2 Infant Feeding Counselling Cards This counselling card flip chart is based on the National Infant and Young Child Feeding Policy. These counselling cards have been created to help health workers trained in infant feeding counselling to support HIV-positive mothers. All HIV-positive mothers should receive counselling on how to feed their babies. This includes general information about the risks and benefits of different infant feeding options, and specific guidance on selecting the best option for their situation. Whatever a mother decides, she should be supported in her choice. Counsellors using these counselling cards should have received specific training on infant and young child feeding counselling. These cards include a flow chart illustrating the counselling process and counselling cards to be used during one-on-one sessions with pregnant woman and mothers. These counselling cards are supported by take-home brochures that can be given to mothers to support the practices related to their chosen feeding option. Counselling Skills Listening and learning skills 1) Use helpful non-verbal communication Keep head level with mother Listen closely Remove barriers Take time Touch appropriately 2) Ask open questions 3) Use responses and gestures that show interest 4) Reflect back what the mother is saying 5) Avoid judging words General counselling guidelines Greet the mother/caregiver and establish confidence Ask the mother about the baby s age and feeding practices Listen to the concerns of the mother an d father Praise what the mother is doing right Identify feeding difficultly if any and causes Observe the baby and mother Answer any questions Discuss possible options to overcome the difficulty Present options and help mother select one that she can try.
3 HOW TO USE THE FLOW CHART 1. IF THIS IS THE FIRST INFANT FEEDING COUNSELLING SESSION: And she is pregnant: Follow steps 1-4. if she needs time to decide which feeding option to choose, follow steps 1-3 and ask her to return to discuss step 4 If she is early in her pregnancy ask her to return again closer to her delivery date to review how to feed her baby. If she already has a child: Follow steps 1-3. if the mother is not breastfeeding at all, however, do not discuss the advantages and disadvantages of breastfeeding. Continue with steps IF THE MOTHERS HAS ALREADY BEEN COUNSELLED AND CHO- SEN A FEEDING METHOD, BUT SHE HAS NOT YET LEARNED HOW TO PRACTICE IT: And she is pregnant Do step 4 only. And she already has a child: Begin with step 4 and continue with step 5 3. IF THIS IS A FOLLOW-UP VISIT: Begin with step 5 Review how to practice the feeding method. REMEMBER: Use listening and learning skills and skills for building confidence and giving support. Check to ensure that the mother understands what you have discussed Arrange for follow up or referral as needed. COUNSELLING FLOW CHART STEP 1 Explain the risks of mother-to-child transmission STEP 2 Explain the advantages and disadvantages of different feeding options starting with the mother s initial preference STEP 3 Explore with the mother her home and family situation and help the mother choose an appropriate feeding option STEP 4 Explain how to practice the chosen feeding option and give her the appropriate take-home pamphlet How to practice exclusive How to give only formula breastfeeding for the Remind the mother that she first 6 months can never breastfeed if chooses formula STEP 5 Follow-up with the mother and baby Monitor growth Check feeding practices Check for signs of illness Discuss feeding for infants 6 to 24 months
4 CARD 1: The risk of mother-to-child transmission USE WITH: All HIV positive woman who are being counselled for the first time ASK: What have you heard about how HIV is passed from mothers to babies? Do you know how many babies get infected through breastfeeding? KEY MESSAGES Women who are HIV infected can pass HIV to their babies by during pregnancy, delivery, or breastfeeding. Not all babies born to HIV-infected woman will become infected. Imagine 20 babies being born to women with HIV. About 13 of those babies will never become infected even if they are breastfed by their mothers until 2 years of age. These are the babies in pink. If no preventive measures are taken, about 4 will be infected through pregnancy and delivery; these are the babies in blue. About 3 will be infected through breastfeeding these are the babies in orange. If a mother breastfeeds her baby exclusively for six months, fewer than one baby of 20 (instead of 3 of 20) will be infected through breastfeeding. If the mother gives replacement milk from birth, 3 babies out of 20 will die before 12 months of other causes like malnutrition, diarrhoea or other common childhood illnesses. The risk of passing HIV through breastfeeding to your baby is higher when you have been recently infected (or re-infected) with HIV, you are at the AIDS stage of the disease, you breastfeed and give other foods and liquids (called mix feeding) at the same time, if you have sores on your nipples, or you breastfeed for a long time (usually more than 18 months or 2 years). There are ways of reducing the risk of HIV transmission to your baby by using ARVs and practicing your chosen feeding option exclusively for six months. It is important to go for PMTCT services to reduce the risk. Your baby can be tested for HIV at 6 weeks of age. Remember to take your baby to the health center for testing. ASK: What questions or concerns do you have about what we have just discussed? REMEMBER : AT EACH FOLLOW UP VISIT DISCUSS THE CHOSEN FEEDING OPTION AND REINFORCE AND SUPPORT THE CHOSEN OPTION WITH RELEVANT INFORMATION.
