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Infant and Young Child Feeding Counselling i
Infant & Young Child Feeding Counselling
A Community–Focused Approach
TRAINER’S GUIDE
ii Infant and Young Child Feeding Counselling
Infant and Young Child Feeding Counselling iii
T
Continued
Acknowledgments
HEtrainingpackageforInfant and Young Child Feeding Counselling: A
Community-Focused Approachreflectsacollaborationthatdrawsonthe
experiencesandpastworkofmanyindividualsandgroups.Thispackage,
includinganintegratedsetofcounsellingcards,anIYCF Counselling Trainer’s Guideand
trainingaids,hasbeendevelopedundertheCAREInfantandYoungChildFeedingin
Emergencies(IYCF-E)Initiative,inpartnershipwithURC/CHS.Thecommunity-focused
counsellingpackagewaspilotedandfirstusedtosupportprogrammingintheDadaab
CampsinnortheasternKenya,wheretheIYCF-EInitiativecurrentlysupportstheworkof
theDadaabIYCFTeam,whosemembersincludeCAREKenya,UNHCR,GTZandNCCK.
TheworkoftheCAREIYCF-EInitiativeissupportedbyagrantfromaprivatedonorto
CAREUSA.
ThetechnicalcontentofthetrainingpackageisbasedontheWHO/UNICEF
breastfeedingcounselling,complementaryfeedingcounselling,andinfantandyoung
childfeedingintegratedcounsellingcourses.Theapproachdrawsfrominfantfeeding
andotherbehaviourchangecommunicationmaterialspreviouslydevelopedbyURC/
CHSinTanzania,Niger,BeninandGuatemala,withsupportfromUSAID.
ItalsoreflectstrainingmaterialdevelopedbytheAcademyforEducational
Development’sLINKAGESProjectandtheIFE(InfantFeedinginEmergencies)Core
Group’sIFE Module 2forhealthandnutritionworkersinemergencysituations.TheIFE
CoreGroupisaninteragencycollaboration(ENN,IBFAN,CAREUSA,UNICEF,UNHCR,
WHOandWFP)focusedonthedevelopmentofpolicyandtrainingmaterialstosupport
appropriateinfantandyoungchildfeedinginemergencies.
Thisversionofthetrainingpackageisa“livingdocument”thathasbeenupdated
followinganinitialpilottestingintheDadaabCampsinMay2007.Additional
adjustmentsareanticipated,basedonfutureuseandtechnicalfeedback.
iv Infant and Young Child Feeding Counselling
Wewouldliketoacknowledgetheactiveparticipationofthefollowingagenciesand
individualsinthedevelopmentofthismaterial:
FromtheDadaabCampsinteragency(UNHCR,CARE,GTZandNKKC)IYCFTeam:
DadaabIYCFCoordinationTeam:RoseNdolo,CAREKenya;GloriaKisia,UNHCR;AnneNjuguna,formerlyCAREKenya
HagaderaCampTeam:MillicentKavosa,KhadijoNoorUbahle,FatumaMohamedAli,DekaAbdiAhmed
DagahaleyCampTeam:VictorMwiti,HabiboYahveIman,AnnaOmarIsmail,MaryanneMohamudAden
IfoCampTeam:PhyllisObote,RoseKathuri(GTZ),HawoNegashStephano,OgudDidumoCham,BashirIbrahimMohamed
FromCAREKenya:
KristinHelz,MohammedQazilbash,FelixOkech,AgnieszkaKorus
IndependentConsultants:
MaryanneStone-Jiménez,InfantandYoungChildFeedingandtrainingspecialist
Dr.FelicitySavage,HonorarySeniorLecturer,InstituteofChildHealthLondon;Chairperson,WorldAllianceforBreastfeedingAction;formerMedicalOfficerDepartmentofChildandAdolescentHealth,WorldHealthOrganization,Geneva
FromURC:
PeggyKoniz-Booher,Sr.TechnicalAdvisor;VictorNolasco,Artist;Kurt
Mulholland,GraphicDesigner;TisnaVeldhuyzenvanZanten,VicePresident
FromtheCAREUSAIYCF-EInitiative:
MaryLung’aho,SpecialAdvisor,IYCF-Emergencies;AbigailBeeson,ProgramAssociate,IYCF-E;BethannCottrell,ChildHealthandNutritionTeamLeader
Mostimportantly,wewouldliketoacknowledgethewomenandyoungchildrenliving
intheDadaabCamps.Wethankthewomenfortheirinspiration,andtheirdesireto
improvethehealthandwholenessofthemselvesandtheirfamilies.
Infant and Young Child Feeding Counselling v
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
5-DayIYCFCounsellingTrainingAgenda. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6
SESSION1 Introductions,Expectations,WhyWeAreHere . . . . . . . . . . . . . . . . . . . . . . . . . . .7
SESSION2 HowtoCounsel:TalkingwiththeMother/Caregiver. . . . . . . . . . . . . . . . . . . . . .11
SESSION3 ImportanceofBreastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18
SESSION4 HowtoBreastfeed. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24
SESSION5 CommonBreastConditions:Symptoms,PreventionandSolutions;andInsufficientMilk…. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30
SESSION6 CommonSituationsthatCanAffectBreastfeeding;andIdentifyingSignsthatRequireMother/Caregiver/FamilytoSeekCare. . . . . . . . . . . . . . . . . .36
SESSION7 HowtoCounsel:PractiseCounsellingwithMothersofBabiesLessthan6Months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .42
SESSION8 HowtoCounsel:Communityand/orFacilityPractiseandFeedback. . . . . . . . . . .56
SESSION9 ComplementaryFeedingPracticesforChildren6–23Months . . . . . . . . . . . . . . .58
SESSION10 FeedingoftheSickInfantandYoungChild. . . . . . . . . . . . . . . . . . . . . . . . . . . . .63
SESSION11 InfantFeeding:HIV-PositiveMother,andSevereMalnutritionofInfantandYoungChild . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .66
SESSION12 HowtoCounsel:PractiseCounsellingwithMothers/CaregiversofBabiesGreaterthan6Months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69
SESSION13 HowtoCounsel:Communityand/orFacilityPractiseandFeedback. . . . . . . . . . .82
SESSION14 FinalEvaluationofIYCFCounsellingTraining . . . . . . . . . . . . . . . . . . . . . . . . . . . .84
APPENDIX1 KeyandSupportingMessagesofCounsellingCards . . . . . . . . . . . . . . . . . . . . . .87
APPENDIX2 ContentsofTrainingPackage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .105
APPENDIX3 DirectionsforMakingBreastModels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .106
APPENDIX4 CutOutsforDailyEvaluation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .107
vi Infant and Young Child Feeding Counselling
Infant and Young Child Feeding Counselling �
TIntroduction
HEInfant and Young Child Feeding Counselling Trainer’s Guideispartofatrainingpackage
totrainlowliteracy,community-levelInfantandYoungChildFeeding(IYCF)Counsellors
tohelpmothers,fathersandothercaregiversoptimallyfeedtheirinfantsandyoung
children.TheGuideisintendedtoequiptrainerswithbasiccounsellingskills,andtechnical
knowledgeofkeypracticesandmessagesrelatedtobreastfeeding,infantandyoungchild
complementaryfeeding,andfeedingofthesickchild.Basiccounsellingskillsinclude:listening
andlearning,buildingthemother’s/caregiver’sconfidence,providingsupportandpracticalhelp,
andnegotiating(“reaching-an-agreement”inDadaab)byapplyingthe“assess,analyzeandact”
steps.
Thekeypracticesareillustratedonanintegratedsetof18counsellingcards,anddescribedin
aMessageBookletthataccompaniestheTrainer’sGuide.Participantsbecomefamiliarwiththe
basiccontentofthekeypracticesandmessagesthroughtheuseofthecounsellingcards.Hands-
onpracticeisthefocusoftheIYCFCounsellorstraining,withemphasisoncounsellingskillsand
theeffectiveuseofthecounsellingcardsandothervisualmaterials.IYCFCounsellorsmaybe
TBAs,CommunityHealthWorkers(CHWs)orprojectstaffwithmoreadvancedIYCFtrainingwho
actaspointsofreferralforthelow-literate,lessexperiencedIYCFCounsellorsandtogetherforma
communitynetworkofIYCFsupport.
TheInfant and Young Child Counselling Trainer’s Guideandtrainingaidsweredevelopedforuse
inlowresourcesettings,withoutdependenceontheuseofslidesorothermediaprojection,flip
chartsorwritingmaterials.(SeeAppendix1forthecontentsofthekeyandsupportingmessages
ofthecounsellingcards;seeAppendix2forthetrainingaids.)
ThroughouttheIYCF Counselling Trainer’s GuidethetrainersarereferredtoasFacilitatorsandthe
traineesasParticipants.
� Infant and Young Child Feeding Counselling
Training AgendaTheIYCF Counselling Trainer’s Guideisdividedinto2–3hoursegmentsandcanbeconductedatdifferenttimeintervalsdependingonvariousprogrammeandhumanresourceconsiderations.Thismodularapproachallowsforflexibilityinschedulingtrainingsessions,andalsoallowsforpracticebetweentheteachingsegments.EachindividualsessionoftheIYCF Counselling Trainer’s Guideoutlinesspecificlearningobjectives,activitydetails,timeallotted,materialsneeded,andmethodologiesforthelearningactivitiesthatFacilitatorsandParticipantswilluse.Theadditionalinstructionsinitalics(andshadedportions)areintendedforusewhentheGuideisusedforpreparingtrainersofIYCFCounsellors.
Training methodologyThecompetency-basedparticipatorytrainingapproachusedinthisGuidereflectskeyprinciplesofbehaviourchangecommunication(BCC)withafocusonthepromotionofsmalldoableactions,andrecognitionofthewidelyacknowledgedtheorythatadultslearnbestbyreflectingontheirownpersonalexperiences.TheapproachusestheexperientiallearningcyclemethodandpreparesParticipantsforhands-onperformanceofskills.Thecourseemploysavarietyoftrainingmethods,includingtheuseofcounsellingmaterials,visualaids,demonstrations,groupdiscussion,casestudies,roleplays,andpractise.Participantsalsoactasresourcepersonsforeachother,andbenefitfromclinicaland/orcommunitypractise,workingdirectlywithbreastfeedingmothers,pregnantwomen,andmothers/caregiverswhohaveyoungchildren.Ideally,
theratioofthenumberofFacilitatorstoParticipantspertrainingshouldbeonetosix.ThetrainingmethodologyusedthroughouttheIYCF Counselling Trainer’s GuidemodelsthesametypeoftrainingusedwithlowliterateParticipants:noflipchartsorwritingmaterials,andpreandpostassessmentsstructuredinawaythatsuggeststheParticipantsmaybenon-literate.
Training LocationWhereverthetrainingisplanned,aclinicalorcommunity-basedsiteshouldbereadilyavailabletosupportthepracticumforcounsellingandnegotiation(“reaching-an-agreement”)withmothers/caregiversonsmalldoableinfantandyoungchildfeedingpractices.Preparethepracticumsitebycoordinatingwithclinicand/orcommunityforarrivalofParticipantsandarrangingforspacetopractisetheskills.
Overview of “Why We Are Here”
General objectives of the IYCF Counselling-A Community-Focused Approach training
Thistrainingisintendedtoaccomplishthefollowing:
1. RaiseawarenessamongIYCFCounsellorsontheimportanceofoptimalbreastfeedingandcomplementaryfeedingforchildren0–23months
2. SensitizeIYCFCounsellorsaboutkeycontactpointsformeetingwithmothers/fathers/caregiverstodiscussandsupportoptimalinfantandyoungchildfeedingpractices
Infant and Young Child Feeding Counselling �
3. IncreasetheknowledgeofIYCFCounsellorsinordertoenablethemtohelpmothersandcaregiverstooptimallyfeedtheirinfantsandyoungchildrenfromunder2years
4. EnhancetheskillsofIYCFCounsellorstosupportmothersandcaregivers.Skillsinclude:
– listeningandlearning
– buildingthemother’s/caregiver’sconfidence
– providingsupportandpracticalhelp—forexample,withattachmentandpositioning,and
– negotiating(“reaching-an-agreement”),ifmodificationofabehaviourisneeded
Specific objectives of the IYCF Counselling - A Community-Focused Approach training
Bytheendofthetraining,Participantswillbeableto:
1. Describepracticesandkeymessagesoninfantandyoungchildfeeding(IYCF)from0–<6months,startingat6months,6–8months,9–11monthsandfrom12–23months
2. Describepracticesandmessagesonfeedingofthesickchildlessthan6monthsandgreaterthan6months
3. Identifywaystopreventandsolvecommonbreastconditions
4. Discussinsufficientmilk,preventionandbuildingupmilksupply
5. Describecommonsituations,beliefsandmythsaffectingbreastfeeding
6. Describebasicinformationofinfantfeedinginthefollowingsituations:1)HIV-positivewoman,and2)severelymalnourishedinfantoryoungchild
7. Identifysignsthatrequirereferraltoahealthpost
8. Mastercounsellingskills:listeningandlearning,buildingconfidence,providingsupportandpracticalhelp,andnegotiating(“reaching-an-agreement”)byapplyingthe“assess,analyze,andact”stepsinordertopromotebehaviouralchangeinmothersandcaregiverssothattheyimprovetheirIYCF-relatedpractices
9. Demonstratetheuseoftheintegratedsetofcounsellingcardsonbreastfeeding,complementaryfeedingforchildren6–23months,hygiene,feedingofthesickchild,andsignsthatrequirereferraltothehealthpost,and
10.Practisetheinitialvisitofcounsellingandnegotiating(“reaching-an-agreement”)withamotherofababy0–<6months,andamotherofababy6–23months(practiseallcounsellingskills:listeningandlearning,buildingconfidence,providingsupportandpracticalhelp,andnegotiating(“reaching-an-agreement”)byapplyingthe“assess,analyze,andact”steps.
Additional Objectives of the Preparation of Trainers Course:
Bytheendofthetraining,ParticipantsattendingthePreparationofTrainersCoursewillalsobeableto:
� Infant and Young Child Feeding Counselling
1. Prepareatrainingformatbyoutliningtheobjectives,activities,timeallotted,materialsneeded,andmethodologiesdescribedintheIYCF Counselling Trainer’s Guide
2. AssigntrainingresponsibilitiesandtasksamongFacilitators
3. UsetheTrainingPackage(integratedsetofcounsellingcards,IYCF Counselling Trainer’s Guide,andtrainingaids)intheroll-outtrainingofIYCFCounsellors
Training Exercises
Forming Small Groups
1. DependingonthenumberofParticipants(forexample,20),andthenumberofgroupstobeformed(forexample,5)askParticipantstocountoffnumbersfrom1to5.Begintocountinaclockwisedirection.Onanotheroccasionbegintocountcounter-clockwise.
2. DependingonthenumberofParticipants(forexample,16),andthenumberofgroupstobeformed(forexample,4),collect16bottlecapsof4differentcolours:4red,4green,4orange,and4black.AskParticipantstoselectabottlecap.Onceselected,askParticipantstoformgroupsaccordingtothecolourselected.
3. Sinkingship:askParticipantstowalkaroundasiftheywereonaship.Announcethattheshipissinkingandlifeboatsarebeinglowered.ThelifeboatswillonlyholdacertainnumberofParticipants.CalloutthenumberofpersonsthelifeboatswillholdandaskParticipantsto
groupthemselvesinthenumbercalled-out.RepeatseveraltimesandfinishwiththenumberofParticipantsyouwisheachgrouptocontain(forexample,todivide15Participantsintogroupsof3,thelast“lifeboat”calledwillbethenumber3).
Review Energizers
ThefollowingaredescriptionsofseveralreviewenergizersthatFacilitatorscanselectfromattheendofeachsessiontoreinforceknowledgeandskillsacquired.
1. ParticipantsandFacilitatorsformacircle.OneFacilitatorhasaballthats/hethrowstooneParticipant.TheFacilitatorasksaquestionoftheParticipantwhocatchestheball.TheParticipantresponds.WhentheParticipanthasansweredcorrectlytothesatisfactionofthegroup,thatParticipantthrowstheballtoanotherParticipantaskinghim/heraquestioninturn.TheParticipantwhothrowstheballasksthequestion.TheParticipantwhocatchestheballanswersthequestion.
2. Form2rowsfacingeachother.Eachrowrepresentsateam.AParticipantfromoneteam/rowasksaquestiontotheParticipantoppositeher/himinthefacingteam/row.ThatParticipantcanseekthehelpofher/histeaminrespondingtothequestion.Whenthequestionisansweredcorrectly,therespondingteamearnsapointandthenasksaquestionoftheotherteam.Ifthequestionisnotansweredcorrectly,theteamthataskedthequestionrespondsandearnsthepoint.Questionsandanswersareproposedbackandforthfromteamtoteam.
Infant and Young Child Feeding Counselling �
3. Form2teams.Eachpersonreceivesacounsellingcardoravisualimage.ThesevisualaidsareanswerstoquestionsthatwillbeaskedbyaFacilitator.Whenaquestionisasked,theParticipantwhobelievess/hehasthecorrectanswerwillshowhercounsellingcardorvisualimage.Ifcorrect,s/hescoresapointforher/histeam.Theteamwiththemostcorrectanswerswinsthegame.
4. Fromabasket,aParticipantselectsacounsellingcardorvisualimageandisaskedtosharethepractices/messages;feedbackisgivenbyotherParticipants.TheprocessisrepeatedforotherParticipants.
5. Form2circles.Onamatinthemiddleofthecircleasetofcounsellingcardsisplaced“facedown”.AParticipantisaskedtochooseacounsellingcardandtelltheotherParticipantsinwhatsituationsanIYCFCounsellorcansharethepractices/messagesthecounsellingcardrepresents.OneFacilitatorispresentineachcircletoassistinresponding.
Daily Evaluations
ThefollowingaredescriptionsofseveraldailyevaluationsthatFacilitatorscanselectfromattheendofeachday(orsession)toassesstheknowledgeandskillsthathavebeenacquiredand/ortoobtainfeedbackfromParticipants.
A. Formbuzzgroupsof3andaskParticipantstoanswerone,two,orallofthefollowingquestionsinagroup*:
1.Whatdidyoulearntodaythatwillbeusefulinyourwork?
2.Whatwassomethingthatyouliked?
3.Giveasuggestionforimprovingtoday’ssessions.
* Ask a Participant from each buzz group to respond to the whole group
B. “Happyfaces”measuringParticipants’moods.Imagesofthefollowingfaces(smiling,neutral,frowning)areplacedonabenchorthefloorandParticipants(attheendofeachday[orsession])areaskedtoplaceastoneorbottlecaponthe“face”thatbestrepresentstheirlevelofsatisfaction(satisfied,mildlysatisfiedandunsatisfied).(SeeAppendix4forCutOuts)
� Infant and Young Child Feeding Counselling5-D
ay IY
CF
Cou
nsel
ling
Ag
end
a
Sess
ion
9(c
ontin
ued)
•C
omp
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ract
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ILY
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IEW
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ay 1
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ion
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Intr
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rain
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ay 4
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Prac
ticum
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an6
Mon
ths:
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and
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Com
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7
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ies
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ellin
g•
Prep
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9•
Com
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ctic
esfo
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ldre
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om
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ths
TEA
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AY
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and
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NC
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ALU
AT
ION
8:30
–10
:30
10:3
0–11
:00
11:0
0–12
:45
12:4
5
14:0
0–15
:45
15:4
5–16
:00
12:0
0
Sess
ion
4•
How
toB
reas
tfee
d•
Mak
ing
dolls
&b
reas
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odel
s•
Goo
dat
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tern
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owto
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ilk
Sess
ion
3•
Imp
orta
nce
of
Brea
stfe
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g•
Key
cont
actp
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sto
p
rom
ote
optim
alin
fant
an
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ung
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ing
Sess
ion
4(c
ontin
ued)
Sess
ion
5•
Com
mon
bre
ast
cond
ition
s:s
ymp
tom
s,
pre
vent
ion
and
solu
tions
•In
suffi
cien
tmilk
:rea
lor
per
ceiv
ed
Sess
ion
13
•Pr
actic
um:H
owto
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unse
lam
othe
rwith
a
baby
less
than
6M
onth
s:
com
mun
itya
nd/o
rfac
ility
p
ract
ise
Sess
ion
11
•In
fant
feed
ing:
HIV
-p
ositi
vem
othe
rand
sev
ere
mal
nutr
ition
ofi
nfan
tand
yo
ung
child
Sess
ion
12
•H
owto
cou
nsel
:pra
ctic
eco
unse
lling
with
mot
hers
of
bab
ies
grea
tert
han
6m
onth
s
Sess
ion
12
(con
tinue
d)–
List
enin
gan
dle
arni
ng
skill
s–
“Ass
ess,
ana
lyze
and
ac
t”s
tep
sto
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ling
•Pr
epar
atio
nfo
rPra
ctic
um
Sess
ion
13
(con
tinue
d)•
Dis
cuss
ion
and
feed
back
of
pra
ctic
ume
xper
ienc
e
Sess
ion
14
•W
hath
ave
we
lear
ned
this
w
eek?
•Tr
aini
nge
valu
atio
n
•C
losi
ng
Infant and Young Child Feeding Counselling �
SESSION1
Introductions, Expectations, Why We Are Here
Learning objectivesBytheendofthesession,Participantswillbeableto:
1. BegintonamefellowParticipantsandFacilitators
2. Discussexpectations
3. Explain“whywearehere”
4. Becomefamiliarwiththeintegratedsetofcounsellingcards
5. For the Preparation of Trainers Course: Become familiar with the IYCF Counselling Trainer’s Guide
ActivitiesActivity1 Introductions(�0 minutes)
Activity2 Whatdoweknownow?(�0 minutes)
Activity3 “Whywearehere”:comparethegeneralandspecificcourse objectiveswiththeParticipants’expectations,andgivean overviewofthetraining(�0 minutes)
Activity4 Presentandreviewtheintegratedsetofcounsellingcards(�0 minutes)
Activity5 Discussadministration,groundrulesandlogistics(�0 minutes)
Activity6 For the Preparation of Trainers Course: Present and review the IYCF Counselling Trainer’s Guide and training aids (�0 minutes)
Total Time 1 hour
Materials needed√ Onecopyoftheintegratedsetofcounsellingcardsforeachparticipant
√ Onecopyof“Whatdoweknownow?”pre-assessmentguidefortheFacilitator(s)
√ For the Preparation of Trainers Course: One IYCF Counselling Trainer’s Guide for each Participant and one or two complete sets of training aids per training team.
