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MY LITTLE BOY
Children grow so quickly, and change so much. This questionnaire asks about any accidents or problems your son may have had now that he is two years old, what he has been eating and drinking, his temperament and the way he may be beginning to understand the world about him.
It is like the other questionnaires you have received. To answer simply tick the box which best describes your son or his situation. Again some questions will seem similar but they are not the same. Please answer all questions that you can. If you cannot answer a question or if it does not apply to you please put a line through it. There are no right or wrong answers. Please just describe what happens in your situation. You may make additional comments at the end. All answers are confidential.
THANK YOU FOR YOUR HELP
SECTION A: YOU AND YOUR SON
When you are at home with your child, how often do you do the following:
-

1 - Every day

2 - Several times a week

3 - About once a week

4 - Rarely

5 - Never

Let him play with paints, mud or other messy objects
Let him use objects to build towers or other creations
Sing to him
Read him stories
Praise him for something he has done
Kiss or cuddle him
Shout at him
Slap him
Go out to a park or playground with him
Have a meal together with him
Let him make a lot of noise (banging saucepans, singing etc)
SECTION B: PLAY THINGS
How many of the following does your child have at home that he can look at or play with?
-

1 - None

2 - One

3 - 2-3

4 - 4 or more

Cuddly animals
Dolls
A swing
Toy cars or lorries
Jigsaw puzzles
Mobiles
Building bricks or blocks
Books
Balls
A walker (that he puts things in and pushes)
The other sort of baby walker that he sits in and walks
Toys where he has to fit things together

Do you have a special place (box, drawer, bag) for his toys which he can go to and choose what he wants to play with?

1
Special place but he is not able to get at it himself
2
Special place and he gets what he wants from it
3
No special place
SECTION C: ACCIDENTS AND INJURIES
However careful a parent is, most children have accidents at sometime or other. Please list on the next pages the times your child has had an accident whether or not he was injured as a result.

Has he been burnt or scalded since he was 15 months old?

1
Yes
2
No
If no, go to C2a on page 7
If yes,
qc_C1_a == 1

how many times?

How many
For each burn or scald please describe below what happened:
Place accident happened (eg. kitchen, garden, creche) What was he burnt with? (e.g tea, iron, electric fire) Date of accident (month, year) Injuries caused (if no injury write none) Who was with him? What did the person with him do? Other (please describe) What treatment did the person with him give? What other treatment did he have?
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
1st accident
2nd accident
3rd accident

Please describe how each accident happened: Burn 1

Generic text

Please describe how each accident happened: Burn 2

Generic text

Please describe how each accident happened: Burn 3

Generic text

Has he been dropped or had a bad fall since he was 15 months old?

1
Yes
2
No
If no, go to C3a on page 8
If yes,
qc_C2_a == 1

how many times?

How many
For each fall please describe below what happened.
Place accident happened (eg. kitchen, garden, creche) What did he fall or drop from (eg. table, baby walker, pram, bed, your arms) Date of fall (month, year) Injuries caused (if no injury write none) Who was with him? What did the person with him do? Other (please describe) What treatment did the person with him give? What other treatment did he have?
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
1st accident
2nd accident
3rd accident

Please describe how each accident happened: Fall 1

Generic text

Please describe how each accident happened: Fall 2

Generic text

Please describe how each accident happened: Fall 3

Generic text

Has he swallowed anything he shouldn't have (such as pills, buttons, disinfectant) since he was 15 months old?

1
Yes
2
No
If no, go to C4a on page 9
If yes,
qc_C3_a == 1

how many times?

How many
For each time please describe below what happened.
Place accident happened (eg. your home, nursery, at friend's) What did he swallow? Date of accident (month, year) Who was with him? What did the person with him do? Other (please describe) What treatment did the person with him give? What other treatment did he have?
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
1st accident
2nd accident
3rd accident

Please describe how each accident happened: Accident 1

Generic text

Please describe how each accident happened: Accident 2

Generic text

Please describe how each accident happened: Accident 3

Generic text

Has he had any other accidents or injuries since he was 15 months old?

1
Yes
2
No
If no, go to C5a on page 10
If yes,
qc_C4_a == 1

how many other accidents?

How many
For each accident or injury please describe below what happened.
Place accident happened (eg. kitchen, garden, creche) What happened? Date of accident (month, year) Injuries caused (if no injury write none) Who was with him? What did the person with him do? Other (please describe) What treatment did the person with him give? What other treatment did he have?
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
1st accident
2nd accident
3rd accident

Please describe how each accident happened: Accident 1

Generic text

Please describe how each accident happened: Accident 2

Generic text

Please describe how each accident happened: Accident 3

Generic text

Has your son ever had an accident that has left him with a scar, a physical disability or a behaviour or psychological problem?

1
Yes
2
No
If no, go to Section D on page 11
If yes,
qc_C5_a == 1

is there a scar?

1
Yes
2
No
If no, go to c) below
If yes,
qc_C5_b == 1

please describe where this is, and how he got it:

Generic text

is there a physical disability?

1
Yes
2
No
If no, go to d) below
If yes,
qc_C5_c == 1

please describe this and how he got it:

Generic text

did he develop a behaviour or psychological problem after an accident?

1
Yes
2
No
If no, go to Section D on page 11
If yes,
qc_C5_d == 1

please describe this, and whether he still has this problem.

