Infant/Toddler Daily Food Intake and Activities
[Pages:1]Infant/Toddler Daily Food Intake and Activities
Child's Name _________________________________________________ Date_______________________
FOOD INTAKE Meal Type
Breakfast
Lunch
Dinner
Food Served
% of Total Intake
____100% ____ 75% ____ 50% ____ 25%
____100% ____ 75% ____ 50% ____ 25%
____100% ____ 75% ____ 50% ____ 25%
Snacks
A.M. P.M.
____100% ____ 75% ____ 50% ____ 25%
____100% ____ 75% ____ 50% ____ 25%
NAPS: ___YES Time(s): (1) _____until _____ (2) _____ until ______ (3) _____until _______
Comments (if any) _____________________________________________________________
_____________________________________________________________________________
___NO
Reason: ______________________________________________________________________
PLAYTIME: _____________________________________________________________________________________
_________________________________________________________________________________________________
OTHER INFORMATION: _________________________________________________________________________
_________________________________________________________________________________________________
For Provider Use ? Infant/Toddler Daily Food Intake and Activities (2015)
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