Reminder: 1/4 cup = 4 tbs 1/3 cup = 5.33 tbs 3 oz. meat = 1 deck of cards 1 oz. cheese = 2 dominoes Rudd Center for Food Policy and Obesity / Page 1 of 9 Meal Observation Tool—Part I: Foods Served Center ID: ____________________________________________________ Date of observation: ____________ Name of observer: _______________________________________________________________________________ Meal observed (circle): Breakfast A.M. Snack Lunch P.M. Snack Procedure: Each observer will watch 3 children, 1 of which will be the same for all observers. Before the children sit for the meal, observers should agree on an empty chair that all observers can see. The child who sits in that chair will be the same child watched by all observers. Each observer should pick 2 other distinct empty chairs that are easily visible and watch the children who sit there. Note: Sometimes older children will sit with the preschoolers. Make sure you are observing a child that is either 3 or 4 years old. 1. What are the characteristics of the children you are observing? Gender Race (Choose white, black, Latino, Asian Weight status (Choose UW for underweight, (Choose M or F) American, American Indian, or Unknown) NW for normal weight, or OW for overweight) Child 1 Child 2 Child 3 2. Which child are you jointly observing with another observer? _______________________________________________ REMEMBER: ASK THE COOK WHAT TYPE OF FAT (e.g., butter, vegetable oil, stick margarine, tub margarine) WAS USED TO COOK EACH MEAL COMPONENT, AND IF POSSIBLE, THE QUANTITY USED Vegetables: __________________________________ Grains: ______________________________________ Protein: ______________________________________ Other: _______________________________________ 3. Circle all of the dishes served at the meal; write in dishes that are not listed. ❑ CHECK HERE if children brought their own lunches. Dish Dish Dish Dish 1. Pizza 6. Macaroni & cheese 11. Deli/tuna sandwiches 16. Chicken patty sandwich 2. Tacos 7. Spaghetti & meatballs 12. Peanut butter & jelly 17. French fries 3. Chicken nuggets/fingers 8. Ravioli 13. Fish sticks/fried filets of fish 18. Beef stew 4. Grilled cheese 9. Hamburgers 14. Salad 19. Veggies & dip 5. Soup 10. Fruit salad 15. Casserole 20. Lasagna 99. OTHER:
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Reminder: 1/4 cup = 4 tbs 1/3 cup = 5.33 tbs 3 oz. meat = 1 deck of cards 1 oz. cheese = 2 dominoes
Rudd Center for Food Policy and Obesity / Page 1 of 9
Meal Observation Tool—Part I: Foods ServedCenter ID: ____________________________________________________ Date of observation: ____________
Name of observer: _______________________________________________________________________________
Meal observed (circle): Breakfast A.M. Snack Lunch P.M. Snack
Procedure: Each observer will watch 3 children, 1 of which will be the same for all observers. Before the
children sit for the meal, observers should agree on an empty chair that all observers can see. The child
who sits in that chair will be the same child watched by all observers. Each observer should pick 2 other
distinct empty chairs that are easily visible and watch the children who sit there.
Note: Sometimes older children will sit with the preschoolers. Make sure you are observing a child that is
either 3 or 4 years old.
1. What are the characteristics of the children you are observing?
Gender Race (Choose white, black, Latino, Asian Weight status (Choose UW for underweight, (Choose M or F) American, American Indian, or Unknown) NW for normal weight, or OW for overweight)
Child 1
Child 2
Child 3
2. Which child are you jointly observing with another observer? _______________________________________________
REMEMBER: ASK THE COOK WHAT TYPE OF FAT (e.g., butter, vegetable oil, stick margarine, tub margarine) WAS USED TO COOK EACH MEAL COMPONENT, AND IF POSSIBLE, THE QUANTITY USED
Vegetables: __________________________________
Grains: ______________________________________
Protein: ______________________________________
Other: _______________________________________
3. Circle all of the dishes served at the meal; write in dishes that are not listed. ❑ ChECk hERE if childrenbrought their own lunches.
