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Questionnaire (Breastfeed Infants) GENERAL INTRUCTION: Fill in The Following Information That Is Needed Below. Part I. Profile

The document contains a questionnaire to assess the cognitive, psychomotor, affective development and academic performance of breastfed and non-breastfed infants. The questionnaire collects the infant's profile information and has parents rate the infant in various areas of development on a scale of 1 to 4, with 4 being highly evident and 1 being not evident. The areas assessed include cognitive skills, physical skills, social-emotional skills, and academic traits. Parents are asked to complete the questionnaire to provide information on their infant's development based on whether the infant was breastfed or non-breastfed.

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Mark Elben
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74 views4 pages

Questionnaire (Breastfeed Infants) GENERAL INTRUCTION: Fill in The Following Information That Is Needed Below. Part I. Profile

The document contains a questionnaire to assess the cognitive, psychomotor, affective development and academic performance of breastfed and non-breastfed infants. The questionnaire collects the infant's profile information and has parents rate the infant in various areas of development on a scale of 1 to 4, with 4 being highly evident and 1 being not evident. The areas assessed include cognitive skills, physical skills, social-emotional skills, and academic traits. Parents are asked to complete the questionnaire to provide information on their infant's development based on whether the infant was breastfed or non-breastfed.

Uploaded by

Mark Elben
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Questionnaire (Breastfeed Infants)

GENERAL INTRUCTION: Fill in the following information that is needed below.


Part I. Profile
Name (optional): _________________________
Age: _________
Sex: ______
Religion: _________________
Civil Status: ____________

Part II. Extent of Breastfeed infants.


The following are verbal interpretation of level scales for collected responses of
breastfed respondents.
4=highly evident
3=evident
2=less evident
1=not evident
Instruction: Please check what level of scale does your child belong.
Cognitive 4 3 2 1
highly evident less not
evident evident evident
 Is able to answer
 Is able to classify objects
 Is able to focus on multiple
aspects of situation
 Is able to think in terms of
present past and future events

Psychomotor 4 3 2 1
highly evident less not
evident evident evident
 No delay in physical
development
 Is able to respond according to
age
 Is able to exert stremous
activity
 Is able to run
 Is able to play game
Affective 4 3 2 1
highly evident less not
evident evident evident
 Love of God
 Love of parents
 Love of peers
 Love of faith
 Love of environment
 Love of sportsmanship

Part III. Extent of Academic Performance


4 3 2 1
highly evident less not
evident evident evident
 Intellectual Capacity (IQ)
 Emotional Capacity (EQ)
 Productive relationship with
people
 Productive relationship with
environment
 Grades obtain from school
Questionnaire (Non-breastfeed Infants)
GENERAL INTRUCTION: Fill in the following information that is needed in the below.
Part I. Profile
Name (optional): _________________________
Age: _________
Sex: ______
Religion: _________________
Civil Status: ____________

Part II. Extent of non-breastfeed infants.


The following are verbal interpretation of level scales for collected responses of
non-breastfed respondents.
4=highly evident
3=evident
2=less evident
1=not evident
Instruction: Please check what level of scale does your child belong.
Cognitive 4 3 2 1
highly evident less not
evident evident evident
 Is able to answer
 Is able to classify objects
 Is able to focus on multiple
aspects of situation
 Is able to think in terms of
present past and future events

Psychomotor 4 3 2 1
highly evident less not
evident evident evident
 No delay in physical
development
 Is able to respond according to
age
 Is able to exert stremous
activity
 Is able to run
 Is able to play game
Affective 4 3 2 1
highly evident less not
evident evident evident
 Love of God
 Love of parents
 Love of peers
 Love of faith
 Love of environment
 Love of sportsmanship

Part III. Extent of Academic Performance


4 3 2 1
highly evident less not
evident evident evident
 Intellectual Capacity (IQ)
 Emotional Capacity (EQ)
 Productive relationship with
people
 Productive relationship with
environment
 Grades obtain from school

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