Exit this survey MPEI Questionnaire - Page 4 of 9 - Up to Age 1 (or Older) 1. First Year of Life Please answer this section if your child is nearly one or older * 1. Please can you provide your child's details below: Name Date of Birth * 2. Please mark the developmental milestones your child reached in their FIRST year of life Yes Sometimes Initally Yes (but lost this skill) No Don't know Smiling Smiling Yes Smiling Sometimes Smiling Initally Yes (but lost this skill) Smiling No Smiling Don't know Vocalizing Vocalizing Yes Vocalizing Sometimes Vocalizing Initally Yes (but lost this skill) Vocalizing No Vocalizing Don't know Fixing and following Fixing and following Yes Fixing and following Sometimes Fixing and following Initally Yes (but lost this skill) Fixing and following No Fixing and following Don't know Gripping an object Gripping an object Yes Gripping an object Sometimes Gripping an object Initally Yes (but lost this skill) Gripping an object No Gripping an object Don't know Holding head up Holding head up Yes Holding head up Sometimes Holding head up Initally Yes (but lost this skill) Holding head up No Holding head up Don't know Eating solid foods Eating solid foods Yes Eating solid foods Sometimes Eating solid foods Initally Yes (but lost this skill) Eating solid foods No Eating solid foods Don't know Sitting unassisted Sitting unassisted Yes Sitting unassisted Sometimes Sitting unassisted Initally Yes (but lost this skill) Sitting unassisted No Sitting unassisted Don't know Pulling up to standing Pulling up to standing Yes Pulling up to standing Sometimes Pulling up to standing Initally Yes (but lost this skill) Pulling up to standing No Pulling up to standing Don't know * 3. Which of the following problems has your child encountered in their FIRST year of life? Yes Sometimes No Don't Know Reflux/Vomiting Reflux/Vomiting Yes Reflux/Vomiting Sometimes Reflux/Vomiting No Reflux/Vomiting Don't Know Constipation Constipation Yes Constipation Sometimes Constipation No Constipation Don't Know Visual Problems Visual Problems Yes Visual Problems Sometimes Visual Problems No Visual Problems Don't Know Prolonged Screaming Episodes Prolonged Screaming Episodes Yes Prolonged Screaming Episodes Sometimes Prolonged Screaming Episodes No Prolonged Screaming Episodes Don't Know Temperature control problems Temperature control problems Yes Temperature control problems Sometimes Temperature control problems No Temperature control problems Don't Know Scoliosis (spinal curve) Scoliosis (spinal curve) Yes Scoliosis (spinal curve) Sometimes Scoliosis (spinal curve) No Scoliosis (spinal curve) Don't Know Hip Displacement Hip Displacement Yes Hip Displacement Sometimes Hip Displacement No Hip Displacement Don't Know Dystonia / Dystonic spasms Dystonia / Dystonic spasms Yes Dystonia / Dystonic spasms Sometimes Dystonia / Dystonic spasms No Dystonia / Dystonic spasms Don't Know Movement Disorder / Tremor Movement Disorder / Tremor Yes Movement Disorder / Tremor Sometimes Movement Disorder / Tremor No Movement Disorder / Tremor Don't Know Recurrent Chest Infections / Pneumonias Recurrent Chest Infections / Pneumonias Yes Recurrent Chest Infections / Pneumonias Sometimes Recurrent Chest Infections / Pneumonias No Recurrent Chest Infections / Pneumonias Don't Know Asthma Asthma Yes Asthma Sometimes Asthma No Asthma Don't Know * 4. Which of the following treatments has your child had (or used) in their FIRST year of life? Yes No Don't Know Fundoplication (tightening of gullet to reduce sickness) Fundoplication (tightening of gullet to reduce sickness) Yes Fundoplication (tightening of gullet to reduce sickness) No Fundoplication (tightening of gullet to reduce sickness) Don't Know Pyloroplasty (loosening the stomach exit to aid emptying) Pyloroplasty (loosening the stomach exit to aid emptying) Yes Pyloroplasty (loosening the stomach exit to aid emptying) No Pyloroplasty (loosening the stomach exit to aid emptying) Don't Know Spinal Brace Spinal Brace Yes Spinal Brace No Spinal Brace Don't Know Spinal Surgery Spinal Surgery Yes Spinal Surgery No Spinal Surgery Don't Know Hip Surgery Hip Surgery Yes Hip Surgery No Hip Surgery Don't Know Continual Oxygen Therapy Continual Oxygen Therapy Yes Continual Oxygen Therapy No Continual Oxygen Therapy Don't Know Ketogenic Diet Ketogenic Diet Yes Ketogenic Diet No Ketogenic Diet Don't Know NG Feeding Tubes NG Feeding Tubes Yes NG Feeding Tubes No NG Feeding Tubes Don't Know Gastrostomy Gastrostomy Yes Gastrostomy No Gastrostomy Don't Know Jejunostomy or Duodenostomy Jejunostomy or Duodenostomy Yes Jejunostomy or Duodenostomy No Jejunostomy or Duodenostomy Don't Know Central IV Line Central IV Line Yes Central IV Line No Central IV Line Don't Know Baclofen Pump (for Dystonic Spasms) Baclofen Pump (for Dystonic Spasms) Yes Baclofen Pump (for Dystonic Spasms) No Baclofen Pump (for Dystonic Spasms) Don't Know Other (please give details in Q6) Other (please give details in Q6) Yes Other (please give details in Q6) No Other (please give details in Q6) Don't Know * 5. If your child has had an MRI scan in the FIRST year of their life and you were informed of any unusual features within this scan - please give details below:(If they have not had one- please write n/a) * 6. Further Information: Done