Infant Feeding Schedule
Campus
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Prue
Olmos
Child's Name
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Child's Date of Birth
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Year
-
Month
Day
Date
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Medical Information
Does your child have any allergies?
*
No
Yes
If Yes, please list Allergies below
Does your child have any medical conditions?
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No
Yes
If Yes, please list Medical Conditions below:
Does your child have any problems with feedings, such as choking or spitting up?
*
No
Yes
If yes, please explain below:
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Feeding Preferences
Feeding Preference
*
Yes
No
Type of Formula/Notes
Breastmilk
Formula
Warm Bottle
If child is receiving breastmilk and supply runs out, what do you want staff to do?
Utensils Used (Check all that apply):
Bottle
Sippy Cup
Spoon
Self Feeding
No
Yes
Feeding Schedule
*
Time/Frequency
Type of Food - Bottle/Food
Amount
1.
2.
3.
4.
5
6
7
8
Date
-
Month
-
Day
Year
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Food Consistency (Check all that apply):
Puree
Junior
Table
Signature
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Date
*
-
Month
-
Day
Year
Date
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