Generic text
SECTION D: PROBLEMS AND TREATMENT
Children often have accidents or illnesses that need treatment. Please indicate which of the following have been given to your child since he was 15 months old.
- If yes, please give full names of substances if you can

1 - No

2 - Yes for one episode only

3 - Yes for 2 or more episodes

Generic text

1 - No

2 - Yes for one episode only

3 - Yes for 2 or more episodes

Generic text

1 - No

2 - Yes for one episode only

3 - Yes for 2 or more episodes

Generic text

1 - No

2 - Yes for one episode only

3 - Yes for 2 or more episodes

Generic text
cough medicine
antibiotics/ penicillin
throat medicine
vitamins
paracetamol/ Calpol
ointment for skin
eye ointment
diarrhoea mixture or pills
dimotapp/ decongestant
ear drops
eye drops
teething gel
laxative
other (please describe)

Children often have accidents or illnesses that need treatment. Please indicate which of the following have been given to your child since he was 15 months old. other (please describe)

Other

Are there any pills, ointments or medicines that he has taken every day or nearly every day for the last 3 months? (Include vitamins, skin cream, laxatives as well as antibiotics, etc)

1
Yes
2
No
If no, go to D3 below
If yes,
qc_D2_a == 1

please describe:

Generic text

Has he been investigated since he was 15 months old by a specialist clinic or a hospital doctor?

1
Yes
2
No
If no go to D4 below
If yes, please describe:
qc_D3 == 1

the problem investigated:

Generic text

where was this done?

Generic text

what was decided? (write SBI if he is still being investigated)

Generic text

please describe any treatment he was given.

Generic text

Has he ever been given glasses to wear?

1
Yes
2
No
If no, go to D5 on page 13
If yes,
qc_D4 == 1

does this cause any problems?

1
Yes
2
No
If no, go to D5 on page 13
If yes,
qc_D4_i == 1

please describe:

Generic text

Has he been given a hearing aid to wear?

1
Yes
2
No
If no, go to D6 below
If yes,
qc_D5 == 1

does this cause any problems?

1
Yes
2
No
If no, go to D6 below
If yes,
qc_D5_i == 1

please describe:

Generic text

Has he ever had a seizure, a fit or a convulsion?

1
Yes
2
No
If no, go to Section E on page 15
If yes,
qc_D6 == 1

how many has he had?

How many

did any of them last more than 15 minutes?

1
Yes
2
No
3
can't say

did his body shake and jerk on just one side?

1
Yes right side
2
Yes, left side
3
No, it was all over
4
can't say

did he have a fever at the time?

1
Yes, each time (or only time)
2
Yes, but not each time
3
No
If no, go to D6e on page 14
If yes,
qc_D6_d == 1 || qc_D6_d == 2

how high was his temperature?

(put NK if you don't know)

Generic text

what was the cause of the fever(s)?

Generic text

did he have more than one episode of fitting during any feverish illness?

1
Yes
2
No

were you given any medicine to give him?

1
Yes
2
No
If no, go to D6f below
If yes,
qc_D6_e == 1

what was this?

Generic text

for how long did you give it?

Generic text

Do you feel that you have been given enough information about his fits or seizures? Space for comments

1
Yes
2
No
Generic text

When the first fit or convulsion happened how old was he? ... months

Age in months

When the first fit or convulsion happened what time of day was it?

Generic text

When the first fit or convulsion happened who was there at the time?

Generic text

When the first fit or convulsion happened what did they do?

Generic text

Have there been any warning signs before he had a fit or convulsion?

1
Yes
2
No
If no, go to Section E on page 15
If yes,
qc_D6_h == 1

please describe:

Generic text
SECTION E: YOUR INFANT AND HIS ENVIRONMENT

How many teeth has he got now?

How many

Do you use a toothbrush to clean his teeth?

1
yes, every day
2
yes, sometimes
3
no not at all

Does he ever have toothpaste?

1
Yes
2
No
If no, go to E2 below
If yes,
qc_E1_c == 1

how old was he when you started using toothpaste? ... months

Age in months

how much do you put on his brush nowadays?

1
brush full
2
half brush full
3
less than half a brush full
4
none

how many times a week do you do this? ... times

How many

does he swallow it or spit it out?

1
swallows it
2
spits it out
3
varies

what type of toothpaste is usually used: (please give exact name and brand)

Generic text

All children get dirty. How often in a normal day: is his face washed?

1
not at all
2
1-2 times
3
3-4 times
4
5 or more times

All children get dirty. How often in a normal day: are his hands washed or wiped?

1
not at all
2
1-2 times
3
3-4 times
4
5 or more times

All children get dirty. How often in a normal day: are his hands cleaned before a meal?

1
always
2
usually
3
sometimes
4
occasionally
5
never

How often does he usually: have a bath or shower:

1
more than once a day
2
once every day
3
several times a week
4
once a week
5
hardly ever

How often does he usually: have his ear holes cleaned:

1
more than once a day
2
once every day
3
several times a week
4
once a week
5
never or hardly ever

What do you think about toilet training for him?

