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ncds_65_pq
STRICTLY CONFIDENTIAL
PARENTAL QUESTIONNAIRE
NATIONAL CHILD DEVELOPMENT STUDY (1958 Cohort)
SPONSORS: Institute of Child Health, University of London National Birthday Trust Fund National Bureau for Co-operation in Child Care National Foundation for Education Research in England and Wales
IN COLLABORATION WITH: ENGLAND AND WALES Association of Chief Education Officers Society of Medical Officers of Health SCOTLAND Association of Directors of Education Association of School Medical and Dental Officers
CHAIRMAN OF CONSULTATIVE COMMITTEE: Sir Lionel Russell, C.B.E., M.A.
CO-CHAIRMAN OF STEERING COMMITTEE: H. L. Elvin, M.A. W. D. Wall, B.A., Ph.D.
CO-DIRECTORS: Neville R. Butler, M.D., M.R.C.P, D.C.H. Mrs. M. L. Kellmor Pringle, B.A., Ph.D., Dip. Ed. Psych.
SENIOR RESEARCH OFFICER: R. Davie, B.A.
SENIOR MEDICAL RESEARCH OFFICER: M. J. Ball, B.Sc., M.B., B.S., D.P.H.

CHILD'S NAME (Surname)

Generic text

CHILD'S NAME (Christian Names)

Generic text

DATE OF BIRTH

Date of birth

TODAY'S DATE

Generic date

SEX

1
Boy
2
Girl

CHILD'S PRESENT HOME ADDRESS

Generic text

CHILD'S PLACE OF BIRTH

Generic text

HOME ADDRESS AT TIME OF CHILD'S BIRTH (IF DIFFERENT FROM PLACE OF BIRTH)

Generic text

CHILD'S NATIONAL HEALTH SERVICE NO.

Generic text
INTRODUCTORY NOTES
Through the co-operation of doctors and midwives all over the country, very comprehensive information was obtained about each child and mother. The results of this study, the 1958 Perinatal Mortality Survey, have already had a considerable impact with a consequent improvement in maternity services and a saving of infant life.
With so much information already available about the children, a unique opportunity presents itself now for relating the ante-natal and birth history of the children to their present development. There is as yet much to learn about the influence of conditions before and at birth on normal educational, physical and emotional growth. There is, too, much to be discovered about the causes and effects of many handicaps and even about their incidence in the child population. Particularly is this the case for minor handicaps, which may nevertheless be educationally significant. A detailed study of a large and representative group affords the opportunity of answering some of these questions.
To make the fullest use of this opportunity, an interdisciplinary project, the National Child Development Study (1958 Cohort) is being sponsored by the four organisations detailed on the front of this booklet. The present phase of this study, which will cover some 16,000 children, is being financed from Government funds. It is inevitable in an undertaking of this size that a good deal of the information to be obtained will be gathered by individual doctors, health visitors, head and class teachers. We are most grateful for the assurances which have already been received that maximum co-operation will be given to this study. We do not underestimate the amount of work involved but we hope that you will feel the project worthy of your professional skill and time.
It has been decided to collect information, if possible, from three sources. The school will make an assessment of the child's progress, and give a few attainment tests. The mother of the child is to be interviewed and the Parental Questionnaire completed by, in most cases, a health visitor. Finally, we hope that the child can be examined by a doctor, who will complete the Medical Questionnaire.
The Parental Questionnaire
This questionnaire would best be completed during an interview with the child's mother. If for any reason the mother is unavailable, please interivew the person who can best answer questions about the child's health and development. Occasionally, a child will not now be living with his own (i.e. natural) mother. In this circumstance, please interview the person who has become for the child a, more or less, permanent mother substitute. Throughout the questionnaire the term "mother" should be taken to imply the child's mother or the permanent mother substitute, except on those few occasions where the term "own mother" is used. The word "father" refers to the child's father or, where appropriate, to the male head of the household.
In interviewing the mother, please assure her at the outset that her answers will be treated in the strictest confidence and that the 16,000 children concerned will be identified by numbers only. If in the light of the mother's response during the interview you feel that a particular question might best be omitted, please feel free to do this, although we are anxious to have the questionnaires fully completed.
Most of the questionnaire has been framed as a series of items to which a number of possible answers is stated. Would you please ring the number in the column opposite the answer you wish to make. We have tried to anticipate likely answers but, where appropriate, have left space for other replies. We apologise to those who may find this approach inhibiting; it has been used to reduce your clerical work and ours. It also simplifies later analysis of the replies. If, however, you feel that a particular answer needs some qualification or amplification, please add comments at that point on the questionnaire.
We should like you to complete the last page of the questionnaire after the interview. The information given on this page will be treated like all the other information, in the strictest confidence.

NAME & ADDRESS OF PRESENT SCHOOL, OR OCCUPATION/TRAINING CENTRE

Generic text

NUMBER OF TIMES FAMILY HAS MOVED SINCE CHILD'S BIRTH (applicable only where the child has been with this family since birth).

How many

Was any of these moves made out of the local area? (i.e., beyond a point where personal contact with former friends could readily be maintained).

1
Yes
2
No
0
Don't know or inapplicable

NAME OF MOTHER (or Mother Substitute) (Surname)

Generic text

NAME OF MOTHER (or Mother Substitute) (Christian Names)

Generic text

RELATIONSHIP OF PRESENT INFORMANT TO CHILD

1
Mother (or Mother Substitute)
2
Other (please specify)
Other

NAME AND ADDRESS OF CHILD'S GENERAL PRACTITIONER

Generic text
PEOPLE IN THE HOUSEHOLD: Please list all the people who normally live in the child's household. Exclude any children, or others, who are only at home for short periods, e.g. school holidays, leave or regular visits. Subject to this, please include: The parents; The present child; Any other children; Any other adults, e.g. relatives or lodgers who are members of the household.
Surname Christian Name Sex Age Relationship to Child, or Status in the Household, e.g. father, stepbrother, lodger
Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text
1
2
3
4
5
6
7
8
9
PEOPLE IN THE HOUSEHOLD: Please list any children of the household not included in list (a), e.g. those who are only at home for holidays or leave.
Surname Christian Name Sex Age (approx. if necessary) Relationship to Child, or Status in the Household
Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text
1
2
3

From the above two tables, please state the total number of children of the household under the age of 21.

How many

Please state the child's position amongst these children.

Child's position

Please ascertain, or state to your knowledge, whether the child is normally cared for by his/her:

1
Own mother
2
Stepmother
3
Foster mother
4
Adoptive mother (i.e. child is legally adopted)
5
Grandmother
6
Other person (Please specify)
7
Other situation (Please specify)
0
Don't know or inapplicable
Other
If not child's own mother,
qc_16 >= 2 && qc_16 <= 7

please ascertain how old the child was when he/she came under the care of the present mother substitute. ... mths./yrs.

Age

Please ascertain, or state to your knowledge, whether the child's father is his/her:

1
Own father
2
Stepfather
3
Foster father
4
Adoptive father (i.e. child is legally adopted)
5
Grandfather
6
Other person (Please specify)
7
Other situation (Please specify)
8
Inapplicable (e.g. no father or no male head of household)
0
Don't know
Other
If not child's own father,
qc_17 >= 2 && qc_17 <= 7

please ascertain how old the child was when he/she came under the care of the present father substitute. ... mths./yrs.

Age
Child's School and Pre-school Experience
Did the child attend a local authority or a private nursery school or class? (Do not include day nursery or playgroup attendance).
-

1 - Yes

2 - No

0 - Don't know

Local authority nursery school or class
Private nursery school or class
(Code as "No" if attended for less than one month in total)
If the child attended a local authority nursery school or class,
qc_18$1;1 == 1

please enquire name of school and local authority, or area.

Generic text
If the child attended a nursery class,
qc_18$1;1 == 1 || qc_18$1;2 == 1

was this in his/her present school?

1
Yes
2
No
0
Don't know or inapplicable
(If the child has not attended a nursery class, please ring "0")

Has the child attended a local authority day nursery?

1
Yes
2
No
0
Don't know
If Yes,
qc_20 == 1

please enquire name of day nursery and local authority, or area:

Generic text

Apart from anything already mentioned, has the child had any other pre-school experience of an organised nature? (e.g. private day nursery, playgroup).

1
Yes
2
No
0
Don't know
If yes,
qc_21 == 1

please state nature of group

Generic text
How old was the child when he/she started school part-time, where appropriate, and full-time? (Include nursery school but not attendance at a day nursery.)
-

1 - Under 3 1/2 yrs. old

2 - 3 1/2 yrs. but less than 4

3 - 4 yrs. but less than 4 1/2

4 - 4 1/2 yrs. but less than 5

5 - 5 yrs. but less than 5 1/2

6 - 5 1/2 yrs. but less than 6

7 - 6 yrs. or older

0 - Don't know or inapplicable

Part-time Schooling
Full-time Schooling
(If the child has never received any schooling, please ring "0")

Since the age of five, how many schools has the child attended? (Count the present school as one; please write the actual number in the box; for "Don't know" or "Inapplicable" enter 00.)

How many

When the child first started school, how soon did he/she settle down? (This refers to nursery schooling, where appropriate, and other schooling, where not.)

1
Within a month
2
Within 1-3 months
3
Was still unsettled after 3 months
0
Don't know or inapplicable

Is the child happy at his/her present school?

1
Happy
2
Not altogether happy
3
Unhappy
0
Don't know or inapplicable
(If the child has been at his/her present school less than three months, please ring "0")

Would the parents like the child to be able to stay on at secondary school after the minimum school leaving age?

