Neonatal Feeding History Form

This neonatal feeding history form provides a comprehensive tool for healthcare providers working with newborns from birth through the first months of life. The form captures critical information about feeding methods, including exclusive breastfeeding, combination feeding, or formula feeding, along with specific details about frequency, duration, and volume of feeds. It documents any feeding difficulties such as poor latching, reflux, excessive spit-up, or signs of inadequate intake that may indicate tongue tie, milk transfer issues, or other concerns.

The form includes sections for maternal health history affecting lactation, birth history, weight gain patterns, stool and urine output tracking, and any interventions attempted such as nipple shields, supplementation, or medication. It helps neonatal nurse practitioners, pediatricians, lactation consultants, and NICU follow-up clinics identify feeding problems early, track growth parameters, and develop appropriate feeding plans. This structured documentation supports coordinated care between multiple providers and ensures continuity when monitoring vulnerable newborns during the critical first weeks of life.