Anticipatory Guidance For The 4 Month Well Child Physician Visit Page 2
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2COLLEGE OF SOUTHERN IDAHO HEAD START/EARLY HEAD START
998 Washington St. N.
PO Box 1238
Twin Falls, Idaho 83303-1238
208-736-0741
______________________________________________________________________________________
Infant Nutritional Screening and Anticipatory Guidance
To be completed within 45 days of enrollment and following each age interval of: Newborn, 2, 4, and 6 months of age.
Breastfeeding:
Do you offer anything other than breast milk of
formula?
In the last 24 hours how many times did your baby
nurse?
Babies 2 months and up:
How long do feedings last?
How often does your baby wake to feed at night?
Do you offer 1 breast or 2 breasts at feedings?
Do you have concerns about breast feeding your
baby when you are away from school/work?
Do you have a comfortable feeding position for you
and baby? If yes what?
Do you have other questions about feeding your
baby?
Is your baby taking any vitamin supplements?
Babies 4 months and up:
Are you feeding your baby formula in addition t
breast feeding?
Besides breast milk or formula, what does your
baby eat or drink?
If yes, what type and how many ounces in 24 hours?
Are you concerned about allergies?
Formula:
Are you interested in a information about introduc-
How many ounces does your baby drink in 24
ing foods to baby or making your own foods? WIC
hours?
offers a First Foods Class for children 1-6 months
old.
How many ounces do you offer at a feeding?
What have you heard about introducing baby foods?
Tell me how you mix your formula?
Babies 6 months and up:
How do you store formula? What do you do with
leftover formula?
Has your baby started to teeth and has that affected
How do you hold your baby when feeding?
feedings?
Do you put your baby to bed with a bottle?
Does baby show readiness to drink from a cup?
Do you prop the bottle for the baby to feed when
you are not holding him or her?
Child Name_________________________________
All Babies:
Date______________
How many wet diapers/ per day?
FE Name ___________________________________
How many dirty diapers/ per day?
Color of stool?
H-WCE-EHSFORMS-4 Month Well Child Antici-
Does your baby have diarrhea? Constipation?
patory Guidance
How do you know when your baby is hungry?
Page 2
Do you use a pacifier for your baby?
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