Sunday, November 17, 2013

"Parent Visit" Documentation Form

Baby's Name:                           G/P:              Gestational age at birth:         
Current age:          
Note any medical interventions or complications at birth:             


Did you explain
Zones to Parents?

Which Zones did baby exhibit?

Did baby move suddenly between Zones?

What help did the baby need to get from oneZone to another?


Did you explain SOSs to parents?

What Body SOSs did you see?

What Behavioral SOSs 
did you see?

How did you respond to the SOS?


Did baby show any self calming behavior?

Did you point out self calming to parent?

Did you demonstrate stepwise calming?

Did you explain normal change in crying patterns of babies starting at 2-weeks-old?


Did baby need help getting to the Ready Zone to eat?

Did baby show any SOSs during feeding?

What actions did you take in response to SOSs?

Was there some confusion about trying to feed baby while in theResting Zone?



© 2016 HUG Your Baby  

Did you explain two types of sleep?

Did you try swaddling or encourage sucking to help baby the to the Ready Zone to play?

What signs of active sleep did you observe?

Did you get baby to look at a toy or a face?

Did you help parents consider how to help child “sleep through” active sleep?

Did you get baby to turn toward the parent's voice?

Did you suggest putting baby down in active sleep?

What surprised you and the parents about the baby's abilities?