Start
alspac_97_msdgu
My Daughter Growing Up
This questionnaire should be answered by the chief child carer. It asks about your child as she continues to develop.
It is like the other questionnaires you have received. To answer simply tick the box which best describes your child or your child's situation. Please answer all questions that you can. If you cannot answer certain questions or if they do not apply to you please put a line through them. 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: GOING TO SCHOOL

Does she go to school?

1
Yes
2
No
If no, go to section B on page 12
qc_A1_a == 2
Else

How old was she when she started school?

Age
Months

How many different schools has she gone to?

How many
What types of school has she gone to? (If more than 3 schools, write in the margin)
1st school 2nd school 3rd school

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

infant school
primary school
private (fee paying )
boarding school
studies at home
special school*
not able to be taught
*If special school
qc_A1_d$*;6 == 1

please describe type

Generic text

Please describe reasons for child being at current school (tick all that apply) It was the only available choice

1
Yes

Please describe reasons for child being at current school (tick all that apply) It was the best available

1
Yes

Please describe reasons for child being at current school (tick all that apply) There were medical reasons please describe

1
Yes
Generic text

Please describe reasons for child being at current school (tick all that apply) There were psychological reasons please describe

1
Yes
Generic text

Please describe reasons for child being at current school (tick all that apply) Other (please tick and describe)

1
Yes
Other

What time does school start ? ... a.m.

Generic time

What time does school end ? ... p.m.

Generic time
Who takes her to and from school nowadays? (Tick all that apply)
Going Coming back

1 - every day

2 - some days

1 - every day

2 - some days

1 - every day

2 - some days

1 - every day

2 - some days

1 - every day

2 - some days

1 - every day

2 - some days

1 - every day

2 - some days

1 - every day

2 - some days

I take her
My partner takes her
A grandparent or adult relative
An older child
Childminder
Other person
Goes on her own
How does she get to school?
Going Coming back

1 - every day

2 - some days

1 - every day

2 - some days

1 - every day

2 - some days

1 - every day

2 - some days

1 - every day

2 - some days

1 - every day

2 - some days

1 - every day

2 - some days

1 - every day

2 - some days

She walks
She goes in a wheelchair
By public transport
School bus/ coach
By car
Rides bicycle
Other (please tick and describe)

How does she get to school? Other(please tick and describe)

Other

How far away is the school?

1
less than 1/2 mile (1 km) away
2
1/2 - 1 mile (1-2 km) away
3
1 - 5 miles (2-8 km) away
4
more than 5 miles (8 km) away

How long does it take to get there in the morning? ... minutes

Minutes
We would like to know what happens after school.

Does she usually go straight home?

1
No
2
Yes
If yes, go to A5c below
If no,
qc_A5_a == 1

where does she go? to a relative's home

1
Every day
2
Some days
3
Never

where does she go? to a friend's home

1
Every day
2
Some days
3
Never

where does she go? to a childminder

1
Every day
2
Some days
3
Never

where does she go? school club

1
Every day
2
Some days
3
Never

where does she go? plays outside

1
Every day
2
Some days
3
Never

where does she go? other (please tick and describe)

1
Every day
2
Some days
3
Never
Other

If she goes straight home are you always there too?

1
yes, always
2
yes, usually
3
yes, sometimes
4
no, hardly ever

When she first arrives home does she have: a meal

1
Yes
2
No

When she first arrives home does she have: a snack

1
Yes
2
No

When she first arrives home does she have: a drink

1
Yes
2
No

How does she feel about school? She looks forward to going

1
Always
2
Usually
3
Sometimes
4
Not at all

How does she feel about school? She enjoys it

1
Always
2
Usually
3
Sometimes
4
Not at all

How does she feel about school? She is stimulated by it

1
Always
2
Usually
3
Sometimes
4
Not at all

How does she feel about school? She is frightened by it

1
Always
2
Usually
3
Sometimes
4
Not at all

How does she feel about school? She talks about her friends

1
Always
2
Usually
3
Sometimes
4
Not at all

How does she feel about school? She seems bored by school

1
Always
2
Usually
3
Sometimes
4
Not at all

How does she feel about school? She likes her teacher (s)

1
Always
2
Usually
3
Sometimes
4
Not at all

How much at school do you think she likes? Reading

1
She likes it a lot
2
She quite likes it
3
She does not like it

How much at school do you think she likes? Maths

1
She likes it a lot
2
She quite likes it
3
She does not like it

How much at school do you think she likes? Writing

1
She likes it a lot
2
She quite likes it
3
She does not like it

How much at school do you think she likes? Games

1
She likes it a lot
2
She quite likes it
3
She does not like it

How much at school do you think she likes? Discussion

1
She likes it a lot
2
She quite likes it
3
She does not like it

How much at school do you think she likes? Other (please tick & describe)

1
She likes it a lot
2
She quite likes it
3
She does not like it
Other
When she finishes school and returns home:
-

1 - Always

2 - Usually

3 - Sometimes

4 - Never

Talk about the events of the day
Ask about what has happened in your day
Read, draw or play quietly by herself
Watch TV
Play with other children
Fall asleep

How many children in her class did she know before attending her present school?

1
none
2
1 child
3
2-3 children
4
more than 3 children

Had she visited this school before her first day?

1
Yes
2
No

Does she bring home things that she has done at school (e.g. painting)?

1
Yes
2
No
If no, go to A13 on page 9
If yes,
qc_A12_a == 1

how often are they put so that everyone can see them?

1
Always
2
Usually
3
Sometimes
4
Never

When she gets home from school how does she behave? excited

1
Always
2
Usually
3
Sometimes
4
Never

When she gets home from school how does she behave? talkative

1
Always
2
Usually
3
Sometimes
4
Never

When she gets home from school how does she behave? withdrawn

1
Always
2
Usually
3
Sometimes
4
Never

When she gets home from school how does she behave? calm

1
Always
2
Usually
3
Sometimes
4
Never

When she gets home from school how does she behave? very active

1
Always
2
Usually
3
Sometimes
4
Never

When she gets home from school how does she behave? sleepy

1
Always
2
Usually
3
Sometimes
4
Never

When she gets home from school how does she behave? angry

1
Always
2
Usually
3
Sometimes
4
Never

When she gets home from school how does she behave? hungry

1
Always
2
Usually
3
Sometimes
4
Never

When she gets home from school how does she behave? tearful

1
Always
2
Usually
3
Sometimes
4
Never

When she gets home from school how does she behave? anxious

1
Always
2
Usually
3
Sometimes
4
Never

When she gets home from school how does she behave? affectionate

1
Always
2
Usually
3
Sometimes
4
Never

When she gets home from school how does she behave? tired

1
Always
2
Usually
3
Sometimes
4
Never

When she gets home from school how does she behave? other (please tick and describe)

1
Always
2
Usually
3
Sometimes
4
Never
Other

Are you interested in what your child does at school?

