Complete comprehensive history and physical exam to assess for underlying etiology for malnutrition.
| Factors |
Evaluate |
| Breastfeeding |
- Frequency, length, number per day, longest interval between feedings, night vs. day
- One or both breasts, softer after feeding, use of nipple shield, any pain or difficulty with latch
- If pumping, how much is produced
- See or hear baby swallow
- Any supplementation of expressed human milk or formula
- Falling asleep at breast
|
| Bottle Feeding |
- Frequency, length, amount per feed and per day, longest interval between feedings, night vs. day
- Formula mixing recipe, type, and concentration
- Bottle type, nipple type and size
- Any supplementation to the bottle other than formula
- Food (including solids) other than human milk or formula
|
| Indicators of Pharyngeal Swallow Dysfunction |
- Coughing during feeding
- Wet, gurgly vocal quality during or immediately after feeding
- Frequent upper respiratory tract infections, fevers, or pneumonia
|
| Reflux |
- Coughing, choking, or gagging with feeds
- Spitting up/vomiting
- Respiratory symptoms with feeding
- Arching, irritability or discomfort with feeds
|
| Social |
- Which caregiver(s) feed the baby, who lives in home
- Is caregiver appropriately following baby’s feeding schedule, need help with childcare, and/or receiving WIC and/or SNAP
- If bottle fed, does family have concerns obtaining formula
- Breast pump availability and type, if applicable
|
| Elimination |
- Number of wet diapers and stool diapers per 24 hours
- Stool appearance (consistency, color)
- Presence of orange or red crystal/powder in diaper
- Presence of blood or mucus in stool
|