**Maine WIC Nutrition
Program**![](media/image1.png){width="0.5152777777777777in"
height="0.9277777777777778in"}

**Child Nutrition Assessment Guidance**

+--------+-------------------+-----+-------------+-------------------+
| **T    | **Guidance**      |     |             |                   |
| opic** |                   |     |             |                   |
+--------+-------------------+-----+-------------+-------------------+
| ####   | ***Sharing growth |     |             |                   |
| #####  | information with  |     |             |                   |
| Growth | parents:***       |     |             |                   |
|        |                   |     |             |                   |
|        | -   *If parent    |     |             |                   |
|        |     desires*,     |     |             |                   |
|        |     show plotted  |     |             |                   |
|        |     measurements; |     |             |                   |
|        |     ***If parent  |     |             |                   |
|        |     desires,***   |     |             |                   |
|        |     print growth  |     |             |                   |
|        |     chart         |     |             |                   |
|        |     ***only*** if |     |             |                   |
|        |     there are a   |     |             |                   |
|        |     minimum of 3  |     |             |                   |
|        |     plots that    |     |             |                   |
|        |     have been     |     |             |                   |
|        |     obtained.     |     |             |                   |
|        |                   |     |             |                   |
|        | -   Reassure      |     |             |                   |
|        |     parent that   |     |             |                   |
|        |     growth is     |     |             |                   |
|        |     normal if it  |     |             |                   |
|        |     consistently  |     |             |                   |
|        |     follows the   |     |             |                   |
|        |     curve of the  |     |             |                   |
|        |     chart         |     |             |                   |
|        |                   |     |             |                   |
|        | ```{=html}        |     |             |                   |
|        | <!-- -->          |     |             |                   |
|        | ```               |     |             |                   |
|        | -   Point out     |     |             |                   |
|        |     that growth   |     |             |                   |
|        |     patterns are  |     |             |                   |
|        |     best          |     |             |                   |
|        |     evaluated     |     |             |                   |
|        |     over a period |     |             |                   |
|        |     of time vs    |     |             |                   |
|        |     one single    |     |             |                   |
|        |     plot          |     |             |                   |
|        |                   |     |             |                   |
|        | -   Adjust for    |     |             |                   |
|        |     gestational   |     |             |                   |
|        |     age for       |     |             |                   |
|        |     babies born   |     |             |                   |
|        |                   |     |             |                   |
|        |  [\<]{.underline} |     |             |                   |
|        |     37 weeks      |     |             |                   |
|        |     until child   |     |             |                   |
|        |     turns 24      |     |             |                   |
|        |     months; if    |     |             |                   |
|        |     needed, print |     |             |                   |
|        |     out chart and |     |             |                   |
|        |     adjust plots  |     |             |                   |
|        |     manually      |     |             |                   |
|        |                   |     |             |                   |
|        | ***If             |     |             |                   |
|        | measurements      |     |             |                   |
|        | obtained are      |     |             |                   |
|        | different than    |     |             |                   |
|        | what parent       |     |             |                   |
|        | reports MD        |     |             |                   |
|        | obtained:***      |     |             |                   |
|        |                   |     |             |                   |
|        | -   Point out     |     |             |                   |
|        |     measuring     |     |             |                   |
|        |     technique     |     |             |                   |
|        |     used by WIC   |     |             |                   |
|        |     staff (child  |     |             |                   |
|        |     measured      |     |             |                   |
|        |     using board   |     |             |                   |
|        |     with flat     |     |             |                   |
|        |     surface for   |     |             |                   |
|        |     head and      |     |             |                   |
|        |     feet; child   |     |             |                   |
|        |     undressed to  |     |             |                   |
|        |     dry diaper;   |     |             |                   |
|        |     child weighed |     |             |                   |
|        |     without heavy |     |             |                   |
|        |     clothing,     |     |             |                   |
|        |     shoes)        |     |             |                   |
|        |                   |     |             |                   |
|        | -   Scales        |     |             |                   |
|        |     routinely     |     |             |                   |
|        |     calibrated    |     |             |                   |
|        |                   |     |             |                   |
|        | -   Growth        |     |             |                   |
|        |     corrected for |     |             |                   |
|        |     gestational   |     |             |                   |
|        |     age until 24  |     |             |                   |
|        |     months        |     |             |                   |
|        |                   |     |             |                   |
|        | ***Child with     |     |             |                   |
|        | inconsistent      |     |             |                   |
|        | growth***         |     |             |                   |
|        | (increase *or*    |     |             |                   |
|        | decrease of \>2   |     |             |                   |
|        | channels in       |     |             |                   |
|        | wt/length         |     |             |                   |
|        | [or]{.underline}  |     |             |                   |
|        | BMI/age over 6    |     |             |                   |
|        | mo):              |     |             |                   |
|        |                   |     |             |                   |
|        | -   Refer file to |     |             |                   |
|        |     LA            |     |             |                   |
|        |     Nutritionist  |     |             |                   |
|        |     for review    |     |             |                   |
|        |                   |     |             |                   |
|        | -   Send a        |     |             |                   |
|        |     nutrition     |     |             |                   |
|        |     assessment to |     |             |                   |
|        |     the physician |     |             |                   |
|        |     which         |     |             |                   |
|        |     communicates  |     |             |                   |
|        |     concern,      |     |             |                   |
|        |     stating plan  |     |             |                   |
|        |     and           |     |             |                   |
|        |     requesting    |     |             |                   |
|        |     feedback      |     |             |                   |
|        |                   |     |             |                   |
|        | -   ***NOTE:**    |     |             |                   |
|        |     Inconsistent  |     |             |                   |
|        |     growth is     |     |             |                   |
|        |     [             |     |             |                   |
|        | not]{.underline}: |     |             |                   |
|        |     \<5^th^%ile   |     |             |                   |
|        |                   |     |             |                   |
|        |    weight/height, |     |             |                   |
|        |     \>95^th^%ile  |     |             |                   |
|        |                   |     |             |                   |
|        |    weight/height, |     |             |                   |
|        |     or single     |     |             |                   |
|        |     growth plots  |     |             |                   |
|        |     at            |     |             |                   |
|        |     \>95^th^%ile  |     |             |                   |
|        |     or            |     |             |                   |
|        |     \<5^th^%ile.* |     |             |                   |
|        |                   |     |             |                   |
|        | ***Child with     |     |             |                   |
|        | inadequate        |     |             |                   |
|        | growth***         |     |             |                   |
|        | (average weight   |     |             |                   |
|        | gain \< 2.7       |     |             |                   |
|        | oz/month          |     |             |                   |
|        | [or]{.underline}  |     |             |                   |
|        | \< 1# over 6      |     |             |                   |
|        | month period):    |     |             |                   |
|        |                   |     |             |                   |
|        | -   Apply risk    |     |             |                   |
|        |     factor **G4** |     |             |                   |
|        |                   |     |             |                   |
|        | -   Refer file to |     |             |                   |
|        |     LA            |     |             |                   |
|        |     Nutritionist  |     |             |                   |
|        |     for review    |     |             |                   |
|        |                   |     |             |                   |
|        | -   Refer         |     |             |                   |
|        |     nutrition     |     |             |                   |
|        |     assessment to |     |             |                   |
|        |     physician     |     |             |                   |
|        |     with concerns |     |             |                   |
|        |     and areas     |     |             |                   |
|        |     addressed     |     |             |                   |
|        |     with parent   |     |             |                   |
+--------+-------------------+-----+-------------+-------------------+
| **C    | -   ***Number     |     | -           |                   |
| hild's |                   |     |    Children |                   |
| Eating |   Meals/Snacks:** |     |     thrive  |                   |
| Pat    |     Ask "How many |     |     with    |                   |
| tern** |     meals and how |     |             |                   |
|        |     many snacks   |     |   structure |                   |
|        |     does \_\_\_   |     |     in all  |                   |
|        |     eat/day?" Ask |     |     areas   |                   |
|        |     for details   |     |     of      |                   |
|        |     about the     |     |     their   |                   |
|        |     snack         |     |     lives.  |                   |
|        |     schedule.*    |     |     Regular |                   |
|        |                   |     |     feeding |                   |
|        | ```{=html}        |     |             |                   |
|        | <!-- -->          |     |    routines |                   |
|        | ```               |     |     are an  |                   |
|        | -   ***Between    |     |     example |                   |
|        |     meals and     |     |     of      |                   |
|        |     snacks:** Ask |     |     this.   |                   |
|        |     "Does \_\_\_  |     |             |                   |
|        |     have anything |     | -   Since   |                   |
|        |     to eat/drink  |     |             |                   |
|        |     between meals |     |    stomachs |                   |
|        |     and snacks?   |     |     are     |                   |
|        |     If so, what?  |     |     still   |                   |
|        |     How is it     |     |     small,  |                   |
|        |     offered?"*    |     |     they    |                   |
|        |                   |     |     need to |                   |
|        | -   ***Child is   |     |     eat     |                   |
|        |     interested in |     |     every   |                   |
|        |     eating meals  |     |     2-3     |                   |
|        |     and snacks.** |     |     hours.  |                   |
|        |     Ask "How does |     |     A daily |                   |
|        |     \_\_\_ show   |     |             |                   |
|        |     interest in   |     |    schedule |                   |
|        |     eating when   |     |     of 3    |                   |
|        |     it is meal or |     |     meals   |                   |
|        |     snack time?"* |     |     and 2-3 |                   |
|        |                   |     |     snacks  |                   |
|        | -   ***Child is   |     |     is      |                   |
|        |     allowed to    |     |             |                   |
|        |     choose        |     |  important. |                   |
|        |     whether to    |     |             |                   |
|        |     eat or not.** |     | -   When    |                   |
|        |     Ask "How do   |     |             |                   |
|        |     you let       |     |    provided |                   |
|        |     \_\_\_ decide |     |     with a  |                   |
|        |     what to eat   |     |             |                   |
|        |     from what     |     |  structured |                   |
|        |     you're        |     |     feeding |                   |
|        |     serving at a  |     |             |                   |
|        |     meal? What do |     |   schedule, |                   |
|        |     you do if     |     |             |                   |
|        |     \_\_\_        |     |    children |                   |
|        |     refuses to    |     |     will    |                   |
|        |     eat what you  |     |     learn   |                   |
|        |     have          |     |     to      |                   |
|        |     offered?"*    |     |     trust   |                   |
|        |                   |     |     that,   |                   |
|        | -   ***Child is   |     |     if they |                   |
|        |     allowed to    |     |     do not  |                   |
|        |     choose how    |     |     eat     |                   |
|        |     much to       |     |     much at |                   |
|        |     eat.** Ask    |     |     a meal, |                   |
|        |     "What do you  |     |     there   |                   |
|        |     do if your    |     |     will be |                   |
|        |     child doesn't |     |     another |                   |
|        |     eat           |     |     feeding |                   |
|        |     everything on |     |     in a    |                   |
|        |     his/her       |     |             |                   |
|        |     plate? How do |     |  reasonable |                   |
|        |     you let       |     |     time    |                   |
|        |     \_\_\_ decide |     |     period. |                   |
|        |     what to eat   |     |             |                   |
|        |     from what     |     | -   Toddler |                   |
|        |     you're        |     |             |                   |
|        |     serving at a  |     |   appetites |                   |
|        |     meal? How do  |     |     can be  |                   |
|        |     you determine |     |     erratic |                   |
|        |     when \_\_\_   |     |     and     |                   |
|        |     is done with  |     |     vary    |                   |
|        |     a meal?"*     |     |     from    |                   |
|        |                   |     |     day to  |                   |
|        |                   |     |     day. In |                   |
|        |                   |     |     order   |                   |
|        |                   |     |     to      |                   |
|        |                   |     |     support |                   |
|        |                   |     |     a       |                   |
|        |                   |     |     healthy |                   |
|        |                   |     |             |                   |
|        |                   |     |   appetite, |                   |
|        |                   |     |             |                   |
|        |                   |     |   encourage |                   |
|        |                   |     |     parent  |                   |
|        |                   |     |     to      |                   |
|        |                   |     |     avoid   |                   |
|        |                   |     |     ad lib  |                   |
|        |                   |     |             |                   |
|        |                   |     |   beverages |                   |
|        |                   |     |     or      |                   |
|        |                   |     |     snacks  |                   |
|        |                   |     |     close   |                   |
|        |                   |     |     to meal |                   |
|        |                   |     |     time.   |                   |
|        |                   |     |     4-6 oz  |                   |
|        |                   |     |     of milk |                   |
|        |                   |     |     at each |                   |
|        |                   |     |     meal    |                   |
|        |                   |     |     and     |                   |
|        |                   |     |     snack,  |                   |
|        |                   |     |     and 4   |                   |
|        |                   |     |     oz of   |                   |
|        |                   |     |     juice   |                   |
|        |                   |     |     all day |                   |
|        |                   |     |     is      |                   |
|        |                   |     |     plenty. |                   |
|        |                   |     |             |                   |
|        |                   |     | -   Because |                   |
|        |                   |     |     toddler |                   |
|        |                   |     |     growth  |                   |
|        |                   |     |     is      |                   |
|        |                   |     |     slowing |                   |
|        |                   |     |     down,   |                   |
|        |                   |     |             |                   |
|        |                   |     |   appetites |                   |
|        |                   |     |     will    |                   |
|        |                   |     |             |                   |
|        |                   |     |   naturally |                   |
|        |                   |     |             |                   |
|        |                   |     |   decrease. |                   |
|        |                   |     |     P       |                   |
|        |                   |     | reschoolers |                   |
|        |                   |     |     have an |                   |
|        |                   |     |             |                   |
|        |                   |     |   increased |                   |
|        |                   |     |             |                   |
|        |                   |     |    appetite |                   |
|        |                   |     |     and     |                   |
|        |                   |     |             |                   |
|        |                   |     |    interest |                   |
|        |                   |     |     in      |                   |
|        |                   |     |     foods.  |                   |
|        |                   |     |             |                   |
|        |                   |     | -   It's    |                   |
|        |                   |     |     normal  |                   |
|        |                   |     |     for     |                   |
|        |                   |     |     amounts |                   |
|        |                   |     |     eaten   |                   |
|        |                   |     |     to vary |                   |
|        |                   |     |     from    |                   |
|        |                   |     |     meal to |                   |
|        |                   |     |     meal    |                   |
|        |                   |     |     and day |                   |
|        |                   |     |     to day. |                   |
|        |                   |     |     Offer   |                   |
|        |                   |     |     small   |                   |
|        |                   |     |             |                   |
|        |                   |     |    servings |                   |
|        |                   |     |     of food |                   |
|        |                   |     |     and     |                   |
|        |                   |     |     allow   |                   |
|        |                   |     |     the     |                   |
|        |                   |     |     child   |                   |
|        |                   |     |     to      |                   |
|        |                   |     |             |                   |
|        |                   |     |   determine |                   |
|        |                   |     |     how     |                   |
|        |                   |     |     much    |                   |
|        |                   |     |     he/she  |                   |
|        |                   |     |     wants   |                   |
|        |                   |     |     to eat. |                   |
|        |                   |     |             |                   |
|        |                   |     | -   Remind  |                   |
|        |                   |     |     parent  |                   |
|        |                   |     |     not to  |                   |
|        |                   |     |             |                   |
|        |                   |     |    struggle |                   |
|        |                   |     |     with    |                   |
|        |                   |     |     child   |                   |
|        |                   |     |     over    |                   |
|        |                   |     |     food.   |                   |
|        |                   |     |             |                   |
|        |                   |     | -           |                   |
|        |                   |     |    Reassure |                   |
|        |                   |     |     parent  |                   |
|        |                   |     |     that if |                   |
|        |                   |     |     the     |                   |
|        |                   |     |     child   |                   |
|        |                   |     |     does    |                   |
|        |                   |     |     not eat |                   |
|        |                   |     |             |                   |
|        |                   |     |  everything |                   |
|        |                   |     |     on the  |                   |
|        |                   |     |     plate   |                   |
|        |                   |     |     at a    |                   |
|        |                   |     |     meal,   |                   |
|        |                   |     |     it's ok |                   |
|        |                   |     |     to      |                   |
|        |                   |     |     trust   |                   |
|        |                   |     |     that    |                   |
|        |                   |     |     he/she  |                   |
|        |                   |     |     is      |                   |
|        |                   |     |     full.   |                   |
+--------+-------------------+-----+-------------+-------------------+
| **     | -   ***Meal       |     | -   Well    |                   |
| Family |     Location:**   |     |             |                   |
| Meal   |     Ask "Where do |     |    balanced |                   |
| /Snack |     you usually   |     |     meals   |                   |
| Pract  |     eat your      |     |     and     |                   |
| ices** |     meals and     |     |             |                   |
|        |     snacks? Where |     |    snacks + |                   |
|        |     does \_\_\_   |     |             |                   |
|        |     eat           |     |    Positive |                   |
|        |                   |     |     eating  |                   |
|        |    meals/snacks?* |     |             |                   |
|        |                   |     | environment |                   |
|        | -   ***Pleasant   |     |     = Well  |                   |
|        |     conve         |     |             |                   |
|        | rsation---include |     |   nourished |                   |
|        |     everyone in   |     |     child.  |                   |
|        |     conversation  |     |             |                   |
|        |     during a      |     |    Children |                   |
|        |     meal.** Ask   |     |     need a  |                   |
|        |     "What is      |     |             |                   |
|        |     conversation  |     |   pleasant, |                   |
|        |     like during   |     |             |                   |
|        |     mealtimes? Is |     |  structured |                   |
|        |     your child    |     |             |                   |
|        |     included?"*   |     |    mealtime |                   |
|        |                   |     |     e       |                   |
|        | -                 |     | nvironment. |                   |
|        |   ***Distractions |     |             |                   |
|        |     are           |     | -   Avoid   |                   |
|        |     minimized.**  |     |     letting |                   |
|        |     Ask "Are      |     |     child   |                   |
|        |     there any     |     |             |                   |
|        |     distractions  |     |   eat/drink |                   |
|        |     for your      |     |     in the  |                   |
|        |     child, such   |     |     car     |                   |
|        |     as television |     |             |                   |
|        |     or nearby     |     | -   Pull    |                   |
|        |     toys, during  |     |     high    |                   |
|        |     mealtime? How |     |     chair   |                   |
|        |     do you help   |     |     up to   |                   |
|        |     \_\_\_ focus  |     |     the     |                   |
|        |     on            |     |     table   |                   |
|        |     mealtime?*"   |     |     to      |                   |
|        |                   |     |     include |                   |
|        | -   ***Seated to  |     |     young   |                   |
|        |     eat or        |     |     toddler |                   |
|        |     drink.** Ask  |     |     in      |                   |
|        |     ""Does \_\_\_ |     |     family  |                   |
|        |     get up and    |     |     meal.   |                   |
|        |     wander away   |     |             |                   |
|        |     from the      |     | -           |                   |
|        |     table during  |     |    Pleasant |                   |
|        |     meals? If so, |     |     c       |                   |
|        |     what do you   |     | onversation |                   |
|        |     do about      |     |     will    |                   |
|        |     it?"*         |     |     help    |                   |
|        |                   |     |     the     |                   |
|        | -   ***Family     |     |     child   |                   |
|        |     enjoys same   |     |             |                   |
|        |     prepared      |     |   associate |                   |
|        |     meal.*** *Ask |     |             |                   |
|        |     "Do you       |     |    mealtime |                   |
|        |     prepare one   |     |     with a  |                   |
|        |     meal for all  |     |     safe    |                   |
|        |     family        |     |     place   |                   |
|        |     members,      |     |     that he |                   |
|        |                   |     |     looks   |                   |
|        |  [or]{.underline} |     |     forward |                   |
|        |     do you fix    |     |     to.     |                   |
|        |     special items |     |             |                   |
|        |     for certain   |     | -           |                   |
|        |     individuals   |     |    Although |                   |
|        |     in the        |     |     young   |                   |
|        |     family?"*     |     |             |                   |
|        |                   |     |    toddlers |                   |
|        | -   ***Parent     |     |     may not |                   |
|        |     eats with     |     |     be able |                   |
|        |     child during  |     |     to      |                   |
|        |                   |     |     carry   |                   |
|        |  meals/snacks.*** |     |     on a    |                   |
|        |     *Ask "Who     |     |     co      |                   |
|        |     usually eats  |     | nversation, |                   |
|        |     with \_\_\_   |     |     they    |                   |
|        |     during meals? |     |     are     |                   |
|        |     Snacks? How   |     |             |                   |
|        |     often do you  |     |    watching |                   |
|        |     sit down with |     |     and     |                   |
|        |     your child    |     |             |                   |
|        |     and eat       |     |    learning |                   |
|        |     together? How |     |     from    |                   |
|        |     do you help   |     |     those   |                   |
|        |     \_\_\_ learn  |     |     around  |                   |
|        |     good table    |     |     them.   |                   |
|        |     manners?"*    |     |             |                   |
|        |                   |     | -           |                   |
|        | -   ***Parent     |     |    Children |                   |
|        |     avoids using  |     |     have    |                   |
|        |     food as       |     |     short   |                   |
|        |     reward or     |     |             |                   |
|        |     punishment.** |     |   attention |                   |
|        |     Ask "Does     |     |     spans.  |                   |
|        |     your child    |     |     Parents |                   |
|        |     ever view     |     |     can     |                   |
|        |     food as a     |     |     help    |                   |
|        |     prize for     |     |     them    |                   |
|        |     good          |     |     eat     |                   |
|        |     behavior?     |     |     well by |                   |
|        |     Examples of   |     |             |                   |
|        |     "prizes"      |     |  minimizing |                   |
|        |     include trips |     |     di      |                   |
|        |     to McD's,     |     | stractions, |                   |
|        |     candy,        |     |     like    |                   |
|        |     dessert,      |     |     turning |                   |
|        |     etc.*         |     |     off the |                   |
|        |                   |     |             |                   |
|        |                   |     |  television |                   |
|        |                   |     |     or loud |                   |
|        |                   |     |     music.  |                   |
|        |                   |     |             |                   |
|        |                   |     | -   Let     |                   |
|        |                   |     |     child   |                   |
|        |                   |     |     leave   |                   |
|        |                   |     |     table   |                   |
|        |                   |     |     when    |                   |
|        |                   |     |             |                   |
|        |                   |     |    finished |                   |
|        |                   |     |     eating  |                   |
|        |                   |     |     but     |                   |
|        |                   |     |     don't   |                   |
|        |                   |     |     allow   |                   |
|        |                   |     |     him/her |                   |
|        |                   |     |     to come |                   |
|        |                   |     |     back to |                   |
|        |                   |     |     graze   |                   |
|        |                   |     |     and     |                   |
|        |                   |     |     pick.   |                   |
|        |                   |     |             |                   |
|        |                   |     | -           |                   |
|        |                   |     |    Children |                   |
|        |                   |     |     can be  |                   |
|        |                   |     |             |                   |
|        |                   |     |    expected |                   |
|        |                   |     |     to eat  |                   |
|        |                   |     |     the     |                   |
|        |                   |     |     same    |                   |
|        |                   |     |     foods   |                   |
|        |                   |     |     as      |                   |
|        |                   |     |             |                   |
|        |                   |     |    everyone |                   |
|        |                   |     |     else in |                   |
|        |                   |     |     the     |                   |
|        |                   |     |     family. |                   |
|        |                   |     |     This    |                   |
|        |                   |     |     helps   |                   |
|        |                   |     |     them to |                   |
|        |                   |     |     feel    |                   |
|        |                   |     |             |                   |
|        |                   |     |    included |                   |
|        |                   |     |     in the  |                   |
|        |                   |     |     family, |                   |
|        |                   |     |     and     |                   |
|        |                   |     |     exposes |                   |
|        |                   |     |     them to |                   |
|        |                   |     |     new     |                   |
|        |                   |     |     tastes  |                   |
|        |                   |     |     and     |                   |
|        |                   |     |             |                   |
|        |                   |     |   textures. |                   |
|        |                   |     |     Avoid   |                   |
|        |                   |     |             |                   |
|        |                   |     |   catering, |                   |
|        |                   |     |     or      |                   |
|        |                   |     |     "short  |                   |
|        |                   |     |     order   |                   |
|        |                   |     |             |                   |
|        |                   |     |    cooking" |                   |
|        |                   |     |     to      |                   |
|        |                   |     |     their   |                   |
|        |                   |     |     p       |                   |
|        |                   |     | references. |                   |
|        |                   |     |             |                   |
|        |                   |     | -   Parents |                   |
|        |                   |     |     can     |                   |
|        |                   |     |     role    |                   |
|        |                   |     |     model   |                   |
|        |                   |     |     for     |                   |
|        |                   |     |     their   |                   |
|        |                   |     |     child   |                   |
|        |                   |     |     by      |                   |
|        |                   |     |     eating  |                   |
|        |                   |     |     a       |                   |
|        |                   |     |     variety |                   |
|        |                   |     |     of      |                   |
|        |                   |     |     foods   |                   |
|        |                   |     |     and     |                   |
|        |                   |     |             |                   |
|        |                   |     |  practicing |                   |
|        |                   |     |     desired |                   |
|        |                   |     |             |                   |
|        |                   |     |    mealtime |                   |
|        |                   |     |             |                   |
|        |                   |     |  behaviors. |                   |
|        |                   |     |     *If*    |                   |
|        |                   |     |     *       |                   |
|        |                   |     | necessary*, |                   |
|        |                   |     |     *ask    |                   |
|        |                   |     |     about   |                   |
|        |                   |     |     the     |                   |
|        |                   |     |             |                   |
|        |                   |     |    parent's |                   |
|        |                   |     |     food    |                   |
|        |                   |     |             |                   |
|        |                   |     | preferences |                   |
|        |                   |     |     and     |                   |
|        |                   |     |     eating  |                   |
|        |                   |     |             |                   |
|        |                   |     |    habits.* |                   |
|        |                   |     |             |                   |
|        |                   |     | -   If the  |                   |
|        |                   |     |     child   |                   |
|        |                   |     |     is      |                   |
|        |                   |     |     aware   |                   |
|        |                   |     |     of the  |                   |
|        |                   |     |             |                   |
|        |                   |     |    parent's |                   |
|        |                   |     |             |                   |
|        |                   |     |    specific |                   |
|        |                   |     |     food    |                   |
|        |                   |     |     like    |                   |
|        |                   |     | s/dislikes, |                   |
|        |                   |     |     the     |                   |
|        |                   |     |     child   |                   |
|        |                   |     |     has too |                   |
|        |                   |     |     much    |                   |
|        |                   |     |     i       |                   |
|        |                   |     | nformation. |                   |
|        |                   |     |             |                   |
|        |                   |     | -   Because |                   |
|        |                   |     |             |                   |
|        |                   |     |    mealtime |                   |
|        |                   |     |     is also |                   |
|        |                   |     |     a       |                   |
|        |                   |     |     social  |                   |
|        |                   |     |     time,   |                   |
|        |                   |     |             |                   |
|        |                   |     |    children |                   |
|        |                   |     |     eat     |                   |
|        |                   |     |     better  |                   |
