Date of Visit ____________________
Your Child's Age ____________________
What is your child's feeding schedule like? What, how much, and how often does he eat?
What new developmental milestones has your child picked up since his last visit? Is he (circle)?
smiling | following objects | laughing | grasping things
rolling over | sitting up with support | sitting up alone
cruising | saying dada/mama | pulling up | walking
Describe any concerns or questions that you have about your child's nutrition, growth, development, safety, etc.
Describe any problems your child has had since his last visit, including vaccine reactions, food intolerances, illnesses, etc.
Information to record from your visit:
Height __________ Weight __________ Head Circumference __________
Vaccines given at this visit (circle the ones your child received):
DTaP Hib IPV HepB Prevnar Varicella MMR
Don't forget to ask about:
- a Vitamin D for breastfeeding babies (two months)
- using an insect repellent (two months)
- using sunscreen (six months)
- a fluoride supplement (six months)
- when to start solid foods (four to six months)
- lead poisoning risk factors (six to nine months)
Your child's next visit will be at ____________ months.
This worksheet was reproduced from The Everything® Father's First Year Book Copyright 2005, F+W Publications, Inc.