1
Yes very
2
Yes mostly
3
No, not really

Are you happy with the teaching your daughter is getting at school?

1
Yes very
2
Yes mostly
3
No, not really

Are you happy with the progress your daughter is making at school?

1
Yes very
2
Yes mostly
3
No, not really

Has she been identified as having any particular learning problems?

1
Yes
2
No
If no, go to A16 on page10
If yes,
qc_A15_a == 1

what is happening? (please tick all that apply) special school

1
Started
2
Planned not started yet

what is happening? (please tick all that apply) special class in normal school

1
Started
2
Planned not started yet

what is happening? (please tick all that apply) special teacher

1
Started
2
Planned not started yet

what is happening? (please tick all that apply)

7
no help available

Space for comments

Long text
Apart from yourself, who has regularly looked after your child when she is not at school? (Please answer for each person or place including childminder or neighbour regularly involved)
Childcare on schooldays in the past 6 months Please list below all regular arrangements before or after school. (If none write NONE)
Person and/or place (e.g. childminder - her home; after school clubs, neighbour etc.) Number of hours per week
How manyGeneric textHow manyGeneric text How manyGeneric textHow manyGeneric text
i)
ii)
iii)
Weekend childcare Please list below all regular childcare arrangements during the weekend in the past 6 months. (If none write NONE)
Person and/or place (e.g. grandmother,my home) Number of hours per week: Saturday Number of hours per week: Sunday
How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many How manyHow manyGeneric textHow manyHow manyGeneric textHow manyGeneric textHow many
i)
ii)
iii)
Childcare during school holidays Please list the arrangements made when childcare was needed during school holidays in the past year. (If none write NONE)
Person and/or place Number of hours per week
How manyGeneric textHow manyGeneric text How manyGeneric textHow manyGeneric text
i)
ii)
iii)
SECTION B: EATING HABITS
How far do the following statements describe your study child?
-

1 - Yes, most of the time

2 - Yes sometimes

3 - No, not at all

She likes to try different foods
She seems to enjoy eating
She seems to prefer sweet foods
She seems to prefer savoury foods
She plays with her food rather than eating eagerly
She is very choosy about the food she eats
She finishes all the food on the plate

Children are often difficult about eating certain foods. When your study child is difficult about a certain food that you would like her to eat, how far do the following sentences describe how you deal with this?

4
Is never difficult
If Is never difficult Go to B3 on page 13
qc_B2 == 4
Else
Children are often difficult about eating certain foods. When your study child is difficult about a certain food that you would like her to eat, how far do the following sentences describe how you deal with this?
-

1 - Yes, most of the time

2 - Yes sometimes

3 - No, not at all

I let her choose something else
I try to encourage her to eat the food by making up a game or story
I mix the food with another food that she likes and will eat
I let her put sauce on the food to cover up the taste/appearance
I try to persuade her to eat just a very small amount of the food
I do not let her leave the table or have anything else to eat until she eats all the food on the plate
I try to encourage her by offering a reward (e.g. a sweet or new toy) if she finishes the food
If she will not eat a certain food I take it away and give her something else to eat
I try not to make an issue of it
I try the same food again on a different day

Children are often difficult about eating certain foods. When your study child is difficult about a certain food that you would like her to eat, how far do the following sentences describe how you deal with this? Other (please tick & describe)

1
Yes, most of the time
2
Yes sometimes
3
No, not at all
Other
When you are preparing food does your study child help in any of the following ways?
-

1 - Yes, often

2 - Yes sometimes

3 - Never/rarely

She helps to choose what we have by looking in the cupboard/fridge
She comes shopping with me and helps to choose food that we buy
She helps with the cooking/ preparation
She helps to get things out for the meal/sets the table
She helps to clear things away after the meal
Do you have any rules that you try to follow when feeding the family?
-

1 - Yes

2 - No

"Proper" cooked meal every day
Fresh fruit every day
Meat, fish, egg or cheese every day
Vegetables or salad every day
Pudding every day (including yoghurt or ice cream)
"Special" meal each week e.g. Sunday lunch
Eat up everything on the plate
Do you try to use any of the following kinds of foods or drinks in meals for your study child?
-

1 - Yes, often

2 - Yes sometimes

3 - Never/rarely

"Whole" food (unrefined, e.g. brown rice or pasta etc.)
Reduced sugar/sugar-free foods or drinks
Reduced fat/fat-free foods or drinks
Low salt foods
Foods or drinks with added Vitamin C
Foods or drinks with added iron
"Organic" foods or drinks
On normal school days how often does your study child eat something at the following times of day?
-

1 - Never

2 - Once in 2 weeks

3 - Once a week

4 - 2-4 times a week

5 - 5 times a week

9 - Don't know

Before school
Mid-morning
Mid-day
Mid-afternoon before 4.30 p.m.
Late afternoon, between 4.30 & 6.00 p.m.
Early evening betweeen 6.00 & 7.30 p.m.
Mid-evening between 7.30 & 9.00 p.m.
Late evening after 9.00 p.m.
How many times a week on school days does your study child have the following foods or drinks before school?
-

1 - Never

2 - Once in 2 weeks

3 - Once a week

4 - 2-4 times a week

5 - 5 times a week

9 - Don't know

Nothing to eat or drink
Has a drink but nothing to eat
Has cereal without milk
Has cereal with milk
Has bread or toast
Has bacon, egg, sausage, or cheese
Has crisps, corn snack or other savoury snack
Has sweet biscuits, sweets or chocolates
Has fruit, yoghurt or fromage frais
Has a milk drink

How many times a week on school days does your study child have the following foods or drinks before school? Has other food (Please tick & describe)

1
Never
2
Once in 2 weeks
3
Once a week
4
2-4 times a week
5
5 times a week
9
Don't know
Other
How many times a week on school days does your study child have as her mid-day meal?
-

1 - Never

2 - Once in 2 weeks

3 - Once a week

4 - 2-4 times a week

5 - 5 times a week

9 - Don't know

Cooked meal at school
Packed lunch provided by school
Packed lunch provided from home
Comes home for a snack lunch
Comes home for a main meal at mid day

How often do you ask your study child about the food she has eaten at school?

1
Never
2
Occasionally
3
Quite often
4
Most days
7
Does not eat at school
How many times a week on school days does your study child have for her tea/evening meal ?
-

1 - Never

2 - Once in 2 weeks

3 - Once a week

4 - 2-4 times a week

5 - 5 times a week

9 - Don't know

Cooked meal with no vegetables or salad
Cooked meal with fresh vegetables or salad
Cooked meal with frozen vegetables
Cooked meal with tinned vegetables
Sandwich or snack meal e.g. Baked beans on toast, pot noodles
How many times a week on school days does your study child have for her tea/evening meal ? How does she eat her evening meal?
-

1 - Never

2 - Once in 2 weeks

3 - Once a week

4 - 2-4 times a week

5 - 5 times a week

9 - Don't know

Sitting up at a table
From a tray/plate on her lap
Using a knife and fork
Using a spoon and/or fingers
Adult(s) eat with her
Other children eat with her but not adults
Eats on her own
On a school day......

Does she have milk at school

1
Yes
2
No

Does she have milk at home

1
Yes
2
No
If no, go to B12 below
qc_B11_b == 2
Else

If milk is drunk at home about how much does she have in total in drinks and on cereal at home?

1
Up to 1/2 pint
2
1/2-1 pint
3
1-1 1/2 pints
4
1 1/2-2 pints
5
more than 2 pints

When your study child is offered vegetables e.g: carrots, green vegetables, peas, sweetcorn etc. (not including potatoes, pasta, tinned spaghetti, baked beans, or rice) which of the following statements best describes her attitude to eating them?

1
Never offered these vegetables
If Never offered these vegetables on question B12i Go to B13 on page 20
qc_B12_i == 1
Else
When your study child is offered vegetables e.g: carrots, green vegetables, peas, sweetcorn etc. (not including potatoes, pasta, tinned spaghetti, baked beans, or rice) which of the following statements best describes her attitude to eating them?
-

1 - Yes, very like her

2 - Yes, somewhat like her

3 - No, not like her

Refuses to eat vegetables when offered
Will eat 1 or 2 types of vegetables only
Will eat vegetables occasionally (twice a week or less)
Prefers to eat vegetables raw rather than cooked
Eats vegetables regularly but needs encouragement (more than twice a week)
Eats vegetables regularly without any fuss (more than twice a week)

When your study child is offered fresh fruit e.g. an apple, pear or banana etc. which of the following statements best describes her attitude to eating it?

1
Never offered fresh fruit
If Never offered fresh fruit on question B13i Go to B14 below
qc_B13_i == 1
Else
When your study child is offered fresh fruit e.g. an apple, pear or banana etc. which of the following statements best describes her attitude to eating it?
-

1 - Yes, very like her

2 - Yes, somewhat like her

3 - No, not like her

9 - Don't know

Refuses to eat fruit when offered
Will eat 1 or 2 types of fruit only
Will eat fruit occasionally (twice a week or less)
Eats fruit regularly but needs encouragement (more than twice a week)
Eats fruit regularly without any fuss (more than twice a week)

Which of the following statements best describes your study child's attitude to eating slices or chunks of meat that need chewing e.g. a slice of chicken, or lamb or pork chop or chunks of meat in stew?

1
Never offered meat
If Never offered meat on question B14i Go to B15 on page 21
qc_B14_i == 1
Else
Which of the following statements best describes your study child's attitude to eating slices or chunks of meat that need chewing e.g. a slice of chicken, or lamb or pork chop or chunks of meat in stew?
-

1 - Yes, very like her

2 - Yes, somewhat like her

3 - No, not like her

9 - Don't know

Refuses to eat meat when offered
Will not eat pieces of meat but will eat mince or sausages or burgers
Eats meat but needs encouragement
Eats meat without any fuss
How often would you describe meal times with your children in the following ways?
-

1 - Never

2 - Occasionally

3 - Quite often

4 - Mostly

Mealtimes are enjoyable for everyone
Mealtimes are a rush
Mealtimes give us time to talk to each other
Mealtimes include arguments between the children
Mealtimes include arguments between adults and children
Mealtimes include arguments between adults

Does your child 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
How often does she suck a dummy or her thumb or finger?
-

1 - most of the time

2 - sometimes

3 - no, never

dummy
thumb of right hand
thumb of left hand
finger(s)

Apart from her finger, thumb or a dummy does she have a special object that she uses for comfort?

1
Yes
2
No
If no go to B18 below
If yes,
qc_B17_b == 1

what is this?

1
blanket
2
cuddly toy
3
other (please describe)
Other

Does she eat coal, soil, dirt or other non-food substances?

1
yes, every day
2
yes, at least once a week
3
yes, less than once a week
4
no, not at all
If yes,
qc_B18 == 1 || qc_B18 == 2 || qc_B18 == 3

please tick and describe what she eats:

Generic text
SECTION C: PROBLEMS AND TREATMENT
Children often have accidents or illnesses that need treatment. Please indicate which of the following have been given to your child in the last 12 months.
- If yes, please give full names of substances if you can

1 - Never

2 - Yes for 1-2 episodes only

3 - Yes for 3 or more episodes

Generic text

1 - Never

2 - Yes for 1-2 episodes only

3 - Yes for 3 or more episodes

Generic text

1 - Never

2 - Yes for 1-2 episodes only

3 - Yes for 3 or more episodes

Generic text

1 - Never

2 - Yes for 1-2 episodes only

3 - Yes for 3 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
iron
laxative
homeopathic medicine
herbal medicine
asthma medication
vaporiser

Children often have accidents or illnesses that need treatment. Please indicate which of the following have been given to your child in the last 12 months. Other (please tick and describe) please give full names of substances if you can

2
Yes for 1-2 episodes only
3
Yes for 3 or more episodes
Generic text
Other

Are there any pills, ointments or medicines that she has taken every day or nearly every day for the last 3 months? (Include vitamins, skin cream, inhaler, laxatives as well as antibiotics, homeopathic and herbal remedies etc.)