|        |                   |     |     when    |                   |
|        |                   |     |     they    |                   |
|        |                   |     |     eat     |                   |
|        |                   |     |     with    |                   |
|        |                   |     |     others. |                   |
|        |                   |     |             |                   |
|        |                   |     | -   Impose  |                   |
|        |                   |     |     limits  |                   |
|        |                   |     |     on      |                   |
|        |                   |     |     u       |                   |
|        |                   |     | nacceptable |                   |
|        |                   |     |             |                   |
|        |                   |     |    mealtime |                   |
|        |                   |     |             |                   |
|        |                   |     |    behavior |                   |
|        |                   |     |     without |                   |
|        |                   |     |             |                   |
|        |                   |     | controlling |                   |
|        |                   |     |     amount  |                   |
|        |                   |     |     of food |                   |
|        |                   |     |     child   |                   |
|        |                   |     |     wants   |                   |
|        |                   |     |     to eat. |                   |
|        |                   |     |             |                   |
|        |                   |     | -   Discuss |                   |
|        |                   |     |     using   |                   |
|        |                   |     |     things  |                   |
|        |                   |     |     other   |                   |
|        |                   |     |     than    |                   |
|        |                   |     |     food to |                   |
|        |                   |     |     reward  |                   |
|        |                   |     |     or      |                   |
|        |                   |     |             |                   |
|        |                   |     |  discipline |                   |
|        |                   |     |     child,  |                   |
|        |                   |     |     such as |                   |
|        |                   |     |             |                   |
|        |                   |     |   stickers, |                   |
|        |                   |     |     trips   |                   |
|        |                   |     |     to the  |                   |
|        |                   |     |             |                   |
|        |                   |     | playground, |                   |
|        |                   |     |     a new   |                   |
|        |                   |     |     game,   |                   |
|        |                   |     |     etc..   |                   |
+--------+-------------------+-----+-------------+-------------------+
| **New  | -   ***Child's    |     | -   It is   |                   |
| f      |     typical       |     |     normal  |                   |
| oods** |     reaction:     |     |     for     |                   |
|        |     accepts,      |     |             |                   |
|        |     wary,         |     |    children |                   |
|        |     refuses.**    |     |     to be   |                   |
|        |     Ask "How does |     |     wary of |                   |
|        |     your child    |     |     trying  |                   |
|        |     react when    |     |     new     |                   |
|        |     you offer a   |     |     f       |                   |
|        |     new food?     |     | oods---they |                   |
|        |     What do you   |     |     may     |                   |
|        |     do if she     |     |     need to |                   |
|        |     doesn't like  |     |     touch,  |                   |
|        |     a particular  |     |     smell,  |                   |
|        |     food?"*       |     |     feel    |                   |
|        |                   |     |     and     |                   |
|        | ```{=html}        |     |     *then*  |                   |
|        | <!-- -->          |     |     taste   |                   |
|        | ```               |     |     before  |                   |
|        | -   ***New foods  |     |     eating. |                   |
|        |     offered       |     |     Be      |                   |
|        |     alongside     |     |             |                   |
|        |     familiar      |     |    prepared |                   |
|        |     foods.** Ask  |     |     to      |                   |
|        |     "Do you offer |     |     offer   |                   |
|        |     new foods     |     |     new/    |                   |
|        |     with other    |     | challenging |                   |
|        |     foods \_\_\_  |     |     foods   |                   |
|        |     is already    |     |     many    |                   |
|        |     familiar      |     |     times   |                   |
|        |     with? When a  |     |     before  |                   |
|        |     new food is   |     |     they    |                   |
|        |     offered, what |     |     agree   |                   |
|        |     else is       |     |     to eat  |                   |
|        |     served with   |     |     it.     |                   |
|        |     it?"*         |     |     Offer   |                   |
|        |                   |     |     new     |                   |
|        |                   |     |     food    |                   |
|        |                   |     |     even if |                   |
|        |                   |     |     child   |                   |
|        |                   |     |     has     |                   |
|        |                   |     |             |                   |
|        |                   |     |    rejected |                   |
|        |                   |     |     it in   |                   |
|        |                   |     |     the     |                   |
|        |                   |     |     past    |                   |
|        |                   |     |             |                   |
|        |                   |     | -           |                   |
|        |                   |     |    Reassure |                   |
|        |                   |     |     parent  |                   |
|        |                   |     |     that    |                   |
|        |                   |     |     it's ok |                   |
|        |                   |     |     for     |                   |
|        |                   |     |     toddler |                   |
|        |                   |     |     to get  |                   |
|        |                   |     |             |                   |
|        |                   |     |    familiar |                   |
|        |                   |     |     with    |                   |
|        |                   |     |     new     |                   |
|        |                   |     |     food by |                   |
|        |                   |     |     putting |                   |
|        |                   |     |     it into |                   |
|        |                   |     |     and     |                   |
|        |                   |     |     taking  |                   |
|        |                   |     |     it back |                   |
|        |                   |     |     out of  |                   |
|        |                   |     |     the     |                   |
|        |                   |     |     m       |                   |
|        |                   |     | outh---this |                   |
|        |                   |     |     is the  |                   |
|        |                   |     |     process |                   |
|        |                   |     |     of      |                   |
|        |                   |     |             |                   |
|        |                   |     |    becoming |                   |
|        |                   |     |             |                   |
|        |                   |     |    familiar |                   |
|        |                   |     |     with a  |                   |
|        |                   |     |     food.   |                   |
|        |                   |     |             |                   |
|        |                   |     | -           |                   |
|        |                   |     |   Introduce |                   |
|        |                   |     |     new     |                   |
|        |                   |     |     food in |                   |
|        |                   |     |     a       |                   |
|        |                   |     |     neutral |                   |
|        |                   |     |     way.    |                   |
|        |                   |     |     Talk    |                   |
|        |                   |     |     about   |                   |
|        |                   |     |     the     |                   |
|        |                   |     |     color,  |                   |
|        |                   |     |     shape,  |                   |
|        |                   |     |     aroma   |                   |
|        |                   |     |     and     |                   |
|        |                   |     |             |                   |
|        |                   |     |    texture, |                   |
|        |                   |     |     but not |                   |
|        |                   |     |     how it  |                   |
|        |                   |     |     tastes. |                   |
|        |                   |     |             |                   |
|        |                   |     | -   Trying  |                   |
|        |                   |     |     new     |                   |
|        |                   |     |     foods   |                   |
|        |                   |     |     takes   |                   |
|        |                   |     |     time,   |                   |
|        |                   |     |     so      |                   |
|        |                   |     |             |                   |
|        |                   |     |   mealtimes |                   |
|        |                   |     |     should  |                   |
|        |                   |     |     be      |                   |
|        |                   |     |     relaxed |                   |
|        |                   |     |     but     |                   |
|        |                   |     |     never   |                   |
|        |                   |     |             |                   |
|        |                   |     |  prolonged. |                   |
|        |                   |     |             |                   |
|        |                   |     | -           |                   |
|        |                   |     |    Reassure |                   |
|        |                   |     |     \_\_\_  |                   |
|        |                   |     |     that he |                   |
|        |                   |     |     has     |                   |
|        |                   |     |     control |                   |
|        |                   |     |     over    |                   |
|        |                   |     |     whether |                   |
|        |                   |     |     or not  |                   |
|        |                   |     |     he      |                   |
|        |                   |     |     tries a |                   |
|        |                   |     |     new/    |                   |
|        |                   |     | challenging |                   |
|        |                   |     |     food by |                   |
|        |                   |     |     telling |                   |
|        |                   |     |     him     |                   |
|        |                   |     |     it's ok |                   |
|        |                   |     |     if he   |                   |
|        |                   |     |     doesn't |                   |
|        |                   |     |     want to |                   |
|        |                   |     |     eat it  |                   |
|        |                   |     |     t       |                   |
|        |                   |     | oday...next |                   |
|        |                   |     |     time he |                   |
|        |                   |     |     might   |                   |
|        |                   |     |     feel    |                   |
|        |                   |     |     d       |                   |
|        |                   |     | ifferently. |                   |
|        |                   |     |     Be      |                   |
|        |                   |     |     assured |                   |
|        |                   |     |     he may  |                   |
|        |                   |     |             |                   |
|        |                   |     |  eventually |                   |
|        |                   |     |     be      |                   |
|        |                   |     |     willing |                   |
|        |                   |     |     to try  |                   |
|        |                   |     |     the     |                   |
|        |                   |     |     food.   |                   |
|        |                   |     |             |                   |
|        |                   |     | -   Offer a |                   |
|        |                   |     |     "safe   |                   |
|        |                   |     |     food"   |                   |
|        |                   |     |     with    |                   |
|        |                   |     |     every   |                   |
|        |                   |     |             |                   |
|        |                   |     | meal---this |                   |