1
Yes
2
No
0
Don't know or inapplicable
3
Other (Please specify)
Other

Is the child at all awkward or clumsy when: Walking?

2
Not at all
3
A little
1
Certainly
0
Don't know or inapplicable

Is the child at all awkward or clumsy when: Running?

2
Not at all
3
A little
1
Certainly
0
Don't know or inapplicable

Is the child at all awkward or clumsy when: Climbing stairs?

2
Not at all
3
A little
1
Certainly
0
Don't know or inapplicable

Is the child at all awkward or clumsy when: Tying a bow?

2
Not at all
3
A little
1
Certainly
0
Don't know or inapplicable

Is the child:

1
Normally active?
2
Inactive and quiet (prefers to sit and watch)?
3
Restless and overactive (can't keep still)?
0
Don't know or inapplicable

Does the child meet other children outside the household? (Exclude going to and from, and in school.)

1
Most days, or every day
2
Quite often
3
Very little
4
Not at all
0
Don't know or inapplicable
Please read this to the mother: "I am going to mention a few difficulties of various kinds which many children have at some time. I'd like you to tell me first whether any of these things have occurred during the last 3 months".
Has occurred in last 3 months

1 - Yes

2 - No

0 - Don't know or inapplicable

Has complained of headaches (more than once)
Has had temper tantrum
Has been reluctant to go to school
Has had bad dreams or night terrors
Has had difficulty in getting off to sleep
Has sleepwalked
Has been faddy-many dislikes over food
Has had poor appetite
Has overeaten for more than the occasional meal

"Were you concerned about any of these or other problems before the child started school?"

1
Yes
2
No
0
Don't know
If Yes,
qc_31 == 1

please specify which problems caused concern

Generic text

"Have you been concerned about any of these or other problems since he/she has been at school?" (But excluding last 3 months.)

1
Yes
2
No
0
Don't know
If Yes,
qc_32 == 1

please specify which difficulties have caused concern

Generic text

Has the child been in the care of the local authority?

1
Yes, is &quot;in care&quot; now
2
Yes, has been &quot;in care&quot; in the past but is not now
3
No, has never been &quot;in care&quot;
0
Don't know
If Yes,
qc_33 == 1

please give child's age at the time and local authority or area

Generic text
Please read this to the mother: "Now I want to mention some description of behaviour shown by many children. I'd like you, first, to tell me whether these kinds of behaviour never happen with ... whether they happen sometimes, or frequently at the present time".
-

3 - Never

2 - Sometimes

1 - Frequently

0 - Don't know or inapplicable

Has difficulty in settling to anything for more than a few moments
Prefers to do things on his/her own rather than with others
Is bullied by other children
Destroys own or others belongings (e.g. tears or breaks)
Is miserable or tearful
Is squirmy or fidgety
Worries about many things
Is irritable, quick to fly off the handle
Sucks thumb or finger during day
Is upset by new situation, by things happening for first time
Has twitches or mannerisms of the face, eyes or body
Fights with other children
Bites nails
Is disobedient at home

Did any of these or other aspects of behaviour cause you any concern before the child started school?

1
Yes
2
No
0
Don't know
If Yes,
qc_35 == 1

please specify the aspects involved

Generic text

Have any of these or other aspects caused you any concern since he/she has been at school? (but not at present).

1
Yes
2
No
0
Don't know
If Yes,
qc_36 == 1

please specify the aspects involved

Generic text

Has the child ever been separated from the mother? (i.e. overnight).

1
Yes
2
No
0
Don't know or inapplicable
(If the answer to this question is No, Don't know or Inapplicable, please ignore the rest of this page).
qc_37 == 2 || qc_37 == 3
Else

Has the child ever been separated from the mother for a period longer than a week?

1
Yes
2
No
0
Don't know or inapplicable
(If the answer to this question is No, Don't know or Inapplicable, please ignore the rest of this page).
qc_38 == 2 || qc_38 == 3
Else
Please obtain the following details about the child's longest period of separation from the mother (i.e. longer than a week) and his/her first period of separation longer than a week. If the occasion was the same one, please nevertheless complete both columns.
Duration in days (e.g., for 11 days enter 011) ... days Age of Child at Separation ... yrs, Age of Child at Separation ... mths. Contact between Child and Mother Please ring appropriate number Child's Placement Please ring appropriate number Other placement (Please specify) Reason for Separation
Age

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherHow manyAge in months

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsAgeHow manyGeneric textHow manyGeneric text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

OtherAgeAge in monthsAge

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

How manyAge in monthsOtherGeneric textGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

AgeHow many

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Age in monthsOtherAgeHow manyAgeAge in months

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Other

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic textHow many
Age

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherHow manyAge in months

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsAgeHow manyGeneric textHow manyGeneric text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

OtherAgeAge in monthsAge

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

How manyAge in monthsOtherGeneric textGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

AgeHow many

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Age in monthsOtherAgeHow manyAgeAge in months

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Other

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic textHow many
Age

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherHow manyAge in months

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsAgeHow manyGeneric textHow manyGeneric text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

OtherAgeAge in monthsAge

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

How manyAge in monthsOtherGeneric textGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

AgeHow many

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Age in monthsOtherAgeHow manyAgeAge in months

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Other

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic textHow many
Age

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherHow manyAge in months

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsAgeHow manyGeneric textHow manyGeneric text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

OtherAgeAge in monthsAge

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

How manyAge in monthsOtherGeneric textGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

AgeHow many

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Age in monthsOtherAgeHow manyAgeAge in months

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Other

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic textHow many
Age

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherHow manyAge in months

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsAgeHow manyGeneric textHow manyGeneric text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

OtherAgeAge in monthsAge

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

How manyAge in monthsOtherGeneric textGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

AgeHow many

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Age in monthsOtherAgeHow manyAgeAge in months

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Other

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic textHow many
Age

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherHow manyAge in months

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsAgeHow manyGeneric textHow manyGeneric text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

OtherAgeAge in monthsAge

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

How manyAge in monthsOtherGeneric textGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

AgeHow many

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Age in monthsOtherAgeHow manyAgeAge in months

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Other

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic textHow many
Age

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherHow manyAge in months

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsAgeHow manyGeneric textHow manyGeneric text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

OtherAgeAge in monthsAge

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

How manyAge in monthsOtherGeneric textGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

AgeHow many

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Age in monthsOtherAgeHow manyAgeAge in months

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Other

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic textHow many
Longest Period of Separation from Mother.
First Separation from Mother.

How many different periods of separation have there been? Before the age of five

How many

How many different periods of separation have there been? Since the age of five

How many

Does either parent read to, or read with, the child? Mother

1
Yes, at least every week
2
Yes occasionally
3
Never, or hardly ever
0
Don't know or inapplicable

Does either parent read to, or read with, the child? Father

1
Yes, at least every week
2
Yes occasionally
3
Never, or hardly ever
0
Don't know or inapplicable

Do the parents take the child out? (e.g. for walks, outings, picnics, visits, shopping). Mother

1
Yes, most weeks
2
Yes, occasionally
3
Never or hardly ever
0
Don't know or inapplicable

Do the parents take the child out? (e.g. for walks, outings, picnics, visits, shopping). Father

1
Yes, most weeks
2
Yes, occasionally
3
Never or hardly ever
0
Don't know or inapplicable

Does the father take a big part in managing the child, or leave mainly to mother?

1
Father takes a big part, or equal part with mother
2
Father takes a smaller part than mother (but mother feels it to be a significant part)
3
Father takes a very small part, or leaves to mother
0
Don't know or inapplicable

Do the parents themselves do any spare time reading? (e.g. of newspapers, books or magazines). Newspapers or Magazines Mother

1
Yes, most days
2
Yes, occasionally
3
Never or hardly ever
0
Don't know or inapplicable

Do the parents themselves do any spare time reading? (e.g. of newspapers, books or magazines). Newspapers or Magazines Father

1
Yes, most days
2
Yes, occasionally
3
Never or hardly ever
0
Don't know or inapplicable

Do the parents themselves do any spare time reading? (e.g. of newspapers, books or magazines). Books or Technical Journals Mother

1
Yes, most weeks
2
Yes, occasionally
3
Never, or hardly ever
0
Don't know or inapplicable

Do the parents themselves do any spare time reading? (e.g. of newspapers, books or magazines). Books or Technical Journals Father

1
Yes, most weeks
2
Yes, occasionally
3
Never, or hardly ever
0
Don't know or inapplicable

What is the occupation of the child's father? (i.e., present male head of household). If not working, give last occupation and give reason, e.g. unemployed, sick. If there is no male head of household, please write "None". Actual Job

Generic text

What is the occupation of the child's father? (i.e., present male head of household). If not working, give last occupation and give reason, e.g. unemployed, sick. If there is no male head of household, please write "None". Industry

Generic text
(As much detail as possible should be given. The actual job should show the type of work done so that we may be able to classify by the skill, qualification or responsibility involved. Terms such as "engineer", "civil servant", "electrical worker", "clerk", do not give sufficient information to allow such classification, and should be expanded.)

Is the father paid weekly, monthly or is he self-employed?

1
Weekly
2
Monthly
3
Self-employed
0
Don't know
If self-employed:
qc_46_c == 3

Does he employ 10 or more persons?

1
Yes
2
No
0
Don't know
If not self-employed:
qc_46_c == 1 || qc_46_c == 2

Does he supervise others? (e.g. foreman, manager, charge-hand).

1
Yes
2
No
0
Don't know

When the father left school, what was his father's job? Actual Job

Generic text

When the father left school, what was his father's job? Industry

Generic text

When the father left school, what was his father's job? Was he:

1
Self-employed, not employing others?
2
Employer?
3
Employee, not supervising others?
4
Employee, supervising others?
0
Don't know

Did the father stay on at school after the minimum school leaving age?