1
Yes
2
No
If no, go to C3a below
If yes,
qc_C2_a == 1

please describe:

Generic text
During the child's early years of life possible problems may be identified - yet when investigated further they are often found not to be problems at all. In this section we are asking about any possible problems that might have arisen.

Since your study child's 5th birthday has she been investigated because it was thought she might have something wrong with her spine, her legs or her feet?

1
Yes
2
No
If no, go to C4a on page 25
If yes,
qc_C3_a == 1

were any problems found?

1
Yes
2
No
9
Don't know
If no, go to C4a on page 25
If yes,
qc_C3_b == 1

please describe:

Generic text

how old was she?

1
5 years old
2
6 years old

what treatment did she have?

Generic text

Since her 5th birthday has anyone thought there might be a problem with her hearing?

1
Yes
2
No
If no, go to C5a below
qc_C4_a == 2
Else

Has your child been seen by a hearing specialist since she was 5?

1
Yes
2
No
If no, go to C5a below
If yes,
qc_C4_b == 1

At what age?

1
5 years old
2
6 years old

What was decided?

Generic text

Has anyone ever thought there might be a problem with her eyesight?

1
Yes
2
No
If no, go to C6a on page 26
If yes,
qc_C5_a == 1

What was thought to be wrong with her eyes?

1
squint (eyes not looking in same direction)
2
colour blind
3
something else (please tick and describe)
4
don't know
Other

Has your child been referred to an eye specialist since her 5th birthday?

1
Yes
2
No
If no, go to C6a on page 26
If yes,
qc_C5_c == 1

at what age?

1
5 years old
2
6 years old

What was decided?

Generic text

What treatment was given?

Generic text

Has anyone ever thought that there might be a problem with her talking?

1
Yes
2
No
If no, go to C7a below
If yes,
qc_C6_a == 1

Has she ever been seen by a speech therapist?

1
Yes
2
No
If no, go to C6c below
If yes,
qc_C6_b == 1

how old was she? ... years

Age

what was decided?

Generic text

Are there still any worries about her talking?

1
Yes
2
No
If yes,
qc_C6_c == 1

please describe

Generic text

Has anyone ever thought there might be a problem with her growth?

1
Yes
2
No
If no, go to C8a on page 27
If yes,
qc_C7_a == 1

Has she ever been seen by a specialist about her growth?

1
Yes
2
No
If no, go to e) below
If yes,
qc_C7_b == 1

how old was she? ... years

Age

what was decided?

Generic text

Are there still worries about her growth?

1
Yes
2
No
If yes,
qc_C7_e == 1

please describe

Generic text

Has anyone ever thought there might be a problem with clumsiness or her movement or coordination?

1
Yes
2
No
If no, go to C9a on page 28
If yes,
qc_C8_a == 1

Has she ever been seen by a specialist about this?

1
Yes
2
No
If no, go to C8e on page 28
If yes,
qc_C8_b == 1

how old was she? ... years

Age

what was decided?

Generic text

Are there still worries about this?

1
Yes
2
No
If yes,
qc_C8_e == 1

please describe

Generic text

Has anyone ever thought there might be a problem with other aspects of her development?

1
Yes
2
No
If no, go to C10a below
If yes,
qc_C9_a == 1

Has she ever been seen by a specialist about this?

1
Yes
2
No
If no, go to e) below
If yes,
qc_C9_b == 1

how old was she? ...years

Age

what was decided?

Generic text

Are there still worries about this?

1
Yes
2
No
If yes,
qc_C9_e == 1

please describe

Generic text

Has anyone ever thought there might be a problem with her behaviour or personality?

1
Yes
2
No
If no, go to C11a on page 29
If yes,
qc_C10_a == 1

Has she ever been seen by a specialist about this?

1
Yes
2
No
If no, go to C10e on page 29
If yes,
qc_C10_b == 1

how old was she? ...years

Age

what was decided?

Generic text

Are there still worries about this?

1
Yes
2
No
If yes,
qc_C10_e == 1

please describe

Generic text

Has anyone ever thought there might be a problem with aches and pains, including headache?

1
Yes
2
No
If no, go to C12a on page 30
If yes,
qc_C11_a == 1

Has she ever been seen by a specialist about this?

1
Yes
2
No
If no, go to C11e below
If yes,
qc_C11_b == 1

how old was she? ...years

Age

what was decided?

Generic text

Are there still worries about this?

1
Yes
2
No
If yes,
qc_C11_e == 1

please describe

Generic text

Have there been any other problems for which your child saw (or is going to see) a specialist since her 5th birthday?

1
Yes
2
No
If no, go to C13a on page 31
If yes,
qc_C12_a == 1

For how many different problems?

How many
Please list, for each problem, what has happened:
What was thought to be the problem? Has she seen a specialist? What age was she the first time she was seen for this problem ? What was decided? What treatment was given?
Generic text

1 - Yes

2 - No

Generic textAgeGeneric textGeneric textGeneric textAgeGeneric text

1 - Yes

2 - No

Generic text

1 - Yes

2 - No

AgeGeneric textGeneric textGeneric text

1 - Yes

2 - No

Generic textGeneric textAgeGeneric textGeneric text

1 - Yes

2 - No

Generic textAge
Generic text

1 - Yes

2 - No

Generic textAgeGeneric textGeneric textGeneric textAgeGeneric text

1 - Yes

2 - No

Generic text

1 - Yes

2 - No

AgeGeneric textGeneric textGeneric text

1 - Yes

2 - No

Generic textGeneric textAgeGeneric textGeneric text

1 - Yes

2 - No

Generic textAge
Generic text

1 - Yes

2 - No

Generic textAgeGeneric textGeneric textGeneric textAgeGeneric text

1 - Yes

2 - No

Generic text

1 - Yes

2 - No

AgeGeneric textGeneric textGeneric text

1 - Yes

2 - No

Generic textGeneric textAgeGeneric textGeneric text

1 - Yes

2 - No

Generic textAge
Generic text

1 - Yes

2 - No

Generic textAgeGeneric textGeneric textGeneric textAgeGeneric text

1 - Yes

2 - No

Generic text

1 - Yes

2 - No

AgeGeneric textGeneric textGeneric text

1 - Yes

2 - No

Generic textGeneric textAgeGeneric textGeneric text

1 - Yes

2 - No

Generic textAge
Generic text

1 - Yes

2 - No

Generic textAgeGeneric textGeneric textGeneric textAgeGeneric text

1 - Yes

2 - No

Generic text

1 - Yes

2 - No

AgeGeneric textGeneric textGeneric text

1 - Yes

2 - No

Generic textGeneric textAgeGeneric textGeneric text

1 - Yes

2 - No

Generic textAge
Problem No.1
Problem No.2
Problem No.3
If more than 3 problems, continue below or on a separate sheet.