Note to the Facilitator: Present an overview of objectives for this session (listed below) and the time allotted for this session.
� Infant and Young Child Feeding Counselling
ACTIVITY 1
Introductions and expectations (�0 minutes)
Methodology: Introduce participant sitting beside you
• AskParticipantstotalktothepersonsittingbesidethem;eachParticipantintroduceshis/herneighborbyname,theirexpectationofthetraining,andsomethingofinterest(favouritecolour).
ACTIVITY 2
“What do we know now?” (�0 minutes)
Methodology: Participants sit in circle facing outwards
• AskParticipantstoformacircleandsitsothattheirbacksarefacingthecenter.
• ExplainthatquestionswillbeaskedandaskParticipantstoraiseonehand(withopenpalm)iftheythinktheansweris“Yes”,toraiseonehand(withclosedfist)iftheythinktheansweris“No”,andtoraiseonehand(pointing2fingers)ifthey“Don’tknow”.
Pre-assessment: What do we know now?
1. Ababyshouldbreastfeedwithinanhourafterbirth.
2. Toproducesenoughmilk,amothershouldbreastfeedfrequently, dayandnight.
3. Colostrumhelpstoprotectbabiesfromillnesseslikediarrheaand respiratoryinfections.
4. At4months,infantsneedwaterandotherdrinksinadditiontobreastmilk.
5. At9-11months,ababyneedscomplementaryfoods4timesaday.
6. Onesignofgoodattachmentisthatthenewborn’schintouchesthe mother’sbreast.
7. Breastfeedingbenefitsthebaby,butnotthemother.
8. Amothercanstillsuccessfullybreastfeedherbabyevenifshethinksshe doesnothaveenoughmilk.
9. Amothercanpreventsoreandcrackednipplesbycorrectlyattachingher babytothebreast.
10. Ababybeginstoneedfoodsinadditiontobreastmilkatabout6months.
11. Amothercanproduceenoughmilktobreastfeedtwins.
Yes No Don’t know
Infant and Young Child Feeding Counselling �
• OneFacilitatorreadsthestatementandanotherFacilitatorrecordstheanswersandnoteswhichtopics(ifany)presentconfusion.
• AdviseParticipantsthatthesetopicswillbediscussedingreaterdetailduringthetraining.
ACTIVITY 3
Summary of purpose and learning objectives (�0 minutes)
Methodology: Brainstorming; Facilitator discusses purpose and learning objectives of training (“why we are here”) with Participants
• Introducelearningobjectives(generalandspecificobjectivesfoundintheIntroductionoftheIYCF Counselling Trainer’s Guide).
• ComparetheobjectiveswiththestatedexpectationsoftheParticipants.
• Presentanoverviewoftraining:buildonParticipants’knowledge,practicecounsellingskills:listeningandlearning;buildingconfidence;providingsupportandpracticalhelp(attachmentandpositioning);andnegotiating(“reaching-an-agreement”)skillsattrainingsiteandwithmothers/caregiversinclinicorcommunitysettingsbyapplyingthe“assess,analyze,andact”steps.
• For the Preparation of Trainers Course, explain that this is a preparation for trainers, and they alone will receive the Trainer’s Guide. Participants of their “roll-out” trainings will ONLY receive the integrated set of counselling cards and key messages booklet.
ACTIVITY 4
Present and review the integrated set of counselling cards (�0 minutes)
Methodology: Buzz groups of 3 Participants
• DistributetheintegratedsetofcounsellingcardstoeachParticipantandthenaskParticipantstoformgroupsof3.
• Explainthatthecounsellingcardsaregoingtobetheirtoolstokeepandthattheyaregoingtotakeafewminutestoexaminethecontentofthecounsellingcards.
• Eachgroupistofindthecardthatshows:apieceoffruit(CCs11,12,13)
• Askagrouptoreportwhichcounsellingcard(s)showtheitem.
• Asktheothergroupsiftheyagree,disagreeorwishtoaddanothercounsellingcard.
• Repeattheprocesswiththeremainingitems/characteristics.Find:– anIYCFcounselortalkingwithamother(CC1)– asignorsymbolthatindicatesthatsomethingshouldhappenduring‘thedayandat
night’,orthatindicatesthechildshouldhave‘amealorasnack’(CCs6,10,11,12,13)
�0 Infant and Young Child Feeding Counselling
– asignorsymbolthatindicatesthatthechildshouldhave‘amealorasnack’(CCs12,13)
– agrandmotherorguardianwithmother(CC2b,3)– asignorsymbolthatindicatesthatayoungchildshouldeat3timesadayand2snacks
(CC13)– asickbabylessthan6months(CC15)– thecardwiththemessagethat‘handsshouldbewashedwithsoapaswellaswater’
(CC14)– thecardwiththemessagethatayounginfantdoesnotneedwater(CC7)
ACTIVITY 5
Discuss administration, ground rules and logistics (�0 minutes)
ACTIVITY 6
For the Preparation of Trainer’s Course: Present and review the IYCF Counselling Trainer’s Guide and training aids (�0 minutes)
Methodology: Small groups according to training team
• Distribute the IYCF Counselling Trainer’s Guide to each Participant, and a set of training aids to each group representing a training team.
• Ask small groups to examine the contents of the IYCF Counselling Trainer’s Guide and the set of training aids.
• Explain the following:
– Facilitators will be modeling the training that Participants will in turn conduct
– Participants will need to become familiar with the IYCF Counselling Trainer’s Guide and the training aids because they will be their tools in training IYCF Counsellors
• Together with Participants, go through Session 1 of the IYCF Counselling Trainer’s Guide, pointing out objectives, activities, time allocated, materials needed, and details/methodology of each activity.
• Guide discussion of Participants’ role as trainers.
Infant and Young Child Feeding Counselling ��
SESSION2
How to Counsel: Talking with the Mother/Caregiver
Learning objectiveBytheendofthesession,Participantswillbeableto:
1. IdentifylisteningandlearningskillsandPRACTISEusingthem
ActivitiesActivity1 Facilitatorsdemonstratelisteningandlearningskills(�0 minutes)
Activity2 Participantspractiselisteningandlearningskills(�0 minutes)
Total Time 1 hour
Materials needed√ SixlisteningandlearningdemonstrationcasesforFacilitators
√ PractiseexercisesfromBreastfeedingCounselling:ATrainingCoursedevelopedbyWHO/UNICEF
Note to the Facilitator: Present an overview of objectives for this session (listed below) and the time allotted for this session.
�� Infant and Young Child Feeding Counselling
ACTIVITY 1
Facilitators demonstrate listening and learning skills (�0 minutes)
Methodology: Demonstration
• Explainthat‘listeningandlearning’skillsarethefirstsetofskillstobelearnedandpractised.Otherskillsare:buildingthemother’s/caregiver’sconfidence;providingsupportandpracticalhelp;andnegotiating(“reaching-an-agreement”)byapplyingthe“assess,analyze,andact”steps.
• Prepareanddemonstratedifferentrole-playsoflisteningandlearningskillsusingthefollowing6exercises(teamof2Facilitators).
• AskParticipantstoidentifythedifferentskills.
• Discuss,summarize,andrepeatthedifferentlisteningandlearningskills.
Demonstration �:
Non-verbal communication
Witheachdemonstrationsayexactlythesamefewwords,andtrytosaytheminthesameway,forexample:“Good morning, Habiba. How is breastfeeding going for you and the baby?”
A. Posture:
Hinders: standwithyourheadhigherthanthemother’s
Helps: sitsothatyourheadislevelwithhers
B. Eye contact:
Helps: lookatherandpayattentionasshespeaks
Hinders: lookawayatsomethingelse,ordownatyournotes
C. Barriers:
Hinders: sitbehindatable,orwritenoteswhileyoutalk
Helps: removethetableorthenotes
Note to the Facilitator: ThefollowingListeningandLearningdemonstrationsarefrom:Breastfeeding Counselling: A Training CoursedevelopedbyWHO/UNICEF
Infant and Young Child Feeding Counselling ��
D. Taking time:
Helps: makeherfeelthatyouhavetime.Sitdownandgreetherwithout hurrying;thenjuststayquietlysmilingather,watchingherbreastfeed, andwaitingforhertoanswer
Hinders: beinahurry.Greetherquickly,showsignsofimpatience,andlookat yourwatch
E. Touch:
Helps: touchthemotherorbabyappropriately
Hinders:touchherinaninappropriateway(Note: If you cannot demonstrate an inappropriate touch, simply demonstrate not touching).
Demonstration �:
Closed questions to which mother can answer `yes’ or `no’
CW = IYCF Counsellor
CW: “Goodmorning,(name).Iam(name),theIYCFCounsellor. Is(nameofbaby)well?”
Mother: “Yes, thank you.”
CW: “Areyoubreastfeedinghim?”
Mother: “Yes”.
CW: “Areyouhavinganydifficulties?”
Mother: “No”.
CW: “Ishebreastfeedingveryoften?”
Mother: “Yes”.
Demonstration �:
Open questions
CW: “Goodmorning,(name).Iam(name),thecommunityIYCFCounsellor. Howis(nameofbaby)?”
Mother: “He is well, and he is very hungry.”
CW: “Tellme,howareyoufeedinghim?”
Mother: “He is breastfeeding. I just have to give him one bottle feed in the evening.”
CW: “Whatmadeyoudecidetodothat?”
Mother: “He wants to feed too much at that time, so I thought that my milk is not enough”.
�� Infant and Young Child Feeding Counselling
Demonstration �:
Using responses and gestures that show interest
CW: “Goodmorning,(name).Howisbreastfeedinggoingforyouthesedays?”
Mother: “Good morning. It is going quite well, I think.”
CW: “Mmm.”(nods,smiles.)
Mother: “Well, I was a bit worried the other day, because he vomited.”
CW: “Ohdear!”(raiseseyebrows,looksinterested.)
Mother: “I wondered if it was something that I ate, so that my milk did not suit him.”
CW: “Aha!”(nodssympathetically).
Demonstration �:
Reflecting back
CW: “Goodmorning(name).Howareyouand(name)today?”
Mother: “He wants to feed too much—he is taking my breast all the time!”
CW: “(Name)isfeedingveryoften?”
Mother: “Yes. This week he is so hungry. I think that my milk is drying up.”
CW: “Heseemshungrierjustforaboutaweek?”
Mother: “Yes, and my sister is telling me that I should give him some bottle feeds as well.”
CW: “Yoursistersaysthatheneedssomethingmore?”
Mother: “Yes. Which formula is best?”
Demonstration �:
Avoid using judging words (� skits)
Skit 1:
CW: “Goodmorning(name).Is(name)breastfeedingnormally?”
Mother: “Well I think so.”
CW: “Doyouthinkyouhaveenoughbreastmilkforhim?”
Mother: “I don’t know……I hope so, but maybe not…..” (She looks worried.)
CW: “Hashegainedweightwellthismonth?MayIseehisgrowthchart?”
Mother: “I don’t know…….”
Infant and Young Child Feeding Counselling ��
Avoiding judging words
Skit 2:
CW: “Goodmorning(name).Howisbreastfeedinggoingforyouand(name)?”
Mother: “It’s going very well. We both enjoy it.”
CW: “Howishisweight?CanIseehisgrowthchart?”
Mother: “Nurse said that he gained more than half a kilo this month. I was pleased.”
CW: “Heisobviouslygettingallthebreastmilkthatheneeds.”
ACTIVITY 2
Participants practise exercises from “Breastfeeding Counselling: A Training Course” developed by WHO/UNICEF (�0 minutes)
Methodology: Small working groups
• FormsmallgroupswithaFacilitatorineachgroup.
Open questions
• Facilitatorreadstheclosedquestion:Doyoubreastfeedyourbaby?andchangesitintoan‘open’question:How are you feeding your baby?
• NexttheFacilitatorreadsthe‘closed’questionsandasksParticipantstochangetheminto‘open’questions.
1.Areyouoftenawayfromyourbaby?Possibleanswer:How many hours are you away from your baby on a daily basis?
2.Areyournipplessore?Possibleanswer:Can you tell more about how your nipples feel?
• Readtheshortstory:
JosephandMabelbring3-month-oldJohnnytotheclinic.Theywanttotalktoyoubecauseheisnotgainingweight.
• AskParticipantstomentiontwoopenquestionsthatyouwouldaskJosephandMabel.Thequestionsmustbeonesthattheycannotsayjust`yes’or`no’to.
�� Infant and Young Child Feeding Counselling
Reflecting back what a mother says
• Facilitatorreadsthestatement:MymothersaysthatIdon’thaveenoughmilk,andthenasksPartici-pantstodecidewhichexamplesofthefollowingstatementsshow‘reflectingback:
a.Doyouthinkyouhaveenough?
b.Whydoesshethinkthat?
c. She says that you have a low milk supply?
• Mentionthat‘c’reflectsbacktheoriginalstatement.
• ReadthestatementsandaskParticipantstomentionwhichanswercorrectly‘reflectsback’thestatement.
1.Mybabyispassingalotofstools—sometimes8inaday.
a. He is passing many stools each day?
b.Whatarethestoolslike?
c.Doesthishappeneveryday,oronlyonsomedays?
2.Hedoesn’tseemtowanttosucklefromme.
a.Hashehadanybottlefeeds?
b.Howlonghasbeenrefusing?
c. He seems to be refusing to suckle?
• AskParticipantsto‘reflectback’thefollowingstatements.
3.Sometimeshedoesn’tpassastoolfor3or4days.Possibleresponse:he doesn’t pass stools for � or � days?
4.Myhusbandsaysthatourbabyisoldenoughtostopbreastfeedingnow.Possibleresponse:your husband thinks the baby is old enough to stop breastfeeding?
• Readtheshortstory:
YoumeetCorainthemarketwithher2-month-oldbaby.Yousayhowwellthebabylooks,andaskhowsheandthebabyaredoing.Corasays“Oh,we’redoingfine.Buthealwaysseemsespeciallyhungryintheevening.”
• AskParticipantstoreflectbackwhatCorasays,andtoencouragehertotellyoumore?Possibleresponse:so you’re doing fine, but you think the baby is especially hungry in the evening? What makes you say this?
Infant and Young Child Feeding Counselling ��
Avoiding judging words
• Reviewthefollowinglistofjudgingwords
Well Normal Enough Problem Crying `too much’
good correct adequate fail unhappy
bad proper inadequate failure happy
badly right satisfied succeed fussy
wrong plentyof success colicky
sufficient
• Readthejudgingstatement:Doeshesucklewell?andtheexampleofputtingthestatementintoanon-judgingstatement:How do you feel he is suckling?
• AskParticipantsto put the following judging questions into non-judging questions
1.Arehisstoolsnormal?Possibleresponse:can you tell me what his stools look like?
2.Ishegainingenoughweight?Possibleresponse:can you please show me his weight card?
3.Doyouhaveanyproblemsbreastfeeding?Possibleresponse:how is breastfeeding going?
4.Doeshecrytoomuchatnight?Possibleresponse:how many times does he wake up at night?
• Reviewlisteningandlearningskillsinplenary
1.Usehelpfulnon-verbalcommunication
– Keepyourheadlevelwithmother/parent/caregiver
– Payattention(eyecontact)
– Removebarriers(tablesandnotes)
– Taketime
– Appropriatetouch
2.Askopenquestions
3.Useresponsesandgesturesthatshowinterest
4.Reflectbackwhatthemothersays
5.Avoidusingjudgingwords
�� Infant and Young Child Feeding Counselling
SESSION3
Importance of Breastfeeding
Note to the Facilitator:Present an overview of objectives (listed below) and the time allocated for this session.
Learning objectivesBytheendofthesession,Participantswillbeableto:
1. Listthecommonillnessesofbabiesintheircommunities
2. Reflectonhowbreastfeedingcanpreventthesecommonillnesses
3. Definecolostrumandexclusivebreastfeeding
4. Discusscommunitybreastfeedingpractices
5. Listthekeycontactpointswhereandwhenoptimalinfantandyoungchildfeedingpracticescanbepromoted
6. Observecounsellingcards1–3(antenatal,delivery,earlypost-partum)andnametheoptimalbreastfeedingpracticesand/ormessages
7. Reviewthebenefitsofbreastfeedingforbaby,motherandfamily
ActivitiesActivity1 Discussiononcommonillnessesofbabiesinthecommunityand
reflectionontherelationshipbetweenbreastfeedingandcommon illnessesofbabies;definitionandimportanceofcolostrum;and definitionofexclusivebreastfeeding (�0 minutes)
Activity2 Sharingofcommunitybreastfeedingpractices(�0 minutes)
Activity3 Keycontactpointstopromoteoptimalinfantandyoungchildfeeding (�0 minutes)
Activity4 Observationofcounsellingcards1–3(antenatal,delivery,early post-partum)anddiscussionoftheoptimalbreastfeedingpracticesand messagesduringthesetimes(�� minutes)
Activity5 Reviewbenefitsofbreastfeedingforbaby,motherandfamily (�� minutes)
Total Time 2 hours
Infant and Young Child Feeding Counselling ��
Materials needed√ Imagesofcommonillnessesinthecommunity:diarrhoea,cough/pneumonia,
malnutrition,vomiting,fever,anaemia
√ Imagesofbreastfeedingmotherandbaby,andhealthymotherandbaby
√ Counsellingcards1-3:antenatal,delivery,andearlypost-partumoptimalpractices/messages
ACTIVITY 1
Discussion of common illnesses of babies in the community (�0 minutes)
Methodology: Brainstorm common illnesses of infants and young children, definition and importance of colostrum, and definition of exclusive breastfeeding
• AskParticipants:“WhatarethecommonillnessesofinfantsandyoungchildreninDadaab?
• AsParticipantsmentioneachillness,putanimageoftheillnessonthefloororwallsothatallcansee.
• Probeuntilallimagesaredisplayed(perhapsskindiseasewillbementioned,butthereisnoimage).
• Putthe‘breastfeedingmotherandbaby’inthecentreoftheotherimages.
• AsksParticipants:whatistherelationshipbetween“theseillnesses”andbreastfeeding(especiallyrespiratoryanddiarrhoealinfections)?
• Putthe‘healthymotherandbaby’inthecentreasaresultofbreastfeeding.
• AskParticipantstodefinecolostrumorthelocalnameforthe“firstmilk”.
• Explaintheimportanceofcolostrum.
• AskParticipantstodefineexclusivebreastfeeding.
• Discussionandsummary.
�0 Infant and Young Child Feeding Counselling
Components and Properties of Colostrum Importance
Antibodies Protectagainstinfectionandallergy
Whitecells Protectagainstinfection
Growthfactors Helpintestinestomatureandpreventsallergiesandfoodintolerance
VitaminA Reducesseverityofsomeinfections(e.g.,measlesanddiarrhea)and preventsvitaminA-relatedeyedisease
Purgativeeffects Cleansmeconium(darkblackstool)topreventjaundiceinnewborns
Content for Activity 1
Colostrumisthefluidinthebreastattheendofpregnancyandintheearlypostpartumperiod.Itisthickerandmoreyellowthanmaturemilk,richinproteinsandvitamins.
Modified:UNICEF/WHO–Breastfeedingcounselling:Atrainingcourse,1993
Exclusive breastfeedingisgivinganinfantnofoodordrink,includingwater,apartfrombreastmilk(includingexpressedbreastmilk),withtheexceptionofdropsorsyrupscontainingvitamins,mineralsupplements,ormedicine.
ACTIVITY 2
Sharing of breastfeeding practices in the community (�0 minutes)
Methodology: Brainstorm community breastfeeding practices
• AskParticipantstosharecommunitybreastfeedingpracticesbyansweringthefollowingquestions:
1.Whendomothersinthecommunityinitiatebreastfeeding?
2.Untilwhatagedomothersexclusivelybreastfeed(onlybreastfeedingwithnowater,liquidsorsolids)?
3.Howfrequentlydomothersbreastfeedovera24hourperiod?
4.Untilwhatagedomothersbreastfeedtheirbabies(howmanymonths/years)?
• Summarizepractices.
Infant and Young Child Feeding Counselling ��
ACTIVITY 3
Where are there opportunities for IYCF Counsellors to promote optimal infant and young child feeding? (�0 minutes)
Methodology: Small groups
• DivideParticipantsintosmallgroupsandaskthemtolisttheplacesandtimes(keycontactpoints)wheretheycanpromoteoptimalinfantandyoungchildfeedingpractices.
• Askonesmallgrouptosharetheiranswerswiththewholegroup.Othersmallgroupsaddadditionalpoints.
• Probeuntilthefollowingpoints(whereandwhenIYCFCounsellorscanshareinformationwithmothersandcaregivers/familymembers)arementioned.
Content for Activity 3
KeycontactpointswhereandwhenIYCFCounsellorscanshareinformationwithmothersandcaregivers/familymembers:
• Ateverycontactwithapregnantwoman(athealthpostorinthecommunity)
• Atdeliveryinhealthcentreorathome
• Atpostpartumcontactsondays2-3,and5-7,andat2weeks,athomeorinthecommunity
• Duringfamilyplanningsessionsathealthpost(orinthecommunity)
• AtEPI(immunization)andgrowthmonitoringsessionsathealthpostorinthecommunity
• Ateverycontactwithmotherorcaregiverofasickchild
Information can also be shared at:
–Supplementaryfeedingprogrammes(SFPs)
–Therapeuticfeedingcentres(TFCs)
–Communitytherapeuticcareprogrammes(CTCs)
�� Infant and Young Child Feeding Counselling
ACTIVITY 4
Discuss the optimal breastfeeding practices and/or messages (�� minutes)
Methodology: Small working groups—Participants observe counselling cards 1, 2a, 2b, and 3 and name the breastfeeding practice(s) and key message(s) illustrated in the counselling cards (CCs)
• Explainthatthisactivitywillconcentrateonlearningthekeymessages.InSession7on“Howtocounselamother”,Participantswillpractisehowtocombinethemessageswithcounsellingskills:howtodecidewhetheramotherneedsadditionalinformation;prioritizeandselectamongkeymessages,andpresentasmallamountofrelevantinformationasasuggestion,notadirective.
• DivideParticipantsintosmallgroups,askingParticipantsineachgrouptousetheircounsellingcardsforthefollowingexercise.