5 Infected through pregnancy and delivery Infected through breastfeeding Not infected
6 CARD 2: Choices for feeding your baby if you are HIV positive USE WITH: All HIV-positive woman who are being counselled for the first time ASK: What choices do women who are HIV positive have for feeding their babies? KEY MESSAGES There are two ways HIV-positive women can feed their babies during the first 6 months: giving only breastmilk or giving only formula. If you choose to breastfeed, it must be exclusive, which means giving only breastmilk (including expressed breastmilk) without any other food or drink, not even water. However drops or syrups of medicines can be given when medically prescribed. This is the safest way for you to breastfeed your baby for the first 6 months. If you choose to give formula, it means that the baby receives only formula and is never breastfed. Babies under six months do not need water, teas, juice or any other food. Give only medicines that have been prescribed by your health care provider. Whatever choice you make you need to follow for it exclusively until the baby completes 6 months. ASK: What questions or concerns do you have about what we have just discussed? REMEMBER : AT EACH FOLLOW UP VISIT DISCUSS THE CHOSEN FEEDING OPTION AND REINFORCE AND SUPPORT THE CHOSEN OPTION WITH RELEVANT INFORMATION.
8 CARD 3: Benefits of exclusive breastfeeding USE WITH: HIV-positive women who are being counselled for the first time. ASK: What so you see in this picture? What do you think exclusive breastfeeding means? KEY MESSAGES Benefits of breastfeeding: Breastmilk is the perfect food for babies, it has all of the nutrients and water a baby needs.. Breastmilk protects them from many diseases, especially diarrhoea and pneumonia.. Breastmilk is free, always available, and does not need any special preparation. Exclusive breastfeeding for the first few months may lower the risk of passing HIV compared to mixed feeding. Exclusive breastfeeding helps you recover from childbirth and protects you from getting pregnant again too soon. ASK: What questions or concerns do you have about what we have just discussed? REMEMBER : AT EACH FOLLOW UP VISIT DISCUSS THE CHOSEN FEEDING OPTION AND REINFORCE AND SUPPORT THE CHOSEN OPTION WITH RELEVANT INFORMATION.
10 CARD 4: Advantages and disadvantages of commercial infant formula USE WITH: Women who are HIV positive ASK: What have you heard about infant formula? Do you know anyone who has given their baby infant formula? KEY MESSAGES Advantages Giving only formula does not place the baby at risk of HIV infection. Formula is made especially for infants. Formula includes most of the nutrients that an infant needs. Other family members can help feed the infant. If the mother falls ill, others can feed her baby while she recovers. Disadvantages Formula does not have antibodies that protect babies from infection. A baby who is fed formula is more likely to get diarrhoea and pneumonia and may develop malnutrition. It requires a continuous, reliable supply of formula to prevent malnutrition. This can be difficult. Formula is very expensive. Families need soap for cleaning cups and utensils used in preparing the formula. Safe preparation of formula requires clean, boiled water; this also requires fuel. Formula needs to be made fresh for each feed, according to the directions, day and night, unless she has access to a refrigerator. The infant needs to drink from a cup, which may take time to learn. The mother must stop breastfeeding completely or the baby will be at risk of HIV infection. In some settings, the family, neighbours or friends may question a mother who does not breastfeed about her HIV status. The mother may become pregnant again soon ASK: What questions or concerns do you have about what we have just discussed? REMEMBER : AT EACH FOLLOW UP VISIT DISCUSS THE CHOSEN FEEDING OPTION AND REINFORCE AND SUPPORT THE CHOSEN OPTION WITH RELEVANT INFORMATION.
12 CARD 5: Helping a mother decide how best to feed her baby USE WITH: ALL HIV-positive woman who are being counselled for the first time to choose the most appropriate feeding option ASK: the question in the left hand column while pointing to the drawing that corresponds to each question. Her responses to all of these questions can help a woman choose the most suitable method for her situation, after she has learned the advantages and disadvantages of each method. Questions for the mother Breastfeeding Formula Feeding Where do you get your drinking water? River, stream, pond, well Standpipe, tap or buy clean water What kind of toilet do you have? None or pit latrine VIP latrine or flush toilet How much money could you afford for formula, fuel and safe drinking water each month*? Do you have money for transportation to get formula when you run out? Can you prepare each feed with boiled water and clean utensils? How would you arrange night feed? She does not have enough money each month No, sometimes No, sometimes She does have enough money available for formula each and every month Always Always Preparation of formula feeds at night difficult Preparation of milk feeds at night possible Does your family know you are HIV positive? No Yes Is your family supportive of formula feeding and are they willing to help? Family not supportive and not willing to help, or don t know can t discuss BEST FEEDING OPTION Family supportive and willing to help *you will need to know the monthly cost of formula in your community. Based on the answers the mother gives, the health worker should advise her to choose the best method for her situation. Always be supportive no matter what decision she makes. REMEMBER : AT EACH FOLLOW UP VISIT DISCUSS THE CHOSEN FEEDING OPTION AND REINFORCE AND SUPPORT THE CHOSEN OPTION WITH RELEVANT INFORMATION.
