Start
nshd_55_iwm
STRICTLY CONFIDENTIAL
OCTOBER 1955
SCHOOL NURSE'S INTERVIEW WITH MOTHER
NATIONAL SURVEY OF THE HEALTH AND DEVELOMENT OF CHILDREN
INSTITUTE OF CHILD HEALTH (UNIVERSITY OF LONDON) SOCIETY OF MEDICAL OFFICERS OF HEALTH and POPULATION INVESTIGATION COMMITTEE At the LONDON SCHOOL OF ECONOMICS

Ref No.

Generic text

Name

Generic text

Address

Generic text

School

Generic text
FOR THOSE WHO HAVE MOVED

New Address

Generic text

L.E.A.

Generic text

School

Generic text
IF THE FAMILY HAS MOVED TO ANOTHER AUTHORITY PLEASE ENTER THE NEW ADDRESS AND THE NAMES OF THE NEW L.E.A. AND NEW SCHOOL IN THE SPACE PROVIDED. IF THE CHILD CANNOT BE TRACED PLEASE ENTER THE LAST ADDRESS AND ANY OTHER INFORMATION THAT MIGHT HELP US TO TRACE HIM. IN EITHER CASE RETURN THE FORM TO WHOMEVER HAS BEEN DELEGATED BY THE SCHOOL MEDICAL OFFICER TO RECEIVE IT.
Approach to the Mother
Remind her that in previous years she gave us most valuable information about herself and her child. We now want to find out what progress her child has made during the last year. All information she gives will, of course, be ABSOLUTELY CONFIDENTIAL.
Purpose of this inquiry
This child was enrolled at birth in a national survey which is being made by a Joint Committee of the Institute of Child Health, the Society of Medical Officers of Health and the Population Investigation Committee. The purpose of the present examination is to bring the medical and social history up to date, to obtain further information about the school absences, and to check information previously noted.
They are drawn from all social classes and during the first nine years of their lives only 8% of the original sample have been lost. The value of this inquiry depends on information being obtained for every possible survey child. The Joint Committee are therefore most anxious that this form should be completed.
How to fill in this form.
Five thousand Mothers scattered all over the country are being interviewed, and it is therefore inportant that the many hundreds of Health Vistors and School Nurses who are seeing them should record their findings in a comparable way. For this reason, and also to reduce the amount of clerical work, this form has been framed as a series of questions, many of which can be answered by one of several printed alternatives. All that is required is to put a circle round the number opposite the printed answer that most nearly describes your findings. If no alternative fits please write the answer in the space directly under the question. Similarly, if you feel that any printed answer, though applicable, does not fully explain your findings, we should be most grateful for any further information you can give us.
In order to ensure that this information is obtained in the same way by the many people taking part in the survey, it is important that the wording and order of this form should be adhered to.
COMPLETED FORMS SHOULD BE RETURNED TO THE SCHOOL MEDICAL OFFICER AND NOT DIRECTLY TO THE JOINT COMMITTEE.
RING THE CODE NUMBER OPPOSITE THE MOTHER'S ANSWER. IF A QUESTION DOES NOT APPLY, STRIKE IT THROUGH.

Person interviewed.

1
Mother
*
Other, namely
Other

If mother not interviewed because she was ill, refused, etc., please give reasons.

Generic text
If this child has died, please state.

Date of death

Date of death

Cause of death (if known)

Generic text
(For all living children)

Where is his child now living ?

1
At home
2
With relatives
3
Adopted
4
Residential school
5
Ill in hospital
*
Elsewhere, namely
Other
1. ACCIDENTS

Last accident recorded. Type

Generic text

Last accident recorded. Age when injured ... yrs.

Age
(Since this accident, or since OCTOBER, 1954)

Has this child had an accident in which he was BURNT or SCALDED, BROKE A BONE, or was BADLY CUT or BRUISED ?

