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alspac_96_mfyosd
My Five Year Old Son
This questionnaire asks about your child now he is 5 years old.
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: 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 he was injured as a result.

Has he been burnt or scalded since he was 4 1/2 years old?

1
Yes
2
No
If no, go to A2a on page 4
If yes,
qc_A1_a == 1

how many times?

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

Please describe how each accident happened: Burn 1

Generic text

Please describe how each accident happened: Burn 2

Generic text

Please describe how each accident happened: Burn 3

Generic text

Has he had a bad fall since he was 4 1/2 years old?

1
Yes
2
No
If no, go to A3a on page 5
If yes,
qc_A2_a == 1

how many times?

How many
For each fall please describe below what happened:
Place accident happened (e.g. kitchen, garden, school) What did he fall from (e.g. table, wall, climbing frame)? Date of fall (month, year) Injuries caused (if no injury write none) Who was with him? What did the person with him do? Other (please describe) What treatment did the person with him give? What other treatment did he have?
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

Please describe how each accident happened: Fall 1

Generic text

Please describe how each accident happened: Fall 2

Generic text

Please describe how each accident happened: Fall 3

Generic text

Has he swallowed anything he shouldn't have (such as pills, buttons, disinfectant) since he was 4 1/2 years old?

1
Yes
2
No
If no, go to A4a on page 6
If yes,
qc_A3_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 he swallow? Date of accident (month, year) Who was with him? What did the person with him do? Other (please describe) What treatment did the person with him give? What other treatment did he have?
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
1st accident
2nd accident
3rd accident

Please describe how each accident happened: Accident 1

Generic text

Please describe how each accident happened: Accident 2

Generic text

Please describe how each accident happened: Accident 3

Generic text

Has he had any other accidents or injuries since he was 4 1/2 years old?

1
Yes
2
No
If no, go to A5 on page 7
If yes,
qc_A4_a == 1

how many other accidents?

How many
For each accident or injury 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) Who was with him? What did the person with him do? Other (please describe) What treatment did the person with him give? What other treatment did he have?
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

Please describe how each accident happened: Accident 1

Generic text

Please describe how each accident happened: Accident 2

Generic text

Please describe how each accident happened: Accident 3

Generic text
Has he had any of the following happen since he was 4 1/2? (tick all that apply)
-

1 - Yes

Broken arm/hand
Broken leg/foot
Broken/cracked skull
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
Badly sunburnt
Nearly drowned
Front tooth (teeth) knocked out
Front tooth/teeth chipped or injured
Other tooth/teeth knocked out or chipped

Has he had any of the following happen since he was 4 1/2? (tick all that apply) Other broken bone (please describe)

1
Yes
Other

Has he had any of the following happen since he was 4 1/2? (tick all that apply) Bitten by animal or human (please describe)

1
Yes
Generic text

Space to describe any serious injuries not described already.

Long text
SECTION B: PROBLEMS AND TREATMENT
Children often have accidents or illnesses that need treatment. Please indicate which of the following have been given to your child since he was 4 1/2 years old.
- If yes, please give full names of substances if you can

1 - Never

2 - Yes for one episode only

3 - Yes for 2 or more episodes

Generic text

1 - Never

2 - Yes for one episode only

3 - Yes for 2 or more episodes

Generic text

1 - Never

2 - Yes for one episode only

3 - Yes for 2 or more episodes

Generic text

1 - Never

2 - Yes for one episode only

3 - Yes for 2 or more episodes

Generic text
cough medicine
antibiotics/penicillin
throat medicine
vitamins
paracetamol/calpol
ointment for skin
eye ointment
diarrhoea mixture or pills
dimotapp/decongestant
ear drops
eye drops
iron
laxative
homeopathic medicine
herbal medicine
other (please tick and describe )

Children often have accidents or illnesses that need treatment. Please indicate which of the following have been given to your child since he was 4 1/2 years old.

Other

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

1
Yes
2
No
If no, go to B3a below
If yes,
qc_B2_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 recently.

Since your study child was 4 years old has he been investigated because it was thought he might have something wrong with his hips, his legs or his feet?

1
Yes
2
No
If no, go to B4a on page 11
If yes,
qc_B3_a == 1

were any problems found?

1
Yes
2
No
9
Don't know
If no, go to B4a on page 11
If yes,
qc_B3_b == 1

please describe:

Generic text

how old was he?

1
4 years old
2
5 years old

what treatment did he have?

Generic text

Since his 4th birthday has anyone thought there might be a problem with his hearing?

1
Yes
2
No
If no, go to B5a below
qc_B4_a == 2
Else

Has your child been seen at the Hearing Assessment Centre or by a specialist since his 4th birthday?

1
Yes
2
No
If no, go to B5a below
If yes,
qc_B4_b == 1

At what age?

1
4 years old
2
5 years old

What was decided?

Generic text

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

1
Yes
2
No
If no, go to B6a on page 12
qc_B5_a == 2
Else

Has he been given any of the following? Glasses

1
No
2
Yes
If yes,
qc_B5_b == 2

how many pairs in total?

How many

Has he been given any of the following? Patches

1
No
2
Yes
If yes,
qc_B5_c == 2

how many months in total has he worn them so far?

