Nutrition And Feeding Care Plan printable pdf download

Nutrition And Feeding Care Plan

Nutrition and Feeding Care Plan

The nutrition and feeding care plan defines all members of the care team, communication guidelines (how, when, and how often),

and all information on a child’s diet and feeding needs for this child while in child care.

Name of Child:

Date:

_________________________________________________

Facility Name:

_________________________________________________

Team Member Names and Titles

(parents of the child are to be included)

Care Coordinator

(responsible for developing and administering Nutrition and Feeding Care Plan):

If training is necessary, then all team members will be trained.

❏ Individualized Family Service Plan (IFSP) attached

❏ Individualized Education Plan (IEP) attached

Communication

What is the team’s communication goal and how will it be achieved

(notes, communication log, phone calls, meetings, etc.):

How often will team communication occur: ❏ Daily ❏ Weekly ❏ Monthly ❏ Bi-monthly ❏ Other

Date and time specifics:

Specific Diet Information

v Medical documentation provided and attached:

❏ Yes

❏ No

❏ Not Needed

Specific nutrition/feeding-related needs and any safety issues:

v Foods to avoid (allergies and/or intolerances):

Planned strategies to support the child’s needs:

Plan for absences of personnel trained and responsible for nutrition/feeding-related procedure(s):

v Food texture/consistency needs:

v Special dietary needs:

v Other:

Eating Equipment/Positioning

v Physical Therapist (PT) and/or Occupational Therapist (OT) consult provided

❏ Yes

❏ No

❏ Not Needed

Special equipment needed:

Specific body positioning for feeding

(attach additional documentation as necessary):

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California Childcare Health Program rev. 05/03

Nutrition And Feeding Care Plan