Form 0920-20FO Att.4n-Month 18 Survey-Revised

Feeding My Baby and Me: Infant Feeding Practices Study III

Att.4n-Month 18 Survey-Revised

18-Month Survey

OMB: 0920-1333

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Form Approved
OMB No. 0920-1333
Exp. Date 4/30/2024

Feeding My Baby and Me: IFPS-III: Month 18

The information you are being asked to provide is authorized to be collected under Section 301 of The Public Health Service Act (42 USC 241). Providing this information is voluntary. CDC will use this information in its study, Feeding My Baby and Me (also known as the Infant Feeding Practices Study III), in order to learn more about the choices mothers make in feeding their babies and toddlers in the first 2 years of life. This information will support efforts to improve the health of our nation’s children. This information will be shared with a contractor, Westat, with which CDC has entered into an agreement to assist with carrying out this study.



Public reporting burden of this collection of information varies from 2 to 24 minutes with an average of 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1333)

DEMOGRAPHICS

A9. Are you currently {CHILD'S NAME}’s caregiver?

  • Yes (GO TO A29)

  • No



[IF A9 = NO, END SURVEY, MAY BE ELIGIBLE FOR FUTURE SURVEYS. SHOW SURVEY INELIGIBILITY SCREEN AND THEN END SURVEY.]

[START SURVEY INELIGIBILITY SCREEN]

We’re sorry, you are not eligible to complete this survey if you are not currently the study child’s caregiver. We will check back with you to see if you are eligible for study surveys in the future. Thank you.

[END SURVEY INELIGIBILITY SCREEN]



A29. Have you moved out of the United States?

  • Yes

  • No



A4. Counting yourself, how many people live in your household? Include all members who live in your household for at least 9 months of the year.

________________ People < 17 years of age

________________ People 18 and older

A6. Which income range category represents the total combined income of all members of your household during the past 12 months? Please include any income from all sources (employment, pensions, social security, etc.).

  • Less than $5,000

  • $5,000 to $7,499

  • $7,500 to $9,999

  • $10,000 to $12,499

  • $12,500 to $14,999

  • $15,000 to $19,999

  • $20,000 to $24,999

  • $25,000 to $29,999

  • $30,000 to $34,999

  • $35,000 to $39,999

  • $40,000 to $49,999

  • $50,000 to $59,999

  • $60,000 to $74,999

  • $75,000 to $99,999

  • $100,000 to $149,999

  • $150,000 or more



FEEDING

Foods Your Child Eats

[PROGRAMMER: LIST EACH REPETITION OF INSTRUCTIONS AND THE GRID THAT FOLLOWS THOSE INSTRUCTIONS ON A SEPARATE PAGE]

In the past 7 days, how often was {CHILD'S NAME} fed each food listed below? Include feedings by everyone who feeds the child and include snack and night time feedings.

Fill in only one column for each item.

    • If {CHILD'S NAME} was fed the food once a day or more, enter the number of feedings per day in the first column.

    • If {CHILD'S NAME} was fed the food less than once a day, enter the number of feedings per week in the second column.

    • If {CHILD'S NAME} was not fed the food at all during the past 7 days, fill in 0 in the second column.

[PROGRAMMER: ONLY ALLOW ONE RESPONSE PER LINE, EITHER FEEDINGS PER DAY OR FEEDINGS PER WEEK]

Breast milk and infant formula

Feedings per day

Feedings per week

Breast milk at your breast



Breast milk in a bottle/cup



Infant formula



Toddler milk (includes follow up formulas or toddler formulas)





[IF INFANT FORMULA >0] In the past week, about how many ounces of infant formula did you child drink at each feeding?

  • 1 to 2

  • 3 to 4

  • 5 to 6

  • 7 to 8

  • More than 8

In the past 7 days, how often was {CHILD'S NAME} fed each beverage listed below? Include feedings by everyone who feeds the child and include snack and night time feedings.

Fill in only one column for each item.

    • If {CHILD'S NAME} was fed the beverage once a day or more, enter the number of feedings per day in the first column.

    • If {CHILD'S NAME} was fed the beverage less than once a day, enter the number of feedings per week in the second column.

    • If {CHILD'S NAME} was not fed the beverage at all during the past 7 days, fill in 0 in the second column.