1
It is too early to start any toilet training yet
2
I have just started toilet training
3
I have been toilet training for some time
If I have been toilet training for some time to question E4
qc_E4 == 3

give age you started training ... months

Age in months

Is he: dry during the day

1
Always
2
Sometimes
3
Never

Is he: dry during the night

1
Always
2
Sometimes
3
Never

Is he: clean during the day

1
Always
2
Sometimes
3
Never

Is he: clean during the night

1
Always
2
Sometimes
3
Never

Please indicate how often during the day he is in a room or enclosed place where people are smoking: Weekdays

1
all the time
2
more than 5 hours
3
3 - 5 hours
4
1 - 2 hours
5
less than 1 hour
6
not at all

Please indicate how often during the day he is in a room or enclosed place where people are smoking: Weekends

1
all the time
2
more than 5 hours
3
3 - 5 hours
4
1 - 2 hours
5
less than 1 hour
6
not at all
Which pets is he in contact with at least once a week either in your home or elsewhere?
-

1 - Yes

2 - No

cat(s)
dog(s)
other furry pet*(s)
other pet*(s)

Which pets is he in contact with at least once a week either in your home or elsewhere? *please describe

Generic text
INDOORS AND OUTDOORS

How many hours in a normal week would you say your child spends out of doors (assuming the weather is reasonable) - please include time spent playing, going to shops, etc.

1
not at all
2
1-2 hours
3
3-6 hours
4
7-13 hours
5
14-20 hours
6
21 hours or more

When he is out of doors, how much time in a week is he by a busy road? ... hours a week

(If less than 1 hour put 97. If none put 00)

Hours per week

How many hours in a normal week does he spend in a car?

1
not at all
2
less than 3 hours
3
3-6 hours
4
7-13 hours
5
14-20 hours
6
21 hours or more
SECTION F: FEEDING

For the main meal of the day does he eat: His main meal: the same food as you

1
Always
2
Almost always
3
Sometimes
4
Almost never
5
Never

For the main meal of the day does he eat: His main meal: a different meal to you

1
Always
2
Almost always
3
Sometimes
4
Almost never
5
Never

Do you feel that you have had difficulties feeding him in the past 9 months?

1
Yes, great difficulty
2
Yes, some difficulty
3
Yes, occasional difficulty
4
No, no difficulty

Does he feed himself?

1
Yes usually
2
Yes sometimes
3
No not at all
Since he was 15 months old has he at any time:
-

1 - Yes, worried me greatly

2 - Yes, worried me a bit

3 - Yes, but did not worry me

4 - No, did not happen

not eaten sufficient amount of food
refused to eat the right food
been choosy with food
over-eaten
been difficult to get into an eating routine
Since he was 15 months old has he had any of the following:
- How often nowadays (Put 00 if no longer happens) ... times a week

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many
baby milk (formula)
follow-on milk
soya formula
hypo-allergenic formula
goats' milk
breast milk
soya milk
ordinary cows' milk
other milk

when he has cows' milk is it mostly:

1
whole
2
semi-skimmed
3
or skimmed
4
never has cows' milk
Since he was 15 months old has he had:
- How often nowadays (Put 00 if no longer happens) ... times a month

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many
baby rice
other baby cereal
breakfast cereal
rusks
bread or toast
biscuits
Since he was 15 months old has he had any of the following prepared baby foods, toddler foods or junior foods (from jar, tin or packet)?
- How often nowadays (Put 00 if no longer happens) ... times a month

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many
savoury - meat
savoury - fish
savoury - vegetable
baby fruit dessert or pudding
baby milk dessert or pudding
Since he was 15 months old has he eaten any of these other foods (not bought baby or toddler foods)
- How often nowadays (Put 00 if no longer happens) ... times a month

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many
egg
cheese
meat or meat products
fish or fish products
potatoes
other vegetables
fruit puddings
milk puddings
Since he was 15 months old has he had:
- How often nowadays (Put 00 if no longer happens) ... times a week

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many
coca cola or pepsi
other fizzy drink
apple juice
blackcurrant juice or rosehip syrup
other fruit juice
a little alcohol
any other fruit drink (e.g. orange squash)
herbal drink (please describe)
gripe water
tea
coffee
sports drinks (eg. Lucozade sport, Dexters) (please describe)
milky chocolate drink
other flavoured milk drink (please describe)

Since he was 15 months old has he had: herbal drink (please describe)

Generic text

Since he was 15 months old has he had: sports drinks (eg. Lucozade sport, Dexters) (please describe)

Generic text

Since he was 15 months old has he had: other flavoured milk drink (please describe)

Other

Which type of these drinks does your child have nowadays?(tick all that apply) tea

1
decaffeinated
2
weak
4
strong
6
does not like
7
does not have

Which type of these drinks does your child have nowadays?(tick all that apply) coffee

1
decaffeinated
2
weak
4
strong
6
does not like
7
does not have

Which type of these drinks does your child have nowadays?(tick all that apply) cola

1
decaffeinated
2
ordinary
4
diet
6
does not like
7
does not have

Which type of these drinks does your child have nowadays?(tick all that apply) other soft drinks

2
ordinary
4
diet
6
does not like
7
does not have
Since he was 15 months old, has your child had the following, whether in baby foods or elsewhere:
- How often nowadays (Put 00 if less than once a month) ... times a month

