Table 1 Health questionnaire

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

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?