|        |                   |     |     is a    |                   |
|        |                   |     |     food    |                   |
|        |                   |     |     your    |                   |
|        |                   |     |     child   |                   |
|        |                   |     |     is      |                   |
|        |                   |     |             |                   |
|        |                   |     |    familiar |                   |
|        |                   |     |     with    |                   |
|        |                   |     |     and has |                   |
|        |                   |     |     liked   |                   |
|        |                   |     |     in the  |                   |
|        |                   |     |     past.   |                   |
|        |                   |     |             |                   |
|        |                   |     | -   By      |                   |
|        |                   |     |             |                   |
|        |                   |     |    offering |                   |
|        |                   |     |     a safe  |                   |
|        |                   |     |     food at |                   |
|        |                   |     |     every   |                   |
|        |                   |     |     meal,   |                   |
|        |                   |     |     it will |                   |
|        |                   |     |     remove  |                   |
|        |                   |     |     the     |                   |
|        |                   |     |     urge to |                   |
|        |                   |     |     cater   |                   |
|        |                   |     |     to the  |                   |
|        |                   |     |     child.  |                   |
+--------+-------------------+-----+-------------+-------------------+
| **     | -   Meals should  |     |             |                   |
| Diet** |     include the   |     |             |                   |
|        |     following to  |     |             |                   |
|        |     help the      |     |             |                   |
|        |     child be      |     |             |                   |
|        |     successful at |     |             |                   |
|        |     eating:       |     |             |                   |
|        |                   |     |             |                   |
|        |     1.            |     |             |                   |
|        |                   |     |             |                   |
|        |     2.            |     |             |                   |
|        | Meat/poultry/fish |     |             |                   |
|        | /eggs/legumes/egg |     |             |                   |
|        |                   |     |             |                   |
|        |     3.            |     |             |                   |
|        |   Fruit/vegetable |     |             |                   |
|        |         or both   |     |             |                   |
|        |                   |     |             |                   |
|        |     4.  Bread---  |     |             |                   |
|        |         ½ slice   |     |             |                   |
|        |                   |     |             |                   |
|        |     5.  Milk--- ½ |     |             |                   |
|        |         to ¾ cup  |     |             |                   |
|        |                   |     |             |                   |
|        |     6.  Butter,   |     |             |                   |
|        |                   |     |             |                   |
|        |        margarine, |     |             |                   |
|        |         salad     |     |             |                   |
|        |         dressing  |     |             |                   |
|        |                   |     |             |                   |
|        | -   Make a        |     |             |                   |
|        |     distinction   |     |             |                   |
|        |     between foods |     |             |                   |
|        |     offered to    |     |             |                   |
|        |     the child and |     |             |                   |
|        |     foods         |     |             |                   |
|        |     selected by   |     |             |                   |
|        |     the child; it |     |             |                   |
|        |     is *not* the  |     |             |                   |
|        |     parent's job  |     |             |                   |
|        |     to make sure  |     |             |                   |
|        |     food gets     |     |             |                   |
|        |     *into* the    |     |             |                   |
|        |     child. It is  |     |             |                   |
|        |     ok if child   |     |             |                   |
|        |     eats only 1-2 |     |             |                   |
|        |     foods at a    |     |             |                   |
|        |     meal.         |     |             |                   |
|        |                   |     |             |                   |
|        | -   Emphasize     |     |             |                   |
|        |     v             |     |             |                   |
|        | ariety---children |     |             |                   |
|        |     love a        |     |             |                   |
|        |     variety of    |     |             |                   |
|        |     color and     |     |             |                   |
|        |     texture.      |     |             |                   |
|        |                   |     |             |                   |
|        | ```{=html}        |     |             |                   |
|        | <!-- -->          |     |             |                   |
|        | ```               |     |             |                   |
|        | -   Serve milk at |     |             |                   |
|        |     every meal in |     |             |                   |
|        |     a cup. Water  |     |             |                   |
|        |     is a great    |     |             |                   |
|        |     beverage in   |     |             |                   |
|        |     between       |     |             |                   |
|        |     meals. If     |     |             |                   |
|        |     juice is      |     |             |                   |
|        |     offered,      |     |             |                   |
|        |                   |     |             |                   |
|        | > 4 ounces/day at |     |             |                   |
|        | > a snack is the  |     |             |                   |
|        | > most that       |     |             |                   |
|        | > should be       |     |             |                   |
|        | > provided.       |     |             |                   |
|        |                   |     |             |                   |
|        | -   *De           |     |             |                   |
|        | ssert*---Children |     |             |                   |
|        |     do not        |     |             |                   |
|        |     understand    |     |             |                   |
|        |     why dessert   |     |             |                   |
|        |     items come    |     |             |                   |
|        |     after the     |     |             |                   |
|        |     rest of a     |     |             |                   |
|        |     meal. When    |     |             |                   |
|        |     offered       |     |             |                   |
|        |     separately,   |     |             |                   |
|        |     dessert is    |     |             |                   |
|        |     viewed as     |     |             |                   |
|        |     something     |     |             |                   |
|        |     special or a  |     |             |                   |
|        |     "treat". When |     |             |                   |
|        |     this becomes  |     |             |                   |
|        |     an issue, try |     |             |                   |
|        |     serving one   |     |             |                   |
|        |                   |     |             |                   |
|        |   age-appropriate |     |             |                   |
|        |     dessert       |     |             |                   |
|        |     portion       |     |             |                   |
|        |     alongside the |     |             |                   |
|        |     meal, so it   |     |             |                   |
|        |     does not      |     |             |                   |
|        |     become the    |     |             |                   |
|        |     "reward". The |     |             |                   |
|        |     child will    |     |             |                   |
|        |     soon learn    |     |             |                   |
|        |     that dessert  |     |             |                   |
|        |     alone will    |     |             |                   |
|        |     not fill them |     |             |                   |
|        |     up *as long   |     |             |                   |
|        |     as parents    |     |             |                   |
|        |     will not give |     |             |                   |
|        |     in to "hunger |     |             |                   |
|        |     cries" soon   |     |             |                   |
|        |     after the     |     |             |                   |
|        |     meal.*        |     |             |                   |
|        |     Parents must  |     |             |                   |
|        |     remain        |     |             |                   |
|        |     consistent    |     |             |                   |
|        |     with regular  |     |             |                   |
|        |     meal and      |     |             |                   |
|        |     snack times.  |     |             |                   |
|        |                   |     |             |                   |
|        | -   Dessert does  |     |             |                   |
|        |     not always    |     |             |                   |
|        |     mean "sweet   |     |             |                   |
|        |     things".      |     |             |                   |
|        |     Fruit can be  |     |             |                   |
|        |     considered a  |     |             |                   |
|        |     dessert item. |     |             |                   |
|        |                   |     |             |                   |
|        | -   Make sure     |     |             |                   |
|        |     foods offered |     |             |                   |
|        |     are healthy   |     |             |                   |
|        |     choices;      |     |             |                   |
|        |     avoid high    |     |             |                   |
|        |     sugar empty   |     |             |                   |
|        |     calorie       |     |             |                   |
|        |     foods.        |     |             |                   |
|        |                   |     |             |                   |
|        | -   If toddler is |     |             |                   |
|        |     still         |     |             |                   |
|        |                   |     |             |                   |
|        |    breastfeeding, |     |             |                   |
|        |     congratulate  |     |             |                   |
|        |     mom on        |     |             |                   |
|        |     continuing    |     |             |                   |
|        |     with this     |     |             |                   |
|        |     relationship, |     |             |                   |
|        |     and share     |     |             |                   |
|        |     that the      |     |             |                   |
|        |     World Health  |     |             |                   |
|        |     Organization  |     |             |                   |
|        |     (WHO) goal    |     |             |                   |
|        |     for           |     |             |                   |
|        |     breastfeeding |     |             |                   |
|        |     is to 2 years |     |             |                   |
|        |     of age.       |     |             |                   |
|        |                   |     |             |                   |
|        | -   *Ask about    |     |             |                   |
|        |     typical meal  |     |             |                   |
|        |     patterns,     |     |             |                   |
|        |     using 24 hour |     |             |                   |
|        |     recall        |     |             |                   |
|        |     information   |     |             |                   |
|        |     if desired.   |     |             |                   |
|        |     List comments |     |             |                   |
|        |     on form.*     |     |             |                   |
|        |                   |     |             |                   |
|        | ```{=html}        |     |             |                   |
|        | <!-- -->          |     |             |                   |
|        | ```               |     |             |                   |
|        | -   Query about   |     |             |                   |
|        |     potentially   |     |             |                   |
|        |     hazardous     |     |             |                   |
|        |     foods such    |     |             |                   |
|        |     as:           |     |             |                   |
|        |                   |     |             |                   |
|        | > unpasteurized   |     |             |                   |
|        | > juices or dairy |     |             |                   |
