VALENCIA POLYMEDIC GENERAL HOSPITAL, INC.

P-13, Poblacion, Sayre High-way, Valencia City, Bukidnon, Philippines

Name of Health Facility: _____________________

Period of Data Collection: _________ to ________
Reporter: _________________________________
Date of Report: ___/____/_____
(day/month/year)

Summary of Infant Feeding Report

Enter the data for the current monitoring period from the “Infant Feeding Record” and calculate the
percentages for the indicators below. If the “Infant feeding record” has not been used but the hospital entered
data from some other source, indicate the source.

TYPE OF DATA NUMBER PERCENTAGE

Total number of babies discharged in the period of data collection
Type of Delivery
Vaginal
Caesarean section without general anesthesia
Caesarean section with general anesthesia
Skin-to-skin contact starting within 5 minutes of birth (or ability to
respond) for at least an hour, with offer of breastfeeding help
Type of Feeding (totals should be equal to 100%)
Exclusive breastfeeding (no supplements)
Mixed feeding (breastfeeding and supplements)
Replacement feeding (no breastfeeding, other liquids or foods
given)
How babies are fed
Breast
Bottle
Cup
Other (please list)
Babies’ location
Rooming/bedding-in
Nursery/observation room
Special care unit
Other
Types of problems related to positioning, attachment and/or infant
feeding (please summarize)

Data Sources:
________________________________________________________________________________________
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