Children’s food diary

Name: ………………………………………………..

DOB: …………………………………………………….

Hospital number: …………………………………

Date:……………………………………………………

To be filled in for three days

A diary of food and drink

We would like you to write down everything your child has to eat and drink each day, and to note the amount that your child had. Wherever possible please use gram amounts but when not possible use common measurements such as tablespoons, teaspoons, or cups.

In order for the analysis to be accurate, please:

• Start a new page for each day. Use more than one page if necessary.
• Write down what your child has to eat or drink, giving as much detail as you can about each item. Say if and how it was cooked, such as fried egg, roast potato, or raw carrot.
• Describe how much of each food and drink your child eats, such as the mls of squash, grams of bread, or number of rashers of bacon, eggs, biscuits and sweets.
• Describe sandwiches in detail such as how many slices of bread, if and what kind of margarine/butter, any mayonnaise or fillings.

If there are any leftovers or waste, such as skin from apple or crusts from bread, please say so.

Please remember to include:

• all drinks such as milky drinks, tea, coffee, drinking chocolate, squash and water
• between meal snacks
• sweets, chocolates
• fruit
• crisps, nuts, and other savoury snacks

Double check questions – please check:

• Have you written down all the foods your child has eaten, including sweets and ‘nibbles’?
  
  
• Have you written all drinks, including water?
• What size glass/cup do you use for drinks……………ml?

Please circle the answer to each question in respect of this week:

• What type of milk does your child use?

Ordinary semi-skimmed skimmed

Other: …………………………………….

• Does your child usually eat fat on meat?

YES NO

• What kind of bread does your child normally eat?

White Granary Wholemeal 50/50

Thin Medium Thick

• If your child drank squash or canned drinks were they:

Low calorie Sugar free Ordinary With added vit C

• When your child has butter or margarine on bread, toast, or crackers do they spread it:

Thin Medium Thick Do not use any

• Does your child eat the peel on fruit?

YES NO

Did your child eat very differently when you kept your food

diary?

If yes, what was different?

Please return this diary by post to your dietitian at the following address:

Department of Nutrition and Dietetics

Box 119

Cambridge University Hospitals NHS Foundation Trust

Hills Road, Cambridge

CB2 0QQ