Do you have legal and medical decision-making authority to answer these screening questions on behalf of your child?

Is your baby between 8 weeks and under 6 months old? 

Is your baby exclusively breastfeeding at least five times daily?

Do you have any concerns about your child’s ability to breastfeed?

Is breastfeeding painful?

When breastfeeding, does your child FREQUENTLY cough or choke?

Has your child established adequate weight gain (per the pediatrician, midwife, NNP, lactation consultant or another medical provider following your child)

Does your child open his or her mouth and suck on your finger when you place it near or in his or her mouth? 

Sucking may happen in as short as 1 second or as long as 2-3 minutes.   If your baby is closer to 4-5 months old, he or she will likely require more time to suck on your finger. 

Be patient, move with your baby, do not force your finger in his or her mouth, and hold your finger as steady as possible. Even one suck counts and you will answer yes below!

For more detailed instructions on how to check for this or to watch a video demonstration please copy and paste this link into a new browser/tab: https://bottlesonpurpose.com/sucking-reflex

Do you have concerns about your child’s development or has anyone expressed concerns about your child’s development?

Is your child spending at least 20-30 minutes on his or her belly cumulatively daily for tummy time? 

*These can be shorter increments added throughout the day and include the time you are holding them on your chest, on their belly in your arms or on your lap, or in other locations where they are on their belly.

Does your child have significant flattening on the back of his or her head?

Do you want your child to take a bottle?

Do you feel comfortable identifying potential medical problems with your child and seeking medical attention for your child accordingly?

I confirm I am a parent or guardian seeking support for my exclusively breastfed baby to take a bottle. I understand that although these screening questions are designed to rule out an underlying feeding issue hindering my baby’s ability to bottle feed, it is impossible to replace an in-person feeding evaluation. I further understand that these screening questions and the Bottles on Purpose program do not constitute medical advice and that if I have any concerns about my baby, I should seek prompt medical attention. I confirm that the information submitted in the pre-screening questions is complete and true to the best of my knowledge. If the answers to the pre-screening questions change at any time, I recognize it is my responsibility to share this information with Peaceful Infant, LLC.