FOOD DIARY
Child’s Name:_____________________________________
Program Name:____________________________________
Directions: Write what your child ate at home for 1 day. Use the following examples to help you.
Meal A:
Peanut Butter Sandwich (2 slices of bread)
1/2 Pear
Small Glass of MilkMeal B:
Soup (Noodles & Vegetables)
Large Glass of Orange Juice(There are no right or wrong answers)
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Day 1 |
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| Breakfast |
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| Lunch |
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| Dinner |
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| Snacks |
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Questions or Comments:
CIRCLE THE FOODS YOUR CHILD ATE
OR DRANK IN THE LAST THREE DAYS
1 -
CALCIUM SOURCES
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2 - PROTEIN SOURCES
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3 - FRUIT AND VEGETABLE SOURCES
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4 - GRAIN SOURCES
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5 - OTHER FOOD SOURCES
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