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alspac_92_misd
MY INFANT DAUGHTER
Babies grow so quickly, and change so much. This questionnaire asks about any accidents or problems she may have had, what she has been eating and drinking, her temperament and the way she may be beginning to understand the world about her.
It is like the other questionnaires you have received. To answer simply tick the box which best describes your daughter or her situation. Again some questions will seem similar but they are not the same. Please answer all questions that you can. If you cannot answer any 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
A1 a

Has she been burnt or scalded since she was 6 months old?

1
Yes
2
No
If no, go to A2a on page 4
If yes,
qc_A1_a == 1
A1 b

how many times?

How many
A1
For each burn or scald please describe below what happened:
Place accident happened (eg. kitchen, garden, creche) What was she burnt with? (e.g tea, iron, electric fire) Date of accident (month, year) Injuries caused (if no injury write none) Who was with her? What did the person with her do? Other (please describe) What treatment did the person with her give? What other treatment did she have?
Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
1st accident
2nd accident
3rd accident
A1 k(i)

Please describe how each accident happened: Burn 1

Generic text
A1 k(ii)

Please describe how each accident happened: Burn 2

Generic text
A1 k(iii)

Please describe how each accident happened: Burn 3

Generic text
A2 a

Has she been dropped or had a bad fall since she was 6 months old?

1
Yes
2
No
If no, go to A3a on page 5
If yes,
qc_A2_a == 1
A2 b

how many times?

How many
A2
For each fall please describe below what happened.
Place accident happened (eg. kitchen, garden, creche) What did she fall or drop from (eg. table, baby walker, pram, bed, your arms) Date of fall (month, year) Injuries caused (if no injury write none) Who was with her? What did the person with her do? Other (please describe) What treatment did the person with her give? What other treatment did she have?
Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
1st accident
2nd accident
3rd accident
A2 k(i)

Please describe how each accident happened: Fall 1

Generic text
A2 k(ii)

Please describe how each accident happened: Fall 2

Generic text
A2 k(iii)

Please describe how each accident happened: Fall 3

Generic text
A3 a

Has she swallowed anything she shouldn't have (such as pills, buttons, disinfectant) since she was 6 months old?

1
Yes
2
No
If no, go to A4a on page 6
If yes,
qc_A3_a == 1
A3 b

how many times?

How many
A3 c-i
For each time please describe below what happened.
Place accident happened (eg. your home, nursery, at friend's) What did she swallow? Date of accident (month, year) Who was with her? What did the person with her do? Other (please describe) What treatment did the person with her give? What other treatment did she have?
Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text 		Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text 		Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text 		Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text 		Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text 		Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text 		Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text 		Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
1st accident
2nd accident
3rd accident
A3 j(i)

Please describe how each accident happened: Accident 1

Generic text
A3 j(ii)

Please describe how each accident happened: Accident 2

Generic text
A3 j(iii)

Please describe how each accident happened: Accident 3

Generic text
A4 a

Has she had any other accidents or injuries since she was 6 months old?

1
Yes
2
No
If no, go to Section B on page 7
If yes,
qc_A4_a == 1
A4 b

how many other accidents?

How many
A4
For each accident or injury please describe below what happened.
Place accident happened (eg. kitchen, garden, creche) What happened? Date of accident (month, year) Injuries caused (if no injury write none) Who was with her? What did the person with her do? Other (please describe) What treatment did the person with her give? What other treatment did she have?
Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
1st accident
2nd accident
3rd accident
A4 k(i)

Please describe how each accident happened: Accident 1

Generic text
A4 k(ii)

Please describe how each accident happened: Accident 2

Generic text
A4 k(iii)

Please describe how each accident happened: Accident 3

Generic text
SECTION B: PROBLEMS AND TREATMENTS
B1 a-n
Children often have accidents or illnesses that need treatment. Please indicate which of the following have been given to your child since she was six months 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
teething gel
laxative
other (please describe)
B1 n

Children often have accidents or illnesses that need treatment. Please indicate which of the following have been given to your child since she was six months old. Since she was 6 months other (please describe)

Other
B2 a

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

1
Yes
2
No
If no, go to B3a below
If yes,
qc_B2_a == 1
B2 b

please describe:

Generic text
During the child's early months of life various possible problems are often identified - yet when investigated further they are often found not to be problems at all. In this section we are asking about any possible problem that might have arisen.
B3 a

Has your toddler been investigated because it was thought she might have something wrong with her hips, her legs or her feet?

1
Yes
2
No
If no go to B4a on page 9
If yes,
qc_B3_a == 1
B3 b

were any problems found?

1
Yes
2
No
9
Don't know
If no, go to B4a on page 9
If yes,
qc_B3_b == 1
B3 b(i)

please describe:

Generic text
B3 b(ii)

how old was she? ... months (put 00 if less than 1 month)

Age in months
B3 b(iii)

what treatment did she have?

Generic text
Your child's hearing
B4 a

Has anyone thought there might be a problem with her hearing?

1
Yes
2
No
If no, go to B5 below
If yes,
qc_B4_a == 1
B4 b

Who first suspected a problem?

1
I did
2
my partner did
3
other relative or friend
4
health visitor
5
doctor
6
someone else (please describe)
Other
B4 c

Has your child been seen at the Hearing Assessment Centre?

1
Yes
2
No
If no, go to B5 below
If yes,
qc_B4_c == 1
B4 d

At what age? ... months

Age in months
B4 e

What was decided?

Generic text
Your child's sight
B5 a

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

1
Yes
2
No
If no go to B6 on page 10
If yes,
qc_B5_a == 1
B5 b

Who first suspected a problem?

1
I did
2
my partner did
3
other relative or friend
4
health visitor
5
doctor
6
someone else (please describe)
Other
B5 c

What was thought to be wrong with her eyes?

1
squint
2
something else (please describe)
9
don't know
Other
B5 d

Has your child ever been referred to an eye specialist?

1
Yes
2
No
If no go to B6 below
If yes,
qc_B5_d == 1
B5 e

at what age? ... months

Age in months
B5 f

What was decided?

Generic text
B5 g

What treatment was given?

Generic text
Other problems
B6 a

Have there been any other problems for which your child was referred to a specialist?

1
Yes
2
No
If no, go to Section C on page 11
If yes
qc_B6_a == 1
B6 b

For how many different problems?

How many
B6 c-g
Please list, for each problem, what has happened:
What was thought to be the problem? Have you seen the specialist? What age was she the first time she was seen for this problem? ... months What was decided? What treatment was given?
Generic text

1 - Yes

2 - No

Generic textAge in monthsGeneric textGeneric textGeneric textAge in monthsGeneric text

1 - Yes

2 - No

Generic text

1 - Yes

2 - No

Age in monthsGeneric textGeneric textGeneric text

1 - Yes

2 - No

Generic textGeneric textAge in monthsGeneric textGeneric text

1 - Yes

2 - No

Generic textAge in months 		Generic text

1 - Yes

2 - No

Generic textAge in monthsGeneric textGeneric textGeneric textAge in monthsGeneric text

1 - Yes

2 - No

Generic text

1 - Yes

2 - No

Age in monthsGeneric textGeneric textGeneric text

1 - Yes

2 - No

Generic textGeneric textAge in monthsGeneric textGeneric text

1 - Yes

2 - No

Generic textAge in months 		Generic text

1 - Yes

2 - No

Generic textAge in monthsGeneric textGeneric textGeneric textAge in monthsGeneric text

1 - Yes

2 - No

Generic text

1 - Yes

2 - No

Age in monthsGeneric textGeneric textGeneric text

1 - Yes

2 - No

Generic textGeneric textAge in monthsGeneric textGeneric text

1 - Yes

2 - No

Generic textAge in months 		Generic text

1 - Yes

2 - No

Generic textAge in monthsGeneric textGeneric textGeneric textAge in monthsGeneric text

1 - Yes

2 - No

Generic text

1 - Yes

2 - No

Age in monthsGeneric textGeneric textGeneric text

1 - Yes

2 - No

Generic textGeneric textAge in monthsGeneric textGeneric text

1 - Yes

2 - No

Generic textAge in months 		Generic text

1 - Yes

2 - No

Generic textAge in monthsGeneric textGeneric textGeneric textAge in monthsGeneric text

1 - Yes

2 - No

Generic text

1 - Yes

2 - No

Age in monthsGeneric textGeneric textGeneric text

1 - Yes

2 - No

Generic textGeneric textAge in monthsGeneric textGeneric text

1 - Yes

2 - No

Generic textAge in months
Problem No. 1
Problem No. 2
Problem No. 3
SECTION C: YOUR INFANT AND HER ENVIRONMENT
C1 a

What does your daughter look like? Her hair is:

1
black
2
dark brown
3
light brown
4
fair
5
reddish
6
other (please describe)
Other
C1 b

What does your daughter look like? Her eyes are:

1
blue
2
brown
3
green
4
other (please describe)
Other
C1 c

Does she have any unusual marks on her face?

1
yes, a scar
2
yes, a birthmark
3
yes, other mark
4
no, not at all
If no, go to C1d below
If yes,
qc_C1_c == 1 || qc_C1_c == 2 || qc_C1_c == 3
C1 c(i)

please describe what the mark is like, where it is and how big it is:

Generic text
C1 c(ii)

what difference do you think this makes to her looks?

1
improves them
2
no difference
3
makes worse
C1 d

Does she have any unusual marks on other parts of her body?

1
yes, a scar
2
yes, a birthmark
3
yes, other mark
4
no, not at all
If no, go to C2a
If yes,
qc_C1_d == 1 || qc_C1_d == 2 || qc_C1_d == 3
C1 d
please describe (for each):
Where it is What it is How big it is
Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text
1
2
3
C2 a

How many teeth has she got now?

How many
C2 b

How old was she when the first one appeared? ... months

Age in months
C2 c

Do you use a toothbrush for the child?

1
yes, every day
2
yes, sometimes
3
no not at all
C2 d

Does she ever have toothpaste?

1
Yes
2
No
If no, go to C3 on page 13
If yes,
qc_C2_d == 1
C2 d(i)

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

Age in months
C2 d(ii)

how much do you put on her brush nowadays?

1
brush full
2
half brush full
3
less than half a brush full
4
none
C2 d(iii)

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

How many
C2 d(iv)

does she swallow it or spit it out?

1
swallows it
2
spits it out
3
varies
C2 d(v)

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

Generic text
C3 a

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

1
not at all
2
1-2 times
3
3-4 times
4
5 or more times
C3 b

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

1
not at all
2
1-2 times
3
3-4 times
4
5 or more times
C3 c

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

1
always
2
usually
3
sometimes
4
occasionally
5
never
C4 a

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

1
more than once a day
2
once every day
3
several times a week
4
once a week
5
hardly ever
C4 b

How often does she usually: have her ear holes cleaned:

1
more than once a day
2
once every day
3
several times a week
4
once a week
5
never or hardly ever
C5

What do you think about toilet training for her?

1
It is too early to start any toilet training yet
2
I have just started toilet training
3
I have been toilet training for some time
If I have been toilet training for some time to question C5
qc_C5 == 3
C5 i

give age you started training ... months

Age in months
C6 a

At what age would you expect a child to be dry? during the day ... months

(If you don't know put 99)

Age in months
C6 b

At what age would you expect a child to be dry? during the night ... months

(If you don't know put 99)

Age in months
C7 a

Is she: dry during the day

1
Always
2
Sometimes
3
Never
C7 b

Is she: dry during the night

1
Always
2
Sometimes
3
Never
C7 c

Is she: clean during the day

1
Always
2
Sometimes
3
Never
C7 d

Is she: clean during the night

1
Always
2
Sometimes
3
Never
C8 i

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

1
all the time
2
more than 5 hours
3
3,4 or 5 hours
4
1 or 2 hours
5
less than 1 hour
6
not at all
C8 ii

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

1
all the time
2
more than 5 hours
3
3,4 or 5 hours
4
1 or 2 hours
5
less than 1 hour
6
not at all
C9 a-d
Which pets is she in contact with at least once a week either in your home or elsewhere?
-

1 - Yes

2 - No
cat(s)
dog(s)
other furry pet*(s)
other pet*(s)
C9 i

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

Generic text
SECTION D: FEEDING
D1

How many meals with solids does she have each day?

How many
D2

Was she breast fed?

1
Yes, she is still being breast fed
2
Yes, was breast fed but now stopped
3
She was never breast fed
If Yes, she is still being breast fed to question D2
qc_D2 == 1
D2 i

How many times a day? ... times

How many
If Yes, was breast fed but now stopped to question D2
qc_D2 == 2
D2 ii

How old was she when breastfeeding stopped?

(put 00 if less than 1 month)

Age in months
D3 a-c
For the main meal of the day does she eat:
-

1 - Always

2 - Almost always

3 - Sometimes

4 - Almost never

5 - Never
the same food as you
a different meal that you prepare
a ready-prepared meal out of a packet or tin
D4 a

Do you feel that you have had difficulties feeding her in the past year?

1
Yes, great difficulty
2
Yes, some difficulty
3
Yes, occasional difficulty
4
No, no difficulty
D4 b

Does she want to feed herself?

1
Yes usually
2
Yes sometimes
3
No not at all
D4 c

Do you let her feed herself?

1
Yes usually
2
Yes sometimes
3
No not at all
D5 a-e
Since she was 6 months old has she at any time:
-

1 - Yes, worried me greatly

2 - Yes, worried me a bit

3 - Yes, but did not worry me

4 - No, did not happen
not eaten sufficient amount of food
refused to eat the right food
been choosy with food
over-eaten
been difficult to get into an eating routine
D6 a-h
Since she was 6 months old has she had any of the following
- Age started ... months How often nowadays (Put 00 if no longer happens) ... times a week
Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months
baby milk (formula)
follow-on milk
soya formula
hypo-allergenic formula
goats' milk
soya milk
ordinary cows' milk
other milk
D6 i

when she has cows' milk is it mostly:

1
whole
2
semi-skimmed
3
or skimmed
4
never had cows milk
D7
Since she was 6 months old has she had:
- Age started ... months How often nowadays (Put 00 if no longer happens) ... times a week
Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months
baby rice
other baby cereal
breakfast cereal
rusks
bread or toast
biscuits
D8
Since she was 6 months old has she had any of the following prepared baby foods, toddler foods or junior foods (from jar, tin or packet)?
- Age started ... months How often nowadays (Put 00 if no longer happens) ... times a week
Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months
savoury - meat
savoury - fish
savoury vegetable
baby fruit dessert or pudding
baby milk dessert or pudding
D9
Since she was 6 months old has she eaten any of these other foods (not bought baby or toddler foods)?
- Age started ... months How often nowadays (Put 00 if no longer happens) ... times a week
Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months
egg
cheese
meat or meat products
fish or fish products
potatoes
other vegetables
fruit puddings
milk puddings
D10 a-k
Since she was 6 months old has she had:
- Age started ... months How often nowadays (Put 00 if no longer happens) ... times a week
Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months
coca cola or pepsi
other fizzy drink
apple juice
blackcurrant juice or rosehip syrup
other fruit juice
a little alcohol
any other fruit drink (e.g. orange squash)
herbal drink (please describe)
gripe water
tea
coffee
D10 h

Since she was 6 months old has she had: herbal drink (please describe)

Generic text
D11 a

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

1
decaffeinated
2
weak
4
strong
6
does not like
7
does not have
D11 b

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

1
decaffeinated
2
weak
4
strong
6
does not like
7
does not have
D11 c

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

1
decaffeinated
2
ordinary
4
diet
6
does not like
7
does not have
D11 d

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

1
decaffeinated
2
ordinary
4
diet
6
does not like
7
does not have
D12 a-t
Since she was 6 months old, has your child had the following, whether in baby foods or elsewhere:
- Age started ... months How often nowadays (Put 00 if no longer happens) ... times a week
Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months
Packet soup
Canned soup
Liver/liver pate
Kidney
Shellfish (eg. prawns mussels, cockles)
Baked beans
Green peas
Other legumes (eg. lentils, chick peas, red kidney beans)
Yoghurt
Figs/fig products
Raw apple
Other raw fruit (eg. banana/orange)
Raw carrot
Other raw vegetables (please describe)
Nuts/nut products
Crisps
Other cocktail or savoury snacks (eg. cheesy biscuits)
Chocolates
Mints (eg. polo)
Sweets
D12 n

Since she was 6 months old, has your child had the following, whether in baby foods or elsewhere: Other raw vegetables (please describe)

Other
D13 a-g
Do you ever add these things to your child's food or use them in preparing her food?
- Age started ... months How often nowadays (Put 00 if no longer happens) ... times a week
Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months
Gravy (made with granules, powder or cubes) or soy sauce
Salt
Herbs (please describe)
Spices (please describe)
Tomato ketchup
Other sauce (please describe)
Sugar
D13 c

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

Generic text
D13 d

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

Generic text
D13 f

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

Generic text
D14 a

Skins and peels: does she eat: apple skin

1
No
2
Yes
3
Doesn't have this at all
D14 b

Skins and peels: does she eat: orange peel

1
No
2
Yes
3
Doesn't have this at all
D14 c

Skins and peels: does she eat: potato skin

1
No
2
Yes
3
Doesn't have this at all
D14 d

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

1
No
2
Yes
3
Doesn't have this at all
Other
D15 a-d
Has your infant ever had:
- Age started ... months How often nowadays (Put 00 if no longer happens) ... times a week
Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months
smoked/cured foods (ham, bacon, smoked fish,smoked cheese)
individually packaged microwave meals
foods cooked on a barbecue
sports drinks (eg. Lucozade sport, Dexters)
If yes
qc_D15_a-d == 2
D15 i

please describe

Generic text
D16

Is she fed 'on demand', i.e. whenever she is hungry?

1
Yes always
2
Yes some of the time
3
No not at all
D17

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

1
Yes
2
No
If no, go to D18
If yes please describe:
qc_D17 == 1
_food < 4 _food < 4
D17 i

Food

Generic text
D17 ii

Age started ... months

Age in months
D17 iii

How often nowadays ... times a week

How many
D18 a

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

1
Usually
2
Sometimes
3
Never
D18 b

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

1
Usually
2
Sometimes
3
Never
D19

Are there any foods that you don't allow your toddler to eat?

1
yes
2
no
If yes,
qc_D19 == 1
D19 i

please list the foods and why:

Generic text
D20

Babies first solid meals are usually a puree. When did your child first start having meals with lumps in? Age started ... months

(if not yet started put 77)

Age in months
D21 a

Who most often feeds her during the day?

1
you
2
partner
3
paid helper
4
other person (describe)
Other
D21 b

Who usually feeds her at night?

1
you
2
partner
3
paid helper
4
don't feed at night
5
other person (describe)
Other
D22

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

1
no, will eat almost anything
2
yes, quite choosy
3
yes, very choosy
D23

Does she drink out of a cup or feeding beaker?

1
yes, usually
2
yes, sometimes
3
no, not at all
D24

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

1
always
2
sometimes
3
never
D25 a

How often does she suck a dummy or her thumb or finger? dummy

2
most of the time
3
sometimes
4
never
D25 b

How often does she suck a dummy or her thumb or finger? thumb/finger

2
most of the time
3
sometimes
4
never
D25 c

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

1
usually
2
sometimes
3
never
7
doesn't have a dummy
D26 a

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

1
Yes
2
No
If no, go to E1
If yes,
qc_D26_a == 1
D26 b

what is this?

1
blanket
2
cuddly toy
3
other (please describe)
Other
SECTION E: CHILDCARE
E1 a(i-viii)
Apart from yourself, who regularly looks after your infant? (Please answer for each person regularly involved).
- If yes, give hours per week and Age of baby when this began (in months)
Hours per week

1 - No

2 - Yes

Age in monthsHours per week

1 - No

2 - Yes

Age in months

1 - No

2 - Yes

Age in monthsHours per week 		Hours per week

1 - No

2 - Yes

Age in monthsHours per week

1 - No

2 - Yes

Age in months

1 - No

2 - Yes

Age in monthsHours per week 		Hours per week

1 - No

2 - Yes

Age in monthsHours per week

1 - No

2 - Yes

Age in months

1 - No

2 - Yes

Age in monthsHours per week
partner
baby's grandparent
other relative
friend/neighbour
paid person outside baby's home (eg. child minder)
paid person in baby's home eg. nanny, baby sitter)
day nursery (creche)
other (please describe)
E1 a(viii)

Apart from yourself, who regularly looks after your infant? (Please answer for each person regularly involved). other (please describe)

Other
E1 b

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

1
I had no choice
2
I could afford it
3
It was convenient
4
It was linked to my job
5
I thought it would be beneficial for my child
6
Other (please describe)
Other
E1 c

How satisfied are you with these arrangements?

1
very satisfied
2
fairly satisfied
3
not at all happy
E2
Since your baby was born, please list below all daytime child care arrangements (other than yourselves) according to the age of this child.
No. of hours/week during the day Person (eg childminder grandmother) Place (eg at home, creche, etc)
Generic textHow manyGeneric textGeneric textHow manyGeneric textHow manyGeneric textGeneric text Generic textHow manyGeneric textGeneric textHow manyGeneric textHow manyGeneric textGeneric text Generic textHow manyGeneric textGeneric textHow manyGeneric textHow manyGeneric textGeneric text
1 month
2 months
3 months
4 months
5 months
6 months
7 months
8 months
9 months
10 months
11 months
12 months
13 months
14 months
15 months
E3

How many different people other than you or your partner have looked after your baby during the day since he was born? (count each nursery or creche as 1 person)

How many
SECTION F: UNDERSTANDING AND TALKING
F1 a-b
Before beginning to speak, children often show signs of understanding some words and phrases. Does your child do any of these?
-

1 - Yes usually

2 - Yes sometimes

3 - No
turns when her name is called
stops what she is doing (even for a moment) when you say 'no'
F2 a

Which of these does your child understand? She understands: Are you sleepy?

1
Yes
2
No
F2 b

Which of these does your child understand? She understands: Be quiet

1
Yes
2
No
F2 c

Which of these does your child understand? She understands: Come here

1
Yes
2
No
F2 d

Which of these does your child understand? She understands: Do you want more?

1
Yes
2
No
F2 e

Which of these does your child understand? She understands: Don't do that

1
Yes
2
No
F2 f

Which of these does your child understand? She understands: Give me a kiss

1
Yes
2
No
F2 g

Which of these does your child understand? She understands: Don't touch

1
Yes
2
No
F2 h

Which of these does your child understand? She understands: Open your mouth

1
Yes
2
No
F2 i

Which of these does your child understand? She understands: Sit down

1
Yes
2
No
F2 j

Which of these does your child understand? She understands: Spit it out

1
Yes
2
No
F2 k

Which of these does your child understand? She understands: Stop it

1
Yes
2
No
F2 l

Which of these does your child understand? She understands: Time for bed

1
Yes
2
No
F3 a

Starting to talk. Some children like to imitate things that they've just heard. How often does your child imitate words?

1
never
2
sometimes
3
often
F3 b

Starting to talk. Some children like to name or label things. How often does your child do this?

1
never
2
sometimes
3
often
F4 a-e
Here are some words that your child might understand and some that she might say. If she uses a different pronunciation (like efant for elephant) tick it anyway. Please tick whether she can do any of the following.
-

1 - She understands but doesn't say

2 - She understands and says

3 - No, neither
ba ba (sheep)
meow (cat)
moo (cow)
quack quack (duck)
woof woof (dog)
F5 a-q
Here are some words that your child might understand and some that she might say. If she uses a different pronunciation (like efant for elephant) tick it anyway. Please tick whether she can do any of the following.
-

1 - She understands but doesn't say

2 - She understands and says

3 - No, neither
bird
butterfly
cat
chicken
cow
dog
donkey
elephant
fish
frog
horse
lion
monkey
owl
penguin
pig
teddy bear
F6 a-g
Here are some words that your child might understand and some that she might say. If she uses a different pronunciation (like efant for elephant) tick it anyway. Please tick whether she can do any of the following.
-

1 - She understands but doesn't say

2 - She understands and says

3 - No, neither
car
bus
bicycle
aeroplane
train
lorry
motorbike
F7 a-t
Here are some words that your child might understand and some that she might say. If she uses a different pronunciation (like efant for elephant) tick it anyway. Please tick whether she can do any of the following.
-

1 - She understands but doesn't say

2 - She understands and says

3 - No, neither
apple
banana
bread
cake
carrots
cheese
chicken
drink
egg
fish
ice cream
juice
meat
milk
orange
peas
sweets
spaghetti
toast
water
F8 a-k
Here are some words that your child might understand and some that she might say. If she uses a different pronunciation (like efant for elephant) tick it anyway. Please tick whether she can do any of the following.
-

1 - She understands but doesn't say

2 - She understands and says

3 - No, neither
button
coat
dress
hat
necklace
T-shirt
nappy
shoe
sock
sweater or jumper
zip
F9 a-s
Here are some words that your child might understand and some that she might say. If she uses a different pronunciation (like efant for elephant) tick it anyway. Please tick whether she can do any of the following.
-

1 - She understands but doesn't say

2 - She understands and says

3 - No, neither
arm
tummy button (or belly button)
cheek
ear
eye
face
foot
finger
hair
hand
head
knee
leg
mouth
nose
tooth
toe
tongue
tummy
F10 a-o
Here are some words that your child might understand and some that she might say. If she uses a different pronunciation (like efant for elephant) tick it anyway. Please tick whether she can do any of the following.
-

