





How many times? (please tick a box) | How old was he/she in months? | What did the person with your child do about the accident? (please tick a box) | |
---|---|---|---|
1 - Once 2 - Twice 3 - 3 or more 4 - Never Age in months1 - Nothing 2 - Treated child themselves 3 - Took child to GP 4 - Took child to hospital 5 - Other |
1 - Once 2 - Twice 3 - 3 or more 4 - Never Age in months1 - Nothing 2 - Treated child themselves 3 - Took child to GP 4 - Took child to hospital 5 - Other |
1 - Once 2 - Twice 3 - 3 or more 4 - Never Age in months1 - Nothing 2 - Treated child themselves 3 - Took child to GP 4 - Took child to hospital 5 - Other |
|
Been burnt or scalded | |||
Been dropped or had a bad fall | |||
Swallowed anything she or he shouldn't (e.g., pills, buttons, disinfectant) | |||
Had any other accidents or injuries ? |
However careful a parent is, most children have accidents at some time or other. Please tell us on the set of questions below about the times your child has had an accident, at what age and if there was any treatment given. Has your child ever … Been burnt or scalded What did the person with your child do about the accident? (please tick a box) Other...
However careful a parent is, most children have accidents at some time or other. Please tell us on the set of questions below about the times your child has had an accident, at what age and if there was any treatment given. Has your child ever … Been dropped or had a bad fall What did the person with your child do about the accident? (please tick a box) Other...
However careful a parent is, most children have accidents at some time or other. Please tell us on the set of questions below about the times your child has had an accident, at what age and if there was any treatment given. Has your child ever … Swallowed anything he or she shouldn't (e.g., pills, buttons, disinfectant) What did the person with your child do about the accident? (please tick a box) Other..
However careful a parent is, most children have accidents at some time or other. Please tell us on the set of questions below about the times your child has had an accident, at what age and if there was any treatment given. Has your child ever … Had any other accidents or injuries ? What did the person with your child do about the accident? (please tick a box) Other...
How well does your child sleep at night? Please place a tick next to each statement that correctly describes your child ...
(you can tick as many as you wish)
Below are a number of statements about parents and babies. Please say how much you agree or disagree with each one ... Babies should be picked up whenever they cry
Please tick a box to show how much you agree with each of these statements..
Below are a number of statements about parents and babies. Please say how much you agree or disagree with each one ... It is important to develop a regular pattern of feeding and sleeping with a baby
Please tick a box to show how much you agree with each of these statements..
Below are a number of statements about parents and babies. Please say how much you agree or disagree with each one ... Babies should be fed whenever they are hungry
Please tick a box to show how much you agree with each of these statements..
Below are a number of statements about parents and babies. Please say how much you agree or disagree with each one ... Babies need to be stimulated if they are to develop well
Please tick a box to show how much you agree with each of these statements..
Below are a number of statements about parents and babies. Please say how much you agree or disagree with each one ... Babies need quiet secure surroundings and should not be disturbed too much
Please tick a box to show how much you agree with each of these statements..
Below are a number of statements about parents and babies. Please say how much you agree or disagree with each one ... Parents need to adapt their lives to the baby's demands
Please tick a box to show how much you agree with each of these statements..
Below are a number of statements about parents and babies. Please say how much you agree or disagree with each one ... A baby should fit into the parent's routine
Please tick a box to show how much you agree with each of these statements..
Below are a number of statements about parents and babies. Please say how much you agree or disagree with each one ... Babies should be left to develop naturally
Please tick a box to show how much you agree with each of these statements..
Below are a number of statements about parents and babies. Please say how much you agree or disagree with each one ... Talking, to even a very young baby, is important
Please tick a box to show how much you agree with each of these statements..
Below are a number of statements about parents and babies. Please say how much you agree or disagree with each one ... Cuddling a baby is very important
Please tick a box to show how much you agree with each of these statements..