How many

Has he been given any of the following? Drops for his eyes

1
No
2
Yes
If yes,
qc_B5_d == 2

Has he been given any of the following? how many bottles in total?

How many

Has he been given any of the following? An operation on his eyes

1
No
2
Yes
If yes,
qc_B5_e == 2

how many in total?

How many

Has he been given any of the following? Anything else

1
No
2
Yes
If yes,
qc_B5_f == 2

write down other treatment given

Other

Has anyone thought that there might be a problem with his talking since his 4th birthday?

1
Yes
2
No
If no, go to B7a below
If yes,
qc_B6_a == 1

Has he been seen by a speech therapist?

1
Yes
2
No
If no, go to B6c below
If yes,
qc_B6_b == 1

how old was he? ... years

Age

what was decided?

Generic text

Are there still any worries about his talking?

1
Yes
2
No
If yes,
qc_B6_c == 1

please describe

Generic text

Since his 4th birthday has anyone thought there might be a problem with his growth?

1
Yes
2
No
If no, go to B8a on page 13
If yes,
qc_B7_a == 1

Has he been seen by a specialist about his growth

1
Yes
2
No
If no, go to B7d on page 13
If yes,
qc_B7_b == 1

what was decided?

Generic text

Are there still worries about his growth?

1
Yes
2
No
If no, go to B8a below
If yes,
qc_B7_d == 1

please describe

Generic text

Since his 4th birthday has anyone thought there might be a problem with clumsiness or his movement or co-ordination?

1
Yes
2
No
If no, go to B9a below
If yes,
qc_B8_a == 1

Has he been seen by a specialist about this?

1
Yes
2
No
If no, go to d) below
If yes,
qc_B8_b == 1

what was decided?

Generic text

Are there still worries about this?

1
Yes
2
No
If no, go to B9a below
If yes,
qc_B8_d == 1

please describe

Generic text

Since his 4th birthday has anyone thought there might be a problem with other aspects of his development?

1
Yes
2
No
If no, go to B10a on page 14
If yes,
qc_B9_a == 1

Has he been seen by a specialist about this?

1
Yes
2
No
If no, go to B9d on page 14
If yes,
qc_B9_b == 1

what was decided?

Generic text

Are there still worries about this?

1
Yes
2
No
If no, go to B10a below
If yes,
qc_B9_d == 1

please describe

Generic text

Have there been any other problems for which your child saw (or is going to see) a specialist since his 4th birthday?

1
Yes
2
No
If no, go to B11a on page 15
If yes,
qc_B10_a == 1

For how many different problems?

How many
Please list each problem, and what has happened?
What was thought to be the problem? Have you seen the specialist about this What age was he the first time he was seen for this problem ? (put 0 if less than 12 months) ... years 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.

Long text

Has he 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_B11_a == 1

what has he had (tick all that apply) a filling?

1
Yes

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

1
Yes
If yes,
qc_B11_a_ii == 1

How many teeth?

How many

Did he have a general anaesthetic for this?

1
Yes
2
No

what has he had (tick all that apply) other treatment? Please describe

1
Yes
Other

Does he use a toothbrush?

1
yes, adult size brush
2
yes, child size brush
3
no, not at all
If no, go to B11e below
qc_B11_b == 3
Else

How often does he brush his teeth?

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

Who brushes his teeth?

1
always brushes himself
2
usually brushes himself
3
sometimes child, sometimes adult
4
usually brushed by adult
5
always brushed by adult
6
other (please describe)
Other

Does he ever have toothpaste?

1
Yes
2
No
If no, go to B11f on page 17
If yes,
qc_B11_e == 1

how much toothpaste does he have on his brush nowadays?

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

how many times a day does this happen? ... times

How many

does he usually swallow it or spit it out?

1
swallows it
2
spits it out
3
varies

what type of toothpaste is usually used?

Generic text

Has he ever had a dental X-ray?

1
Yes
2
No

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

1
Yes
2
No
If no, go to B12 below
If yes,
qc_B11_g == 1

how many? ... teeth

How many
Please remember - the Children of the Nineties Tooth Fairy would love to have any teeth and send a badge to your son.
Only use the bags we send you.
If you don't have a bag call the office.

Are there any foods or drinks that your child is allergic to?

1
yes definitely
2
yes possibly
3
no, not at all
9
don't know
If no, or don't know go to B13a on page 19
If yes,
qc_B12 == 1 || qc_B12 == 2

please describe which foods or drinks

Generic text

was the reaction caused by eating or touching the food or drink?

1
eating/drinking
2
touching
3
both

what happens when he does have the reaction? (tick all that apply) bright red rash

1
Yes
If yes,
qc_B12_c_i == 1

over what part of body?

Generic text

what happens when he does have the reaction? (tick all that apply) hives (white raised bumps on skin)

1
Yes
If yes,
qc_B12_c_ii == 1

over what part of body

Generic text

what happens when he does have the reaction? (tick all that apply) wheezing or whistling in the chest

1
Yes

what happens when he does have the reaction? (tick all that apply) vomiting

1
Yes

what happens when he does have the reaction? (tick all that apply) diarrhoea

1
Yes

what happens when he does have the reaction? (tick all that apply) difficulty breathing

1
Yes

what happens when he does have the reaction? (tick all that apply) stops breathing

1
Yes

what happens when he does have the reaction? (tick all that apply) headache

1
Yes

what happens when he does have the reaction? (tick all that apply) swelling

1
Yes
If yes,
qc_B12_c_ix == 1

describe where

Generic text

what happens when he does have the reaction? (tick all that apply) other reaction (please describe )

1
Yes
Other

How long after eating or drinking or touching does this usually happen?

