3 Day Food Log printable pdf download

Name:

Date of Birth:

3 Day Food Log

In order to provide an accurate diet record it is important to follow these guidelines:

Specify the type of food whenever possible (brand names, % milk, etc.)

Pizza ‐‐> 1 slice, medium Pizza Hut, cheese pizza; crackers ‐‐‐> graham crackers

Include the amount of food given/eaten in measurable quantities (cup, fluid ounce, tablespoon, 1 slice, etc.)

5 Bites ‐‐‐> 2 tsp; Handful ‐‐‐> 1/2 cup

Describe how the food was prepared (grilled, fried, scrambled, 1 tsp oil added, etc.)

Chocolate milk ‐‐‐> whole milk w/ 2 TBS chocolate sryup; Sandwich ‐‐‐> 1 slice bread w/ 1 TBS peanut butter

*Try your best to record each meal/snack after it is eaten, it is much more accurate this way*

*Send food record 2 weeks prior to appointment to the appropriate address*

After completion of your child's food record, a nutrient analysis will be completed by a dietitian

****SEE SAMPLE BELOW****

How much

Place

How much eaten

offered

Type of food

H = Home

Comments

Brand Name

(Please use

(Record measurable

Mealtime

(Include preperation ‐ fried, baked, oil added, pureed

A = Away

(If applicable)

measurements ‐ 1

volumes: %, TBS, items,

etc.)

S = School

cup, 1 tsp, 2 oz

mL, etc.)

T = Therapy

package, etc.)

DATE: 01/01/01

Day 1

Pepperidge Farm w/

7:30am

100% Wheat toast w/ 1tsp margarine

1 slice

3/4 slice

Happy, ate normal amount

Smart Balance

Peanut Butter

Skippy ‐ natural

1 tbs

1 tsp

Banana

1/2 med. size

25%

Chocolate milk, ready‐to‐drink, low fat

Nesquick

4 fl oz

2 fl oz

Typically consumes 4oz

10:00am

Yogurt, strawberry

Yoplait, original

6 oz

2 TBS

Distracted, below normal amount

Chewy Chocolate chip granola bar

Quaker

1 bar

10%

Gagged, then refused

Apple juice

Minute Maid

200 mL

45 mL

Drinks from straw

Crackers, cheddar

Goldfish

1/4 cup

5 fish

Preferred food

12:00pm

Mac and cheese, prepared w/ water & 1tsp butter

Easy Mac

2 oz

10%

Recently added butter to increase calories

Mandarin oranges, in light syrup, drained

Del Monte

1 fruit cup

2 slices

New food

2 quarter sized slices, 1/2"

Hot dog (beef frank), no bun

Oscar Mayer

Eats plain ‐ no ketchup, etc.

thick