Medical Questions

 

 

When was your child Diagnosed?  

 

What was their apgar scores?

         

Was their immune system weak?


Does your child have high fevers frequent?              

 

Does your child have seizures?

         

Does your child have sleep apnea?

 

Does your child have reflux?

 

Does your child have colic?  

 

Does your child have asthma?

 

Does your child use NG or G-tubes?

         

Does your child choke on thin liquids?

         

Does your child choke on thick liquids?

   
Does your child choke on pureed food?

         

Does your child choke on soft chunky food?

   

Does your child choke on hard chunky food?


Does your child have dry skin?

         

Does your child have eczma?

         

Did your child have jaundice at birth?

     
Has your child ever had kidney infections?

         

Has your child ever had urine infections?                  

 

Has your child ever had ear infections?

         
Has your child got gromits/tubes?

         

Has your child got blocked tear ducts?

 

Does your child have some hearing impairment?        

 

Does your child suffer constipation regularly?            

 

Is your child day toilet trained?

 

Is your child night toilet trained?                                                  Have you tried any methods to have dry nights?        

                                              

Does your child withhold bowel movements?  

 

Does your child suffer autoaggressions


 

         

Thank you for your participation. Occasionally the results will be update.

 

Mandy

mandycain@bigpond.com

Physical Questions

 

Does you child have low muscle tone?

 

Does your child have hypertonic (strong) arms or legs?

 

Is your child of short stature?

 

Does your child have large ears?

 

Does your child have small ear canals?

 

Does you child have low set ears?

         

Does your child have a abnormal shaped head?

         

Which side of your child's body is dominent?

 

Does your child have difficulty gripping objects?

         
Does your child have small hands?

 

Does your child have small feet?

         

Is your child missing a simian creases?

 

 

Is your child's 5th Digits permantly bent?

         

Does your child have any other bent digits?

 

Does your child have long digits?

 

Does your child have thin nails?

 

Does your child have thick nails?

         

Does your child have tiny nails?

 

Does your child have any inward toe nails?

         

Is your child's 5th toe nail bent upwards?

 

Does your child have any other bent toe nails?

         
Does your child have close set eyes?

 

Does your child have any lazy eyes?

         

Does your child regularly looked cross eyed?

 

Does your child have epicanthal folds?

 

Does your child have Ptosis ?

 

Does your child have down turned eyes?

 

Does your child have long eyelashes?

 

Is your child short sighted?

         
Is your child long sighted?

 

Does your child have a broad nose?

         
Does your child have a receeding chin?

 

Is your child's teeth delayed development?

         
Does your child have a high palate?

 

Does your child have a cleft palate?

 

Is your child's teeth crooked?  

 

Does your child have a fake row of teeth?

         
Is your child's adenoids enlarged?

 

Is your child's tonsils enlarged?

         
Does your child have dislocated hips?

 

Does your child have a hole in their heart?

         
Does your child have Dextrocardia?

 

Does your child have Scoliosis?

 

Does your child have kyphosis?

 

Does your child have lordosis?

             
Does your child have c
lub feet?

 

 

Does your child have the opposit to club foot (outwards)?

   
Is your child flat footed?

 

Does your child wear orthotics?

         
Does your child have a retracted penis?

 

Does your child have undescended testicles?

   
Does your child have a sacral dimple?

 

Does your child have a pilonidal cyst?   

 

Does your child have or proned to osteoporosis?

 

Does your child have a septum over grown in their nose?

Developmental stages

(The age they developed this ability.)

 

Birth weight? (pounds or grams)                                                        

 

Birth Length? (inches or centremetres)

 

Birth Head Circumference? (inches or centremetres)

 

The age he/she rolled tummy to back?

 

The age he/she rolled back to tummy?

 

The age he/she sat up?

 

The age he/she first holds head up?

 

The age he/she commando crawled?

 

The age he/she crawled?        

 

The age he/she cruised around the chairs or walking frame?

 

The age he/she walked independantly?    

   

The age he/she said first word?  

   

How Many words now?    

 

What words?  

 

The age he/she first did sign language?

 

The age he/she first smiled?

 

The age he/she first laughed?

 

The age he/she got first tooth?

 

The age he/she first recognises name?

 

The age he/she finds hands?

 

The age he/she finds feet?

 

First full night sleep?

 

First time he/she clapped their hands?

 

First game?

 

What was the game?

 

First tantrum?

 

Age he/she first dranks bottle unaided?

 

Age he/she first ates pureed food?

 

Age he/she first ate soft food?

 

Age he/she first ate hard food?

 

Age he/she first ate hand food?

 

Age he/she first drank from cup?

 

Age he/she first held a spoon?

 

Age he/she first ate unaided?

 

First time he/she draws?

 

First time he/she kisses?

 

First dry day?

 

First dry night?

 

Age he/she first counts?

 

Age he/she dresses unaided?

Childrens' Habits

 

 

Does the child thump his/her head on wall etc?

 

Does the child throw his/her head back?

 

Does the child rock or shakes head repetitively?

 

Does the child kick his/her feet repetitively?

 

Does the child have a high pain threshold?

 

Does the child throws objects repetitively?

 

Does the child have something to hold fulltime?

 

Does the child love music?

 

Does the child enjoy dancing?

 

Is the child of very happy nature?

 

Is the child regularly miserable?

 

Does the child regularly throw tantrums?

 

Is the child abnormally stubborn?

 

Does the child dislike solitude?

 

Does the child regularly touch everything?

 

Does the child love eating?

 

Does the child dislike eating?

 

Does the child bight his/her hand or arm etc?

 

Does the child suck finger or thumb?

 

Does the child chew on clothes?

 

Does the child chew on toys, chairs etc?

 

Does the child dribble abnormal more so?

 

Is the child affectionate?

 

Does the child have any fear of falling or hurting themself?

 

Is the child tenacious?

 

Does the child social normally?

 

Does the child rub his/her hand across face repetitvely?

 

Does the child have an extroadinary memory?

 

Does the child love baths/showers?

 

Does the child have a fascination with mirrors?

 Survey

Child's Details

 

 

Surname

 

First name

 

Child's karyotype  

 

 

Age      

     

DOB (day,month,year)

 

E-mail

Please complete the questionaire by clicking on the appropriate answer and then submit it. Please click on YES, NO or OUT GROWN if the child used to do something though has out grown that habit etc. It will then be posted up on the existing survey. Any questions please email Mandy at mandycain@bigpond.com

 

DISCLAIMER

All information on the survey is not professional and should not be taken as medical information. While all care has been taken, the information contained in this survey is not written by a medical professional and as such should not replace the valuable and personal information of your own health care professionals.

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