WIC: Child Feeding Video Questions

2. First Name

3. Last Name

5. HH or ID#*

6. Phone

7. Date/Time of Appointment*
   Date/Time of Appointment

   Date/Time of Appointment

9. Child Feeding Video Questions

11. 1. What do you do when your child will hardly eat at the dinner table?*

    1. a) Let them be, they will get their food needs throughout the day.
    2. b) Make them clean their plate.

    Choose the best answer.

12. 2. Letting your kids help prepare dinner or make their own plate will...*

    1. a) Get them interested in the food.
    2. b) Teach them how to make good food choices.
    3. c) Improve feeding behaviors.
    4. d) All of the above.

    Choose the best answer.

14. 3. Name 3 ways to help get your child involved at mealtime to help improve their interest in the food they eat.*

16. 4. Why should you let your child help out with dinner and serve themselves?*

    1. a) It helps them develop their fine motor skills.
    2. b) Makes them aware of when they are hungry or full.
    3. c) Dont. They will only make a mess.
    4. d) Teaches them how to make good food choices.
    5. e) A, B, D.
    6. f) B and D only

    Choose the best answer.

18. 5. Which of the following isn't useful to help develop proper feeding behaviors?*

    1. a) Enjoy each other while enjoying family meals.
    2. b) Let them eat anything and everything.
    3. c) Help them be independent at mealtime.
    4. d) Let them serve themselves.

    Choose the best aswer.

Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit Submit and Print

* indicates a required field