1
less than 1 hr
2
1-2 hrs
3
3-5 hrs
4
6 hrs or more
9
don't know

How old was he when this first happened? ... years old

Age

How many times has a reaction happened? ... times

How many

How old was he the last time a reaction happened? ... years old

Age
What have you done about these reactions? (tick all that apply)
-

1 - Yes

Avoided the foods that caused them
Took to GP to investigate
Investigated in hospital

What have you done about these reactions? (tick all that apply) Other (please describe)

1
Yes
Other

What advice have you been given? (if none, write NONE)

Generic text

What treatment has your child been given for the problem? (if none, write NONE)

Generic text

Apart from food and drink are there any other things to which he is allergic?

1
Yes
2
No
If no, go to Section C on page 21
If yes,
qc_B13_a == 1

What is he allergic to? (tick all that apply) pollen

1
Yes

What is he allergic to? (tick all that apply) cat

1
Yes

What is he allergic to? (tick all that apply) dog

1
Yes

What is he allergic to? (tick all that apply) bee sting

1
Yes

What is he allergic to? (tick all that apply) house dust

1
Yes

What is he allergic to? (tick all that apply) other (please tick and describe)

1
Yes
Other

How does he react to these? (tick all that apply) wheezing

1
Yes

How does he react to these? (tick all that apply) breathlessness

1
Yes

How does he react to these? (tick all that apply) sneezing

1
Yes

How does he react to these? (tick all that apply) rash

1
Yes

How does he react to these? (tick all that apply) other (please tick and describe)

1
Yes

Space for any comments about allergies.

Long text
SECTION C: YOUR CHILD'S ENVIRONMENT
Which animals in either your home or elsewhere does he touch 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)
other furry animal*(s)
bird(s)
other creatures*

Which animals in either your home or elsewhere does he touch at least once a week? (*please tick and describe ... )

Generic text

All children get dirty. How often when he's at home: is his face washed?

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

All children get dirty. How often when he's at home: are his hands washed or wiped?

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

All children get dirty. How often when he's at home: are his hands cleaned before a meal?

1
always
2
usually
3
sometimes
4
occasionally
5
never

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

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

How often does he normally: have his ear holes cleaned

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

How often during a day is he 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 he 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

How often in a normal week does your child: wet himself during the day

1
Never
2
Occasional accident but less than once a week
3
About once a week
4
More than once a week
5
Every day

How often in a normal week 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
More than once a week
5
Every day

How often in a normal week does your child: dirty his pants during the day

1
Never
2
Occasional accident but less than once a week
3
About once a week
4
More than once a week
5
Every day

How often in a normal week does your child: dirty himself at night

1
Never
2
Occasional accident but less than once a week
3
About once a week
4
More than once a week
5
Every day
In a normal week, for how long is he left at home alone or just with other young children (aged less than 12)?*
-

1 - not at all

2 - only for a few minutes

3 - for less than an hour

4 - for more than an hour

during the day:
at night:
(* by this we mean with no adults or children older than 11 at home at all)
How much time on average does he spend each day during term time:
on a weekday on a weekend day

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 or constructing things
playing by himself
looking at books
SECTION D: CHILD CARE AND ACTIVITIES
During the time since he was 4 years old, have you and your partner been employed? Please answer for each age:
Mother

1 - Full time

2 - Part time

3 - Not employed

4 year to 4 1/2
4 1/2 to 5th birthday
5th birthday to now

During the time since he was 4 years old, have you and your partner been employed? Please answer for each age: Partner

7
No partner
If No partner to question D1ii
qc_D1_ii == 7
Else
During the time since he was 4 years old, have you and your partner been employed? Please answer for each age:
Partner

1 - Full time

2 - Part time

3 - Not employed

4 year to 4 1/2
4 1/2 to 5th birthday
5th birthday to now
Apart from yourself, who has regularly looked after your child when you were not with him? Childcare on weekdays Please list below all regular arrangements for your child during weekdays since he was 4 1/2 (if none write NONE).
Age of child when started ... years Age of child when started ... months Person and/or place (eg. childminder-her home; kindergarten, school) Number of hours per week Age of child when stopped (put 777 if still happening) ... years Age of child when stopped (put 777 if still happening) ... months
AgeMonthsNumber of hours in a weekAgeMonthsGeneric textMonthsAgeGeneric textAgeNumber of hours in a weekMonthsGeneric textMonthsAgeNumber of hours in a weekAgeMonthsAgeMonthsNumber of hours in a weekGeneric textMonthsAgeAgeMonthsMonthsNumber of hours in a weekAgeGeneric textAgeNumber of hours in a weekMonthsGeneric textMonthsAge AgeMonthsNumber of hours in a weekAgeMonthsGeneric textMonthsAgeGeneric textAgeNumber of hours in a weekMonthsGeneric textMonthsAgeNumber of hours in a weekAgeMonthsAgeMonthsNumber of hours in a weekGeneric textMonthsAgeAgeMonthsMonthsNumber of hours in a weekAgeGeneric textAgeNumber of hours in a weekMonthsGeneric textMonthsAge AgeMonthsNumber of hours in a weekAgeMonthsGeneric textMonthsAgeGeneric textAgeNumber of hours in a weekMonthsGeneric textMonthsAgeNumber of hours in a weekAgeMonthsAgeMonthsNumber of hours in a weekGeneric textMonthsAgeAgeMonthsMonthsNumber of hours in a weekAgeGeneric textAgeNumber of hours in a weekMonthsGeneric textMonthsAge AgeMonthsNumber of hours in a weekAgeMonthsGeneric textMonthsAgeGeneric textAgeNumber of hours in a weekMonthsGeneric textMonthsAgeNumber of hours in a weekAgeMonthsAgeMonthsNumber of hours in a weekGeneric textMonthsAgeAgeMonthsMonthsNumber of hours in a weekAgeGeneric textAgeNumber of hours in a weekMonthsGeneric textMonthsAge AgeMonthsNumber of hours in a weekAgeMonthsGeneric textMonthsAgeGeneric textAgeNumber of hours in a weekMonthsGeneric textMonthsAgeNumber of hours in a weekAgeMonthsAgeMonthsNumber of hours in a weekGeneric textMonthsAgeAgeMonthsMonthsNumber of hours in a weekAgeGeneric textAgeNumber of hours in a weekMonthsGeneric textMonthsAge AgeMonthsNumber of hours in a weekAgeMonthsGeneric textMonthsAgeGeneric textAgeNumber of hours in a weekMonthsGeneric textMonthsAgeNumber of hours in a weekAgeMonthsAgeMonthsNumber of hours in a weekGeneric textMonthsAgeAgeMonthsMonthsNumber of hours in a weekAgeGeneric textAgeNumber of hours in a weekMonthsGeneric textMonthsAge
1
2
3
Apart from yourself, who has regularly looked after your child when you were not with him? Weekend childcare Please list below all regular childcare arrangements during the weekend since he was 4 1/2 (if none write NONE).
Age of child when started ... years Age of child when started ... months Person and/or place (eg. grandmother-my home) Number of hours per week Saturday Number of hours per week Sunday Age of child when stopped (put 777 if still happening) ... years Age of child when stopped (put 777 if still happening) ... months
Number of hours in a dayAgeGeneric textMonthsMonthsNumber of hours in a dayAgeAgeMonthsMonthsAgeNumber of hours in a dayNumber of hours in a dayGeneric textNumber of hours in a dayGeneric textMonthsAgeMonthsNumber of hours in a dayAgeNumber of hours in a dayAgeMonthsNumber of hours in a dayAgeMonthsGeneric textGeneric textAgeNumber of hours in a dayNumber of hours in a dayMonthsMonthsAgeGeneric textAgeMonthsAgeMonthsNumber of hours in a dayNumber of hours in a dayNumber of hours in a dayAgeMonthsMonthsAgeGeneric textNumber of hours in a day Number of hours in a dayAgeGeneric textMonthsMonthsNumber of hours in a dayAgeAgeMonthsMonthsAgeNumber of hours in a dayNumber of hours in a dayGeneric textNumber of hours in a dayGeneric textMonthsAgeMonthsNumber of hours in a dayAgeNumber of hours in a dayAgeMonthsNumber of hours in a dayAgeMonthsGeneric textGeneric textAgeNumber of hours in a dayNumber of hours in a dayMonthsMonthsAgeGeneric textAgeMonthsAgeMonthsNumber of hours in a dayNumber of hours in a dayNumber of hours in a dayAgeMonthsMonthsAgeGeneric textNumber of hours in a day Number of hours in a dayAgeGeneric textMonthsMonthsNumber of hours in a dayAgeAgeMonthsMonthsAgeNumber of hours in a dayNumber of hours in a dayGeneric textNumber of hours in a dayGeneric textMonthsAgeMonthsNumber of hours in a dayAgeNumber of hours in a dayAgeMonthsNumber of hours in a dayAgeMonthsGeneric textGeneric textAgeNumber of hours in a dayNumber of hours in a dayMonthsMonthsAgeGeneric textAgeMonthsAgeMonthsNumber of hours in a dayNumber of hours in a dayNumber of hours in a dayAgeMonthsMonthsAgeGeneric textNumber of hours in a day Number of hours in a dayAgeGeneric textMonthsMonthsNumber of hours in a dayAgeAgeMonthsMonthsAgeNumber of hours in a dayNumber of hours in a dayGeneric textNumber of hours in a dayGeneric textMonthsAgeMonthsNumber of hours in a dayAgeNumber of hours in a dayAgeMonthsNumber of hours in a dayAgeMonthsGeneric textGeneric textAgeNumber of hours in a dayNumber of hours in a dayMonthsMonthsAgeGeneric textAgeMonthsAgeMonthsNumber of hours in a dayNumber of hours in a dayNumber of hours in a dayAgeMonthsMonthsAgeGeneric textNumber of hours in a day Number of hours in a dayAgeGeneric textMonthsMonthsNumber of hours in a dayAgeAgeMonthsMonthsAgeNumber of hours in a dayNumber of hours in a dayGeneric textNumber of hours in a dayGeneric textMonthsAgeMonthsNumber of hours in a dayAgeNumber of hours in a dayAgeMonthsNumber of hours in a dayAgeMonthsGeneric textGeneric textAgeNumber of hours in a dayNumber of hours in a dayMonthsMonthsAgeGeneric textAgeMonthsAgeMonthsNumber of hours in a dayNumber of hours in a dayNumber of hours in a dayAgeMonthsMonthsAgeGeneric textNumber of hours in a day Number of hours in a dayAgeGeneric textMonthsMonthsNumber of hours in a dayAgeAgeMonthsMonthsAgeNumber of hours in a dayNumber of hours in a dayGeneric textNumber of hours in a dayGeneric textMonthsAgeMonthsNumber of hours in a dayAgeNumber of hours in a dayAgeMonthsNumber of hours in a dayAgeMonthsGeneric textGeneric textAgeNumber of hours in a dayNumber of hours in a dayMonthsMonthsAgeGeneric textAgeMonthsAgeMonthsNumber of hours in a dayNumber of hours in a dayNumber of hours in a dayAgeMonthsMonthsAgeGeneric textNumber of hours in a day Number of hours in a dayAgeGeneric textMonthsMonthsNumber of hours in a dayAgeAgeMonthsMonthsAgeNumber of hours in a dayNumber of hours in a dayGeneric textNumber of hours in a dayGeneric textMonthsAgeMonthsNumber of hours in a dayAgeNumber of hours in a dayAgeMonthsNumber of hours in a dayAgeMonthsGeneric textGeneric textAgeNumber of hours in a dayNumber of hours in a dayMonthsMonthsAgeGeneric textAgeMonthsAgeMonthsNumber of hours in a dayNumber of hours in a dayNumber of hours in a dayAgeMonthsMonthsAgeGeneric textNumber of hours in a day
1
2
3
Apart from yourself, who has regularly looked after your child when you were not with him? Childcare during the holidays of people who normally care for him Please list the arrangements made for each time this happened. (If none write NONE)
Age of child when started ... years Age of child when started ... months Substitute person and/or place Number of weeks this happened
AgeMonthsNumber of weeksGeneric textMonthsNumber of weeksGeneric textAgeNumber of weeksMonthsGeneric textAgeGeneric textMonthsAgeNumber of weeks AgeMonthsNumber of weeksGeneric textMonthsNumber of weeksGeneric textAgeNumber of weeksMonthsGeneric textAgeGeneric textMonthsAgeNumber of weeks AgeMonthsNumber of weeksGeneric textMonthsNumber of weeksGeneric textAgeNumber of weeksMonthsGeneric textAgeGeneric textMonthsAgeNumber of weeks AgeMonthsNumber of weeksGeneric textMonthsNumber of weeksGeneric textAgeNumber of weeksMonthsGeneric textAgeGeneric textMonthsAgeNumber of weeks
1
2
3
What type of school does your child nowadays attend
- Please give name of school

