• Feeding History

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    Pick a Date
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  • IF YOUR CHILD EATS BY MOUTH, PLEASE ANSWER THE FOLLOWING QUESTIONS:

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  • Describe your child’s mealtime:

    Who typically feeds your child?      
    Who typically eats with your child?       
    What type of chair is used?      
    Are child's feet supported?   
    How long do meals typically last?       
       

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  • Would you describe your child’s weight as:            

  • Select any problems that your child has encountered:                                

  • Should be Empty: