Evaluation Paperwork
I thought I would add the first few pages of the questionnaire we filled out before going to the psychologist to this blog. I don't have the check marked pages. I had retyped this section to give me more room to elaborate...
DEVELOPMENTAL FACTORS
How was the mother’s health during pregnancy? Fair. I had bleeding outside of the placenta in the first trimester, low progesterone, diabetes, incompetent cervix, and suspected gastro paresis.
How old was the mother when the child was born? 27
Did the mother use any of the following substances or medications during pregnancy?
Beer or wine?
never
How was the mother’s health during pregnancy? Fair. I had bleeding outside of the placenta in the first trimester, low progesterone, diabetes, incompetent cervix, and suspected gastro paresis.
How old was the mother when the child was born? 27
Did the mother use any of the following substances or medications during pregnancy?
Beer or wine?
never
once or twice
moderately
moderately
often often
Hard liquor?
never
once or twice
once or twice
moderately
often often
often often
Coffee or other caffeine (coke, etc)?
never
once or twice
moderately
moderately
often
Cigarettes?
never
once or twice
once or twice
moderately
often often
often often
Did the mother ingest any drugs (prescribed or unprescribed) during pregnancy?
Yes – Ambien, Avandia, Metformin, Insulin, Colace, IV antibiotics (unknown name), Demerol, Magnesium Sulfate, Trebuteline, Yeast Infection medications
Did the mother have toxemia or eclampsia? No. Was there Rh factor incompatibility? No.
What was the duration of labor? Started pitocin at 12:00am. Contractions began around 7-8:00am. Jamie was born at 1:04pm. The pushing phase of labor was very quick. I had him in just a few pushes. I did have incompetent cervix and at 24 weeks I had a cerclage placed. I was 4cm dilated when it was placed. My water broke at 31 weeks. I took trebuteline frequently to stave off labor.
Was the infant born on schedule? No – He was born at 36 weeks.
Was the mother given any drugs to ease the pain of labor? Yes – Demerol and an epidural
Was delivery (circle all that apply):
Normal Induced Cesarean Forceps
Was there evidence of fetal distress during labor or during birth? Yes – His heart rate dropped a few times. He had the umbilical cord wrapped around his neck twice.
What was the child’s birth weight? 5lbs 10oz
Were there any health complications for the infant following birth? Yes – He had difficulty breathing and had to be on CPAP for a short while. He had jaundice.
INFANCY
Were there early feeding problems? Yes – I had supply issues and I had to supplement him with formula. Due to his small size the pediatrician had us add extra scoops of formula when I supplemented. I had to quit breastfeeding him at 3 months because I had pancreatitis. He never seemed to have any issues actually taking in his feedings.
Was the child colicky? No
Were there early sleep pattern difficulties? No, but he did not sleep well in the bassinet. He got used to the swing when he was small and had to have it moving to sleep. He had some problems with allergies that required he be propped up for sleeping, that’s why he slept in the swing.
Were there problems with the infant’s responsiveness (alertness)? No
Did the child experience any health problems during infancy? Allergies
Was the child an “easy” baby? (or did he/she cry a lot? Follow a schedule fairly well? Etc) He was a very easy baby. I used to brag about how good he was all the time. He never did like to be swaddled or rocked a lot. He didn’t love his bassinet, but when he moved to his crib he slept like a dream, only waking at feeding time.
How did the baby behave with other people? The same as above. Until he reached toddler hood he was very easy going and would let anyone hold him. I can’t remember what age he became a bit shy.
How would you rate the activity level of the child as an infant/toddler? I’m not positive
Very active Active Average Less Active Not Active
Were there early feeding problems? Yes – I had supply issues and I had to supplement him with formula. Due to his small size the pediatrician had us add extra scoops of formula when I supplemented. I had to quit breastfeeding him at 3 months because I had pancreatitis. He never seemed to have any issues actually taking in his feedings.
Was the child colicky? No
Were there early sleep pattern difficulties? No, but he did not sleep well in the bassinet. He got used to the swing when he was small and had to have it moving to sleep. He had some problems with allergies that required he be propped up for sleeping, that’s why he slept in the swing.
Were there problems with the infant’s responsiveness (alertness)? No
Did the child experience any health problems during infancy? Allergies
Was the child an “easy” baby? (or did he/she cry a lot? Follow a schedule fairly well? Etc) He was a very easy baby. I used to brag about how good he was all the time. He never did like to be swaddled or rocked a lot. He didn’t love his bassinet, but when he moved to his crib he slept like a dream, only waking at feeding time.
How did the baby behave with other people? The same as above. Until he reached toddler hood he was very easy going and would let anyone hold him. I can’t remember what age he became a bit shy.
How would you rate the activity level of the child as an infant/toddler? I’m not positive
Very active Active Average Less Active Not Active
DEVELOPMENTAL MILESTONES
At what age did the child sit up? 7 months Crawl? 7 months Walk? 1 year 2 months
At what age did the child speak single words (other than “mama” or “dada”)? I think he started trying to say kitty at 6 months. I’m not sure. I never could figure out for sure if he was saying words or if we were just hearing things in baby babble so I never put a date in the baby book.
At what age did the child string two or more words together? Unknown
At what age was the child toilet trained (bladder control)? He began at 3 years 8 months. We’re still working on full bladder control. He has no sleeping control. Bowel control? The same, though he has full daytime bowel control unless he has severe diarrhea.
Approximately how much time did toilet training take from onset to completion? Still in progress
MEDICAL HISTORY
How is the child’s hearing? good fair poor
Vision? good fair poor
Gross motor coordination? good fair poor
Speech articulation? good fair poor
At what age did the child sit up? 7 months Crawl? 7 months Walk? 1 year 2 months
At what age did the child speak single words (other than “mama” or “dada”)? I think he started trying to say kitty at 6 months. I’m not sure. I never could figure out for sure if he was saying words or if we were just hearing things in baby babble so I never put a date in the baby book.
At what age did the child string two or more words together? Unknown
At what age was the child toilet trained (bladder control)? He began at 3 years 8 months. We’re still working on full bladder control. He has no sleeping control. Bowel control? The same, though he has full daytime bowel control unless he has severe diarrhea.
Approximately how much time did toilet training take from onset to completion? Still in progress
MEDICAL HISTORY
How is the child’s hearing? good fair poor
Vision? good fair poor
Gross motor coordination? good fair poor
Speech articulation? good fair poor
He has not been checked for these things but his pediatrician said his speach was behind.
Has the child had any chronic health problems (asthma, diabetes, heart condition)? Only allergies.
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