Patient – Paediatric Detailed Intake Form
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Had colic or cried excessively as infant?
Breast fed?
Has growth been normal?
Frequent ear infections with chronic antibiotics and/or tubes?
Dizziness or fainting spells?
Gastroesophageal reflux?
Unexplained or recurrent episodes of vomiting?
Diarrhoea or other bowel problems?
Soils pants or has bowel accidents?
Daytime urinary incontinence (‘wets’ pants)?