1
Yes
0
No
(If "yes")
qc_4_b == 1
Please give the following details about each accident starting with the earliest:
Type of injury (enter as BURN, SCALD, BROKEN BONE, CUT, etc.) Part or Parts injured Age when injured (in years and months) Treatment, Hosp. I.P., Hosp. O.P., Nursing Home, Own Home If treated in own home, who gave treatment (Doctor, Nurse, other) Details of any remaining scarring, disability or deformity
Generic textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric text Generic textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric text Generic textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric text Generic textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric text Generic textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric text Generic textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric text
First Accident 1
Second 2
Please give the following details about each accident starting with the earliest:
DETAILS of how each ACCIDENT OCCURRED (if burnt by fire, say whether electric, gas, open fire or stove) WHERE IT OCCURRED (Own Home, School, Sreet, etc.)
Generic textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric text
First Accident 1
Second 2
II. INFECTIOUS DISEASES
Please give the following information about any attacks of WHOOPING COUGH, MEASLES, MUMPS or SCARLET FEVER this child has had since OCTOBER 1954.
Age at onset (years and months) Where treated Hosp. IP Hosp. OP Nursing Home Own Home If treated in own home who gave treatment? (Doctor, Nurse, other)
Generic textAge in years and monthsGeneric textGeneric textAge in years and monthsGeneric textAge in years and monthsGeneric textGeneric text Generic textAge in years and monthsGeneric textGeneric textAge in years and monthsGeneric textAge in years and monthsGeneric textGeneric text Generic textAge in years and monthsGeneric textGeneric textAge in years and monthsGeneric textAge in years and monthsGeneric textGeneric text
Whooping Cough
Measles
Mumps
Scarlet Fever
(Attacks recorded in previous surveys are given in red.)
(For those who have had whooping cough since October 1954)
qc_5_a$1;1 != NULL

Was there any doubt that it was whooping cough ?

0
Doubtful
1
Certain

How long did the whooping cough last ? ... weeks

How many

Details of complications, if any

Generic text
III. ADMISSIONS TO HOSPITAL

Details of last Hospital Admission Recorded in this Survey. Illness

Generic text

Details of last Hospital Admission Recorded in this Survey. Hospital

Generic text

Details of last Hospital Admission Recorded in this Survey. Age

Age
(If nothing recorded there has been no admission before OCTOBER, 1954)

Has this child been an IN-PATIENT in a HOSPITAL or NURSING HOME since OCTOBER 1954.

1
Yes
0
No
(If "yes")
qc_6_b == 1
Please give the following details about each admission including any accidents or infectious diseases noted in Sections I or II.
Nature of illness Nature of operation performed (if any) Date of admission
Generic textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric text Generic textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric text Generic textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric text
1
2
Please give the following details about each admission including any accidents or infectious diseases noted in Sections I or II.
Name and Address of Hospital or Nursing Home Name of Doctor or Specialist in Charge of Child
Generic textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric text
1
2
IV. SCHOOL CLINIC AND OUT-PATIENT DEPARTMENT ATTENDANCES

Details of last Clinic Attendance Recorded in this Survey. Name of Clinic

Generic text

Details of last Clinic Attendance Recorded in this Survey. Reason for attending

Generic text

Details of last Clinic Attendance Recorded in this Survey. Age

Age

Has this child attended a School Clinic or Out-Patient Department of a Hospital since OCTOBER 1954?

1
Yes
0
No
(If "yes")
qc_7_b == 1
Please give the following details about each Clinic attended.
Name of School Clinic or Out-Patient Dept. Reason for attending Date of FIRST attendance (month and year) Date of LAST attendance (month and year) (If still attending strike through) Number of attendances Present condition

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1
2
V. SCHOOL ABSENCES
Please complete the information given below about the child's absences during the past year.
Information from School Absence Record: Period of Absence: From Information from School Absence Record: Period of Absence: To Information from School Absence Record: Reason for Absence Please give these additional details: If child was ill: Where treated Hospital I.P. Hospital O.P. Nursing Home Own Home Please give these additional details: If child was ill: If treated at home who gave treatment? (Doctor Chemist Nurse, Other) Please give these additional details: Remarks
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
1
2
3
VI. BED WETTING

Is the child now dry by day ?

