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 sit without any support?
2. Does your child transfer object from hand to hand?
3. Does your child respond to his /her name ?
4. Does your child babble example –“ ba” “ba” “da” “ma”?
5. Does the child avoid bumping into objects while moving ?
6.Does your child enjoy playing hide and seek (peek- a-boo)?
I hereby confirm that the information I have provided about the medical condition of my child is true to the best of my knowledge.
