All About Me - Infants (0-1 Year)

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Date: _______
All About Me ~ Infants (0-1 year)
Parent’s Name(s): _____________________________________________________________________
Parent’s Phone Number(s): ____________________________________________________________
Baby’s name: __________________________________________ Date of Birth: _________________
Baby’s Birthplace: _____________________________________________________________________
Baby’s Pediatrician: ___________________________________________________________________
Are you breastfeeding your baby? ___ Yes ___ No
If No: which formula do you give your baby? ______________________________________
Which kind of bottle/nipple does your baby use?
_______________________________________________________________________________________
Is your baby currently enrolled in WIC? ___ Yes ___ No
My baby’s eating schedule is every: 2-4hrs ___ 4-6hrs ___ 6-8hrs ___ other _____
At each feeding my baby drinks: 2-4oz ___4-6oz ___ 6-8oz ___ other ___________
Foods my baby has tried: ________________________________________________________________
Does your baby use a pacifier? ___ Yes ___ No
Does your baby like to be swaddled to sleep? ___ Yes ___ No
Does your baby have any particular routines to go to sleep (music, rocking, etc.)?
__________________________________________________________________________________________
__________________________________________________________________________________________
What is your baby’s nap time schedule?
__________________________________________________________________________________________
(5/12)
County of San Diego/Health and Human Services Agency/Child Welfare Services

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