1 - She understands but doesn't say

2 - She understands and says

3 - No, neither
bathroom
bed
bedroom
chair
door
drawer
kitchen
living room or lounge
oven
fridge
sink
stairs
table
TV
window
F11 a-l
Here are some words that your child might understand and some that she might say. If she uses a different pronunciation (like efant for elephant) tick it anyway. Please tick whether she can do any of the following.
-

1 - She understands but doesn't say

2 - She understands and says

3 - No, neither
flower
garden
home
house
moon
park
rain
sky
sun
swing
tree
water
F12 a-h
Here are some words that your child might understand and some that she might say. If she uses a different pronunciation (like efant for elephant) tick it anyway. Please tick whether she can do any of the following.
-

1 - She understands but doesn't say

2 - She understands and says

3 - No, neither
bath
breakfast
hello
night night
no
please
thank you
yes
F13 a-t
Here are some words that your child might understand and some that she might say. If she uses a different pronunciation (like efant for elephant) tick it anyway. Please tick whether she can do any of the following.
-

1 - She understands but doesn't say

2 - She understands and says

3 - No, neither
asleep
all gone
bad
big
broken
cold
dirty
dry
empty
gentle
happy
hot
hungry
hurt
little
naughty
nice
thirsty
tired
wet
F14 a-j
When children are first learning to communicate, they often use gestures to make their wishes known. Which does your infant do?
-

1 - Not yet

2 - Sometimes

3 - Often
extends arm to show you something she is holding
reaches out and gives you a toy or some object that she is holding
points (with arm & index finger extended) at some interesting object or event
waves bye-bye on her own when someone leaves
extends her arms upward to signal a wish to be picked up
shakes head 'no'
nods head 'yes'
gestures 'hush' by placing finger to lips
asks for something by opening and closing hand
blows kisses from a distance
F15 a-p
Does she do or try to do any of the following?
-

1 - Yes does

2 - Yes tries

3 - No
eat with a spoon or fork
drink from a cup containing liquid
comb or brush own hair
brush teeth
wipe face or hands with a towel or cloth
put on hat
put on a shoe or sock
put on a necklace, bracelet or watch
lay head on hands and squeeze eyes shut as if sleeping
blow to indicate something is hot
hold plane and make it 'fly'
put telephone to ear
sniff flowers
push toy car or truck
pour pretend liquid from one container to another
stir pretend liquid in a cup or pan with a spoon
SECTION G: HER GROWTH
G1-15
Do you have any records of your baby's growth since she was 6 months old? If so please list the dates on which your baby was weighed and how much she weighed each time. Also add lengths, head circumferences, and arm circumferences if they were measured.
Date Weight Length Head circumference Arm circumference
Generic textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text Generic textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text Generic textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text Generic textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text Generic textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
H1 a

This questionnaire was completed by: mother

1
Yes
2
No
H1 b

This questionnaire was completed by: father

1
Yes
2
No
H1 c

This questionnaire was completed by: other (please describe)

1
Yes
2
No
Other
H2

Please give the date on which you completed this questionnaire:

Generic date
H3

Please give the date of birth of your infant:

Generic date
THANK YOU VERY MUCH FOR YOUR HELP
H i

Space for any additional comments you would like to make

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

alspac_92_misd

MY INFANT DAUGHTER

s_intro_i
Babies grow so quickly, and change so much. This questionnaire asks about any accidents or problems she may have had, what she has been eating and drinking, her temperament and the way she may be beginning to understand the world about her.
s_intro_ii
It is like the other questionnaires you have received. To answer simply tick the box which best describes your daughter or her situation. Again some questions will seem similar but they are not the same. Please answer all questions that you can. If you cannot answer any 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.
s_intro_iii
THANK YOU FOR YOUR HELP

SECTION A: ACCIDENTS AND INJURIES

A1 a
Has she been burnt or scalded since she was 6 months old?
1
Yes
2
No
s_qA1a
If no, go to A2a on page 4
A1 b
how many times?
How many
If yes,
A1

For each burn or scald please describe below what happened:

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
1st accident
2nd accident
3rd accident
If yes,
A1 k(i)
Please describe how each accident happened: Burn 1
Generic text
If yes,
A1 k(ii)
Please describe how each accident happened: Burn 2
Generic text
If yes,
A1 k(iii)
Please describe how each accident happened: Burn 3
Generic text
If yes,
A2 a
Has she been dropped or had a bad fall since she was 6 months old?
1
Yes
2
No
s_qA2a
If no, go to A3a on page 5
A2 b
how many times?
How many
If yes,
A2

For each fall please describe below what happened.

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
1st accident
2nd accident
3rd accident
If yes,
A2 k(i)
Please describe how each accident happened: Fall 1
Generic text
If yes,
A2 k(ii)
Please describe how each accident happened: Fall 2
Generic text
If yes,
A2 k(iii)
Please describe how each accident happened: Fall 3
Generic text
If yes,
A3 a
Has she swallowed anything she shouldn't have (such as pills, buttons, disinfectant) since she was 6 months old?
1
Yes
2
No
s_qA3a
If no, go to A4a on page 6
A3 b
how many times?
How many
If yes,
A3 c-i

For each time please describe below what happened.

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text 		Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text 		Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text 		Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text 		Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text 		Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text 		Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text 		Generic textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textOtherGeneric textGeneric textGeneric dateOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric dateGeneric textOtherGeneric dateGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateOtherGeneric textGeneric textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic text
1st accident
2nd accident
3rd accident
If yes,
A3 j(i)
Please describe how each accident happened: Accident 1
Generic text
If yes,
A3 j(ii)
Please describe how each accident happened: Accident 2
Generic text
If yes,
A3 j(iii)
Please describe how each accident happened: Accident 3
Generic text
If yes,
A4 a
Has she had any other accidents or injuries since she was 6 months old?
1
Yes
2
No
s_qA4a
If no, go to Section B on page 7
A4 b
how many other accidents?
How many
If yes,
A4

For each accident or injury please describe below what happened.

