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Infant Feeding Schedule Form?
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Cat Herder
07:41 PM 07-08-2011
The provider shall secure from the parents infant formula and feeding plan for children under 1 year of age.
Child’s Name Child’s Birthday Date Plan Completed
_____________ ______________ ______________
What type of formula is used? ___________________________________________
Amount of formula to be given: ___________________________________________
Updated amounts of formula:
Date:___________
Date:___________
Date:____________
Instructions for the introduction of solid foods:
Food likes:
Food dislikes:
Does child take a pacifier? Yes No If yes, when? _________________________________
Does your child have Allergies/Known Medical Conditions (Include any premixed formula)? Yes No
If yes, please list: ______________________________________________________________________
Your child will be placed on back to sleep per SIDS rules unless written doctor’s statement is provided.
CHILD’S SCHEDULE:
Breakfast_______
(approximate time) Type and approximate amount of food
Lunch _______
(approximate time) Type and approximate amount of food
Dinner _______
(approximate time) Type and approximate amount of food
Morning Nap ______ Afternoon Nap ________
(approximate time) (approximate time)
Infant feeding plan needs to be updated every three months, or as needed, in regards to adding new foods or other dietary changes with a new parent/guardian signature and date:
Parent/Guardian Signature____________ Date_____________
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