| 1. |
What does your child eat for breakfast? |
| |
|
|
| |
|
|
| |
|
|
| 2. |
How many dairy servings does your child consume per day on average? 1 serving = 1 glass milk (soy or cows) or 1 matchbox (30g) cheese or 175 ml yogurt |
| |
|
|
| |
|
|
| |
|
|
| 3. |
How many proper sit down meals does your child eat a day? |
| |
|
|
| |
|
|
| |
|
|
| 4. |
Does your child take a multivitamin supplement regularly? |
| |
|
|
| |
|
|
| |
|
|
| 5. |
How often is your child physically active? |
| |
|
|
| |
|
|
| |
|
|
| 6. |
Does your child take a packed lunch to school? |
| |
|
|
| |
|
|
| |
|
|
| 7. |
How many servings of fruit does your child eat per day?
1 serving = 1banana, pear, apple etc. or ½ glass fresh fruit juice |
| |
|
|
| |
|
|
| |
|
|
| 8. |
How many servings of dark green or yellow vegetables does your child eat?
1 serving = 1/2 cup cooked or raw |
| |
|
|
| |
|
|
| |
|
|
| 9. |
What bread does your child eat? |
| |
|
|
| |
|
|
| |
|
|
| 10. |
Does your child eat breakfast every morning?
How often does your child eat protein-based foods (i.e.-red meat, poultry, fish, soya, eggs, legumes, or nuts) |
| |
|
|
| |
|
|
| |
|
|
| 11. |
How often does your child eat any of the following?
Chocolates or sweets, crisps or fried potato chips, cakes and biscuits or ice-cream |
| |
|
|
| |
|
|
| |
|
|
| |
|
|
| 12. |
How often does your child eat fast or take-away foods? |
| |
|
|
| |
|
|
| |
|
|
| 13. |
How often does your child get tuck shop or pocket money to buy sweets, chips etc. |
| |
|
|
| |
|
|
| |
|
|
| |
|
|
| 14. |
Do you reward your child with food? E.g. If they eat all their dinner, they may have a chocolate? |
| |
|
|
| |
|
|
| |
|
|
| 15. |
What does your child drink during the day? |
| |
|
|
| |
|
|
| |
|
|
| 16. |
How many glasses of water does your child drink a day? |
| |
|
|
| |
|
|
| |
|
|
| 17. |
How would you classify your child’s bowel habits? |
| |
|
|
| |
|
|
| |
|
|
| 18. |
Does your child suffer from any food related allergies? |
| |
|
|
| |
|
|
| 19. |
If answer to question above is yes, have you sought medical advice on how to approach this allergy with regards to your child’s diet? |
| |
|
|
| |
|
|
