YEAST QUESTIONNAIRE

Circle the appropriate point score for questions you answer "yes".  Total your score and record it at the end of the questionnaire.

 

Question:

Score
1.   During the two years before your child was born, were you bothered by recurrent vaginitis, menstrual irregularities, premenstrual tension, fatigue, headache, depression, digestive disorders or "feeling bad all over"?

30

    
2.    Was your child bothered by thrush? (Score 10 if mild, score 20 if severe or persistent) 10 20  
3.    Was your child bothered by frequent diaper rashes in infancy? (Score 10 is mild, 20 if severe or persistent) 10 20  
4.    During infancy, was your child bothered by colic and irritability lasting over 3 months?  (Score 10 if mild, 20 if moderate or severe) 10 20  
5.    Are his/her symptoms worse on damp days or in damp or moldy places? 20    
6.  Has your child been bothered by recurrent or persistent "athlete's foot" or chronic fungous infections of his skin or nails? 20    
7.    Has your child been bothered by recurrent hives, eczema or other skin problems? 10    
8.  Has your children received:
     a)  4 or more courses of antibiotic drugs during the past year?  Or has s/he received continuous "prophylactic" courses or antibiotic drugs?		 80    
     b)  8 or more courses of "broad spectrum" antibiotics (such as amoxicillin, Keflex, Septra, Bactrim, or Ceclor) during the past three years 50    
9.    Has your child experienced recurrent ear problems? 10    
10.  Has your child had tubes inserted in his ears? 10    
11.  Has your child been labeled "hyperactive"?  (Score 10 if mild, 20 if moderate or severe) 10 20  
12.  Is your child bothered by learning problems (even though his early developmental history was normal)? 10    
13.  Does your child have a short attention span? 10    
14.  Is your child persistently irritable, unhappy and hard to please? 10    
15.  Has your child been bothered by persistent or recurrent digestive problems, including constipation, diarrhea, bloating or excessive gas? (Score 10 if mild, 20 if moderate, 30 if severe. 10 20 30
16.  Has he been bothered by persistent nasal congestion, cough and/or wheezing? 10    
17.  Is your child unusually tired or unhappy or depressed? (Score 10 if mild, 20 if severe) 10 20  
18.  Has your child been bothered by recurrent headaches, abdominal pain, or muscle aches?  (Score 10 if mild, 20 if severe) 10 20  
19.  Does your child crave sweets? 10    
20.  Does exposure to perfume, insecticides, gas or other chemicals provoke moderate to severed symptoms? 30    
21.  Does tobacco smoke really bother him? 20    
22.  Do you feel that your child isn't well, yet diagnostic tests and studies haven't revealed the cause? 10    
TOTAL SCORE      

 

 

Reproduced with permission from Dr. Crook