the road, home and elsewhere, accidental ingestion of medicines/poisons, burns/scalds, fractures, eye injuries, near-drowning, bad cuts and other injuries, with or without unconciousness, and non-accidental injuries.
1
Yes - accidental swallowing of medicines or poisons
2
Yes - burn(s), scald(s)
3
Yes - road traffic accident(s)
4
Yes - Accident resulting in unconciousness
5
Yes - other accidents
6
No accident
0
Not known
please state total number of accidents specified above
How many

Please give details of every "accident"

Age (years and months) Where did it happen? (Road, home, school, etc.) What happened?* Description of &quot;injuries&quot; (e.g. burn/scald, fracture, head injury with unconciousness, etc) Part(s) of body involved (head, eyes, limbs, etc.) Where treated? (G.P., Casualty, Inpatient) Treatment, including stitches, operation(s), plaster cast(s), traction, etc. Name and address of hospital in full if attended or admitted
Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text
First
Second
Third
Fourth
*If ingestion of medicines/poisons, give name of substance.
Has N ever had one or more attacks or bouts in which he/she had wheezing on the chest, regardless of the cause?
1
Yes
2
No
0
Not known
Age at first or only attack in which he/she wheezed on the chest: ... years ... mths
Age
Age in months
How many attacks occurred: in first 12 months of life?
How many
How many attacks occurred: between first and fourth birthdays?
How many
How many attacks occurred: since fourth birthday?
How many
Number of times ever admitted to hospital with any wheezing in the chest, whatever the cause
How many
Please describe what the mother was told about the diagnosis in her own words
Generic text
Check whether there have been any hospital admission(s) or out-patient attendance(s) for the above, if so, make sure they are included in B.9 and B.10 respectively.
Has N ever had any form of convulsion, fit, seizure or other turn in which conciousness was lost, or any part of the body made abnormal movements?
1
Yes
2
No, never
0
Not known
from health visitor's and mother's knowledge, and from records if possible, please give the most accurate diagnosis of the attack(s).
1
Epilepsy
2
Febrile convulsion(s)
3
Fainting, blackout(s)
4
Other diagnosis, namely
0
Not known
Other
please ask mother to describe the first attack form it took
Generic text
please ask mother to describe the first attack how soon seen by G.P., or admitted, if at all
Generic text
please ask mother to describe subsequent attack(s), if any. form they took if different from above
Generic text
please ask mother to describe subsequent attack(s), if any. investigations, if any
Generic text
please ask mother to describe subsequent attack(s), if any. medication and dates
Generic text

give number of convulsions, fits or seizures in each agegroup specified below.

Number of attacks
How many
First four weeks
1-12 months
Over 1 yr under 2
Over 2 under 3
Over 3 under 4
Over 4 years
Check whether there have been any hospital admission(s) or out-patient attendance(s) for the above, if so, make sure they are included in B.9 and B.10 respectively.
Has N ever worn or been prescribed glasses?
1
Yes - still has to wear them
2
Yes - but does not have to wear them now
3
No
0
Not known
Has N ever had a squint?
1
Yes - now
2
Yes - in past but not now
3
No, never
0
Not known
what treatment was given?
1
Medical advice - &quot;No treatment needed&quot;
2
Patch over one eye
3
Glasses
4
Eye exercises
5
Operation
6
Treatment advised, but not known what
7
Never attended for advice or treatment
0
Not known
Has N ever had a stammer or stutter or any other difficulty with speech? Stammer or stutter
1
Yes, at present - mild
2
Yes, at present - severe
3
Yes - in past but not now
4
No
0
Not known
Has N ever had a stammer or stutter or any other difficulty with speech? Other speech difficulty
1
Yes, at present - mild
2
Yes, at present - severe
3
Yes - in past but not now
4
No
0
Not known
give details
Generic text
Do people outside N's household easily understand what he/she says?
1
N's main language not English
2
All or nearly all of N's speech is understood outside immediate family
3
Some of N's speech understood outside immediate family
4
Hardly any of N's speech understood outside immediate family
5
N's speech understood only by immediate family
6
Even immediate family have difficulty in understanding N's speech
7
Other answer, namely
0
Not known if others understand N
Other
From the health visitor's knowledge, observation and from records, has N ever been diagnosed as having any congenital abnormality or suspected congenital abnormality?
1
Yes - Mongol
2
Yes - Spina bifida (meningomyelocele)
3
Yes - Hydrocephalus
4
Yes - Hare-lip
5
Yes - Cleft palate
6
Yes - Congenital heart condition (diagnosed)
7
Yes - Suspected congenital heart condition (murmur, etc)
8
Yes - Skin naevus (portwine, strawberry, etc)
9
Yes - Any other congenital abnormality, specify
0
No, none of the above
Other
please describe abnormalities
Generic text
From the health visitor's knowledge and observations, and where necessary from available records, does N have any physical or mental disability or handicap, or any other condition interfering with normal everyday life or which might be a problem at school?
1
Yes - but no real handicap
2
Yes - mild handicap
3
Yes - severe handicap
4
No disability or handicap
0
Not known
please give following details Actual diagnosis
Generic text
please give following details Effect on home or school life, if any
Generic text
indicate into which of the following categories the condition, handicap or disability falls
1
Visual defect
2
Hearing defect
3
Speech defect
4
Mental handicap or disability
5
Emotional problem
6
Motor/locomotor problem
7
Respiratory problem
8
Severe congenital condition
9
Severe aquired condition (e.g. malignancy)
0
Other condition, specify
Other
Has N's natural mother or natural father or any brothers or sisters of N's ever had any of the following? Natural mother
1
Asthma
2
Hayfever
3
Eczema
4
Late reader, i.e. not reading by 7 years
5
Poor reader or non-reader at present
6
Convulsions(s) or fit(s)
7
Bedwetting, after 5 years of age
8
Late in learning to speak
9
None of above
Has N's natural mother or natural father or any brothers or sisters of N's ever had any of the following? Natural father
1
Asthma
2
Hayfever
3
Eczema
4
Late reader, i.e. not reading by 7 years
5
Poor reader or non-reader at present
6
Convulsions(s) or fit(s)
7
Bedwetting, after 5 years of age
8
Late in learning to speak
9
None of above
Has N's natural mother or natural father or any brothers or sisters of N's ever had any of the following? Sibling(s)
1
Asthma
2
Hayfever
3
Eczema
4
Late reader, i.e. not reading by 7 years
5
Poor reader or non-reader at present
6
Convulsions(s) or fit(s)
7
Bedwetting, after 5 years of age
8
Late in learning to speak
9
None of above
10
No siblings

SECTION C TELEVISION VIEWING AND READING

Does N ever watch television at home?
1
Yes - almost every day
2
Yes - occasionally
3
No, never
0
Not known

Complete the following details of N's television viewing at home in the past seven days, by ringing all appropriate numbers for each day. Start with yesterday and go back day by day through the week.

-

1 - Morning (e.g. before 1 pm)

2 - Early afternoon (e.g. 1 pm-4 pm)

3 - Late afternoon (e.g. 4 pm-6 pm)

4 - Early evening (e.g. 6 pm-9 pm)

5 - Late evening (e.g. after 9 pm)

6 - Did not watch TV that day

0 - Not known

Mon
Tue
Wed
Thur
Fri
Sat
Sun

Give total number of hours N watched each day in the past seven days

Mon Tue Wed Thur Fri Sat Sun
How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow many How manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow manyHow