Epidemiology of respiratory symptoms in children with Down syndrome: a nationwide prospective web-based parent-reported study

Verstegen, Ruud HJ; van Hout, Roeland WNM; de Vries, Esther

doi:10.1186/1471-2431-14-103

Table 1 Annual questionnaire regarding background, daily activities and medical history of participating child with Down syndrome

From: Epidemiology of respiratory symptoms in children with Down syndrome: a nationwide prospective web-based parent-reported study

General questions
Child with Down syndrome	Date of birth
Child with Down syndrome	Gender
Father/Mother	Date of birth
History of allergy, asthma and/or eczema?	Yes		No
Siblings	Number of older siblings
Siblings	Number of younger siblings
History of allergy, asthma and/or eczema?	Yes		No
Does anyone smoke (almost) daily within the house?	Yes		No
Daily activities
Divide the 14 half-days present in each week between the following activities:	Home			Grandparents/family/host family
	Child day care			Special needs day care
	Playgroup (age 2-4y)			Pre-school kindergarten (age 4-5y)
	Primary school (age 6-12y)			Special primary school
	Secondary school			Special secondary school
	Work placement			Working
	Other
If attending regular education, what grade is your child in?
Medical history
Compared to other children with the same age, the frequency of being ill is:	Lower		Equal	Higher
Does your child have a history of any of the following illnesses, complaints or medication usage?
Congenital heart disease	Yes		No
If yes, please specify	VSD	ASD	AVSD	Tetralogy of Fallot	Other	Unknown
If yes, was surgery performed?	Yes		No
Hypothyroid disease	Yes		No
If yes, diagnosed at what age?
Diabetes mellitus	Yes		No
If yes, diagnosed at what age?
Congenital malformations of the gastrointestinal tract	Yes		No
If yes, please specify:	Oesophageal atresia		Duodenal atresia		Imperforate anus
If yes, please specify:	Other		Unknown
Celiac disease	Yes		No
If yes, diagnosed at what age?
Impaired hearing	Yes		No
If yes, diagnosed at what age?
Chronic snoring	Yes		No
If yes, present since what age?
Breathing with open mouth	Yes		No
If yes, present since what age?
Frequently suffering from serious colds	Yes		No, but did in the past			No
If complaints used to be present, until what age?
Wheezing	Yes		No, but did in the past			No
If complaints used to be present, until what age?
Eye disorders	Yes		No
If yes, please specify:	Cataract	Glaucoma	Strabismus		Amblyopia
If yes, please specify:	Wears glasses		Other		Unknown
Leukaemia	Yes		No
If yes, diagnosed at what age?
Antibiotic use for respiratory tract/ENT* infections in the past year	0-5 times		6-10 times more than 10 times
Hospital admission for RSV infection <2 years	Yes		No
ENT-surgery	Yes		No
If yes, please specify:	Tympanic tubes		Adenoidectomy			Tonsillectomy
Daily antibiotic prophylaxis	Yes		No, but did in the past			No
Inhaled corticoid for coughing, mucus and/or wheezing	Yes		No, but did in the past			No

*ENT Ear-nose-throat.

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ISSN: 1471-2431

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