(Please answer for each person regularly involved. If no one else helps care for him/her, tick the 'no' column all the way down)
No | Yes | If YES, Please give hours per week | If YES, Please give age of baby when this began (in months) | |
---|---|---|---|---|
1 - tick 1 - tick Hours in weekAge in months |
1 - tick 1 - tick Hours in weekAge in months |
1 - tick 1 - tick Hours in weekAge in months |
1 - tick 1 - tick Hours in weekAge in months |
|
my baby’s father | ||||
my current partner | ||||
baby's grandparent | ||||
other relative | ||||
friend/neighbour | ||||
paid person outside baby's home (eg. child minder) | ||||
paid person in baby's home (eg. nanny, baby sitter) | ||||
day nursery (or creche) | ||||
other (please describe) |

Is the place where you live owned or rented by you?
(Please circle one answer from the list below)

What is your employment status now?
(please tick one or more box to tell us)

Is this the same as when we spoke to you at your 20 week scan appointment?
(please tick a box)

What is their employment status now?
(please tick a box to tell us)


Are you receiving any benefits now?
(Please tick ALL relevant boxes below)





Becoming a parent can be enjoyable and challenging! The following questions ask about the level of help and support you feel you have… I have no one to share my feelings with
Please tick us a box for each statement
Becoming a parent can be enjoyable and challenging! The following questions ask about the level of help and support you feel you have… My partner provides the emotional support I need
Please tick us a box for each statement
Becoming a parent can be enjoyable and challenging! The following questions ask about the level of help and support you feel you have… There are other mothers with whom I can share my experiences
Please tick us a box for each statement
Becoming a parent can be enjoyable and challenging! The following questions ask about the level of help and support you feel you have… There are members of my family who give me emotional support
Please tick us a box for each statement

We would like to know how stressed or worried you have felt during the last 3 months. On the following scale 0 indicates feeling extremely relaxed and 10 indicates feeling extremely stressed or worried. Please circle a number to say how worried and stressed you have been feeling since your baby's birth?



The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Been able to concentrate on whatever you are doing?
The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Lost much sleep over worry?
The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Felt that you are playing a useful part in things?
The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Felt capable of making decisions about things?
The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Felt constantly under strain?
The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Felt you couldn't over come your difficulties?
The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Been able to enjoy your normal day-to-day activities?
The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Been able to face up to your problems?
The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Been feeling unhappy and depressed?
The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Been losing confidence in yourself?
The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Been thinking of your self as a worthless person?
The following questions ask about your health in general. For each statement, please circle the response that comes closest to how you have been feeling over the past few weeks. Have you recently ... Been feeling reasonably happy, all things considered?














DURING THE PAST WEEK ... How often did your baby ...seem angry (crying or fussing) when left you her/him in the cot?
Please be sure to circle a number for every item.
DURING THE PAST WEEK ... After sleeping, how often did your baby ... cry if someone doesn't come within a few minutes?
Please be sure to circle a number for every item.


DURING THE PAST WEEK? When being dressed or undressed during the last week, how often did the baby ...wave his/her arms and kick?
Please be sure to circle a number for every item.
DURING THE PAST WEEK? When being dressed or undressed during the last week, how often did the baby ...squirm and/or try to roll away?
Please be sure to circle a number for every item.
DURING THE PAST WEEK? When being dressed or undressed during the last week, how often did the baby ...smile or laugh?
Please be sure to circle a number for every item.

DURING THE PAST WEEK? When something the baby was playing with had to be removed, how often did s/he ...cry or show distress for a time?
Please be sure to circle a number for every item.
DURING THE PAST WEEK? When something the baby was playing with had to be removed, how often did s/he ...seem not bothered?
Please be sure to circle a number for every item.
DURING THE PAST WEEK? How often during the last week did the baby: …smile or laugh after accomplishing something (e.g. stacking blocks)
Please be sure to circle a number for every item.
DURING THE PAST WEEK? When your baby saw a toy s/he wanted, how often did s/he: ...get very excited about getting it?
Please be sure to circle a number for every item.

