PDF Pediatric Nutrition Intake Form 2026

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The document is a Pediatric Nutrition Intake Form created by Fenella Wong, a Holistic Nutritional Consultant. It is designed for parents or guardians of children up to 12 years old to provide detailed information about the child's health concerns, medical history, dietary habits, and lifestyle factors. The form includes sections on stress levels, exercise, sleep patterns, family medical history, and a seven-day food diary. It emphasizes the importance of holistic nutrition in supporting the child's overall well-being.
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  1. Click ‘Get Form’ to open the Pediatric Nutrition Intake Form in our editor.
  2. Begin by entering the child's name, date of birth, sex, height, and weight in the designated fields at the top of the form.
  3. Fill in the address details for both the child and parent/guardian, including phone number and email for easy communication.
  4. Address health concerns by listing them in order of priority. If applicable, provide details about any diagnosed health conditions.
  5. Indicate your child's living situation and stress levels. Check all relevant factors contributing to their stress.
  6. Complete sections on dietary habits, exercise routines, and any medications or supplements your child is currently taking.
  7. Finally, review all entries for accuracy before saving or sharing the completed form directly from our platform.

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For fulfilling the professional obligations of pediatricians to the society at large, the purview of pediatrics commences with the fetus and continues through newborn, infancy, preschool and school age including adolescence up to and including 18 years of age.
Another way to generalize caloric need is that an infant needs 100cal/kg/day, ages 1 to 3 years need 80 kcal/kg/day, 4 to 5 years needs 70kcal/kg/day, 6 to 8 years needs 60 to 65 kcal/kg/day and 9+ needs 35 to 45 kcal/kg/day.
A pediatric patient is an individual target of healthcare services who is minor to 15 years old (in some countries 21). Pediatric patients are: neonates (0-28 days of life), infants (28 days -12 months), toddlers (1-3 years), preschoolers (3-5 years), school aged children (6-10 years), adolescents (11-16 years).

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Balanced and healthy diet strengthens your childs immune system, helps him or her maintain healthy weight, and aids in his or her brain and bone development. DiabetesPCOS (Polycystic ovary syndrome) and orthopedic problems like osteoporosis or rickets and dental problems may also show early signs at this age.
Pediatrics is the branch of medicine dealing with the health and medical care of infants, children, and adolescents from birth up to the age of 18. The word paediatrics means healer of children; they are derived from two Greek words: (pais = child) and (iatros = doctor or healer).
Young children should be fed frequently and in adequate quantities throughout the day, and their meals must be nutrient-dense and comprised of a variety of food groups. Caregivers should prepare and feed meals with clean hands and dishes, and interact with their child to respond to his or her hunger signals.
In short, it helps the child and the family gain the strength to carry on with daily life. Pediatric care is family-focused. The care not only alleviates the suffering but guides the parents and care givers to be able to look after the welfare of the child in a better way.
Pediatric nutrition is the maintenance of a proper well-balanced diet consisting of the essential nutrients and the adequate caloric intake necessary to promote growth and sustain the physiologic requirements at the various stages of a child development.

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