0
Never wet
1
Sometimes wet

Is the child now dry by night ?

0
Never wet
1
Wet occasionally
2
Wet several nights a week
3
Wet every night
(If "wet")
qc_9_a == 1 || (qc_9_b >= 1 && qc_9_b <= 3)

How are you trying to get him dry ?

Generic text
VII. GENERAL HEALTH AND BEHAVIOUR

Are you in any way worried about this child's health?

1
Yes
0
No
(If "yes")
qc_10_a == 1

Please give your reasons for worrying

Generic text

Are you in any way worried about this child's behaviour?

1
Yes
0
No
(If "yes")
qc_11_a == 1

Please give your reasons for worrying

Generic text

Are you in any way worried about this child's progress at school?

1
Yes
0
No
(If "yes")
qc_12_a == 1

Please give your reasons for worrying.

Generic text

Does this child have difficulties in his relations with his brothers and sisters ?

1
Yes
0
No
y
No brothers or sisters
(If "yes")
qc_13_a == 1

What are these difficulties ?

Generic text

Does this child have difficulties in his relations with other children at school ?

1
Yes
0
No
x
Don't know
(If "yes")
qc_14_a == 1

What are these difficulties ?

Generic text
VIII. THE MOTHER'S WORK

Have you been in paid work (either inside or outside the home) since OCTOBER, 1954

1
Yes
0
No
(If "yes")
qc_15_a == 1
Please give the following details of each period of employment.
Exact nature of work No. of days worked per week Time of leaving home Time of getting back home Date of taking job Date of leaving job
Days per weekGeneric textGeneric timeGeneric timeGeneric dateGeneric dateGeneric textGeneric timeGeneric dateDays per weekGeneric timeGeneric dateGeneric dateGeneric dateGeneric timeGeneric timeDays per weekGeneric textGeneric timeGeneric textGeneric timeGeneric dateGeneric dateDays per weekDays per weekGeneric dateGeneric textGeneric timeGeneric timeGeneric dateGeneric timeGeneric timeGeneric dateGeneric dateGeneric textDays per week Days per weekGeneric textGeneric timeGeneric timeGeneric dateGeneric dateGeneric textGeneric timeGeneric dateDays per weekGeneric timeGeneric dateGeneric dateGeneric dateGeneric timeGeneric timeDays per weekGeneric textGeneric timeGeneric textGeneric timeGeneric dateGeneric dateDays per weekDays per weekGeneric dateGeneric textGeneric timeGeneric timeGeneric dateGeneric timeGeneric timeGeneric dateGeneric dateGeneric textDays per week Days per weekGeneric textGeneric timeGeneric timeGeneric dateGeneric dateGeneric textGeneric timeGeneric dateDays per weekGeneric timeGeneric dateGeneric dateGeneric dateGeneric timeGeneric timeDays per weekGeneric textGeneric timeGeneric textGeneric timeGeneric dateGeneric dateDays per weekDays per weekGeneric dateGeneric textGeneric timeGeneric timeGeneric dateGeneric timeGeneric timeGeneric dateGeneric dateGeneric textDays per week Days per weekGeneric textGeneric timeGeneric timeGeneric dateGeneric dateGeneric textGeneric timeGeneric dateDays per weekGeneric timeGeneric dateGeneric dateGeneric dateGeneric timeGeneric timeDays per weekGeneric textGeneric timeGeneric textGeneric timeGeneric dateGeneric dateDays per weekDays per weekGeneric dateGeneric textGeneric timeGeneric timeGeneric dateGeneric timeGeneric timeGeneric dateGeneric dateGeneric textDays per week Days per weekGeneric textGeneric timeGeneric timeGeneric dateGeneric dateGeneric textGeneric timeGeneric dateDays per weekGeneric timeGeneric dateGeneric dateGeneric dateGeneric timeGeneric timeDays per weekGeneric textGeneric timeGeneric textGeneric timeGeneric dateGeneric dateDays per weekDays per weekGeneric dateGeneric textGeneric timeGeneric timeGeneric dateGeneric timeGeneric timeGeneric dateGeneric dateGeneric textDays per week Days per weekGeneric textGeneric timeGeneric timeGeneric dateGeneric dateGeneric textGeneric timeGeneric dateDays per weekGeneric timeGeneric dateGeneric dateGeneric dateGeneric timeGeneric timeDays per weekGeneric textGeneric timeGeneric textGeneric timeGeneric dateGeneric dateDays per weekDays per weekGeneric dateGeneric textGeneric timeGeneric timeGeneric dateGeneric timeGeneric timeGeneric dateGeneric dateGeneric textDays per week
1
2
3
(The last emloyment recorded in this survey is entered in red)