[PROGRAMMER: ONLY ALLOW ONE RESPONSE PER LINE, EITHER FEEDINGS PER DAY OR FEEDINGS PER WEEK]

Beverages

Feedings per day

Feedings per week

Water: include tap, bottled, or unflavored sparkling water



100% pure fruit juice or 100% pure vegetable juice



Regular soda or pop that contains sugar. Don't include diet soda or diet pop



Sweetened fruit drinks such as Kool-Aid, lemonade, sweet tea, Hi-C, cranberry cocktail, Gatorade, or flavored milk (e.g., chocolate, strawberry, vanilla)



Unsweetened cow's milk (includes milk added to foods such as cereals)



Unsweetened other milk such as soy milk, rice milk, or goat milk.





In the past 7 days, how often was {CHILD’S NAME} fed each food listed below? Include feedings by everyone who feeds the baby and include snack and night time feedings.

Fill in only one column for each item.

    • If {CHILD’S NAME} was fed the food once a day or more, enter the number of feedings per day in the first column.

    • If {CHILD’S NAME} was fed the food less than once a day, enter the number of feedings per week in the second column.

    • If {CHILD’S NAME} was not fed the food at all during the past 7 days, fill in 0 in the second column.

[PROGRAMMER: ONLY ALLOW ONE RESPONSE PER LINE, EITHER FEEDINGS PER DAY OR FEEDINGS PER WEEK]

Grains

Feedings per day

Feedings per week

Hot or cold cereal (do not include baby cereal)



Rice, pasta, breads (includes, rice, pasta, toast, rolls, bagels, cornbread, tortillas, bread in sandwiches, pancakes, waffles, crackers, etc.)





In the past 7 days, how often was {CHILD’S NAME} fed each food listed below? Include feedings by everyone who feeds the baby and include snack and night time feedings.

Fill in only one column for each item.

    • If {CHILD’S NAME} was fed the food once a day or more, enter the number of feedings per day in the first column.

    • If {CHILD’S NAME} was fed the food less than once a day, enter the number of feedings per week in the second column.

    • If {CHILD’S NAME} was not fed the food at all during the past 7 days, fill in 0 in the second column.

[PROGRAMMER: ONLY ALLOW ONE RESPONSE PER LINE, EITHER FEEDINGS PER DAY OR FEEDINGS PER WEEK]

Meats and Other Protein Foods

Feedings per day

Feedings per week

Meat (not processed): chicken, turkey, pork, beef, or lamb



Processed meat: baby food meats, combination dinners, bacon, ham, lunch meats, hot dogs, etc.



Fish or shellfish



Eggs



Beans: Refried beans, black beans, white beans, baked beans, beans in soup, pork and beans, or any other cooked dried beans. Don't include green beans.



Peanut butter, other peanut foods, or nuts



Soy foods: tofu, frozen soy desserts, etc.





In the past 7 days, how often was {CHILD’S NAME} fed each food listed below? Include feedings by everyone who feeds the baby and include snack and night time feedings.

Fill in only one column for each item.

    • If {CHILD’S NAME} was fed the food once a day or more, enter the number of feedings per day in the first column.

    • If {CHILD’S NAME} was fed the food less than once a day, enter the number of feedings per week in the second column.

    • If {CHILD’S NAME} was not fed the food at all during the past 7 days, fill in 0 in the second column.

[PROGRAMMER: ONLY ALLOW ONE RESPONSE PER LINE, EITHER FEEDINGS PER DAY OR FEEDINGS PER WEEK]

Fruits and Vegetables

Feedings per day

Feedings per week

Fruits: fresh, frozen, or canned, pureed baby food, or in squeezable pouches. Don't include juice.



Potatoes: baked, boiled, or mashed potatoes, or sweet potatoes



Fried potatoes including French fries, home fries, or hash browns



Green leafy vegetables: spinach, kale, collards, lettuce, or other green leafy vegetables



Other vegetables: fresh, frozen, or canned, or in squeezable pouches (other than green leafy or lettuce salads, potatoes, or cooked dried beans)



Tomato sauces: Mexican-type salsa with tomato, spaghetti noodles with tomato sauce, or mixed into foods such as lasagna (do not include tomato sauce on pizza)





In the past 7 days, how often was {CHILD’S NAME} fed each food listed below? Include feedings by everyone who feeds the baby and include snack and night time feedings.

Fill in only one column for each item.

    • If {CHILD’S NAME} was fed the food once a day or more, enter the number of feedings per day in the first column.

    • If {CHILD’S NAME} was fed the food less than once a day, enter the number of feedings per week in the second column.

