Growing up with EB Survey

Gender: Age: Type of EB:

female male

At what age did you or your child? Roll Over: Sat unsupported: Crawled: Pulled self up: Walked: Got first tooth: Begin sleeping through the night regularly:

Did you or your child receive physical therapy, occupational therapy and/or Speech/feeding therapy?

yes no

If so, which one(s)?

If so, did you find the therapy helpful?

yes no N/A

Do/did you/they suffer from Acid Reflux?

yes no

Are you/they lactose intolerant or were at some point?

yes no

Do you/they have a G-tube?

yes no

If so, at what age did you/they get it?

For those have had dilatations, at what age was your/their first one?

Length of hospital stay after birth?

Issues with constipation?

yes no

Name (optional)

E-Mail (optional)

Any questions or comments?

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