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many
Packet soup
Canned soup
Liver/liver pate
Kidney
Shellfish (eg.prawns mussels, cockles)
Baked beans
Green peas
Other legumes (eg. lentils, chick peas, red kidney beans)
Yoghurt
Figs/fig products
Raw apple
Other raw fruit (eg. banana/orange)
Raw carrot
Other raw vegetables (please describe)
Nuts/nut products
Crisps
Other cocktail or savoury snacks (eg. cheesy biscuits)
Chocolates
Mints (eg. polo)
Sweets

Since he was 15 months old, has your child had the following, whether in baby foods or elsewhere: Other raw vegetables (please describe)

Generic text
Do you ever add these things to your child's food or use them in preparing his food?
- How often nowadays (Put 00 if less than once a month) ... times a month

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many
Gravy (made with granules, powder or cubes) or soy sauce
Salt
Herbs (please describe)
Spices (please describe)
Tomato ketchup
Other sauce (please describe)
Sugar

Do you ever add these things to your child's food or use them in preparing his food? Herbs (please describe)

Generic text

Do you ever add these things to your child's food or use them in preparing his food? Spices (please describe)

Generic text

Do you ever add these things to your child's food or use them in preparing his food? Other sauce (please describe)

Other

Skins and peels: does he eat: apple skin

1
No
2
Yes
3
Doesn't have this fruit/veg at all

Skins and peels: does he eat: orange peel

1
No
2
Yes
3
Doesn't have this fruit/veg at all

Skins and peels: does he eat: potato skin

1
No
2
Yes
3
Doesn't have this fruit/veg at all

Skins and peels: does he eat: other fruit or vegetable skin (please describe)

1
No
2
Yes
3
Doesn't have this fruit/veg at all
Other
Does he have:
- How often nowadays (Put 00 if less than once a month) ... times a month

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many

1 - No

2 - Yes

How many
smoked/cured foods (ham,bacon, smoked fish,smoked cheese)
individually packaged microwave meals
foods cooked on a barbecue

Are there any other foods that your child eats that haven't been included above?

1
Yes
2
No
If no, go to F16 on page 25
If yes please describe:
qc_F15 == 1
_food < 4 _food < 4

Food

Generic text

How often nowadays ... times a month

How many
(If more than 3, please continue on a separate sheet)

When shopping do you deliberately choose for him labels that say: low sugar

1
Usually
2
Sometimes
3
Never

When shopping do you deliberately choose for him labels that say: iron added

1
Usually
2
Sometimes
3
Never

Does your toddler have definite likes and dislikes as far as food is concerned?

1
no, will eat almost anything
2
yes, quite choosy
3
yes, very choosy

Does he drink out of a cup or feeding beaker?

1
yes, usually
2
yes, sometimes
3
no, not at all

How often do you put him down to sleep with a bottle (whether at night or during the day)?

1
always
2
sometimes
3
never

How often does he suck a dummy or his thumb or finger? dummy

2
most of the time
3
sometimes
4
never

How often does he suck a dummy or his thumb or finger? thumb/finger

2
most of the time
3
sometimes
4
never

When you give him a dummy, how often is it dipped in or filled with something that tastes nice?

1
usually
2
sometimes
3
never
7
doesn't have a dummy

Apart from his fingers, thumb or a dummy does he have a special object that he uses for comfort?

1
Yes
2
No
If no, go to G1 on page 27
If yes,
qc_F21_a == 1

what is this?

1
blanket
2
cuddly toy
3
other (please describe)
Other
SECTION G: CHILDCARE
Apart from yourself, who regularly has looked after your son when you are not there, since he was 15 months old? (Please answer for each person regularly involved).
- If yes, give hours per week and his age when this began (in months)
Hours per week

1 - No

2 - Yes

Age in monthsHours per week

1 - No

2 - Yes

Age in months

1 - No

2 - Yes

Age in monthsHours per week
Hours per week

1 - No

2 - Yes

Age in monthsHours per week

1 - No

2 - Yes

Age in months

1 - No

2 - Yes

Age in monthsHours per week
Hours per week

1 - No

2 - Yes

Age in monthsHours per week

1 - No

2 - Yes

Age in months

1 - No

2 - Yes

Age in monthsHours per week
partner
baby's grandparent
other relative
friend/neighbour
paid person outside baby's home (eg. child minder)
paid person in baby's home (eg. nanny, baby sitter)
day nursery (creche)
other (please describe)

Apart from yourself, who regularly has looked after your son when you are not there, since he was 15 months old?(Please answer for each person regularly involved). other (please describe)

Other

What was the main reason for choosing this form of childcare?

1
I had no choice
2
I could afford it
3
It was convenient
4
It was linked to my job
5
I thought it would be beneficial for my child
6
Other (please describe)
Other

How satisfied are you with these arrangements?

1
very satisfied
2
fairly satisfied
3
not at all happy
Please list below all daytime child care arrangements (other than yourselves) that he has had since he was 15 months old.
No. of hours/week during the day Person (eg childminder, grandmother) Place (eg at home creche, etc)
Generic textHow manyGeneric textGeneric textHow manyGeneric textHow manyGeneric textGeneric text Generic textHow manyGeneric textGeneric textHow manyGeneric textHow manyGeneric textGeneric text Generic textHow manyGeneric textGeneric textHow manyGeneric textHow manyGeneric textGeneric text
15 months
16 months
17 months
18 months
19 months
20 months
21 months
22 months
23 months
24 months
SECTION H: UNDERSTANDING AND TALKING
We are interested in the words your child understands and those he SAYS. Please mark the words you have heard your child use. If your child uses a different pronunciation of a word (for example, "raffe instead of "giraffe" or "sketti" for "spaghetti"), mark the word anyway. This is a list of some of the words that may be used by young children. Don't worry if your child doesn't say any of these yet.

