英語の問診票（2歳6か月児用）

英語版問診票（2歳6か月児用）
1.When did your child start walking?
2.Can your child walk up the stairs by himself or herself, keeping his or her feet together at each step?	yes	no
3.Can your child run?	yes	no
4.Can your child kick a ball?	yes	no
5.When someone calls your child's name, does he/she look at the person and make eye contact with them?	yes	no
6.Does your child try to get the parent's attention to him or herself?	yes	no
7.Does your child watch what you are watching with you?	yes	no
8.When something unusual happens, does your child look at you to check your reaction?	yes	no
9.Does your child imitate any behavior by someone in TVs or adults?	yes	no
10.Does your child let you know before peeing?	yes	no
11.Have you started poop and pee training for your child?	yes	no
12.What kind of play does your child like? Please write down in detail.





13.Can your child eat on their own with a spoon or fork?	yes	no
14.What kind of snacks do you give your child?



15.Has your child been diagnosed with a food allergy from a doctor?	no	yes
If yes, (1)now under treatment? or (2)under obserbvation?	(1)	(2)
16.Does your child have any problems with appetite or picky eating?







17.Compared to six months ago, does your child speak more words?	yes	no
18.How does your child act when he/she wants you to do something?
a).Ahhhh....ugh...
b)． Point at something
c)．Say it in words (e.g., wan wan, mamma)
d)．Say it in two-word sentences
e)．Pull your hand.
19.Do you have any concerns about your child’s language development?	no	yes
20.Do you have anything you want to consult about your child’s language development?	no	yes
21.Describe your current state.
a)Do you enjoy spending time with your child？	yes	no
b)Do you fell anxioas about childcare?	yes	no
c)Are you tired of childcare?	yes	no
d)Do you often slap and scold your child?	yes	no
22.Is the child’s father involved in childcare?	yes	no
23.Is there anyone who helps you with childcare(except the father)?	yes	no
24.Can you relax with your child?	yes	no
25.Are you having trouble with raising your child?	no	yes
26.Is there anyone to talk about childraising when you are having trouble?	yes	no
27.Do you read picture books to your child?	yes	no
28.How many hours do you show your child any video such as TVs, DVDs or Smartphones?	minutes

英語の問診票（2歳6か月児用）

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英語の問診票（2歳6か月児用）

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