Has she visited the dentist in the last 12 months?

1
yes for treatment
2
yes, for inspection only
3
no, not at all
If yes, for treatment
qc_C13_a == 1

what has she had (tick all that apply) a filling

1
Yes

what has she had (tick all that apply) a tooth taken out?

1
Yes
If yes,
qc_C13_a_ii == 1

How many teeth?

How many

Did she have a general anaesthetic for this?

1
Yes
2
No

for treatment, what has she had (tick all that apply) tooth brace

1
Yes

for treatment, what has she had (tick all that apply) other treatment? please describe

1
Yes
Other

How often does she brush her teeth?

1
more than once each day
2
once every day
3
less than once a day
4
not at all

Does she ever have toothpaste?

1
Yes
2
No
If no, go to C13d on page32
If yes,
qc_C13_c == 1

how much toothpaste does she have on her brush nowadays?

1
brush full
2
half brush
3
less than half a brush
4
none
9
don't know

how many times a day does she use toothpaste ... times

How many

does she usually swallow it or spit it out?

1
swallows it
2
spits it out
3
varies
9
don't know

what type of toothpaste is usually used?

Generic text

Has she ever had a dental X-ray?

1
Yes
2
No

Have any of her first (milk) teeth fallen out?

1
Yes
2
No
If no, go to Section D on page 33
If yes,
qc_C13_e == 1

how many? ... teeth

How many

Are there any other problems with her teeth?

1
Yes
2
No
If yes,
qc_C13_f == 1

please describe

Generic text
Please remember - the Children of the Nineties Tooth Fairy would love to have any teeth and send a badge to your daughter. Only use the bags we send you. If you don't have a bag call the office.
SECTION D: ACCIDENTS AND INJURIES
However careful a parent is, most children have accidents at some time or other. Please list on the next pages the times your child has had an accident, whether or not she was injured as a result.

Has she been burnt or scalded in the past 12 months?

1
Yes
2
No
If no, go to D2a on page 34
If yes,
qc_D1_a == 1

how many times?

How many
For each accident please describe below what happened:
Place accident happened (e.g.kitchen, park, school) What was she burnt with? (e.g. tea, iron, electric fire, bonfire, fireworks) Date of accident (month, year) Injuries caused (if no injury write none) Who was with her? What did the person with her do? Other (please describe) What treatment did the person with her give? What other treatment did she have?
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her 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 she had an accident while playing sports or games in the past 12 months?

1
Yes
2
No
If no, go to D3a on page 35
If yes,
qc_D2_a == 1

how many times?

How many
For each accident please describe below what happened:
Place it happened (e.g.playground, street, school) What happened (e.g.hit by ball, fell off trampoline) Date of accident (month, year) Injuries caused (if no injury write none) Who was with her? What did the person with her do? Other (please describe) What treatment did the person with her give? What other treatment did she have?
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her 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 she swallowed anything she shouldn't have (such as pills, buttons, disinfectant) in the past 12 months?

1
Yes
2
No
If no, go to D4a on page 36
If yes,
qc_D3_a == 1

how many times?

How many
For each time please describe below what happened:
Place accident happened (e.g. your home, school, at friend's) What did she swallow? (e.g. bleach, aspirin, marble) Date of accident (month, year) Who was with her? What did the person with her do? Other (please describe) What treatment did the person with her give? What other treatment did she have?
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her 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 she had any injuries involving traffic in the past 12 months?

1
Yes
2
No
If no, go to D5a on page 37
If yes,
qc_D4_a == 1

how many times?

How many
For each accident or injury please describe below what happened:
Where was she and what was she doing (e.g. sitting in car; riding a bicycle) What happened (e.g. car hit tree; cycle toppled into path of motor vehicle) Date of accident (month, year) Injuries caused (if no injury write none) Who was with her? What did the person with her do? Other (please describe) What treatment did the person with her give? What other treatment did she have?
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her 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 her 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 her 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 her 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 she ever been injured by the action of another person (whether intentionally or not)

1
Yes
2
No
If no, go to D6a on page 38
If yes,
qc_D5_a == 1

how many times?

How many
For each time please describe below what happened:
Person involved (e.g. stranger, sister, child's father) What happened ? Date of injury (month, year) Who else was with her? What did the person with her do? Other (please describe) What treatment did the person with her give? What other treatment did she have?
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
1st injury
2nd injury
3rd injury

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 she had any other accidents or injuries in the past 12 months?

1
Yes
2
No
If no, go to D7 on page 39
If yes,
qc_D6_a == 1

how many times?

