Children Daily Care Plan printable pdf download

Daily Care Plan

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Child’s Name: __________________ Nickname: ________________ Day/Date: ___________

Diagnosis: _____________________________________________________________________

Allergies (include food allergies): _________________________________________________

______________________________________________________________________________

Medications: (See Daily Medication Chart)

______________________________________________________________________________

Meal Times

Breakfast ___________________ Lunch ____________________Dinner__________________

General Diet: _________________________ Special Diet: _____________________________

Favorite Foods: ________________________________________________________________

Special Utensils? _______________________ Special Dishes? __________________________

Snacks ~ What? _________________________________ When? ________________________

Feeding tube: Y ___ N ___ Feeding Tube Care: _____________________________________

Oral Care: ____________________________________________________________________

Equipment

(Wheelchair, walker, standing frame, high chair, braces, crutches, etc.)

_____

_________________________________________________________________________________________

______________________________________________________________________________

Daily Activities

Crawls: ____________ Stands Alone: ____________ Walks Alone:______________________

Stands With Assistance: ________________ Walks With Assistance:____________________

Favorites Activties:_____________________________________________________________

Favorite Toy: __________________________________________________________________

Activities to Avoid: _____________________________________________________________

Plays Outside:_________________________________________________________________

Plays Inside: ________________________________ Where? ___________________________

Range Of Motion/Exercises: _____________________________________________________

______________________________________________________________________________

Calming/Comfort Techniques

(Rocking, singing, quiet, favorite song, pacifier, etc. etc.)

_______________________________________________________________________

_______

Children Daily Care Plan