• HaveeachgroupstudyCC1andnamethebreastfeedingpractice/sand/orkeymessage/sthatcanbesharedwiththeexpectantmother.
• Askonesmallgrouptosharewiththewholegroupandothersmallgroupsaddadditionalpoints.
• Probeuntilthekeyandsupportingmessages(foundinAppendix2oftheIYCFCounsellingTrainer’sGuide)arementioned.
• HavethesmallgroupsrepeattheprocessuntilCCs2a,2b,and3havebeenobservedandstudied,andthebreastfeedingpractice/sand/orkeymessage/sarenamed.
ACTIVITY 5
Review the benefits of breastfeeding for the baby, mother and family (�� minutes)
Methodology: Circle and ball
• AskParticipantstoformacircle.
• Throwtheballtooneparticipantandaskher/himtonameabenefitofbreastfeedingforthebaby,themotherorthefamily.
• Whens/hehasnamedabenefitofbreastfeedingforthebaby,themotherorthefamily,s/heinturnthrowstheballtoanotherparticipantandasksthatparticipanttogiveanotherbenefitofbreastfeedingtothebaby,motherorfamily.
• Continueuntilthefollowingbenefitsofbreastfeedingforthebaby,motherorfamilyhavebeenmentioned.
Infant and Young Child Feeding Counselling ��
Content for Activity 5
Benefits of Breastmilk for the Baby
• Savesbabies’lives.
• Thebabybenefitsfromthecolostrum,whichprotectshim/herfromdiseases.Thecolostrumactsasalaxativecleaningthebaby’sstomach.
• Hasallthebabyneedsforthefirst6months.
• Containsenoughwaterforthebaby’sfirst6months.
• Providefoodsecurityinemergencies.
• Promotesadequategrowthanddevelopment
• Stimulatesoptimalbraindevelopment
• Protectsagainstdiseases,especiallyagainstdiarrhoeaandrespiratoryinfections.
• Isalwaysclean,ready,andattherighttemperature.
• Iseasytodigest.
Benefits of Breastfeeding for the Mother
• Puttingthebabytothebreastimmediatelyafterbirthhelpsexpeltheplacenta,andreducesbleedingafterdelivery.
• Thebaby’ssucklingstimulatesuterinecontractions.
• Breastfeedingthebabyimmediatelyandfrequentlystimulatesmilkproduction.
• Breastfeedingthebabyimmediatelyandfrequentlypreventsengorgement.
• Breastfeedingiseconomical.
• Breastfeedingstimulatesbondingbetweenamotherandherbaby.
• Breastfeedingisgoodformaternalhealth.
• Breastfeedingprotectsagainstearlypregnancywhichhelpsprotectawoman’sownhealthandnu-trition.
• Breastfeedingcontributestofoodsecurityfortheinfant.
Benefits of Breastfeeding for the Family
• Decreasedsickness
• Decreasedmedicalexpenses
• Protectionagainstearlypregnancy
�� Infant and Young Child Feeding Counselling
SESSION4
How to Breastfeed
Note to the Facilitator:Present an overview of objectives (listed below) and the time allocated for this session.
Learning objectivesBytheendofthesession,Participantswillbeableto:
1. For the Preparation of Trainers Course: Make dolls and model breasts
2. Recognizegoodandpoorattachment
3. Demonstrategoodattachmentandpositioning
4. Explaintheresultsofpoorattachment
5. Describeeffectivesuckling
6. Describehandexpressionandstorageofbreastmilk;andhowtocupfeed
ActivitiesActivity1 For the Preparation of Trainers Course: Making dolls
and breast models (�0 minutes)
Activity2 Goodattachmentandpositioningatthebreast(� hour)
Activity3 Signsofeffectivesuckling(�0 minutes)
Activity4 Breastfeedingpattern(frequency,duration,demand,nightfeeding), andexclusivebreastfeeding(�0 minutes)
Activity5 Howtohandexpressandstorebreastmilk;andhowtocupfeed (�0 minutes)
Total Time 2½–3 hours
Materials needed√ For the Preparation of Trainers Course: Materials to make dolls and breast
models
√ Counsellingcards4and5onattachmentandpositioning
√ Dollsand/orbabies
Note: If possible, make arrangements in advance to have breastfeeding women present to demonstrate positioning and attachment.
Infant and Young Child Feeding Counselling ��
√ Imagesof‘goodattachment’and‘poorattachment’,and‘Howthebreastmakesmilk’
√ Counsellingcard6:BreastfeedonDemand,BothDayandNight;CC7:DuringtheFirst6Months,YourBabyNeedsONLYYourBreastmilk;andCC8:HowtoHandExpressBreastmilkandCupFeed
√ Photoofmilkexpressionandcupfeeding
√ Smallcupwithliquid
ACTIVITY 1
For the Preparation of Trainer’s Course: Making dolls and breast models (�0 minutes)
Methodology: Small groups from the same health post help each other make dolls and breast models
• Demonstrate how to make a doll using simple materials (paper rolled into a ball for the head covered in same fabric used for the body, small bottle filled with water for trunk of doll, rubber bands to help define neck, arms and legs, typical baby clothes if available, and a cloth or blanket to cover the doll).
• Participants work together to make their dolls.
• Demonstrate how to make a breast model using simple materials (2 socks: 1 sock resembling skin colour to show the outside of the breast, and another sock to show the inside of the breast – Instructions for Making Cloth Breast Models, Appendix 1, Breastfeeding Management and Promotion in a Baby-Friendly Hospital, an 18 hour course for maternity staff, UNICEF/WHO 1993. Appendix 3.
Note: Each training team should create at least one doll for use in conducting future trainings.
ACTIVITY 2
Good attachment and positioning at the breast (�0 minutes)
Methodology: Small groups and Demonstration
• Formsmallgroupsof6ParticipantswithaFacilitatorineachgroup.
• PassaroundtoParticipantstheimagesof‘goodattachment’and‘poorattachment’.Askforcommentsanddescriptionofimages.
�� Infant and Young Child Feeding Counselling
• UsingCounsellingCard#4ANDifpossiblearealmother,pointoutandexplainthe4signsofgoodattachment:mouthopen,moreareolashowingabovethanbelowthenipple,lowerlipturnedout,andchintouchingbreast.(Aimthebaby’slowerlipwellbelowthenipplesothatthenipplegoestothetopofthebaby’smouthandthebaby’schintouchesthebreast.)
• Explainwhathappensiftheattachmentiswrong:
– Soreandcrackednipples
– Painleadstopoormilkreleaseandslowsmilkproduction.
• UsingCounsellingCard#5ANDifpossiblearealmother,demonstrateandexplainthevariouspositionsdeliberatelyandclearly(pointoutwhenheadshouldnotbeheld,anddonotholdbabytoofarouttotheside)andrepeatthe4signsofgoodattachment:mouthopen,moreareolashowingabovethanbelowthenipple,lowerlipturnedout,andchintouchingbreast.
• Explainhowtohelpamotherattachandpositionababyatherbreast
– alwaysobserveamotherbeforeyouhelpher
– giveamotherhelponlyifshehasdifficulty
– letthemotherdoasmuchaspossibleherself
– makesuresheunderstandswhattodosothatshecandoitherself
• Demonstratewithparticipanthowtohelpattachandpositionababy(Facilitatoractsascounsellor,andparticipantasmother)—seetablebelow
• Inworkinggroupsof6,askParticipantstopractiseintriadswithdollsorrolled-uptowels/material:mother,counsellorandobserver—helping‘mother’tousegoodattachment(4signs)andgoodpositioning.Eachparticipantpractiseseachrole.(ParticipantscanpractisePOSITIONINGababyandhelpingamothertodoso,buttheycannotpractiseATTACHMENTuntiltheyarewitharealmotherandbaby.Theycangothroughallthestepswitheachotherandwithadollsothattheyknowwhattodowitharealmother.)
• Motherandbabydemonstrateattachmentandpositioning(orFacilitatordemonstrateswithadollorrolled-uptowel/material).AskParticipantstoobserveattachmentandpositioninganddecideifmotherisusinggoodattachmentandpositioning,explainanydifferencestheysaw,andhelpmothertomodifyattachmentandpositioning.
• Recapcounsellingcards4and5:howtohelpmotherattachandposition,andmessagesforthemother.
• Discussionandsummary.
Infant and Young Child Feeding Counselling ��
Content for Activity 2
How to help attach a baby
• Greetmother,introduceyourself
• Assessabreastfeed
• Ifthebabyispoorlyattached,askmotherifshewouldlikesomehelptoimprovebaby’sattachment
–makesuremotherissittinginacomfortable,relaxedposition
–becomfortableandrelaxedyourself
–explainthe4signsofgoodattachment
–showmotherhowtosupportherbreastwithherhandtoofferittoherbaby(sheshouldrestherfingersonherchestwallunderherbreast)
–explainhowsheshouldtouchherbaby’slipswithhernipple,sothatheopenshis/hermouth
–explainthatsheshouldwaituntilherbaby’smouthopenswide
–explainhowtoquicklymovethebabytoherbreast(aimingherbaby’slipbelowhernipple,sothathis/herchinwilltouchherbreast)
• Noticehowthemotherresponds
• Lookforallthesignsofgoodattachment
• Iftheattachmentisnotgood,tryagain
ACTIVITY 3
Signs of effective suckling (�0 minutes)
Methodology: Small groups
• Insmallgroupsof6Participants,passaroundtoParticipantstheimagesof‘Howthebreastmakesmilk’.
• AskParticipantstoexplainhowtheythinkthebreastmakesmilk.
• FollowthearrowswiththeParticipantsandexplainthatsucklingatthenipplestimulatesnervepathwaysandsendsamessagetothebraintomakemilkandto“letdown”themilk—makesthemilkflow.
• Explainthat‘themorethebabysucklesandremovesthemilk,themoremilkisproduced’—buildsupmilksupply.
• Explainthatgood suckling achieves EFFICIENT milk transfer.
• AskParticipants:“whatarethesignsofeffectivesuckling?”
�� Infant and Young Child Feeding Counselling
• ProbeParticipantstomentionthekeyandsupportingmessages(foundinAppendix1oftheIYCF Counselling Trainer’s Guide—CC#4:Howtoattachbabytobreast;fill-inthegaps.
–Tosucklewell,ababyneedstobewellattachedatthebreast.
–Thebabyshouldbeclosetothebreast,withawideopenmouth,sothats/hecantakeinplentyoftheareolaandnotjustthenipple.
–Youshouldseemoreareolaabovethebaby’smouththanbelow;andthechinshouldtouchthebreast(thishelpstoensurethatthebaby’stongueisundertheareolasothats/hecanpressoutthemilkfrombelow).
–Youmaybeabletoseethatthebaby’slowerlipisturnedoutwards(butitmaybedifficulttoseeifthechinisclosetothebreast).
–Goodattachmenthelpsthebabytogetthemilkmoreeasily.
–Goodattachmentalsohelpsthemother’smilkflowwellandensuresagoodsupply.
–Goodattachmenthelpstopreventsoreandcrackednipples.
–Theinfanttakesslowdeepsuckles,sometimespausing.
–Themothermaybeabletoseeorhearherbabyswallowingafteroneortwosuckles.
–Sucklingiscomfortableandpainfreeformother.
–Babyfinishesthefeed,releasesbreastandlookscontentedandrelaxed.
–Thebreastissofterafterthefeed.
• Discussionandsummary.
ACTIVITY 4
Discuss breastfeeding pattern (frequency, duration, demand, night feeding), and exclusive breastfeeding.
Methodology: Participants observe counselling cards 6 and 7 and name the breastfeeding practice(s) and key message(s) demonstrated in the counselling cards
• DivideParticipantsintosmallgroups,askingParticipantsineachgrouptousetheircounsellingcardsforthefollowingexercise.
• HaveeachgroupstudyCCs6and7andnamethebreastfeedingpractice/sandkeymessage/sthecardsrepresent.
• Askonesmallgrouptosharetheirresultswiththewholegroup.Othersmallgroupsaddadditionalpoints.
• Probeuntilthekeyandsupportingmessages(foundinAppendix2oftheIYCFCounsellingTrainer’sGuide)arementioned.
• Discussionandsummary.
Infant and Young Child Feeding Counselling ��
ACTIVITY 5
How to hand express and store breastmilk; and how to cup feed (�0 minutes)
Methodology: Presentation/demonstration and triads
• DistributeCounsellingCard#8
• FollowthestepsintheCounsellingCardverydeliberately,sothatParticipantscancopythisactionafterwards.
• Askawillingbreastfeedingmothertodemonstratethetechniqueofexpressingbreastmilk.
• Ifnobreastfeedingmotherisavailable,Facilitatorcandemonstratethetechniqueusingthebreastmodel.
• AskParticipantstopractiseusingbreastmodels.
• AskParticipantstolistthe“steps”ofexpression.
• Ingroupsof3askParticipantstotaketurnsexplainingtoeachotherhowtoexpressbreastmilk,andhowtostoreit.
• Explainstorageprocedures:
–Storebreastmilkinaclean,coveredcontainer.Milkcanbestored8–10hoursatroomtemperatureinacoolplaceand72hoursintherefrigerator.
–Giveinfantexpressedbreastmilkfromacup.
–Bottlesareunsafetousebecausetheyaredifficulttowashandcanbeeasilycontaminated.
• Distributephotoofmilkexpressionandcupfeeding.
• Demonstratecupfeeding:
–Bringcuptothebaby’slowerlipandallowbabytotakesmallamountsofmilk.Donotpourthemilkintobaby’smouth.
• Passaroundadollandacupwithliquidinitforeachparticipanttopractisecupfeedingtechnique.
• Discussionandsummarywiththewholegroup.
�0 Infant and Young Child Feeding Counselling
SESSION5
Common Breast Conditions: Symptoms, Prevention and Solutions; and Insufficient Milk
Learning objectivesBytheendofthesession,Participantswillbeableto:
1. Recognisecommonbreastconditionsthatcanoccurduringbreastfeeding
2. Describethesymptomsoftheconditions
3. Describehowtopreventtheseconditions
4. Helpmotherstoovercometheseconditions
5. Helpmotherswhohaverealorperceivedinsufficiencyofmilk
ActivitiesActivity1 Identifycommonbreastconditionsthatcanoccurduringbreastfeeding
(�� minutes)
Activity2 Identifysymptoms,preventionmeasuresandtreatmentfor3ofthe mostcommonbreastconditions(�0 minutes)
Activity3 Discussinsufficientmilk:perceivedandrealandhowtobuildupmilk supply(�0 minutes)
Total Time 1 hour 15 minutes
Materials needed√ Photosofengorgement,sore/crackednipple,blockedductandmastitis,inverted
nipples,Candida(thrush),andcheckingforthrushinbaby’smouth
Note to the Facilitator:Present an overview of objectives (listed below) and the time allocated for this session.
Infant and Young Child Feeding Counselling ��
ACTIVITY 1
Identify common breast conditions that can occur during breastfeeding (�� minutes)
Methodology: Brainstorm
• BrainstormcommonbreastconditionsthatParticipantshaveidentifiedintheircommunities.
• AsParticipantsmentioneachbreastcondition,putanimageoftheconditiononthefloororwallsothatallcansee.
• Probeuntilallimagesaredisplayed.
ACTIVITY 2
Identify symptoms, prevention measures and solutions for 3 of the most common breast conditions (�0 minutes)
Methodology: Small working groups
• DivideParticipantsinto3workinggroupsandassignacommonbreastcondition,withcorrespondingphoto,toeachgroup:engorgement,soreandcrackednipples,orpluggedductsthatcanleadtomastitis.
• Askeachgrouptodiscusssymptoms,preventionandtreatmentoftheassignedcommonbreastcondition.
• Eachgrouppresentstheirfindingstothewholegroup.
• Discussionandsummarywiththewholegroup.
• Fill-ingapsusingTable1:Commonbreastfeedingconditions
ACTIVITY 3
Identify symptoms and prevention measures for insufficient milk: perceived or real, and how to build up milk supply (�0 minutes)
Methodology: Small working groups
• Inthesameworkinggroups,askeachgrouptodiscussinsufficientmilk:perceivedorrealintermsofsymptomsandprevention,andhowtobuildupmilksupply.
• Askonegrouptopresenttheirfindingstothewholegroup.
• Askothergroupstocontributeanyadditionalpoints.
• Discussionandsummarywiththewholegroup.
• Fill-ingapsusingTable2:Insufficientbreastmilk
�� Infant and Young Child Feeding Counselling
Breast Condition
Engorgement
Table 1: Common Breastfeeding Conditions
Symptoms:
• Swelling
• Tenderness
• Warmth,
• Slightredness
• Pain
• 24hourfever
• Skinshiny,tightandnippleflattened
• Usuallybeginsonthe3rd–5thdayafterbirth
Sore or Cracked Nipples
Symptoms:
• Breast/nipplepain
• Cracksacrosstopofnippleoraroundbase
• Occasionalbleeding
• Maybecomeinfected
Prevention
• Goodattachment
• Startbreastfeedingwithinanhourofbirth
• Breastfeedfrequentlyondemand(asoftenandaslongasbabywants)dayandnight:10–12timesper24hours
• Goodattachment
• Donotusebottles
• Donotusesoaporcreamsonnipples
Solutions
q Applycoldcompressestobreaststoreduceswelling;thenapplywarmthtohelpmilktoflow
q Breastfeedmorefrequently
q Offerbothbreasts
q Improveattachment
q Gentlestrokingofbreastshelpstostimulatemilkflow
q Pressaroundareolatoreduceoedema,tohelpbabytoattach
q Expressmilktorelievepressureuntilbabycansuckle
Warmth may be warm water, shower or bath if possible, warm dry cloth, not necessarily compress
q Donotstopbreastfeeding
q Improveattachment
q Begintobreastfeedonthesidethathurtsless
q Varybreastfeedingpositions
q Letbabycomeoffbreastbyhim/herselforremovethebabyfromthebreastbybreakingsuctionfirst
q Applydropsofbreastmilktonipplesandallowtoairdry
q Donotusesoaporcreamonnipples
q Donotwaituntilthebreastisfulltobreastfeed
q Donotusebottles
Continued
Infant and Young Child Feeding Counselling ��
• Getsupportfromthefamilytoperformnon-infantcarechores
• Ensuregoodattachment
• Breastfeedondemand,andletinfantfinish/comeoffbreastbyhim/herself
• Avoidholdingthebreastinscissorshold
• Avoidtightclothing
Plugged Ducts and Mastitis q Donotstopbreastfeeding(ifmilkisnotremovedriskofabscessincreases;letbabyfeedasoftenass/hewill)
q Applywarmth(water,hottowel,warmsunetc.)
q Holdbabyindifferentpositions,andensuregoodattachment
q Applygentlepressuretobreastwithflatofhand,rollingfingerstowardsnipple;thenexpressmilkorletbabyfeedevery2–3hoursdayandnight
q Rest(mother)
q Drinkmoreliquids(mother)
q Ifnoimprovementin24hoursreferforantibiotics
Breast Condition Prevention Solutions
Symptoms of Plugged Ducts:
• Lump,tender,localizedredness,feelswell,nofever
Symptoms of Mastitis
• Hardswelling
• Severepain
• Rednessinonearea
• Generallynotfeelingwell
• Fever
• Sometimesababyrefusestofeedasmilktastesmoresalty
Flat and inverted nipples q IfnipplesareFLAT,feednormally
q Babysucklesfromthebreast—notfromthenipple
q Helpisonlyneededtoattachbabyafterdelivery;nothingisusefulbeforedelivery,butnipplesoftenimproveatthetimeofbirth
q Ifnipplecanbepulledout,thenbabycanpullitouttoo;ifnipplegoesin,stilltrytoattachbaby.Leaningoverbabycanhelp.
q Helpbabytoattachasearlyaspossiblebeforemilkcomesinandthereisriskofengorgement.Sucklingearlyatdeliveryprobablyhelps.Stimulatingthenippleatdeliverymayhelpnippletostandoutmore.
q Trydifferentpositions
q Enticebabywithdropsofexpressedbreastmilkonnipple
q Expressmilkuntilbabyisabletoattach—sendtomoreexperiencedcounsellor
q Ifnipplesarelargeorelongated,trytogetbabytotakemorebreastintomouth
Continued
�� Infant and Young Child Feeding Counselling
Breast Condition Prevention Solutions
Candida (Thrush) q Checkforthrushinbaby’smouth:whitepatchesinsidecheckorontongue
q Babymayhaverashonbottom
q Refertohealthpersonneltoconfirmdiagnosis
q Followtreatmentdirectionsofhealthpersonnelforbothmotherandbaby
Sore, red, itchy nipples
whitepatchesinsideorontongue,ormaybearashonbottom
Infant and Young Child Feeding Counselling ��
Insufficient Breastmilk Prevention Solutions
Table 2: Insufficient Breastmilk
Perceived by mother
• You“think”youdonothaveenoughmilk
• (Babyrestlessorunsatisfied)
Firstdecideifthebabyisgettingenoughbreastmilkornot(weight,urineoutput)
• Startbreastfeedingwithinanhourofbirth
• Staywithbaby
• Ensuregoodattachment
• Encouragefrequentdemandfeeding
• Letbabyfinishfirstbreastfirst
• Breastfeedexclusivelydayandnight
• Avoidbottles
• Encourageuseofnon-oestrogenfamilyplanningmethods
• SameasaboveBaby not getting enough Breastmilk
• Insufficientweightgain
• Fewerthan6wets/day
q Listentomother’sconcernsandwhyshethinksshedoesnothaveenoughmilk
q Decideifthereisaclearcauseofthedifficulty(poorbreastfeedingpattern,mother’smentalcondition,babyormotherill)
q Checkbaby’sweightandurineoutput(ifpoorweightgainrefer)
q Buildmother’sconfidence—reassureherthatshecanproduceenoughmilk
q Explainwhattheproblemmaybe—growthspurts
q Explainforeandhindmilk
q Checkandimproveattachment
q Suggeststoppinganysupplements—water,formulas,tea,orliquids
q Avoidseparationfrombabyandcareofbabybyothers
q Suggestimprovementstofeedingpattern.Feedbabyfrequentlyondemand,dayandnight.
q Finishthefirstbreastfirst—letthebabycomeoffthebreastbyhim/herself
q Ensuremothergetsenoughtodrink
q Thebreastsmakeasmuchmilkasthebabytakes—ifs/hetakesmore,thebreastsmakemore(thebreastislikea“factory”—themoredemandformilk,themoresupply)
q Sameasabove
q Ifnoimprovementinweightgainafter1week,refermotherandbabytonearesthealthpost
�� Infant and Young Child Feeding Counselling
SESSION6
Common Situations that Can Affect Breastfeeding; and Identifying Signs that Require Mother/Caregiver/Family to Seek Care
Learning objectivesBytheendofthesession,Participantswillbeableto:
1. Discusscommonsituationsthatcanaffectbreastfeeding
2. Identifysignsthatrequirethemother/caregiver/familytoseekcare
ActivitiesActivity1 Discusscommonsituationsthatcanaffectbreastfeeding(�0 minutes)
Activity2 Referralfordifficultproblems(�0 minutes)
Activity3 Identifysignsrequiringthemother/caregiver/familytoseekcarefor theirchild(�0 minutes)
Total Time 1½ hours
Materials needed√ 2envelopes,eachwithasetofimagesofcommonsituationsthatcanaffect
breastfeeding:sickmother,feedingalowbirthweightbaby(kangaroomothercare),malnourishedmother,twins,refusaltobreastfeed,pregnancy,andmotherawayfrombaby
√ CounsellingCard17:SignsRequiringtheMother/Caregiver/FamilytoSeekCare
Note to the Facilitator: Present an overview of objectives (listed below) and the time allocated for this session.
Infant and Young Child Feeding Counselling ��
ACTIVITY 1
Discuss Common Situations that can affect breastfeeding (�0 minutes)
Methodology: “Pick from the envelope”
• DivideParticipantsintotwogroupstoplay“pickfromtheenvelope”.
• Giveeachgroupabasketwithasetofimagesrepresentingacommonsituationorbeliefthatcanaffectbreastfeeding.
• Eachgroupisdividedinto2teams.
• Oneparticipantfromteam1isaskedto“pickfromtheenvelope,”lookattheimage,consultwithotherteammembers,andanswerthequestionofhowawomanwiththissituationorbeliefcanbesupportedtosuccessfullybreastfeedherbaby.
• Discussion.
• Then,oneparticipantfromteam2“picksfromtheenvelope”andanswers(withthehelpofteam)thenextsituationthatcanaffectbreastfeeding.
• Switchfromoneteamtotheotheruntilall‘commonsituationsthatcanaffectbreastfeeding’havebeen“pickedfromtheenvelope”.
• Discusshowstresscanaffectbreastfeeding(noimageavailable).
• Discussionandsummary.
Content for Activity 1 on following page
�� Infant and Young Child Feeding Counselling
Content for Activity 1
• Whenthemotherissufferingfromheadaches,backaches,colds,diarrhea,oranyothercommonillness(malaria,anemia,evencholera),sheSHOULDCONTINUETOBREASTFEEDHERBABY.
• Themotherneedstorestanddrinkplentyoffluidstohelpherrecover.
• Ifmotherdoesnotgetbetter,sheshouldconsultadoctorandsaythatsheisbreastfeeding.
• Motherneedssupportforgoodattachment,andhelpwithsupportiveholds.
• Feedingpattern:longslowfeedsareOK—keepbabyatthebreast.
• Directbreastfeedingmaynotbepossibleforseveralweeks,butmothersshouldbeencouragedtoexpressbreastmilkandfeedthebreastmilktotheinfantusingacup.
• Ifthebabysleepsforlongperiodsoftime,trytolooselycoverbabytohelpawakenhim/her.
• Cryingisthelastsignofhunger.EarliersignsofhungerincludeaCOMBINATIONofthefollowingsigns:beingalertandrestless,openingmouthandturninghead,puttingtongueinandout,suckingonhandorfist.Onesignbyitselfmaynotindicatehunger.
• Position(placedbetweenmother’snakedbreastwithlegsflexedandsecuredinacloththatpassesjustundertheinfant’searsandistiedaroundthemother’schest)
– Skin-to-skincontact(SSC)
– Provideswarmthandstabilizesbreathing
– Mother’ssmell,touch,feel/warmth,voice,andtasteofthebreastmilk helptostimulatethebabytoestablishsuccessfulbreastfeeding
• Breastfeeding(earlyandexclusivebreastfeedingbydirectexpressionorexpressedbreastmilkgivenbycup)
• Motherandbabyarerarelyseparated
• MothersneedstoeatmorefoodFORHEROWNHEALTH(“feedthemotherandletherbreastfeedherbaby”).
• MothersneedtotakevitaminAwithin6weeksafterdelivery,andadailymultivitamin,ifavailable.
• Motherscanproducemilkifthebabysuckles
Sick Mother
Low Birth Weight Baby
Kangaroo Mother Care
Malnourished mother
Continued
Common Situations that Can Affect Breastfeeding
Special Situation Solutions
Infant and Young Child Feeding Counselling ��
• Amothercanexclusivelybreastfeedbothbabies.
• THEMOREABABYSUCKLES,THEMOREMILKTHEMOTHERPRODUCES.
• Mothersoftwinsproduceenoughmilktofeedbothbabiesifthebabiesbreastfeedfrequentlyandarewellattached.
• Thetwinsneedtostartbreastfeedingassoonaspossibleafterbirth—iftheycannotsuckleimmediately,helpthemothertoexpressandcupfeed.Buildupthemilksupplyfromveryearlytoensurethatbreastsmakeenoughfortwobabies.
Usuallyrefusaltobreastfeedistheresultofbadexperiences,suchaspressureonthehead.Refusalmayalsoresultwhenmastitisresultsinthechangedtasteofthebreastmik(moresalty).
• Letthebabyhavelotsofskin-to-skincontact;letbabyhaveagoodexperiencejustcuddlingmotherbeforepressingtosuckle
• Donotpressuretobreastfeed
• Donotpressbackofhead
• Expressandfeedbycupuntilbabyiswillingtosuckle
• Expressdirectlyintobaby’smouth
• Letbabytrylotsofdifferentpositions
• Avoidgivingthebabyteatsandbottles
• Checkbaby’smouthforsignsofthrush
• Waitforthebabytobewideawakeandhungry(butnotcrying)beforeofferingthebreast.
• Gentlyteasethebaby’sbottomlipwiththenippleuntils/heopenshis/hermouthwide.
• Inmostcountriesamotherisencouragedtodiscontinuebreastfeedingwhenshebecomespregnant.Shemaybelieveitisharmfultooneorotherbabytobreastfeedwhilesheispregnant.Sometimesthemother’snipplesfeeltenderifsheispregnant.Itisperfectlysafetobreastfeedtwobabiesandwillnotharmeitherbaby—therewillbeenoughmilkforboth.
• Ifbabyisunder1yearofage,itmaybemorebeneficialtothebabytocontinuebreastfeedingtosustainhealth,growth,anddevelopment.
• Motherneedstobeencouragedtoeatmoretimesadayforherownhealthandtosupportbothbreastfeedingandthegrowthofthefetus.
Common Situations that Can Affect Breastfeeding Continued
Special Situation Solutions
Twins
Baby who refuses the breast
New pregnancy
Continued
�0 Infant and Young Child Feeding Counselling
Common Situations that Can Affect Breastfeeding Continued
Special Situation Solutions
• Breastmilkdoesnotspoilbecauseofmother’sstress,andproductiondoesnotdecrease.However,milkmaynotflowwelltemporarily.
• Ifmothercontinuestobreastfeed,milkflowwillstartagain.
• Keepbabyinskin-to-skincontactwithmotherifshewillpermit.
• Findreassuringcompanionstolisten,givemotheranopportunitytotalk,andprovideemotionalsupportandpracticalhelp.
• Trytorelaxandbreastfeedbaby.
• Drinkawarmbeveragesuchasteaorwarmwater,tohelprelaxandassisttheletdownreflex.
• Ifnecessary,providetemporaryartificialfeedsbycup.
• Mothershouldexpressmilkandstorethebreastmilkforusewhileawayfromthebaby;thebabyshouldbefedthismilkattimeswhens/hewouldnormallyfeed.
• Teachcaregiverhowtosafelyfeedexpressedbreastmilk.
• Mothershouldsleepwithbabyandallowinfanttofeedfrequentlyatnightandwhensheisathome.
• Motherwhoisabletokeepherinfantwithherattheworksiteshouldfeedherinfantfrequently.
Stress
Mother away from baby
Infant and Young Child Feeding Counselling ��
ACTIVITY 2
Referral for difficult problems (�0 minutes)
Methodology: Brainstorm
• Brainstormwhereand/ortowhomtheIYCFcounsellorscangoforreferralwhenthereareproblemss/heisunabletohandle.
• Discussionandsummary.
ACTIVITY 3
Identify signs requiring the mother/caregiver/family to seek care (�0 minutes)
Methodology: Brainstorm and small groups
• Brainstormsignsthatrequirereferraltothehealthpostbymother/caregiver/family.
• DivideParticipantsintosmallgroups.
• AskeachgrouptostudyCounsellingCard17andtoidentifythesignsthatrequirereferraltothehealthpostbymother/caregiver/family.
• Askonesmallgrouptosharewiththewholegroupthesignsrequiringreferraltoahealthpostbymother/caregiver/familyshownintheCounsellingCard17.Othersmallgroupstoaddadditionalpoints.
• Probeuntilthekeyandsupportingmessages(foundinAppendix1oftheIYCFCounsellingTrainer’sGuide)arementioned.
• Discussionandsummary:
– Recognizesignsrequiringreferraltothehealthpostbymother/caregiver/family
– Refermother
– Supportmother
• Discussionandsummary.
�� Infant and Young Child Feeding Counselling
SESSION7
How to Counsel: Practise Counselling with Mothers of Babies Less than 6 Months
Note to the Facilitator: Present an overview of objectives (listed below) and the time allocated for this session.
Learning objectivesBytheendofthesession,Participantswillbeableto:
1. Listcounsellingskills:
– listeningandlearning
– buildingthemother’s/caregiver’sconfidence
– providingsupportandpracticalhelp,and
– negotiating(“reaching-an-agreement”)
2. Describethe“assess,analyzeandact”stepstocounselling
3. UseaCounsellingCardincounselling
4. Practisetheprocessofcounsellingwithamotherofababylessthan6months
ActivitiesActivity1 Listcounsellingskills,anddescribethe“assess,analyzeandact”steps
tocounselling(�0 minutes)
Activity2 Modelthe“assess,analyzeandact”stepstoCounsellingtoencourage motherstotryoptimalbreastfeedingpractices:initialcontactwith motherofbabylessthan6months(�� minutes)
Activity3 Discussmodeldemonstration(�� minutes)
Activity4 Practisethe“assess,analyzeandact”stepstocounsellinginaninitial contactwithmotherofbabylessthan6months(�0 minutes)
Activity5 Discussthe“assess,analyzeandact”stepstocounsellingforfollow-up contact(s)(�0 minutes)
Activity6 Prepareforpracticum(�0 minutes)
Total Time 2½ hours
Infant and Young Child Feeding Counselling ��
Materials needed√ 4CaseStudiesofcounsellingforbabylessthan6months
√ 4follow-upCaseStudiesofcounsellingforbabylessthan6months
√ Eachparticipanthasasetofcounsellingcards
ACTIVITY 1
List counselling skills and describe the “assess, analyze and act” steps to counselling (�0 minutes)
Methodology: Brainstorming and description of “assess, analyze and act” steps of counselling
á List counselling skills
• Brainstormwithwholegroupthekindsofcounsellingskills
• Probeuntilthefollowingcounsellingskillshavebeenmentioned:listeningandlearning(practicedinSession2),buildingthemother’s/caregiver’sconfidence,providingsupportandpracticalhelp,andnegotiating(“reaching-an-agreement”)
• Fill-ingapswithadescriptionofthe“assess,analyzeandact”stepsofcounselling
á Describe the “assess, analyze and act” steps
Assess mother and baby situation
• Greetthemother/fatherandestablishconfidence
• Askthemotheraboutageofbaby,currentfeedingpractices,andhealth
• Askquestionstolearnmother’ssituationandconcerns
• Listentotheconcernsofthemotherandfather,andobservebabyandmother
• Acceptwhatmotherisdoingwithoutdisagreeingoragreeing
• Lookforthingsthatmotherisdoingrightorthataregoingwelltopraise
Analyze
• Identifyfeedingdifficulty,ifany,andcausesofthedifficulty
• Ifthereismorethanonedifficulty,prioritizedifficulties
• Answerthemother’squestions(ifany)
�� Infant and Young Child Feeding Counselling
Act
• Dependingontheageandsituationofthebaby,selectandgivesmallamountofRELEVANTINFORMATIONononeortwoofthefollowingtopicscoveredintheCCs;useCCstohelpmotherunderstandandremembertheinformation.
• Benefitsofcolostrum(Session3:ImportanceofBreastfeeding,andCCs2aand2b)
• Thatthereisenoughwaterforthebabyinthebreastmilk(CC7)
• Benefitsofexclusivebreastfeedinguntilthebabyis6months(CC7)
• Therisksofgivingwatertothebaby
• Howababysuckles(attachmentandpositioning)(CCs4and5)
• Ababy’snormalfeedingpattern
• Thebreastsmakeasmuchmilkasthebabytakes—ifhetakesmore,thebreastsmakemore.Thebreastislikea“factory”—themoredemand(formilk),themoresupply(CC6)
• KangarooMotherCare
– Skin-to-skincontact(SSC)
– Warmth
• Whenandhowtoexpressbreastmilkandhowtofeedthebabywithacup(CC8)
• Whentostartcomplementaryfoodsandhowtodoit(moreinformationlater)
• ShowrelevantCounsellingCard(s)andaskmothertocommentonwhatsheobservesishappeninginthecard,andtorelateittoherownsituation.
• Askthemotherwhatshethinksaboutthisinformation.
• Discusswiththemother/fatherdifferentfeasibleoptionstoovercomethedifficulty.
• Suggestwhatthemothermightdo,givingheratleasttwopossibilities,andaskherwhatshefeelsabletodo.
– Putas“suggestionnotcommand”(meaningnottellingamotherwhattodo)
– Presentoptions/smalldo-ableactions(time-bound)andhelpmotherselectonethatshecantry
– Givemotherasayinthedecision,andtheopportunitytosayno,ortochooseanotherway
• Negotiate(“reach-an-agreement”)withthemothertotryanewbehaviour,ortotakeafurtherstepsuchasdiscussingthesuggestionswithanotherfamilymember.
• Makeafollow-upappointmentwithmother.
• Praisethemotherandthankherforhertime.
Infant and Young Child Feeding Counselling ��
ACTIVITY 2
Model the “assess, analyze and act” steps to counselling to encourage mothers to try optimal breastfeeding practices: initial contact with mother of baby less than 6 months (�� minutes)
Methodology: Demonstration
á Model the “assess, analyze and act” steps
• Model(2Facilitators)theinitialcounsellingcontactofanIYCFCounsellortoTamimawith2-monthsonAhmed(modelthe“assess,analyzeandactsteps”).(Thefacilitatorsshouldpreparethisdemonstrationinadvance).
Assess mother and baby situation
• ListentowhatTaminasays[TaminatellstheCounsellorshebreastfeeds,butdoesnotproduceenoughmilk,andsoshefeedsAhmedothermilk.]
• AskafewquestionstounderstandwhyTamimathinksshedoesnothaveenoughmilk.
• PraiseTaminaforbreastfeedingAhmed.
Analyze
• Taminahasapparentorrealinsufficiencyofbreastmilk.
Act
• Relatethereasonsforapparentorrealinsufficiencybreastmilk(keyandsupportingmessages:Session5).
• CheckattachmentandifpossibleweightgainoratleastappearanceandhealthofAhmed.
• AskTaminahowmanytimesAhmedhasurinatedduringthelast24hours(fromthistimeyesterdaytotoday.
• ShowCCs6and7:‘BreastfeedonDemand,bothDayandNight’and‘Duringthefirst6Months,YourBabyNeedsONLYYourBreastmilk’andaskTaminatocommentonwhatsheobservesishappeninginthecardandtorelateittoherownsituationofinsufficiencyofbreastmilk.
• Ifattachmentisnotgood,showCCs4and5:‘HowtoAttachBabytotheBreast’and‘BreastfeedingPositions’andaskTaminatocommentonwhatsheobservesishappeninginthecardandtorelateittohowsheattachesandpositionsAhmed.
• GiverelevantandsmallamountofinformationregardingthemessagesofCCs4,5,6and7usingsimplelanguage.
• AskTaminawhatshethinksaboutthisinformation.
�� Infant and Young Child Feeding Counselling
• DiscusswithTaminadifferentfeasibleoptionstoovercomethedifficultyofapparentorrealinsufficientmilk.
• Putas“suggestionnotcommand”(meaningnottellingTaminawhattodo).
• Presentoptions/smalldo-ableactions(time-bound)andhelpTaminaselectonethatshecantry.
• GiveTaminaasayinthedecision,andtheopportunitytosayno,ortochooseanotherway.
• Modifyrecommendations,ifnecessary,tosuitTamina’spreferences.
• Makeafollow-upappointmentwithTamina.
• PraiseTaminaandthankherforhertime.
ACTIVITY 3
Discuss model demonstration (�� minutes)
Methodology: Presentation and discussion
á Discuss model demonstration
• TwoFacilitators(CounsellorandTamina)repeatinitialcounsellingcontactwithTamina,stoppingaftereachstepof“assess,analyzeandact”
• CounsellorshowsCounsellingCard4anddiscusseswithTamina:
1.Observe—WhatishappeningintheCounsellingCard?
2.Relatetoyourownsituation–Whatdoyouagreeordisagreewith?Why?Whatdopeopleinyourcommunitydo?
• GivesrelevantandsmallamountofinformationregardingmessagesofCounsellingCard4usingsimplelanguage
• AsksTaminawhatshethinksaboutthisinformation.
• RepeatsstepsusingCounsellingCard5,6and7.
• Discussesdifferentfeasibleoptionstoovercomethedifficultyofapparentorrealinsufficientmilk.
• HelpsTaminaselectasmalldo-ableactions(time-bound)thatshecantry.
• Makesafollow-upcontactappointment.
• Discussionandrepetitionof“assess,analyze,andact”stepswithParticipants.
Infant and Young Child Feeding Counselling ��
ACTIVITY 4
Practise the “assess, analyze, and act” steps to counselling in an initial contact with mother of baby less than months (�0 minutes)
Methodology: Practise and role-play counselling skills during initial contact
á Practise
AskParticipantstorecalltheoptimalbreastfeedingpractices(CC1).
Participantsaredividedintotriads:mother,IYCFCounsellor,andobserver.
• PractiseCaseStudy1:Askthe‘mothers’ofthetriadstogathertogether.
• AcasestudyisreadONLYtothe‘mothers’ofthetriads,andthe‘mothers’returntotheirtriads.
• The‘Counsellorofeachtriad’asksthemotherabouthersituation,andpractisesthe“assess,analyze,andact”steps:listeningandlearning,buildingconfidence,providingsupportandpracticalhelp,negotiating(“reaching-an-agreement”),andshowingrelevantCounsellingCard(s).
• InthetriadtheObserver’staskistorecalltheskillsthe‘Counsellor’practised(observer’schecklistfollowsforeachcasestudy).
TheParticipantsinthetriadsswitchroles.
• PractiseCaseStudy2:AsecondcasestudyisreadONLYtothe‘mothers’ofthetriads,andthe‘mothers’returntotheirtriads.
• The‘Counsellorofeachtriad’asksthemotherabouthersituation,andpractisesthe“assess,analyze,andact”steps:listeningandlearning,buildingconfidence,providingsupportandpracticalhelp,negotiating(“reaching-an-agreement”),andshowingrelevantCounsellingCard(s).
• InthetriadtheObserver’staskistorecalltheskillsthe‘Counsellor’practised(observer’schecklistfollowsforeachcasestudy).
TheParticipantsoncemoreswitchrolesintheirtriads.
• PractiseCaseStudy3:AthirdcasestudyisreadONLYtothemothersofthetriads,andthe‘mothers’returntotheirtriads.
• The‘Counsellorofeachtriad’asksthemotherabouthersituation,andpractisesthe“assess,analyze,andact”steps:listeningandlearning,buildingconfidence,providingsupportandpracticalhelp,negotiating(“reaching-an-agreement”),andshowingrelevantCounsellingCard(s).
�� Infant and Young Child Feeding Counselling
• InthetriadtheObserver’staskistorecalltheskillsthe‘Counsellor’practised(observer’schecklistfollowsforeachcasestudy).
• Onetriaddemonstratesacasestudyinfrontofthewholegroup.
• Discussionandsummary.
• Repeatprocessonemoretimewithamorecomplicatedcasestudy(CaseStudy4)thatneedsreferral.
Case Studies for Activity 4
Case Study �:
Initial Contact
Read to mother:YouareFatuma.Yourson,Shukri,istwoweeksold.Youhavebeenbreastfeedingandyouwanttocontinue,butyournipplesareverysore.
Checklist for Observer (of the ‘Counsellor’)—Did the Counsellor?
• AskFatumaquestions,listentoherandacceptFatuma’spracticesandconcerns.
• PraiseFatumaforbreastfeedingherbaby,Shukri.
• ObservehowFatumabreastfeeds.
• ObservethatShukriisnotATTACHEDwell(possibly).
• ExplainthatthenipplesorenesscouldbeduetothewaythatShukriissuckling.
• AskFatumaifshewouldliketheCounsellortoshowheradifferentwaytoattachandholdShukri.
• ShowCCs4and5:‘HowtoAttachBabytotheBreast’and‘BreastfeedingPositions’andaskFatumatocommentonwhatsheobservesishappeninginthecardandtorelateittoherownsituation.
• ShowFatumahowtoattachandpositionShukriatherbreast.
• ObtainanagreementwithFatuma:e.g.FatumaagreedtotryattachingandpositioningShukriinthiswayforthenextcoupleofdaystoseeifhernipplesimprove.
• Makeafollow-upappointmentwithFatuma.
• PraiseFatumaandthankherforhertime.
Infant and Young Child Feeding Counselling ��
Case Study �:
Initial Contact
Read to mother:YouareMurayo.Yourdaughter,Habiba,isthreeweeksold.YouarebreastfeedingHabibabecauseyouknowbreastmilkisthebestfoodforher.YouarealsogivingHabibasipsofwaterbecauseitissohot.
Checklist for Observer (of the ‘Counsellor’)—Did the Counsellor?