Dish Dish Dish Dish
1. Pizza 6. Macaroni & cheese 11. Deli/tuna sandwiches 16. Chicken patty sandwich2. Tacos 7. Spaghetti & meatballs 12. Peanut butter & jelly 17. French fries3. Chicken nuggets/fingers 8. Ravioli 13. Fish sticks/fried filets of fish 18. Beef stew4. Grilled cheese 9. Hamburgers 14. Salad 19. Veggies & dip5. Soup 10. Fruit salad 15. Casserole 20. Lasagna99. OTHER:
Reminder: 1/4 cup = 4 tbs 1/3 cup = 5.33 tbs 3 oz. meat = 1 deck of cards 1 oz. cheese = 2 dominoes
MIXED DISHES (STEWS, SOUPS, CASSEROLES)Instructions: If children are served a mixed dish such as a soup, stew, or casserole for which it is difficult to estimate the amount of each component of the dish, use the table below to record the types of mixed dishes served. Please use this only for truly mixed dishes; make your best effort to estimate the components of a salad, sandwich, or pasta dish. Write the name of the dish under “Type” along with the corresponding number from the list below. If the dish served is not listed, write in the name along with 888 for “other”. Record the serving size in number of tablespoons, diameter (in inches), or area (inches squared). Also record additional helpings, and the amount not eaten. Record the brand of food, and list the components of the dish. Do not re-record the components of a dish listed in this table elsewhere in the observation tool.
Rudd Center for Food Policy and Obesity / Page 2 of 9
1. Beef stew2. Beef vegetable soup3. Burrito4. Calzone or hot pocket5. Casserole
6. Chicken soup7. Chowder8. Lasagna9. Minestrone soup10. Nachos
11.Pizza12. Tacos13. Vegetable Soup
888. Other
Contains what ingredients (e.g. which vegetables,
Type Child Amount left on Brand meats, beans, observed Serving 1 Serving 2 Serving 3 plate at end of (if known/ cheeses, grains,
meal (not eaten) applicable) fruits, sauces)
Child 1 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ by ___ inches ___ by ___ inches ___ by ___ inches ___ by ___ inches
Child 2 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ by ___ inches ___ by ___ inches ___ by ___ inches ___ by ___ inches
Child 3 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ by ___ inches ___ by ___ inches ___ by ___ inches ___ by ___ inches
Child 1 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ by ___ inches ___ by ___ inches ___ by ___ inches ___ by ___ inches
Child 2 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ by ___ inches ___ by ___ inches ___ by ___ inches ___ by ___ inches
Child 3 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ by ___ inches ___ by ___ inches ___ by ___ inches ___ by ___ inches
Child 1 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ by ___ inches ___ by ___ inches ___ by ___ inches ___ by ___ inches
Child 2 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ by ___ inches ___ by ___ inches ___ by ___ inches ___ by ___ inches
Child 3 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ by ___ inches ___ by ___ inches ___ by ___ inches ___ by ___ inches
Child 1 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ by ___ inches ___ by ___ inches ___ by ___ inches ___ by ___ inches
Child 2 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ by ___ inches ___ by ___ inches ___ by ___ inches ___ by ___ inches
Child 3 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ by ___ inches ___ by ___ inches ___ by ___ inches ___ by ___ inches
Reminder: 1/4 cup = 4 tbs 1/3 cup = 5.33 tbs 3 oz. meat = 1 deck of cards 1 oz. cheese = 2 dominoes
I. FRUITInstructions: Use the table below to record the types of fruit served to children. Write in the name of the fruit under “fruit type” along with the corresponding number from the list below. If the fruit served is not listed below, write in the name and number it as 888 for “other”. Record the serving size in number of tablespoons or fraction/number of whole fruit; record additional helpings, and record amount not eaten. Check the appropriate box to describe how the fruit was prepared.
Rudd Center for Food Policy and Obesity / Page 3 of 9
1. Apples (portion of whole fruit)2. Bananas (portion of whole fruit)3. Blueberries (tablespoons)4. Cantaloupe (portion of whole fruit)5. Dried apricots (tablespoons)6. Fruit cocktail (tablespoons)7. Grapes (tablespoons)
8. Honeydew melon (portion of whole fruit)9. Kiwi (portion of whole fruit)10. Mango (portion of whole fruit)11. Oranges (portion of whole fruit)12. Peaches (portion of whole fruit)13. Pears (portion of whole fruit)14. Pineapple (portion of whole fruit)
15. Raisins (tablespoons)16. Raspberries (tablespoons)17. Strawberries (tablespoons)18. Watermelon (tablespoons)
888. Other
Amount left onChild plate at end of Is the fruit fresh,
Type observed Serving 1 Serving 2 Serving 3 meal (not eaten) frozen, dried or canned?