|        | > products        |     |             |                   |
|        | >                 |     |             |                   |
|        | > raw or          |     |             |                   |
|        | > undercooked     |     |             |                   |
|        | > meat, fish,     |     |             |                   |
|        | > poultry and     |     |             |                   |
|        | > eggs            |     |             |                   |
|        | >                 |     |             |                   |
|        | > foods           |     |             |                   |
|        | > potentially     |     |             |                   |
|        | > contaminated    |     |             |                   |
|        | > with bacteria,  |     |             |                   |
|        | > including       |     |             |                   |
|        | > unwashed        |     |             |                   |
|        | > produce         |     |             |                   |
|        |                   |     |             |                   |
|        | -   Avoid choking |     |             |                   |
|        |     hazard foods  |     |             |                   |
|        |     [with         |     |             |                   |
|        |     toddl         |     |             |                   |
|        | ers]{.underline}: |     |             |                   |
|        |                   |     |             |                   |
|        | > hard candy      |     |             |                   |
|        | > spoonfuls of    |     |             |                   |
|        | > peanut butter   |     |             |                   |
|        | > raisins         |     |             |                   |
|        | > marshmallows    |     |             |                   |
|        | >                 |     |             |                   |
|        | > nuts popcorn    |     |             |                   |
|        | > other dried     |     |             |                   |
|        | > fruits seeds    |     |             |                   |
|        | >                 |     |             |                   |
|        | > whole grapes    |     |             |                   |
|        | > pretzels large  |     |             |                   |
|        | > chunks of food  |     |             |                   |
|        | > raw carrots     |     |             |                   |
|        | >                 |     |             |                   |
|        | > chips hot dogs  |     |             |                   |
+--------+-------------------+-----+-------------+-------------------+
| ###### | **12-17           | *   |             | **24-36           |
| ### Fe | months---**       | *18 |             | months---**       |
| eding  |                   | -23 |             |                   |
| Skills | -   May eat       | mo  |             | -   can hold own  |
|        |     less---growth | nth |             |     cup           |
|        |     slowing down  | s** |             |                   |
|        |                   | --- |             | -   can use spoon |
|        | -                 |     |             |     by self       |
|        |   grasps/releases | -   |             |                   |
|        |     foods with    |     |             | -   will spill a  |
|        |     fingers       | may |             |     lot           |
|        |                   |     |             |                   |
|        | -   can hold      |     |             | -   can chew more |
|        |     spoon but     | eat |             |     foods well    |
|        |     hasn't        |     |             |                   |
|        |     mastered how  |   l |             | -   has definite  |
|        |     to use        | ess |             |                   |
|        |                   | --- |             |    likes/dislikes |
|        | -   can turn      | gro |             |                   |
|        |     spoon in      | wth |             | -   will insist   |
|        |     mouth         |     |             |     on doing      |
|        |                   |   s |             |     things        |
|        | -   can hold cup  | low |             |     himself       |
|        |     but may have  | ing |             |                   |
|        |     difficulty    |     |             | -   prefers       |
|        |     letting go    |   d |             |     routine       |
|        |                   | own |             |                   |
|        | -   wants food    |     |             | -   may dawdle    |
|        |     others are    | -   |             |     during meals  |
|        |     eating        |  li |             |                   |
|        |                   | kes |             | -   may have food |
|        | -   likes to eat  |     |             |     jags          |
|        |     with hands    |  to |             |                   |
|        |     and make a    |     |             | -   may prefer    |
|        |     mess          |     |             |     foods in      |
|        |                   | eat |             |     certain       |
|        | ```{=html}        |     |             |     shapes        |
|        | <!-- -->          |   w |             |                   |
|        | ```               | ith |             | -   will like to  |
|        | -   ***Ask the    |     |             |     help in       |
|        |     following     |  ha |             |     kitchen       |
|        |     questions:*** | nds |             |                   |
|        |                   |     |             | ```{=html}        |
|        | > *"How are       | -   |             | <!-- -->          |
|        | > beverages       |  li |             | ```               |
|        | > served?"*       | kes |             | -   Provide       |
|        | >                 |     |             |     child-sized   |
|        | > *"What are your |     |             |     utensils      |
|        | > weaning         | try |             |                   |
|        | > plans?"*        | ing |             | -   Provide       |
|        |                   |     |             |     opportunities |
|        | -   Encourage use |  fo |             |     for child to  |
|        |     of open-mouth | ods |             |     help with     |
|        |     cup rather    |     |             |     meals         |
|        |     than          |  of |             |                   |
|        |     spillproof or |     |             |                   |
|        |     sip cup.      |   v |             |                   |
|        |                   | ary |             |                   |
|        | **3 to 4          | ing |             |                   |
|        | years---**        |     |             |                   |
|        |                   |  te |             |                   |
|        | -   Can pour      | xtu |             |                   |
|        |     liquids from  | res |             |                   |
|        |     a small       |     |             |                   |
|        |     pitcher       | -   |             |                   |
|        |                   |   p |             |                   |
|        | -   Can use own   | ref |             |                   |
|        |     fork          | ers |             |                   |
|        |                   |     |             |                   |
|        | -   Can chew most |   r |             |                   |
|        |     foods         | out |             |                   |
|        |                   | ine |             |                   |
|        | -   Has increased |     |             |                   |
|        |     appetite and  | -   |             |                   |
|        |     interest in   |     |             |                   |
|        |     foods         | has |             |                   |
|        |                   |     |             |                   |
|        | -   Likes foods   |  fa |             |                   |
|        |     in various    | vor |             |                   |
|        |     shapes and    | ite |             |                   |
|        |     colors        |     |             |                   |
|        |                   |  fo |             |                   |
|        | -   Will be       | ods |             |                   |
|        |     influenced by |     |             |                   |
|        |     television    | -   |             |                   |
|        |                   |   g |             |                   |
|        | -   Will like to  | ets |             |                   |
|        |     imitate the   |     |             |                   |
|        |     cook          |   d |             |                   |
|        |                   | ist |             |                   |
|        |                   | rac |             |                   |
|        |                   | ted |             |                   |
|        |                   |     |             |                   |
|        |                   |     |             |                   |
|        |                   | eas |             |                   |
|        |                   | ily |             |                   |
|        |                   |     |             |                   |
|        |                   | -   |             |                   |
|        |                   |  Re |             |                   |
|        |                   | ass |             |                   |
|        |                   | ure |             |                   |
|        |                   |     |             |                   |
|        |                   |     |             |                   |
|        |                   | par |             |                   |
|        |                   | ent |             |                   |
|        |                   |     |             |                   |
|        |                   |   t |             |                   |
|        |                   | hat |             |                   |
|        |                   |     |             |                   |
|        |                   |   i |             |                   |
|        |                   | t's |             |                   |
|        |                   |     |             |                   |
|        |                   |  ok |             |                   |
|        |                   |     |             |                   |
|        |                   |  if |             |                   |
|        |                   |     |             |                   |
|        |                   |   t |             |                   |
|        |                   | odd |             |                   |
|        |                   | ler |             |                   |
|        |                   |     |             |                   |
|        |                   |  ma |             |                   |
|        |                   | kes |             |                   |
|        |                   |     |             |                   |
|        |                   |   a |             |                   |
|        |                   |     |             |                   |
|        |                   |  me |             |                   |
|        |                   | ss- |             |                   |
|        |                   | --t |             |                   |
|        |                   | his |             |                   |
|        |                   |     |             |                   |
|        |                   |  is |             |                   |
|        |                   |     |             |                   |
|        |                   |     |             |                   |
|        |                   | how |             |                   |
|        |                   |     |             |                   |
|        |                   |     |             |                   |
|        |                   | she |             |                   |
|        |                   |     |             |                   |
|        |                   |     |             |                   |
|        |                   | lea |             |                   |
|        |                   | rns |             |                   |
|        |                   |     |             |                   |
|        |                   |     |             |                   |
|        |                   | and |             |                   |
|        |                   |     |             |                   |
|        |                   |  it |             |                   |
|        |                   |     |             |                   |
|        |                   |  he |             |                   |
|        |                   | lps |             |                   |
|        |                   |     |             |                   |
|        |                   |     |             |                   |
|        |                   | her |             |                   |
|        |                   |     |             |                   |
|        |                   |  en |             |                   |
|        |                   | joy |             |                   |
|        |                   |     |             |                   |
|        |                   |   e |             |                   |
|        |                   | ati |             |                   |
|        |                   | ng. |             |                   |
|        |                   |     |             |                   |
|        |                   | -   |             |                   |
|        |                   |  ** |             |                   |
|        |                   | *If |             |                   |
|        |                   |     |             |                   |
|        |                   |  st |             |                   |
|        |                   | ill |             |                   |
|        |                   |     |             |                   |
|        |                   |  on |             |                   |
|        |                   |     |             |                   |