• AskMurayoquestions,listentoherandacceptMurayo’spracticesandconcerns.
• PraiseMurayoforbreastfeedingherbaby,Habiba.
• ACCEPTthatMurayoisgivingwateraswell.
• ProvideMurayowithinformationthatbreastmilkcontainsallthewaterHabibaneedsduringthefirst6-months,eveninveryhotweather.
• ShowCounsellingCard7:‘Duringthefirst6Months,YourBabyNeedsONLYYourBreastmilk’andaskMurayotocommentonwhatsheobservesishappeninginthecardandtorelateittoherownsituation.
• SUGGESTthatMurayoconsidertheoptionofexclusivelybreastfeeding(givingonlybreastmilkandnootherliquids),askingifMurayowouldbewillingtotryexclusivelybreastfeedingHabibaforafewdays.
• Murayothenwantedtodiscussandsays:“Well,butwhatifsheisthirsty”,andthen‘Counsellor’suggestedbreastfeedingmoreoftenandexplainedthatHabibawillgetmorewaterthatway.
• ObtainanagreementwithMurayo:e.g.Murayoagreedtotryexclusivelybreastfeedingforthenextfewdays.
• Makeafollow-upappointmentwithMurayo.
• PraiseMurayoandthankherforhertime.
�0 Infant and Young Child Feeding Counselling
Case Study �:
Initial Contact
Read to mother:YouareTamima.Youarepregnantwithyoursecondchild.YoucometovisittheCounsellorwithyourmother.Yourfirstchild,Hussein,is2½yearsold.WhenHusseinwasbornyouwereverytired.YourmothertookHusseinawayforafewdaystoallowyoutorest.Yourmotherplanstodothesameafterthenewbabyisborn.
Checklist for Observer (of the ‘Counsellor’)—Did the Counsellor?
• AskTaminaquestions,listentoherandacceptTamina’spracticesandconcerns.
• TalktoTaminaandhermother,praisethemotherforsupportingTamima,andagreethatitisgoodforanewmothertorestafterdelivery.
• Explaintheimportanceofstartingbreastfeedingverysoonafterbirth,andofbreastfeedingexclusively.
• AskifitwouldbepossibleforTamima’smothertofindawaytolookafterTamimaandherbabytogether,sothatTamimacouldrestandbreastfeedthebaby?
• ShowCCs2a,2band3:‘DeliveryinFacility’,‘HomeDelivery’,and‘GrandmotherOfferingFoodtoBreastfeedingDaughter/Daughter-in-law’andaskTaminatocommentonwhatsheobservesishappeninginthecard(s)andtorelateittoherownsituation.
• ExplaintheimportanceofgoodnutritionforTaminaandaskifitwouldbepossibleforTamina’smothertoseethatTaminaeatsmorethanusual.
• ObtainanagreementwithTamina’smother:e.g.Tamima’smotheragreedtohelpTaminawithherotherworkandcarefortheolderchildwhileTaminacaresforthenewbaby;shealsoagreedtomakesureTaminaeatsanextramealaday).
• Makeafollow-upappointmentwithTamina.
• PraiseTaminaandthankherforhertime.
Infant and Young Child Feeding Counselling ��
Case Study �:
Initial Contact
Read to mother:YouareSaidia.Youarebreastfeedingyourthreemonthold,Mohammed.Youhave2otherchildren.Youandyourhusbandwantmorechildrenandyouwouldliketobecomepregnantthisyear.
Checklist for Observer (of the ‘Counsellor’)—Did the Counsellor?
• AskSaidiaquestions,listentoherandacceptSaidia’spracticesandconcerns.
• PraiseSaidiaforbreastfeedingMohammed.
• ExplaintheimportanceofexclusivelybreastfeedingMohammedfor6months.
• ProvideinformationabouttheimportanceofcontinuingtobreastfeedMohammedfor2years.
• ShowCounsellingCard6:‘OptimalChildSpacing’andaskSaidiatocommentonwhatsheobservesishappeninginthecardandtorelateittoherownsituation.
• Explainthatcloselyspacedpregnanciesriskherhealthandthatoftheolderbabyandthenewborn.
• ReferSaidiatothefamilyplanningcounsellor.
• ObtainanagreementwithSaidia:e.g.Saidiaagreedtoseethefamilyplanningcounsellor.
• Makeafollow-upappointmentwithSaidia.
• PraiseSaidiaandthankherforhertime.
�� Infant and Young Child Feeding Counselling
ACTIVITY 5
Discuss the “assess, analyze and act” steps to counselling for follow-up contact(s) (�0 minutes)
Methodology: Brainstorm and practise
• Withthewholegroup,brainstormadditionalpointstobediscussedwithmotherduringcounsellingforfollow-upcontact(s).
• DivideParticipantsintoasmanygroupsasthereareFacilitators(withaFacilitatorineachgroup).
• Read(Facilitatorineachgroup)follow-upcontactcasestudyandaskoneParticipantinthesmallgrouptocommentonwhats/hewouldsaytothemotherduringthisfollow-upcontact.
• Askifanyonehasanythingelsetoadd?
• AskParticipantstoreflectonthe“assess,analyzeandact”stepsofcounselling,askingthequestion:DidtheCounsellor...........?(SeeActivity1ofSession7andfollowthe“assess,analyzeandact”steps).
• Whenthefirstfollow-upcontactiscomplete,repeatthesameprocessfortheremindingfollow-upcontactcasestudies(4follow-upcontactcasestudiesintotal).
• Discussionandsummary.
Content for Activity 5
Points to discuss in Follow-up Contact(s) Counselling
• Askhowthebabyandmotheraredoing(isthebabybetterorworse?)
• Askwhetherthemothertried(orcontinued)theagreeduponnewbehaviour.
• Congratulatemotherfortrying(orcontinuing)thenewbehaviour.
• Ifthemotherdidnottrythenewbehaviourorgaveup,askwhy?
• Askwhathappenedwhenshetried(orcontinued)thenewbehaviour.
• Askwhethershemadeanychangestothenewbehaviourandwhy?
• Askwhatdifficultiesshehad,howshesolvedthem,orhelpherfindwaystosolvethedifficultiesshemighthavehadorthinkofalternatives.
• Listentothemother’squestions,concernsanddoubts.
• Askwhethershelikesthenewbehaviouragreeduponandifshethinksshewillcontinueorwhattodoifshedoesnotcontinue.
• Praisethemotherandmotivatehertocontinuethenewbehaviour.
• Remindthemothertotakethechildtobeweighed(attendEPI,immunizationsandgrowthmonitoringsessions).
Infant and Young Child Feeding Counselling ��
• Tellthemotherwhereshecangetadditionalsupportfromcommunity-basedhealthworkers,healthposts,ormothersupportgroups.
• Agreeonadateforthenextcontact.
• Dependingontheageofthechild:
– talktothemotheraboutanewbehaviour
– encouragethemothertotryanewbehaviour
Follow-up contact case studies for Activity 5
Case Study �:
Follow-up Contact
FatumatellsyouthathernipplesaremuchbetterandShukriwhoisonemontholdisbreastfeedingwell.FatumaiswonderinghowshecanknowthatShukriisgrowingenough.
Did the Counsellor?
• AskhowShukriandFatumaaredoing(isthebabybetterorworse?)
• PraiseFatumaforchanginghowShukriwasattachedtoherbreast.
• AskthenumberoftimesShukriwets,frequencyoffeedings,Shukri’sbehaviour,cryingetc.
• ShowCounsellingCard6:‘BreastfeedonDemand,BothDayandNight’andaskFatumatocommentonwhatsheobservesishappeninginthecardandtorelateittoherownsituation.
• ReviewwithFatumathatbreastmilkcontainsallthenutrientsShukrineedsinhisfirst6monthstogrowstongandhealthy
• SUGGESTthatFatumacontinueexclusivelybreastfeedingShukriondemand,bothdayandnight.
�� Infant and Young Child Feeding Counselling
Case Study �:
Follow-up Contact
MurayotellsyouthatsheisonlygivingbreastmilkandHabiba,whois3monthsold,isbreastfeedingwell.Murayotellsyouthatshedoesn’tthinksheshouldexclusivelybreastfeedHabibafor6monthsandthatHabibaneedsfoodbeforethen.
Did the Counsellor?
• PraiseMurayofortryingthenewpracticeofexclusivelybreastfeedingHabiba.
• ListentoherstoryandacceptedMurayo’sfeelings.
• ReviewwithMurayoinformationthatbreastmilkcontainsallthewaterHabibaneedsduringthefirst6-months,eveninveryhotweather.
• ShowCounsellingCard7:‘Duringthefirst6Months,YourBabyNeedsONLYYourBreastmilk’andaskedMurayotocommentonwhatsheobservesishappeninginthecardandtorelateittoherownsituation.
• SUGGESTthatMurayocontinueexclusivelybreastfeedingHabiba.
Case Study �:
Follow-up Contact with Tamina and her mother
Tamina’smothertellsyouthatshestillthinksherdaughterneedstorestafterthebirth,“shewillbeweakandthebreastmilkwillnotyethavecomein”.
Did the Counsellor?
• AskhowTaminaisdoing.
• Listentowhatthegrandmotherhadtosay,askheraboutherownexperienceswhenshegavebirthandwhatthepracticeswerethen,andwhattheoutcomewas.
• Praisegrandmotherforbeingconcernedaboutherdaughter.
• Talktograndmotheragainaboutearlyinitiationandmilkproduction,andtheimportanceofcolos-trum.
Continued
Infant and Young Child Feeding Counselling ��
ACTIVITY 6
Prepare for practicum (�0 minutes)
• Participantsformpairs(Facilitatorneedstobesensitivetolanguageandgender)
• AskeachParticipanttobringhis/hersetofcounsellingcards
• Arrangetimeformeetingandtransportation(ifneeded)
Case Study �: Continued
• ShowCCs2aor2band3:‘DeliveryinFacility’,‘HomeDelivery’,and‘GrandmotherOfferingFoodtoBreastfeedingDaughter/Daughter-in-law’andaskTamina’smothertocommentonwhatsheobservesishappeninginthecard(s)andtorelateittoherdaughter’ssituation.
• SUGGESTthatgrandmotherhelpherdaughtergettherestsheneedsafterdeliveryandkeepmotherandbabytogether.
Case Study �:
Follow-up Contact
SaidiatellsyoushehasbeenfeedingAli,whois4monthsold,asoftenandaslongashewantsbothdayandnight.Saidiatellsyouthatsheistalkingtoherhusbandaboutvisitingthefamilyplanningcounsellortogether,buthestillwantsanotherbabysoon.
Did the Counsellor?
• AskhowSaidiaandAliaredoing.
• PraiseSaidiaforexclusivelybreastfeedingAli.
• CongratulateSaidiaforherintentionofgoingtogetherwithherhusbandtoseethefamilyplanningcounsellor.
• EncourageSaidiatomakeanappointmenttoseethefamilyplanningcounsellor.
�� Infant and Young Child Feeding Counselling
SESSION8
How to Counsel a Mother with a Baby less than 6 Months: Community and/or Facility Practise and Feedback
Note to the Facilitator: Present an overview of objectives (listed below) and the time allocated for this session.
Learning objectiveBytheendofthesession,Participantswillbeableto:
1. PractiseCounselling:listeningandlearningskills,buildingthemother’s/caregiver’sconfidence,providingsupportandpracticalhelp,andnegotiating(“reaching-an-agreement”)withmothersofbabieslessthan6monthsathealthcentersorinthecommunity
ActivitiesActivity1 Practisecounselling:listeningandlearningskills,buildingthemother’s/
caregiver’sconfidence,providingsupportandpracticalhelp,and negotiating(“reaching-an-agreement”byapplyingthe“assess,analyze andact”steps(� hours)
Activity2 Feedbackonpractise(� hour)
Total Time 3 hours
Materials needed√ Counsellingcardsonbreastfeedingpractices:2–9
Advance preparation• Makeanappointmentatthehealthpostaweekaheadtodothefieldpractise
duringimmunizationorweighingsessions,or
• Makeanappointmentwiththecommunityhealthworkeraweekaheadforcommunityvisits
• Preparegroups,giveinstructionsthedaybefore
Infant and Young Child Feeding Counselling ��
ACTIVITY 1
Practise counselling: listening and learning skills, building the mother’s confidence, providing support and practical help, and negotiating (“reaching-an-agreement” by applying the “assess, analyze and act” steps) (� hours)
Methodology: Practise
• BeforetheParticipantsleaveforthepractice-site,brieflyreviewCounsellingskills:listeningandlearning,buildingthemother’sconfidence,providingsupportandpracticalhelp,negotiating(“reaching-an-agreement”),anduseofcounsellingcardsbyapplyingthe“assess,analyze,andact”steps.
• DivideParticipantsinpairsandexplaintheexercise:oneParticipantwillpractiseCounselling:listeningandlearningskills,buildingthemother’sconfidence,providingsupportandpracticalhelp,negotiating(“reaching-an-agreement”)anduseofcounsellingcardsbyapplyingthe“assess,analyzeandact”stepswiththemother,whiletheotherParticipantfollowsthedialogueinordertogivefeedbacklater.
• ParticipantschangerolesuntileachParticipantpractisesatleast2counsellingactivities.
ACTIVITY 2
Feedback on practise session (� hour)
Methodology: Feedback discussion
• Attrainingsite,withthewholegroup,eachpairofParticipantswillsummarizeforthegrouptheiruseoflisteningandlearningskills,buildingthemother’sconfidence,providingsupportandpracticalhelp,negotiating(“reaching-an-agreement”)anduseofcounsellingcardsbyapplyingthe“assess,analyzeandact”steps.Theirsummaryshouldincludethechild’snameandage,anydifficultyidentified,optionssuggested,andbehaviourmotheragreedtotry.
• Participantsreceiveandgivefeedback
• Discussionandsummary
�� Infant and Young Child Feeding Counselling
SESSION9
Complementary Feeding Practices for Children from 6–23 Months
Learning objectivesBytheendofthesession,Participantswillbeableto:
1. Describekeypractices/messagespertainingtochildfeedingfrom6to23months.
2. Describethecharacteristicsofcomplementaryfeedingforeachagegroupwithregardto:Frequency,Amount,Thickness(consistency),Variety(differentfoods),Activeorresponsivefeeding,andHygiene(FATVAH).
3. Comparethedifferencebetweenrunnysoftfoods(poorthickness/consistency)andcorrectthickness/consistency(firstsoftcomplementaryfoodsshouldbethickenoughtostayonspoon).
ActivitiesActivity1 Answerquestionsoncurrentcomplementaryfeedingpracticesinyour
communityforchildrenfrom6–23months(�� minutes)
Activity2 UsingtheCCs,discusstherecommended(oroptimal)infantand youngchildcomplementaryfeedingpracticesforchildrenfrom 6–23monthsandmessages(� hour �� minutes)
Activity3 Demonstrationofappropriatethickness/consistencyoffirstsoftfoods (�0 minutes)
Total Time 3 hours
Materials needed√ Counsellingcardsonkeycomplementaryfeedingpractices/messagesfor
childrenfrom6–23months(CCs10,11,12,13,and14)
√ Image:‘Feedmoreasthebabygrows’
√ Smallamountofpreparedporridge,smallamountofmilk,2bowlsand2spoons
Note to the Facilitator: Present an overview of objectives (listed below) and the time allocated for this session.
Infant and Young Child Feeding Counselling ��
ACTIVITY 1
Answer questions on current complementary feeding practices in your community for children from 6–23 months (�� minutes)
Methodology: Small working groups/questions and answers
• DivideParticipantsinto5workinggroups.
• Haveeachgroupanswer2questions(Facilitatorsrotateamongthegroupsand‘read’thequestions).
• RemindParticipantsthatquestionsrelatetoFrequency,Amount,Thickness(consistency),Variety(differentfoods),Activeorresponsivefeeding,andHygiene:FATVAH.
• Group 1:Inyourcommunity,
1.Whendoesababybegintoeatsomethingelseotherthanbreastmilk?
2.Howmanytimesadaydoesababyeat:at6months,from6–8months,from9–11months,andfrom12–23months?
• Group 2:Inyourcommunity,
1.Howmuchdoesababyeat:at6months,from6–8months,from9–11months,andfrom12–23months?
2.Whatisthethicknessorconsistencyofthefoodababyeats:at6months,from6–8months,from9–11months,andfrom12–23months?
• Group 3:Inyourcommunity,
1.Whatdoesababyeat:at6months,from6–8months,from9–11months,andfrom12–23months?
2.Aretherefoodsayoungchildshouldnoteat?
• Group 4:Inyourcommunity,
1.Whohelpstheyoungchildeat?—motherorcaregiver,brotherorsister,noone?
2.Doesaninfantandyoungchilduseaseparatebowl/dish?Doyouthinkayoungchildshoulduseaseparatebowl/dish?
• Group 5:Inyourcommunity,
FacilitatorneedstoremindtheParticipantsthatthequestionsrelatetoFATVAH.
1.Whatdoesamotherorcaregiverdobeforepreparingfood,andbeforeayoungchildeats?
2.Howlongshouldbreastfeedingcontinue?
�0 Infant and Young Child Feeding Counselling
• Havethesmallgroupssharetheiranswerswiththewholegroup.
• Reviewthecharacteristicsofcomplementaryfeedingpracticesforchildrenfrom6–23months:frequency,amount,thickness(consistency),variety(differentfoods),activefeedingandhygienicpreparationoffood(FATVAH).
• ReviewwithParticipantstheconceptofactiveorresponsivefeeding(below)
• Discussionandfill-ingaps.
Content for Activity 1
Active or Responsive feeding
• Feedinfantsdirectlyandassistolderchildrenwhentheyfeedthemselves.Feedslowlyandpatiently,andencouragechildrentoeat,butdonotforcethem.
• Ifchildrenrefusemanyfoods,experimentwithdifferentfoodcombinations,tastes,texturesandmethodsofencouragement.
• Minimisedistractionsduringmealsifthechildlosesinteresteasily.
• Rememberthatfeedingtimesareperiodsoflearningandlove—talktochildrenduringfeeding,witheyetoeyecontact.
ACTIVITY 2
Discuss the key complementary feeding practices and messages for children from 6–23 months (�½ hours)
Methodology: Participants observe counselling cards 10, 11, 12, 13, and 14 and name optimal complementary feeding practices and messages for children from 6–23 months
• DivideParticipantsintosmallgroups,askingParticipantsineachgrouptousetheircounsellingcardsforthefollowingexercise.
• HaveeachgroupstudyCounsellingCard10andnamethecomplementaryfeedingpractice/sandmessage/sthatthecardrepresentsforyoungchildrenat6months.
• AskonesmallgrouptosharewiththewholegroupthecomplementaryfeedingpracticesandmessagesshownintheCounsellingCard.Othersmallgroupsshouldaddadditionalpoints.
• Probeuntilthekeyandsupportingmessages(foundinAppendix1oftheIYCF Counselling Trainer’s Guide)arementioned.
• Haveeachsmallgrouprepeattheprocessuntilthesetofcounsellingcardsoncomplementaryfeedingpracticeshasbeenobservedandstudied(CCs11–14)andthekeyandsupportingmessages(foundinAppendix1oftheIYCF Counselling Trainer’s Guideandthefollowingtable)arementioned.
Infant and Young Child Feeding Counselling ��
Content for Activity 2
ACTIVITY 3
Review the key complementary feeding practices and messages for children from 6–23 months (�0 minutes)
Methodology: Passing ball game
• AskParticipantstoformacircle.
• PassaroundtheImagetitled‘Feedmoreasthebabygrows’andtogetherlookatFrequency,Amount,Thickness(consistency),andVariety.
• Toconsolidatenewknowledge—throwtheballtooneParticipantandaskher/himtonameacomplementaryfeedingpracticeormessage(s)forchildrenfrom6–23months.
• WhentheParticipanthasnamedacomplementaryfeedingpracticeormessageforchildrenfrom6–23months,s/hethrowstheballtoanotherParticipantandasksthatParticipanttomentionadifferentpracticeormessage.
• Continueuntilallcomplementaryfeedingpracticesormessagesforchildrenfrom6–23monthshavebeenrepeated.
• ReviewGuidingPrinciplesforComplementaryFeeding(below)
Amounts of Foods to Offer
Age
6–8months
Texture
Startwiththickporridge,wellmashedfoods
Continuewithmashedfamilyfoods
Finelychoppedormashedfoods,andfoodsthatbabycanpickup
Frequency
2–3mealsperdayplusfrequentbreastfeeds
Dependingonthechild’sappetite1–2snacksmaybeoffered
3–4mealsplusbreastfeeds
Dependingonthechild’sappetite1–2snacksmaybeoffered
3–4mealsplusbreastfeeds
Dependingonthechild’sappetite1–2snacksmaybeoffered
Amount of food an average child will usually eat at each meal*
Startwith2–3tablespoonfulsperfeed
Increasegraduallyto½ofa250mlcup
Ifbabyisnotbreastfed,giveinaddition:1–2cupsofmilkperday,and1–2extramealsperday.
WHO/CAH(ChildandAdolescentHealth)2006
*Adaptthecharttouseasuitablelocalcup/bowltoshowtheamount.Theamountsassumeanenergydensityof0.8to1Kcal/g.
½ofa250mlcup/bowl
¾to1250mlcup/bowlFamilyfoods,choppedormashedifnecessary
9–11months
12–23months
�� Infant and Young Child Feeding Counselling
Content for Activity 3
Guiding Principles for Complementary Feeding
1. Practiceexclusivebreastfeedingfrombirthto6monthsofageandintroducecomplementaryfoodsat6monthsofage(180days)whilecontinuingtobreastfeed.
2. Continuefrequent,on-demandbreastfeedinguntil2yearsofageorbeyond.
3. Practiceactiveorresponsivefeeding,applyingtheprinciplesofpsychosocialcare.
4. Practicegoodhygieneandproperfoodhandling.
5. Startat6monthsofagewithsmallamountsoffoodandincreasethequantityasthechildgetsolder,whilemaintainingfrequentbreastfeeding.
6. Graduallyincreasefoodconsistencyandvarietyastheinfantgrowsolder,adaptingtotheinfant’srequire-mentsandabilities.
7. Increasethenumberoftimesthatthechildisfedcomplementaryfoodsasthechildgetsolder.
8. Feedavarietyofnutrient-richfoodstoensurethatallnutrientneedsaremet.
9. Usefortifiedcomplementaryfoodsorvitamin-mineralsupplementsfortheinfant,asneeded.
10.Increasefluidintakeduringillness,includingmorefrequentbreastfeeding,andencouragethechildtoeatfavouritesoftfoods.Afterillness,givefoodmoreoftenthanusualandencouragethechildtoeatmore.