    • If {CHILD’S NAME} was not fed the food at all during the past 7 days, fill in 0 in the second column.

[PROGRAMMER: ONLY ALLOW ONE RESPONSE PER LINE, EITHER FEEDINGS PER DAY OR FEEDINGS PER WEEK]

Dairy

Feedings per day

Feedings per week

Cheese: all types (include cheese as a snack, on a sandwich, or in foods such as lasagna, quesadillas, or casseroles). Do not count cheese on pizza



Other dairy products, such as pudding or yogurt. Don't include sugar free or plain kinds





In the past 7 days, how often was {CHILD’S NAME} fed each food listed below? Include feedings by everyone who feeds the baby and include snack and night time feedings.

Fill in only one column for each item.

    • If {CHILD’S NAME} was fed the food once a day or more, enter the number of feedings per day in the first column.

    • If {CHILD’S NAME} was fed the food less than once a day, enter the number of feedings per week in the second column.

    • If {CHILD’S NAME} was not fed the food at all during the past 7 days, fill in 0 in the second column.

[PROGRAMMER: ONLY ALLOW ONE RESPONSE PER LINE, EITHER FEEDINGS PER DAY OR FEEDINGS PER WEEK]

Sweets and Desserts

Feedings per day

Feedings per week

Ice cream or other frozen dairy desserts, such as frozen yogurt and sherbet. Don't include sugar free kinds



Sugar free frozen dairy desserts or sugar free pudding, plain or sugar free yogurt, or other sugar free dairy products



Sweet foods: candy, cookies, cake, doughnuts, muffins, pop-tarts, etc. Don't count frozen or sugar free desserts





In the past 7 days, how often was {CHILD’S NAME} fed each food listed below? Include feedings by everyone who feeds the baby and include snack and night time feedings.

Fill in only one column for each item.

    • If {CHILD’S NAME} was fed the food once a day or more, enter the number of feedings per day in the first column.

    • If {CHILD’S NAME} was fed the food less than once a day, enter the number of feedings per week in the second column.

    • If {CHILD’S NAME} was not fed the food at all during the past 7 days, fill in 0 in the second column.

[PROGRAMMER: ONLY ALLOW ONE RESPONSE PER LINE, EITHER FEEDINGS PER DAY OR FEEDINGS PER WEEK]



Snacks and Other Foods

Feedings per day

Feedings per week

Pizza: frozen pizza, fast food pizza, homemade pizza, or other pizza



Snacks such as potato chips, corn chips, pretzels, or popcorn







Feeding Breast Milk

E5. [ASK IF E4 FROM PREVIOUS SURVEY INCLUDES DATE AND R HAS NOT ALREADY ANSWERED YES] Has {CHILD'S NAME} stopped directly feeding at your breast?

  • Yes

  • No (GO TO E11)

E6. How old was {FILL: HE/SHE} when {FILL: HE/SHE} completely stopped feeding directly from your breast? Do not answer about pumped or expressed milk. You will be asked about that later. (Day 0 is the day your child was born)

My child completely stopped feeding at my breast at ___ days OR ___ weeks OR ___ months



E8. What were the two most important reasons for your decision to stop feeding your child directly at your breast?

[PROGRAMMER: ONLY ALLOW ONE RESPONSE PER COLUMN, DO NOT ALLOW BOTH COLUMNS CHECKED FOR SAME LINE]


Most important reason

Second most important reason

I wanted or needed someone else to feed my child



Breast milk alone did not satisfy my child



I wanted my body back to myself



I was sick or had to take medicine



I could not breastfeed while working or going to school



My child lost interest in nursing or began to wean himself or herself



I was pregnant



Other reason





E11. [ASK IF E10 FROM PREVIOUS SURVEY INCLUDES DATE AND R HAS NOT ALREADY ANSWERED YES] Have you stopped pumping or hand-expressing breast milk?

  • Yes

  • No (GO TO E16)

[IF E11 = VALID SKIP, SKIP TO E16]



E12. How old was {FILL: HE/SHE} when you completely stopped pumping or hand-expressing breast milk? (Day 0 is the day your child was born). Do not answer about feeding your child your pumped breast milk. You will be asked about that later.

I completely stopped pumping or hand-expressing my breast milk at___ days OR ___ weeks OR ___ months



E13. What were the two most important reasons for your decision to stop pumping or hand-expressing breast milk?