DURING THE PAST WEEK? How often during the last week did your baby ...cry or show distress at change in parents' appearance (glasses off, shower cap on, etc.)?
Please be sure to circle a number for every item.
DURING THE PAST WEEK? How often during the last week did your baby ...protest being placed in a confining place (infant seat, play pen, car seat, etc)?
Please be sure to circle a number for every item.
DURING THE PAST WEEK? How often during the last week did your baby ...startle at a sudden change in body position (e.g. when moved suddenly)?
Please be sure to circle a number for every item.
DURING THE PAST WEEK? How often during the last week did your baby ...show a strong desire for something s/he wanted?
Please be sure to circle a number for every item.
DURING THE PAST WEEK? How often during the last week did your baby ...seem excited when you or other adults acted in an excited manner around him/her?
Please be sure to circle a number for every item.
DURING THE PAST WEEK? When the baby wanted something, how often did s/he ...become upset when s/he could not get what s/he wanted?
Please be sure to circle a number for every item.
DURING THE PAST WEEK? When the baby wanted something, how often did s/he ...have tantrums (crying, screaming, face red, etc.) when s/he did not
Please be sure to circle a number for every item.
DURING THE PAST WEEK? When placed in an infant seat or car seat, how often did the baby ...show distress at first; then quiet down?
Please be sure to circle a number for every item.
DURING THE PAST WEEK? When placed in an infant seat or car seat, how often did the baby ...squirm and turn body?
Please be sure to circle a number for every item.
DURING THE PAST WEEK? When something the baby was playing with had to be removed, how often did he/she ...cry or show distress for a time?
Please be sure to circle a number for every item.
DURING THE PAST TWO WEEKS When introduced to an unfamiliar adult, how often did the baby: ...refuse to go to the unfamiliar person?
Please be sure to circle a number for every item.
DURING THE PAST TWO WEEKS When introduced to an unfamiliar adult, how often did the baby: ...hang back from the adult?
Please be sure to circle a number for every item.
DURING THE PAST TWO WEEKS When introduced to an unfamiliar adult, how often did the baby: ...never "warm up" to the unfamiliar adult?
Please be sure to circle a number for every item.
DURING THE PAST TWO WEEKS When in the presence of several unfamiliar adults, how often s/he: ...cling to a parent?
Please be sure to circle a number for every item.
DURING THE PAST TWO WEEKS When in the presence of several unfamiliar adults, how often s/he: ...continue to be upset for 10 minutes or longer?
Please be sure to circle a number for every item.
DURING THE PAST TWO WEEKS When visiting a new place, how often did the baby ...show distress for the first few minutes?
Please be sure to circle a number for every item.
DURING THE PAST TWO WEEKS When visiting a new place, how often did the baby ...continue to be upset for 10 minutes or more?
Please be sure to circle a number for every item.
DURING THE PAST TWO WEEKS When visiting a new place, how often did the baby ...get excited about exploring new surroundings?
Please be sure to circle a number for every item.
DURING THE PAST TWO WEEKS When visiting a new place, how often did the baby ...move about actively when s/he is exploring new surroundings?
Please be sure to circle a number for every item.
DURING THE PAST TWO WEEKS When your baby was approached by an unfamiliar person when you and s/he were out (e.g., shopping), how often did the baby: ...show distress?
Please be sure to circle a number for every item.
DURING THE PAST TWO WEEKS When your baby was approached by an unfamiliar person when you and s/he were out (e.g., shopping), how often did the baby: ...cry?
Please be sure to circle a number for every item.
DURING THE PAST TWO WEEKS When an unfamiliar adult came to your home or flat, how often did your baby: ...allow her/himself to be picked up without protest?
Please be sure to circle a number for every item.
DURING THE PAST TWO WEEKS When an unfamiliar adult came to your home or flat, how often did your baby: ...cry when the visitor attempted to pick her/him up?
Please be sure to circle a number for every item.
DURING THE PAST TWO WEEKS When you returned from having been away and the baby was awake how often did s/he: ...smile or laugh?
Please be sure to circle a number for every item.





Overall, when you were younger (up to 16 years old) do you think that you had difficulties in one or more of the following areas: emotions, concentration, behaviour or being able to get on with other people?




Circle the number that best fits, using the scale:
Get angry with me | Be interested | Show upset (e.g. crying) | Talk calmly with me | Show she was happy | Be amused or find it funny | |
---|---|---|---|---|---|---|
1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always |
1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always |
1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always |
1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always |
1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always |
1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always 1 - Almost never 2 - Seldom 3 - Quite often 4 - Almost always |
|
If I showed anger in an argument : | ||||||
If I showed upset (e.g. crying): | ||||||
If I talked about something that interests me: | ||||||
If I talked about hopes for the future: | ||||||
If I talked about something I found funny: | ||||||
If I showed happiness over good news: |

Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Handling Family finances
Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Matters of recreation
Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Religious matters
Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Demonstrations of Affection
Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Friends
Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Sex relations
Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Conventionality (correct or proper behaviour)
Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Philosophy of life
Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Ways of dealing with parents or in-laws
Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Aims, goals and things believed important
Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Amount of time spent together
Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Making major decisions
Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Household tasks
Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Leisure time interests and activities
Most people have disagreements in their relationships. Please tell us below how much agreement or disagreement there is between you and your partner for each item on the list below… Career decisions
The dots on the following line represent different degrees of happiness in your relationship. The middle point, ‘happy’ represents the degree of happiness in most relationships. Please circle the dot which best describes the degree of happiness, all things considered, of your relationship
Which of the following statements best describe how you feel about the future of your relationship?