Who looks after this child when he comes home from school ?

1
Mother
2
Father
3
Other children
4
Grandparent
5
Other person, namely
0
No one
Other
IX. SCHOOLNG

During the last year have you or your husband met this child's class teacher or head teacher ?

3
Yes, both
1
Yes, class teacher
2
Yes, head teacher
0
Neither
(If "yes")
qc_16_a >= 1 && qc_16_a <= 3

Did you discuss this child's school progress with either or both of them ?

3
Yes, with both
1
Yes, with class teacher
2
Yes, with head teacher
0
No

In October 1954, you said you would like your child to go to ... School.

Generic text

Do you still wish him to go there ?

1
Yes
0
No
(If "no")
qc_17_a_i == 0

Where would you now like him to go ?

1
Grammar
2
Secondary Modern
3
Technical
4
Fee-paying
x
Do not know
(If "no" to question 17 (a))

Please give the name of the school if decided upon.

Generic text

Why have you changed your mind since last year ?

Generic text

Last October you had not yet chosen the school you wanted your child to attend. Have you done so now ?

1
Yes
0
No
(If "yes")
qc_18_a == 1

What type of school is it ?

1
Grammar
2
Secondary Modern
3
Technical
4
Fee-paying
x
Do not know

Please give the name of the school, if decided upon.

Generic text
  1. CHECK ON PAST INFORMATION This year we have asked fewer questions than in previous years because we wish to take the opportunity to inquire about special conditions that have been reported in earlier surveys, and to clear up any outstanding points. Please check carefully with the mother the details given below and supply the additional information asked for if at all possible.
Long text
INFORMATION GIVEN BY SCHOOL NURSE OR HEALTH VISITOR
(Please answer the following questions from your own knowledge. DO NOT ask the mother directly)

Please state from your OWN KNOWLEDGE whether the parents of this child are-

1
Married & living together
2
Legally separated
3
Divorced
4
Permanently separated for other reasons
5
Widowed
*
Other, namely
Other

Are this child's shoes in a satisfactory or unsatisfactory state of repair ?

1
Satisfactory
0
Unsatisfactory

Is this child's clothing in a satisfactory or unsatisfactory state of repair ?

1
Satisfactory
0
Unsatisfactory

Please compare (c) the cleanliness of this child and (d) the cleanliness of this home with the standard of others in your care. Cleanliness of the child

1
Average
2
Among the most clean
3
Among the least clean

Please compare (c) the cleanliness of this child and (d) the cleanliness of this home with the standard of others in your care. Cleanliness of the home

1
Average
2
Among the most clean
3
Among the least clean

Please comment on any lack of facilities in the home (for example, shared W.C., Bathroom, etc., lack of running hot water, dampness or condensation, lack of services such as electricity, gas, water).

Long text

Please comment on any circumstances in the family that may be relevant to the child's growth and health.

