Kick Count Form printable pdf download

Kick Count Form

Kick Count Instructions

KICK COUNT CARD

And easy way to check the health of your baby is to count the number

of times the baby kicks once each day. At the same time every day,

after you have eaten, record the amount of time it takes for your baby

to kick 10 times.

Name

For example, on Monday, you begin to count your baby’s kicks at 7:00

P.M. you baby has kicked 10 times. You then fill out the chart like this

36th Week

Kaiser Number

Minutes

Prenatal Doctor or Nurse Practitioner

Due Date

1 hour

1.5

hours

Blood Type________

Rh________

Remember that every baby is an individual. The have times when

they sleep and times when they are active. If you start counting and

the baby isn’t kicking, stop, walk around for 5 minutes, and then count

again. (Helpful hints: Count baby’s kicks after you have eaten. Most

babies are most active after the evening meal).

At the end of two hours if your baby has not kicked 10 times then call

784-4267.

Kicks = movements, twists, turns

Please bring this chart with you to each of your prenatal check-

ups.

Kick Count Form