Nutrition Assessment – Children Edits

Question / Question Description / Mandatory/Optional
Entry
* / Age 12-23 or 24-59 month range
Only one field may be entered.
* / 6-digit numeric field
CAREGIVER
1 / Child’s appetite indicator
Only one field may be entered.
2 / Child’s appetite changes indicator
If ‘Y’, change text must be entered
If ‘N’ change text must be blank
3 / Child’s eating habits indicator
If ‘Y’, eating text must be entered
If ‘N’, eating text must be blank
4 / Certain foods text is optional
5 / Choke or gag on food indicator
If ‘Y’, choke/gag list text must be entered
If ‘N’, choke/gag list text must be blank
6 / Most foods prepared
If Other is checked, food text must be entered, if Other is blank, food text must be blank
MEAL PATTERN
7 / Number of meals and/or snacks per day
One or both fields must be entered and at least one of them must be greater than zero; all snack on types of foods indicators are optional
8 / Weekly family meals together must be entered and contain a days/week numeric value between 0 and 7
9 / Same foods as rest of family
Only one field may be entered, if Rarely field is entered, then list text must be entered, if Rarely field is blank, list text must be blank
10 / Eat at childcare setting must be entered and contain a days/week numeric value between 0 and 7
11 / Weekly meals from a restaurant must be entered and contain a numeric value
12 / Number of meals and/or snacks per day
One or both fields must be entered and at least one of them must be greater than zero
EATING PATTERN
13 / Most foods prepared indicators; at least one field must be entered
14 / Lack of food indicator
If indicator = ‘Y’ then at least one food type must be entered, if indicator = ‘N’ then all other fields must be blank
15 / Too much food indicator
If indicator = ‘Y’, then list text must be entered
If indicator = ‘N’ then list text must be blank
16 / Child frequently eat sweet foods indicator
If ‘Y’ then item/amount field must be entered
If ‘N’ then all other fields must be blank
*17 / Does child eat such food as indicators
All entries must be completed with either a ‘Y’ for yes or ‘N’ for no / If any answer is marked Yes, RF 425 is auto assigned
*18 / Eat non-food items indicator
If indicator = ‘Y’ then at least one non-food type must be entered, if Other is marked, non-food text must be entered, if Other is blank, non-food text must be blank; if indicator = ‘N’, then all other fields must be blank / If Yes is marked, RF 425 is auto assigned
19 / Child feeds self indicator
If indicator = ‘Y’, at least feed self type field must be entered; if indicator = ‘N’, all other fields must be blank
*20 / Child on special diet indicator
If ‘Y’, then at least one special diet must be entered, if Other is marked then diet text must be entered, if Other is blank, diet text must be blank; if ‘N’, then all other fields must be blank / If Vegetarian, Vegan, or Macrobiotic is marked, RF 427 is auto assigned
21 / Breast feeding child indicator
If indicator = ‘Y’, text field must be entered
If indicator = ‘N’, text field must be blank
BEVERAGES
22 / Drink milk indicator
If indicator = ‘Y’, at least one drink milk item must be entered, if formula indicator = ‘Y’, then Formula Name must be entered, if formula indicator is blank then Formula Name must be blank, if Other is marked then drink text must be entered, if Other is blank then drink text must be blank; if Indicator = ‘N’, all other fields must be blank
23 / Drink milk frequency
If drink milk indicator in Question # 22 = ‘Y’, drink milk frequency must be entered and only one field entry is allowed; if drink milk indicator = ‘N’ then drink milk frequency is optional / Based on
Question # 22
*24 / Other beverage drinks
At least one field must be entered, if Other is marked, beverage text must be entered, if Other is blank, beverage text must be blank.
If 100% juice is marked, Q25 must be answered. / RF 425 is auto assigned if SD, GW/KA, R P/S, W SA, or FD is marked
25 / How often child drinks 100% juice......
Only one option can be marked. / Based on
Question # 24
26 / Water source for drinking
Only one source type can be entered; if City, Rural or Bottled Water is entered then all 26-a fields must be blank; if Private Well is entered then water test (26-a) must be entered; if water test is yes then test results (26-a) must be entered; otherwise test result must be blank; portions 26-b and 26-c must be entered with only one field entry per question
BABY BOTTLE AND SIPPY CUPS
27 / Child drink from bottle indicator must be entered
28 / What is fed in bottle indicators
If question # 27 indicator = ‘Y’ then at least one fed in bottle indicator must be entered, if Other is marked, then fed in bottle text must be entered, if Other is blank, then fed in bottle text must be blank; if question # 27 indicator = ‘N’, then all fed in bottle fields must be blank / Based on
Question # 27
29 / Child take bottle to bed must be entered
30 / Child carry bottle or sippy cup must be entered
SUPPLEMENTS
31 / Take supplements indicator
If indicator = ‘Y’, then at least one supplement item must be entered, if Others is marked, then supplement text must be entered, if Others is blank then supplement text must be blank; if Indicator = ‘N’ then all other fields must be blank
FOOD SECURITY AND PROGRAM PARTICIPATION
32 / Eat less than person should indicator must be entered; either yes/no or don’t know field must be marked but not both
33 / Child enrolled in specific listed program must be entered
34 / Family participate in program indicator
If indicator = ‘Y’, then at least one program data field must be entered, if Other is marked, then program text must be entered, if Other is blank then program text must be blank; if indicator = ‘N’ then all program indicator fields must be blank
35 / Adequate equipment indicator must be entered
PHYSICAL ACTIVITY
36 / Child’s play indoor activities must be entered and only one field entry is allowed
37 / Child’s play outdoor activities must be entered and only one field entry is allowed

Current as of 6/19/2007

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