14 CARD 6: Understanding exclusive breastfeeding USE WITH: Mothers who have decided to breastfeed their baby. ASK: What so you see in this picture? What does exclusive breastfeeding mean? Why is exclusive breastfeeding important? KEY MESSAGES Breastmilk is the perfect food for babies, it has all of the nutrients and water a baby needs for the first 6 months. Exclusive breastfeeding means giving only breastmilk to a baby for the first six months of life. This means a baby does not receive water, other liquids, or foods, except for medicines and vitamins prescribed by a doctor or nurse. If you give other foods or liquids (including water, juice, teas, other milks) to a baby even in small amounts while breastfeeding, it can increase the risk of HIV infection to your baby. Be sure to hold and attach your baby to the breast properly. Check for sores in your baby s mouth every day and get them treated as soon as possible. Come back if you have any problems with breastfeeding or sore nipples or red, painful breasts. ASK: What questions or concerns do you have about what we have just discussed? Is there any reason why you will not be able to exclusively breastfeed? What are the challenges you expect? How can you overcome those challenges? REMEMBER : AT EACH FOLLOW UP VISIT DISCUSS THE CHOSEN FEEDING OPTION AND REINFORCE AND SUPPORT THE CHOSEN OPTION WITH RELEVANT INFORMATION.
16 CARD 7: How to exclusively breastfeed your baby for the first 6 months USE WITH: Mothers who have decided to breastfeed their baby. ASK: What do you see in this picture? How soon after birth do woman you usually begin breastfeeding? KEY MESSAGES After giving birth, put the baby in skin-to-skin contact and start breastfeeding within the first hour of birth. The first yellowish and watery milk that comes in is very good for your baby. Giving it is like a vaccination and protects your baby from many diseases. Breastfeed your baby day and night and whenever the baby wants to eat. Starting breastfeeding early and breastfeeding your baby often will help your body make enough milk and keep your breasts from getting engorged (swollen). You will know that your baby is getting enough milk if she /he urinates at least six times per day. The urine should be light in colour and not strong smelling. If you choose to breastfeed, it must be exclusive. This means that baby has only breastmilk (no water, teas, juices, food or other milk) for the first 6 months. ASK: What questions or concerns do you have about what we have just discussed? REMEMBER : AT EACH FOLLOW UP VISIT DISCUSS THE CHOSEN FEEDING OPTION AND REINFORCE AND SUPPORT THE CHOSEN OPTION WITH RELEVANT INFORMATION.
18 CARD 8: How to hold and attach your baby for breastfeeding USE WITH: Mothers who have chosen to breastfeed ASK: Can you show me how you would hold your baby when breastfeeding? How would you attach the baby to the breast? KEY MESSAGES It is important to hold and attach your baby correctly when breastfeeding in order to prevent breast problems. Hold the baby close to you, facing the breast, with his/her neck and body straight and supported. Support the breast by holding your fingers against your chest wall below your breast. Your first finger should support the breast, with your thumb above. Do not hold your fingers too close to the nipple. Remember: safer breastfeeding means giving only breastmilk and not giving any other foods or drinks, not even water for the first 6 months. It is important to seek care immediately if there is a problem. This will help your breast health and your baby s survival. REVIEW: The take-home flyers on how to exclusively breastfeed and proper positioning and attachment with the mother. ASK: What questions or concerns do you have about what we have just discussed? What difficulties do you think you might have with exclusive breastfeeding? How can you deal with those difficulties? REMEMBER : AT EACH FOLLOW UP VISIT DISCUSS THE CHOSEN FEEDING OPTION AND REINFORCE AND SUPPORT THE CHOSEN OPTION WITH RELEVANT INFORMATION.
20 CARD 9: Hand expressing breastmilk USE WITH: Women who have chosen exclusive breastfeeding and need to leave their babies for a short time, have mastitis, engorged breasts, babies who are unable to suckle, babies with low birth weight, and breastfeeding women who are transitioning after 6 months. ASK: What do you see in this picture? Have you ever expressed breastmilk? If yes, how? When can it be helpful to express breastmilk? KEY MESSAGES There are many reasons why expressing breastmilk is useful and important for women who are exclusively breastfeeding: To leave milk for your baby if you are going to be away. If your breasts are so swollen that they are uncomfortable and it is difficult for your baby to breastfeed. If your baby was born early, is too small to suckle well, is weak or refusing to suckle. To maintain breastmilk production if you or your baby are sick. To apply to cracked or sore nipples to help them heal. How to express Wash the cup or jar and its cover with warm, clean water and soap. It is best to boil these utensils to make sure they are clean. Wash your hands with soap and clean water before and after expressing milk. Sit or stand comfortably in a quiet, private place. Drink something warm and try to relax. It may help if someone massages your back. Apply a warm clothe to your breasts. Lightly massage them and gently pull or roll your nipples. Put your thumb on the breast above the nipple and areola (coloured area) and your first finger below the nipple and areola. Support your breast with your other fingers. Gently press your thumb and first finger together. Press and release, press and release, in order to start the milk flowing. This should not hurt. It is does, then you are not doing it right. Press the same way on the sides of the areola in order to empty all parts of the breast. Do not squeeze the nipple itself or rub your fingers over the skin. Your fingers should roll over the breast. Express one breast until the flow slows, and then change to the other breast. Then do both breasts again. Change hands when one gets tired. You can use either hand for either breast. Store your expressed breastmilk in a clean, covered container in a cool place until you are ready to feed your baby. Expressed milk can be stored for up to 8 hours in a cool place. [If a mother has a refrigerator, expressed breastmilk can stay for 72 hours.] REVIEW: The take-home flyers on how to hand expressing breastmilk. ASK: What questions or concerns do you have about what we have just discussed? What difficulties might you have with expressing milk? How REMEMBER : AT EACH FOLLOW UP VISIT DISCUSS THE CHOSEN FEEDING OPTION AND REINFORCE AND SUPPORT THE CHOSEN OPTION WITH RELEVANT INFORMATION.