ACTIVITY 4
Demonstrate appropriate thickness/consistency of first soft foods (�0 minutes)
Methodology: Demonstration of preparation of runny porridge and correct thickness/consistency porridge
• Bringasmallamountofpreparedporridge,asmallamountofmilk,2bowlsand2spoons.
• Inonebowl,mixsomepreparedporridgewithtoomuchmilk.Asaresulttheporridgerunsoffthespoon.
• PassaroundthebowlwithrunnyporridgetotheParticipants.
• Inanotherbowl,mixsomepreparedporridgewithalittlemilk.Asaresulttheporridgeisthickeranddoesnotrunoffthespoon.
• PassaroundthebowlwiththickerporridgetotheParticipants.
• Discussandcomparecorrectandincorrectthickness/consistencyoffirstsoftfoods.
Infant and Young Child Feeding Counselling ��
SESSION10
Feeding the Sick Infant and Young Child
Learning objectivesBytheendofthesession,Participantswillbeableto:
1. Counseloninfantandyoungchildfeedingduringandafterillness.
2. Explainthereasonsfortherecommendedpractices.
ActivitiesActivity1 Currentpracticesonfeedingthesickinfantandyoungchild
(�0 minutes)
Activity2 Idealfeedingofthesickinfantandyoungchild(�0 minutes)
Total Time 1 hour
Materials needed√ Counsellingcards15and16:FeedingtheSickInfantandYoungChild(lessthan
6months,andgreaterthan6months)
Note to the Facilitator: Present an overview of objectives (listed below) and the time allocated for this session.
�� Infant and Young Child Feeding Counselling
ACTIVITY 1
Current practices in Feeding the Sick Infant and Young Child (�0 minutes)
Methodology: Small working groups
• DivideParticipantsinto4workinggroups.
• Ask2groupstodiscussthecurrentpracticesinyourcommunityforfeedingasickinfantfrom0<6monthsduringandafterillness.
• Ask2groupstodiscussthecurrentpracticesinyourcommunityoffeedingasickinfantandyoungchildfrom6–23monthsduringandafterillness.
• Haveoneofeachofthepairedgroupsreporttothewholegroup.Othergroupshouldnotrepeatthesameinformation,butonlyaddnewinformation.
• Discussionandsummary.
ACTIVITY 2
Feeding of the Sick Infant and Young Child (�0 minutes)
Methodology: Observe/reflect on practices/messages on Feeding the Sick Infant and Young Child using counselling cards 15 and 16
• DivideParticipantsintosmallgroups.
• Haveeachgroup:
– studyCCs15and16:FeedingtheSickInfantandYoungChild(lessthan6monthsandgreaterthan6months)andnamethepracticesandmessage(s).
– discussthepreventionandmanagementofdiarrhoeaforinfantslessthan6monthsandforinfantsandyoungchildrengreaterthan6months.
• AskonesmallgrouptosharewiththewholegroupthefeedingofthesickinfantandyoungchildpracticesandmessagesshownintheCCs15and16.Othersmallgroupsaddadditionalpoints.
• Probeuntilthekeyandsupportingmessages(foundinAppendix1oftheIYCFCounsellingTrainer’sGuide)arementioned.
• Askanothergrouptosharewiththewholegroupthepreventionandmanagementofdiarrhoeaforinfantslessthan6monthsandforinfantsandyoungchildrengreaterthan6months.Othersmallgroupsaddadditionalpoints.(below)
• Discussionandsummary.
Infant and Young Child Feeding Counselling ��
Content for Activity 2
Prevention of diarrhoea
• Exclusivelybreastfeedingfrom0–<6months
• Washhandswashingbeforepreparingfood,feedinginfantsandyoungchildren,andafterusingthelatrineandcleaningbaby’sbottom
• Disposeofwastes
• Keepdrinkingwaterincleancoveredcontainer
• Makesureyourbabyandyoungchildareup-to-dateontheirimmunizations
• BeginvitaminAsupplementationtwiceyearlyat6months
• Donotusefeedingbottles
Management of infant and young child with diarrhoea
• Continueexclusivebreastfeeding
• Increasefrequencyofbreastfeedingtoreplaceliquidlost,andafter6months,increasebreastfeedingandincreasefrequencyofcomplementaryfoods
• Donotusefeedingbottles
• Identifyandtreatunderlyingcause
• Seekhelpathealthpost
�� Infant and Young Child Feeding Counselling
SESSION11
Infant Feeding: HIV-positive Mother; and Severe Malnutrition of Infant and Young Child
Learning objectiveBytheendofthesession,Participantswillbeableto:
1. Describebasicinformationofinfantfeedinginthefollowingcircumstances:1)HIV-positivemother,and2)severemalnutritionofinfantandyoungchild.(30minutes)
ActivityActivity1. Presentinformationofinfantfeedinginthefollowingcircumstances:
HIV-positivemother,andseveremalnutritionofinfantandyoungchild (�0 minutes)
Total Time 30 minutes
Note to the Facilitator: Present an overview of objectives (listed below) and the time allocated for this session.
Infant and Young Child Feeding Counselling ��
ACTIVITY 1
Present information of infant feeding in the following circumstances: HIV-positive mother, and severe malnutrition of infant and young child (�0 minutes)
Methodology: Presentation
A. PresentinformationoninfantfeedingwhenwomanisHIV-positive.
HIV-positive woman
• VariousinfantfeedingoptionsshouldbediscussedwiththeHIV-positivewoman:
1.Replacementfeedingwhenacceptable,feasible,affordable,sustainableandsafe
– Acceptable:themotherperceivesnobarriertoreplacementfeeding(culturalorsocial,fearofstigmaordiscrimination)
– Feasible:themother(orfamily)hasadequatetime,knowledge,skillsandotherresourcestopreparethereplacementfoodandfeedtheinfantupto12timesin24hours
– Affordable:themotherandfamily,withcommunityorhealth-systemsupportifnecessary,canpayforthecostofpurchasing/producing,preparingandusingreplacementfeeding,includingallingredients:fuel,cleanwater,soapandequipment,withoutcompromisingthehealthandnutritionofthefamily.
– Sustainable:availabilityofcontinuousanduninterruptedsupply,anddependablesystemofdistributionforallingredientsandproductsneededforsafereplacementfeeding,foraslongastheinfantneedsit,uptooneyearofageorlonger
– Safe:replacementfoodsarecorrectlyandhygienicallypreparedandstoredandfed,preferablebycup.
2.Exclusivebreastfeedingforthefirst6monthsfollowedbycessationoncereplacementfeedingisAFASS.
3.Otherbreastmilkoptions:
– expressionandheattreatmentofherownbreastmilk
– wet-nursing(breastfeedingfromanHIV-negativewoman)
• IfanHIV-positivemotherchoosestobreastfeed,sheshouldpracticeexclusivebreastfeedingforthefirst6months,OR,sheshouldformulafeedexclusively.
• Mixedfeedingisthemostdangerousthingtodo,andmayincreaseHIVtransmission.
• Preventbreastproblemsbybreastfeedingfrequentlyandondemand;makecertaininfantiswell-attachedandsucklingwell.
�� Infant and Young Child Feeding Counselling
• Motherswhoexperiencebreastdifficultiessuchasmastitis,crackednipples,orbreastabscessshouldbreastfeedwiththeunaffectedbreastandexpressanddiscardmilkfromtheaffectedbreast.
• Mothershouldseekimmediatecareforababywiththrushororallesions.
• At6monthsmothershouldintroduceappropriatecomplementaryfoods.
• Whenbabyis6months,referHIV-positivemotherstoanHIVcounsellorwhocanreviewinfantfeedingoptionswiththemother.
Note:Thelactatingwomanshouldusecondomstoprotectherselffromre-exposure.
B. Presentinformationonbreastfeedingwheninfantoryoungchildisseverelymalnourished
Severely malnourished infants or young children
• Breastfeedingisprotectivewhenchildissuspectedofbeingmalnourishedorisvisiblythin.
• Refermalnourishedchildrenforcarewhichshouldinclude:
– Assessmentofchild’sfeedinghistoryandcurrentfeedingpracticesuponadmission.
– Monitoringbreastfeeds(halfanhourbeforeeachtherapeuticfeed)andweightgainduringtreatment.
– Supportformaintenanceofmilksupplybeforeandaftertreatmentinthe2scenarios:separationofmother/babyormother/babytogether.
– Supplementalsucklingasrecommended.
– Correctionoffeedingproblemsandcurrentfeedingpracticespriortodischarge;developmentoffollow-upplantosupportthemothertofeedappropriatelyfollowingdischarge.
• Supportlinksbetweenrehabilitationprograms(supplementary,therapeuticandcommunitytherapeuticcareprograms)andcommunitysystems.
Infant and Young Child Feeding Counselling ��
SESSION12
How to Counsel: Practise Counselling with Mothers/Caregivers of Babies Greater than 6 Months
Note to the Facilitator: Present an overview of objectives (listed below) and the time allocated for this session.
Learning objectivesBytheendofthesession,Participantswillbeableto:
1. Listcounsellingskills:
– listeningandlearning
– buildingthemother’s/caregiver’sconfidence
– providingsupportandpracticalhelp,and
– negotiating(“reaching-an-agreement”)
2. Describethe“assess,analyzeandact”stepstocounselling
3. UseaCounsellingCardincounselling
4. Practisetheprocessofcounsellingwithamotherofayoungchildfrom6–23months
ActivitiesActivity1 Listcounsellingskills,anddescribethe“assess,analyzeandact”steps
tocounselling(�0 minutes)
Activity2 Modelthe“assess,analyzeandact”stepstoCounsellingtoencourage motherstotryoptimalcomplementaryfeedingpractices:initialcontact withmotherofyoungchildfrom6–23months(�� minutes)
Activity3 Discussmodeldemonstration(�� minutes)
Activity4 Practisethe“assess,analyzeandact”stepstocounsellinginaninitial contactwithmotherofbabylessthan6months(�0 minutes)
Activity5 Discussthe“assess,analyzeandact”stepstocounsellingforfollow-up contact(s)(�0 minutes)
Activity6 Prepareforpracticum(�0 minutes)
Total Time 2 ½ hoursContinued
�0 Infant and Young Child Feeding Counselling
Materials needed√ 4CaseStudiesofcounsellingforyoungchild6–23months
√ 4follow-upCaseStudiesofcounsellingforyoungchild6–23months
√ Eachparticipanthasasetofcounsellingcards
ACTIVITY 1
List counselling skills and describe the “assess, analyze and act” steps to counselling (�0 minutes)
Methodology: Brainstorming and presentation
á List counselling skills
• Brainstormwithwholegroupthekindsofcounsellingskills
• ProbeuntilthefollowingCounsellingskillshavebeenmentioned:listeningandlearning(practisedinSession2),buildingthemother’s/caregiver’sconfidence,providingsupportandpracticalhelp,andnegotiating(“reaching-an-agreement”)
• Fill-ingapswithadescriptionofthe“assess,analyzeandact”stepsofcounselling
á Describe the “assess, analyze and act” steps
Assess mother and baby situation
• Greetthemother/fatherandestablishconfidence
• Askthemotheraboutageofbaby,currentfeedingpractices,andhealth
• Askquestionstolearnmother’ssituationandconcerns
• Listentotheconcernsofthemotherandfather,andobservebabyandmother
• Acceptwhatmotherisdoingwithoutdisagreeingoragreeing
• Lookforthingsthatmotherisdoingrightorthataregoingwelltopraise
Analyze
• Identifyfeedingdifficulty,ifany,andcausesofthedifficulty
• Ifthereismorethanonedifficulty,prioritizedifficulties
• Answerthemother’squestions(ifany)
Infant and Young Child Feeding Counselling ��
Act
• Dependingontheageandsituationofthebaby,selectandgivesmallamountofRELEVANTINFORMATIONusingsimplelanguageononeortwoofthefollowingtopics:
– Bytheageof6monthsthestomachofthebabyisreadytoreceivefoodotherthanbreastmilk
– Discussthecharacteristicsofcomplementaryfeeding:frequency,amount,thickness(consistency),andvariety(differentkindsoffoods),activefeeding,andhygiene(FATVAH)
– Duringthefirstyear,breastmilkcontinuestobethemostimportantpartofyourbaby’sdiet
– At6monthsbegintogivesoftfoods2timesdaily(2–3tablespoonsofsoftfoodseachtime)
– From6–8months,givefood3timesdaily(graduallyincreaseto½cup[250ml]offoodeachtime)
– From9–11months,givefood3timesdailyplus1snack(give½cup[250ml]offoodeachtime)
– From12–23months,givefood3timesdailyplus2snacks(graduallyincreaseto¾to1cup[250ml]offoodeachtime)
– Increasetheamountoffoodasbabygetsolder
– Around9monthsbegintogivesolidfoods
– Enrichthedietbyaddingothercerealsandlegumes,fruitsandvegetables,animalproducts
– Talktobabywhilefeeding
– Washhandsandutensilsbeforepreparationoffoodandfeedingthebaby
– Storefoodincleanarea;don’tgivefoodthatwaspreparedthedaybefore.
– Continuebreastfeedingupto2yearsandbeyond
• Ifafeedingdifficultyhasbeenidentified,showrelevantCounsellingCard(s)andaskmothertocommentonwhatsheobservesishappeninginthecard,andtorelateittoherownsituation.Ifnofeedingdifficultyhasbeenidentified,congratulatemotherandaskhertocontinueattendingwellbabygrowthpromotionandmonitoringsessions.
• Askthemotherwhatshethinksaboutthisinformation.
• Discusswiththemother/fatherdifferentfeasibleoptionstoovercomethedifficulty.
• Suggestwhatthemothermightdo,givingheratleasttwopossibilities,andaskherwhatshefeelsabletodo.
– Putas“suggestionnotcommand”(meaningnottellingamotherwhattodo)
�� Infant and Young Child Feeding Counselling
– Presentoptions/smalldo-ableactions(time-bound)andhelpmotherselectonethatshecantry
– Givemotherasayinthedecision,andtheopportunitytosayno,ortochooseanotherway
• Negotiate(“reach-an-agreement”)withthemothertotryanewbehaviour,ortotakeafurtherstepsuchasdiscussingthesuggestionswithanotherfamilymember.
• Makeafollow-upappointmentwithmother.
• Praisethemotherandthankherforhertime.
ACTIVITY 2
Model the “assess, analyze and act” steps to counselling to encourage mothers to try optimal complementary feeding practices: initial contact with mother of young child from 6–23 months (�� minutes)
Methodology: Demonstration
á Model the “assess, analyze and act” steps
• Model(2Facilitators)theinitialCounsellingcontactofanIYCFCounsellortoFatumawith6½monthdaughterSafio(modelthe“assess,analyzeandact”steps).(Thefacilitatorsshouldpreparethisdemonstrationinadvance).
Assess mother and baby situation
• ListentowhatFatumasays[FatumatellstheCounsellorshefeedsherdaughterwateryporridgeoranjeraandgiveswatertoSafiobesidesbreastfeeding.]
• AskafewquestionstounderstandwhatfoodsFatumagivestoSafio,howoftenandhowmuch,andwhyFatumagiveswatertoSafio.
• PraiseFatumaforbreastfeedingSafio.
Analyze
• FatumaneedsguidanceonoptimalcomplementaryfeedingpracticesforSafio.
Act
• CheckappearanceandhealthofSafio
• TalktoFatumaaboutthecharacteristicsofcomplementaryfeeding:frequency,amount,thickness(consistency),variety(differentkindsoffood),activeorresponsivefeedingandhygiene
• ShowCCs10and11:‘ComplementaryFeedingat6Months’and‘ComplementaryFeedingfrom6–8Months’andaskFatumatocommentonwhatsheobservesishappeninginthecardsandtorelateittoherownsituation.
Infant and Young Child Feeding Counselling ��
• Giverelevantinformationandsmallamountofinformationregardingthemessagesofcounsellingcards10and11,usingsimplelanguage.
• AskFatumawhatshethinksaboutthisinformation.
• DiscusswithFatumadifferentfeasibleoptionstohelpheroptimallyfeedSafio.
• Putas“suggestionnotcommand”(meaningnottellingFatumawhattodo).
• Presentoptions/smalldo-ableactions(time-bound)andhelpFatumaselectonethatshecantry
• GiveFatumaasayinthedecision,andtheopportunitytosayno,ortochooseanotherway
• Modifyrecommendations,ifnecessary,tosuitFatuma’spreferences.
• Makeafollow-upappointmentwithFatuma.
ACTIVITY 3
Discuss model demonstration (�� minutes)
Methodology: Presentation and discussion
á Discuss model demonstration
• TwoFacilitators(CounsellorandFatuma)repeatinitialcounsellingcontactwithFatuma,stoppingaftereachstepof“assess,analyzeandact”.
• CounsellorshowsCounsellingCard10anddiscusseswithFatuma:
1.Observe—WhatishappeningintheCounsellingCard?
2.Relatetoyourownsituation—Whatdoyouagreeordisagreewith?Why?Whatdopeopleinyourcommunitydo?
• GiverelevantandsmallamountofinformationregardingthemessagesofCounsellingCard10,usingsimplelanguage.
• AskFatumawhatshethinksaboutthisinformation.
• RepeatstepsusingCounsellingCard11.
• DiscussdifferentfeasibleoptionstoguideFatumainofferingcomplementaryfoodstoSafio.
• HelpFatumaselectsmalldo-ableactions(time-bound)thatshecantry.
• Makeafollow-upcontactappointment.
• Discussionandrepetitionof“assess,analyze,andact”stepswithParticipants.
�� Infant and Young Child Feeding Counselling
ACTIVITY 4
Practise the “assess, analyze, and act” steps to counselling in an initial contact with mother of a young child from 6–23 months (�0 minutes)
Methodology: Practise and role-play counselling skills during initial contact
á Practise
AskParticipantstorecalltheoptimalcomplementaryfeedingpractices(Session9).
Participantsaredividedintotriads:mother,IYCFCounsellor,andobserver.
• PracticeCaseStudy1:Askthe‘mothers’ofthetriadstogathertogether.
• AcasestudyisreadONLYtothe‘mothers’ofthetriads,andthe‘mothers’returntotheirtriads.
• The‘Counsellorofeachtriad’asksthemotherabouthersituation,andpractisesthe“assess,analyze,andact”steps:listeningandlearning,buildingconfidence,providingsupportandpracticalhelp,negotiating(“reaching-an-agreement”),andshowingrelevantCounsellingCard(s).
• InthetriadtheObserver’staskistorecalltheskillsthe‘Counsellor’practised(observer’schecklistfollowsforeachcasestudy).
TheParticipantsinthetriadsswitchroles.
• PracticeCaseStudy2:AsecondcasestudyisreadONLYtothe‘mothers’ofthetriads,andthe‘mothers’returntotheirtriads.
• The‘Counsellorofeachtriad’asksthemotherabouthersituation,andpractisesthe“assess,analyze,andact”steps:listeningandlearning,buildingconfidence,providingsupportandpracticalhelp,negotiating(“reaching-an-agreement”),andshowingrelevantCounsellingCard(s).
• InthetriadtheObserver’staskistorecalltheskillsthe‘Counsellor’practised(observer’schecklistfollowsforeachcasestudy).
TheParticipantsoncemoreswitchrolesintheirtriads.
• PracticeCaseStudy3:AthirdcasestudyisreadONLYtothemothersofthetriads,andthe‘mothers’returntotheirtriads.
• The‘Counsellorofeachtriad’asksthemotherabouthersituation,andpractisesthe“assess,analyze,andact”steps:listeningandlearning,buildingconfidence,providingsupportandpracticalhelp,negotiating(“reaching-an-agreement”),andshowingrelevantCounsellingCard(s).
Infant and Young Child Feeding Counselling ��
• InthetriadtheObserver’staskistorecalltheskillsthe‘Counsellor’practised(observer’schecklistfollowsforeachcasestudy).
• Onetriaddemonstratesacasestudyinfrontofthewholegroup.
• Discussionandsummary.
• Repeatprocessonemoretimewithamorecomplicatedcasestudy(CaseStudy4)thatneedsreferral.
Case Studies for Activity 4
Case Study �:
Initial Contact
Read to mother:YouareMurayo.YourdaughterHabibais12monthsoldandyougiveherporridgeoranjera2timesadayandbitesofwhateveryouarefeedingthefamilythatday.YouarealsobreastfeedingHabiba.
Checklist for Observer (of the ‘Counsellor’) – Did the Counsellor?
• AskMurayoquestions,listentoherandacceptMurayo’spracticesandconcerns.
• PraiseMurayoforbreastfeedingherbaby,Habiba.
• DiscusswithMurayoselectedpointsofCCs13and14:‘Complementaryfeedingforyoungchildren12–23months’,and‘Hygiene’.
• SuggestwhatMurayomightdo,giveheratleasttwopossibilities,andaskherwhatshefeelsabletodo.
• ObtainagreementwithMurayototryanewbehaviour:e.g.MurayoagreestotryfeedingHabibamoretimeseachday.
• Makeafollow-upappointmentwithFatuma.
• PraiseFatumaandthankherforhertime.
�� Infant and Young Child Feeding Counselling
Case Study �:
Initial Contact
Read to mother:YouareFatuma.Youhavea9month-olddaughter,Mariam,whoiseatingsomewateryporridgeonceaday.Mariamhaddiarrheathelast2days.
Checklist for Observer (of the ‘Counsellor’) – Did the Counsellor?
• AskFatumaquestions,listentoherandacceptFatuma’spracticesandconcerns.
• ReviewwithFatumaselectedpointsofCCs12,14,and16:‘Complementaryfeedingforyoungchildren9–11months’,‘Hygiene’,and‘Feedingsickyoungchildgreaterthan6months’.
• SuggestwhatFatumamightdo,gaveheratleasttwopossibilities,andaskedherwhatshefeelsabletodo.
• ObtainanagreementwithFatumatotryanewbehaviour,ortotakeafurtherstep.
• Madeafollow-upappointmentwithFatuma.
• PraisedFatumaandthankherforhertime.