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text 		Other

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric dateGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textOtherGeneric textGeneric textGeneric textGeneric textGeneric dateGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textGeneric textGeneric textOtherGeneric textGeneric dateGeneric date

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

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

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic textGeneric textGeneric textOtherGeneric textGeneric textGeneric textGeneric text

1 - Nothing

2 - Treated her themselves

3 - Took to doctor

4 - Took to hospital

5 - Other (please describe)

Generic dateGeneric text
1st accident
2nd accident
3rd accident
If yes,
A4 k(i)
Please describe how each accident happened: Accident 1
Generic text
If yes,
A4 k(ii)
Please describe how each accident happened: Accident 2
Generic text
If yes,
A4 k(iii)
Please describe how each accident happened: Accident 3
Generic text
If yes,

SECTION B: PROBLEMS AND TREATMENTS

B1 a-n

Children often have accidents or illnesses that need treatment. Please indicate which of the following have been given to your child since she was six months 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
teething gel
laxative
other (please describe)
B1 n
Children often have accidents or illnesses that need treatment. Please indicate which of the following have been given to your child since she was six months old. Since she was 6 months other (please describe)
Other
B2 a
Are there any pills, ointments or medicines that she has taken every day or nearly every day for the last 3 months? (Include vitamins, skin cream, laxatives as well as antibiotics, etc)
1
Yes
2
No
s_qB2a
If no, go to B3a below
B2 b
please describe:
Generic text
If yes,
s_section_B
During the child's early months of life various possible problems are often identified - yet when investigated further they are often found not to be problems at all. In this section we are asking about any possible problem that might have arisen.
B3 a
Has your toddler been investigated because it was thought she might have something wrong with her hips, her legs or her feet?
1
Yes
2
No
s_qB3a
If no go to B4a on page 9
B3 b
were any problems found?
1
Yes
2
No
9
Don't know
If yes,
s_qB3b
If no, go to B4a on page 9
If yes,
B3 b(i)
please describe:
Generic text
If yes,
If yes,
B3 b(ii)
how old was she? ... months (put 00 if less than 1 month)
Age in months
If yes,
If yes,
B3 b(iii)
what treatment did she have?
Generic text
If yes,
If yes,

Your child's hearing

B4 a
Has anyone thought there might be a problem with her hearing?
1
Yes
2
No
s_qB4a
If no, go to B5 below
B4 b
Who first suspected a problem?
1
I did
2
my partner did
3
other relative or friend
4
health visitor
5
doctor
6
someone else (please describe)
Other
If yes,
B4 c
Has your child been seen at the Hearing Assessment Centre?
1
Yes
2
No
If yes,
s_qB4c
If no, go to B5 below
If yes,
B4 d
At what age? ... months
Age in months
If yes,
If yes,
B4 e
What was decided?
Generic text
If yes,
If yes,

Your child's sight

B5 a
Has anyone thought there might be a problem with her eyesight?
1
Yes
2
No
s_qB5a
If no go to B6 on page 10
B5 b
Who first suspected a problem?
1
I did
2
my partner did
3
other relative or friend
4
health visitor
5
doctor
6
someone else (please describe)
Other
If yes,
B5 c
What was thought to be wrong with her eyes?
1
squint
2
something else (please describe)
9
don't know
Other
If yes,
B5 d
Has your child ever been referred to an eye specialist?
1
Yes
2
No
If yes,
s_qB5d
If no go to B6 below
If yes,
B5 e
at what age? ... months
Age in months
If yes,
If yes,
B5 f
What was decided?
Generic text
If yes,
If yes,
B5 g
What treatment was given?
Generic text
If yes,
If yes,

Other problems

B6 a
Have there been any other problems for which your child was referred to a specialist?
1
Yes
2
No
s_qB6a
If no, go to Section C on page 11
B6 b
For how many different problems?
How many
If yes
B6 c-g

Please list, for each problem, what has happened:

What was thought to be the problem? Have you seen the specialist? What age was she the first time she was seen for this problem? ... months What was decided? What treatment was given?
Generic text

1 - Yes

2 - No

Generic textAge in monthsGeneric textGeneric textGeneric textAge in monthsGeneric text

1 - Yes

2 - No

Generic text

1 - Yes

2 - No

Age in monthsGeneric textGeneric textGeneric text

1 - Yes

2 - No

Generic textGeneric textAge in monthsGeneric textGeneric text

1 - Yes

2 - No

Generic textAge in months 		Generic text

1 - Yes

2 - No

Generic textAge in monthsGeneric textGeneric textGeneric textAge in monthsGeneric text

1 - Yes

2 - No

Generic text

1 - Yes

2 - No

Age in monthsGeneric textGeneric textGeneric text

1 - Yes

2 - No

Generic textGeneric textAge in monthsGeneric textGeneric text

1 - Yes

2 - No

Generic textAge in months 		Generic text

1 - Yes

2 - No

Generic textAge in monthsGeneric textGeneric textGeneric textAge in monthsGeneric text

1 - Yes

2 - No

Generic text

1 - Yes

2 - No

Age in monthsGeneric textGeneric textGeneric text

1 - Yes

2 - No

Generic textGeneric textAge in monthsGeneric textGeneric text

1 - Yes

2 - No

Generic textAge in months 		Generic text

1 - Yes

2 - No

Generic textAge in monthsGeneric textGeneric textGeneric textAge in monthsGeneric text

1 - Yes

2 - No

Generic text

1 - Yes

2 - No

Age in monthsGeneric textGeneric textGeneric text

1 - Yes

2 - No

Generic textGeneric textAge in monthsGeneric textGeneric text

1 - Yes

2 - No

Generic textAge in months 		Generic text

1 - Yes

2 - No

Generic textAge in monthsGeneric textGeneric textGeneric textAge in monthsGeneric text

1 - Yes

2 - No

Generic text

1 - Yes

2 - No

Age in monthsGeneric textGeneric textGeneric text

1 - Yes

2 - No

Generic textGeneric textAge in monthsGeneric textGeneric text

1 - Yes

2 - No

Generic textAge in months
Problem No. 1
Problem No. 2
Problem No. 3
If yes

SECTION C: YOUR INFANT AND HER ENVIRONMENT

C1 a
What does your daughter look like? Her hair is:
1
black
2
dark brown
3
light brown
4
fair
5
reddish
6
other (please describe)
Other
C1 b
What does your daughter look like? Her eyes are:
1
blue
2
brown
3
green
4
other (please describe)
Other
C1 c
Does she have any unusual marks on her face?
1
yes, a scar
2
yes, a birthmark
3
yes, other mark
4
no, not at all
s_qC1c
If no, go to C1d below
C1 c(i)
please describe what the mark is like, where it is and how big it is:
Generic text
If yes,
C1 c(ii)
what difference do you think this makes to her looks?
1
improves them
2
no difference
3
makes worse
If yes,
C1 d
Does she have any unusual marks on other parts of her body?
1
yes, a scar
2
yes, a birthmark
3
yes, other mark
4
no, not at all
s_qC1d
If no, go to C2a
C1 d

please describe (for each):