22 CARD 10: How to prepare formula in a hygienic way USE WITH: HIV-positive woman who have chosen exclusive formula feeding for the first 6 months. ASK: What do you see in these pictures? Why do you think she is doing this? Is this something you can do? What are some ways that you can practice good hygiene when preparing formula? KEY MESSAGES Simple ways to practice good hygiene are to: KEEP CLEAN Wash your hands with soap and water before preparing formula or before feeding your child and also after going to the toilet. Wash your child s cup thoroughly with soap and clean, warm water and boil it. Keep food preparation surfaces clean using water and soap or detergent to clean them every day. The baby s dishes and utensils should only be used for feeding the baby. USE SAFE WATER Use water that has been boiled for mixing formula. REVIEW: The brochure, How to feed your baby formula. DEMONSTRATE how to measure and prepare formula. ASK: What questions or concerns do you have about what we have just discussed? What difficulties might you have in preparing formula? How can you deal with those difficulties? REMEMBER : AT EACH FOLLOW UP VISIT DISCUSS THE CHOSEN FEEDING OPTION AND REINFORCE AND SUPPORT THE CHOSEN OPTION WITH RELEVANT INFORMATION.
24 CARD 11: How to feed your baby formula with a cup USE WITH: HIV-positive woman who have chosen to use infant formula ASK: What do you see in this picture? What do you think about how this baby is being fed? Have you ever this done before? KEY MESSAGES If you decide to feed your baby only formula for the first six months, it is best to feed from a cup. This is better than bottle feeding because: It is harder to clean bottles and keep them clean, so they can have many germs that can make your baby sick You have to pay more attention to your baby when you cup-feed than when you use a bottle, and this can help to stimulate and comfort him/her Prepare enough formula for one feed and give that formula to the baby immediately after it is prepared. DEMONSTRATE CUP FEEDING WITH THE MOTHER S BABY OR A DOLL Clean the cup with soap and water before filling it with formula Make sure your baby is awake. Sit in an upright position holding your baby. Put a cloth underneath his/her chin to catch any spills. Hold the cup to the baby s lips and pour it carefully so that the milk touches the lips and swallows. Do not pour the milk quickly or push on the baby s lower lip. Let the baby take the milk at his/her own speed. When the baby closes the mouth and turns away, she/he has had enough. If your baby does not drink very much, offer him/her more at the next feed or feed him/her earlier than usual. Talk to your baby and look into your baby s eyes to show your love. Review: the take-home flyer on cup-feeding with the mother ASK: What questions or concerns do you have about what we have just discussed? What difficulties do you think you might have with cup-feeding? How can you deal with those difficulties? REMEMBER : AT EACH FOLLOW UP VISIT DISCUSS THE CHOSEN FEEDING OPTION AND REINFORCE AND SUPPORT THE CHOSEN OPTION WITH RELEVANT INFORMATION.
26 CARD 12: Infant formula important facts USE WITH: HIV-positive woman who have chosen to use infant formula ASK: What do you see in this picture? Why do you think it is important to follow the instruction for making formula exactly? Have you ever seen formula prepared? If yes, how was it done? KEY MESSAGES If you have decided to give your baby formula, your baby will not need any other foods, liquids, or water for the first 6 months old. Do not breastfeed or give her food, water or any other types of liquids Your baby can become sick or not grow well if she/he does not drink enough formula or if you do not prepare it correctly. If you do not have enough formula, do NOT add more water to make it last longer. Prepare the formula soon before giving it to your baby so that it has time to cool. (Formula should be given within one hour of preparation) Only make enough formula for one feed at a time. Formula that is left out for more than one hour may spoil and make your baby sick. If there is formula left throw it away, do not store it for later. Do not keep formula in a flask. You can keep hot water in the flask to make more formula for each feed. Be sure to check the expiry date on the tin before preparing formula for your baby. Number of Number of Number 500 g tins 450 g tins 400 g tins Month needed per month needed per month needed per month First month Second month Third month Fourth month Fifth month Sixth month ASK: What questions or concerns do you have about what we have just discussed? REMEMBER : AT EACH FOLLOW UP VISIT DISCUSS THE CHOSEN FEEDING OPTION AND REINFORCE AND SUPPORT THE CHOSEN OPTION WITH RELEVANT INFORMATION.
