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 climb upstairs and downstairs?
2. Does your child feed self either with hand or spoon?
3. Does your child join 2 words together like mama milk , car – go?
4. Does your child play along with other children?
5. Does your child enjoy simple pretend play like feeding a doll?
I hereby confirm that the information I have provided about the medical condition of my child is true to the best of my knowledge.