1 - Yes

Generic text

1 - Yes

Generic text

1 - Yes

Generic text

1 - Yes

Generic text
infant school full-time
infant school part-time
special school (please tick & describe)
other (please tick & describe)
Who takes him 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 him
My partner takes him
A grandparent or adult relative
An older child
Childminder
Other person
Goes on his own
How does he get there?
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

He walks
He goes in a wheelchair/pushchair
School bus/coach
By public transport (train or bus)
By car
Rides bicycle
Other (please describe)

How does he get there? Other (please 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

How many
We would like to know what happens after school

Does he usually go straight home?

1
No
2
Yes
If yes, go to D7c below
If no,
qc_D7_a == 1

where does he go? to a relative's home

1
Every day
2
Some days
3
Never

where does he go? to a friend's home

1
Every day
2
Some days
3
Never

where does he go? to a childminder

1
Every day
2
Some days
3
Never

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

1
Every day
2
Some days
3
Never
Other

If he goes straight home are you always there?

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

When he first arrives home does he have: a meal

1
Yes
2
No

When he first arrives home does he have: a snack

1
Yes
2
No

When he first arrives home does he have: a drink

1
Yes
2
No

How does he feel about school? He looks forward to going

1
Always
2
Usually
3
Sometimes
4
Not at all

How does he feel about school? He enjoys it

1
Always
2
Usually
3
Sometimes
4
Not at all

How does he feel about school? He is stimulated by it

1
Always
2
Usually
3
Sometimes
4
Not at all

How does he feel about school? He is frightened by it

1
Always
2
Usually
3
Sometimes
4
Not at all

How does he feel about school? He talks about his friends

1
Always
2
Usually
3
Sometimes
4
Not at all

How does he feel about school? He seems bored by school

1
Always
2
Usually
3
Sometimes
4
Not at all

How does he feel about school? He likes his class teacher (s)

1
Always
2
Usually
3
Sometimes
4
Not at all
When he finishes 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 himself
Watch TV
Play with other children
Fall asleep

How many children in his class did he know before attending this school?

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

Had he visited the school before his first day?

1
Yes
2
No

Does he bring home things that he has done during the day (e.g. painting)?

