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 pick up small objects using thumb and index finger like peas raisins?
3. Does your child stops activity in response to “NO”?
4. Does your child say one meaningful word clearly like amma appa mama dada?
5. Does your child imitate action like bye-bye /clap/kiss ?
7. Does your child search for completely hidden objects?
I hereby confirm that the information I have provided about the medical condition of my child is true to the best of my knowledge.
