Pediatric Assessment Templates

The templates included here are provided as a resource only and do not reflect ASHA policies regarding documentation or clinical practice. To request customizable templates in Word format, please e-mail healthservices@asha.org and indicate which templates you would like to receive. These templates were developed by Special Interest Group 13 (Swallowing and Swallowing Disorders [Dysphagia]).

Available Templates

Feeding History and Clinical Assessment

Infants (6 months and younger) [PDF]

Children (6 months and older) [PDF]

Glossary of Terms and Conditions [PDF]

Videofluoroscopic Swallowing Studies

Infants (Consuming liquids only) [PDF]

Children (Consuming liquids and solids) [PDF]