1
Yes
2
No
If no, go to D14 below
If yes,
qc_D13_a == 1

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

1
Always
2
Usually
3
Sometimes
4
Never

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

1
Always
2
Usually
3
Sometimes
4
Never

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

1
Always
2
Usually
3
Sometimes
4
Never

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

1
Always
2
Usually
3
Sometimes
4
Never

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

1
Always
2
Usually
3
Sometimes
4
Never

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

1
Always
2
Usually
3
Sometimes
4
Never

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

1
Always
2
Usually
3
Sometimes
4
Never

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

1
Always
2
Usually
3
Sometimes
4
Never

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

1
Always
2
Usually
3
Sometimes
4
Never

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

1
Always
2
Usually
3
Sometimes
4
Never

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

1
Always
2
Usually
3
Sometimes
4
Never

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

1
Always
2
Usually
3
Sometimes
4
Never

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

1
Always
2
Usually
3
Sometimes
4
Never

When he gets home from school how does he behave? other (please tick & describe)

1
Always
2
Usually
3
Sometimes
4
Never
Other

How often does your partner do these activities with your child?

7
Have no partner
If Have no partner to question D15 Go to D16 on page 31
qc_D15 == 7
Else
How often does your partner do these activities with your child?
-

1 - Often

2 - Sometimes

3 - Rarely

4 - Never

gives him a bath or shower
makes things with him
sings to him
reads to him
plays with toys
cuddles him
active play (eg ball games, hide and seek)
takes him to a park or playground
puts him to bed
takes him swimming
draws or paints with him
prepares food for him

How often does your partner do these activities with your child? other (please tick & describe)

1
Often
2
Sometimes
3
Rarely
4
Never
Other
How often do you do these activities with your child?
-

1 - Often

2 - Sometimes

3 - Rarely

4 - Never

bath (or shower) him
make things with him
sing to him
read to him
play with toys
cuddle him
active play (eg. ball games wrestling, hide and seek)
take him to the park or playground
put him to bed
take him swimming or other activity
draw or paint with him
prepare food for him

How often do you do these activities with your child? other (please tick and describe)

1
Often
2
Sometimes
3
Rarely
4
Never
Other

About how often does your child do the following during term time: Go to a park or playground

1
Every day
2
2-6 times a week
3
once a week
4
once a month
5
not at all

About how often does your child do the following during term time: Go swimming

1
Every day
2
2-6 times a week
3
once a week
4
once a month
5
not at all

About how often does your child do the following during term time: Play a musical instrument (e.g. piano, recorder )

1
Every day
2
2-6 times a week
3
once a week
4
once a month
5
not at all

About how often does your child do the following during term time: Go to a library

1
Every day
2
2-6 times a week
3
once a week
4
once a month
5
not at all

About how often does your child do the following during term time: Go to special groups (such as Beavers or Rainbows) Please tick and describe group

1
Every day
2
2-6 times a week
3
once a week
4
once a month
5
not at all
Generic text

About how often does your child do the following during term time: Go to Sunday school or other religious group

1
Every day
2
2-6 times a week
3
once a week
4
once a month
5
not at all

About how often does your child do the following during term time: Go to special classes or clubs for some activity (e.g. dancing, judo, sports ) Please tick and describe

1
Every day
2
2-6 times a week
3
once a week
4
once a month
5
not at all
Generic text

About how often does your child do the following during term time: Go to special classes because of learning difficulty Please tick and describe

1
Every day
2
2-6 times a week
3
once a week
4
once a month
5
not at all
Generic text

About how often does your child do the following during term time: Have physiotherapy

1
Every day
2
2-6 times a week
3
once a week
4
once a month
5
not at all

About how often does your child do the following during term time: See his grandparents

1
Every day
2
2-6 times a week
3
once a week
4
once a month
5
not at all

About how often does your child do the following during term time: Play computer games

1
Every day
2
2-6 times a week
3
once a week
4
once a month
5
not at all

About how often does your child do the following during term time: Help in the house

1
Every day
2
2-6 times a week
3
once a week
4
once a month
5
not at all

Has he had his ear or ears pierced?

1
Yes
2
No
SECTION E: EATING

Some children just have snacks all day while others wait for meals. How would you describe your child?

1
snacks all day, no real meals
2
snacks all day, but also has meals
3
doesn't snack much, mainly has meals
4
other (please describe)
Other

How many real meals a day does your child have now ?

How many

When would you say is his main meal of the day? on weekdays

1
Breakfast
2
Mid morning
3
Midday
4
Mid afternoon
5
Early evening
6
Late evening
7
Doesn't have a main meal

When would you say is his main meal of the day? on Saturdays

1
Breakfast
2
Mid morning
3
Midday
4
Mid afternoon
5
Early evening
6
Late evening
7
Doesn't have a main meal

When would you say is his main meal of the day? on Sundays

1
Breakfast
2
Mid morning
3
Midday
4
Mid afternoon
5
Early evening
6
Late evening
7
Doesn't have a main meal
If no main meal, go to E3 on page 35
qc_E2_a_i == 7 && qc_E2_a_ii == 7 && qc_E2_a_iii == 7
Else

On a typical week how often does he eat his main meal in these places? at home

1
Never
2
1-2 days a week
3
3-5 days a week
4
6-7 days a week

On a typical week how often does he eat his main meal in these places? at school

1
Never
2
1-2 days a week
3
3-5 days a week
4
6-7 days a week

On a typical week how often does he eat his main meal in these places? other (please tick and describe)

1
Never
2
1-2 days a week
3
3-5 days a week
4
6-7 days a week
Other

In the past year have you had difficulties getting him to eat what you wanted him to?

