Free Mental Health Checkup By MantraCare

This test evaluates your child’s eating habits, identifying patterns and potential gaps in their diet. It helps ensure they are receiving the right nutrients for healthy growth, energy, and overall well-being.

Branch Code:*

Your name*

Mobile No.

Email Address

Name of your child*

Age of your child*

Gender of your child*

Height of you child*

Weight of your child*

Any current/ past medical or health concerns in your child*

Any medical history in your family (like Diabetes, Thyroid etc.)*

Main concerns about nutrition or food habits (if any):*

The following statements relate to your child’s eating habits, attitudes toward food, and body awareness. Please indicate how often each statement applies to your child:

1. How do you rate the dietary habits of your child*

Good

Not Healthy

2. At home where does your child typically have meals?*

At the dining table

In front of the TV

In the bedroom

3.How often does your child demand junk food?*

Daily

Once a week

Does not prefer

4. How often does your child eat meals with the family?*

Daily

Maybe once a week

Rarely

Never

5. How often does your child use screens (TV, mobile, tablet) while eating?*

One meal a day

Two

All meals

None

6. How many glasses of water does your child drink daily?*

Less than 3

3–5

6–8

More than 8

7. Does your child frequently experience issues like constipation, stomach aches, or irregular bowel movements?*

Yes

Sometimes

8. Is your child involved in any physical activities or sports? If yes, what are they, and how frequently?*

Daily

Few times a week

Rarely

Never

9. How much time do you spend engaging in one-on-one activities with your child daily?*

Less than 30 mins

30-60 mins

More than an hour

10. Has your child ever mentioned being bullied or having conflicts with peers?*

Yes

Unsure

The following statements relate to your child’s eating habits, attitudes toward food, and body awareness. Please indicate how often each statement applies to your child:

1. Does your child decide what they want to eat for snacks or meals?*

Always

Sometimes

Rarely

2. Does your child enjoy eating meals with the family with some healthy and happy conversations?*

Yes

Sometimes

3. How many glasses of water does your child drink daily?*

Less than 5

5-8

9 or more

4. How do you rate the energy levels of your child?*

Excellent

Average

Not so good

5. Does your child actively participate in hobbies or extracurricular activities?*

Yes

Sometimes

6. Does your child understand the importance of eating healthy and staying active?*

Yes

Somewhat

7. How do you rate the gut health of your child?*

Very Good

Not so good

Not good at all. Has frequent gut issues

8. "Is your child actively involved in sports? How often?*

Daily

3-5 times a week

Rarely

Never

9. How much time does your child spend on screens daily (excluding schoolwork)?*

Less than 1 hour

1-2 hours

More than 2 hours

10. How many hours of sleep does your child get on school nights?*

Less than 6

6-8

More than 8

For Girls

11. Has your daughter begun menstruating ?

Yes

12. Are your daughter’s menstrual cycles regular?

Yes

Unsure

The following statements relate to your child’s eating habits, attitudes toward food, and body awareness. Please indicate how often each statement applies to your child:

1. Does your child frequently feel low on energy or tired, even after adequate rest?*

Yes

Sometimes

2. Does your child frequently experience issues like bloating, constipation, diarrhea, or stomach pain?*

Often

Sometimes

Rarely

3. How often does your child consume foods that support gut health, like yogurt, fermented foods, or whole grains?*

Daily

Occasionally

Rarely

4. Does your child eat enough fiber-rich foods (like fruits, vegetables, and whole grains) and drink enough water?*

Yes

Sometimes

5. Does your child often feel irritable, anxious, or low in mood, especially after experiencing digestive issues?*

Yes

Sometimes

6. How often does your child skip meals?*

Never

Occasionally

Frequently

7. How often does your child consume fast food or sugary beverages?*

Rarely

Weekly

Daily

8. Does your child understand what constitutes a healthy, balanced diet?*

Yes

Somewhat

9. Does your child feel stressed about school or academics?*

Often

Sometimes

Rarely

10. How many hours does your child spend on screens daily (excluding schoolwork)?*

Less than 2

2-4

More than 4

For Girls

11. Has your daughter begun menstruating ?

Yes

12. Are your daughter’s menstrual cycles regular?

Yes

Unsure

Hidden

Behavioral and Dietary Patterns Score

Hidden

Body Image and Physical Well Being Score

Hidden

Psychological and Emotional Factors Score

Name

This field is for validation purposes and should be left unchanged.

Children Nutrition Assessment