1
Yes
2
No
0
Don't know
If Yes,
qc_48 == 1

at what age did he finish full-time education? ... yrs.

Age

Has the mother been in paid work since the child's birth? (Include only work outside the home). Before the child started school

1
Part-time or Temporary (More than one month's duration)
2
Full-time
3
Mother has not worked
0
Don't know or inapplicable

Has the mother been in paid work since the child's birth? (Include only work outside the home). Since the child started school

1
Part-time or Temporary (More than one month's duration)
2
Full-time
3
Mother has not worked
0
Don't know or inapplicable
If the mother has worked,
qc_49_a == 1 || qc_49_a == 2 || qc_49_b == 1 || qc_49_b == 2

please give brief details of duration and hours worked

Long text

What is the accommodation occupied by this household?

1
Whole house
2
Flat (self-contained)
3
Rooms
4
Other (please specify)
0
Don't know or inapplicable
Other

Is the accommodation:

1
Owned by the household, or being bought?
2
Council rented?
3
Private rented?
4
Rent free?
5
Other (please specify)
0
Don't know or inapplicable
Other

How many rooms are there? (Include rooms used by lodgers or relatives who are members of the household; exclude bathroom, scullery or kitchen unless used as a living room) ... rms.

How many

Has the household got, or does it share: Bathroom?

1
Sole use
2
Shared
3
None
0
Don't know or inapplicable

Has the household got, or does it share: Indoor Lavatory?

1
Sole use
2
Shared
3
None
0
Don't know or inapplicable

Has the household got, or does it share: Outside Lavatory?

1
Sole use
2
Shared
3
None
0
Don't know or inapplicable

Has the household got, or does it share: Cooking Facilities?

1
Sole use
2
Shared
3
None
0
Don't know or inapplicable

Has the household got, or does it share: Hot Water Supply?

1
Sole use
2
Shared
3
None
0
Don't know or inapplicable

Has the household got, or does it share: Garden, Yard?

1
Sole use
2
Shared
3
None
0
Don't know or inapplicable

Did the child attend an Infant Welfare Clinic or Toddlers' Clinic? Infant Welfare Clinic (under 1 year)

1
No
2
Yes Regularly
3
Yes Occasionally
0
Don't know

Did the child attend an Infant Welfare Clinic or Toddlers' Clinic? Toddlers' Clinic (1-5 years)

1
No
2
Yes Regularly
3
Yes Occasionally
0
Don't know
IMMUNISATION AND VACCINATION

Has the child received any immunisation against: Diphtheria

1
Yes
2
No (objects to it)
3
No (all other reasons)
0
Don't know

Has the child received any immunisation against: Poliomyelitis

1
Yes
2
No (objects to it)
3
No (all other reasons)
0
Don't know

Has the child received any immunisation against: Smallpox

1
Yes
2
No (objects to it)
3
No (all other reasons)
0
Don't know

What infectious diseases has the child had, and at what ages? Measles

2
No
1
Yes
0
Don't know

What infectious diseases has the child had, and at what ages? German measles

2
No
1
Yes
0
Don't know

What infectious diseases has the child had, and at what ages? Whooping cough

2
No
1
Yes
0
Don't know

What infectious diseases has the child had, and at what ages? Chicken pox

2
No
1
Yes
0
Don't know

What infectious diseases has the child had, and at what ages? Mumps

2
No
1
Yes
0
Don't know

What infectious diseases has the child had, and at what ages? Scarlet fever

2
No
1
Yes
0
Don't know

What infectious diseases has the child had, and at what ages? Others (e.g., glandular fever, tuberculosis, etc.) Specify

2
No
1
Yes
0
Don't know
Other

BREAST FEEDING Was the child breast fed (partly or wholly) as a baby?

1
No
2
Yes under 1 month
3
Yes over 1 month
0
Don't know
WALKING

By 1 1/2 years of age was the child walking alone?

2
No
1
Yes
0
Don't know
If not,
qc_58 == 2

at what age?

Age
SPEECH

By two years of age was the child talking? (i.e., joining two words)

2
No
1
Yes
0
Don't know
If not,
qc_59_a == 2

at what age?

Age

Has there ever been any stammer or stutter

2
No
1
Yes
0
Don't know

Age at onset

Age

Present now?

Generic text

Any other speech difficulty? Specify

2
No
1
Yes
0
Don't know
Other

Is English the mother's usual language with this child?

2
No
1
Yes
0
Don't know
OUT-PATIENT AND CLINIC ATTENDANCES
Has the child attended any of the following?
- Name of Hospital or Clinic, and Town Age
Age

2 - No

1 - Yes

0 - Don't know

Generic textAge

2 - No

1 - Yes

0 - Don't know

Generic text

2 - No

1 - Yes

0 - Don't know

Generic textAge
Age

2 - No

1 - Yes

0 - Don't know

Generic textAge

2 - No

1 - Yes

0 - Don't know

Generic text

2 - No

1 - Yes

0 - Don't know

Generic textAge
Age

2 - No

1 - Yes

0 - Don't know

Generic textAge

2 - No

1 - Yes

0 - Don't know

Generic text

2 - No

1 - Yes

0 - Don't know

Generic textAge
Eye dept. or clinic, optician, or orthoptist
Physiotherapy or remedial exercises
Child guidance clinic
Speech therapy
Hearing or audiology
Dental clinic, dentist or orthodontist
Have there been any outpatient, other clinic or specialist appointments?

Has the child attended any of the following? Have there been any outpatient, other clinic or specialist appointments? Specify

Long text

Has the child ever had a dental gas?

2
No
1
Yes
0
Don't know
If yes,
qc_61 == 1

how many times?

How many
HOSPITAL ADMISSIONS
Has the child ever been admitted to hospital for any of the following:
- (Specify) Name of Hospital and Town Age

2 - No

1 - Yes

0 - Don't know

AgeGeneric textGeneric textAgeGeneric textGeneric text

2 - No

1 - Yes

0 - Don't know

Generic textAgeGeneric text

2 - No

1 - Yes

0 - Don't know

Generic textAge

2 - No

1 - Yes

0 - Don't know

Generic text

2 - No

1 - Yes

0 - Don't know

AgeGeneric textGeneric textAgeGeneric textGeneric text

2 - No

1 - Yes

0 - Don't know

Generic textAgeGeneric text

2 - No

1 - Yes

0 - Don't know

Generic textAge

2 - No

1 - Yes

0 - Don't know

Generic text

2 - No

1 - Yes

0 - Don't know

AgeGeneric textGeneric textAgeGeneric textGeneric text

2 - No

1 - Yes

0 - Don't know

Generic textAgeGeneric text

2 - No

1 - Yes

0 - Don't know

Generic textAge

2 - No

1 - Yes

0 - Don't know

Generic text

2 - No

1 - Yes

0 - Don't know

AgeGeneric textGeneric textAgeGeneric textGeneric text

2 - No

1 - Yes

0 - Don't know

Generic textAgeGeneric text

2 - No

1 - Yes

0 - Don't know

Generic textAge

2 - No

1 - Yes

0 - Don't know

Generic text
Tonsils and/or adenoids
Abdominal operation
Hernia repair
Other operations (including blood transfusions)
Road accidents
Other accident or injury
Illnesses, investigations or tests
Hospital admission for any other reason

Has the child ever been admitted to hospital for any of the following: Home accidents (e.g. burns, scalds, poisoning, injury)

2
No
1
Yes
0
Don't know

Has the child ever been admitted to hospital for any of the following: Home accidents (e.g. burns, scalds, poisoning, injury) Name of Hospital and Town

Generic text

Has the child ever been admitted to hospital for any of the following: Home accidents (e.g. burns, scalds, poisoning, injury) Age

Age
MEDICAL HISTORY
GENERAL

Has the child, to the mother's knowledge, any physical handicap or disabling condition? Specify

2
No
1
Yes
0
Don't know
Generic text

Does the mother consider the child to be particularly sensitive or highly strung? Specify

2
No
1
Yes
0
Don't know
Generic text
EAR, NOSE AND THROAT

Has the child had more than 3 throat and/or ear infections (with fever) in the past year?

2
No
1
Yes
0
Don't know

Has the child ever had: Hay fever or sneezing attacks

2
No
1
Yes
0
Don't know

Has the child ever had: Habitual snoring or mouth breathing

2
No
1
Yes
0
Don't know

Has the child ever had: Running ears (i.e. pus, not wax)

2
No
1
Yes
0
Don't know

No. of times in past 12 mths.

How many

Has the child ever had: Earache, without running ears

2
No
1
Yes
0
Don't know

No. of times in past 12 mths.

How many

Has the child ever had: Hearing difficulty (suspected or confirmed) Specify

2
No
1
Yes
0
Don't know
Generic text

Age

Age

Present now?

Generic text

Has the child ever had: Other ear trouble Specify

2
No
1
Yes
0
Don't know
Other
RESPIRATORY SYSTEM

Has the child ever had: Attacks of asthma

2
No
1
Yes
0
Don't know

No. of times in all?

How many

No. of times in past 12 mths.

How many

Has the child ever had: Bronchitis with wheezing

2
No
1
Yes
0
Don't know

No. of times in past 12 mths.

How many

Has the child ever had: Pneumonia

2
No
1
Yes
0
Don't know

At what age?

Age

Has the child ever had: Other respiratory disease Specify

2
No
1
Yes
0
Don't know
Other
C.V.S.

Has the child had: Rheumatic fever

2
No
1
Yes
0
Don't know

At what age?

