Infant FeedingSurvey

By completing this survey, you acknowledge that you have read and understood the participant information sheet, and you consent to participate in this research project.

Introductory/DemographicQuestions

1. Pleasecircleyour genderMaleFemale

2. Pleasestate your age:

3. Pleasecirclewhichoptioncorrespondstoyourhighestlevelof completed education:

a. Noschooling

b. Someprimaryschool

c. Completedprimaryschool

d. Somesecondary(high)school

e. Completedsecondaryschool (Yr 12)

f.TAFEqualification

g.Universitydegree

h. Other(pleasespecify)

4. IsEnglish thelanguagespokenmostof the timeathome?YesNo

5. Were you born inAustralia?YesNo

6. What is the child’s cultural background?

a. Indigenous Australian

b. Pacific Island

c. Caucasian

d. Asian

e. Subcontinent

f. Middle East

g. Africa

h. Other (please specify)

7. Howmanychildren doyoucarefor?(pleasecircle)

  1. One

b. Two

c. Three

d. Four ormore

Questionsabout yourchild’sdiet

Answer allofthefollowingquestions for your YOUNGESTchild only

8. Pleasestatetheageofyour YOUNGESTchild:

9. Circlethe genderofyour YOUNGESTchild: Male Female

10. Wasyour childever breastfed? Yes No Don’tKnow (If No orDon’tKnowgoto question 13)

In thefollowing questionsthephrase‘EXCLUSIVELY breastfed’isused. ‘Exclusively breastfed’means thattheinfant/child received only breastmilkand nootherliquidsorsolids,excluding medicine.

11.Wasyour childever EXCLUSIVELYbreastfed? Yes NoDon’t Know (If No orDon’tKnowgoto question 13)

12.Until whatagewasyourchild EXCLUSIVELY breastfed?

a. 0-1 month

b. 1-2 months

c. 2-3 months

d. 3-4 months

e. 4-5 months

f. 5-6 months

g. More than 6 months

h. My child is still exclusively breastfed

i. Don’t know

13.Please complete the following table regarding infant feeding:

Food / Have you introduced this drink into your child’s diet? / Approximately how old was your child when you introduced this drink? / How often did your child consume this drink?
Infant formula (breast milk substitute) / No
Yes
Don’t know / ___ yrs ___ months
NA / More than once a day
Once daily
Two to three times per week
Weekly
Monthly
Less than once a month
Water / No
Yes
Don’t know / ___ yrs ___ months
NA / More than once a day
Once daily
Two to three times per week
Weekly
Monthly
Less than once a month
Cow’s milk / No
Yes
Don’t know / ___ yrs ___ months
NA / More than once a day
Once daily
Two to three times per week
Weekly
Monthly
Less than once a month
Cordial / No
Yes
Don’t know / ___ yrs ___ months
NA / More than once a day
Once daily
Two to three times per week
Weekly
Monthly
Less than once a month
Flavoured milk (e.g. chocolate milk) / No
Yes
Don’t know / ___ yrs ___ months
NA / More than once a day
Once daily
Two to three times per week
Weekly
Monthly
Less than once a month
100% Fruit juice / No
Yes
Don’t know / ___ yrs ___ months
NA / More than once a day
Once daily
Two to three times per week
Weekly
Monthly
Less than once a month
Fruit drink (sweetened, diluted fruit juice) / No
Yes
Don’t know / ___ yrs ___ months
NA / More than once a day
Once daily
Two to three times per week
Weekly
Monthly
Less than once a month
Non-caffeinated soft-drinks (e.g. lemonade) / No
Yes
Don’t know / ___ yrs ___ months
NA / More than once a day
Once daily
Two to three times per week
Weekly
Monthly
Less than once a month
Caffeinated soft-drinks (e,g cola) / No
Yes
Don’t know / ___ yrs ___ months
NA / More than once a day
Once Daily
Two to three times per week Weekly
Monthly
Less than once a month
“Energy” drinks (such as those with high caffeine, guaran, taurine or ginseng) / No
Yes
Don’t know / ___ yrs ___ months
NA / More than once a day
Once Daily
Two to three times per week
Weekly
Monthly
Less than once a month
Coffee / No
Yes
Don’t know / ___ yrs ___ months
NA / More than once a day
Once Daily
Two to three times per week
Weekly
Monthly
Less than once a month
Tea / No
Yes
Don’t know / ___ yrs ___ months
NA / More than once a day
Once Daily
Two to three times per week
Weekly
Monthly
Less than once a month
Solid Foods (ingredients)
Specify ______/ No
Yes
Don’t know / ___ yrs ___ months
NA / More than once a day
Once Daily
Two to three times per week
Weekly
Monthly
Less than once a month