Child 1 _____ tbs or _____ tbs or _____ tbs or _____ tbs or _______ whole fruit _______ whole fruit _______ whole fruit _______ whole fruit
Child 2 _____ tbs or _____ tbs or _____ tbs or _____ tbs or _______ whole fruit _______ whole fruit _______ whole fruit _______ whole fruit
Child 3 _____ tbs or _____ tbs or _____ tbs or _____ tbs or _______ whole fruit _______ whole fruit _______ whole fruit _______ whole fruit
Child 1 _____ tbs or _____ tbs or _____ tbs or _____ tbs or _______ whole fruit _______ whole fruit _______ whole fruit _______ whole fruit
Child 2 _____ tbs or _____ tbs or _____ tbs or _____ tbs or _______ whole fruit _______ whole fruit _______ whole fruit _______ whole fruit
Child 3 _____ tbs or _____ tbs or _____ tbs or _____ tbs or _______ whole fruit _______ whole fruit _______ whole fruit _______ whole fruit
Child 1 _____ tbs or _____ tbs or _____ tbs or _____ tbs or _______ whole fruit _______ whole fruit _______ whole fruit _______ whole fruit
Child 2 _____ tbs or _____ tbs or _____ tbs or _____ tbs or _______ whole fruit _______ whole fruit _______ whole fruit _______ whole fruit
Child 3 _____ tbs or _____ tbs or _____ tbs or _____ tbs or _______ whole fruit _______ whole fruit _______ whole fruit _______ whole fruit
Child 1 _____ tbs or _____ tbs or _____ tbs or _____ tbs or _______ whole fruit _______ whole fruit _______ whole fruit _______ whole fruit
Child 2 _____ tbs or _____ tbs or _____ tbs or _____ tbs or _______ whole fruit _______ whole fruit _______ whole fruit _______ whole fruit
Child 3 _____ tbs or _____ tbs or _____ tbs or _____ tbs or _______ whole fruit _______ whole fruit _______ whole fruit _______ whole fruit
❑ None Served
Reminder: 1/4 cup = 4 tbs 1/3 cup = 5.33 tbs 3 oz. meat = 1 deck of cards 1 oz. cheese = 2 dominoes
II. VEGETABLESInstructions: Use the table below to record the types of vegetables served to children. Write the name of the vegetable under “vegetable type” along with the corresponding number from the list below. If the vegetable served is not listed below, write in the name and number it as 888 for “other”. Record the serving size in number of tablespoons or in number of pieces (circle which one you are using); record additional helpings and amount not eaten; and check the appropriate box for how the vegetable was prepared. If no vegetables were served at the meal, check “none served” at the bottom of the page.
Rudd Center for Food Policy and Obesity / Page 4 of 9
1. Bell peppers (portion of whole piece)2. Broccoli (tablespoons)3. Carrots (portion of whole piece)4. Cauliflower (tablespoons)5. Celery (portion of whole piece)6. Corn (tablespoons)7. Eggplant (portion of whole piece)
8. Green beans (tablespoons)9. Lettuce/ mesclun for salads (tablespoons)10. Pumpkin/ butternut squash (tablespoons)11. Peas (tablespoons)12. Spinach/chard/ kale/ collards (tablespoons)13. Sugar snap peas (tablespoons)14. Sweet potatoes/yams (portion of whole
piece)15. Tomatoes (portion of whole piece)16. White potatoes (portion of whole piece)17. Vegetable mix (portion of whole piece)18. Zucchini /summer squash (portion of wholepiece)888. Other
Amount Cooking method Type of cooking Do the left on (deep fried/ fat used (butter, vegetables plate at breaded, margarine, appear to be
Vegetable Child end of meal steamed, shortening, or fresh, frozen, Type observed Serving 1 Serving 2 Serving 3 (not eaten) boiled, or raw) vegetable oil) or canned?
Child 1 _____ tbs _____ tbs _____ tbs _____ tbs ___ pieces ___ pieces ___ pieces ___ pieces
Child 2 _____ tbs _____ tbs _____ tbs _____ tbs ___ pieces ___ pieces ___ pieces ___ pieces
Child 3 _____ tbs _____ tbs _____ tbs _____ tbs ___ pieces ___ pieces ___ pieces ___ pieces
Child 1 _____ tbs _____ tbs _____ tbs _____ tbs ___ pieces ___ pieces ___ pieces ___ pieces
Child 2 _____ tbs _____ tbs _____ tbs _____ tbs ___ pieces ___ pieces ___ pieces ___ pieces
Child 3 _____ tbs _____ tbs _____ tbs _____ tbs ___ pieces ___ pieces ___ pieces ___ pieces
Child 1 _____ tbs _____ tbs _____ tbs _____ tbs ___ pieces ___ pieces ___ pieces ___ pieces
Child 2 _____ tbs _____ tbs _____ tbs _____ tbs ___ pieces ___ pieces ___ pieces ___ pieces
Child 3 _____ tbs _____ tbs _____ tbs _____ tbs ___ pieces ___ pieces ___ pieces ___ pieces
Child 1 _____ tbs _____ tbs _____ tbs _____ tbs ___ pieces ___ pieces ___ pieces ___ pieces
Child 2 _____ tbs _____ tbs _____ tbs _____ tbs ___ pieces ___ pieces ___ pieces ___ pieces
Child 3 _____ tbs _____ tbs _____ tbs _____ tbs ___ pieces ___ pieces ___ pieces ___ pieces
❑ None Served
Reminder: 1/4 cup = 4 tbs 1/3 cup = 5.33 tbs 3 oz. meat = 1 deck of cards 1 oz. cheese = 2 dominoes
III. GRAINS AND STARCHESInstructions: Use the table below to record the types of grain products served to children. Write the name under “grain type” along with the corresponding number in the list below. If the grain product served is not listed below, write in the name and number it as 888 for “other”. Record the serving size in number of tablespoons (for loose grains such as rice and cereal) or pieces/slices (for breads, pastries, and tortillas). If you record the number of pieces/slices, also record the length and width or the diameter. Record additional helpings and amount not eaten. Check the appropriate box for whether it was whole grain. If no grain products were served at the meal at all, check “none served” at the bottom of the page.
1. Bagel (pieces/area)2. Bread (pieces/area)3. Cereal, cold (tablespoons)4. Cereal, hot (tablespoons)5. Cornbread (pieces/area)6. Crackers, not graham (pieces)7. Croissants (pieces/area)8. Danish /scones/other flaky pastry (pieces/area)
9. Doughnuts (pieces/area)10. Doughnut holes (pieces/area)11. English muffins (pieces/area)12. French toast (pieces/area)13. Mini doughnuts (pieces/area)14. Muffins (pieces/area)15. Pancakes (pieces/area)16. Pasta (tablespoons)17. Pita (pieces/area)
18. Pretzels (pieces)19. Quick bread (pieces/area)20. Rice (tablespoons)21. Rice cakes (pieces/area)22. Sandwich roll/ hot dog bun(pieces/area)23. Tortilla, corn (pieces/area)24. Tortilla, flour (pieces/area)25. Waffles (pieces/area)888. Other
Amount Whole grain Type of cooking left on content fat used (butter, plate at (refined, margarine,
Grain Child end of meal partial, shortening, or Type observed Serving 1 Serving 2 Serving 3 (not eaten) or 100%) vegetable oil)
Child 1 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ pieces (area: ___ by ___ in.) ___ pieces ___ pieces ___ pieces
Child 2 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ pieces (area: ___ by ___ in.) ___ pieces ___ pieces ___ pieces
Child 3 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ pieces (area: ___ by ___ in.) ___ pieces ___ pieces ___ pieces
Child 1 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ pieces (area: ___ by ___ in.) ___ pieces ___ pieces ___ pieces
Child 2 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ pieces (area: ___ by ___ in.) ___ pieces ___ pieces ___ pieces
Child 3 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ pieces (area: ___ by ___ in.) ___ pieces ___ pieces ___ pieces
Child 1 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ pieces (area: ___ by ___ in.) ___ pieces ___ pieces ___ pieces
Child 2 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ pieces (area: ___ by ___ in.) ___ pieces ___ pieces ___ pieces
Child 3 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ pieces (area: ___ by ___ in.) ___ pieces ___ pieces ___ pieces
Child 1 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ pieces (area: ___ by ___ in.) ___ pieces ___ pieces ___ pieces
Child 2 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ pieces (area: ___ by ___ in.) ___ pieces ___ pieces ___ pieces
Child 3 _____ tbs or _____ tbs or _____ tbs or _____ tbs or ___ pieces (area: ___ by ___ in.) ___ pieces ___ pieces ___ pieces
❑ None Served
Rudd Center for Food Policy and Obesity / Page 5 of 9
Reminder: 1/4 cup = 4 tbs 1/3 cup = 5.33 tbs 3 oz. meat = 1 deck of cards 1 oz. cheese = 2 dominoes
IV. PROTEINSInstructions: Use the table below to record the types of protein served to children. Write in the name of the protein under “meat/meat alternative type” along with the corresponding number in the list below. If the protein served is not listed below, write in the name and number it as 888 for “other”. Record the serving size in number of ounces, tablespoons, or in number of whole pieces (circle); record additional helpings and amount not eaten; and check the appropriate box for how the protein was prepared. If no meats or meat alternatives were served at the meal, check “none served” at the bottom of the page.
1. Bacon (oz)2. Beans or legumes, not hummus/dip (tbs)3. Beef, hamburger (oz)4. Beef, roast (oz)5. Cheese, low-fat (oz)6. Cheese, regular (oz)7. Chicken or turkey, cold cut (oz)8. Chicken or turkey, plain (oz)9. Chicken or turkey, ground (oz)10. Chicken or turkey nuggets (pieces)
11. Chicken or turkey patties (pieces)12. Eggs (pieces)13. Fish, plain (oz)14. Fish, fish sticks (pieces)15. Fish, tuna salad (tbs)16. Ham (oz)17. Hot dogs (pieces)18. Nuts, whole (tbs)19. Peanut butter or other nut butter (tbs)
20. Pepperoni (oz)21. Sausage (oz)22. Tofu (tbs)23. Veggie burgers/ soy nuggets (pieces)24. Yogurt, non/low-fat, unflavored (tbs)25. Yogurt, non/low-fat, flavored (tbs)26. Yogurt, whole fat, unflavored (tbs)27. Yogurt, whole fat, flavored (tbs)888. Other
Cooking method Meat/ (deep fried/ Meat Amount left on breaded, grilled, Alternative Child plate at end of roasted, baked, Type observed Serving 1 Serving 2 Serving 3 meal (not eaten) sautéed, or boiled)
Child 1 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
Child 2 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
Child 3 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
Child 1 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
Child 2 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
Child 3 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
Child 1 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
Child 2 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
Child 3 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
Child 1 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
Child 2 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
Child 3 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
❑ None Served
Rudd Center for Food Policy and Obesity / Page 6 of 9
Reminder: 1/4 cup = 4 tbs 1/3 cup = 5.33 tbs 3 oz. meat = 1 deck of cards 1 oz. cheese = 2 dominoes
V. CONDIMENTS/COOKING FATS/SPREADSInstructions: Use the table below to record the types of condiments, spreads, and cooking fats served to children. Write the name of the item under “condiment type” along with the corresponding number in the list below. If the condiment served is not listed below, write in the name and number it as 888 for “other”. Record the serving size in number of tablespoons; also record additional helpings and amount not eaten. Check the appropriate box for whether the condiment was light or low fat (if applicable). If no condiments/cooking fats/spreads were served, check “none served” at the bottom of the page.Reminder: 1 tbs cheese or tomato sauce covers about ½ cup macaroni. 1 tbs smooth peanut butter covers 1 slice of bread. 1 tbs cream cheese covers a large bagel half. 1 tsp mayonnaise, butter, or ketchup covers 1 slice bread. 1 tbs salad dressing covers 2 tbs lettuce.
1. Butter2. Cheese sauce3. Cream cheese4. Cream sauce5. Guacamole6. Honey7. Hummus
8. Jam/jelly/preserves9. Ketchup10. Maple syrup11. Mayonnaise12. Mustard13. Salad dressing14. Salsa
15. Soft margarine16. Stick margarine17. Sour cream18. Vegetable oil
888. Other
Child Amount left on plate Condiment/Cooking fat/Spread Type observed Serving 1 Serving 2 Serving 3 at end of meal (not eaten) Light/low fat
Child 1 _____ tbs _____ tbs _____ tbs _____ tbs
Child 2 _____ tbs _____ tbs _____ tbs _____ tbs
Child 3 _____ tbs _____ tbs _____ tbs _____ tbs
Child 1 _____ tbs _____ tbs _____ tbs _____ tbs
Child 2 _____ tbs _____ tbs _____ tbs _____ tbs
Child 3 _____ tbs _____ tbs _____ tbs _____ tbs
Child 1 _____ tbs _____ tbs _____ tbs _____ tbs
Child 2 _____ tbs _____ tbs _____ tbs _____ tbs
Child 3 _____ tbs _____ tbs _____ tbs _____ tbs
Child 1 _____ tbs _____ tbs _____ tbs _____ tbs
Child 2 _____ tbs _____ tbs _____ tbs _____ tbs
Child 3 _____ tbs _____ tbs _____ tbs _____ tbs
❑ None Served
Rudd Center for Food Policy and Obesity / Page 7 of 9
Reminder: 1/4 cup = 4 tbs 1/3 cup = 5.33 tbs 3 oz. meat = 1 deck of cards 1 oz. cheese = 2 dominoes
VI. BEVERAGESInstructions: Use the table below to record the types of beverages served to children (including water). Write in the name of the item under “beverage type” along with the corresponding number in the list below. If the beverage served is not listed below, write in the name and number it as 888 for other. Record the serving size in number of tablespoons, additional helpings, and amount not consumed.
1. 1% milk, unflavored2. 1% milk, flavored3. 2% milk, unflavored4. 2% milk, flavored5. Skim milk, unflavored6. Skim milk, flavored7. Whole milk, unflavored
8. Whole milk, flavored9. Non-dairy milk, unflavored10. Non-dairy milk, flavored11. Fruit juice, 100%12. Fruit drinks, not 100% (e.g. lemonade, bugjuice)13. Iced tea
14. Soda15. Sports drinks16. Water
888. Other
Child Amount left in cup Beverage Type observed Serving 1 Serving 2 Serving 3 at end of meal (not eaten)
Child 1 _____ tbs _____ tbs _____ tbs _____ tbs
Child 2 _____ tbs _____ tbs _____ tbs _____ tbs
Child 3 _____ tbs _____ tbs _____ tbs _____ tbs
Child 1 _____ tbs _____ tbs _____ tbs _____ tbs
Child 2 _____ tbs _____ tbs _____ tbs _____ tbs
Child 3 _____ tbs _____ tbs _____ tbs _____ tbs
Child 1 _____ tbs _____ tbs _____ tbs _____ tbs
Child 2 _____ tbs _____ tbs _____ tbs _____ tbs
Child 3 _____ tbs _____ tbs _____ tbs _____ tbs
Child 1 _____ tbs _____ tbs _____ tbs _____ tbs
Child 2 _____ tbs _____ tbs _____ tbs _____ tbs
Child 3 _____ tbs _____ tbs _____ tbs _____ tbs
❑ None Served
Rudd Center for Food Policy and Obesity / Page 8 of 9
Reminder: 1/4 cup = 4 tbs 1/3 cup = 5.33 tbs 3 oz. meat = 1 deck of cards 1 oz. cheese = 2 dominoes
VII. “OTHER” FOODSInstructions: Use the table below to record the types of “other” foods served to children. Write in the name of the item under “type” along with the corresponding number in the list below. If the food served is not listed below, write in the name and number it as 888 for other. Record the serving size in tablespoons or pieces, additional helpings, and amount not eaten. If no “other” foods were served, check “none served” at the bottom of the page.
1. Animal crackers (pieces)2. Baked chips (pieces)3. Cake (pieces)4. Candy, not including chocolate (pieces)5. Cheese puffs (pieces)6. Chex mix (tbs)7. Chocolate bars (pieces)8. Chocolate kisses (pieces)9. Chocolate M & Ms (tbs)
10. Cookies (pieces)11. Corn chips, e.g. Fritos (tbs)12. Cupcakes (pieces)13. Frozen yogurt (tbs)14. Fruit roll-up (pieces)15. Graham crackers (pieces)16. Ice cream (tbs)17. Jello (tbs)18. Pop tart (pieces)
19. Popcorn, no butter (tbs)20. Popcorn, with butter (tbs)21. Popsicles (pieces)22. Potato chips (tbs)23. Pudding (tbs)24. Tortilla chips (tbs)888. Other
Child Serving 1 Amount left on plate Type observed (circle which unit) Serving 2 Serving 3 at end of meal (not eaten)
Child 1 _____ oz / pieces _____ oz / pieces _____ oz / pieces _____ oz / pieces
Child 2 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
Child 3 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
Child 1 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
Child 2 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
Child 3 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
Child 1 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
Child 2 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
Child 3 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
Child 1 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
Child 2 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
Child 3 _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs _____ oz / pieces / tbs
❑ None Served
Rudd Center for Food Policy and Obesity / Page 9 of 9
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