Age

Has the child had: Chorea (St. Vitus' Dance)

2
No
1
Yes
0
Don't know

At what age?

Age

Has the child had: Congenital heart condition Specify

2
No
1
Yes
0
Don't know
Generic text

Has the child had: Parent, brother or sister with congenital heart condition Specify

2
No
1
Yes
0
Don't know
Generic text
ALIMENTARY AND UROGENITAL SYSTEMS

Has the child ever been/or had: Periodic vomiting or bilious attacks

2
No
1
Yes
0
Don't know

No. of times in past 12 mths.

How many

Has the child ever been/or had: Periodic abdominal pain

2
No
1
Yes
0
Don't know

No. of times in past 12 mths.

How many

Has the child ever been/or had: Recurrent mouth ulcers

2
No
1
Yes
0
Don't know

Has the child ever been/or had: Hernia of any sort

2
No
1
Yes
0
Don't know

Site

Generic text

Has the child ever been/or had: Other serious digestive, bowel or alimentary disorder Specify

2
No
1
Yes
0
Don't know
Other

Has the child ever been/or had: Infection in the urine (requiring medical treatment)

2
No
1
Yes
0
Don't know

No. of times in all

How many

No. of times in past 12 mths.

How many

Has the child ever been/or had: Wet by day after 3 years of age (Ignore occasional mishaps)

2
No
1
Yes
0
Don't know

How often in past 12 mths.

How many

Has the child ever been/or had: Wet by night after 5 years of age (Ignore occasional mishaps)

2
No
1
Yes
0
Don't know

How often in past 12 mths.

How many

Has the child ever been/or had: Soiled by day after 4 years of age (Ignore occasional mishaps)

2
No
1
Yes
0
Don't know

How often in past 12 mths.

How many

Has the child ever been/or had: Nephritis or other kidney or U-G disorder Specify

2
No
1
Yes
0
Don't know
Other

Age

Age

Has the child ever been/or had: Parent, brother or sister with disorder of alimentary or U-G tract

2
No
1
Yes
0
Don't know
METABOLISM AND BLOOD

Is there a history of: Sugar diabetes

2
No
1
Yes
0
Don't know

Age at onset

Age

Is there a history of: Any diabetes in parents, brothers or sisters Specify

2
No
1
Yes
0
Don't know
Generic text

Is there a history of: Any thyroid, pituitary or adrenal gland disorder Specify

2
No
1
Yes
0
Don't know
Generic text

Is there a history of: Any blood disorder Specify

2
No
1
Yes
0
Don't know
Generic text
SKIN

Is there a history of: Eczema in the first year

2
No
1
Yes
0
Don't know

Month of onset

Month

Sites

Generic text

Is there a history of: Eczema after the first year

2
No
1
Yes
0
Don't know

Any present now?

Generic text

Sites

Generic text

Is there a history of: "Strawberry marks" (raised vascular naevi)

2
No
1
Yes
0
Don't know

Age

Age

Site

Generic text

Is there a history of: "Port wine stains" (flat vascular naevi)

2
No
1
Yes
0
Don't know

Age

Age

Site

Generic text

Is there a history of: Other skin condition, including hair or nail disorder Specify

2
No
1
Yes
0
Don't know
Other
C.N.S. AND SKELETAL SYSTEM

Has the child had: A fit or convulsion in the first year of life

2
No
1
Yes
0
Don't know

No. in the first year

How many

Age at first fit

Age

Has the child had: A fit or convulsion after the first year

2
No
1
Yes
0
Don't know

No. in first 12 mths

How many

Total No. of fits

How many

Has the child had: Petit mal or "blank spells"

2
No
1
Yes
0
Don't know

Age at onset

Age

No. of times last year

How many

Any drug treatment for above condiions?

Generic text

Has the child had: Frequent headaches or migraine

2
No
1
Yes
0
Don't know

No. of times in past 12 mths?

How many

Has the child had: Travel sickness

2
No
1
Yes
0
Don't know

Age

Age

Has the child had: Tics or habit spasms Specify

2
No
1
Yes
0
Don't know
Generic text

Any in past 12 mths?

Generic text

Has the child had: Breath holding, head banging or "rocking" Specify

2
No
1
Yes
0
Don't know
Generic text

At what age?

Age

Has the child had: Concussion or head injury (with unconsciousness) Specify

2
No
1
Yes
0
Don't know
Generic text

Age

Age

Has the child had: Unusual size or shape of skull Specify

2
No
1
Yes
0
Don't know
Generic text

Has the child had: Any spinal trouble Specify

2
No
1
Yes
0
Don't know
Generic text

Has the child had: Congenital dislocation of hip

2
No
1
Yes
0
Don't know
  1. or L. or both?
Generic text

Has the child had: Talipes Specify type

2
No
1
Yes
0
Don't know
Generic text
  1. or L. or both
Generic text

Has the child had: Any fractures

2
No
1
Yes
0
Don't know

Site(s)

Generic text

Age(s)

Generic text

Has the child had: Any other bone or joint disorder Specify

2
No
1
Yes
0
Don't know
Other

Has the child had: Has any parent, brother or sister had a fit or convulsion Specify

2
No
1
Yes
0
Don't know
Generic text

LATERALITY Does the mother think the child is:

1
Right-handed
2
Left-handed
3
Mixed R. and L.
0
Don't know
VISION

Has the child had: Squint or suspected squint Specify

2
No
1
Yes
0
Don't know
Generic text

Age

Age

Present now?

Generic text

Has the child had: Any other eye trouble? Specify

2
No
1
Yes
0
Don't know
Other

Has the child had: Have glasses been prescribed?

2
No
1
Yes
0
Don't know

At what age?

Age

Reason

Generic text
Children Born to this Mother (complete only where the mother is the child's own mother and, if not, please enter 00 for Questions 73(a) and 73(b). Please list all children born to this mother. Include the present child, and any that have since died and any stillbirths, ringing the numbers in the appropriate columns. Please enter twins separately, and omit miscarriages.
Date of birth Sex Survival Birth Birth Wt. (approx. if necessary) ... lbs. Birth Wt. (approx. if necessary) ... ozs. Complications of Pregnancy Presentation Method of Delivery Please specify any handicap or disability, or cause and date of death

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

Date of birthGeneric textozs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - M

2 - F

lbs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - M

2 - F

Date of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

Generic text

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Vertex

2 - Breech

3 - Don't know/Other

lbs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - M

2 - F

1 - Domiciliary

2 - Institutional

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

lbs.ozs.Generic textDate of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - M

2 - F

Generic text

1 - Vertex

2 - Breech

3 - Don't know/Other

Date of birthozs.lbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

Date of birthlbs.

1 - M

2 - F

Generic textlbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

Date of birth

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

ozs.

1 - M

2 - F

Generic text

1 - Domiciliary

2 - Institutional

lbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Domiciliary

2 - Institutional

ozs.

1 - M

2 - F

Date of birthGeneric textGeneric text

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

lbs.

1 - Domiciliary

2 - Institutional

Date of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

ozs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

Generic text

1 - Domiciliary

2 - Institutional

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

lbs.Date of birth

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Alive now

2 - Stillbirth

3 - Died subsequently

lbs.ozs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

Generic textDate of birth

1 - Domiciliary

2 - Institutional

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

Date of birthGeneric textozs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - M

2 - F

lbs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - M

2 - F

Date of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

Generic text

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Vertex

2 - Breech

3 - Don't know/Other

lbs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - M

2 - F

1 - Domiciliary

2 - Institutional

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

lbs.ozs.Generic textDate of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - M

2 - F

Generic text

1 - Vertex

2 - Breech

3 - Don't know/Other

Date of birthozs.lbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

Date of birthlbs.

1 - M

2 - F

Generic textlbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

Date of birth

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

ozs.

1 - M

2 - F

Generic text

1 - Domiciliary

2 - Institutional

lbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Domiciliary

2 - Institutional

ozs.

1 - M

2 - F

Date of birthGeneric textGeneric text

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

lbs.

1 - Domiciliary

2 - Institutional

Date of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

ozs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

Generic text

1 - Domiciliary

2 - Institutional

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

lbs.Date of birth

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Alive now

2 - Stillbirth

3 - Died subsequently

lbs.ozs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

Generic textDate of birth

1 - Domiciliary

2 - Institutional

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

Date of birthGeneric textozs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - M

2 - F

lbs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - M

2 - F

Date of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

Generic text

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Vertex

2 - Breech

3 - Don't know/Other

lbs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - M

2 - F

1 - Domiciliary

2 - Institutional

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

lbs.ozs.Generic textDate of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - M

2 - F

Generic text

1 - Vertex

2 - Breech

3 - Don't know/Other

Date of birthozs.lbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

Date of birthlbs.

1 - M

2 - F

Generic textlbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

Date of birth

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

ozs.

1 - M

2 - F

Generic text

1 - Domiciliary

2 - Institutional

lbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Domiciliary

2 - Institutional

ozs.

1 - M

2 - F

Date of birthGeneric textGeneric text

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

lbs.

1 - Domiciliary

2 - Institutional

Date of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

ozs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

Generic text

1 - Domiciliary

2 - Institutional

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

lbs.Date of birth

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Alive now

2 - Stillbirth

3 - Died subsequently

lbs.ozs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

Generic textDate of birth

1 - Domiciliary

2 - Institutional

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

Date of birthGeneric textozs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - M

2 - F

lbs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - M

2 - F

Date of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

Generic text

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Vertex

2 - Breech

3 - Don't know/Other

lbs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - M

2 - F

1 - Domiciliary

2 - Institutional

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

lbs.ozs.Generic textDate of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - M

2 - F

Generic text

1 - Vertex

2 - Breech

3 - Don't know/Other

Date of birthozs.lbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

Date of birthlbs.