28 CARD 13: Complementary Foods USE WITH: Mothers with babies 6 months of age and older ASK: What do you see in this picture? At what age do babies need to start to eat food in addition to breastmilk? What are the best foods for babies at 6 months? KEY MESSAGES After your baby completes 6 months, start to give a variety of foods in addition to either breastmilk or formula to help your baby grow and develop. If you are breastfeeding, continue to breastfeed on demand during the day and the night. If you are not breastfeeding, continue to give your baby formula. Start with 1-2 spoons of thick porridge, and then begin to add soft, mashed foods. Give your baby more as he or she grows older. By 12 months your baby can eat one cup of food at each meal. As your baby grows, give you baby more foods in addition to breastmilk. Give healthy snacks between meals, such as fruit, yogurt, or peanut butter on bread. If your baby seems thirsty, give water from a cup. Give water after or between meals. If your baby is not breastfed, he or she will need 2 to 4 cups of water each day. ASK: What questions or concerns do you have about what we have just discussed? REMEMBER : AT EACH FOLLOW UP VISIT DISCUSS THE CHOSEN FEEDING OPTION AND REINFORCE AND SUPPORT THE CHOSEN OPTION WITH RELEVANT INFORMATION.
30 CARD 14: Complementary Foods USE WITH: Mothers with babies 6 months of age and older ASK: What do you see in this picture? What foods does your family eat most often? KEY MESSAGES Every day, your baby needs: Fruits and vegetables to protect your baby from illness Orange fruits and vegetables, such as carrots and apricots, and dark green vegetables, such as spinach and other green leafy vegetables are especially good Other fruits and vegetables that are available are pear, cabbage, carrot, pumpkin, tomatoes, peaches, apricots, beet root, oranges, onions, green pepper Meat, milk, beans, nuts and eggs to build muscles Chicken, fish, red meats, pork or liver are very important. Eggs, beans, milk, peanuts, cheese, peas, lentils, and nuts are also very good. Starches for energy Give thick porridges and grains served together with other foods, such as meat, vegetables, or beans. Sorghum, wheat, maize, rice, potatoes, bananas, fermented porridge Oils and fats for brain development Add a spoon of oil (sunflower, vegetable, nut), butter, margarine, or lard to porridges. Pumpkin seeds and mayonnaise can also be given Remember: Avoid giving candy, cakes, and sugary drinks, such as soda, tea, and fruit juices. These foods fill your baby up without giving your baby any important nutrients. Food specially fortified for infants older than 6 months, such as fortified cereals, are very good for your baby. REMEMBER : AT EACH FOLLOW UP VISIT DISCUSS THE CHOSEN FEEDING OPTION AND REINFORCE AND SUPPORT THE CHOSEN OPTION WITH RELEVANT INFORMATION.
32 CARD 15: How to feed your baby after 6 months USE WITH: Mothers with babies 6 months of age and older ASK: What do you see in this picture? What foods does your family eat most often? KEY MESSAGES Give family foods that are mashed or cut into smaller pieces Feed your baby with his or her own bowl and spoon. Allow your baby to feed himself/herself with finger foods Encourage your baby to eat, be patient, and give your baby time. Once your baby stops eating, wait a little, and then offer more. Do not force-feed your baby Introduce one new food at a time. If your baby does not like a food the first time, try preparing it in a different way or try mixing it with breast milk if you have been breastfeeding If your baby does not finish a meal, serve the next meal sooner or give more at the next meal Feed your baby as soon as he or she seems hungry Bring your baby to be weighed once a month to be sure he/she is growing well ASK: What questions or concerns do you have about what we have just discussed? REMEMBER: AT EACH FOLLOW UP VISIT DISCUSS THE CHOSEN FEEDING OPTION AND REINFORCE AND SUPPORT THE CHOSEN OPTION WITH RELEVANT INFORMATION.
34 CARD 16: Keeping food clean and safe USE WITH: Mothers with babies 6 months of age and older ASK: What are ways to keep our children clean and healthy? What are things you do in your home to keep your children and food clean? What are changes you could make to keep your home cleaner and safer? KEY MESSAGES Keep Clean Wash your hands and your baby s hands with soap and running water before preparing food or serving food, after touching raw meat, and after using the toilet or changing diapers. Then let your hands air dry. Wash utensils, bowls, and cups, and kitchen area with hot water and soap. Store food in covered, clean containers off of the ground, away from dirt and insects. Use Safe Food and Water Always boil water before giving it to a baby. Use pasteurized milk. If your infant is younger than 12 months old, boil cow milk before use. Give liquids in a cup without a spout. Avoid using baby bottles. Wash fruits and vegetables in clean water, especially if they are not peeled. Carefully follow the instructions on the box for powdered milk or infant formula. Cook Thoroughly and Keep Food at Safe Temperatures Serve foods immediately after cooking. Prepare only enough food for one meal at a time. If you do not have a refrigerator, store cooked food in a covered container and use within two hours. Leftover food can be stored in a clean, covered container in the refrigerator for up to 24 hours but should be thoroughly reheated before serving. ASK: What questions or concerns do you have about what we have just discussed? REMEMBER : AT EACH FOLLOW UP VISIT DISCUSS THE CHOSEN FEEDING OPTION AND REINFORCE AND SUPPORT THE CHOSEN OPTION WITH RELEVANT INFORMATION.
