REFLUX INITIAL ASSESSMENT

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EVERYTHING BABY

PREGNANCY & BIRTHING INFORMATION

FEEDING

How are you currently feeding your baby?
If you answered formula or combination, please list what formulas you have tried and which you one you are currently using. Please be brand specific. Note if buying outside of UAE.

SYMPTOM TRACKER

In each of the following sections please mark which symptoms are being experienced by your baby. Note the frequency and the severity of each symptom out of 10 (10 = very severe). A day will cover a full 24 hour period.

Feeding

After feeding

Please note if your baby is experiencing any green or yellow vomiting, or unexplained blood in vomit, these are considered RED FLAGS and your baby should be assessed by a medical doctor as soon as possible.

Respiratory

Please note if your baby is experiencing difficulty in breathing or their face is going blue, these are considered RED FLAGS and your baby should be assessed by a medical doctor as soon as possible.

Positional

Sleep

Digestive

Please note if your baby is experiencing unexplained blood in their poop, this an considered a RED FLAG and your baby should be assessed by a medical doctor as soon as possible.

Physical or General Symptoms

DAY IN THE LIFE OF

Max. file size: 100 MB.
Max. file size: 100 MB.
Max. file size: 100 MB.
Max. file size: 100 MB.
Max. file size: 100 MB.
Max. file size: 100 MB.
Things of importance to note: Time of medication or supplements given; Time of milk feeds and breast or formula; Sleep and wake timings, including night time; Note symptoms experienced, include time of day, and severity; Note what happened on wake ups during the night