1 - M

2 - F

Generic textlbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

Date of birth

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

ozs.

1 - M

2 - F

Generic text

1 - Domiciliary

2 - Institutional

lbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Domiciliary

2 - Institutional

ozs.

1 - M

2 - F

Date of birthGeneric textGeneric text

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

lbs.

1 - Domiciliary

2 - Institutional

Date of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

ozs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

Generic text

1 - Domiciliary

2 - Institutional

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

lbs.Date of birth

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Alive now

2 - Stillbirth

3 - Died subsequently

lbs.ozs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

Generic textDate of birth

1 - Domiciliary

2 - Institutional

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

Date of birthGeneric textozs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - M

2 - F

lbs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - M

2 - F

Date of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

Generic text

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Vertex

2 - Breech

3 - Don't know/Other

lbs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - M

2 - F

1 - Domiciliary

2 - Institutional

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

lbs.ozs.Generic textDate of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - M

2 - F

Generic text

1 - Vertex

2 - Breech

3 - Don't know/Other

Date of birthozs.lbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

Date of birthlbs.

1 - M

2 - F

Generic textlbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

Date of birth

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

ozs.

1 - M

2 - F

Generic text

1 - Domiciliary

2 - Institutional

lbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Domiciliary

2 - Institutional

ozs.

1 - M

2 - F

Date of birthGeneric textGeneric text

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

lbs.

1 - Domiciliary

2 - Institutional

Date of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

ozs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

Generic text

1 - Domiciliary

2 - Institutional

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

lbs.Date of birth

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Alive now

2 - Stillbirth

3 - Died subsequently

lbs.ozs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

Generic textDate of birth

1 - Domiciliary

2 - Institutional

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

Date of birthGeneric textozs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - M

2 - F

lbs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - M

2 - F

Date of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

Generic text

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Vertex

2 - Breech

3 - Don't know/Other

lbs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - M

2 - F

1 - Domiciliary

2 - Institutional

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

lbs.ozs.Generic textDate of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - M

2 - F

Generic text

1 - Vertex

2 - Breech

3 - Don't know/Other

Date of birthozs.lbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

Date of birthlbs.

1 - M

2 - F

Generic textlbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

Date of birth

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

ozs.

1 - M

2 - F

Generic text

1 - Domiciliary

2 - Institutional

lbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Domiciliary

2 - Institutional

ozs.

1 - M

2 - F

Date of birthGeneric textGeneric text

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

lbs.

1 - Domiciliary

2 - Institutional

Date of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

ozs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

Generic text

1 - Domiciliary

2 - Institutional

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

lbs.Date of birth

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Alive now

2 - Stillbirth

3 - Died subsequently

lbs.ozs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

Generic textDate of birth

1 - Domiciliary

2 - Institutional

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

Date of birthGeneric textozs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - M

2 - F

lbs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - M

2 - F

Date of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

Generic text

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Vertex

2 - Breech

3 - Don't know/Other

lbs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - M

2 - F

1 - Domiciliary

2 - Institutional

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

lbs.ozs.Generic textDate of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - M

2 - F

Generic text

1 - Vertex

2 - Breech

3 - Don't know/Other

Date of birthozs.lbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

Date of birthlbs.

1 - M

2 - F

Generic textlbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

Date of birth

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

ozs.

1 - M

2 - F

Generic text

1 - Domiciliary

2 - Institutional

lbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Domiciliary

2 - Institutional

ozs.

1 - M

2 - F

Date of birthGeneric textGeneric text

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

lbs.

1 - Domiciliary

2 - Institutional

Date of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

ozs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

Generic text

1 - Domiciliary

2 - Institutional

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

lbs.Date of birth

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Alive now

2 - Stillbirth

3 - Died subsequently

lbs.ozs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

Generic textDate of birth

1 - Domiciliary

2 - Institutional

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

Date of birthGeneric textozs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - M

2 - F

lbs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - M

2 - F

Date of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

Generic text

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Vertex

2 - Breech

3 - Don't know/Other

lbs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - M

2 - F

1 - Domiciliary

2 - Institutional

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

lbs.ozs.Generic textDate of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - M

2 - F

Generic text

1 - Vertex

2 - Breech

3 - Don't know/Other

Date of birthozs.lbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

Date of birthlbs.

1 - M

2 - F

Generic textlbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

Date of birth

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

ozs.

1 - M

2 - F

Generic text

1 - Domiciliary

2 - Institutional

lbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Domiciliary

2 - Institutional

ozs.

1 - M

2 - F

Date of birthGeneric textGeneric text

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

lbs.

1 - Domiciliary

2 - Institutional

Date of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

ozs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

Generic text

1 - Domiciliary

2 - Institutional

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

lbs.Date of birth

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Alive now

2 - Stillbirth

3 - Died subsequently

lbs.ozs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

Generic textDate of birth

1 - Domiciliary

2 - Institutional

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

Date of birthGeneric textozs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - M

2 - F

lbs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - M

2 - F

Date of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

Generic text

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Vertex

2 - Breech

3 - Don't know/Other

lbs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - M

2 - F

1 - Domiciliary

2 - Institutional

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

lbs.ozs.Generic textDate of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - M

2 - F

Generic text

1 - Vertex

2 - Breech

3 - Don't know/Other

Date of birthozs.lbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

Date of birthlbs.

1 - M

2 - F

Generic textlbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

Date of birth

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

ozs.

1 - M

2 - F

Generic text

1 - Domiciliary

2 - Institutional

lbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Domiciliary

2 - Institutional

ozs.

1 - M

2 - F

Date of birthGeneric textGeneric text

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

lbs.

1 - Domiciliary

2 - Institutional

Date of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

ozs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

Generic text

1 - Domiciliary

2 - Institutional

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

lbs.Date of birth

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Alive now

2 - Stillbirth

3 - Died subsequently

lbs.ozs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

Generic textDate of birth

1 - Domiciliary

2 - Institutional

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

Date of birthGeneric textozs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - M

2 - F

lbs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - M

2 - F

Date of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

Generic text

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Vertex

2 - Breech

3 - Don't know/Other

lbs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - M

2 - F

1 - Domiciliary

2 - Institutional

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

lbs.ozs.Generic textDate of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

1 - M

2 - F

Generic text

1 - Vertex

2 - Breech

3 - Don't know/Other

Date of birthozs.lbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Domiciliary

2 - Institutional

Date of birthlbs.

1 - M

2 - F

Generic textlbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

Date of birth

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

ozs.

1 - M

2 - F

Generic text

1 - Domiciliary

2 - Institutional

lbs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Alive now

2 - Stillbirth

3 - Died subsequently

1 - Domiciliary

2 - Institutional

ozs.

1 - M

2 - F

Date of birthGeneric textGeneric text

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

lbs.

1 - Domiciliary

2 - Institutional

Date of birth

1 - Alive now

2 - Stillbirth

3 - Died subsequently

ozs.

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Vertex

2 - Breech

3 - Don't know/Other

1 - Vertex

2 - Breech

3 - Don't know/Other

Generic text

1 - Domiciliary

2 - Institutional

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

ozs.

1 - Alive now

2 - Stillbirth

3 - Died subsequently

lbs.Date of birth

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Spontaneous

2 - Forceps

3 - Caesarian

0 - Don't know/Other

1 - M

2 - F

1 - Alive now

2 - Stillbirth

3 - Died subsequently

lbs.ozs.

1 - Normal

2 - Toxaemia

3 - A.P.H.

0 - Don't know/Other

Generic textDate of birth

1 - Domiciliary

2 - Institutional

1 - Vertex

2 - Breech

3 - Don't know/Other

1.
2.
3.
4.
5.
6.
7.
8.
9.

From the above table, please state first the total number of births including the present child, and then the child's position in birth order. (N.B.: Twins=1 birth). Number of births (e.g., for 6 births enter 06; if not known or inapplicable enter 00).

How many

From the above table, please state first the total number of births including the present child, and then the child's position in birth order. (N.B.: Twins=1 birth). Child's position in birth order (e.g., for first born enter 01).

Child's position

Was this child a single or multiple birth?