(Tick both columns if he says and understands)

He says He understands

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

Hello
Don't
Dinner
Call
Turn round
We are interested in the words your child understands and those he SAYS. Please mark the words you have heard your child use. If your child uses a different pronunciation of a word (for example, "raffe instead of "giraffe" or "sketti" for "spaghetti"), mark the word anyway. This is a list of some of the words that may be used by young children. Don't worry if your child doesn't say any of these yet.

(Tick both columns if he says and understands)

He says He understands

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

Dog/Puppy
Bear/Teddy
Chicken
Goose
Animal
Crocodile
Hen
We are interested in the words your child understands and those he SAYS. Please mark the words you have heard your child use. If your child uses a different pronunciation of a word (for example, "raffe instead of "giraffe" or "sketti" for "spaghetti"), mark the word anyway. This is a list of some of the words that may be used by young children. Don't worry if your child doesn't say any of these yet.

(Tick both columns if he says and understands)

He says He understands

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

Nose
Hand
Head
Finger
We are interested in the words your child understands and those he SAYS. Please mark the words you have heard your child use. If your child uses a different pronunciation of a word (for example, "raffe instead of "giraffe" or "sketti" for "spaghetti"), mark the word anyway. This is a list of some of the words that may be used by young children. Don't worry if your child doesn't say any of these yet.

(Tick both columns if he says and understands)

He says He understands

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

Sock
Coat
Pyjamas
Jumper
Tights
We are interested in the words your child understands and those he SAYS. Please mark the words you have heard your child use. If your child uses a different pronunciation of a word (for example, "raffe instead of "giraffe" or "sketti" for "spaghetti"), mark the word anyway. This is a list of some of the words that may be used by young children. Don't worry if your child doesn't say any of these yet.

(Tick both columns if he says and understands)

He says He understands

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

Cheese
Biscuit
Raisin
Pizza
Butter
Chips
Beefburger
Peas
Potato
Strawberry
Spaghetti
Lemonade
Nuts
We are interested in the words your child understands and those he SAYS. Please mark the words you have heard your child use. If your child uses a different pronunciation of a word (for example, "raffe instead of "giraffe" or "sketti" for "spaghetti"), mark the word anyway. This is a list of some of the words that may be used by young children. Don't worry if your child doesn't say any of these yet.

(Tick both columns if he says and understands)

He says He understands

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

Door
Window
Settee/sofa
Sink
Bedroom
Washing machine
We are interested in the words your child understands and those he SAYS. Please mark the words you have heard your child use. If your child uses a different pronunciation of a word (for example, "raffe instead of "giraffe" or "sketti" for "spaghetti"), mark the word anyway. This is a list of some of the words that may be used by young children. Don't worry if your child doesn't say any of these yet.

(Tick both columns if he says and understands)

He says He understands

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

Bottle
Box
Fork
Money
Glasses
Plate
Knife
Camera
Heater
We are interested in the words your child understands and those he SAYS. Please mark the words you have heard your child use. If your child uses a different pronunciation of a word (for example, "raffe instead of "giraffe" or "sketti" for "spaghetti"), mark the word anyway. This is a list of some of the words that may be used by young children. Don't worry if your child doesn't say any of these yet.

(Tick both columns if he says and understands)

He says He understands

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

Tree
Rain
Star
House
Snow
Roof
We are interested in the words your child understands and those he SAYS. Please mark the words you have heard your child use. If your child uses a different pronunciation of a word (for example, "raffe instead of "giraffe" or "sketti" for "spaghetti"), mark the word anyway. This is a list of some of the words that may be used by young children. Don't worry if your child doesn't say any of these yet.

(Tick both columns if he says and understands)

He says He understands

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

Mummy
Boy
Clown
Lady
Princess
Person
We are interested in the words your child understands and those he SAYS. Please mark the words you have heard your child use. If your child uses a different pronunciation of a word (for example, "raffe instead of "giraffe" or "sketti" for "spaghetti"), mark the word anyway. This is a list of some of the words that may be used by young children. Don't worry if your child doesn't say any of these yet.

(Tick both columns if he says and understands)

He says He understands

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

Park
Farm
Church
Library
We are interested in the words your child understands and those he SAYS. Please mark the words you have heard your child use. If your child uses a different pronunciation of a word (for example, "raffe instead of "giraffe" or "sketti" for "spaghetti"), mark the word anyway. This is a list of some of the words that may be used by young children. Don't worry if your child doesn't say any of these yet.

(Tick both columns if he says and understands)

He says He understands

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

Down
The
On top of
With
An
We are interested in the words your child understands and those he SAYS. Please mark the words you have heard your child use. If your child uses a different pronunciation of a word (for example, "raffe instead of "giraffe" or "sketti" for "spaghetti"), mark the word anyway. This is a list of some of the words that may be used by young children. Don't worry if your child doesn't say any of these yet.

