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Supplementary Information for Children Under 12 Months

Child Information

* All fields are mandatory

My child drinks: breast milkformulabreast milk and formula
My child has started eating solid foods: YesNo
If YES, food must be: pureedmashedsteamed until softother

My child can self-feed: YES (independently)YES (with support)NO

Sleep Arrangements

Note: According to the Joint Statement on Safe Sleep: Preventing Sudden Infant Deaths in Canada, children up to their first birthday will be placed on their backs for sleep. This has been Health Canada’s recommendation since 1993, as a means to reduce the risk of Sudden Infant Death Syndrome (SIDS).
The requirement for an infant sleep position may only be waived if a medical doctor/physician recommends differently in writing.



Does your child have any special sleep requirements (e.g., soother, must be rocked to sleep)? YESNO