NUTRITION QUESTIONNAIRE FOR INFANTS 09/30/2014 Source: Bright Future Nutrition at http://www.brightfu tures.org/nutrition/pdf/pocket.pdf 1 1. How… [616095]

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NUTRITION QUESTIONNAIRE FOR INFANTS

09/30/2014
Source: Bright Future Nutrition at http://www.brightfu tures.org/nutrition/pdf/pocket.pdf 1 1. How would you describe feeding time with your baby?
(Check all that apply.)
 Always pleasant
 Usually pleasant
 Sometimes pleasant
 Never pleasant

2. How do you know when you r baby is hungry or has had enough to eat?

3 What type of milk do you feed your baby and how often?
(Check all that apply.)
 Iron-fortified infant formula
 Evaporated milk
 Whole milk
 Reduced -fat (2%) milk
 Low-fat (1 %) milk
 Fat-free (skim) milk
 Goat's milk
 Soymilk

4. What types of things can your baby do?
(Check all that apply.)

 Open mouth for breast or bottle
 Drink liquids
 Follow objects and sounds with eyes
 Put hand in mouth
 Sit with support
 Bring objects to mouth and bite them
 Hold bottle without support
 Drink from a cup that is held

5. Does your baby eat solid foods? If yes, w hich ones?

NUTRITION QUESTIONNAIRE FOR INFANTS

09/30/2014
Source: Bright Future Nutrition at http://www.brightfu tures.org/nutrition/pdf/pocket.pdf 2 6. Does your baby drink juice? If yes, how much?

7. Does your baby take a bottle to bed at night or carry a bottle around during the day?

8. Do you add honey to your baby's bottle or dip your baby's pacifier in honey ?

9. What is the source of the water your baby drinks? Sources include public, well,
commercially bottled, and home system -processed water .

10. Do you have a working stove, oven, and refrigerator where you live?

11. Were there any days last month when your family didn't have enough food to eat or
enough money to buy food ?

12. What concerns or questions do you have about feeding your baby or how your baby is
growing ? Do you have any concerns or questions about your baby’s weight ?

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