Monday, December 28, 2015

"Parent Visit" Form

Baby's Initials______; Gestational age at time of visit______; Gestational age at birth____

  1. Newborn Zones
    1. Did you explain newborn Zones to parents?
    2. Which Zones did baby exhibit?
    3. Did baby move suddenly between one Zone and another suggesting Zone regulation issues?
    4. What help did baby need move successfully from one Zone to another?
  2. SOSs – Signs of Over-Stimulation
    1. Did you explain SOSs to parents?
    2. What Body SOSs did you see?
    3. What Behavioral SOSs did you see?
    4. How did you respond to the SOSs?
  3.  Eating
    1. Did baby need help getting to the Ready Zone to eat?
    2. Did baby show any SOSs during feeding?
    3. What actions did you take to respond to SOSs?
    4. Did the parent attempt to feed baby in the Resting Zone?
  4. Calming
    1. Did baby show any self calming behavior and did you point out these behaviors to the parents?
    2. Did you demonstrate a stepwise approach to calming the baby?
    3. Did you explain normal changes in the crying patterns of babies?
  5. Sleeping
    1. Did you explain the two types of sleep in a baby?
    2. What signs of Active/Light sleep did you observe?
    3. Did the parents consider how to help the baby “sleep through” Active/Light sleep?
    4. Did the parents consider putting the baby down in Active/Light sleep?
  6. Interactive Abilities
    1. Did you get the baby to turn to and look at a toy or face?
    2. Did you get the baby to turn to the parent’s voice?
    3. Did you need swaddle the baby a few minutes to see if that increased her interactive ability?
    4. What surprised the parent about the baby’s abilities?