NS4469 - Rev. 2021/12/30 Baby Friendly Initiative Panel 4 - Feeding and Diaper/Stool Monitoring Form

Oct 13, 2026

NS4469 (Rev. 2021/12/30) Baby Friendly Initiative Panel 4 provides structured sections for tracking newborn feeding and elimination, including wet diaper and stool checkboxes, date and time, feed amounts, and comments. It includes special feeding instructions, D.O.B., gestational age, birth and discharge weight, and formula type with a recall-safety reference. Guidance covers first health check timing, when to call for help, where to get support, and indicators that the baby may be feeding inadequately or showing warning symptoms.

LanguageEnglish

CategoryForms

FormatPDF

Pages2

Reading Time1 min

AccessFree to download

Feeding and elimination tracking

Special feeding instructions and safety references

When to schedule the first health checkup

When to call for help and where to get help

How much formula to feed by age

How to tell if the baby is getting enough

NS4469 (Rev. 2021/12/30) Baby Friendly Initiative Panel 4 |
| | Wet Diapers ( R check boxes) c c c c c c c | | Stools ( R check boxes)
c c c c | | --- | --- | --- | --- | --- | | Date | | Time | Feed Amount | Comments | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | Wet Diapers ( R check boxes) c c c c c c | | | Stools ( R check boxes)
c c c c | | Date | Time | | Feed Amount | Comments | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
SPECIAL FEEDING INSTRUCTIONS | | | | | | D.O. B. GESTATIONAL AGE BIRTH WEIGHT DISCHARGE WEIGHT
Type of Formula:

To check for recalls of formula go to [www.healthycanadians.gc.ca](www.healthycanadians.gc.ca) and click on "recalls & safety alerts"
Signature:
References:
1) American Academy of Pediatrics. (2019) . Baby’s First Days: Bowel Movements and Urination. Retrieved from [https://www.healthychildren.org/English/ages-stages/baby/Pages/Babys-First=Days-Bowel-Movements-and-Urination.aspx](https://www.healthychildren.org/English/ages-stages/baby/Pages/Babys-First=Days-Bowel-Movements-and-Urination.aspx)
2) Best Start Resource Centre. (2017) . Infant Formula: What you Need to Know. Retrieved from: [https://resources.beststart.org/product/b19e](https://resources.beststart.org/product/b19e)infant-formula-booklet/
3) Health Link BC. (2019) . Bowel Movements in babies. Retrieved from [https://www.healthlinkbc.ca/health-topics/abo3062](https://www.healthlinkbc.ca/health-topics/abo3062)
[4](4)) Mohrbacher, N. (2013) . Breastfeeding Solutions: Quick Tips for the Most Common Nursing Challenges. Oakland, CA: Harbinger Publications, p. 38.
Originally developed by the Middlesex London Breastfeeding Coalition in 1999 and revised in 2009, 2014. Currently revised by the Breastfeeding Coalition of Southwestern Ontario with representation from London Health Sciences Centre, Chatham-Kent Health Alliance, and
Strathroy Middlesex General Hospital, December 2019 | | | | | | | | | | | --- | --- | --- | --- | | FORMULA FEEDING GUIDELINES FOR THE NEWBORN

WHEN DO I MAKE MY BABY’S FIRST HEALTH CHECKUP?
• Call your baby’s primary health care provider (doctor, midwife, nurse practitioner) to make an appointment. All babies should be seen within 2 to 3 days after discharge.

WHEN DO I CALL FOR HELP?
CALL IF YOUR BABY:
• is too sleepy or does not feed at least 8 times in 24 hours
• is not having enough wet diapers or stools (bowel movements) a day
* See chart on next page
• Is having blackish/green bowel movements after day 4 or 5
• has a dry or sticky mouth
• has skin that looks yellow or the whites of your baby’s eyes look yellow
• has an underarm temperature greater than 37.5°C (99 .5°F) or less than 36.5°C (97 .7°F)
If you are very concerned about your baby’s health, contact your health care provider right away. If your health care provider is not available, go to your nearest emergency department.

WHERE CAN I GET HELP?
• Call Middlesex London Health Unit 519-663-5317 to speak with Public Health Nurse, Weekdays 8:30 am to 4:30 pm or visit the website [at ](at www.healthunit.com)[www.healthunit.com](at www.healthunit.com)
• If you live outside Middlesex London call your local health unit
• Your baby’s health care provider
• TeleHealth Services 1-866-797-0000 24 hours a day, 7 days a week
• Best Start Nutrition Resources: [https://resources.beststart.org/product](https://resources.beststart.org/product)category/resources/nutrition/ | | | | NS4469 (Rev. 2021/12/30) Panel 1 NS4469 (Rev. 2021/12/30) Panel 2 FEEDING GUIDELINES The baby’s cues should guide how much formula is taken. It is better to feed on cue rather than feed at a set time and a set amount. Always respo

FAQs

How soon should a newborn have a first health checkup after discharge?

All babies should be seen within 2 to 3 days after discharge. Call the baby’s primary health care provider to make an appointment.

When should parents call for help during formula feeding?

Call for help if the baby is too sleepy or does not feed at least 8 times in 24 hours, has insufficient wet diapers or stools, has concerning bowel movement color after day 4 or 5, a dry/sticky mouth, yellow-looking skin or eyes, or abnormal underarm temperature.

How can parents assess whether the baby is getting enough feeding?

Use the daily checklist in the table for behavior, number of stools in 24 hours, and number of wet diapers in 24 hours, noting expected stool color changes and urine observations across days 1 to 6.

Oct 13, 2026

Upload by Jordan Avery