1
Single birth
2
Twins: Identical: First born
3
Twins: Identical: Second born
4
Twins: Identical: Position unknown
5
Twins: Non-Identical: First born
6
Twins: Non-Identical: Second born
7
Twins: Non-Identical: Position unknown
8
Twin birth but no details
9
One of triplets
0
Don't know
END OF INTERVIEW
Please thank the mother and ask her to bring or send a sample of the child's urine to the medical examination. When completed, please ensure that this questionnaire is in the hands of the doctor in time for his examination of the child.
STRICTLY CONFIDENTIAL
SOCIAL ENVIRONMENT
For completion by the Health visitor only, without questionning the family
We are anxious to determine the social environment in which children are growing up today.
The following questions relate to the services provided by statutory and voluntary organisations to assist families in dealing with their social and domestic difficulties.
It is not intended to infringe upon the privacy of the home. All information obtained is used solely for statistical analysis and questionnaires are identified by number only.
Has this family to your knowledge required the services of any of the following statutory or voluntary bodies?
-

2 - No

1 - Yes

0 - Don't know

Children's Dept.
Dr. Barnardo's or other Children's Society
Psychiatric Social Worker
School Welfare or Attendance Officer
Nat. Assistance Board
N.S.P.C.C. or R.S.S.P.C.C.
Family Service Unit
Probation Officer
Marriage Guidance Council
Tuberculosis Health Visitor
Mental Welfare Officer
National Council for Unmarried Mother (or similar body)

Has this family to your knowledge required the services of any of the following statutory or voluntary bodies? Any Handicapped Children's Association (Specify)

2
No
1
Yes
0
Don't know
Generic text

Has this family to your knowledge required the services of any of the following statutory or voluntary bodies? Other Statutory or Voluntary Body (Specify)

2
No
1
Yes
0
Don't know
Other

Under which categories would you list the difficulties of this family? Housing

2
No
1
Yes
0
Don't know

Under which categories would you list the difficulties of this family? Financial

2
No
1
Yes
0
Don't know

Under which categories would you list the difficulties of this family? Physical illness or disability

2
No
1
Yes
0
Don't know

Under which categories would you list the difficulties of this family? Mental illness or neurosis

2
No
1
Yes
0
Don't know

Under which categories would you list the difficulties of this family? Mental subnormality

2
No
1
Yes
0
Don't know

Under which categories would you list the difficulties of this family? Death of child's father

2
No
1
Yes
0
Don't know

Under which categories would you list the difficulties of this family? Death of child's mother

2
No
1
Yes
0
Don't know

Under which categories would you list the difficulties of this family? Divorce, separation or desertion

2
No
1
Yes
0
Don't know

Under which categories would you list the difficulties of this family? Domestic tension

2
No
1
Yes
0
Don't know

Under which categories would you list the difficulties of this family? "In-law" conflicts

2
No
1
Yes
0
Don't know

Under which categories would you list the difficulties of this family? Unemployment

2
No
1
Yes
0
Don't know

Under which categories would you list the difficulties of this family? Alcoholism

2
No
1
Yes
0
Don't know

Under which categories would you list the difficulties of this family? Any other serious difficulties affecting child's development (Specify briefly)

2
No
1
Yes
0
Don't know
Other

Does the pattern of living of this family differ markedly from that of the neighbourhood?

2
No
1
Yes
0
Don't know

Does the mother:

1
Speak English as her native tongue, or reasonably well as an acquired language.
2
Speak English poorly as an acquired language, or not at all
0
Don't know, or inapplicable
End

ncds_65_pq

STRICTLY CONFIDENTIAL
PARENTAL QUESTIONNAIRE
NATIONAL CHILD DEVELOPMENT STUDY (1958 Cohort)
SPONSORS: Institute of Child Health, University of London National Birthday Trust Fund National Bureau for Co-operation in Child Care National Foundation for Education Research in England and Wales
IN COLLABORATION WITH: ENGLAND AND WALES Association of Chief Education Officers Society of Medical Officers of Health SCOTLAND Association of Directors of Education Association of School Medical and Dental Officers
CHAIRMAN OF CONSULTATIVE COMMITTEE: Sir Lionel Russell, C.B.E., M.A.
CO-CHAIRMAN OF STEERING COMMITTEE: H. L. Elvin, M.A. W. D. Wall, B.A., Ph.D.
CO-DIRECTORS: Neville R. Butler, M.D., M.R.C.P, D.C.H. Mrs. M. L. Kellmor Pringle, B.A., Ph.D., Dip. Ed. Psych.
SENIOR RESEARCH OFFICER: R. Davie, B.A.
SENIOR MEDICAL RESEARCH OFFICER: M. J. Ball, B.Sc., M.B., B.S., D.P.H.
CHILD'S NAME (Surname)
Generic text
CHILD'S NAME (Christian Names)
Generic text
DATE OF BIRTH
Date of birth
TODAY'S DATE
Generic date
SEX
1
Boy
2
Girl
CHILD'S PRESENT HOME ADDRESS
Generic text
CHILD'S PLACE OF BIRTH
Generic text
HOME ADDRESS AT TIME OF CHILD'S BIRTH (IF DIFFERENT FROM PLACE OF BIRTH)
Generic text
CHILD'S NATIONAL HEALTH SERVICE NO.
Generic text
INTRODUCTORY NOTES
Through the co-operation of doctors and midwives all over the country, very comprehensive information was obtained about each child and mother. The results of this study, the 1958 Perinatal Mortality Survey, have already had a considerable impact with a consequent improvement in maternity services and a saving of infant life.
With so much information already available about the children, a unique opportunity presents itself now for relating the ante-natal and birth history of the children to their present development. There is as yet much to learn about the influence of conditions before and at birth on normal educational, physical and emotional growth. There is, too, much to be discovered about the causes and effects of many handicaps and even about their incidence in the child population. Particularly is this the case for minor handicaps, which may nevertheless be educationally significant. A detailed study of a large and representative group affords the opportunity of answering some of these questions.
To make the fullest use of this opportunity, an interdisciplinary project, the National Child Development Study (1958 Cohort) is being sponsored by the four organisations detailed on the front of this booklet. The present phase of this study, which will cover some 16,000 children, is being financed from Government funds. It is inevitable in an undertaking of this size that a good deal of the information to be obtained will be gathered by individual doctors, health visitors, head and class teachers. We are most grateful for the assurances which have already been received that maximum co-operation will be given to this study. We do not underestimate the amount of work involved but we hope that you will feel the project worthy of your professional skill and time.
It has been decided to collect information, if possible, from three sources. The school will make an assessment of the child's progress, and give a few attainment tests. The mother of the child is to be interviewed and the Parental Questionnaire completed by, in most cases, a health visitor. Finally, we hope that the child can be examined by a doctor, who will complete the Medical Questionnaire.
The Parental Questionnaire
This questionnaire would best be completed during an interview with the child's mother. If for any reason the mother is unavailable, please interivew the person who can best answer questions about the child's health and development. Occasionally, a child will not now be living with his own (i.e. natural) mother. In this circumstance, please interview the person who has become for the child a, more or less, permanent mother substitute. Throughout the questionnaire the term "mother" should be taken to imply the child's mother or the permanent mother substitute, except on those few occasions where the term "own mother" is used. The word "father" refers to the child's father or, where appropriate, to the male head of the household.
In interviewing the mother, please assure her at the outset that her answers will be treated in the strictest confidence and that the 16,000 children concerned will be identified by numbers only. If in the light of the mother's response during the interview you feel that a particular question might best be omitted, please feel free to do this, although we are anxious to have the questionnaires fully completed.
Most of the questionnaire has been framed as a series of items to which a number of possible answers is stated. Would you please ring the number in the column opposite the answer you wish to make. We have tried to anticipate likely answers but, where appropriate, have left space for other replies. We apologise to those who may find this approach inhibiting; it has been used to reduce your clerical work and ours. It also simplifies later analysis of the replies. If, however, you feel that a particular answer needs some qualification or amplification, please add comments at that point on the questionnaire.
We should like you to complete the last page of the questionnaire after the interview. The information given on this page will be treated like all the other information, in the strictest confidence.
NAME & ADDRESS OF PRESENT SCHOOL, OR OCCUPATION/TRAINING CENTRE
Generic text
NUMBER OF TIMES FAMILY HAS MOVED SINCE CHILD'S BIRTH (applicable only where the child has been with this family since birth).
How many
Was any of these moves made out of the local area? (i.e., beyond a point where personal contact with former friends could readily be maintained).
1
Yes
2
No
0
Don't know or inapplicable
NAME OF MOTHER (or Mother Substitute) (Surname)
Generic text
NAME OF MOTHER (or Mother Substitute) (Christian Names)
Generic text
RELATIONSHIP OF PRESENT INFORMANT TO CHILD
1
Mother (or Mother Substitute)
2
Other (please specify)
Other
NAME AND ADDRESS OF CHILD'S GENERAL PRACTITIONER
Generic text

PEOPLE IN THE HOUSEHOLD: Please list all the people who normally live in the child's household. Exclude any children, or others, who are only at home for short periods, e.g. school holidays, leave or regular visits. Subject to this, please include: The parents; The present child; Any other children; Any other adults, e.g. relatives or lodgers who are members of the household.

Surname Christian Name Sex Age Relationship to Child, or Status in the Household, e.g. father, stepbrother, lodger
Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text
1
2
3
4
5
6
7
8
9

PEOPLE IN THE HOUSEHOLD: Please list any children of the household not included in list (a), e.g. those who are only at home for holidays or leave.

Surname Christian Name Sex Age (approx. if necessary) Relationship to Child, or Status in the Household
Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text Generic textAgeGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textAgeGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric textGeneric textGeneric textGeneric textAgeGeneric textGeneric text
1
2
3
From the above two tables, please state the total number of children of the household under the age of 21.
How many
Please state the child's position amongst these children.
Child's position
Please ascertain, or state to your knowledge, whether the child is normally cared for by his/her:
1
Own mother
2
Stepmother
3
Foster mother
4
Adoptive mother (i.e. child is legally adopted)
5
Grandmother
6
Other person (Please specify)
7
Other situation (Please specify)
0
Don't know or inapplicable
Other
please ascertain how old the child was when he/she came under the care of the present mother substitute. ... mths./yrs.
Age
Please ascertain, or state to your knowledge, whether the child's father is his/her:
1
Own father
2
Stepfather
3
Foster father
4
Adoptive father (i.e. child is legally adopted)
5
Grandfather
6
Other person (Please specify)
7
Other situation (Please specify)
8
Inapplicable (e.g. no father or no male head of household)
0
Don't know
Other
please ascertain how old the child was when he/she came under the care of the present father substitute. ... mths./yrs.
Age
Child's School and Pre-school Experience

Did the child attend a local authority or a private nursery school or class? (Do not include day nursery or playgroup attendance).

