Nutrition Practices (Breastfeeding)
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Tell me how it is feeding #babys#.
Listen, ask, and assess for
● Hunger and satiety cues
● Number of wet/dirty diapers
● Appetite changes
● Constipation or diarrhea
● Vomiting
● Breastfeeding or formula
What concerns or challenges are you having?
Listen, ask, and assess for
● Frequency
● Ounce/bottle and bottles/day
● Difficulty latching on/positioning
● Weak/ineffective suck
● Jaundice
● Breastfeeding support avaliable
● Baby preferring one breast
● Baby not intereseted
● Breasts leaking/nipple care
● Breast pump needs/questions
● Plans for returning to work/school
● Teething/biting
If bottle feeding, listen, ask, and assess for
● Amount of formula
● Ounces/bottle or bottles/day
● Formula brand/type
● How is formula mixed
● Water source
● Contents other than formula
● Storage/handling
Does your baby take any vitamins, minerals, herbs, or dietary supplements?
What other questions or concerns do you have about feeding #babys#? Or, is there anything you would like to change?
Listen, ask, and assess for
● Dietary progression
● Making baby food
● When to start solids
● Introducing a cup
● Weaning breast/bottle
● Types of solids
Other Nutrition Risks
Nutrition Practices (Not Breastfeeding)
Tell me how it is feeding #babys#.
Listen, ask, and assess for
● Hunger and satiety cues
● Number of wet/dirty diapers
● Appetite changes
● Constipation or diarrhea
● Vomiting
How do you prepare formula?
Listen, ask, and assess for
● Amount of formula
● Ounces/bottle or bottles/day
● Formula brand/type
● How is formula mixed
● Water source
● Contents other than formula
● Storage/handling
Does your baby take any vitamins, minerals, herbs, or dietary supplements?
What other questions or concerns do you have about feeding #babys#? Or is there anything you would like to change?
Listen, ask, and assess for
● Dietary progression
● Making baby food
● When to start solids
● Introducing a cup
● Weaning bottle
● Type of solids
Other Nutrition Risks
Health/Medical
What concerns do you have about #baby# health?
Does #babys# have any medical problems diagnosed by a doctor?
Medical Conditions
Is #babys# currently on any medication?
Listen, ask, and assess for
● Medications that compromise nutritional status
Biological Mother
BioMotherHtWt
lbs
lbs
in
Biological Father
lbs
in
Immunizations
Can we look over #baby# shot record today?
Have any DTaP shots been given?
# of DTaP immunizations
Oral Health
What questions do you have regarding caring for #baby# gums and teeth?
Life Style
How active is #babys# every day?
Listen, ask, and assess for
● Strollers
● Play pens
● Infant seats
● Car seats
Listen, ask, and assess for planned physical activity times for
● Crawling
● Rolling over
● Moving muscles (massage)
● Walking
In the past seven days, has #babys# been in an enclosed space (i.e. car, home, child care) while someone used tobacco products?
What else can I help you with?
Listen, ask, and assess for
● Abuse/Neglect in the last 6 months
● Limiting ability to make appropriate feeding decisions or prepare foods
Moms WIC Participation
Was mother on WIC during her pregnancy?
If no, would she have been eligible?