How many
For each time please describe below what happened:
Place accident happened (e.g. kitchen, garden, street, school) What happened ? Date of accident (month, year) Injuries caused (if no injury write none) What did the person with her do? Other (please describe) What treatment did the person with her give? What other treatment did she have?
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated her 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 her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her 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 her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her 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:

Generic text

Please describe how each accident happened: Accident 3

Generic text
Has she had any of the following happen since she was born? (tick all questions and all time periods that apply)
Yes, aged 0 - 2 years Yes, aged 3-4 years Yes, since 5th birthday

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

Broken arm/hand
Broken leg/foot
Broken/cracked skull
Other broken bone (please describe)
Unconscious because of a head injury
Cut(s) requiring stitches
Burn or scald having a skin graft
A road traffic accident
An accident in a playground
An accident at school, nursery, creche
Stung by wasp or bee
Bitten by animal or human please tick and describe
Badly sunburnt
Nearly drowned
Front tooth (teeth) knocked out
Front tooth/teeth chipped or injured
Other tooth/teeth knocked out or chipped

Has she had any of the following happen since she was born? (tick all questions and all time periods that apply) Other broken bone (please describe)

Other

Has she had any of the following happen since she was born? (tick all questions and all time periods that apply) Bitten by animal or human please tick and describe

Generic text

Has the study child ever had an accident that has had effects that are still present? yes, a scar

1
Yes

Has the study child ever had an accident that has had effects that are still present? yes, a behaviour difference

1
Yes

Has the study child ever had an accident that has had effects that are still present? yes, other (please tick and describe )

1
Yes
Other
SECTION E: YOUR CHILD'S ENVIRONMENT
Which animals in either your home or elsewhere does she touch or have close contact with at least once a week?
-

1 - Yes in our home

2 - Yes elsewhere

3 - Yes both

4 - No, not at all

cat (s)
dog (s )
birds

Which animals in either your home or elsewhere does she touch or have close contact with at least once a week? other creatures* *please tick and describe

1
Yes in our home
2
Yes elsewhere
3
Yes both
4
No, not at all
Other

All children get dirty. How often in a normal day at home: does she wash her face?

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 at home: does she wash or wipe her hands?

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 at home: does she clean her hands before a meal?

1
always
2
usually
3
sometimes
4
occasionally
5
never
How much time on average does she spend each day:
on a school weekday on a weekend day on normal days in school holidays

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

1 - Not at all

2 - less than 1 hour

3 - 1-2 hours

4 - 3 or more hours

in a car, bus or other transport
out of doors in summer
out of doors in winter
watching T.V
with other children
drawing, making, constructing things
playing by herself
school homework
reading books for pleasure
playing musical instruments
using a computer
on the telephone

How often does she normally: have a bath or shower:

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

How often does she normally: clean her ear holes:

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

How often does she normally: wash her hair:

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

How often during a day is she 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

How often during a day is she 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
Using the toilet:

How often does she show signs (eg fidgets) when she needs to go to the toilet?

1
never
2
sometimes
3
often

When she needs to, how often does she go to the toilet without you having to remind her?

1
never
2
sometimes
3
often
4
always

Does she have to dash to the toilet quickly when she realises she needs to go?

1
yes, has to go straight away
2
can hold for a short time (less than 5 minutes)
3
can hold for longer than 5 minutes

How often does she usually go to the toilet during the day?

1
less than 5 times a day
2
5-9 times a day
3
10 or more times a day
9
don't know

How often does she usually get up to go to the toilet at night?

1
not at all
2
once
3
twice
4
3 or more times
9
don't know

How often usually does your child: dirty her pants during the day

1
Never
2
Occasional accident but less than once a week
3
About once a week
4
2-5 times a week
5
Nearly everyday
6
More than once a day

How often usually does your child: dirty herself at night

1
Never
2
Occasional accident but less than once a week
3
About once a week
4
2-5 times a week
5
Nearly everyday
6
More than once a day

How often usually does your child: wet herself during the day

1
Never
2
Occasional accident but less than once a week
3
About once a week
4
2-5 times a week
5
Nearly everyday
6
More than once a day

How often usually does your child: wet the bed at night

1
Never
2
Occasional accident but less than once a week
3
About once a week
4
2-5 times a week
5
Nearly everyday
6
More than once a day
If she wets at night, how often does she:
-

1 - never

2 - sometimes

3 - often

4 - always

wake up after wetting
seem to wet soon after going to sleep
seem upset when the bed is wet

In a normal week for how long is she left at home alone or just with other young children (aged less than 12)?* during the day:

1
not at all
2
only for a few minutes
3
for less than an hour
4
for more than an hour

In a normal week for how long is she left at home alone or just with other young children (aged less than 12)?* at night:

1
not at all
2
only for a few minutes
3
for less than an hour
4
for more than an hour
(* by this we mean with no adults or older children (aged 12 or more) at home at all)
SECTION F: YOU AND YOUR CHILD

Most parents have a battle of wills with their children. How often do you have a battle with your study daughter?

1
never
2
rarely
3
sometimes
4
frequently
If never, go to F2a on page 48
qc_F1_a == 1
Else

What are they usually about (please tick all that apply)? going to sleep

1
Yes

What are they usually about (please tick all that apply)? eating

1
Yes

What are they usually about (please tick all that apply)? type of food

1
Yes

What are they usually about (please tick all that apply)? helping in home

1
Yes

What are they usually about (please tick all that apply)? getting up in the morning

1
Yes

What are they usually about (please tick all that apply)? homework

1
Yes

What are they usually about (please tick all that apply)? dressing

1
Yes

What are they usually about (please tick all that apply)? other please desribe

1
Yes
Other

Who most often wins?

1
me
2
she does
3
about even
4
neither of us

How often does she refuse to go to bed?

1
most of the time
2
often
3
at times
4
rarely
5
never

How often does she refuse to do homework?

1
most of the time
2
often
3
at times
4
rarely
5
never
7
is not given homework

How often does she have temper tantrums or get into a real rage?

1
more than once a day
2
most days
3
at least once a week
4
less than once a week
5
never
If never, go to F4 on page 50
If she has temper tantrums:
qc_F3_a == 1 || qc_F3_a == 2 || qc_F3_a == 3 || qc_F3_a == 4
Why do you think they happen? (please tick all that apply)
-

1 - Yes

failure to get what she wants
failure to make herself understood
reaction to being corrected
refusal by child to do something
failure to get attention
feeling that a sibling gets preferential treatment
no particular reason

Why do you think they happen? (please tick all that apply) other (please describe)

1
Yes
Other
When she has temper tantrums how often do you:
-

1 - Often

2 - Sometimes

3 - Never

ignore it, let her get it out of her system
send her away for 'time out' e.g. send her to her bedroom
try to hold and cuddle her
try to reason with her
threaten her
say hurtful things you regret
leave it for someone else to cope with
slap or hit her
try to distract her
shout at her

When she has temper tantrums how often do you: other (please tick and describe)

1
Often
2
Sometimes
3
Never

Space for comments:

Long text

How often does she do the following: repeatedly rocks her head or body for no reason

1
Often
2
Sometimes
3
Never

How often does she do the following: has a tic or twitch

1
Often
2
Sometimes
3
Never

How often does she do the following: has other unusual behaviour (please tick and describe)

1
Often
2
Sometimes
3
Never
Other

How often does she do the following: bites her nails?

