Maternal POC Part 2

MATERNAL INFANT HEALTH PROGRAM (MIHP) INFANT PLAN OF CARE Part 2 Interventions By Risk Level

Beneficiary:

Feeding and Nutrition

INTERVENTION RISK INFORMATION INTERVENTIONS LEVEL Using Motivational Interviewing techniques, complete the following interventions:

Refused all interventions

Not currently enrolled in WIC 1. Provide information (phone number, address) about local WIC Program MODERATE Date 1st Addressed: Date: Does not hold baby while feeding 2. Assist family with enrolling infant in WIC Puts baby to bed with liquid other than Date 1st Addressed: water in bottle 3. Educate regarding concerns of bottle propping Poor weight gain/not following growth Date 1st Addressed: curve 4. Educate family about baby bottle tooth decay Parent has concern or question about Date 1st Addressed: infant feeding 5. Discuss growth chart findings Early introduction of solids Date 1st Addressed:

Feeding inappropriate foods to infant 6. Educate on infant feeding cues Date 1st Addressed: Premature Infant 7. Review proper formula preparation Difficulties eating Date 1st Addressed:

8. Review infant feeding guidelines Date 1st Addressed:

9. Educate on when to introduce solids Date 1st Addressed:

10. Refer to physician, Early On or Occupational Therapist for feeding difficulties Date 1st Addressed:

I005 1.1.17 MATERNAL INFANT HEALTH PROGRAM (MIHP) INFANT PLAN OF CARE Part 2 Interventions By Risk Level

11. Discuss family and household attitudes, beliefs and practices and how they may affect infant feeding (e.g. bottle propping, early introduction of solids, etc.) Date 1st Addressed:

12. Refer to lactation counselor after obtaining physician’s order Date 1st Addressed:

13. Refer to Registered Dietitian after obtaining physician’s order Date 1st Addressed:

HIGH No age appropriate food for infant (i.e. no In addition to Moderate interventions: Date: formula and mom is not breastfeeding) 14. Discuss resources for obtaining infant formula Date 1st Addressed:

15. Create a plan so family does not run out of formula again in the future Date 1st Addressed:

16. Contact CPS at 855-444-3911 if family cannot resolve this issue immediately Date 1st Addressed:

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