(Tick both columns if he says and understands)

He says He understands

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

Mine
These
Him
Hers
Us
We are interested in the words your child understands and those he SAYS. Please mark the words you have heard your child use. If your child uses a different pronunciation of a word (for example, "raffe instead of "giraffe" or "sketti" for "spaghetti"), mark the word anyway. This is a list of some of the words that may be used by young children. Don't worry if your child doesn't say any of these yet.

(Tick both columns if he says and understands)

He says He understands

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

Ouch
Wet
Happy
Hurt
Sleepy
New
Green
Fast
Quiet
Awake
White
First
Mad
We are interested in the words your child understands and those he SAYS. Please mark the words you have heard your child use. If your child uses a different pronunciation of a word (for example, "raffe instead of "giraffe" or "sketti" for "spaghetti"), mark the word anyway. This is a list of some of the words that may be used by young children. Don't worry if your child doesn't say any of these yet.

(Tick both columns if he says and understands)

He says He understands

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

More
Some
Any
We are interested in the words your child understands and those he SAYS. Please mark the words you have heard your child use. If your child uses a different pronunciation of a word (for example, "raffe instead of "giraffe" or "sketti" for "spaghetti"), mark the word anyway. This is a list of some of the words that may be used by young children. Don't worry if your child doesn't say any of these yet.

(Tick both columns if he says and understands)

He says He understands

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

What?
Which?
We are interested in the words your child understands and those he SAYS. Please mark the words you have heard your child use. If your child uses a different pronunciation of a word (for example, "raffe instead of "giraffe" or "sketti" for "spaghetti"), mark the word anyway. This is a list of some of the words that may be used by young children. Don't worry if your child doesn't say any of these yet.

(Tick both columns if he says and understands)

He says He understands

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

Night
Today
We are interested in the words your child understands and those he SAYS. Please mark the words you have heard your child use. If your child uses a different pronunciation of a word (for example, "raffe instead of "giraffe" or "sketti" for "spaghetti"), mark the word anyway. This is a list of some of the words that may be used by young children. Don't worry if your child doesn't say any of these yet.

(Tick both columns if he says and understands)

He says He understands

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

Toy
Bubbles
Football
We are interested in the words your child understands and those he SAYS. Please mark the words you have heard your child use. If your child uses a different pronunciation of a word (for example, "raffe instead of "giraffe" or "sketti" for "spaghetti"), mark the word anyway. This is a list of some of the words that may be used by young children. Don't worry if your child doesn't say any of these yet.

(Tick both columns if he says and understands)

He says He understands

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

Boat
Train
We are interested in the words your child understands and those he SAYS. Please mark the words you have heard your child use. If your child uses a different pronunciation of a word (for example, "raffe instead of "giraffe" or "sketti" for "spaghetti"), mark the word anyway. This is a list of some of the words that may be used by young children. Don't worry if your child doesn't say any of these yet.

(Tick both columns if he says and understands)

He says He understands

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

Kiss
Bite
Help
Comb
Close
Cook
Turn on/off
Fix
Look
Splash
Shake
Pull
Touch
Put
Cover
Drop
Taste
Lie down
Wish
Do
Have to
Are
Were

To talk about more than one thing, we add an "s" to many words. For example, cars, shoes, dogs, and keys. Has your son begun to do this?

1
Not yet
2
Sometimes
3
Often

To talk about ownership, we add an "s", for example , Daddy's key, kitty's dish, and baby's bottle. Has your son begun to do this?

1
Not yet
2
Sometimes
3
Often

To talk about activities, we sometimes add " ing" to verbs. For example, looking, running, and crying. Has your son begun to do this?

1
Not yet
2
Sometimes
3
Often

To talk about things that happened in the past, we often add " ed" to the verb. For example, kissed, opened, and pushed. Has your son begun to do this?

1
Not yet
2
Sometimes
3
Often
Below are some plural words. Please indicate in each column which your son uses and/or understands (if any).
Yes he says Yes he understands

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

children
feet
men
mice
teeth
Next are some words that indicate that something happened in the past; please mark in each column which he says and/or understands.
Yes he says Yes he understands

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

ate
blew
bought
broke
came
drank
drove
fell
flew
got
had
heard
held
lost
made
ran
sat
saw
took
went

Has your son begun to combine words yet, such as " nother sweet", or "doggie bite?"

1
Not yet
2
Sometimes
3
Often
If not yet, go to section I on page 36.
qc_H22 == 1
Else

Please list three of the longest combinations you have heard your child say recently.

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SECTION I: TEMPERAMENT
The next questions are important. They will tell us about his personality. Some questions look similar but are not. Please tick the box which describes how often your son behaves like the description.