1
Often
2
Sometimes
3
Never
Activities

About how often does she go to: local shops

1
Nearly every day
2
2-5 times a week
3
Once a week
4
Once a month
5
A few times a year
6
Once or twice a year
7
Never

About how often does she go to: department store

1
Nearly every day
2
2-5 times a week
3
Once a week
4
Once a month
5
A few times a year
6
Once or twice a year
7
Never

About how often does she go to: supermarket

1
Nearly every day
2
2-5 times a week
3
Once a week
4
Once a month
5
A few times a year
6
Once or twice a year
7
Never

About how often does she go to: public park or playground

1
Nearly every day
2
2-5 times a week
3
Once a week
4
Once a month
5
A few times a year
6
Once or twice a year
7
Never

About how often does she go to: visits to friends

1
Nearly every day
2
2-5 times a week
3
Once a week
4
Once a month
5
A few times a year
6
Once or twice a year
7
Never

About how often does she go to: visits to relatives

1
Nearly every day
2
2-5 times a week
3
Once a week
4
Once a month
5
A few times a year
6
Once or twice a year
7
Never

About how often does she go to: library

1
Nearly every day
2
2-5 times a week
3
Once a week
4
Once a month
5
A few times a year
6
Once or twice a year
7
Never

About how often does she go to: places of interest (e.g. Zoo, museum)

1
Nearly every day
2
2-5 times a week
3
Once a week
4
Once a month
5
A few times a year
6
Once or twice a year
7
Never

About how often does she go to: places of entertainment (e.g. funfair, cinema, theatre)

1
Nearly every day
2
2-5 times a week
3
Once a week
4
Once a month
5
A few times a year
6
Once or twice a year
7
Never

About how often does she go to: swimming pool or other sporting area

1
Nearly every day
2
2-5 times a week
3
Once a week
4
Once a month
5
A few times a year
6
Once or twice a year
7
Never

How much choice do you allow her in deciding what foods she eats at meals at home? Main meal

1
she can choose from any food available
2
she is given a choice from a few alternatives that an adult chooses
3
an adult decides what she will eat

How much choice do you allow her in deciding what foods she eats at meals at home? Snacks

1
she can choose from any food available
2
she is given a choice from a few alternatives that an adult chooses
3
an adult decides what she will eat

Do you allow her to choose what clothes she will wear at home?

1
she always takes part in choosing
2
she has some choice
3
she has no choice in what she will wear

Does her school have a uniform?

1
yes, all children have to wear it
2
yes, but children don't have to wear it
3
no, no school uniform

Does your child have the following to play with: cuddly toys

1
Yes, and plays with
2
Yes, but doesn't play with
3
No, doesn't have

Does your child have the following to play with: construction toys (e.g. lego)

1
Yes, and plays with
2
Yes, but doesn't play with
3
No, doesn't have

Does your child have the following to play with: computer games

1
Yes, and plays with
2
Yes, but doesn't play with
3
No, doesn't have

Does your child have the following to play with: bicycle

1
Yes, and plays with
2
Yes, but doesn't play with
3
No, doesn't have

Does your child have the following to play with: card games

1
Yes, and plays with
2
Yes, but doesn't play with
3
No, doesn't have

Does your child have the following to play with: board games

1
Yes, and plays with
2
Yes, but doesn't play with
3
No, doesn't have

Does your child have the following to play with: jigsaw puzzles

1
Yes, and plays with
2
Yes, but doesn't play with
3
No, doesn't have

Does your child have the following to play with: action dolls (e.g. Barbie, Power Rangers)

1
Yes, and plays with
2
Yes, but doesn't play with
3
No, doesn't have

How many books does the child have of his own ? ... books

How many
About books:

Does she belong to a library?

1
Yes
2
No
If no, go to F10 below
If yes,
qc_D9_a == 1

How often does she borrow books from a library?

1
never
2
less than once a week
3
about once a week
4
more than once a week
What sort of books does she like? (tick all that apply)
-

1 - Yes

Books with lots of pictures
Story books
Books with horrific fantasy creatures
Books with factual information (e.g. about cars, pets)
Doesn't like books at all
Does she read a comic or children's magazine or newspaper each week?
-

1 - Yes

yes, comic
yes, magazine
yes, newspaper
no, none of these

How often do you have a conversation with her?

1
never
2
rarely (once a week)
3
sometimes (several times a week)
4
often (nearly every day)
5
almost always (at least once a day)
What particular tasks does she do at home? (please tick all that apply)
-

1 - Often

2 - Occasionally

3 - Not at all

making her bed
cleaning her room
tidying her room
setting or clearing the table
looking after a pet

What particular tasks does she do at home? (please tick all that apply) other task (please tick and describe)

1
Often
2
Occasionally
3
Not at all
Other

Does she do these tasks: Because she wants to

1
Often
2
Occasionally
3
Not at all

Does she do these tasks: Because you tell her to

1
Often
2
Occasionally
3
Not at all

Does she do these tasks: Because she will get a reward

1
Often
2
Occasionally
3
Not at all

Is there a television set at home?

1
Yes and she watches it
2
Yes, but she does not watch it
3
No
If no, go to F16 on page 56
qc_F14_a == 3
Else

How often is your child allowed to watch the television or a video?

1
whenever she wants
2
when I decide it is suitable
3
hardly ever
If hardly ever, go to F16 on page 56
qc_F14_b == 3
Else

When do you normally have the television on? Weekdays

1
all day
2
most of the day
3
1/2 the day
4
less than 1/2 the day
5
not at all

When do you normally have the television on? Weekends

1
all day
2
most of the day
3
1/2 the day
4
less than 1/2 the day
5
not at all
Does your child watch television or a video when it is on?
-

1 - Always

2 - Sometimes

3 - Never

yes, but while playing at the same time
yes, and pays attention
no, she ignores it
If she does watch TV,
qc_F14_d_i-iii$1;1;2 == 1 || qc_F14_d_i-iii$1;1;2 == 2

what programmes does she see? (tick all that apply) children's programmes

1
Yes
2
No
9
Don't know

what programmes does she see? (tick all that apply) other programmes

1
Yes
2
No
9
Don't know

what programmes does she see? (tick all that apply) children's videos

1
Yes
2
No
9
Don't know

what programmes does she see? (tick all that apply) other videos

1
Yes
2
No
9
Don't know

Do you watch as a family?