36 CARD 17: Feeding an HIV-positive baby from 6 to 24 months USE WITH: Mothers and caregivers with babies 6 months of age and older who have tested positive for HIV ASK: What do you see in this picture? KEY MESSAGES After children complete 6 months, they need additional food as well as breastmilk. HIV-positive children need extra energy and nutrients to grow and fight infections, even when the child appears healthy or has a weak appetite Continue breastfeeding for as long as possible Follow the directions of the medical treatment prescribed by the health worker Feed your child 5-8 times per day with nutritious foods and energy-rich foods Give germinated, fermented, or fortified foods when possible Meals should include meat, eggs, milk, or vegetables as well as staple foods, such as maize or porridge Give your child vitamin A drops twice per year. If available, give your child daily micronutrient supplements also Take extra care with food safety and hygiene to avoid infections Your child should be weighed and measured every month to make sure he/she is growing well REMEMBER : AT EACH FOLLOW UP VISIT DISCUSS THE CHOSEN FEEDING OPTION AND REINFORCE AND SUPPORT THE CHOSEN OPTION WITH RELEVANT INFORMATION.
Living and Eating Well Eating Well for Young Children We have many children to feed, Ma. But some are HIV+ve and others HIV-ve. Do they need to eat different food? No, Ma. All children need a good, balanced
Infant and Young Child Feeding National Counselling Cards for Health Workers Acknowledgements The Ministry of Health would like to very sincerely thank the University Research Co., LLC (URC) Nulife Program,
Department of Health Healthy foods and drinks for children aged 1 4 years 13 Growing Strong Feeding you and your baby Great state. Great opportunity. 1 By the time your child is one year old, they should
HIV/AIDS AND NUTRITION agriculture Department: Agriculture REPUBLIC OF SOUTH AFRICA HIV/AIDS AND NUTRITION Eating correctly does make a difference! When your body gets enough of the right food, you will
Day One Nutrition Education and Rehabilitation Program (NERP) Training 1 Exercise 1: Review of Model Family Chart and Food Square Time - 20 minutes To review the elements of the previous training session
What is TB? Do many people get tuberculosis (TB)? Yes, Tuberculosis is a serious problem all over the world. Between 6 and 10 million in South Africa are infected by the TB germ. It is infectious, so it
gestational diabetes my pregnancy, my baby, and me What is Gestational Diabetes? Gestational diabetes occurs when your body cannot make adequate use of sugar in the blood. It is first found during pregnancy.
Patient Education Page 51 Caring for Yourself and Your New Baby Common Concerns About Breastfeeding Breastfeeding is healthy and natural. So are the questions and concerns that come with it. Whether you
Nutrition: General Guidelines for Infants to Toddlers Beginning at 12 months of age: - Between 12 15 months of age, babies will master drinking from a cup and feeding himself/herself with fingers and a
2 A breastfed baby s bowel motions are soft, a bright yellow colour and often very frequent, but each baby is different. Breastfed babies don t usually get constipated, even though some babies only have
F A C T S H E E T 1 Expressing and Storing Breastmilk Learning how to express breastmilk is an important skill for all mothers. Expressing breastmilk allows you to: Rub some milk onto your nipples to keep
The South African Guidelines for Healthy Eating and Food Guide For more information contact: Department of Health. Directorate: Nutrition Private Bag X828; Pretoria 0001. This information pamphlet provides
Cholera Prevention and Control: Introduction and Community Engagement Module 1 Introduction This guide instructs how to prevent cholera illnesses and deaths in your communities. These slides and modules
Guidelines for New Diarrhea Treatment Protocols for Community-Based Healthcare Workers Not yet field-tested Table of Contents Introduction 1 Overview of Diarrhea 1 The Role of the Community-Based Health
Healthy Eating 6 th grade Family & Consumer Sciences What are some reasons we eat? Hunger or Appetite Nutritional Requirements The Need For Energy Our Attitude towards a food Our Emotions The Smell, texture,
NINE TO TWELVE MONTHS When your baby is ready, around nine or ten months, let him feed himself small pieces of soft table foods. You will know he is ready when he can: Chew and swallow small bites of soft,
Feeding Your Baby in an Emergency: For babies aged 0 12 months Introduction Emergencies can happen at any time with little or no warning. Babies are at more risk of becoming dehydrated or getting an infection
Nutrition Topics for WIC Participants and Families BABIES 0-3 MONTHS 4 MONTHS 5-6 MONTHS 7-12 MONTHS WEANING FROM THE BOTTLE TO A CUP NURSING BOTTLE CAVITIES WHEN YOUR BABY IS CONSTIPATED LEAD & NUTRITION
Getting the Help You Need If you have questions or problems, don t wait. Another nursing mother or mothers support group can often help. Your hospital, WIC office, baby s doctor, midwife, or obstetrician/gynecologist
2015 Health Guidelines for Parents with small Children Health Guidelines for Parents with small Children When you are new in a foreign country and have young children, there are often many things which
When your breastfed baby needs extra milk 2 When Your Breastfed Baby Needs Extra Milk When your breastfed baby needs extra milk Occasionally breastfed babies may need to be given extra milk (also called
The Safe Use of Breastmilk Substitutes Contents Know the facts and make an informed decision...1 Combining breastfeeding and formula...2 Commercial formula...2 Types of formula...3 Recalls...4 Choosing
Feeding Baby Infant Formula Introduction The guidelines in this book are for healthy, fullterm babies. Breastfeeding is best for babies. If you are supplementing breast milk or you are not breastfeeding,
Information for patients Breastfeeding for mothers with diabetes Jessop Wing This leaflet has been written to help answer some of the questions mothers ask about how their diabetes may affect the breastfeeding
Feeding Baby Infant Formula Introduction The guidelines in this book are for healthy, fullterm babies. Breastfeeding is best for babies. If you are supplementing breast milk or you are not breastfeeding,
Healthy eating for toddlers Toddlerhood is a time where children learn about new foods and where life long eating habits are often established. To help children grow up to be healthy adults, it is important
Feeding Your Baby Infant Formula Feeding Your Baby Infant Formula Infant formula is made for babies who are not breastfed. There are many reasons why some mothers don t breastfeed. If you have feelings
Living and Eating Well Eating Well on Anti-Retrovirals (ARVs) for Adults This booklet will give you important information about how to eat better and manage your health through nutrition when you are on
Vegetarian Diet Throughout the Life Cycle: Infancy to Teenager Years Before your child or family decides to change to a vegetarian diet, it is important to know that all vegetarian diets are not alike.
