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Half sister has excessive sleepiness
fam5m31_chk
under Family History in
CHAT variables
Defined as having this 3 or more times per week
Full brothers have acute life threatening episode (ALTE)
fam5a22_chk
under Family History in
CHAT variables
Also known as acute life threatening episodes
Half brothers have acute life threatening episode (ALTE)
fam5a32_chk
under Family History in
CHAT variables
Also known as acute life threatening episodes
Full brother has eating disorder
fam5j22_chk
under Family History in
CHAT variables
This includes anorexia and bulimia
Half brother has eating disorder
fam5j32_chk
under Family History in
CHAT variables
This includes anorexia and bulimia
Full brother has excessive sleepiness
fam5m22_chk
under Family History in
CHAT variables
Defined as having this 3 or more times per week
Half brother has excessive sleepiness
fam5m32_chk
under Family History in
CHAT variables
Defined as having this 3 or more times per week
Biological parents have excessive sleepiness
fam6i1
under Family History in
CHAT variables
Defined as having this 3 or more times per week
Biological father has excessive sleepiness
fam6i3
under Family History in
CHAT variables
Defined as having this 3 or more times per week
Full sister has Sudden Infant Death Syndrome (SIDS)
fam5b21_chk
under Family History in
CHAT variables
Also known as crib death or Sudden Infant Death Syndrome (SIDS)
Half sister has Sudden Infant Death Syndrome (SIDS)
fam5b31_chk
under Family History in
CHAT variables
Also known as crib death or Sudden Infant Death Syndrome (SIDS)
Full brothers has Sudden Infant Death Syndrome (SIDS)
fam5b22_chk
under Family History in
CHAT variables
Also known as crib death or Sudden Infant Death Syndrome (SIDS)
Half brother has Sudden Infant Death Syndrome (SIDS)
fam5b32_chk
under Family History in
CHAT variables
Also known as crib death or Sudden Infant Death Syndrome (SIDS)
Do any siblings have acute life threatening episode (ALTE)?
fam5a1
under Family History in
CHAT variables
Also known as acute life threatening episodes
Parents medical conditions
fam6
under Family History in
CHAT variables
Has either biological parent currently or ever had any of the following conditions?
Mother smoke during pregnancy?
fam1
under Family History in
CHAT variables
Did your child's biological mother smoke at least one cigarette a day while she was pregnant with your child?
Did your child have a cough?
fam11a
under General Health in
CHAT variables
Did your child cough often?
fam11b
under General Health in
CHAT variables
Defined as coughing on most days for at least 3 consecutive months
Did your child usually bring up phlegm from the chest?
fam11c
under General Health in
CHAT variables
Did your child bring up phlegm often?
fam11d
under General Health in
CHAT variables
Did your child usually bring up phlegm in the morning?
fam11e
under General Health in
CHAT variables
Did your child have periods of worsened cough or phlegm?
fam11f
under General Health in
CHAT variables
Did your child have an asthma like attack?
fam11g
under General Health in
CHAT variables
Defined as an attack of wheezing that made him or her feel short of breath
Did your child experience shortness of breath?
fam11h1
under General Health in
CHAT variables
Defined as occurring during mild exercise such as walking on level ground or up a slight hill.
If yes, please answer the following:
fam11h2
under General Health in
CHAT variables
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