Family Road Map Guide
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Health History, continued<br />
Numbers and ages of siblings not living with child or youth (including step-siblings):<br />
Describe any important life events in the past that affect your child’s or youth’s physical or behavioral health (Ex.: family<br />
divorce, major move, tragedy or trauma):<br />
<strong>Family</strong> Health History:<br />
Describe any medical, behavioral, or mental health diagnoses in parents, grandparents, or siblings:<br />
Describe any unusual, “weird,” or negative behavior in close family members. (Example: older brother and father often<br />
have sudden rages.) INCLUDE ALCOHOL AND OTHER SUBSTANCE ABUSE.<br />
How often does the child get regular exercise?<br />
What kind(s) of exercise or sports does the child participate in?<br />
Any unusual diet or feeding problems?<br />
Other comments about physical, mental, or developmental health (look back at “Your Child’s Developmental Profile” on<br />
page 19 for other information to add):<br />
Developmental<br />
Milestones<br />
It can be hard to remember when a<br />
child did certain things (especially if<br />
the child has been ill or events in the<br />
family have been difficult). Sometimes<br />
it helps to look at family pictures. This<br />
record may also be in your primary care<br />
doctor’s files. You may need to compare<br />
notes with others in the family. That’s<br />
why it’s better to gather this information<br />
ahead of time.<br />
Developmental History:<br />
Activity<br />
Rolled over without help<br />
Sat up without support<br />
Crawled<br />
Walked<br />
Ate solid foods<br />
Fed self with spoon<br />
Pointed to objects<br />
Babbled<br />
Used single words<br />
Used a string of three words<br />
Spoke in sentences<br />
Age learned<br />
<strong>Family</strong> <strong>Road</strong> <strong>Map</strong>: A Step-By-Step <strong>Guide</strong> to Navigating Health, Education, and Insurance Services for Families with Special Needs. Copyright © 2017, Melton Hill<br />
Media, LLC. All rights reserved.<br />
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