Questionnaire:

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

9) Did you have to miss work today?

A. Yes

B. No

C. Would not have worked anyway

10) Were you able to complete all of your planned activities and errands for today?

A. Yes

B. Some of them

C. No