He gets sleepy at about the same time each evening (within 1/2 hour)

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He fidgets during quiet activities (story telling, etc)

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He takes feeds quietly with mild expression of likes and dislikes

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He is pleasant (smiles, laughs) when first arriving in unfamiliar places

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

His initial reaction to seeing the doctor is acceptance

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He pays attention to games with mum/dad for only a minute or so

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

His bowel movements come at different times from day to day (over 1 hour difference)

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He is fussy on waking up (frowns, complains, cries)

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He reacts to a disliked food even if it is mixed with a preferred one

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He accepts delays (for several minutes) for desired objects or activities (snacks, treats, gifts)

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He usually stays still when being dressed

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He continues an activity in spite of noises in the same room

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He shows strong reactions (cries, stamps feet) to failure

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He plays continuously for more than 10 minutes at a time with a favourite toy

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He ignores the temperature of food, whether hot or cold

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He varies from day to day in wanting a drink or snack before bedtime

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He sits still while waiting for food

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He is easily excited by praise (laughs, yells, jumps)

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He cries after a fall or bump

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He approaches and plays with unfamiliar pets (small dogs, cats)

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He stops eating and looks up when a person walks by

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He seems unaware of differences in taste of familiar liquids (different milks and juices)

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He moves about actively when he explores new places

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He fusses or whines when his bottom is cleaned after bowel movement

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He smiles when played with by unfamiliar adults

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He looks up from play when I enter the room

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He spends over 1 hour reading books/looking at pictures

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He responds intensely (screams, yells) when frustrated

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He eats about the same amount of solid food at meals from day to day

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He remains pleasant when hungry & waiting for food to be prepared

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He allows face washing without protest (squirming, turning away)

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

The amount of milk or juice he drinks at mealtimes is unpredictable from meal to meal (over 50gm (2oz) difference)

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He practices physical activities (climbing, jumping, pushing objects)

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He vigorously resists extra food/drink when full (spits out, clamps mouth closed, hits out at spoon, etc)

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He plays actively (bangs, throws, runs) with toys indoors

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He ignores voices when playing with a favourite toy

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He approaches (moves towards) new visitors at home

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He plays outside on hot or cold days without seeming to notice temperature differences

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He continues playing with other children for under 5 minutes and then goes elsewhere

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He continues to look at a picture book in spite of distracting noises (car horns, doorbells, etc)

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He wants a snack at a different time each day (over 1 hour difference)

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He is pleasant when put down for a nap or at night

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He speaks right away to unfamiliar adults

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He reacts strongly (cries or screams) when unable to finish playing

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He enjoys games with running and jumping more than games when sitting down

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He notices wet clothing and wants to be changed right away

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He loses interest in a new toy or game within an hour

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He runs to get where he wants to go

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

For the first few minutes in a new place (shop, home) he is wary (clings to me, holds back)

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He takes daytime naps at differing times (over half hour difference) from day to day

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He reacts mildly (frown or smile) when his play is interrupted by me

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He accepts being dressed and undressed without protest

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He is outgoing with adult strangers outside the home

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

His period of greatest physical activity comes at the same time of day

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He can be coaxed out of a forbidden activity

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He stops playing and watches when someone walks by

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He goes back to the same activity after a brief interruption (snack, trip to the lavatory)

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He laughs or smiles when meeting other children

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He will avoid doing something wrong if punished firmly once or twice

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He continues to play with a toy in spite of sudden noises from outside (car horn)

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He ignores dirt on himself

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

His time of waking in morning varies greatly (by 1 hour or more) from day to day

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He has moody or 'off' days when he is fussy all day

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He reacts mildly (frown/smile) when another child takes his toy

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He sticks at a routine task (dressing, picking up toys) for 5 minutes or more

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He stops eating and looks up when he hears an unusual noise (telephone, doorbell)

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He sits reasonably still during hair brushing or nail cutting, etc.

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He shows much bodily movement (stamps, swings arms) when upset or crying

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He is pleasant during face washing

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

His first reaction at home to an approach by strangers is acceptance (reaches out, looks at)

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He is hungry at dinner time

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He continues to get into forbidden areas or objects in spite of my warnings

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He stops to examine new objects thoroughly (5 minutes or more)

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He ignores smells (smoke, cooking, perfume) whether pleasant or not

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He looks up from an activity when he hears the sounds of children playing

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He falls asleep at about the same length of time after being put to bed

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He is moody for more than a few minutes when corrected or disciplined

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He is shy on meeting another child for the first time

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He is still wary of strangers after 15 minutes

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He frets or cries when first learning a new task (dressing self, picking up toys

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He sits quietly in the bath

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He practises a new skill (throwing, piling blocks, drawing) for 10 minutes or more

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He ignores differences in taste or consistency of familiar foods

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He is fearful of being put down in an unfamiliar place (supermarket trolley, new push chair, playpen) even when I'm present

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He frowns or complains when left to play alone

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He accepts within 10 minutes (feels at home, at ease) new surroundings (home, shop, play area)

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He looks up from play when the telephone or doorbell rings

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

He will always choose a new, unfamiliar toy to play with rather than one he knows

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always

In one play session he likes to play with many different toys rather than just one or two

1
Almost never
2
Rarely
3
Sometimes
4
Often
5
Almost always
SECTION J: HIS GROWTH
Do you have any records of your baby's growth since he was 15 months old? If so please list the dates on which your baby was weighed and how much he weighed each time. Also add lengths, head circumferences, and arm circumferences if they were measured. [If you have no records please don't worry].
Date Weight Length Head circumference Arm circumference
Generic textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text Generic textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text Generic textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text Generic textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text Generic textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text
1
2
3
4
5
6

This questionnaire was completed by: mother

1
Yes
2
No

This questionnaire was completed by: father

1
Yes
2
No

This questionnaire was completed by: other (please describe)

1
Yes
2
No
Other

Please give the date on which you completed this questionnaire:

Generic date

Please give the date of birth of your son:

