Paediatric Feeding History Form

Please complete and submit before assessment.


    Child's name
    Parent



    7. At what age was your child introduced to:

    Baby cereal
    Finger foods



    10. Describe your child’s mealtime:

    Who typically feeds your child?
    What type of chair is used?
    Does your child use utensils or any type of special cups/bowls (describe)?

    What times does your child usually eat?

    Breakfast
    Dinner



    13. How do you know when your child is hungry or full?

    Hungry




    IdealUnderweightOverweight



    DentalFrequent constipationFrequent diarrheaVomitingChokingGaggingCoughing


    18. Describe how you and your child feel after a feeding:

    You

    List the foods that your child will currently eat and drink (put a star next to their favourites)