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Chiropractic Journal of Australia : CJA September 2012
Chiropractic Journal of Australia Volume 42 Number 3 September 2012 107 CHIROPRACTIC AND BREASTFEEDING PROBLEMS STEWART Hard clamp; this suck hurts. E If the suck was abnormal, please rate the mother’s perception of the ability to suck: 0 1 2 3 4 5 6 7 8 9 10 Excellent Good Ok Poor Extremely Poor 5. Does your baby tend to choke, gag, or cough a lot throughout the feed? YES NO If YES: Please rate the amount of choking, gagging, and coughing throughout the feed. 0 1 2 3 4 5 6 7 8 9 10 None A little Moderate A lot Severe 6. Do you feel pain when feeding? YES NO If YES (i) is one side worse? Left Right Both equal (ii) Please rate the pain (if there is pain each side, rate both and label) 0 1 2 3 4 5 6 7 8 9 10 None A little Moderate A lot Severe 7. Do you fnd breastfeeding stressful? YES NO If YES: Please rate your stress out of ten, assuming 10 is high stress and 0 is none: 0 1 2 3 4 5 6 7 8 9 10 No Stress A little Moderate A lot Severe 8. Has there been any of the following? a. mastitis YES NO IF YES, when______________________________ b. tongue tie YES NO IF YES, when______________________________ c. low milk supply YES NO If YES, when_______________________________ d. stress YES NO Clarify____________________________________ Subluxations: Location and Listing. Please note visit when corrected (on post-treatment quesionairre) Eg. L. AI GHJ. Corrected at visit 3 Other notes: Primary: Secondary:
CJA June 2012
CJA December 2012