1
Yes, great difficulty
2
Yes, some difficulty
3
Yes, occasional difficulty
4
No, no difficulty
If yes,
qc_E3 == 1 || qc_E3 == 2 || qc_E3 == 3

please describe the problems:

Generic text
In the past year has he at any time:
-

1 - Yes, worried me greatly

2 - Yes, worried me a bit

3 - Yes, but did not worry me

4 - No did not happen

deliberately not eaten enough food
refused to eat the food you think he should eat
been choosy with food
over-eaten
been difficult to get into an eating routine
How far do the following statements describe your study child?
-

1 - Yes, most of the time

2 - Yes sometimes

3 - No, not at all

He likes to try different foods
He seems to enjoy eating
He seems to prefer sweet foods
He seems to prefer savoury foods
He plays with his food rather than eating eagerly
He is very choosy about the food he eats
He 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 you would like him to eat, how far do the following sentences describe how you deal with this?

4
Is never difficult
If Is never difficult to question E6, Go to E7 on page 37
qc_E6 == 4
Else
Children are often difficult about eating certain foods. When your study child is difficult about a certain food you would like him 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 him choose something else
I try to encourage him to eat the food by making up a game or story
I mix the food with another food that he likes and will eat
I let him put sauce on the food to cover up the taste/appearance
I try to persuade him to eat just a very small amount of the food
I do not let him leave the table or have anything else to eat until he eats all the food on the plate
I try to encourage him by offering a reward (e.g. a sweet or new toy) if he finishes the food
If he will not eat a certain food I take it away and give him 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 you would like him 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

He helps choose what we have by looking in the cupboard/fridge
He comes shopping with me and helps choose food we buy
He helps with the cooking/preparation
He helps to get things out for the meal/sets the table
He 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 school days how often does your study child usually eat at each of 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 between 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 his 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 he has eaten at school?

1
Never
2
Occasionally
3
Quite often
4
Most days
5
Does not eat at school
How many times a week on school days does your study child have for his 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
Sitting up at a table
Eaten from a tray/plate on his lap
Eaten using a knife and fork
Eaten using a spoon and/or fingers
Adult(s) eating with him
Other children eating with him but not adults
Eating on his own

How much milk does your child usually drink on a school day?

1
Does not drink milk

How much milk does your child usually drink on a school day? Has milk at school

1
Yes
2
No

How much milk does your child usually drink on a school day? Has milk at home

1
Yes
2
No
If milk is drunk at home
qc_E15_c == 1

about how much does he 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 his attitude to eating them?

1
Never offered these vegetables
If Never offered these vegetables to question E16i Go to E17 on page 43
qc_E16_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 his attitude to eating them?
-

1 - Yes, very like him

2 - Yes, somewhat like him

3 - No, not like him

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 his attitude to eating it?

1
Never offered fresh fruit
If Never offered fresh fruit to question E17i Go to E18 below
qc_E17_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 his attitude to eating it?
-

1 - Yes, very like him

2 - Yes, somewhat like him

3 - No, not like him

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 to question E18i Go to E19 on page 44
qc_E18_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 him

2 - Yes, somewhat like him

3 - No, not like him

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

Is your child at present a vegetarian?

1
Yes
2
No

Is your child at present a vegan (i.e. does not eat meat, poultry, fish, eggs, butter, milk or cheese)?

1
Yes
2
No

Is your child at present on any other kind of special diet?

1
Yes
2
No
If no, go to E23 on page 45
If yes,
qc_E22 == 1

please describe below.

Generic text

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 he suck a dummy or his 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 his finger, thumb or a dummy does he have a special object that he uses for comfort?

1
Yes
2
No
If no, go to E25 below
If yes,
qc_E24_b == 1

what is this?

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

Does he 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_E25 == 1 || qc_E25 == 2 || qc_E25 == 3

please describe what he eats:

Generic text
SECTION F: HIS GROWTH AND HIS SHOES
Please list the dates on which your child was weighed since he was 4 1/2 years old and how much he weighed each time. Also add height and head circumferences, if they were measured. If you don't know, please write DK and go to F5, below.
Date Weight Height Head circumference
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1
2
3
4

What size shoes does he take?

