Reproducible Forms

Developmental Pre-Feeding Checklist:

A Global Approach

Nrume ________________________ _ _ _ _ _ _ _ _ Assessment date _ _ _ _ _ __

Present
Present- With Not
Spontaneous Facilitation Present
1 Month
Feeding position Supine with the head slightly
ele'vated; or prone; or reclining

.
at an angle of less than 45 degrees;

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or siddying

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Food types Is fed only liquids from the

D
bottle or breast

-E
Food quantity Takes 2 to 6 ounces of liquid

O
per feeding, at 6 or more PR
feedings per day
Sucking liquids Uses a suckling or sucking pattern
y

with the bottle or breast. Loses

lb

some liquid during sucking

ia

Swallowing liquids Swallows thin liquids with a

er

suckle-swallow pattern. Tongue

at

may protrude slightly through

m

the lips with an extension-

ed

retraction movement
Coordination of sucking, Sequences two or more sucks
ht

swallowing, and breathing from the breast or bottle before

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pausing to breathe or swallow

py

Control of drooling Rarely drools because of minimal

co

saliva production
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3 Months
Feeding position Is fed in a supported semi-sitting
pOsition, reclining at an angle
of 45 to 90 degrees

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