Infant and Child Feeding Practices Questionnaire Form
Please complete this form to help us understand current infant and child feeding practices. All questions relate to non-sensitive aspects of feeding and nutrition.
Caregiver Full Name
*
First Name
Last Name
Relationship to Child
*
Please Select
Parent
Grandparent
Other Family Member
Guardian
Other
Child's Age (in months)
*
Current Primary Feeding Method
*
Breastfeeding
Infant Formula
Combination (Breastfeeding & Formula)
Solid Foods
Other
At what age did you introduce solid foods?
How many times per day is your child typically fed (including milk and solids)?
*
Which of the following foods does your child currently eat? (Select all that apply)
*
Cereals or grains
Fruits
Vegetables
Meat or poultry
Dairy products
Sweets or snacks
Other
Does your child use a bottle or pacifier?
Bottle
Pacifier
Both
Neither
Describe your child’s typical meal routine (times, locations, who is present, etc.)
What challenges, if any, have you faced with your child's feeding?
Submit
Should be Empty: