16. Did the mother have any infection/ disease during pregnancy
17. Did the child cry immediately after birth
21. Was the child admitted in NICU (Neonatal Intensive Care Unit)after delivery?
22. Is Your Child Vaccinated Up to Date?
1. Abnormal (Large or small) head:
3. Frequent jerky movement of eyes:
4. Abnormal shape of ear/lips/nose/hands or legs:
6. Limp walking of your child:
7. Short length of one limb:
10. Underweight/Overweight
11. Pale, easily get tired:
14. Fits/ unconsciousness:
16. White/ brownish spots on teeth:
17. Swollen bleeding gums.
18. Itching in the night and oval spots in between fingers
19. Shortness of breath / wheezing
1. Does your child roll over or turn over either direction?
2.Does your child grasp a small object by using his whole hand?
3. Does your child utter consonant sounds like “p” “b” “m” ?
4. Does your child watch TV or any toy without titling his/her head?
5. Does your child raises hands to be picked up by parents?
6. Does the child look for spoon or toy that has dropped?
I hereby confirm that the information I have provided about the medical condition of my child is true to the best of my knowledge.