1
Yes often
2
Yes sometimes
3
No never

Do you discuss what you have seen on TV with your study child?

1
Yes often
2
Yes sometimes
3
No never

About how close to the TV does she usually sit?

1
less than 1 metre
2
about 1 metre
3
more than 1 metre
4
varies

Does she use the TV to play computer games?

1
Yes
2
No

How often does she play with other children (other than brothers or sisters) outside school?

1
every day
2
2-6 times a week
3
once a week
4
less than once a week
5
never

When you and your child meet again after being apart does she tell you what she's been doing?

1
yes, always
2
yes, sometimes
3
hardly ever
4
never

Does she share with you her feelings and worries?

1
yes, always
2
yes, sometimes
3
hardly ever
4
never
5
don't know how often

Do you think she likes to be with you?

1
yes, always
2
yes, sometimes
3
hardly ever
4
never

Do you feel that she dominates the household?

1
Yes, usually
2
Yes, sometimes
3
No, not at all

Do you start by being firm but then give way?

1
Yes, usually
2
Yes, sometimes
3
No, not at all

Does she make collections of things (e.g. stamps, coins)

1
Yes
2
No

On a day when the weather is reasonable where does she prefer to play?

1
Prefers out of doors
2
Prefers indoors
3
No preference

Does she prefer to play?

1
On her own
2
With other children
3
Either
4
Doesn't play at all

Does she like to take part in competitive games? (i.e. one with winners and losers)

1
Yes
2
No

Does she take a leading role when playing with other children?

1
Yes
2
No

Does she like making up stories?

1
Yes
2
No

Do you insist: that she goes to bed at bedtime

1
Yes I insist always
2
Sometimes I insist
3
I never insist

Do you insist: that she obeys you

1
Yes I insist always
2
Sometimes I insist
3
I never insist

Do you insist: that she eats what you give her

1
Yes I insist always
2
Sometimes I insist
3
I never insist

Do you insist: that she is polite to adults

1
Yes I insist always
2
Sometimes I insist
3
I never insist

Do you insist: that she is considerate of other's feelings

1
Yes I insist always
2
Sometimes I insist
3
I never insist

Do you insist: that she keeps herself clean

1
Yes I insist always
2
Sometimes I insist
3
I never insist

Do you insist: that she keeps her belongings tidy

1
Yes I insist always
2
Sometimes I insist
3
I never insist

Do you object: if she makes a lot of noise

1
Yes I object always
2
Sometimes I object
3
I never object

Do you object: if she brings friends home

1
Yes I object always
2
Sometimes I object
3
I never object

Do you object: if she interrupts your conversation

1
Yes I object always
2
Sometimes I object
3
I never object
SECTION G: HER GROWTH AND HER SHOES
Please list the dates on which your child was weighed since she was 5 1/2 years old and how much she weighed each time. Also add height and head circumferences, if they were measured. If you don't know, please write DK and go to G2, below.
Date Weight Height Head circumference
Generic textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric dateGeneric textGeneric textGeneric text
1.
2.

What size shoes does she take?

Float
How often nowadays does she wear the following footwear:
Out of doors Indoors

1 - Usually

2 - Sometimes

3 - Never

1 - Usually

2 - Sometimes

3 - Never

1 - Usually

2 - Sometimes

3 - Never

1 - Usually

2 - Sometimes

3 - Never

1 - Usually

2 - Sometimes

3 - Never

1 - Usually

2 - Sometimes

3 - Never

1 - Usually

2 - Sometimes

3 - Never

1 - Usually

2 - Sometimes

3 - Never

sandals
trainers/ plimsolls
slippers
shoes
other (please tick and describe)

How often nowadays does she wear the following footwear: other (please tick and describe)

Other

How long do you usually let her hair grow before cutting it?

1
less than 1 inch
2
more than 1 inch but not shoulder length
3
shoulder length
4
longer than shoulder
5
never cut it
6
other, please describe
Other

This questionnaire was completed by: (tick all that apply) mother

1
Yes

This questionnaire was completed by: (tick all that apply) father

1
Yes

This questionnaire was completed by: (tick all that apply) other (please tick & describe)

1
Yes
Other

Please give the date on which you completed this questionnaire:

Generic date

Please give the date of birth of your child:

Generic date
THANK YOU VERY MUCH FOR YOUR HELP

Space for any additional comment you would like to make

Generic text
NB Please remember we cannot reply to any comment unless you sign it.
When completed, please return the questionnaire to: Professor Jean Golding Children of the Nineties - ALSPAC Institute of Child Health
End

alspac_97_msdgu

My Daughter Growing Up
This questionnaire should be answered by the chief child carer. It asks about your child as she continues to develop.
It is like the other questionnaires you have received. To answer simply tick the box which best describes your child or your child's situation. Please answer all questions that you can. If you cannot answer certain questions or if they do not apply to you please put a line through them. 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: GOING TO SCHOOL

Does she go to school?
1
Yes
2
No
How old was she when she started school?
Age
Months
How many different schools has she gone to?
How many

What types of school has she gone to? (If more than 3 schools, write in the margin)

1st school 2nd school 3rd school

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

1 - Yes

infant school
primary school
private (fee paying )
boarding school
studies at home
special school*
not able to be taught
please describe type
Generic text
Please describe reasons for child being at current school (tick all that apply) It was the only available choice
1
Yes
Please describe reasons for child being at current school (tick all that apply) It was the best available
1
Yes
Please describe reasons for child being at current school (tick all that apply) There were medical reasons please describe
1
Yes
Generic text
Please describe reasons for child being at current school (tick all that apply) There were psychological reasons please describe
1
Yes
Generic text
Please describe reasons for child being at current school (tick all that apply) Other (please tick and describe)
1
Yes
Other