Where it is What it is How big it is
Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text Generic textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric text
1
2
3
If yes,
C2 a
How many teeth has she got now?
How many
C2 b
How old was she when the first one appeared? ... months
Age in months
C2 c
Do you use a toothbrush for the child?
1
yes, every day
2
yes, sometimes
3
no not at all
C2 d
Does she ever have toothpaste?
1
Yes
2
No
s_qC2d
If no, go to C3 on page 13
C2 d(i)
how old was she when you started using toothpaste? ... months
Age in months
If yes,
C2 d(ii)
how much do you put on her brush nowadays?
1
brush full
2
half brush full
3
less than half a brush full
4
none
If yes,
C2 d(iii)
how many times a day do you do this? ... times
How many
If yes,
C2 d(iv)
does she swallow it or spit it out?
1
swallows it
2
spits it out
3
varies
If yes,
C2 d(v)
what type of toothpaste is usually used: (please give exact name and brand)
Generic text
If yes,
C3 a
All children get dirty. How often in a normal day: is her face washed?
1
not at all
2
1-2 times
3
3-4 times
4
5 or more times
C3 b
All children get dirty. How often in a normal day: are her hands washed or wiped?
1
not at all
2
1-2 times
3
3-4 times
4
5 or more times
C3 c
All children get dirty. How often in a normal day: are her hands cleaned before a meal?
1
always
2
usually
3
sometimes
4
occasionally
5
never
C4 a
How often does she usually: have a bath or shower:
1
more than once a day
2
once every day
3
several times a week
4
once a week
5
hardly ever
C4 b
How often does she usually: have her ear holes cleaned:
1
more than once a day
2
once every day
3
several times a week
4
once a week
5
never or hardly ever
C5
What do you think about toilet training for her?
1
It is too early to start any toilet training yet
2
I have just started toilet training
3
I have been toilet training for some time
C5 i
give age you started training ... months
Age in months
If I have been toilet training for some time to question C5
C6 a
At what age would you expect a child to be dry? during the day ... months
Age in months
C6 b
At what age would you expect a child to be dry? during the night ... months
Age in months
C7 a
Is she: dry during the day
1
Always
2
Sometimes
3
Never
C7 b
Is she: dry during the night
1
Always
2
Sometimes
3
Never
C7 c
Is she: clean during the day
1
Always
2
Sometimes
3
Never
C7 d
Is she: clean during the night
1
Always
2
Sometimes
3
Never
C8 i
Please indicate how often during the day she is in a room or enclosed place where people are smoking: Weekdays
1
all the time
2
more than 5 hours
3
3,4 or 5 hours
4
1 or 2 hours
5
less than 1 hour
6
not at all
C8 ii
Please indicate how often during the day she is in a room or enclosed place where people are smoking: Weekends
1
all the time
2
more than 5 hours
3
3,4 or 5 hours
4
1 or 2 hours
5
less than 1 hour
6
not at all
C9 a-d

Which pets is she in contact with at least once a week either in your home or elsewhere?

-

1 - Yes

2 - No
cat(s)
dog(s)
other furry pet*(s)
other pet*(s)
C9 i
Which pets is she in contact with at least once a week either in your home or elsewhere? *please describe
Generic text

SECTION D: FEEDING

D1
How many meals with solids does she have each day?
How many
D2
Was she breast fed?
1
Yes, she is still being breast fed
2
Yes, was breast fed but now stopped
3
She was never breast fed
D2 i
How many times a day? ... times
How many
If Yes, she is still being breast fed to question D2
D2 ii
How old was she when breastfeeding stopped?
Age in months
If Yes, was breast fed but now stopped to question D2
D3 a-c

For the main meal of the day does she eat:

-

1 - Always

2 - Almost always

3 - Sometimes

4 - Almost never

5 - Never
the same food as you
a different meal that you prepare
a ready-prepared meal out of a packet or tin
D4 a
Do you feel that you have had difficulties feeding her in the past year?
1
Yes, great difficulty
2
Yes, some difficulty
3
Yes, occasional difficulty
4
No, no difficulty
D4 b
Does she want to feed herself?
1
Yes usually
2
Yes sometimes
3
No not at all
D4 c
Do you let her feed herself?
1
Yes usually
2
Yes sometimes
3
No not at all
D5 a-e

Since she was 6 months old has she at any time:

-

1 - Yes, worried me greatly

2 - Yes, worried me a bit

3 - Yes, but did not worry me

4 - No, did not happen
not eaten sufficient amount of food
refused to eat the right food
been choosy with food
over-eaten
been difficult to get into an eating routine
D6 a-h

Since she was 6 months old has she had any of the following

- Age started ... months How often nowadays (Put 00 if no longer happens) ... times a week
Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months
baby milk (formula)
follow-on milk
soya formula
hypo-allergenic formula
goats' milk
soya milk
ordinary cows' milk
other milk
D6 i
when she has cows' milk is it mostly:
1
whole
2
semi-skimmed
3
or skimmed
4
never had cows milk
D7

Since she was 6 months old has she had:

- Age started ... months How often nowadays (Put 00 if no longer happens) ... times a week
Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months
baby rice
other baby cereal
breakfast cereal
rusks
bread or toast
biscuits
D8

Since she was 6 months old has she had any of the following prepared baby foods, toddler foods or junior foods (from jar, tin or packet)?

- Age started ... months How often nowadays (Put 00 if no longer happens) ... times a week
Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months
savoury - meat
savoury - fish
savoury vegetable
baby fruit dessert or pudding
baby milk dessert or pudding
D9

Since she was 6 months old has she eaten any of these other foods (not bought baby or toddler foods)?