|        |                   |   b |             |                   |
|        |                   | ott |             |                   |
|        |                   | le, |             |                   |
|        |                   | *** |             |                   |
|        |                   |     |             |                   |
|        |                   |   * |             |                   |
|        |                   | ask |             |                   |
|        |                   |     |             |                   |
|        |                   |  "W |             |                   |
|        |                   | hat |             |                   |
|        |                   |     |             |                   |
|        |                   |     |             |                   |
|        |                   | are |             |                   |
|        |                   |     |             |                   |
|        |                   |   y |             |                   |
|        |                   | our |             |                   |
|        |                   |     |             |                   |
|        |                   |   w |             |                   |
|        |                   | ean |             |                   |
|        |                   | ing |             |                   |
|        |                   |     |             |                   |
|        |                   |  pl |             |                   |
|        |                   | ans |             |                   |
|        |                   | ?"* |             |                   |
|        |                   |     |             |                   |
|        |                   | > . |             |                   |
|        |                   |     |             |                   |
|        |                   | **4 |             |                   |
|        |                   | to  |             |                   |
|        |                   | 5   |             |                   |
|        |                   | y   |             |                   |
|        |                   | ear |             |                   |
|        |                   | s-- |             |                   |
|        |                   | -** |             |                   |
|        |                   |     |             |                   |
|        |                   | -   |             |                   |
|        |                   |   A |             |                   |
|        |                   | ble |             |                   |
|        |                   |     |             |                   |
|        |                   |  to |             |                   |
|        |                   |     |             |                   |
|        |                   |     |             |                   |
|        |                   | use |             |                   |
|        |                   |     |             |                   |
|        |                   |  kn |             |                   |
|        |                   | ife |             |                   |
|        |                   |     |             |                   |
|        |                   |     |             |                   |
|        |                   | and |             |                   |
|        |                   |     |             |                   |
|        |                   |   f |             |                   |
|        |                   | ork |             |                   |
|        |                   |     |             |                   |
|        |                   | -   |             |                   |
|        |                   |   A |             |                   |
|        |                   | ble |             |                   |
|        |                   |     |             |                   |
|        |                   |  to |             |                   |
|        |                   |     |             |                   |
|        |                   |     |             |                   |
|        |                   | use |             |                   |
|        |                   |     |             |                   |
|        |                   |     |             |                   |
|        |                   | cup |             |                   |
|        |                   |     |             |                   |
|        |                   |   w |             |                   |
|        |                   | ell |             |                   |
|        |                   |     |             |                   |
|        |                   | -   |             |                   |
|        |                   |   M |             |                   |
|        |                   | ore |             |                   |
|        |                   |     |             |                   |
|        |                   |   i |             |                   |
|        |                   | nte |             |                   |
|        |                   | res |             |                   |
|        |                   | ted |             |                   |
|        |                   |     |             |                   |
|        |                   |  in |             |                   |
|        |                   |     |             |                   |
|        |                   |   t |             |                   |
|        |                   | alk |             |                   |
|        |                   | ing |             |                   |
|        |                   |     |             |                   |
|        |                   |   t |             |                   |
|        |                   | han |             |                   |
|        |                   |     |             |                   |
|        |                   |     |             |                   |
|        |                   | eat |             |                   |
|        |                   | ing |             |                   |
|        |                   |     |             |                   |
|        |                   | -   |             |                   |
|        |                   |     |             |                   |
|        |                   | May |             |                   |
|        |                   |     |             |                   |
|        |                   |   h |             |                   |
|        |                   | ave |             |                   |
|        |                   |     |             |                   |
|        |                   |   f |             |                   |
|        |                   | ood |             |                   |
|        |                   |     |             |                   |
|        |                   |   j |             |                   |
|        |                   | ags |             |                   |
|        |                   |     |             |                   |
|        |                   | -   |             |                   |
|        |                   |     |             |                   |
|        |                   | Can |             |                   |
|        |                   |     |             |                   |
|        |                   |  be |             |                   |
|        |                   |     |             |                   |
|        |                   |     |             |                   |
|        |                   | mot |             |                   |
|        |                   | iva |             |                   |
|        |                   | ted |             |                   |
|        |                   |     |             |                   |
|        |                   |  to |             |                   |
|        |                   |     |             |                   |
|        |                   |     |             |                   |
|        |                   | eat |             |                   |
|        |                   |     |             |                   |
|        |                   | -   |             |                   |
|        |                   |  Li |             |                   |
|        |                   | kes |             |                   |
|        |                   |     |             |                   |
|        |                   |  to |             |                   |
|        |                   |     |             |                   |
|        |                   |   h |             |                   |
|        |                   | elp |             |                   |
|        |                   |     |             |                   |
|        |                   |   p |             |                   |
|        |                   | rep |             |                   |
|        |                   | are |             |                   |
|        |                   |     |             |                   |
|        |                   |   f |             |                   |
|        |                   | ood |             |                   |
|        |                   |     |             |                   |
|        |                   | -   |             |                   |
|        |                   |   I |             |                   |
|        |                   | nte |             |                   |
|        |                   | res |             |                   |
|        |                   | ted |             |                   |
|        |                   |     |             |                   |
|        |                   |  in |             |                   |
|        |                   |     |             |                   |
|        |                   |  wh |             |                   |
|        |                   | ere |             |                   |
|        |                   |     |             |                   |
|        |                   |   f |             |                   |
|        |                   | ood |             |                   |
|        |                   |     |             |                   |
|        |                   |  co |             |                   |
|        |                   | mes |             |                   |
|        |                   |     |             |                   |
|        |                   |   f |             |                   |
|        |                   | rom |             |                   |
|        |                   |     |             |                   |
|        |                   | -   |             |                   |
|        |                   |     |             |                   |
|        |                   | Inc |             |                   |
|        |                   | rea |             |                   |
|        |                   | sin |             |                   |
|        |                   | gly |             |                   |
|        |                   |     |             |                   |
|        |                   |   i |             |                   |
|        |                   | nfl |             |                   |
|        |                   | uen |             |                   |
|        |                   | ced |             |                   |
|        |                   |     |             |                   |
|        |                   |  by |             |                   |
|        |                   |     |             |                   |
|        |                   |     |             |                   |
|        |                   | pee |             |                   |
|        |                   | rs, |             |                   |
|        |                   |     |             |                   |
|        |                   |  me |             |                   |
|        |                   | dia |             |                   |
+--------+-------------------+-----+-------------+-------------------+
| **     | -   Encourage     |     |             |                   |
| Dental |     **[pare       |     |             |                   |
| Care** | nt]{.underline}** |     |             |                   |
|        |     to brush the  |     |             |                   |
|        |     child's teeth |     |             |                   |
|        |     a minimum of  |     |             |                   |
|        |     twice/day.    |     |             |                   |
|        |     Children are  |     |             |                   |
|        |     not capable   |     |             |                   |
|        |     of doing an   |     |             |                   |
|        |     adequate job  |     |             |                   |
|        |     of brushing   |     |             |                   |
|        |     by themselves |     |             |                   |
|        |     until they    |     |             |                   |
|        |     are about 7   |     |             |                   |
|        |     or 8 years    |     |             |                   |
|        |     old. After    |     |             |                   |
|        |     mealtimes, if |     |             |                   |
|        |     a toothbrush  |     |             |                   |
|        |     is not        |     |             |                   |
|        |     available,    |     |             |                   |
|        |     have child    |     |             |                   |
|        |     drink water   |     |             |                   |
|        |     to rinse the  |     |             |                   |
|        |     mouth.        |     |             |                   |
|        |                   |     |             |                   |
|        | -   Include date  |     |             |                   |
|        |     of last       |     |             |                   |
|        |     hygiene       |     |             |                   |
|        |     visit,        |     |             |                   |
|        |     including WIC |     |             |                   |