[PROGRAMMER: ONLY ALLOW ONE RESPONSE PER COLUMN, DO NOT ALLOW BOTH COLUMNS CHECKED FOR SAME LINE]


Most important reason

Second most important reason

Pumping milk no longer seemed worth the effort it required



Too many challenges related to pumping at work or school



Pumping supplies cost too much



I was not getting enough pumped milk



I had enough milk stored to reach my breastfeeding goal



I was pregnant



I was sick or had to take medicine



Other reason





E16. [ASK IF E15 FROM PREVIOUS SURVEY INCLUDES DATE AND R HAS NOT ALREADY ANSWERED YES] Have you stopped feeding your child pumped or expressed breast milk?

  • Yes

  • No (GO TO E24)



[IF E16 = VALID SKIP, GO TO E19]

E17. How old was {FILL: HE/SHE} when {FILL: HE/SHE} completely stopped being fed any pumped or expressed breast milk? Do not answer about feeding directly at your breast. (Day 0 is the day your child was born)

My child completely stopped being fed pumped or expressed breast milk at___ days OR ___ weeks OR ___ months



E19. [IF E4 OR E15 HAVE DATE IN ANY SURVEY AND E5 ≠ NO AND E16 ≠ NO, ASK E19. ONCE ANSWERED, DO NOT ASK AGAIN IN FUTURE SURVEYS] Did you feed your child breast milk (at the breast or pumped/expressed milk) as long as you wanted?

  • Yes

  • No



Feeding Formula

E24. [ASK IF E23 INCLUDES DATE FROM PREVIOUS SURVEY AND R HAS NOT ALREADY ANSWERED YES] Has {CHILD'S NAME} stopped being fed infant formula?

  • Yes

  • No (GO to C66)



E25. How old was {FILL: HE/SHE} when {FILL: HE/SHE} completely stopped being fed infant formula? (Day 0 is the day your child was born)

My child completely stopped feeding infant formula at ___ days OR ___ weeks OR ___ months





E26. What were the two most important reasons for your decision to stop feeding {CHILD'S NAME} infant formula?

[PROGRAMMER: ONLY ALLOW ONE RESPONSE PER COLUMN, DO NOT ALLOW BOTH COLUMNS CHECKED FOR SAME LINE]


Most important reason

Second most important reason

My child started drinking other milk(s) (such as cow's milk, soy milk, rice milk, or goat's milk)



My child started drinking other drinks (such as water, juice, sweetened fruit drinks, or soda or pop)



I fed my child my breast milk



I fed my child breast milk from someone else



My doctor told me to stop



I thought it was time to be done



Other reason





Feeding Practices and Beliefs

These next questions are about beliefs you may have about your child and other toddlers.

How much do you agree or disagree with the following statements?


Disagree

Slightly Disagree

Neutral

Slightly Agree

Agree

C66. {CHILD'S NAME} leaves food on {FILL: HIS/HER} plate at the end of meal.






C67. {CHILD'S NAME} cannot eat a meal if {FILL: HE/SHE} has had a snack just before.






C68. {CHILD'S NAME} is always asking for food.






C69. If allowed to, {CHILD'S NAME} would eat too much.






C84. It is important for parents to have rules for how much a toddler eats






C85. A toddler should never eat fast food










The following are statements that parents or children may do. Please indicate how often you or your child do the following:


Never

Seldom

Half the time

Most of the time

Always

C70. {CHILD'S NAME} lets me know when {FILL: HE/SHE} is full






C72. I talk to {CHILD'S NAME} to encourage {FILL: HIM/HER} to eat






C81. I try to get {CHILD'S NAME} to finish {FILL: HIS/HER} food






C82. I insist {CHILD'S NAME} re-tries new foods that were refused at the same meal






C88. I allow {CHILD'S NAME} to watch TV while eating if {FILL: HE/SHE} wants






C89. I allow {CHILD'S NAME} to eat fast food if {FILL: HE/SHE} wants






C90. I allow {CHILD'S NAME} to drink sugared drinks/soda if {FILL: HE/SHE} wants






C91. I allow {CHILD'S NAME} to eat desserts/sweets if {FILL: HE/SHE} wants






C115. I let {CHILD'S NAME} decide how much to eat






C116. I pay attention when {CHILD'S NAME} seems to be telling me that {FILL: HE/SHE} is full or hungry






C117. I allow {CHILD'S NAME} to eat when {FILL: HE/SHE} is hungry






The next questions are about your child’s eating behavior. For each statement, please select the response that most closely reflects your child’s eating behavior.