- Age started ... months How often nowadays (Put 00 if no longer happens) ... times a week
Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months
egg
cheese
meat or meat products
fish or fish products
potatoes
other vegetables
fruit puddings
milk puddings
D10 a-k

Since she was 6 months old has she had:

- Age started ... months How often nowadays (Put 00 if no longer happens) ... times a week
Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months
coca cola or pepsi
other fizzy drink
apple juice
blackcurrant juice or rosehip syrup
other fruit juice
a little alcohol
any other fruit drink (e.g. orange squash)
herbal drink (please describe)
gripe water
tea
coffee
D10 h
Since she was 6 months old has she had: herbal drink (please describe)
Generic text
D11 a
Which type of these drinks does your child have nowadays?(tick all that apply) tea
1
decaffeinated
2
weak
4
strong
6
does not like
7
does not have
D11 b
Which type of these drinks does your child have nowadays?(tick all that apply) coffee
1
decaffeinated
2
weak
4
strong
6
does not like
7
does not have
D11 c
Which type of these drinks does your child have nowadays?(tick all that apply) cola
1
decaffeinated
2
ordinary
4
diet
6
does not like
7
does not have
D11 d
Which type of these drinks does your child have nowadays?(tick all that apply) other soft drinks
1
decaffeinated
2
ordinary
4
diet
6
does not like
7
does not have
D12 a-t

Since she was 6 months old, has your child had the following, whether in baby foods or elsewhere:

- Age started ... months How often nowadays (Put 00 if no longer happens) ... times a week
Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months
Packet soup
Canned soup
Liver/liver pate
Kidney
Shellfish (eg. prawns mussels, cockles)
Baked beans
Green peas
Other legumes (eg. lentils, chick peas, red kidney beans)
Yoghurt
Figs/fig products
Raw apple
Other raw fruit (eg. banana/orange)
Raw carrot
Other raw vegetables (please describe)
Nuts/nut products
Crisps
Other cocktail or savoury snacks (eg. cheesy biscuits)
Chocolates
Mints (eg. polo)
Sweets
D12 n
Since she was 6 months old, has your child had the following, whether in baby foods or elsewhere: Other raw vegetables (please describe)
Other
D13 a-g

Do you ever add these things to your child's food or use them in preparing her food?

- Age started ... months How often nowadays (Put 00 if no longer happens) ... times a week
Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months
Gravy (made with granules, powder or cubes) or soy sauce
Salt
Herbs (please describe)
Spices (please describe)
Tomato ketchup
Other sauce (please describe)
Sugar
D13 c
Do you ever add these things to your child's food or use them in preparing her food? Herbs (please describe)
Generic text
D13 d
Do you ever add these things to your child's food or use them in preparing her food? Spices (please describe)
Generic text
D13 f
Do you ever add these things to your child's food or use them in preparing her food? Other sauce (please describe)
Generic text
D14 a
Skins and peels: does she eat: apple skin
1
No
2
Yes
3
Doesn't have this at all
D14 b
Skins and peels: does she eat: orange peel
1
No
2
Yes
3
Doesn't have this at all
D14 c
Skins and peels: does she eat: potato skin
1
No
2
Yes
3
Doesn't have this at all
D14 d
Skins and peels: does she eat: other fruit or vegetable skin (please describe)
1
No
2
Yes
3
Doesn't have this at all
Other
D15 a-d

Has your infant ever had:

- Age started ... months How often nowadays (Put 00 if no longer happens) ... times a week
Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months 		Age in months

1 - No

2 - Yes

How manyAge in months

1 - No

2 - Yes

How many

1 - No

2 - Yes

How manyAge in months
smoked/cured foods (ham, bacon, smoked fish,smoked cheese)
individually packaged microwave meals
foods cooked on a barbecue
sports drinks (eg. Lucozade sport, Dexters)
D15 i
please describe
Generic text
If yes
D16
Is she fed 'on demand', i.e. whenever she is hungry?
1
Yes always
2
Yes some of the time
3
No not at all
D17
Are there any other foods that your child eats that haven't been included above?
1
Yes
2
No
s_qD17
If no, go to D18

_food < 4

D17 i
Food
Generic text
If yes please describe:
D17 ii
Age started ... months
Age in months
If yes please describe:
D17 iii
How often nowadays ... times a week
How many
If yes please describe:
D18 a
When shopping do you deliberately choose for your toddler labels that say: low sugar
1
Usually
2
Sometimes
3
Never
D18 b
When shopping do you deliberately choose for your toddler labels that say: iron added
1
Usually
2
Sometimes
3
Never
D19
Are there any foods that you don't allow your toddler to eat?
1
yes
2
no
D19 i
please list the foods and why:
Generic text
If yes,
D20
Babies first solid meals are usually a puree. When did your child first start having meals with lumps in? Age started ... months
Age in months
D21 a
Who most often feeds her during the day?
1
you
2
partner
3
paid helper
4
other person (describe)
Other
D21 b
Who usually feeds her at night?
1
you
2
partner
3
paid helper
4
don't feed at night
5
other person (describe)
Other
D22
Does your toddler have definite likes and dislikes as far as food is concerned?
1
no, will eat almost anything
2
yes, quite choosy
3
yes, very choosy
D23
Does she drink out of a cup or feeding beaker?
1
yes, usually
2
yes, sometimes
3
no, not at all
D24
How often do you put her down to sleep with a bottle (whether at night or during the day)?
1
always
2
sometimes
3
never
D25 a
How often does she suck a dummy or her thumb or finger? dummy
2
most of the time
3
sometimes
4
never
D25 b
How often does she suck a dummy or her thumb or finger? thumb/finger
2
most of the time
3
sometimes
4
never
D25 c
When you give her a dummy, how often is it dipped in or filled with something that tastes nice?
1
usually
2
sometimes
3
never
7
doesn't have a dummy
D26 a
Apart from her fingers, thumb or a dummy does she have a special object that she uses for comfort?
1
Yes
2
No
s_qD26a
If no, go to E1
D26 b
what is this?
1
blanket
2
cuddly toy
3
other (please describe)
Other
If yes,

SECTION E: CHILDCARE

E1 a(i-viii)

Apart from yourself, who regularly looks after your infant? (Please answer for each person regularly involved).

- If yes, give hours per week and Age of baby when this began (in months)
Hours per week

1 - No

2 - Yes

Age in monthsHours per week

1 - No

2 - Yes

Age in months

1 - No

2 - Yes

Age in monthsHours per week 		Hours per week

1 - No

2 - Yes

Age in monthsHours per week

1 - No

2 - Yes

Age in months

1 - No

2 - Yes

Age in monthsHours per week 		Hours per week

1 - No

2 - Yes

Age in monthsHours per week

1 - No

2 - Yes

Age in months

1 - No

2 - Yes

Age in monthsHours per week
partner
baby's grandparent
other relative
friend/neighbour
paid person outside baby's home (eg. child minder)
paid person in baby's home eg. nanny, baby sitter)
day nursery (creche)
other (please describe)
E1 a(viii)
Apart from yourself, who regularly looks after your infant? (Please answer for each person regularly involved). other (please describe)
Other
E1 b
What was the main reason for choosing this form of childcare?
1
I had no choice
2
I could afford it
3
It was convenient
4
It was linked to my job