Key and Supporting Messages

Transcription

1 Key and Supporting Messages Counselling Cards For Community Volunteers

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3 Positive Counselling Skills Positive Counselling Skills are important for all community volunteers. Listening and learning skills 1) Use helpful non-verbal communication: Keep head level with caretaker(s) Pay attention Reduce physical barriers Take time Touch appropriately Positive Counselling Skills Positive Counselling Skills are important for all community volunteers. Listening and learning skills 1) Use helpful non-verbal communication: Keep head level with caretaker(s) Pay attention Reduce physical barriers Take time Touch appropriately 2) Ask open questions 3) Use responses and gestures that show interest 4) Reflect back what the caretaker says 5) Avoid using judging words General counselling guidelines Organise your counselling tools before beginning a counselling session. Use the appropriate counselling cards that are needed. Listen to the concerns of the caretaker(s). Greet the caretaker(s) and establish confidence. Praise what the caretaker(s) are doing right. If the woman is pregnant, refer to counselling cards and leaflet on Identify feeding difficulties, if any, and causes of the difficulties. maternal nutrition (Card 1) and the cards on early initiation (Card 2) and exclusive breastfeeding (Card 4). Observe baby and caretaker(s). All pregnant and lactating women should be counselled with Cards Answer questions that caretaker(s) have (if any). 13 and 14, explaining the risks of passing HIV to the baby. All Discuss with the caretaker(s) different feasible options to overcome mothers should be encouraged to have an HIV-test and to disclose the difficulties. their status. Present options and help the caretaker(s) select one that they are If she has an infant less than 2 years old, ask the caretaker about the willing is most appropriate given her own Special Situation. age of her baby and current feeding practices. Use the counselling cards that correspond with the age of the child and also the cards that discusses the next development stage (Cards 7, 8, 9 and 10). 2) Ask open questions 3) Use responses and gestures that show interest 4) Reflect back what the caretaker says 5) Avoid using judging words General counselling guidelines Organise your counselling tools before beginning a counselling session. Use the appropriate counselling cards that are needed. Greet the caretaker(s) and establish confidence. If the woman is pregnant, refer to counselling cards and leaflet on maternal nutrition (Card 1) and the cards on early initiation (Card 2) and exclusive breastfeeding (Card 4). All pregnant and lactating women should be counselled with Cards 13 and 14, explaining the risks of passing HIV to the baby. All mothers should be encouraged to have an HIV- test and to disclose their status. If she has an infant less than 2 years old, ask the caretaker about the age of her baby and current feeding practices. Use the counselling cards that correspond with the age of the child and also the cards that discusses the next development stage (Cards 7, 8, 9 and 10). Listen to the concerns of the caretaker(s). 1

4 Praise what the caretaker(s) are doing right. Identify feeding difficulties, if any, and causes of the difficulties. Observe baby and caretaker(s). Answer questions that caretaker(s) have (if any). Discuss with the caretaker(s) different feasible options to overcome the difficulties. Present options and help the caretaker(s) select one that she is willing is most appropriate given her own Special Situation. 2

5 Counselling Card 1 Maternal Nutrition during Pregnancy and Breastfeeding Key Messages: Eat one extra meal a day during pregnancy in addition to regular meals, and two extra meals during breastfeeding. Eat plenty of fruits and vegetables with every meal. Card 1 Drink enough liquids every day (8 glasses or 3 full NICE cups). Avoid taking tea or coffee with meals because they interfere with iron absorption and may contribute to aneamia. It is better to drink tea or coffee an hour before or after a meal. Throughout your pregnancy and for at least 3 months after your baby is born you need iron and folic acid to prevent anaemia. It is better to take iron tablets with meals to increase absorption and avoid potential side effects, particularly nausea. Always use iodised salt to prevent poor brain development, poor physical growth and goiter. Iodised salt also protects against unexplained abortions, miscarriages and stillbirths. Get a vitamin A capsule from the nearest health facility and take immediately after delivery or within 8 weeks to help build your baby s immune system through your breast milk. Take de-worming tablets as prescribed to treat worms and to prevent anemia. Do not use alcohol, narcotics or tobacco products. 3

6 Sleep under an insecticide-treated mosquito net to prevent malaria. Take antimalarials as prescribed by a health worker. Attend antenatal care at least four times during pregnancy and always follow your health worker s recommendations. Special note for the adolescent mother: Before the age of 18 your body is still growing. You need extra care, more food and more rest than an older pregnant or breastfeeding mother to enable your body to grow fully and ensure that it produces enough milk for your baby. 4

