Infant Care Plan

This form will help not only the staff but more importantly your little one. If you can better familiarize us with your child's daily routine we can make this an enjoyable and beneficial experience. A new form needs to be completed by you quarterly.

Child's name

Birthdate

Date

Mother's Name

Work #

Cell #

Father's Name

Work #

Cell #

SLEEPING INFORMAION

A state required sleep plan will be completed seperately.

Where does your child sleep/nap? (i.e. in a crib, in bed with parents, etc.)

How do you put your child to sleep?

Does your child have a favorite toy or security object they sleep with?

Approximately what time(s) and for how long does your child nap?

In what position does your child sleep?

DIAPERING INFORMAION

We do not use powder at diaper changes, based on recommendations of the American Academy of Pediatrics, American Medical Association, and the Department of Public Health.

If you provide prescription or non-prescription ointment, it will be applied as needed if the required authorization forms are completed. Prescription ointments must be in the original container and the medication policy will apply. If so, what do you do? Does your child resist diaper changes?

If you use any diaper ointments or creams what kind?

Does your child resist diaper changes?

If so what do you do?

FEEDING INFORMAION

Is your child breastfed or bottle fed?

What kind of formula?

If applicable

Do you burp your child?

In what position and how often?

Are there any special instructions from your child's physician relating to special diet or feeding?

What kinds of solid foods does your child eat?

What is the schedule for introducing new foods?

Food allergies

Food likes or dislikes

FEEDING SCHEDULE

WHAT TIME & WHAT FOOD

HOW MUCH

Time & Food

How much

Time & Food

How much

Time & Food

How much

Time & Food

How much

Time & Food

How much

Does your child use a cup or utensils?

Explain

GENERAL INFORMAION

Does your child have any favorite toys or activities?

For young infants - When playing does your child have any position they favor or dislike?

What do you do if your child becomes fussy and all his physical needs have been met?

Additional information that you think would be helpful in caring for your child?

Parent's signature

Clear

Date

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