Case Study �:
Initial Contact
Read to mother:YouareHalima.Youarebreastfeedingyourbaby,Sheikhwhois7monthsold,andyouarenotgivinganyfoodstohim.
Checklist for Observer (of the ‘Counsellor’) – Did the Counsellor?
• AskHalimaquestions,listentoherandacceptHalima’spracticesandconcerns.
• ReviewwithHalimaselectedpointsofCCs11and14:‘Complementaryfeedingforyoungchildren6–8months’,and‘Hygiene’.
• SuggestwhatHalimamightdo,giveheratleasttwopossibilities,andaskherwhatshefeelsabletodo.
• ObtainanagreementwithHalimatotryanewbehaviour,ortotakeafurtherstep.
• Makeafollow-upappointmentwithHalima.
• PraiseHalimaandthankherforhertime.
Infant and Young Child Feeding Counselling ��
Case Study �:
Initial Contact
Read to mother:YouareHalimo.YourbabyTaminais6½monthsold.Youtellthe‘Counsellor’thatTaminaistooyoungforfoodbecauseherstomachistoosmall.Youmentionthatyouwillcontinuetoonlybreastfeedheruntilsheisolder.Yourhusbandandmother-in-lawagreewithyou.Taminahasnotgainedweightinthelast2weeks.
Checklist for Observer (of the ‘Counsellor’) – Did the Counsellor?
• AskHalimoquestions,listentoherandacceptHalimo’spracticesandconcerns.
• PraiseHalimoforbreastfeedingherbaby.
• DiscusswithHalimoselectedpointsofCCs10and11:‘Complementaryfeedingat6months’,and‘Complementaryfeedingfrom6–8months’.
• SuggestwhatHalimomightdo,givingheratleasttwopossibilities,andaskherwhatshefeelsabletodo.
• Referhertothehealthposttobeweighed,andtotalktotheHealthWorkerthere.
• ObtainanagreementwithHalimo:e.g.togotothehealthpost.
• Makeafollow-upappointmentwithHalimo.
• PraiseHalimoandthankherforhertime.
�� Infant and Young Child Feeding Counselling
ACTIVITY 5
Discuss the “assess, analyze and act” steps to counselling for follow-up contact(s) (�0 minutes)
Methodology: Brainstorm and practise
• Withthewholegroup,brainstormadditionalpointstobediscussedwithmotherduringcounsellingforfollow-upcontact(s).
• DivideParticipantsintoasmanygroupsasthereareFacilitators(withaFacilitatorineachgroup).
• Read(Facilitatorineachgroup)follow-upcontactcasestudyandaskoneParticipantinthesmallgrouptocommentonwhats/hewouldsaytothemotherduringthisfollow-upcontact.
• Askifanyonehasanythingelsetoadd?
• AskParticipantstoreflectonthe“assess,analyzeandact”stepsofcounselling,askingthequestion:DidtheCounsellor………………?(SeeActivity1ofSession12andfollowthe“assess,analyzeandact”steps).
• Whenthefirstfollow-upcontactiscomplete,repeatthesameprocessfortheremainingfollow-upcontactcasestudies(4follow-upcontactcasestudiesintotal).
• Discussionandsummary.
Content for Activity 5
Points to discuss in Follow-up Contact(s) Counselling
• Askhowthebabyandmotheraredoing(isthebabybetterorworse?)
• Askwhetherthemothertried(orcontinued)theagreeduponnewbehaviour.
• Congratulatemotherfortrying(orcontinuing)thenewbehaviour.
• Ifthemotherdidnottrythenewbehaviourorgaveup,askwhy?
• Askwhathappenedwhenshetried(orcontinued)thenewbehaviour.
• Askwhethershemadeanychangestothenewbehaviourandwhy?
• Askwhatdifficultiesshehad,howshesolvedthem,orhelpherfindwaystosolvethedifficultiesshemighthavehadorthinkofalternatives.
• Listentothemother’squestions,concernsanddoubts.
• Askwhethershelikesthenewbehaviouragreeduponandifshethinksshewillcontinueorwhattodoifshedoesnotcontinue.
• Praisethemotherandmotivatehertocontinuethenewbehaviour.
• Remindthemothertotakethechildtobeweighed(attendEPIimmunizationsandgrowthmonitoringsessions).
Infant and Young Child Feeding Counselling ��
• Tellthemotherwhereshecangetadditionalsupportfromcommunity-basedhealthworkers,healthposts,ormothersupportgroups.
• Agreeonadateforthenextcontact.
• Dependingontheageofthechild:
– talktothemotheraboutanewbehaviour
– encouragethemothertotryanewbehaviour
Follow-up Contact Case Studies for Activity 5
Case Study �:
Follow-up Contact
Murayoannouncesthather1yearold,Habiba,noweatswhateverthefamilyeatsthatday,onceinthemorningandonceatnight.Murayotellsyouthatsheisplanningtostopbreastfeedingsoon.
Did the Counsellor?
• AskhowsheandHabibaaredoing(isHabibabetterorworse?)
• ListentoMurayo’sstoryandacceptherfeelings.
• ListentodetailsofHabiba’sbehaviour.
• AskMurayowhysheisplanningtostopbreastfeeding.
• TalkwithMurayoaboutcontinuedfrequent,on-demandbreastfeedinguntil2yearsofageorbeyond.
• SUGGESTthatMurayocontinuebreastfeedingHabibalonger.
• ReviewwithMurayothepointsdiscussedinCC13:‘Complementaryfeedingforyoungchildren12–23months’:
– InHabiba’s2ndyear,breastmilkcontinuestomakeup1/3ofherdiet.
– From12monthsonwards,feedHabiba5timesaday(3mealsand2snacks).
• ObtainanewagreementwithMurayo.
• Makeafollow-upappointmentwithMurayo.
• PraiseMurayoandthankherforhertime.
�0 Infant and Young Child Feeding Counselling
Case Study �:
Follow-up Contact
Fatumatellsyouthatshehasbeengivingthickporridgetoher9-montholdbaby,Shukri,onceaday.Sheisalsobreastfeedingmorefrequentlyandhasnoticedlessdiarrhoea.
Did the Counsellor?
• AskhowsheandShukriaredoing(isShukribetterorworse?)
• ListentoFatuma’sstory.
• PraiseFatumaforbreastfeedingmorefrequently.
• ListentodetailsofShukri’sbehaviour.
• ReviewwithFatumathepointsdiscussedinCC12:‘Complementaryfeedingforyoungchildren9–11months’:
– From9monthsonwards,feedShukri4timesaday(3mealsand1snack).
• ObtainanewagreementwithFatuma.
• Makeafollow-upappointmentwithFatuma.
• PraiseFatumaandthankherforhertime.
Case Study �:
Follow-up Contact
Halimasaysthather7-montholdbaby,Sheikh,noweatsporridgeoranjerawithlentilsandsomeoil2timesaday.Halimathinksherbabyisdoingverywell.
Did the Counsellor?
• AskhowsheandSheikharedoing(isSheikhbetterorworse?)
• ListentoHalima’sstory.
• ListentodetailsofSheikh’sbehaviour.
• PraiseHalimaforhowwellSheikhisdoing.
• ReviewwithHalimathepointsdiscussedinCC11:‘Complementaryfeedingforyoungchildren6–8months’:
– From6monthsonwards,feedSheikh2-3timesaday.
• ObtainanagreementwithHalima.
• Makeafollow-upappointmentwithHalima.
• PraiseHalimaandthankherforhertime.
Infant and Young Child Feeding Counselling ��
Case Study �:
Follow-up Contact
Safiotellsyouthatshehasstillbeenfeedingherneartwo-yearold,Tamina,3timesadayaswellascontinuingtobreastfeedher.
Did the Counsellor?
• AskhowsheandTaminaaredoing(isTaminabetterorworse?)
• ListentoSafio’sstory.
• PraiseSafioforcontinuingtobreastfeedTamina.
• ListentodetailsofTamina’sbehaviour.
• PraiseSafioforhowwellTaminaisdoing.
• ReviewwithSafiothepointsdiscussedinCC13:‘Complementaryfeedingforyoungchildren12–23months’:
– InTamina’s2ndyear,breastmilkcontinuestomakeup1/3ofherdiet.
– From12monthsonwards,feedTamina5timesaday(3mealsand2snacks).(F)
• ObtainanewagreementwithSafio.
• Makeafollow-upappointmentwithSafio.
• PraiseSafioandthankherforhertime.
ACTIVITY 6
Prepare for practicum (�0 minutes)
• Participantsformpairs(Facilitatorneedstobesensitivetolanguageandgender).
• Askeachparticipanttobringhis/hersetofcounsellingcards.
• Arrangetimeformeetingandtransportation(ifneeded).
�� Infant and Young Child Feeding Counselling
SESSION13
How to Counsel a Mother/Caregiver with a Young Child from 6–23 Months: Community and/or Facility Practise and Feedback
Note to the Facilitator: Present an overview of objectives (listed below) and the time allocated for this session.
Learning objectiveBytheendofthesession,Participantswillbeableto:
1. PractiseCounselling:listeningandlearningskills,buildingthemother’s/caregiver’sconfidence,providingsupportandpracticalhelp,andnegotiating(“reaching-an-agreement”)withmothersofyoungchildrenfrom6–23monthsathealthcentersorinthecommunity
ActivitiesActivity1 Practisecounselling:listeningandlearningskills,buildingthemother’s/
caregiver’sconfidence,providingsupportandpracticalhelp,and negotiating(“reaching-an-agreement”byapplyingthe“assess,analyze andact”steps(� hours)
Activity2 Feedbackonpractise(� hour)
Total Time 3 hours
Materials needed√ Entiresetofcounsellingcardsonoptimalbreastfeedingpracticesandoptimal
complementaryfeedingpracticesforchildrenfrom0–23months
√ CounsellingCardonHygiene:14
Advance preparation• Makeanappointmentatthehealthpostaweekaheadtodothefieldpractise
duringimmunizationorweighingsessions,or
• Makeanappointmentwiththecommunityhealthworkeraweekaheadforcommunityvisits
• Preparegroups,giveinstructionsthedaybefore
Infant and Young Child Feeding Counselling ��
ACTIVITY 1
Practise counselling: listening and learning skills, building the mother’s confidence, providing support and practical help, and negotiating (“reaching-an-agreement” by applying the “assess, analyze and act” steps (� hours)
Methodology: Practise
• BeforetheParticipantsleaveforthepractice-site,brieflyreviewCounsellingskills:listeningandlearning,buildingthemother’sconfidence,providingsupportandpracticalhelp,negotiating(“reaching-an-agreement”),anduseofcounsellingcardsbyapplyingthe“assess,analyze,andact”steps.
• DivideParticipantsinpairsandexplaintheexercise:oneParticipantwillpractiseCounselling:listeningandlearningskills,buildingthemother’sconfidence,providingsupportandpracticalhelp,negotiating(“reaching-an-agreement”)anduseofcounsellingcardsbyapplyingthe“assess,analyzeandact”stepswiththemother,whiletheotherParticipantfollowsthedialogueinordertogivefeedbacklater.
• ParticipantschangerolesuntileachParticipantpractisesatleast2counsellingactivities.
ACTIVITY 2
Feedback on practise session (� hour)
Methodology: Feedback discussion
• Attrainingsite,withthewholegroup,eachpairofParticipantswillsummarizeforthegrouptheiruseoflisteningandlearningskills,buildingthemother’sconfidence,providingsupportandpracticalhelp,negotiating(“reaching-an-agreement”)anduseofcounsellingcardsbyapplyingthe“assess,analyzeandact”steps.Theirsummaryshouldincludethechild’snameandage,anydifficultyidentified,optionssuggested,andbehaviourmotheragreedtotry
• Participantsreceiveandgivefeedback
• Discussionandsummary
�� Infant and Young Child Feeding Counselling
SESSION14
Final Evaluation of IYCF Counselling Training
Learning objectivesBytheendofthesession,Participantswill:
1. Examine“whathavewelearnedthisweek?”
2. EvaluatetheIYCFCounsellingtraining
ActivitiesActivity1 “Whathavewelearnedthisweek?”(�0 minutes)
Activity2 EvaluationofIYCFCounsellingtrainingandlistentoresults (�� minutes)
Total Time 45 minutes
Materials needed√ Onecopyof“Whathavewelearnedthisweek?”post-assessmentforFacilitator
Note to the Facilitator: Present an overview of objectives (listed below) and the time allocated for this session.
ACTIVITY 1
“What have we learned this week?” (�0 minutes)
Methodology: Participants sit in circle facing outwards
• AskParticipantstoformacircleandsitsothattheirbacksarefacingthecenter.
• ExplainthatquestionswillbeaskedandaskParticipantstoraisetheirhand(withopenpalm)iftheythinktheansweris“Yes”,toraisetheirhand(withclosedfist)iftheythinktheansweris“No”,andtoraisetheirhand(pointing2fingers)ifthey“Don’tknow”.
• OneFacilitatorreadsthequestionsandanotherFacilitatorrecordstheanswers.
• Compareresultsofpreandpost-assessmentsandsharewithParticipants.
Infant and Young Child Feeding Counselling ��
What have we learned this week?
1. Ababyshouldbreastfeedwithinanhourafterbirth.
2. Toproducesenoughmilk,amothershouldbreastfeedfrequently,dayandnight.
3. Colostrumhelpstoprotectbabiesfromillnesseslikediarrheaand respiratoryinfections.
4. At4months,infantsneedwaterandotherdrinksinadditiontobreastmilk.
5. At9-11months,ababyneedscomplementaryfoods4timesaday.
6. Onesignofgoodattachmentisthatthenewborn’schintouchesthe mother’sbreast.
7. Breastfeedingbenefitsthebaby,butnotthemother.
8. Amothercanstillsuccessfullybreastfeedherbabyevenifshethinksshe doesnothaveenoughmilk.
9. Amothercanpreventsoreandcrackednipplesbycorrectlyattaching herbabytothebreast.
10. Ababybeginstoneedfoodsinadditiontobreastmilkatabout6months.
11. Amothercanproduceenoughmilktobreastfeedtwins.
ACTIVITY 2
Evaluation of IYCF Counselling training and listen to results (�� minutes)
Methodology: Participants form buzz groups of 3
• AskParticipantstoformbuzzgroupsof3.
• Explainthattheirsuggestionswillbeusedtoimprovefuturetrainings.
• Explainthatquestionswillbeaskedandthateachgroupshoulddiscussamongthemselveswhattheythink.
• OneFacilitatorreadsthefollowingquestions,onebyone.Aftereachquestion,askbuzzgroupstosharetheircomments(anotherFacilitatorrecordstheanswers).
1.Whatdidyoulikeabouttheteachingmethod?
2.Howwillyouusethecounsellingcards?
3.Whatdidyoulearninthepracticeatthehealthpostorinthecommunity?
4.Doyoufeelreadytocounselmothers/caregiversaboutinfantandyoungchildfeeding?
5.Whatsuggestionsdoyouhavetoimprovethetraining?
6.Doyouhaveanyothercomments?Pleaseshare.
Don’t Yes No know
�� Infant and Young Child Feeding Counselling
Notes
Infant and Young Child Feeding Counselling ��
APPENDIX1
Counselling Cards: Key and Supporting Messages 18 counselling cards
1. Antenatal
2. DeliveryinFacility(Card2a)/HomeDelivery(Card2b)
3. GrandmotherOfferingFoodtoBreastfeedingDaughter/Daughter-in-law
4. HowtoAttachBabytotheBreast
5. BreastfeedingPositions
6. BreastfeedonDemand,BothDayandNight
7. DuringtheFirst6Months,YourBabyNeedsONLYYourBreastmilk
8. HowtoHandExpressBreastmilkandCupFeed
9. OptimalChildSpacing
10.ComplementaryFeedingStartingat6Months
11.ComplementaryFeedingfrom6–8Months
12.ComplementaryFeedingfrom9–11Months
13.ComplementaryFeedingfrom12–23Months
14.Hygiene:WashYourHandswithSoapandWater
15.BreastfeedingaSickBabyLessthan6Months
16.BreastfeedingaSickChildGreaterthan6Months
17.SignsthatRequireMother/Caregiver/FamilytoSeekCare
�� Infant and Young Child Feeding Counselling
CounsellingCard1
Antenatal
Key Messages
1. Breastfeedyourbabywithin1hourofbirth.(counsellingcards2aand2b)
2. Breastfeedyourbabyfrequently,dayandnight,toestablishyourbreastmilksupply.(counsellingcard6)
3. Exclusivelybreastfeedyourbabybygivingonlyyourownmilkforthefirst6months.(counsellingcard7)
4. Makesureyourbabyiswellattachedtothebreast.(counsellingcard4)
5. Makesurebabyisinacomfortablepositionatthebreastandisabletoeffectivelysuckleinthefirstweeksandmonths.(counsellingcard5)
6. Youshouldeattohungeranddrinktothirsttokeepyouandyourbabyhealthyandtoprepareyourbodyforbreastfeeding.
• Increasefoodintake:“anadditionalmeal,morefoodthanusual,andavarieddiet”.
• TakevitaminAatdeliveryorwithin6weeksafterdelivery.
• EatfoodsrichinvitaminA(papaya,mangoes,carrots,pumpkins,liver).
• Continueiron/folicacidsupplementationtocomplete6monthsintotal(duringpregnancyand/orlactation).
• Useiodizedsaltforthewholefamily.
• Usetreatedbednetstoreducemalariainfection.
• Ifavailable,takede-wormingtreatmentduring3rdtrimesterofpregnancytoreducehookworminfection.
• Reduceworkloadtoensureopportunityforresttohelpconserveenergy
Infant and Young Child Feeding Counselling ��
CounsellingCards2aand2b
Delivery in Facility (Card 2a) / Home Delivery (Card 2b)
Key Messages
• Assoonasyourbabyisborn,letthemidwifeputthenakedbabybetweenyourbreasts,coverhimorherlightlyandkeepthebabythereforatleastonhour—oraslongasyouwant.Thebabymayjustrestforatime,keepingwarmandlearninghowyoufeelandsmell
• Yourbabywillstartshowingsignsofinterestinbreastfeedingandmaytrytomovetothebreastwithinthehour.Letthebabystartsucklingthen—thisisthebesttimeforyouandyourbabytolearnaboutbreastfeedingandtobond.
• Thebaby’ssucklinghelpsyourwombcontract,whichpushesouttheplacentaandreducesbleeding.Youmayfeelquiteastrongcontractionatthistime;itisagoodsignthatthingsareworkingwell.
• Thefirstmilkthatcomesiscalledcolostrum.Itisyellowandstickyandfullofgoodthingswhichhelpprotectyourbaby.Makesurethatyourbabytakesthecolostrum.
• Breastfeedingfrombirthhelpsthemilk“comein”andensuresplentyofbreastmilk.
Supporting Messages
• Itiseasierforyourbabytolearntosuckleifs/hestartsearlywhilethebreastisstillsoft.
• Theamountofcolostrummaybesmall,butevenafewdropshelpprotectyourbaby.
• Colostrumwillhelpyourbabypasshis/herfirstdarkstool.
• Yourbabydoesnotneedwaterorotherfeedsgivenbeforebreastfeeding(foods,sugarwaterorliquids/fluids).Theycancauseadelayinyourmilk“comingin”(orstartingtoflow)andcanmakeyourbabyill.Calvesandbabygoatsdonotneedextrawaterafterbirth.
�0 Infant and Young Child Feeding Counselling
CounsellingCard3
Grandmother Offering Food to Breastfeeding Daughter/Daughter-in-law
For the caregiver of mother:
Key Messages
• Keepthemotherandbabytogetherfrombirth.Stayingtogetherhelpsthemotherandbabyrestandrecover,breastfeedondemand(asoftenasthebabywants),andbond.
• Ensurethatthebreastfeedingmothereatsanadditionalmealeachdaybecausesheiseatingfortwo,herselfandthebaby.
Supporting Messages
• EnsurethatthebreastfeedingmothereatstheporridgefromthePLP(PregnantandLactatingProgramme)andpartoftheextrarationthatisgivenwhenthebabyisregistered.Eatingmorehelpshermaintainherhealthandthehealthofthebaby.
• Bringfoodandwatertothemotherandletherbreastfeedthebaby.
• Mothersneedtobeprioritizedforfamilyfoodandneedhelpwithhouseholdwork.
• Mothersneedtotakeadvantageofallopportunitiestoeatmorefood.
Infant and Young Child Feeding Counselling ��
CounsellingCard4
How to Attach Baby to the Breast
Skills
• Startwiththebaby’snoseoppositeyournipple,sothatthebabyhastoreachuptothenipple.
• Touchthebaby’slowerlipwiththenipple.Waituntilthebaby’smouthopenswide,andthenquicklymovethebabyontothebreast.
• Aimthebaby’slowerlipwellbelowthenipplesothatthenipplegoestothetopofthebaby’smouthandthebaby’schin
touchesthebreast(thishelpstoensurethatthebaby’stongueisundertheareolasothatthebabycanpressoutthemilk).
• Fromtheoutsidethereshouldbemoreareolashowingabovethanbelowthenipple(thisiseasierforthecounsellortoseethanyouwhocannotseewhatisbelowthebaby’smouth).
• Thebaby’slowerlipshouldbeturnedoutwards(thisiseasierforthecounsellortoseethanyouwhocannotseewhatisbelowthebaby’smouth).
Effective suckling
• Tosucklewell,ababyneedstobewellattachedatyourbreast.
• Thebaby’smouthshouldbeopenwide,sothats/hecantakeinplentyoftheareolaandnotjustthenipple.
• Thebabyshouldbeheldclosetothebreast.
• Thebabytakesslowdeepsuckles,sometimespausing.
• Youmaybeabletoseeorhearyourbabyswallowingafteroneortwosuckles.
• Sucklingiscomfortableandpainfreeforyou.
• Babyfinishesthefeed,releasesbreastandlookscontentedandrelaxed.
• Thebreastissofterafterthefeed.
• Sucklingwellhelpsyouproducemilkandsatisfyyourbaby.
Risks of poor attachment
• Soreandcrackednipples. • Poormilkrelease. • Slowmilkproduction.
�� Infant and Young Child Feeding Counselling
CounsellingCard5
Breastfeeding Positions
Skills
• Toensuregoodattachment,yourbabyneedstobewellpositionedatthebreast.Thereareseveraldifferentpositionsthatyoucanuse.
• Youcanbreastfeedsittingorlyingdownorstandingifyouwish.
