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Infant feeding record
1. Ref. UNICEF/WHO BFHI Section 4: Hospital Self-Appraisal and Monitoring, 2009
INFANT FEEDING RECORD
Date of Delivery ………………………………………………………………………………. Type of Delivery………………………………………………………………………….
Name of Infant ……………………..Bed No. …………………………… UHID / IP No. …………………………….. Admitting Consultant: ……………………………………..
Date &
Time
Breast-
feeding
Y= Yes
N= No
Supplements /
Replacement feeds
How baby fed and
amount
1 =Breast
2= Spoon Feed
Other (specify)
Actions taken OUTPUT Signature of Nurse
What
N = None
W= Water
F= Formula
H= Home prep
O = Other
(Specify)
Why Urine Stool Vomit