Table 2.
Developmental Sensory History questions.
| Question/category |
|---|
| MATERNAL HEALTH DURING PREGNANCY1 |
| Did the mother: |
| Have any infections/illnesses during pregnancy? If yes, please describe1 |
| Have any shocks or unusual stresses during pregnancy? If yes, please describe1 |
| Receive any medication during pregnancy? If yes, what kind1 |
| Have any complications during delivery/labor? If yes, please describe |
| CHILD'S BIRTH |
| Was the child full term?1 |
| Was the child premature? |
| Weight at birth1 |
| Number of weeks1 |
| Was the child breech (feet first)? |
| Did the child require forceps for delivery?1 |
| Did the child require suction for delivery?1 |
| Did the child have any birth injuries?1 |
| Did the child require intensive care hospitalization? |
| Was the child jaundiced?1 |
| EARLY CHILDHOOD ILLNESSES AND INJURIES |
| Has your child had any of the following? If yes, please describe and give approximate dates. |
| Childhood disease or major illnesses |
| Serious injury |
| Ear infections |
| Tubes in ears1 |
| Allergies |
| Seizures |
| Other |
| INFANCY AND CHILDHOOD |
| Does or did your child: |
| Have feeding problems? If yes, please describe |
| Have sleeping problems? If yes, please describe |
| Have colic? If yes, for how long?1 |
| Prefer certain positions as an infant? If yes, please describe1 |
| Dislike lying on stomach?1 |
| Dislike lying on back?1 |
| Enjoy bouncing?1 |
| Become calmed by car rides or infant swings?1 |
| Become nauseated by car rides or infant swings?1 |
| Go through the “terrible two”? If no, please describe your child's toddler stage1 |
| DEVELOPMENTAL MILESTONES |
| Please provide approximate ages if remembered, or comment on anything unusual: |
| Roll over |
| Walk |
| Say words |
| Sit alone |
| Say sentences |
| Crawl |
| Was crawling phase brief?1 |
| Was crawling stage absent?1 |
| Did child experience hesitancy or delays in learning to go down stairs?1 |
1These questions were missing from the adult Developmental Sensory History.