-

1 - Yes

2 - No

0 - Don't know

Local authority nursery school or class
Private nursery school or class
(Code as "No" if attended for less than one month in total)
please enquire name of school and local authority, or area.
Generic text
was this in his/her present school?
1
Yes
2
No
0
Don't know or inapplicable
(If the child has not attended a nursery class, please ring "0")
Has the child attended a local authority day nursery?
1
Yes
2
No
0
Don't know
please enquire name of day nursery and local authority, or area:
Generic text
Apart from anything already mentioned, has the child had any other pre-school experience of an organised nature? (e.g. private day nursery, playgroup).
1
Yes
2
No
0
Don't know
please state nature of group
Generic text

How old was the child when he/she started school part-time, where appropriate, and full-time? (Include nursery school but not attendance at a day nursery.)

-

1 - Under 3 1/2 yrs. old

2 - 3 1/2 yrs. but less than 4

3 - 4 yrs. but less than 4 1/2

4 - 4 1/2 yrs. but less than 5

5 - 5 yrs. but less than 5 1/2

6 - 5 1/2 yrs. but less than 6

7 - 6 yrs. or older

0 - Don't know or inapplicable

Part-time Schooling
Full-time Schooling
(If the child has never received any schooling, please ring "0")
Since the age of five, how many schools has the child attended? (Count the present school as one; please write the actual number in the box; for "Don't know" or "Inapplicable" enter 00.)
How many
When the child first started school, how soon did he/she settle down? (This refers to nursery schooling, where appropriate, and other schooling, where not.)
1
Within a month
2
Within 1-3 months
3
Was still unsettled after 3 months
0
Don't know or inapplicable
Is the child happy at his/her present school?
1
Happy
2
Not altogether happy
3
Unhappy
0
Don't know or inapplicable
(If the child has been at his/her present school less than three months, please ring "0")
Would the parents like the child to be able to stay on at secondary school after the minimum school leaving age?
1
Yes
2
No
0
Don't know or inapplicable
3
Other (Please specify)
Other
Is the child at all awkward or clumsy when: Walking?
2
Not at all
3
A little
1
Certainly
0
Don't know or inapplicable
Is the child at all awkward or clumsy when: Running?
2
Not at all
3
A little
1
Certainly
0
Don't know or inapplicable
Is the child at all awkward or clumsy when: Climbing stairs?
2
Not at all
3
A little
1
Certainly
0
Don't know or inapplicable
Is the child at all awkward or clumsy when: Tying a bow?
2
Not at all
3
A little
1
Certainly
0
Don't know or inapplicable
Is the child:
1
Normally active?
2
Inactive and quiet (prefers to sit and watch)?
3
Restless and overactive (can't keep still)?
0
Don't know or inapplicable
Does the child meet other children outside the household? (Exclude going to and from, and in school.)
1
Most days, or every day
2
Quite often
3
Very little
4
Not at all
0
Don't know or inapplicable

Please read this to the mother: "I am going to mention a few difficulties of various kinds which many children have at some time. I'd like you to tell me first whether any of these things have occurred during the last 3 months".

Has occurred in last 3 months

1 - Yes

2 - No

0 - Don't know or inapplicable

Has complained of headaches (more than once)
Has had temper tantrum
Has been reluctant to go to school
Has had bad dreams or night terrors
Has had difficulty in getting off to sleep
Has sleepwalked
Has been faddy-many dislikes over food
Has had poor appetite
Has overeaten for more than the occasional meal
"Were you concerned about any of these or other problems before the child started school?"
1
Yes
2
No
0
Don't know
please specify which problems caused concern
Generic text
"Have you been concerned about any of these or other problems since he/she has been at school?" (But excluding last 3 months.)
1
Yes
2
No
0
Don't know
please specify which difficulties have caused concern
Generic text
Has the child been in the care of the local authority?
1
Yes, is &quot;in care&quot; now
2
Yes, has been &quot;in care&quot; in the past but is not now
3
No, has never been &quot;in care&quot;
0
Don't know
please give child's age at the time and local authority or area
Generic text

Please read this to the mother: "Now I want to mention some description of behaviour shown by many children. I'd like you, first, to tell me whether these kinds of behaviour never happen with ... whether they happen sometimes, or frequently at the present time".

-

3 - Never

2 - Sometimes

1 - Frequently

0 - Don't know or inapplicable

Has difficulty in settling to anything for more than a few moments
Prefers to do things on his/her own rather than with others
Is bullied by other children
Destroys own or others belongings (e.g. tears or breaks)
Is miserable or tearful
Is squirmy or fidgety
Worries about many things
Is irritable, quick to fly off the handle
Sucks thumb or finger during day
Is upset by new situation, by things happening for first time
Has twitches or mannerisms of the face, eyes or body
Fights with other children
Bites nails
Is disobedient at home
Did any of these or other aspects of behaviour cause you any concern before the child started school?
1
Yes
2
No
0
Don't know
please specify the aspects involved
Generic text
Have any of these or other aspects caused you any concern since he/she has been at school? (but not at present).
1
Yes
2
No
0
Don't know
please specify the aspects involved
Generic text
Has the child ever been separated from the mother? (i.e. overnight).
1
Yes
2
No
0
Don't know or inapplicable
Has the child ever been separated from the mother for a period longer than a week?
1
Yes
2
No
0
Don't know or inapplicable

Please obtain the following details about the child's longest period of separation from the mother (i.e. longer than a week) and his/her first period of separation longer than a week. If the occasion was the same one, please nevertheless complete both columns.

Duration in days (e.g., for 11 days enter 011) ... days Age of Child at Separation ... yrs, Age of Child at Separation ... mths. Contact between Child and Mother Please ring appropriate number Child's Placement Please ring appropriate number Other placement (Please specify) Reason for Separation
Age

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherHow manyAge in months

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsAgeHow manyGeneric textHow manyGeneric text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

OtherAgeAge in monthsAge

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

How manyAge in monthsOtherGeneric textGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

AgeHow many

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Age in monthsOtherAgeHow manyAgeAge in months

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Other

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic textHow many
Age

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherHow manyAge in months

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsAgeHow manyGeneric textHow manyGeneric text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

OtherAgeAge in monthsAge

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

How manyAge in monthsOtherGeneric textGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

AgeHow many

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Age in monthsOtherAgeHow manyAgeAge in months

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Other

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic textHow many
Age

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherHow manyAge in months

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsAgeHow manyGeneric textHow manyGeneric text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

OtherAgeAge in monthsAge

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

How manyAge in monthsOtherGeneric textGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

AgeHow many

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Age in monthsOtherAgeHow manyAgeAge in months

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Other

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic textHow many
Age

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherHow manyAge in months

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsAgeHow manyGeneric textHow manyGeneric text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

OtherAgeAge in monthsAge

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

How manyAge in monthsOtherGeneric textGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

AgeHow many

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Age in monthsOtherAgeHow manyAgeAge in months

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Other

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic textHow many
Age

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherHow manyAge in months

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsAgeHow manyGeneric textHow manyGeneric text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

OtherAgeAge in monthsAge

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

How manyAge in monthsOtherGeneric textGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

AgeHow many

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Age in monthsOtherAgeHow manyAgeAge in months

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Other

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic textHow many
Age

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherHow manyAge in months

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsAgeHow manyGeneric textHow manyGeneric text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

OtherAgeAge in monthsAge

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

How manyAge in monthsOtherGeneric textGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

AgeHow many

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Age in monthsOtherAgeHow manyAgeAge in months

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Other

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic textHow many
Age

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherHow manyAge in months

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsAgeHow manyGeneric textHow manyGeneric text

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

OtherAgeAge in monthsAge

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

How manyAge in monthsOtherGeneric textGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

AgeHow many

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

OtherAge in monthsGeneric text

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Age in monthsOtherAgeHow manyAgeAge in months

1 - At home

2 - In hospital

3 - At home of relative or friend known to the child

4 - Boarding school or institution

0 - Don't know or inapplicable

5 - Other placement (Please specify)