Long text

Date of interview

Generic date

Length of interview ... mins.

How many

Name of School Nurse or Health Visitor

Generic text
End

nshd_55_iwm

STRICTLY CONFIDENTIAL
OCTOBER 1955
SCHOOL NURSE'S INTERVIEW WITH MOTHER
NATIONAL SURVEY OF THE HEALTH AND DEVELOMENT OF CHILDREN
INSTITUTE OF CHILD HEALTH (UNIVERSITY OF LONDON) SOCIETY OF MEDICAL OFFICERS OF HEALTH and POPULATION INVESTIGATION COMMITTEE At the LONDON SCHOOL OF ECONOMICS
Ref No.
Generic text
Name
Generic text
Address
Generic text
School
Generic text

FOR THOSE WHO HAVE MOVED

New Address
Generic text
L.E.A.
Generic text
School
Generic text
IF THE FAMILY HAS MOVED TO ANOTHER AUTHORITY PLEASE ENTER THE NEW ADDRESS AND THE NAMES OF THE NEW L.E.A. AND NEW SCHOOL IN THE SPACE PROVIDED. IF THE CHILD CANNOT BE TRACED PLEASE ENTER THE LAST ADDRESS AND ANY OTHER INFORMATION THAT MIGHT HELP US TO TRACE HIM. IN EITHER CASE RETURN THE FORM TO WHOMEVER HAS BEEN DELEGATED BY THE SCHOOL MEDICAL OFFICER TO RECEIVE IT.
Approach to the Mother
Remind her that in previous years she gave us most valuable information about herself and her child. We now want to find out what progress her child has made during the last year. All information she gives will, of course, be ABSOLUTELY CONFIDENTIAL.
Purpose of this inquiry
This child was enrolled at birth in a national survey which is being made by a Joint Committee of the Institute of Child Health, the Society of Medical Officers of Health and the Population Investigation Committee. The purpose of the present examination is to bring the medical and social history up to date, to obtain further information about the school absences, and to check information previously noted.
They are drawn from all social classes and during the first nine years of their lives only 8% of the original sample have been lost. The value of this inquiry depends on information being obtained for every possible survey child. The Joint Committee are therefore most anxious that this form should be completed.
How to fill in this form.
Five thousand Mothers scattered all over the country are being interviewed, and it is therefore inportant that the many hundreds of Health Vistors and School Nurses who are seeing them should record their findings in a comparable way. For this reason, and also to reduce the amount of clerical work, this form has been framed as a series of questions, many of which can be answered by one of several printed alternatives. All that is required is to put a circle round the number opposite the printed answer that most nearly describes your findings. If no alternative fits please write the answer in the space directly under the question. Similarly, if you feel that any printed answer, though applicable, does not fully explain your findings, we should be most grateful for any further information you can give us.
In order to ensure that this information is obtained in the same way by the many people taking part in the survey, it is important that the wording and order of this form should be adhered to.
COMPLETED FORMS SHOULD BE RETURNED TO THE SCHOOL MEDICAL OFFICER AND NOT DIRECTLY TO THE JOINT COMMITTEE.
RING THE CODE NUMBER OPPOSITE THE MOTHER'S ANSWER. IF A QUESTION DOES NOT APPLY, STRIKE IT THROUGH.
Person interviewed.
1
Mother
*
Other, namely
Other
If mother not interviewed because she was ill, refused, etc., please give reasons.
Generic text
Date of death
Date of death
Cause of death (if known)
Generic text
(For all living children)
Where is his child now living ?
1
At home
2
With relatives
3
Adopted
4
Residential school
5
Ill in hospital
*
Elsewhere, namely
Other

1. ACCIDENTS

Last accident recorded. Type
Generic text
Last accident recorded. Age when injured ... yrs.
Age
(Since this accident, or since OCTOBER, 1954)
Has this child had an accident in which he was BURNT or SCALDED, BROKE A BONE, or was BADLY CUT or BRUISED ?
1
Yes
0
No

