1. What is your age? Under 18 Years Old 18 to 24 Years Old 25 to 30 Years Old 31 to 40 Years Old 41 to 50 Years Old 51 to 60 Years Old Over 60 Years Old 2. What is your gender? Male Female 3. Does your baby spit-up frequently (alternatively, does the milk come up in the throat and then the baby swallows it back down - silent reflux)? Yes, after almost every feeding Most of the time, but not always Occasionally, but not after ever feeding Rarely or not at all 4. Does your baby have frequent, wet-sounding hiccups? Yes, after almost every feeding Usually daily Occasionally Hardly ever 5. Is your baby very irritable or has "colicky behavior"? Yes, he/she cried pretty much non-stop Yes, he/she is pretty fussy, but not continuously He/she is occassionally fussy, particularly after feeding No, he/she is very content most of the time. 6. Is your baby able to comfortably lie on his/her back for any length of time? No, the screaming begins the minute he/she is flat. He/she really doesn't like that position, but will tolerate it for a few (example length of time to change diaper). That position bothers him/her sometimes, but not always. He/she can sleep very peacefully flat on back. 7. Does your baby have trouble sleeping for any length of time? Yes, he/she wakes very frequently both from naps and at night and just can't seem to get comfortable. He/she sleeps OK, but does seem to wake more frequently than I would expect. Occasionally has some trouble getting or staying asleep. Sleeps great pretty much all the time. 8. Is your baby chronically congested/wheezing/coughing? Yes, he/she has constant "head-cold" symptoms. Tends to get congested, particularly when lying flat. Occasionally, but not every day. Only congested when legitimately sick. 9. Does your baby have feeding issues? Does he/she pull of the bottle or breast frequently? Arch away from the bottle? Yes, it's a nightmare feeding him/her at every feeding. Often he/she has issues and will pull off or not want to finish a bottle/breastfeeding session if we stop to burp. Occasionally have some issues with feeding, but generally OK. No, he/she eats great all the time. 10. Does your baby eat very little OR does he/she seem to want to eat constantly? Over or under-eating. Yes, he/she's barely gaining weight or actually losing OR he/she's is eating large amounts every 1.5-2hours. We struggle to get him/her to eat enough, but growth seems OK OR he/she seems to eat more than normal. He/she occasionally struggles with bottles, but does pretty well overall No problems with eating at all. 11. Does your baby have issues with frequent choking and/or gagging? Yes, Constant chocking and gagging particularly while or just after eating. Some episodes of chocking/gagging. A few times, but not frequently. Not at all. 12. Does your baby have trouble gaining weight, OR is your baby gaining excessive weight very quickly? Yes, he/she's not even on the charts OR he/she is 95% weight and much lower percentile for height He/she's a bit under/over the normal for his/her height and struggles to maintain appropriate weight gain. He/she is a little small/chunky, but no major concerns. No problems with weight gain - just right for his/her age. 13. Does your baby ever have any breathing problems? Stops breathing (apnea)? Turns bluish/grayish (cyanotic apnea)? Yes, this has happened frequently to my baby! It has happened but not frequently. Hasn't ever happened.