Yorketown Community Children s Centre Food Safety and Healthy Eating Policy Policy Number 1 Link to CCQA Principles Family Day Care Quality Assurance (FDCQA) Quality Practices Guide (2004) Principle 4.2
University College Hospital How to get enough iron in your child s diet Information for parents and guardians Department of Nutrition & Dietetics (Paediatrics) If you would like this document in another
Local Contact Baby s first foods To order this publication and others, visit www.health.wa.gov.au/ordering This document can be made available in alternative formats on request from a person with a disability.
01 Balanced diet The Eatwell Plate What is a balanced diet? Your balanced diet will be specific to you it will depend on your age, your body weight and your gender. It also depends on how active you are.
Infant formula How you feed your baby is an important decision. York Region supports all families by providing information based on facts. This will help you make an informed decision. Preparing and storing
This booklet was developed by: The Department of Nutrition and Dietetics St George s Hospital NHS Trust Blackshaw Road London SW17 0QT 020 8725 2036 High energy foods Created by: Department of Nutrition
How to prepare your baby s bottle Cleaning and Sterilising Using or storing sterilised bottles Preparing a bottle feed Storing and warming feeds Feeding your baby Crèches, childminders and other childcare
Healthy Eating During Pregnancy Pregnancy is a time of great change. Your body is changing to allow your baby to grow and develop. Good nutrition will help you meet the extra demands of pregnancy while
How to Feed Your Baby with Infant Formula How to Feed Your Baby with Infant Formula has been developed for parents who have made an informed decision to feed their baby with infant formula. It tells you
High-iron diet What is iron? Iron is a mineral found in every cell of the human body. Iron helps to carry oxygen from our lungs, around our bodies, to our brain and our muscles. This helps to keep us physically
Supporting School Food Guidelines information for parents and caregivers HEALTHY STUDENTS HEALTHY SCHOOLS 2008 3 Healthy choices available in our schools This brochure provides parents and caregivers with
DURHAM REGION HEALTH DEPARTMENT Feeding Your Baby Formula What s Inside Choosing an Infant Formula... 3 Amount of Formula Babies Need... 5 Preparing Infant Formula... 6 Choosing the Right Water...6 Types
CHAPTER 4 Nutrition 51 Learning About Nutrition Nutrition Nutrition is how the body uses food to stay healthy. Good nutrition means that the body gets enough of the foods it needs to stay healthy. Poor
What is iron? Iron deficiency in children (8 years or younger) Iron is a mineral found in food that your body needs. It is bound to hemoglobin, which is an important part of red blood cells. Iron helps
Suggested Open Ended Questions Suggested Affirming Statements Suggested Nutrition Education Statements Caregiver: How did your baby s last check-up go? Primary Feeding: Tell me about the kind of formula
Iron Deficiency Anaemia Iron deficiency anaemia is a common type of anaemia that develops due to insufficient iron. Iron is necessary to make haemoglobin, a substance in red blood cells that enables them
Feeding Guide First feedings When starting solid foods, introducing your baby to one new food for three to five days at a time is a good way to check for allergic reactions. Most pediatricians recommend
Nutrition, Feeding Guidelines, and Vitamins in Infants & Toddlers Presented By Annie Mack MD Pediatrics / Internal Medicine 1 Objectives Discuss feeding guidelines When and how to start solids in infants
Making Healthy Food Choices Section 2: Module 5 1 Nutrition For Health What is healthy Tips on planning meals Making a shopping list/ Bulk orders Using WIC foods Cook and freeze What foods to choose How
HEALTHY EATING, HEALTHY LIVING IN THE UNITED STATES A Nutrition Education Flip Chart U.S. COMMITTEE FOR REFUGEES AND IMMIGRANTS Flip Chart Prepared by: U.S. Committee for Refugees and Immigrants Food and
NUTRITION & EXERCISE DURING PREGNANCY Preparation for pregnancy A mother brings to her pregnancy, all of her previous life experiences; diet, food habits, attitudes. Birth defects occur before the 10th
Infant Formula Feeding Formula Feeding Breast milk has many important advantages for a baby. Commercial formulas provide the next best alternative. If you decide to use infant formula, this handout has
10 Steps to Baby Friendly Care Dear Family, Truman Medical Center Hospital Hill is committed to wellness for our patients and community. We believe wellness begins at birth and have adopted the Baby Friendly
2 The symptoms of HIV infection Saleema s story HIV infection and HIV disease The first weeks of HIV infection The quiet stage of HIV infection The beginning of HIV disease Answering Saleema s questions
GUIDELINES FOR CONSISTENCY MODIFICATIONS OF FOODS AND LIQUIDS 1. Alterations to the consistency of foods and/ or liquids presented to the individual are made in accordance with the recommendation of an