Please give the following details about each accident starting with the earliest:

Type of injury (enter as BURN, SCALD, BROKEN BONE, CUT, etc.) Part or Parts injured Age when injured (in years and months) Treatment, Hosp. I.P., Hosp. O.P., Nursing Home, Own Home If treated in own home, who gave treatment (Doctor, Nurse, other) Details of any remaining scarring, disability or deformity
Generic textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric text Generic textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric text Generic textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric text Generic textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric text Generic textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric text Generic textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textAge in years and monthsGeneric textGeneric textGeneric textGeneric text
First Accident 1
Second 2

Please give the following details about each accident starting with the earliest:

DETAILS of how each ACCIDENT OCCURRED (if burnt by fire, say whether electric, gas, open fire or stove) WHERE IT OCCURRED (Own Home, School, Sreet, etc.)
Generic textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric text
First Accident 1
Second 2

II. INFECTIOUS DISEASES

Please give the following information about any attacks of WHOOPING COUGH, MEASLES, MUMPS or SCARLET FEVER this child has had since OCTOBER 1954.

Age at onset (years and months) Where treated Hosp. IP Hosp. OP Nursing Home Own Home If treated in own home who gave treatment? (Doctor, Nurse, other)
Generic textAge in years and monthsGeneric textGeneric textAge in years and monthsGeneric textAge in years and monthsGeneric textGeneric text Generic textAge in years and monthsGeneric textGeneric textAge in years and monthsGeneric textAge in years and monthsGeneric textGeneric text Generic textAge in years and monthsGeneric textGeneric textAge in years and monthsGeneric textAge in years and monthsGeneric textGeneric text
Whooping Cough
Measles
Mumps
Scarlet Fever
(Attacks recorded in previous surveys are given in red.)
Was there any doubt that it was whooping cough ?
0
Doubtful
1
Certain
How long did the whooping cough last ? ... weeks
How many
Details of complications, if any
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III. ADMISSIONS TO HOSPITAL

Details of last Hospital Admission Recorded in this Survey. Illness
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Details of last Hospital Admission Recorded in this Survey. Hospital
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Details of last Hospital Admission Recorded in this Survey. Age
Age
(If nothing recorded there has been no admission before OCTOBER, 1954)
Has this child been an IN-PATIENT in a HOSPITAL or NURSING HOME since OCTOBER 1954.
1
Yes
0
No

Please give the following details about each admission including any accidents or infectious diseases noted in Sections I or II.

Nature of illness Nature of operation performed (if any) Date of admission
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1
2

Please give the following details about each admission including any accidents or infectious diseases noted in Sections I or II.

Name and Address of Hospital or Nursing Home Name of Doctor or Specialist in Charge of Child
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1
2

IV. SCHOOL CLINIC AND OUT-PATIENT DEPARTMENT ATTENDANCES

Details of last Clinic Attendance Recorded in this Survey. Name of Clinic
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Details of last Clinic Attendance Recorded in this Survey. Reason for attending
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Details of last Clinic Attendance Recorded in this Survey. Age
Age
Has this child attended a School Clinic or Out-Patient Department of a Hospital since OCTOBER 1954?
1
Yes
0
No

Please give the following details about each Clinic attended.

Name of School Clinic or Out-Patient Dept. Reason for attending Date of FIRST attendance (month and year) Date of LAST attendance (month and year) (If still attending strike through) Number of attendances Present condition

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textGeneric textGeneric dateGeneric dateHow manyGeneric textGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic textGeneric dateGeneric dateGeneric dateGeneric textGeneric text

1 - cured

2 - improved

3 - unchanged

4 - worse

How manyGeneric textHow manyGeneric textGeneric dateGeneric date

1 - cured

2 - improved

3 - unchanged

4 - worse

1 - cured

2 - improved

3 - unchanged

4 - worse

Generic dateHow manyGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric dateHow many

1 - cured

2 - improved

3 - unchanged

4 - worse

1
2

V. SCHOOL ABSENCES

Please complete the information given below about the child's absences during the past year.

