questions

yes

No/comment

1

Do you have Family history of diagnosed asthma/allergy?

2

Do you have family history of smoking recent or current?

3

Do you have family history of TB in recent or current or past?

4

Does the child get at least an episode a monthly ?

5

Are most of the episodes with significant fever?

6

Does each episode begin with runny nose?

7

Does each episode begin with sneezing?

8

Does the child have sneeze dominant nose symptoms?

9

Does the child rub nose often , scratch eyes, ears?

10

Does the child make funny throat sounds?

11

Did runny nose last for more than 10 days on any occasion?

12

Does the child keep mouth open in sleep?

13

Does the child snore in sleep?

14

Does the child get frequent night awakenings due to nose or throat issues?

15

Does the child cough more than wheeze?``

16

Does the child wheeze more than cough?

17

Is the cough more on lying down?

18

Is the cough more late night or early morning?

19

Does the child vomit after cough?

20

Does the child get breathless every month for more than 6 hours?

21

Does the child get breathless more at late night or early morning?

22

Does the child have cough more than wheeze or breathlessness?

23

Does the child get more than two sleepy nights a week?

24

Does the child have reduced appetite?

25

Does the child have slow swallowing?

26

Does the child have constipationor straining or skipping a day motion?

26

Do you think that dietary items aggrevate his symptoms?

27

Do you think thatdust/smole/cold/diet/fumes smell etc things aggrevate symptoms?

28

Does the child get similar symptoms on change of location?

29

Is your child gaining appropriate weight?

30

Did your child need repeated xrays/hospitalisations?

31

Do the symptoms interfere in speech or sports or study?

32

Do you offer milk to your child on daily basis?