Speech Language Pathologists, Nancy L. Foreman and Associates, SPEECH is the WINDOW and MIRROR of the MIND

Slow or stagnant speech development

Consistently hoarse voice

General Case History: Child - Page 3 of 5

 

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SECTION IV – BIRTH HISTORY

Is the mother R.H. negative? 
Did the mother have any illnesses during her pregnancy with this child?
Take medicine (other than vitamins)? 
Almost have a miscarriage? 
If yes to any of these, explain: 
Has the mother had previous miscarriages?
Was labor very long or especially short?
If yes, estimate time: 
Was the birth of the child normal? 
If not, explain: 
Did the child have any trouble breathing after birth?
Did the child look blue or yellow after birth?
Did the child come home from the hospital with the mother?
If not, why? 
Please describe any conditions 
concerning pregnancy or birth 
of this child which were not normal: 

SECTION V – PHYSICAL DEVELOPMENT

At what age did the child:   
Sit Alone?   Crawl?  Walk Alone?
Achieve Bladder Control?  Day   Night
Achieve Bowel Control?  Day   Night
Feed Self?   Dress Self?
Did the child achieve these skills at about the same rate as other children?
If not, describe: 
How was the child fed? 
Describe feeding problems, if any: 
Is the child a “picky” or “fussy” eater now?
Does he seem to have any trouble swallowing?       Chewing?
Does the child still drool? 
If so, when? 

 

 

 

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