Effects of Simethicone and Vivatlac Baby in Infantile Colic
Phase: PHASE2
Conditions: Infantile Colic
Sponsor: The President Stanisław Wojciechowski State University of Applied Sciences in Kalisz

Effects of Simethicone and Multilac Baby in Infantile Colic
Doctor Information
Doctor
Date
Patient Data
General Patient Data
Patient Initials
Gender:
male
female
Date of birth:
Delivery type:
Normal
Ceasarian section
Birth in pregnancy week:
Weight at time of birth:
Breast feeding:
yes
no
Formula feeding:
yes
no
Antibiotics therapies:
yes
no
Details of antibiotics therapy:
Pro-/Synbiotics
yes
no
Details of Pro-/Syn-Therapy
Primary Diagnostics (before treatment start) 
Days of crying during last 3 weeks?
Average duration of crying?
Number of crying phases per day?
Can the child be calmed during crying?
yes
no
Bloated belly?
yes
no
Retracted legs?
yes
no
Red face?
yes
no
Problems to fall asleep?
yes
no
Short (<30 min) sleeping periodes during the day?
yes
no
Short  (<16h) total sleeping time per day?
yes
no
Number of sleeping periodes per day?
Comments
2020 03 02 Patient Assessment Sheet Day 0 PL & EN
Docuemnt date: March 02, 2020