Other

1 - At least daily

2 - At least weekly

3 - At least monthly

4 - No contact

0 - Don't know or inapplicable

Generic textHow many
Longest Period of Separation from Mother.
First Separation from Mother.
How many different periods of separation have there been? Before the age of five
How many
How many different periods of separation have there been? Since the age of five
How many
Does either parent read to, or read with, the child? Mother
1
Yes, at least every week
2
Yes occasionally
3
Never, or hardly ever
0
Don't know or inapplicable
Does either parent read to, or read with, the child? Father
1
Yes, at least every week
2
Yes occasionally
3
Never, or hardly ever
0
Don't know or inapplicable
Do the parents take the child out? (e.g. for walks, outings, picnics, visits, shopping). Mother
1
Yes, most weeks
2
Yes, occasionally
3
Never or hardly ever
0
Don't know or inapplicable
Do the parents take the child out? (e.g. for walks, outings, picnics, visits, shopping). Father
1
Yes, most weeks
2
Yes, occasionally
3
Never or hardly ever
0
Don't know or inapplicable
Does the father take a big part in managing the child, or leave mainly to mother?
1
Father takes a big part, or equal part with mother
2
Father takes a smaller part than mother (but mother feels it to be a significant part)
3
Father takes a very small part, or leaves to mother
0
Don't know or inapplicable
Do the parents themselves do any spare time reading? (e.g. of newspapers, books or magazines). Newspapers or Magazines Mother
1
Yes, most days
2
Yes, occasionally
3
Never or hardly ever
0
Don't know or inapplicable
Do the parents themselves do any spare time reading? (e.g. of newspapers, books or magazines). Newspapers or Magazines Father
1
Yes, most days
2
Yes, occasionally
3
Never or hardly ever
0
Don't know or inapplicable
Do the parents themselves do any spare time reading? (e.g. of newspapers, books or magazines). Books or Technical Journals Mother
1
Yes, most weeks
2
Yes, occasionally
3
Never, or hardly ever
0
Don't know or inapplicable
Do the parents themselves do any spare time reading? (e.g. of newspapers, books or magazines). Books or Technical Journals Father
1
Yes, most weeks
2
Yes, occasionally
3
Never, or hardly ever
0
Don't know or inapplicable
What is the occupation of the child's father? (i.e., present male head of household). If not working, give last occupation and give reason, e.g. unemployed, sick. If there is no male head of household, please write "None". Actual Job
Generic text
What is the occupation of the child's father? (i.e., present male head of household). If not working, give last occupation and give reason, e.g. unemployed, sick. If there is no male head of household, please write "None". Industry
Generic text
(As much detail as possible should be given. The actual job should show the type of work done so that we may be able to classify by the skill, qualification or responsibility involved. Terms such as "engineer", "civil servant", "electrical worker", "clerk", do not give sufficient information to allow such classification, and should be expanded.)
Is the father paid weekly, monthly or is he self-employed?
1
Weekly
2
Monthly
3
Self-employed
0
Don't know
Does he employ 10 or more persons?
1
Yes
2
No
0
Don't know
Does he supervise others? (e.g. foreman, manager, charge-hand).
1
Yes
2
No
0
Don't know
When the father left school, what was his father's job? Actual Job
Generic text
When the father left school, what was his father's job? Industry
Generic text
When the father left school, what was his father's job? Was he:
1
Self-employed, not employing others?
2
Employer?
3
Employee, not supervising others?
4
Employee, supervising others?
0
Don't know
Did the father stay on at school after the minimum school leaving age?
1
Yes
2
No
0
Don't know
at what age did he finish full-time education? ... yrs.
Age
Has the mother been in paid work since the child's birth? (Include only work outside the home). Before the child started school
1
Part-time or Temporary (More than one month's duration)
2
Full-time
3
Mother has not worked
0
Don't know or inapplicable
Has the mother been in paid work since the child's birth? (Include only work outside the home). Since the child started school
1
Part-time or Temporary (More than one month's duration)
2
Full-time
3
Mother has not worked
0
Don't know or inapplicable
please give brief details of duration and hours worked
Long text
What is the accommodation occupied by this household?
1
Whole house
2
Flat (self-contained)
3
Rooms
4
Other (please specify)
0
Don't know or inapplicable
Other
Is the accommodation:
1
Owned by the household, or being bought?
2
Council rented?
3
Private rented?
4
Rent free?
5
Other (please specify)
0
Don't know or inapplicable
Other
How many rooms are there? (Include rooms used by lodgers or relatives who are members of the household; exclude bathroom, scullery or kitchen unless used as a living room) ... rms.
How many
Has the household got, or does it share: Bathroom?
1
Sole use
2
Shared
3
None
0
Don't know or inapplicable
Has the household got, or does it share: Indoor Lavatory?
1
Sole use
2
Shared
3
None
0
Don't know or inapplicable
Has the household got, or does it share: Outside Lavatory?
1
Sole use
2
Shared
3
None
0
Don't know or inapplicable
Has the household got, or does it share: Cooking Facilities?
1
Sole use
2
Shared
3
None
0
Don't know or inapplicable
Has the household got, or does it share: Hot Water Supply?
1
Sole use
2
Shared
3
None
0
Don't know or inapplicable
Has the household got, or does it share: Garden, Yard?
1
Sole use
2
Shared
3
None
0
Don't know or inapplicable
Did the child attend an Infant Welfare Clinic or Toddlers' Clinic? Infant Welfare Clinic (under 1 year)
1
No
2
Yes Regularly
3
Yes Occasionally
0
Don't know
Did the child attend an Infant Welfare Clinic or Toddlers' Clinic? Toddlers' Clinic (1-5 years)
1
No
2
Yes Regularly
3
Yes Occasionally
0
Don't know

IMMUNISATION AND VACCINATION

Has the child received any immunisation against: Diphtheria
1
Yes
2
No (objects to it)
3
No (all other reasons)
0
Don't know
Has the child received any immunisation against: Poliomyelitis
1
Yes
2
No (objects to it)
3
No (all other reasons)
0
Don't know
Has the child received any immunisation against: Smallpox
1
Yes
2
No (objects to it)
3
No (all other reasons)
0
Don't know
What infectious diseases has the child had, and at what ages? Measles
2
No
1
Yes
0
Don't know
What infectious diseases has the child had, and at what ages? German measles
2
No
1
Yes
0
Don't know
What infectious diseases has the child had, and at what ages? Whooping cough
2
No
1
Yes
0
Don't know
What infectious diseases has the child had, and at what ages? Chicken pox
2
No
1
Yes
0
Don't know
What infectious diseases has the child had, and at what ages? Mumps
2
No
1
Yes
0
Don't know
What infectious diseases has the child had, and at what ages? Scarlet fever
2
No
1
Yes
0
Don't know
What infectious diseases has the child had, and at what ages? Others (e.g., glandular fever, tuberculosis, etc.) Specify
2
No
1
Yes
0
Don't know
Other
BREAST FEEDING Was the child breast fed (partly or wholly) as a baby?
1
No
2
Yes under 1 month
3
Yes over 1 month
0
Don't know

WALKING

By 1 1/2 years of age was the child walking alone?
2
No
1
Yes
0
Don't know
at what age?
Age

SPEECH

By two years of age was the child talking? (i.e., joining two words)
2
No
1
Yes
0
Don't know
at what age?
Age
Has there ever been any stammer or stutter
2
No
1
Yes
0
Don't know
Age at onset
Age
Present now?
Generic text
Any other speech difficulty? Specify
2
No
1
Yes
0
Don't know
Other
Is English the mother's usual language with this child?
2
No
1
Yes
0
Don't know

OUT-PATIENT AND CLINIC ATTENDANCES

Has the child attended any of the following?

- Name of Hospital or Clinic, and Town Age
Age

2 - No

1 - Yes

0 - Don't know

Generic textAge

2 - No

1 - Yes

0 - Don't know

Generic text

2 - No

1 - Yes

0 - Don't know

Generic textAge
Age

2 - No

1 - Yes

0 - Don't know

Generic textAge

2 - No

1 - Yes

0 - Don't know

Generic text

2 - No

1 - Yes

0 - Don't know

Generic textAge
Age

2 - No

1 - Yes

0 - Don't know

Generic textAge

2 - No

1 - Yes

0 - Don't know

Generic text

2 - No

1 - Yes

0 - Don't know

Generic textAge
Eye dept. or clinic, optician, or orthoptist
Physiotherapy or remedial exercises
Child guidance clinic
Speech therapy
Hearing or audiology
Dental clinic, dentist or orthodontist
Have there been any outpatient, other clinic or specialist appointments?
Has the child attended any of the following? Have there been any outpatient, other clinic or specialist appointments? Specify
Long text
Has the child ever had a dental gas?
2
No
1
Yes
0
Don't know
how many times?
How many

HOSPITAL ADMISSIONS

Has the child ever been admitted to hospital for any of the following:

- (Specify) Name of Hospital and Town Age

2 - No

1 - Yes

0 - Don't know

AgeGeneric textGeneric textAgeGeneric textGeneric text

2 - No

1 - Yes

0 - Don't know

Generic textAgeGeneric text

2 - No

1 - Yes

0 - Don't know

Generic textAge

2 - No

1 - Yes

0 - Don't know

Generic text

2 - No

1 - Yes

0 - Don't know

AgeGeneric textGeneric textAgeGeneric textGeneric text

2 - No

1 - Yes

0 - Don't know

Generic textAgeGeneric text

2 - No

1 - Yes

0 - Don't know

Generic textAge

2 - No

1 - Yes

0 - Don't know

Generic text

2 - No

1 - Yes

0 - Don't know

AgeGeneric textGeneric textAgeGeneric textGeneric text

2 - No

1 - Yes

0 - Don't know

Generic textAgeGeneric text

2 - No

1 - Yes

0 - Don't know

Generic textAge

2 - No

1 - Yes

0 - Don't know

Generic text

2 - No

1 - Yes

0 - Don't know

AgeGeneric textGeneric textAgeGeneric textGeneric text

2 - No

1 - Yes

0 - Don't know

Generic textAgeGeneric text

2 - No

1 - Yes

0 - Don't know

Generic textAge

2 - No

1 - Yes

0 - Don't know

Generic text
Tonsils and/or adenoids
Abdominal operation
Hernia repair
Other operations (including blood transfusions)
Road accidents
Other accident or injury
Illnesses, investigations or tests
Hospital admission for any other reason
Has the child ever been admitted to hospital for any of the following: Home accidents (e.g. burns, scalds, poisoning, injury)
2
No
1
Yes
0
Don't know
Has the child ever been admitted to hospital for any of the following: Home accidents (e.g. burns, scalds, poisoning, injury) Name of Hospital and Town
Generic text
Has the child ever been admitted to hospital for any of the following: Home accidents (e.g. burns, scalds, poisoning, injury) Age
Age

MEDICAL HISTORY

GENERAL

Has the child, to the mother's knowledge, any physical handicap or disabling condition? Specify
2
No
1
Yes
0
Don't know
Generic text
Does the mother consider the child to be particularly sensitive or highly strung? Specify
2
No
1
Yes
0
Don't know
Generic text

EAR, NOSE AND THROAT

Has the child had more than 3 throat and/or ear infections (with fever) in the past year?
2
No
1
Yes
0
Don't know
Has the child ever had: Hay fever or sneezing attacks
2
No
1
Yes
0
Don't know