7 Counselling Card 2 Early Initiation of Breastfeeding Key Messages: Putting a baby on the breast immediately after birth provides the best start for your baby and can save his or her life. Immediate skin to skin contact provides warmth and promotes bonding. As soon as your baby is born, have the midwife put the naked baby between your breasts, cover him or her lightly and keep the baby there for at least one hour. Let the baby on your chest start suckling when he or she starts showing signs of interest. Card 2 Put your baby on the breast within one hour of birth to help expel the placenta and reduce bleeding. Breastfeeding while the breast is still soft helps a baby learn to suckle. The thick yellowish milk known as colostrum is very healthy and helps protect your baby from illness. Colostrum will help to expel your baby s first dark stool. Water or pre-lacteals (sugar water or liquids/fluids) are NOT necessary and dangerous. They cause a delay in your milk coming in (or start flowing). Even though your baby feeds for short periods of time, this small amount of milk is enough. During these early hours, feed your baby often (every 1 1/2 to 2 hours) for short feeding times. Frequent feeding will help your milk to flow sufficiently over the next few days. 5

8 Counselling Card 3 Positioning and Attachment Key Messages: Correct positioning and attachment help to ensure that the baby suckles well and the mother produces a good supply of breast milk. Cradle position Cross cradle for Cross position Lying down Under arm small Infants for twins position Under arm position for twins Correct positioning and attachment help to prevent sore and cracked nipples. Positioning Ensure that your baby is well-positioned by baby s: tummy facing your tummy head and body in line whole body supported nose facing the nipple Your baby should be able to look up at your face. The baby should not be held flat to the mother s chest or abdomen. Card 3 You should hold your breast with your fingers in a C shape, the thumb being above the dark part of the breast (areola) and the other fingers below. Fingers should not be in scissor hold because this method tends to put pressure on the milk ducts and can take the nipple out of the infant s mouth. There are different ways to position the baby: Cradle position (most commonly used) Cross cradle position (suitable for small infants) Side-lying position (can be used right after delivery, to rest while breastfeeding or at night) Under-arm position (best used after a Caesarean section, when the nipples are painful and to breastfeed twins or small infants) 6

9 Attachment When you first begin to breastfeed, you may need to help the baby attach well to the breast to avoid hurting your nipples. Touch the baby s lips with your nipple. When the baby s mouth opens wide, move the baby quickly onto the breast, aiming the lower lip slightly below the nipple. The baby s tongue should be over the bottom gums. If the baby is in a poor position, or if you feel any pain, then gently take the baby off the breast and start again. Check that your baby is feeding well by seeing that the baby s: mouth is wide open and has most of the darker skin (areola) in his or her mouth lower lip is turned outward chin is touching the breast cheeks are rounded taking slow deep sucks, sometimes pausing You may also hear the baby swallowing. Let your baby empty one breast first and come off the breast on his or her own. This will ensure that your baby gets the most nutritious and satisfying milk. If still hungry, offer your baby the other breast. 7

10 Counselling Card 4 Exclusive Breastfeeding for the First 6 Months Card 4 Key Messages: Feeding the baby ONLY breast milk up to 6 months helps a mother to recover from child birth and protects her from getting pregnant too soon. Do not give anything else, NOT even water (nor tea, glucose water, gripe water, other animal milks, infant formula or porridge). Resist pressure from others. Even if you work outside home you can maintain exclusive breastfeeding (Card 17). If the mother is complaining about lack of breast milk go to Card 5. Breast milk provides all the food and water a baby needs during the first 6 months of life. The thick yellowish milk known as colostrum that is produced during the first few days after delivery is very important because it protects your baby from many diseases. Do not give any food or drink to your newborn baby, the yellowish milk is enough. Giving something else than breast milk will interfere with breast milk production. Even during very hot weather, breast milk will satisfy the baby s thirst during the first 6 months. The mother may need additional water to satisfy her own thirst. If the baby takes water or other liquids, she or he suckles the breast less and the mother produces less milk. This leads to poor growth. 8

11 Breastfeeding the baby often, at least 10 times, day and night, helps to produce lots of breast milk to ensure that the baby grows healthy. Breastfeeding protects the baby from diarrhoea and respiratory infections. Breast milk is inexpensive, always available and does not need any preparation. 9

