Questionnaire: |
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1) Have you or your child been drinking? | A. Not at all | B. Sips reluctantly when encouraged | C. Sips on their own | D. Drinking as usual |
2) Have you or your child been eating? | A. Not at all | B. A few mouthfuls | C. Eating less than normal | D. Eating normally |
3) What kind of foods have you or your child been eating? | A. Has not been eating | B. Juices and fluids | C. Soft foods | D. Regular diet |
4) Have you or your child been talking? | A. Not at all | B. A few words quietly | C. In a normal voice but less talkative than usual | D. Talking as usual |
5) Have you or your child been active? | A. No, lying in bed | B. Reluctant to sit up in bed | C. Sitting up in bed | D. Getting out of bed |
6) Has your child been playing? | A. Not at all | B. Playing in bed | C. Getting up to watch others | D. Getting up to play |
7) How have you or your child/s mood been? | A. Silent | B. Unhappy and miserable | C. A little upset | D. Content , cheerful |
8) Did your child have to miss school/daycare today? | A. Yes | B. No | C. Does not attend school/daycare |
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9) Did you have to miss work today? | A. Yes | B. No | C. Would not have worked anyway |
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10) Were you able to complete all of your planned activities and errands for today? | A. Yes | B. Some of them | C. No |
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