These are general guidelines to help improve blood sugar levels. Talk to your dietitian about how they fit into your specific kidney diet. Foods are made up of protein, fat and carbohydrate. Protein (meat
Healthy eating for breastfeeding mothers Healthy eating is important when you are breastfeeding. Your body has a greater need for most nutrients. Some of the extra energy required for breastfeeding comes
Ear Gastroenteritis Infections gastroenteritis Gastroenteritis can be caused by many different germs, and the effects of gastro on babies and children depend on several things including: the age of the
SS-207-06 For more information, visit the Ohio Department of Aging web site at: http://www.goldenbuckeye.com and Ohio State University Extension s Aging in Ohio web site at: http://www.hec.ohio-state.edu/famlife/aging
BASIC NUTRITION: GUIDELINES FOR BALANCED MEALS AND SPECIAL DIETS LESSON PLAN Lesson Overview Time: One Hour This lesson covers the basics of good nutrition, recommendations for a balanced diet, and special
Breastfeeding Works! How to Meet the Needs of Breastfed Babies in Child Care Massachusetts Department of Public Health Bureau of Family and Community Health Nutrition and Physical Activity Unit WIC Nutrition
Preparation of Infant Formula Feeds and Formula Feeding Away From Home Information for parents who choose to bottle feed their baby Excellent Care with Compassion 2 Breast milk is the best food for babies.
Making Milk for Your Baby Mother s milk, time-tested for millions of years, is the best nutrient for babies because it is nature s perfect food. Robert Mendelsohn Making milk for your baby is one of the
Nutritional Glossary This glossary provides nutrition information about the nutrients commonly found in fruits, vegetables, and other plant foods Each glossary definition has a long and a short version.
1-2 week old check-up Patient and Family Education This teaching sheet contains general information only. Talk with your child s doctor or a member of your child s healthcare team about specific care of
Diet for Oral Surgery/Wired Jaw After oral surgery no chewing is allowed for a period of 4-8 weeks. During this time you will need a blenderized or liquid diet. This pamphlet will help you to get adequate
Infant Formula (Breastmilk Substitute) Feeding Congratulations on your new baby! If you have made an informed decision not to breastfeed, this handout will provide you with information on the safe preparation
Florida Department of Health WIC Program This institution is an equal opportunity provider. 1/2016 1 EBT stands for Electronic Benefits Transfer. EBT is a simple, secure, and convenient way to buy your
Eating and Drinking for Action Your body needs fuel and ﬂuids to stay alive and to allow your muscles to work during exercise. You get fuel and ﬂuid from the foods and drink you take in everyday. Energy,
Packing a Safe & Healthy Lunch for School Educational programs of the Texas A&M AgriLife Extension Service are open to all people without regard to race, color, sex, disability, religion, age, or national
PTOTS Child Feeding and Physical Activity Knowledge, Belief and Attitudes Questionnaire This survey is about child feeding and physical activity. It has been developed to help us understand your knowledge,
Iron TEEN GIRLS need almost 30% more than boys! Iron Quiz 1. Are you female? 2. Do you avoid red meat? 3. Are you trying to lose weight by eating less? 4. Do you often skip meals? 5. Do you drink tea or
Healthy Menu Planning Please save paper and print the pages of this resource back-to-back! Table of Contents Considerations for Planning Menus... 4 Menu Planning Principles... 4 Menu Cycling...5 Guidelines
70 Feeding Infants 10 Sanitary Food Preparation & Safe Food Handling Babies are more susceptible to bacteria than older children, and unsanitary food conditions can cause serious infections. General cleanliness,
MEAL PLANNING FOR MECHANICAL SOFT DIET Definition of Terms Calories Protein Blenderized Pureed Units of energy. A nutrient used by your body for growth and repair. The best sources are milk, meats, fish,
Feeding Your Baby Infant Formula Feeding Your Baby Infant Formula Infant formula is made for babies up to 12 months who are not breastfed. There are many reasons why some mothers don t breastfeed. If you
Maternal, Infant, and Young Child Nutrition in Malawi Community Nutrition Workers COUNSELING CARDS DECEMBER 2011 This document was produced through support provided by the United States Agency for International
Community Health Worker Training Materials for Cholera Prevention and Control U.S. Department of Health and Human Services Centers for Disease Control and Prevention v2.0 CS218556 Table of Contents Community
How to prepare your baby s bottle feed New Safety Advice Powdered infant formula is not sterile. It may contain bacteria that can make your baby sick. You can reduce the risk to your baby if you prepare