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. 2014 Dec 30;16(6):500. doi: 10.1186/s13058-014-0500-0

Table 1.

Health questionnaire

Questionnaire items
Delivery and current health status
1 Delivery statistics: weight, weeks gestation, C-section or vaginal delivery
2 Did your child have any medical problems at the time of delivery such as having fever, needing oxygen, or being admitted to a special care unit, such as intensive care?
3 Did your child have any medical problems in the first month after birth after being discharged home after delivery?
4 Do you consider your child to be healthy?
5 Does your child have any of the following:
Breathing problems such as asthma
Heart problems such as a heart murmur
Stomach or other gastrointestinal problems such as heartburn
Bone/skeletal problems such as arthritis
Urinary problems (kidney or bladder problems)
Neurological problems (numbness, weakness)
Ear/nose/throat problems including hearing
Allergies/eczema
Eye/visual problems
Developmental/social history
6 If in school, has your child had any difficulties in school such as requiring smaller class size, extra tutoring or one-on-one teaching?
7 Has your child started to have any developmental changes related to puberty?
8 Has your child become pregnant or fathered a child?
9 Has your child tried to conceive, but had difficulty?
Concerns about cancer and parenthood
This section detailed the number of previous pregnancies at time of diagnosis, wishes for future pregnancies, Reproductive Concerns Scale and questions related to how pervasive the thoughts of cancer are in day-to-day life.