Generic date
THANK YOU VERY MUCH FOR YOUR HELP

Space for any additional comments you would like to make

Long text
NB Please remember that we cannot respond personally to your comments unless they are signed.
When completed, please return the questionnaire to: Dr. Jean Golding, Children of the Nineties - ALSPAC, Institute of Child Health, 24, Tyndall Avenue, Bristol. BS8 1BR. Tel: Bristol 256260
End

alspac_93_mlbg

MY LITTLE BOY
Children grow so quickly, and change so much. This questionnaire asks about any accidents or problems your son may have had now that he is two years old, what he has been eating and drinking, his temperament and the way he may be beginning to understand the world about him.
It is like the other questionnaires you have received. To answer simply tick the box which best describes your son or his situation. Again some questions will seem similar but they are not the same. Please answer all questions that you can. If you cannot answer a question or if it does not apply to you please put a line through it. There are no right or wrong answers. Please just describe what happens in your situation. You may make additional comments at the end. All answers are confidential.
THANK YOU FOR YOUR HELP

SECTION A: YOU AND YOUR SON

When you are at home with your child, how often do you do the following:

-

1 - Every day

2 - Several times a week

3 - About once a week

4 - Rarely

5 - Never

Let him play with paints, mud or other messy objects
Let him use objects to build towers or other creations
Sing to him
Read him stories
Praise him for something he has done
Kiss or cuddle him
Shout at him
Slap him
Go out to a park or playground with him
Have a meal together with him
Let him make a lot of noise (banging saucepans, singing etc)

SECTION B: PLAY THINGS

How many of the following does your child have at home that he can look at or play with?

-

1 - None

2 - One

3 - 2-3

4 - 4 or more

Cuddly animals
Dolls
A swing
Toy cars or lorries
Jigsaw puzzles
Mobiles
Building bricks or blocks
Books
Balls
A walker (that he puts things in and pushes)
The other sort of baby walker that he sits in and walks
Toys where he has to fit things together
Do you have a special place (box, drawer, bag) for his toys which he can go to and choose what he wants to play with?
1
Special place but he is not able to get at it himself
2
Special place and he gets what he wants from it
3
No special place

SECTION C: ACCIDENTS AND INJURIES

However careful a parent is, most children have accidents at sometime or other. Please list on the next pages the times your child has had an accident whether or not he was injured as a result.
Has he been burnt or scalded since he was 15 months old?
1
Yes
2
No
If no, go to C2a on page 7
how many times?
How many

For each burn or scald please describe below what happened:

Place accident happened (eg. kitchen, garden, creche) What was he burnt with? (e.g tea, iron, electric fire) Date of accident (month, year) Injuries caused (if no injury write none) Who was with him? What did the person with him do? Other (please describe) What treatment did the person with him give? What other treatment did he have?
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
1st accident
2nd accident
3rd accident
Please describe how each accident happened: Burn 1
Generic text
Please describe how each accident happened: Burn 2
Generic text
Please describe how each accident happened: Burn 3
Generic text
Has he been dropped or had a bad fall since he was 15 months old?
1
Yes
2
No
If no, go to C3a on page 8
how many times?
How many

For each fall please describe below what happened.

Place accident happened (eg. kitchen, garden, creche) What did he fall or drop from (eg. table, baby walker, pram, bed, your arms) Date of fall (month, year) Injuries caused (if no injury write none) Who was with him? What did the person with him do? Other (please describe) What treatment did the person with him give? What other treatment did he have?
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
1st accident
2nd accident
3rd accident
Please describe how each accident happened: Fall 1
Generic text
Please describe how each accident happened: Fall 2
Generic text
Please describe how each accident happened: Fall 3
Generic text
Has he swallowed anything he shouldn't have (such as pills, buttons, disinfectant) since he was 15 months old?
1
Yes
2
No
If no, go to C4a on page 9
how many times?
How many

For each time please describe below what happened.

Place accident happened (eg. your home, nursery, at friend's) What did he swallow? Date of accident (month, year) Who was with him? What did the person with him do? Other (please describe) What treatment did the person with him give? What other treatment did he have?
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
1st accident
2nd accident
3rd accident
Please describe how each accident happened: Accident 1
Generic text
Please describe how each accident happened: Accident 2
Generic text
Please describe how each accident happened: Accident 3
Generic text
Has he had any other accidents or injuries since he was 15 months old?
1
Yes
2
No
If no, go to C5a on page 10
how many other accidents?
How many

For each accident or injury please describe below what happened.

Place accident happened (eg. kitchen, garden, creche) What happened? Date of accident (month, year) Injuries caused (if no injury write none) Who was with him? What did the person with him do? Other (please describe) What treatment did the person with him give? What other treatment did he have?
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateOther

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
1st accident
2nd accident
3rd accident
Please describe how each accident happened: Accident 1
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Please describe how each accident happened: Accident 2
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Please describe how each accident happened: Accident 3
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Has your son ever had an accident that has left him with a scar, a physical disability or a behaviour or psychological problem?
1
Yes
2
No
If no, go to Section D on page 11
is there a scar?
1
Yes
2
No
If no, go to c) below
please describe where this is, and how he got it:
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is there a physical disability?
1
Yes
2
No
If no, go to d) below
please describe this and how he got it:
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did he develop a behaviour or psychological problem after an accident?