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SECTION A: YOU AND YOUR BABY
SECTION B: FEEDING
Which types of bottle milk have you used? Please indicate the brands and how long you used them for this baby.
- | If yes, for how long: | |
---|---|---|
1 - No 2 - Yes Generic text1 - No 2 - Yes Generic text |
1 - No 2 - Yes Generic text1 - No 2 - Yes Generic text |
|
SMA Gold | ||
SMA White | ||
Cow & Gate Plus | ||
Cow & Gate Premium | ||
Farley's Oster Milk | ||
Oster Milk 2 | ||
Farley's Junior | ||
Other (please describe) |
Does she have any of the following now?
- | If yes give make(s): | |
---|---|---|
1 - No 2 - Yes Generic text1 - No 2 - Yes Generic text |
1 - No 2 - Yes Generic text1 - No 2 - Yes Generic text |
|
fruit juice | ||
vitamins | ||
glucose solution | ||
cereals | ||
other |
SECTION C: SLEEPING
In what position is your baby: (tick all that apply) when she goes down for the night?
- | |
---|---|
1 - Yes |
|
Lying on her back | |
Lying on her side | |
Lying on her front |
In what position is your baby: (tick all that apply) when she wakes up?
- | |
---|---|
1 - Yes |
|
Lying on her back | |
Lying on her side | |
Lying on her front |
SECTION D: CRYING
We are interested in the pattern of your baby's crying during a day. How much does your baby cry at the following times:
- | |
---|---|
1 - Yes always 2 - Yes often 3 - Yes sometimes 4 - Hardly ever 9 - Don't know |
|
mornings | |
afternoon (before 5pm) | |
in the late afternoon/evenings (5 pm onwards) | |
during the night |
SECTION E: VOMITING AND STOOLS
SECTION F: YOUR BABY'S HEALTH
SECTION G: LOOKING AFTER YOUR BABY
SECTION H: ABOUT YOUR BABY
Babies vary a lot in how soon they do things. Nowadays, how often does your baby:
- | |
---|---|
1 - Often 2 - Sometimes 3 - Rarely 4 - Never |
|
look at your face when you feed her | |
follow you with her eyes | |
smile | |
laugh | |
squeal | |
lift her head when on her tummy | |
touch her hands together | |
startle when she hears a sound |
Below are some words used to describe babies. Please indicate how much your baby is like these descriptions.
- | |
---|---|
1 - Very like my baby 2 - Like my baby 3 - Unlike my baby 4 - Very unlike my baby 5 - Can't say |
|
placid | |
communicative | |
grizzly | |
fretful | |
demanding | |
angry | |
cuddly | |
active | |
sociable | |
withdrawn | |
stubborn | |
unresponsive | |
happy | |
alert |
My Young Baby Boy/Girl