Never

Rarely

Sometimes

Often

Always

C99. My child gets full up easily






C100. My child gets full before {FILL: HIS/HER} meal is finished






C101. Even if my child is full up, {FILL: HE/SHE} finds room to eat {FILL: HIS/HER} favorite food






C102. My child enjoys tasting new foods






C103. My child enjoys a wide variety of foods






C104. My child decides that {FILL: HE/SHE} doesn’t like food, even without tasting it










HEALTH AND LIFESTYLE



C46. Which of the following was {CHILD'S NAME} given in vitamin or mineral drops [or pills] or chewables at least 3 days a week during the past week?


Yes

No

Iron only vitamin



Vitamin D only vitamin



Multivitamin



Other vitamins





H24. Which of the following problems did {CHILD'S NAME} have during the past month?


Yes

No

Fever



Diarrhea or vomiting



Ear infection



Severe respiratory infection (e.g., pneumonia, bronchiolitis)



Wheeze



Eczema (atopic dermatitis)



COVID-19







H6. What kind of birth control are you or your spouse/partner using now?

Select all that apply.

  • Hormonal IUD (Mirena®, Skyla®, Kyleena®, Liletta®)

  • Implant (Nexplanon®)

  • Shot (Depo-Provera®)

  • Progestin-only pill (e.g. mini-pill)

  • Combined contraception (e.g. combined pill, patch [OrthoEvra®] or vaginal ring [NuvaRing®])

  • Non hormonal method (for example permanent sterilization [e.g., tubes tied, Essure®, vasectomy], copper [non-hormonal] IUD, condoms, not having sex at certain times [rhythm method or natural family planning], withdrawal [pulling out], diaphragm, cervical cap, sponge, not having sex, no method, not applicable [e.g. hysterectomy, same-sex partner])





[PROGRAMMER: DISPLAY CONTACT INFORMATION SECTION]

CONTACT INFORMATION SCREEN



1-MONTH SURVEY AND ONWARDS:

Thank you very much for completing the survey! Please take a moment to review your information and update as needed.

We can provide you with a link for $X immediately after you complete this survey or mail you a check. Which would you prefer?



Preference for receiving the money for the survey:

 Check [PROGRAMMER: IF CHECK IS SELECTED BUT THERE IS NO ADDRESS, DISPLAY MESSAGE “Please enter your mailing address below”]

 Online gift card [PROGRAMMER: IF GIFT CARD IS SELECTED BUT THERE IS NO EMAIL ADDRESS, DISPLAY MESSAGE “Please enter your email address below”]



[PROGRAMMER: PRE-POPULATE ALL CONTACT INFORMATION THAT HAS BEEN PROVIDED ON PREVIOUS SURVEY(S). IF NO INFORMATION HAS BEEN PROVIDED, LEAVE BLANK]



Contact Information



Name*:

Cell Phone Number*:

Email address*:



*Would you prefer to receive study information through text or email or both?

 Text Email Both Text and Email

*This information is required.

[PROGRAMMER: DISPLAY IF INFORMATION HAS BEEN PRE-POPULATED]



Is this information still correct?

Yes

No [PROGRAMMER: IF NO, PROVIDE BLANK CONTACT INFORMATION FOR RESPONDENT TO UPDATE]

[PROGRAMMER: MAILING ADDRESS IS ONLY DISPLAYED IF CHECK IS INDICATED ABOVE AND NO MAILING ADDRESS HAS BEEN PROVIDED PREVIOUSLY]



Address 1:

Address 2:

Zip code:



[PROGRAMMER: PRE-POPULATE STATE AND CITY]



Contact Information of someone the study can contact in case we lose touch with you:

Please provide the name and contact information of another person who would always know how to contact you (such as your partner, parent, or friend). We will contact them only if we cannot reach you by email or text. Please let them know they have your permission to share your contact information with the study.



Name:



Relationship: Spouse/Partner/Parent/Sibling/Other Relative/Friend



Phone Number:

Email address:



[IF CHECK: Please look out for a check from Westat in 5 -7 business days IF VIRTUAL GIFT CARD: Please look out for an email or text with a link to your online gift card]. Your next survey will start [NEXT SURVEY START DATE]. We will send you a reminder on that day. Please make sure to update your contact information at this website at any time your phone number or email address changes. Thank you for your continued participation in the Feeding My Baby and Me Study.







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