|        |     dental visit  |     |             |                   |
|        |     if hygiene    |     |             |                   |
|        |     clinics are   |     |             |                   |
|        |     provided at   |     |             |                   |
|        |     WIC.          |     |             |                   |
|        |                   |     |             |                   |
|        | -   Ask parent    |     |             |                   |
|        |     what, if      |     |             |                   |
|        |     anything,     |     |             |                   |
|        |     child drinks  |     |             |                   |
|        |     to fall       |     |             |                   |
|        |     asleep. If a  |     |             |                   |
|        |     beverage is   |     |             |                   |
|        |     provided to   |     |             |                   |
|        |     child when he |     |             |                   |
|        |     is falling    |     |             |                   |
|        |     asleep:       |     |             |                   |
|        |                   |     |             |                   |
|        | > **►**ask what   |     |             |                   |
|        | > it is provided  |     |             |                   |
|        | > in (bottle, sip |     |             |                   |
|        | > cup)            |     |             |                   |
|        | >                 |     |             |                   |
|        | > **►**remind     |     |             |                   |
|        | > parent that,    |     |             |                   |
|        | > after brushing  |     |             |                   |
|        | > the teeth at    |     |             |                   |
|        | > night before    |     |             |                   |
|        | > bedtime, the    |     |             |                   |
|        | > only beverage   |     |             |                   |
|        | > that            |     |             |                   |
|        |                   |     |             |                   |
|        | should be offered |     |             |                   |
|        | is plain water.   |     |             |                   |
+--------+-------------------+-----+-------------+-------------------+
| **     | -   Record which  |     |             |                   |
| Topics |     topics were   |     |             |                   |
| Discu  |                   |     |             |                   |
| ssed** |   covered---there |     |             |                   |
|        |     may be        |     |             |                   |
|        |     several       |     |             |                   |
|        |     things        |     |             |                   |
|        |     checked off   |     |             |                   |
|        |     in the        |     |             |                   |
|        |     various       |     |             |                   |
|        |     sections, but |     |             |                   |
|        |     the counselor |     |             |                   |
|        |     chooses to    |     |             |                   |
|        |     limit the     |     |             |                   |
|        |     discussion to |     |             |                   |
|        |     avoid         |     |             |                   |
|        |     overloading   |     |             |                   |
|        |     the parent.   |     |             |                   |
|        |     It is         |     |             |                   |
|        |     recommended   |     |             |                   |
|        |     that          |     |             |                   |
|        |     discussions   |     |             |                   |
|        |     be limited to |     |             |                   |
|        |     three topics. |     |             |                   |
+--------+-------------------+-----+-------------+-------------------+
| **     | -   If parent     |     |             |                   |
| Parent |     states that a |     |             |                   |
| wants  |     change needs  |     |             |                   |
| to     |     to happen and |     |             |                   |
| work   |     he/she is     |     |             |                   |
| o      |     willing to    |     |             |                   |
| n...** |     work on it,   |     |             |                   |
|        |     record what   |     |             |                   |
|        |     decision was  |     |             |                   |
|        |     made.         |     |             |                   |
+--------+-------------------+-----+-------------+-------------------+
| **At   | -   Record what   |     |             |                   |
| next   |     should be     |     |             |                   |
| appt** |     checked on at |     |             |                   |
|        |     followup,     |     |             |                   |
|        |     including     |     |             |                   |
|        |     immunization  |     |             |                   |
|        |     records, Fl   |     |             |                   |
|        |     tests, lead   |     |             |                   |
|        |     tests, etc.   |     |             |                   |
+--------+-------------------+-----+-------------+-------------------+

##### Child Health Assessment Form

##### Guidance

+---------------------------+------------------------------------------+
| ## Question               | **Suggested Action**                     |
+---------------------------+------------------------------------------+
| Child's physician/dentist | If no MD---refer to local hospital       |
|                           | physician referral service               |
|                           |                                          |
|                           | If no dentist---if child enrolled in     |
|                           | MaineCare, refer to MaineCare member     |
|                           | services (1-800-977-6740) for dentist    |
|                           | who will accept new MaineCare patients.  |
|                           | If not receiving MaineCare, refer to     |
|                           | area clinics.                            |
+---------------------------+------------------------------------------+
| Health Insurance          | If none, refer to MaineCare              |
+---------------------------+------------------------------------------+
| Child's Birth Weight      | If birth weight was \< 5 ½ lbs., assign  |
|                           | risk factor for low birth weight ***for  |
|                           | children \<24 months.*** Query parent    |
|                           | about child's gestational age at         |
|                           | birth---***if child was born \>3 weeks   |
|                           | premature***, adjust plots on growth     |
|                           | chart until child is 24 mo.              |
+---------------------------+------------------------------------------+
| What services does your   | Use appropriate code in "other services" |
| child currently receive?  | field of cert record; refer to programs  |
|                           | as needed.                               |
+---------------------------+------------------------------------------+
| Does your child have any  | If **yes** selected---                   |
| current medical/dental    |                                          |
| problems?                 | -   Refer as needed to primary care      |
|                           |     provider or dentist/dental clinic    |
|                           |                                          |
|                           | -   send for confirmation of diagnosis   |
|                           |     when needed to apply appropriate     |
|                           |     nutrition risk.                      |
+---------------------------+------------------------------------------+
| Does your child drink a   | If **yes** selected---                   |
| special formula,          |                                          |
| nutrition supplement or   | -   Request prescription for special     |
| herbal beverage?          |     formula as needed                    |
|                           |                                          |
|                           | -   Consult with physician when          |
|                           |     nutrition supplement is being used   |
|                           |     and the child is able to eat         |
|                           |     normally. *WIC cannot provide a      |
|                           |     nutrition supplement unless the      |
|                           |     child's ability to eat is precluded  |
|                           |     or restricted by a medical           |
|                           |     condition.*                          |
|                           |                                          |
|                           | -   Provide information to parent re:    |
|                           |     specific herbs as needed.            |
|                           |                                          |
|                           | -   Apply nutrition risk factor as       |
|                           |     appropriate.                         |
+---------------------------+------------------------------------------+
| Does your child take any  | If **yes** selected---                   |
| medications, vitamins or  |                                          |
| supplements (including    | -   Research nutrition implications of   |
| herbs)?                   |     specific medications as well as      |
|                           |     vitamins or supplements.             |
|                           |                                          |
|                           | -   Apply risk factors as appropriate.   |
+---------------------------+------------------------------------------+
| Are there any foods your  | If **yes** selected---                   |
| child cannot eat because  |                                          |
| they cause problems?      | -   Adjust food package accordingly      |
|                           |                                          |
|                           | -   Apply risk factor if appropriate.    |
+---------------------------+------------------------------------------+
| Do any of your child's    | Be sure to have parent include family    |
| family members have a     | members of both biological parents in    |
| history of food allergy?  | the response. If **yes** selected---     |
|                           |                                          |
|                           | -   Counsel parent to delay introduction |
|                           |     of common allergenic foods (peanuts, |
|                           |     tree nuts, shellfish, eggs, citrus,  |
|                           |     and possibly wheat, corn or dairy    |
|                           |     for those especially sensitive) for  |
|                           |     toddlers.                            |
+---------------------------+------------------------------------------+
| Does your child live in   | ###### If *                              |
| or spend time in a home   | *yes** to either question is selected--- |
| built before 1978?        |                                          |
|                           | -   Discuss risk for lead exposure and   |
| If yes, is the home being |     importance of lead testing at 12 and |
| remodeled?                |     24 months                            |
|                           |                                          |
|                           | -   Share ways to reduce lead exposure:  |
|                           |     frequent **wet**, rather than dry,   |
|                           |     **dust removal**; **paint over**     |
|                           |     peeling paint; **remove shoes** at   |
|                           |     door; keep **paint chips** away from |
|                           |     young children                       |
+---------------------------+------------------------------------------+
| Is your child around      | ###### If **yes** selected---            |
| people who smoke          |                                          |
| cigarettes, pipes or      | -   Offer information on **hazards of    |
| cigars?                   |     second-hand smoke for kids**         |
|                           |                                          |
|                           | ###### Refer to **s                      |
|                           | moking cessation programs** as requested |
+---------------------------+------------------------------------------+
| Were there any days last  | ###### If **yes** selected---            |
| month when your family    |                                          |
| did not have enough food  | -   Give referral information for area   |
| to eat or enough money to |     resources, including Food Stamps,    |
| buy food?                 |     Food Banks                           |
+---------------------------+------------------------------------------+
| Do you have problems      | ###### If **yes** is selected---         |
| refrigerating or          |                                          |
| heating/cooking your      | -   Adjust food package accordingly      |
| food?                     |                                          |
|                           | -   Refer to area resources for          |
|                           |     assistance                           |
+---------------------------+------------------------------------------+
| Does your drinking water  | ###### If **yes** selected---            |
| come from a well?         |                                          |
|                           | -   Ensure safety of water supply        |
|                           |                                          |
|                           | ######                                   |
|                           | Provide information for fluoride testing |
+---------------------------+------------------------------------------+