VALENCIA POLYMEDIC GENERAL HOSPITAL, INC.

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

vpgh2015@ymail.com (088) 828-8000

INFANT FEEDING RECORD

Skin-to- Supplements²/ Any

How baby Baby’s
skin Breast- Replacement Feeds³ problems
Type of is fed location
contact feeding What Why⁴ 1= Rooming-in⁵ related to
Delivery Date
Baby’s Date of and offer 2= Nursery/ OB positioning
1= NSVD 1= breast room Actions taken of dis-
ID Delivery 2= CS w/o of BF help¹ 1= Yes 0= None
2= bottle or
Gen 2= No 1= Water 3= Special Care charge
1= meets
2= Formula
3= cup Unit attachment
3= CS w/ Gen criterion 4= other
2= does not 3= Home Prep
(specify)
4= other or infant
4= Others (specify)
meet criterion feeding
55977 5/20/ 3 1 1 0 1,3 1 Infant Delayed milk 5/26/
2022 feeding production 2022
(mother teach
how to milk let
down by using
syringe
technique)
56038 5/24/ 3 1 1 0 1 1 Infant Delayed milk 5/27/
2022 feeding production 2022
(mother teach
how to milk let
down by using
syringe
technique)
1. Skin-to-skin contact and offer breastfeeding help: Mother and baby together skin-to-skin from within 5 minutes of birth or recovery for at least an hour and mother shown how to tell when
baby is ready for breastfeeding and offered help if needed (unless delay in contact is justified)
2. Supplements: Any liquids/foods besides breast milk
3. Replacement feeds: Feeding infants who are receiving no breast milk with a diet that provides the nutrients they need until the age when they can be fully fed on family foods.
4. Why: 1. Premature baby, 2. Baby with severe hypoglycemia, 3. Baby with inborn error of metabolism, 4. Baby with acute water loss (i.e phototherapy for jaundice), 5. Severe maternal illness,
6. Mother on medication, 7. Mother HIV positive and replacement feeds are AFASS, 8. Mother’s fully informed choice, 9. Other (specify)
5. Definition of rooming-in: Mother and baby stay in the same room 24 hours a day and not separated unless for justified reason.