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Child Health Questionnaire Checklist

Child Health Questionnaire Checklist

5.0 stars

Scores 4.80 with 90 votes

Children, Health

103 tasks

By Laura Cooper Peterson

Child Health Questionnaire Checklist

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Behavior and temperament
- Prefers to play alone
- Better with one on one interaction
- Does not smile as often
- Seems depressed
- Is anxious
- Hyperactive or restless
- Unable to disregard unimportant stimuli
- Impulsive
- Disruptive
- Easily distracted
- Forgetful
- Physically abusive
- Verbally abusive
- Frequent tantrums
- Mood swings for no reason
- Short attention span
- Uncomfortable in crowds
- Becomes easily annoyed
- Bothered by loud noises
- Bothered by bright lights
- Shows little remorse
- Emotionally unstable
- Little interest or pleasure in doing things
- Jekyll-and-Hyde type of personality
Autistic tendencies (if applicable)
- Shows little to no eye contact
- Speech is literal
- Content and happier to be alone
- Seems to be in “own world”
- Lacks displays of affection
- Lacks response from others
- Does not point out objects of interest to others
- Indifferent to surroundings
- Lacks interest in toys
- Marked reduction in activity level
- Increase in activity level
- Over-sensitive to pain
- Under-sensitive to pain
- Undeveloped motor skills
- Does not understand consequences
- Lines things up
- Loves patterns
- Color coordinated objects
- Inappropriate attachment to objects
- Displays daily obsessive routines
Medication side effects
- Behavior changes
- Stomach upset/aches
- Mouth burns
- Leg / calf cramps
- Drowsiness
- Confusion
- Clumsiness
- Nausea
- Unresponsive at times
- Mental confusion
- Lethargic
- Tired or tense a lot
Learning and cognition
- IQ lower than average
- Unable to process new information
- Unable to retain new information
- Has trouble performing daily tasks
- Needs constant reminders
- Does not carry on full conversation
- Repeats sentences
- Talks to himself
- Delay in academic achievement
- Lacks common sense
- Is a slow starter
- Moves slowly
- Speaks slowly
Other questions of interest
- Eyes are “glazed over”
- Breaks out in rashes/hives
- Has eczema
- Fidgety or restless
- Is vomiting a problem
- Has recurrent colds
- Eating or not eating affects behavior
- Facial color is pale
- Dark circles under eyes
- Headaches
- Stomach viruses often
- Wets the bed or self
- Constipated often
- Diarrhea often
- Craves certain foods
- Has ear infections
- Poor appetite
- Gets car sick
- Odor or fumes make them sick
- Loves the smell of gas or paint
- Trouble going to sleep
- Would steal chocolate
- Has food cravings like milk, peanut butter, eggs
- Asthma
- Tonsillitis, strep throat
- Very ticklish
- Clears throat a lot
- Walks on tip toes
- Has dry skin

Download

Download PDF
Download Word DOC
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5.0 stars

Scores 4.80 with 90 votes

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