Infant Feeding Schedule

SAMPLE

FORM

7415 Fayetteville Road | Durham, North Carolina 27713

Phone: 919.484.2858

Name of Child ____________________________________________Date________________

Date of Birth _____________________________________________

Instructions

1. Food/Bottles Brought Daily (quantity):

2. Instructions for Feeding:

A. Bottles (breast milk, formula, milk, juice)

B. Food (baby food, cereal, table food)

3. I plan to nurse: (approximate time)

________

Parent Signature

Changes in Schedule

(Must be recorded as eating habits change)

Parent or Staff

Food:

Date to Introduce:

New Instructions:

Signature:

Milk

Baby Food

Juice

Cereal

Table Food

*Must be completed for all children less than 15 months old

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Parent category: Life