– Cradle position(mostcommonposition)
– Opposite arm—usefulfornewbornsandsmallorweakbabies,oranybabywithadifficultyattaching
– Lying down(usefulsoonafterdeliveryandatanytimetorestwhilebreastfeeding)
– Under-arm position(usefulfortwinsandlow-birth-weightbabies)
Supporting Messages
• Whateverpositionyouchooseyouneedtobecomfortablewithyourbacksupported.
• Bringthebabytoyou;donotleanforwardtothebaby.
• Thebaby’sbodyshouldbestraight,notbentortwisted,butwiththeheadslightlyback.
• Thebaby’sbodyshouldbefacingyouandclosetoyousothatyouaresupportingthebaby’swholebody,notjusttheneckandshoulders,withyourhandandforearm.
• Thebabyshouldbeabletolookupintoyourface,notheldflattoyourchestorabdomen.
• Holdyourbreastwithyourfingersina“Cshape”,withthethumbabovethedarkpartofthebreast(areola)andtheotherfingersbelow.
• Fingersshouldnotbein“scissorhold”becausethismethodtendstoputpressureonthemilkductsandcanpullthenippleoutofthebaby’smouth.
Infant and Young Child Feeding Counselling ��
CounsellingCard6
Breastfeed on Demand, Both Day and Night
Key Messages
• Breastmilkprovidesallthenourishmentyourbabyneedsforthefirst6months.
• Breastfeedthebabyoften,atleast8–10times,dayandnight,toproducelotsofbreastmilkandensurethatyourbabygrowshealthy.(Dependingonageofbaby,s/hemaynotneed10feedsadayifsucklingeffectively.)
• Letbabysuckleaslongass/hewants—letbabycomeoffthebreasthim/herself.Donottakethebabyoff.
Supporting Messages
• Moresucklingmakesmorebreastmilk(providedbabyiswellattached),andifababysucklesless,thebreastsmakelessbreastmilk.
• Thebreastsmakeasmuchmilkasthebabytakes—ifbabytakesmore,thebreastsmakemore(thebreastislikea“factory”—themoredemandformilk,themoresupply).
• Signsthatababywantstobreastfeed:
A combination of: (not just one alone)
– Restlessness
– Openingmouthandturningheadfromsidetoside
– Puttingtongueinandout
– Suckingonfingersorfists
Note: Begin breastfeeding before the baby starts crying. Crying is a late sign of hunger.
• Feedsthatareregularlymorethanhalfanhour(exceptinthefirstweekorsoorwhenbabyislow-birth-weight)orfeedsthatareveryfrequent(moreoftenthanevery1–1.5hoursallthetime)maybeasignthatyourbabyisnotwellattached.Askthecounsellortowatchthebabyfeed,andtrytoimprovetheattachment.
�� Infant and Young Child Feeding Counselling
CounsellingCard7
During the First 6 Months, Your Baby Needs ONLY Your Breastmilk
Key Messages
• Breastfeedingmakesyourbabygrowstrongandhealthyandhelpstopreventdiarrhoeaandrespiratoryinfections.
• Breastmilkisthebestfoodanditisallthatyourbabyneedsforthefirst6months.
• Givingotherfeedscanmakeyourbabyill.
• Donotgiveanythingelsetoyourbabybefore6months,NOTevenwater(tea,sugarwater,gripewater,otheranimalmilks,infantformulaorporridge).
• Evenduringveryhotweather,breastmilkcansatisfyyourbaby’sthirstduringthefirst6months.You may need additional water to satisfy your own thirst.
Supporting Messages
• Thereisenoughwaterforbabyinyourbreastmilk.
• Therisksofgivingwatertoyourbabyare:Riskofdiarrhea,baby’sstomachgettingfullwithwaterandfeedingless,loosingweight,malnutrition,infrequentfeedingleadingtodecreasedbreastmilkproduction.
• Ifyourbabytakeswaterorotherliquids,s/hesucklesthebreastlessandyouproducelessmilk.Thisleadstopoorgrowthofyourbaby.
• Ifyoufeedanyotherfoodsorliquidstoyourbreastfedbaby,youriskbecomingpregnantinthefirstmonthsafteryougivebirth.
• Babycamelsandgoatsdonotneedextrawaterwhentheyareborn.
• Breastfeedingisanaturalresourceforfoodsecurity.
Infant and Young Child Feeding Counselling ��
CounsellingCard8
How to Hand Express Breastmilk and Cup Feed
• Sometimesyouneedtoexpressmilkforyourbaby:
– ifyourbabyistooweakorsmalltosuckleeffectively
– ifyourbabyistakinglongerthanusualtolearntosuckle,forexamplebecauseofinvertednipples
– ifyouhavetobeawayfromyourbabyforsomehours
– tofeedalow-birth-weightbabywhocannotbreastfeed
– tofeedasickbaby,whocannotsuckleenough
– tokeepupthesupplyofbreastmilkwhenyouorbabyisill
– torelieveengorgementorblockedduct
• Toexpressmilkfollowthesesteps:– Washhands– Prepareacleancontainer– Gentlymassagebreastsinacircularmotion—lightmassageisskinstimulationforthe
reflex– Positionthumbontheupperedgeoftheareolaandtheotherfingersontheundersideof
thebreastbehindtheareola– Presstheareolabehindthenipplebetweenthefingersandthumb– Milkmaystarttoflowindrops,orsometimesinfinestreams—collectitinthecontainer– Ifitisverysmalldropsofcolostrum,itmayhelptocollectitinasyringedirectfromthe
nipple– Avoidrubbingtheskin,whichcancausebruising;orsqueezingthenipple,whichstopsthe
flowofmilk– Forlargebreasts,firstliftthebreast– Rotatethethumbandfingerpositionsandcompressandreleaseallaroundtheareola– Expressonebreastforatleast3–5minutesuntiltheflowslows,thenexpressotherside,
thenrepeatbothsidesagain(20–30minutestotal)
• Storebreastmilkinaclean,coveredcontainer.Milkcanbestored8–10hoursatroomtemperatureinacoolplaceand72hoursintherefrigerator.
• Givebabyexpressedbreastmilkfromacup.Bringcuptothebaby’slowerlipandallowbabytotakesmallamountsofmilk.Donotpourthemilkintobaby’smouth.
• Bottlesareunsafetousebecausetheyaredifficulttowashandcanbeeasilycontaminated.
�� Infant and Young Child Feeding Counselling
CounsellingCard9
Optimal Child Spacing
Key Messages
• Feedingyourbabyonlybreastmilkforthefirst6monthscanhelpspacebirthsinawaythatishealthyforbothyouandyourbaby.
• Optimalchildspacinghelpsensurehealthychildrenandalsoprotectsyou.
• Youarenotlikelytobecomepregnantwhenyoumeetthefollowing3criteria:
– youhavenoreturnofmenses,and
– youexclusivelybreastfedyourbabyfor6months,and
– yourbabyisyoungerthan6months
• Whenyounolongermeetoneofthesecriteria,youneedtostartafamilyplanningmethodtoavoidpregnancy
Supporting Messages
• Whenyoudonotexclusivelybreastfeedfrombirthyoucanbecomepregnantasearlyas6weeksafterdelivery.Closelyspacedpregnanciesriskyourhealth,andthatoftheolderbabyandthenewborn.
• Ifyouwantfurtherinformationaboutchildspacing,pleasegotothefamilyplanningclinic.
Infant and Young Child Feeding Counselling ��
CounsellingCard10
Complementary Feeding Starting at 6 Months
Key Messages
• Continuebreastfeedingyourbabyondemand,dayandnight,tomaintainhis/herhealthandstrength.
• Breastmilkcontinuestobethemostimportantpartofyourbaby’sdiet.
• Atabout6months,yourbabyisdevelopmentallyreadyandbeginstoneedotherfoodsinadditiontobreastmilk.
• Thinkofthefollowingcharacteristicswhengivingcomplementaryfoodstoyourbaby:F=Frequency,A=Amount,T=Thickness(consistency),V=Variety(differentkindsoffoods),A=Active/responsivefeeding,andH=Hygiene(FATVAH)
• Introducesoftfood(mashedpotato,mashedbananaorporridge)at6monthsofage,2-to-3timesaday.(F)
• Startwith2-3tablespoonfulsperfeed.(A)
• Whenpossibleusebreastmilk,goat,camel,coworsheepmilktopreparethesoftfood.
• Theconsistencyofthesoftfoodshouldbethickenoughsothatitdoesnotrunoffthespoon.(T)
• Bepatientandactivelyencourageyourbabytoeat.(A)
• Avoidusingbottlestofeedyourbaby.Theyareverydifficulttokeepcleanandcanmakeyourbabysickwithdiarrhoea.(H)
• Foodsgiventothebabymustbestoredinhygienicconditionstoavoidcontaminationandillness.(H)
Safe preparation and storage of complementary foods
Guideline: practice good hygiene and proper food handling by
• Washyourownandbaby’shandsbeforefoodpreparationandeating,andafterusingtoiletandcleaningbaby’sbottom
• Usecleanutensilstoprepareandservefood;cleansurface,keepcleanutensilscovered;usecleancupsandbowlstofeedchildren
• Treatwaterfordrinking;keepdrinkingwaterincleancoveredcontainer
• Servefoodsimmediatelyafterpreparation
• Storefoodssafely:keepintightlycoveredcontainers,storefoodsdryifpossible
�� Infant and Young Child Feeding Counselling
CounsellingCard11
Complementary Feeding from 6–8 Months
Key Messages
• Continuebreastfeedingyourbabyondemand,dayandnighttomaintainhis/herhealthandstrength.
• Breastmilkcontinuestobethemostimportantpartofyourbaby’sdiet.
• Thinkofthefollowingcharacteristicswhengivingcomplementaryfoodstoyourbaby:F=Frequency,A=Amount,T=Thickness(consistency),V=Variety(differentkindsoffoods),A=Active/responsivefeeding,andH=Hygiene(FATVAH)
• From7monthsonwards,feedyourbaby3timesaday.(F)
• Graduallyincreasetheamountoffoodto½ofa250mlcup.Babieshavesmallstomachsandcanonlyeatsmallamountsateachmeal.(A)
• Mashandsoftenthefoodssothebabycaneasilychewandswallow;breastmilkorotheranimalmilkcanbeusedtopreparethesoftfood.
• Thickenthebaby’sfoodasthebabygrowsolder,makingsurethatitisstillabletoeasilyswallowwithoutchoking.(T)
• Trytoincludeatleastasmallbitofafoodfromeachgroupinatleastonemealperday,orasoftenaspossible:a)wheatflour,bulgurflour,maizemeal,CSB,orpotatoes;b)lentils,greengrams,beansoryellowsplitpeas,c)meat,poultry,orfish,d)eggs,e)darkgreenvegetable,fruitssuchasmango,papaya,orangesorbananas,andf)oilorghee.(V)
• Animalmilks(goat,camel,etc.)arealsousefulsourcesofnutrients.
• Ifpossible,alsoincludegroundnutsthathavebeenroastedandthengroundorsmashedintoafinepowder.
• Bepatientandactivelyencourageyourbabytoeat.Useaseparateplatetofeedthebabytomakesures/heeatsallthefoodgiven.(A)
• Foodsgiventothebabymustbestoredinhygienicconditionstoavoiddiarrhoeaandillness.(H)
Infant and Young Child Feeding Counselling ��
CounsellingCard12
Complementary Feeding from 9–11 Months
Key Messages
• Continuebreastfeedingyouryoungchildondemand,dayandnighttomaintainhis/herhealthandstrength.
• Breastmilkcontinuestobethemostimportantpartofyouryoungchild’sdiet.
• Thinkofthefollowingcharacteristicswhengivingcomplementaryfoodstoyouryoungchild:F=Frequency,A=Amount,T=Thickness(consistency),V=Variety(differentkindsoffoods),A=Active/responsivefeeding,andH=Hygiene(FATVAH)
• From9monthsonwards,feedyouryoungchild4timesaday(3mealsand1snack).(F)Snacks:
– extrafoodsbetweenmealsthatareeasytoprepare
– theseextrafoodsareinadditiontothemeals—theydonotreplacemeals
– goodsnacksprovideenergyandnutrients(nottobeconfusedwithsweets)
– (giveexamplesoflocalsnacks)
• Giveyouryoungchild½ofa250mlcup/bowlateachfeed.Youngchildrenhavesmallstomachsandcanonlyeatsmallamountsateachmeal.(A)
• Thickentheyoungchild’sfoodasthechildgrowsolder,makingsurethatitisstillabletoeasilyswallowwithoutchoking;breastmilkorotheranimalmilkcanbeusedtopreparethefood.(T)
• By9monthstheyoungchildshouldbeabletobegineatingfingerfoodssuchaspiecesofripemangoandpapaya,bananaandvegetables
• Trytoincludeatleastasmallbitofafoodfromeachgroupinatleastonemealperday,orasoftenaspossible:a)wheatflour,bulgurflour,maizemeal,CSB,orpotatoes;b)lentils,greengrams,beansoryellowsplitpeas,c)meat,poultry,orfish,d)eggs,e)darkgreenvegetable,fruitssuchasmango,papaya,orangesorbananas,andf)oilorghee.(V)
• Animalmilks(goat,camel,etc.)arealsousefulsourcesofnutrients.
• Ifpossible,alsoincludegroundnutsthathavebeenroastedandthengroundorsmashedintoafinepowder.
• Bepatientandactivelyencourageyouryoungchildtoeat.Useaseparateplatetofeedtheyoungchildtomakesures/heeatsallthefoodgiven.(A)
• Foodsgiventotheyoungchildmustbestoredinhygienicconditionstoavoiddiarrhoeaandillness.(H)
�00 Infant and Young Child Feeding Counselling
CounsellingCard13
Complementary Feeding from 12 – 23 Months
Key Messages
• Continuebreastfeedingyouryoungchildondemand,dayandnighttomaintainhis/herhealthandstrength.
• Inyouryoungchild’s2ndyear,breastmilkcontinuestomakeup1/3ofhis/herdiet.
• Thinkofthefollowingcharacteristicswhengivingfoodstoyouryoungchild:F=Frequency,A=Amount,T=Thickness(consistency),V=Variety(differentkindsoffoods),A=Active/responsivefeeding,andH=Hygiene(FATVAH)
• From12monthsonwards,feedyouryoungchild5timesaday(3mealsand2snacks).(F)
Snacks: – extrafoodsbetweenmealsthatareeasytoprepare– theseextrafoodsareinadditiontothemeals—theydonotreplacemeals– goodsnacksprovideenergyandnutrients(nottobeconfusedwithsweets)– (giveexamplesoflocalsnacks)
• Giveyouryoungchild¾to1250mlcup/bowlateachfeed.(A)
• Cutthefoodintosmallpiecessotheyoungchildcaneasilychewandswallow.
• Thickentheyoungchild’sfoodasthechildgrowsolder,makingsurethatitisstillabletoeasilyswallowwithoutchoking.(T)
• By12monthsothersolidfoodscanbegiveasmanytimesaspossibleeachday.
• Trytoincludeatleastasmallbitofafoodfromeachgroupinatleastonemealperday,orasoftenaspossible:a)wheatflour,bulgurflour,maizemeal,CSB,orpotatoes;b)lentils,greengrams,beansoryellowsplitpeas,c)meat,poultry,orfish,d)eggs,e)darkgreenvegetable,fruitssuchasmango,papaya,orangesorbananas,andf)oilorghee.(V)
• Animalmilks(goat,camel,etc.)arealsousefulsourcesofnutrients.
• Ifpossible,alsoincludegroundnutsthathavebeenroastedandthengroundorsmashedintoafinepowder.
• Bepatientandactivelyencourageyouryoungchildtoeat.Useaseparateplatetofeedtheyoungchildtomakesures/heeatsallthefoodgiven.Childreneatmoreslowlythanadults,soputthechild’sportionofthefamilymealinhisownbowl.(A)
• Youngchildrenshouldbesupervisedduringmealtimetomakesuretheyeatallthefoodputontheirplate.(A)
• Foodsgiventotheyoungchildmustbestoredinhygienicconditionstoavoiddiarrhoeaandillness.(H)
Infant and Young Child Feeding Counselling �0�
CounsellingCard14
Hygiene: Wash Your Hands with Soap and Water
Key Messages
• Washyourhandswithsoap(orash)andwaterbeforepreparingfood,beforeeating,andbeforefeedingyoungchildren.
• Washyourchild’shandswithsoap(orash)andwaterbefores/heeats.
• Washyourhandswithsoap(orash)andwaterafterusingthelatrineorcleaningthebaby’sbottom.
• Feedyouryoungchildusingcleanhands,cleanutensilsandcleancups.Avoidusingfeedingbottles,asthismaycauseyouryoungchildtogetdiarrhoea.
• Keepfoodsincoveredcontainersandstorefooddry,ifpossible.
– Foodshouldbetightlycoveredtopreventinsectsanddirtgettingintoit.
– Foodcanbekeptlongerwhenitisinadryformthanwhenitisinliquidorsemi-liquidform.
�0� Infant and Young Child Feeding Counselling
CounsellingCard15
Breastfeeding a Sick Baby Less than 6 Months
Key Messages
• Breastfeedingmoreduringillnesswillhelpbabyfightthesicknessandnotloseweight.
• Breastfeedingalsoprovidescomforttoasickbaby.
• Ifthebabyittooweaktosuckle,itisimportanttoexpressbreastmilktogivethebaby,eitherbycuporbyexpressingdirectlyintothebaby’smouth.Thiswillhelpthemotherkeepuphermilksupplyandpreventengorgement.
• Practiceexclusivebreastfeedingfrom0–6months.
NOTE:Themothermayneedsupporttore-establishexclusivebreastfeeding.
Infant and Young Child Feeding Counselling �0�
CounsellingCard16
Feeding a Sick Child Greater than 6 Months
Key Messages
• Duringillness,increasethefrequencyofbreastfeedingandofferadditionalfoodtoyourchildtomaintainhis/herstrength,reduceweightlossandrecoverfaster.(Oftenillyoungchildrenbreastfeedmorefrequently).
• Fluidandfoodrequirementsarehigherduringillness.
• Taketimetopatientlyencourageyoursickchildtoeatashis/herappetitemaybedecreasedbecauseoftheillness.
• Itiseasierforasickchildtoeatsmallfrequentmeals.
• Feedthechildfoodss/helikesinsmallquantitiesthroughouttheday.
• Offertheyoungchildsimplefoodslikeporridge,evenifs/hedoesnotexpressinterestineating.Avoidspicyorfattyfoods.
• Keepencouragingtheyoungchildtoeat.
Feeding during recovery
• Whenyouryoungchildhasrecovered,givehim/heroneadditionalmealofsolidfoodeachdayduringthenexttwoweeks.Thiswillhelpthechildregainweightlostduringillness.
• Alsobreastfedmorefrequentlyduringtwoweeksafterrecovery.
• Takeenoughtimetoactivelyencourageyouryoungchildtoeatthisextrafoodandbreastfeedmorefrequentlywhenhis/herappetitereturns.
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CounsellingCard17
Signs that Require Mother/Caregiver/Family to Seek Care
Take your baby or young child to health post if s/he shows the following signs:
• Anaemia(lookforpalmarpallor)
• Diarrhoea(bloodinstoolorpersistentdiarrhoea,sunkeneyes)
• Fever(possibleriskofmalaria)
• Vomiting(cannotkeepanythingdown)
• Respiratoryinfections(cough,pneumonia/chestin-drawing)
• Malnourishedchild:visiblewastingoroedema
• Refusaltoeat
Infant and Young Child Feeding Counselling �0�
APPENDIX2
Training AidsSession 3
√ Imagesofcommonillnessesinthecommunity:diarrhoea,cough/pneumonia,malnutrition,vomiting,fever,anaemia
√ Imagesof‘breastfeedingmotherandbaby’,and‘healthymotherandbaby’
Session 4
√ Materialsformakingdollsandmodelbreasts
√ Doll(s)
√ Imagesof‘goodattachment’and‘poorattachment’,and‘Howthebreastmakesmilk’
Note: If possible, make arrangements in advance to have breastfeeding women present to demonstrate positioning and attachment.
√ Photoofmilkexpressionandcupfeeding
√ Smallcupwithliquid
Session 5
√ Photosofengorgement,sore/crackednipple,andpluggedduct/mastitis
√ PhotosofCandida(thrush),checkingforthrushinbaby’smouth,andinvertednipples
Session 6
√ 2setsofimagesof“commonsituationsaffectingbreastfeeding”:
– sickmother,
– feedingalowbirthweightbaby,
– kangaroomothercare,
– malnourishedmother,
– twins,
– refusaltobreastfeed,
– pregnancy,and
– motherawayfrombaby
Session 9
√ Image:‘Feedmoreasthebabygrows’
√ Smallamountofpreparedporridge,smallamountofmilk,2bowlsand2spoons
�0� Infant and Young Child Feeding Counselling
APPENDIX3
Instructions for making cloth breast models
Skin Colour Sock
Aroundtheheelofthesock,sewacircularrunningstitch(pursestringsuture)withadiameterof4cm.Drawittogetherto1.5cmdiameterandstuffitwithpaperorothersubstancetomakea“nipple.”Sewafewstitchesathebaseofthenippletokeepthepaperinplace.Useafelt-tippentodrawanareolaaroundthenipple.
White Sock
Ontheheelofthesock,useafelt-tippentodrawasimplestructureofthebreast:alveoli,ducts,andnipplepores.Besurethelactiferoussinuseswillbeintheareolaarea.
Putting the Two Socks Together
Stufftheheelofthewhitesockwithanythingsoft.Holdthetwoendsofthesocktogetheratthebackandformtheheeltothesizeandshapeofabreast.Variousshapesofbreastscanbeshown.Pullthebrownsockovertheformedbreastsothatthenippleisoverthepores.
Making Two Breasts
Iftwobreastsaremade,theycanbewornoverclothingtodemonstratepositioningandattachment.Holdtheminplacewithanoldnylonstockingtiedaroundthechest.Thecorrectpositionofthefingersforhandexpressionandmassagecanalsobedemonstrated.
Usetwosocks,onesockinalightbrownorothercolourresemblingskintoshowtheoutsideofthebreast,andtheothersockinwhitetoshowtheinsideofthebreast.
Infant and Young Child Feeding Counselling �0�
APPENDIX4
Cut Outs for Daily Evaluation
�0� Infant and Young Child Feeding Counselling