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Questionnaires

North Carolina Infant Feeding Study

North Carolina Infant Feeding Study

For more information about North Carolina Infant Feeding Study questionnaires, contact Walter J. Rogan, M.D.

 

Initial Questionnaire for Mothers(317KB)  

Women were enrolled while pregnant and were given this initial enrollment questionnaire. It includes pregnancy-related health and disease conditions, prescription drug use during pregnancy, socio-demographic data, diet, exposures, smoking, alcohol and pregnancy history.

 

Medical Records Extraction for Mother(143KB)  

This form was used to extract information from the mother's medical record, especially information about prenatal records, pregnancy conditions, prescription drug use during pregnancy, infections during pregnancy and information on previous pregnancies.

 

Medical Record Abstraction for Mother: Additions
This form adds additional data to the medical record abstraction, specifically on labor and delivery conditions.

 

Follow-up Questionnaire for Mothers(272KB)  

This questionnaire for mothers was administered after the birth of the index child. It includes information on breast feeding, bottle feeding and weaning, illnesses and issues with the baby, mother's diet since baby's birth, and baby's illnesses.

 

Medical Records Abstraction for Baby: Information from Baby's Chart at Birth(117KB)
This form was used to extract information from the baby's medical record, including information about gestational age, weight, length, information on delivery and baby's Apgar score.

 

Brazleton Neonatal Behavioral Assessment Scale (NBAS) Examination(154KB)  

The Brazleton NBAS was administered to infants soon after birth to assess behavior and reflexes.

 

Examination of Infant(64KB)  

This brief physical examination was administered to infants soon after birth and includes information on congenital anomalies and the Bayley Scales of Infant Development (BSID). Bayley Scales measure mental (MDI) and motor (or physical) development (PDI) and behavior of infants from one to 42 months of age. The BSID measures a child's level of development in three domains: cognitive, motor and behavioral.

 

Physical examination: 1-Year and Older(121KB)  

This brief physical examination was administered to children more than 1-year-old and includes information on congenital anomalies and abnormalities, an annual repeat of the Bayley BSID (MDI and PDI), and the McCarthy Scales of Children's Abilities (MSCA). The McCarthy Scales uses game-like tasks to assess the abilities of preschool children, producing 6 scale scores: verbal, perceptual-performance, quantitative, composite (general cognitive), memory and motor.

 

Physical examination: 1-Year and Older(400KB)  

This questionnaire is a later, slightly modified version of the original physical exam questionnaire.

 

Interval History: 1-Year and Older(313KB)  

This questionnaire, administered to the mother, is about the child and includes items about the child's hospitalizations, illnesses, daycare, behavior, diet, breast and bottle feeding, and weaning.

 

Interval History (Revised - 3/1981)(481KB)  

This questionnaire is a later, slightly modified version of the original interval history questionnaire.

 

Medical Records Abstraction for Child: Record Review of Child 1-Year and Older (Revised - 5/1979)(291KB)
This form was used to extract information from the child's medical record, including child's hospitalizations, prescription drugs, congenital anomalies and illnesses.

 

Medical Records Abstraction for Child: Record Review of Child 1-Year and Older (Revised - 3/1981)(124KB)
This questionnaire is a later, slightly modified version of the original medical records abstraction and includes information on immunizations, doctor visits and illnesses.

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