Information from School Absence Record: Period of Absence: From Information from School Absence Record: Period of Absence: To Information from School Absence Record: Reason for Absence Please give these additional details: If child was ill: Where treated Hospital I.P. Hospital O.P. Nursing Home Own Home Please give these additional details: If child was ill: If treated at home who gave treatment? (Doctor Chemist Nurse, Other) Please give these additional details: Remarks
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1
2
3

VI. BED WETTING

Is the child now dry by day ?
0
Never wet
1
Sometimes wet
Is the child now dry by night ?
0
Never wet
1
Wet occasionally
2
Wet several nights a week
3
Wet every night
How are you trying to get him dry ?
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VII. GENERAL HEALTH AND BEHAVIOUR

Are you in any way worried about this child's health?
1
Yes
0
No
Please give your reasons for worrying
Generic text
Are you in any way worried about this child's behaviour?
1
Yes
0
No
Please give your reasons for worrying
Generic text
Are you in any way worried about this child's progress at school?
1
Yes
0
No
Please give your reasons for worrying.
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Does this child have difficulties in his relations with his brothers and sisters ?
1
Yes
0
No
y
No brothers or sisters
What are these difficulties ?
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Does this child have difficulties in his relations with other children at school ?
1
Yes
0
No
x
Don't know
What are these difficulties ?
Generic text

VIII. THE MOTHER'S WORK

Have you been in paid work (either inside or outside the home) since OCTOBER, 1954
1
Yes
0
No

Please give the following details of each period of employment.

Exact nature of work No. of days worked per week Time of leaving home Time of getting back home Date of taking job Date of leaving job
Days per weekGeneric textGeneric timeGeneric timeGeneric dateGeneric dateGeneric textGeneric timeGeneric dateDays per weekGeneric timeGeneric dateGeneric dateGeneric dateGeneric timeGeneric timeDays per weekGeneric textGeneric timeGeneric textGeneric timeGeneric dateGeneric dateDays per weekDays per weekGeneric dateGeneric textGeneric timeGeneric timeGeneric dateGeneric timeGeneric timeGeneric dateGeneric dateGeneric textDays per week Days per weekGeneric textGeneric timeGeneric timeGeneric dateGeneric dateGeneric textGeneric timeGeneric dateDays per weekGeneric timeGeneric dateGeneric dateGeneric dateGeneric timeGeneric timeDays per weekGeneric textGeneric timeGeneric textGeneric timeGeneric dateGeneric dateDays per weekDays per weekGeneric dateGeneric textGeneric timeGeneric timeGeneric dateGeneric timeGeneric timeGeneric dateGeneric dateGeneric textDays per week Days per weekGeneric textGeneric timeGeneric timeGeneric dateGeneric dateGeneric textGeneric timeGeneric dateDays per weekGeneric timeGeneric dateGeneric dateGeneric dateGeneric timeGeneric timeDays per weekGeneric textGeneric timeGeneric textGeneric timeGeneric dateGeneric dateDays per weekDays per weekGeneric dateGeneric textGeneric timeGeneric timeGeneric dateGeneric timeGeneric timeGeneric dateGeneric dateGeneric textDays per week Days per weekGeneric textGeneric timeGeneric timeGeneric dateGeneric dateGeneric textGeneric timeGeneric dateDays per weekGeneric timeGeneric dateGeneric dateGeneric dateGeneric timeGeneric timeDays per weekGeneric textGeneric timeGeneric textGeneric timeGeneric dateGeneric dateDays per weekDays per weekGeneric dateGeneric textGeneric timeGeneric timeGeneric dateGeneric timeGeneric timeGeneric dateGeneric dateGeneric textDays per week Days per weekGeneric textGeneric timeGeneric timeGeneric dateGeneric dateGeneric textGeneric timeGeneric dateDays per weekGeneric timeGeneric dateGeneric dateGeneric dateGeneric timeGeneric timeDays per weekGeneric textGeneric timeGeneric textGeneric timeGeneric dateGeneric dateDays per weekDays per weekGeneric dateGeneric textGeneric timeGeneric timeGeneric dateGeneric timeGeneric timeGeneric dateGeneric dateGeneric textDays per week Days per weekGeneric textGeneric timeGeneric timeGeneric dateGeneric dateGeneric textGeneric timeGeneric dateDays per weekGeneric timeGeneric dateGeneric dateGeneric dateGeneric timeGeneric timeDays per weekGeneric textGeneric timeGeneric textGeneric timeGeneric dateGeneric dateDays per weekDays per weekGeneric dateGeneric textGeneric timeGeneric timeGeneric dateGeneric timeGeneric timeGeneric dateGeneric dateGeneric textDays per week
1
2
3
(The last emloyment recorded in this survey is entered in red)
Who looks after this child when he comes home from school ?
1
Mother
2
Father
3
Other children
4
Grandparent
5
Other person, namely
0
No one
Other

