Version August 2025
| Suggested questions | Rationale for question |
| General aspects | |
| When does the child eat? | Regular and appropriately spaced feeding intervals (ie, meals and snacks) are needed to optimize appetite and total intake. |
| How much juice (or other sweetened beverages such as soda) does the child drink per day? | Excessive sweetened beverages can suppress appetite with low nutritional value. |
| Does the family follow a special diet (eg, vegetarian, "heart-healthy")? What advice has been followed thus far? | A special or restricted diet requires further evaluation to ensure appropriate nutrient intake. Some of these diets (eg, vegetarian) can be healthy if they are well balanced and have adequate nutrient density. Subsequent counseling will also be shaped by the family's decisions about the child's dietary restriction. |
| When did the child begin solid foods? How were they introduced? How were they tolerated? | Delayed introduction of solid foods (eg, >6 months of age) or poor tolerance can inhibit weight gain. |
| Does the child spit up or vomit in relation to feeding? | Symptoms that are temporally related to specific foods may indicate a food intolerance (eg, food protein intolerance or lactose intolerance). Alternatively, if the caregivers perceive an intolerance, they may underfeed the child even if there is no physiologic intolerance. |
| Do you notice if there are any food or beverages that cause increased gastrointestinal symptoms? | |
| Does the child seem to get tired when feeding? (Tiring is different from falling asleep.) | May indicate a cardiac or pulmonary disorder. |
| Food insecurity | |
| During the past year, have you worried that your food would run out before you got money to buy more? | These are standard questions for screening for food insecurity. Families who endorse either of these questions may benefit from resources to improve food security (eg, referral to public assistance programs and/or social worker), plus further evaluation and guidance to ensure appropriate nutrient intake. |
| During the past year, were there times when the food you bought just didn't last and you didn't have money to get more? | |
| Breastfed infants* | |
| How often does the baby breastfeed? | Infants should breastfeed:
|
| Do you feel any nipple pain while breastfeeding? If so, what do you do? | Nipple pain while breastfeeding usually indicates an ineffective latch. |
| How long does the baby nurse? | Duration of breastfeeding is weakly correlated with total intake but also depends on the effectiveness of the baby's suck and milk flow. |
| Can you hear the baby swallow as they feed? | Audible swallows are a sign of effective intake (milk transfer). |
| Do your breasts feel full between feeds? How many hours after a feed do they start to feel full? | Breast fullness or engorgement indicates good milk production. Milk production usually can be boosted by more frequent feeds and/or pumping to completely empty the breasts. |
| Does the baby have a strong suck/strong latch? | A weak suck may indicate a neurologic disorder. |
| Do you feel the sensation of letdown (a warm, tingly feeling as the milk begins to flow from the breast when the baby cries)? | Letdown sensation is a normal response during breastfeeding and usually is associated with increased milk flow. This is distinct from a dysphoric milk ejection reflex, which is an uncommon condition characterized by unpleasant emotions that occur only with letdown and last a few minutes. |
| Are you feeling stressed or fatigued? | These stressors may result in low milk production and/or may be markers for other breastfeeding problems (pain, insufficient feeding frequency). |
| Are you giving the baby a vitamin D supplement? | Exclusively breastfed infants require supplemental vitamin D (400 international units [10 micrograms] daily). Alternatively, the supplement can be supplied by high-dose vitamin D taken by the mother (4000 to 6400 international units [100 to 160 micrograms] daily). |
| Are you giving the baby an iron supplement? | After 4 months of age, exclusively breastfed infants should have an additional source of iron, such as iron-fortified infant cereal or a liquid iron supplement, to provide 1 mg/kg iron daily. |
| Formula-fed infants | |
| How much formula does the baby drink? How often? | Daily intake should be approximately:
|
| Do you use ready-to-feed, concentrated, or powdered formula? If concentrated or powdered, how do you mix it? | Improper preparation of formula can lead to insufficient nutrient intake. |
| Do you sometimes dilute the formula more to try to make it last longer? | Families with food insecurity may dilute the formula to reduce expense. |
| Do you add anything (eg, infant cereal, baby foods) to the bottle? | If the milk or formula is too thick, the baby may have a hard time getting it from the bottle. |
| Do you hold the bottle during feedings or prop the bottle in the infant's mouth? | Propping the bottle can lead to caries and is a marker for lower attention to the infant during feedings. |
| Feeding environment | |
| Who feeds the child? If the child is fed by multiple caregivers, do they have consistent feeding styles? | These questions help to identify whether the child might be eating poorly because of distractions or a stressful eating environment. |
| Where does the child eat (eg, in a high chair, on a caregiver's lap)? | |
| Does the child usually eat alone or with others? | |
| Are there mealtime distractions (eg, television)? | |
| Feeding behavior/interactions | |
| How do you know when the child is hungry? | These questions help to elicit information about the child's appetite and caregiver-child interactions around food and feeding. Either excessive pressure to eat or low attention to the child's hunger can contribute to poor feeding. |
| How do you know when the child is not hungry? | |
| Do you say or do anything when the child eats well? | |
| Do you say or do anything when the child eats poorly? | |
| Do you have battles with the child about eating? What happens? | |
| Does the child have strong likes and dislikes (ie, is the child "picky")? If so, how do you handle this? | |
| Does the child feed differently with different people? | |
| Does the child make a mess when they eat? If so, is this hard for you? | |
| Does the child refuse food? If so, when does this tend to happen and/or with what foods? | Some food refusal is normal, particularly in toddlers and with specific foods (picky eating). Frequent refusal of many foods can be related to problems with caregiver-child feeding interactions or poor appetite. Occasionally, specific food refusal is a sign of a food intolerance. |