Float
How often nowadays does he 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 he wear the following footwear: other (please tick and 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 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:

Date of birth
THANK YOU VERY MUCH FOR YOUR HELP

Space for any additional comments you would like to make

Long text
Please remember we cannot reply to any comment unless you sign it.
End

alspac_96_mfyosd

My Five Year Old Son
This questionnaire asks about your child now he is 5 years old.
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: 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 he was injured as a result.
Has he been burnt or scalded since he was 4 1/2 years old?
1
Yes
2
No
If no, go to A2a on page 4
how many times?
How many

For each burn or scald please describe below what happened:

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
1st accident
2nd accident
3rd accident
Please describe how each accident happened: Burn 1
Generic text
Please describe how each accident happened: Burn 2
Generic text
Please describe how each accident happened: Burn 3
Generic text
Has he had a bad fall since he was 4 1/2 years old?
1
Yes
2
No
If no, go to A3a on page 5
how many times?
How many

For each fall please describe below what happened:

Place accident happened (e.g. kitchen, garden, school) What did he fall from (e.g. table, wall, climbing frame)? Date of fall (month, year) Injuries caused (if no injury write none) Who was with him? What did the person with him do? Other (please describe) What treatment did the person with him give? What other treatment did he have?
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
1st fall
2nd fall
3rd fall
Please describe how each accident happened: Fall 1
Generic text
Please describe how each accident happened: Fall 2
Generic text
Please describe how each accident happened: Fall 3
Generic text
Has he swallowed anything he shouldn't have (such as pills, buttons, disinfectant) since he was 4 1/2 years old?
1
Yes
2
No
If no, go to A4a on page 6
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 he swallow? Date of accident (month, year) Who was with him? What did the person with him do? Other (please describe) What treatment did the person with him give? What other treatment did he have?
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
Generic textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
1st accident
2nd accident
3rd accident
Please describe how each accident happened: Accident 1
Generic text
Please describe how each accident happened: Accident 2
Generic text
Please describe how each accident happened: Accident 3
Generic text
Has he had any other accidents or injuries since he was 4 1/2 years old?
1
Yes
2
No
If no, go to A5 on page 7
how many other accidents?
How many

For each accident or injury 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) Who was with him? What did the person with him do? Other (please describe) What treatment did the person with him give? What other treatment did he have?
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
Other

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated him themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
1st accident
2nd accident
3rd accident
Please describe how each accident happened: Accident 1
Generic text
Please describe how each accident happened: Accident 2
Generic text
Please describe how each accident happened: Accident 3
Generic text

Has he had any of the following happen since he was 4 1/2? (tick all that apply)

-

1 - Yes

Broken arm/hand
Broken leg/foot
Broken/cracked skull
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
Badly sunburnt
Nearly drowned
Front tooth (teeth) knocked out
Front tooth/teeth chipped or injured
Other tooth/teeth knocked out or chipped
Has he had any of the following happen since he was 4 1/2? (tick all that apply) Other broken bone (please describe)
1
Yes
Other
Has he had any of the following happen since he was 4 1/2? (tick all that apply) Bitten by animal or human (please describe)
1
Yes
Generic text
Space to describe any serious injuries not described already.
Long text

SECTION B: PROBLEMS AND TREATMENT

Children often have accidents or illnesses that need treatment. Please indicate which of the following have been given to your child since he was 4 1/2 years old.

- If yes, please give full names of substances if you can

1 - Never

2 - Yes for one episode only

3 - Yes for 2 or more episodes

Generic text

1 - Never

2 - Yes for one episode only

3 - Yes for 2 or more episodes

Generic text

1 - Never

2 - Yes for one episode only

3 - Yes for 2 or more episodes

Generic text

1 - Never

2 - Yes for one episode only

3 - Yes for 2 or more episodes

Generic text
cough medicine
antibiotics/penicillin
throat medicine
vitamins
paracetamol/calpol
ointment for skin
eye ointment
diarrhoea mixture or pills
dimotapp/decongestant
ear drops
eye drops
iron
laxative
homeopathic medicine
herbal medicine
other (please tick and describe )
Children often have accidents or illnesses that need treatment. Please indicate which of the following have been given to your child since he was 4 1/2 years old.
Other
Are there any pills, ointments or medicines that he has taken every day or nearly every day for the last 3 months? (Include vitamins, iron, skin cream, laxatives as well as antibiotics, homeopathic and herbal remedies etc.)
1
Yes
2
No
If no, go to B3a below
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 recently.
Since your study child was 4 years old has he been investigated because it was thought he might have something wrong with his hips, his legs or his feet?
1
Yes
2
No
If no, go to B4a on page 11
were any problems found?
1
Yes
2
No
9
Don't know
If no, go to B4a on page 11
please describe:
Generic text
how old was he?
1
4 years old
2
5 years old
what treatment did he have?
Generic text
Since his 4th birthday has anyone thought there might be a problem with his hearing?
1
Yes
2
No
Has your child been seen at the Hearing Assessment Centre or by a specialist since his 4th birthday?
1
Yes
2
No
If no, go to B5a below
At what age?
1
4 years old
2
5 years old
What was decided?
Generic text
Has anyone ever thought there might be a problem with his eyesight?
1
Yes
2
No
Has he been given any of the following? Glasses
1
No
2
Yes
how many pairs in total?
How many
Has he been given any of the following? Patches
1
No
2
Yes
how many months in total has he worn them so far?
How many
Has he been given any of the following? Drops for his eyes
1
No
2
Yes
Has he been given any of the following? how many bottles in total?
How many
Has he been given any of the following? An operation on his eyes
1
No
2
Yes
how many in total?
How many
Has he been given any of the following? Anything else
1
No
2
Yes
write down other treatment given
Other
Has anyone thought that there might be a problem with his talking since his 4th birthday?
1
Yes
2
No