IX. SCHOOLNG

During the last year have you or your husband met this child's class teacher or head teacher ?
3
Yes, both
1
Yes, class teacher
2
Yes, head teacher
0
Neither
Did you discuss this child's school progress with either or both of them ?
3
Yes, with both
1
Yes, with class teacher
2
Yes, with head teacher
0
No
In October 1954, you said you would like your child to go to ... School.
Generic text
Do you still wish him to go there ?
1
Yes
0
No
Where would you now like him to go ?
1
Grammar
2
Secondary Modern
3
Technical
4
Fee-paying
x
Do not know
(If "no" to question 17 (a))
Please give the name of the school if decided upon.
Generic text
Why have you changed your mind since last year ?
Generic text
Last October you had not yet chosen the school you wanted your child to attend. Have you done so now ?
1
Yes
0
No
What type of school is it ?
1
Grammar
2
Secondary Modern
3
Technical
4
Fee-paying
x
Do not know
Please give the name of the school, if decided upon.
Generic text
X. CHECK ON PAST INFORMATION This year we have asked fewer questions than in previous years because we wish to take the opportunity to inquire about special conditions that have been reported in earlier surveys, and to clear up any outstanding points. Please check carefully with the mother the details given below and supply the additional information asked for if at all possible.
Long text

INFORMATION GIVEN BY SCHOOL NURSE OR HEALTH VISITOR

(Please answer the following questions from your own knowledge. DO NOT ask the mother directly)
Please state from your OWN KNOWLEDGE whether the parents of this child are-
1
Married & living together
2
Legally separated
3
Divorced
4
Permanently separated for other reasons
5
Widowed
*
Other, namely
Other
Are this child's shoes in a satisfactory or unsatisfactory state of repair ?
1
Satisfactory
0
Unsatisfactory
Is this child's clothing in a satisfactory or unsatisfactory state of repair ?
1
Satisfactory
0
Unsatisfactory
Please compare (c) the cleanliness of this child and (d) the cleanliness of this home with the standard of others in your care. Cleanliness of the child
1
Average
2
Among the most clean
3
Among the least clean
Please compare (c) the cleanliness of this child and (d) the cleanliness of this home with the standard of others in your care. Cleanliness of the home
1
Average
2
Among the most clean
3
Among the least clean
Please comment on any lack of facilities in the home (for example, shared W.C., Bathroom, etc., lack of running hot water, dampness or condensation, lack of services such as electricity, gas, water).
Long text
Please comment on any circumstances in the family that may be relevant to the child's growth and health.
Long text
Date of interview
Generic date
Length of interview ... mins.
How many
Name of School Nurse or Health Visitor
Generic text
Name

1955 School Nurse's Interview with Mother