12 Counselling Card 5 Feeding more often Increases Your Breast Milk Supply Key Messages: Card 5 Note for the community volunteer: Many mothers think they are not producing enough breast milk. If a mother expresses this concern, it is important to ask questions to find out the following: (Ask to see the GPM card) Is the baby gaining weight following the growth curve? Is the baby having at least 6 wets in 24 hours? Is the baby relaxed and satisfied after feeds, or frustrated and crying? (If the baby is under 6 months) Is the baby receiving anything else than breast milk? Ask the mother to do the following: Breastfeed frequently, 12 times a day if the baby wants. (If the baby has been receiving other foods) Stop giving the other foods. This will make your baby suckle more and increase your milk production. Breastfeed day and night. Encourage longer breastfeeds If the baby is ill or sleepy, encourage the mother to wake him or her and offer the breast often. Encourage the mother to give the breast for comfort. Observe positioning and attachment of the baby and correct accordingly (Refer to Card 4). Encourage support from the family to perform household chores. Avoid bottles, teats and spouted cups. 10

13 Counselling Card 6 How to Hand Express Breast Milk Key Messages: Wash your hands with soap and running water. Make sure the container you will use to express your breast milk is clean. Sit or stand in a comfortable position, in a quiet place. Use any hand for either breast. Put your thumb on the breast above the dark area around the nipple. Place your first finger below the nipple and the dark area. Support your breast with your remaining fingers. Compress the breast while moving your hand away from the chest wall. This should not hurt. If it does, then you are not doing it right. Press the same way on each side of the dark area around the nipple in order to empty all parts of the breast. Do not squeeze the nipple itself or rub your fingers over the skin Express one breast for 3 to 5 minutes until the flow slows down and then switch to the other breast. Then do each breast again. Change your hands when the one hand gets tired. It usually takes 20 to 30 minutes to express all of the milk. If your milk does not come easily, massage your breasts. A warm cloth or drink, a back massage or thinking about your baby might also help. Store your expressed breast milk in a clean covered container until you are ready to feed your baby. Expressed milk can be stored for up to 8 hours in a cool place. Always feed the baby using a clean open cup. Even a newborn baby learns quickly how to drink from a cup. DO NOT use bottles, teats or cups with a mouth piece. They are difficult to clean and can cause your baby to become sick. 11 Card 6

14 Counselling Card 7 Complementary Feeding 6 months 6 months Key Messages: At about 6 months, your baby is developmentally ready and needs other foods in addition to breast milk. Card 7 Continue breastfeeding your baby on demand, day and night to maintain his or her health and strength as breast milk continues to be the most important part of your baby s diet. Always give breast milk first before giving other foods. HIV positive mothers who have decided to stop breastfeeding should feed their babies at least 1 full NICE cup of milk every day. (A full NICE cup is 500 ml.) Think of the following characteristics when giving complementary foods to your baby: F = Frequency, A = Amount, T = Thickness (consistency), V = Variety (different kinds of foods), A = Active/responsive feeding, and H = Hygiene (FATVAH). F Feed your baby 3 times a day. A Start with 2-3 heaped tablespoons per feed. T/V Introduce soft food (mashed potato, mashed banana, porridge). Be careful not to make the baby s food too thin. A Be patient and actively encourage your young child to eat. Use a separate plate for the child to make sure he or she eats all the food given. H To give water and any liquid foods always use a clean open cup. DO NOT use bottles, teats or spouted cups to feed your baby. They are very difficult to keep clean and can make your baby sick with diarrhoea. Foods given to the baby must be prepared in hygienic conditions to avoid diarrhoea and illness. 12

15 Counselling Card 8 Complementary Feeding 7-8 months Key Messages: 7-8 months Complementary Feeding from Months Continue breastfeeding your baby on demand, day and night to maintain his or her health and strength as breast milk continues to be the most important part of your baby s diet. Card 8 When feeding a baby between 7-8 months old always give breast milk first before giving other foods. HIV positive mothers who have decided to stop breastfeeding should feed their babies at least 1 full NICE cup of milk every day. (A full NICE cup is 500 ml.) Think of the following characteristics when giving complementary foods to your baby: F = Frequency, A = Amount, T = Thickness (consistency), V = Variety (different kinds of foods), A = Active/responsive feeding, and H = Hygiene (FATVAH). F Feed your baby 3 times a day. A Gradually increase the amount of food at least one-third (1/3) of a NICE cup. (A full NICE cup is 500 ml.) Babies have small stomachs and can only eat small amounts at each meal. T Mash and soften the foods so the baby can easily chew and swallow; breastmilk or animal milk can be used to prepare the soft food, do not add water. Be careful not to make the baby s food too thin. T Thicken the baby s food as the baby grows older, making sure that he or she is still able to easily swallow without choking. 13

16 V Every day, or as often as possible, your baby needs at least a small bit of a food from each of the following groups : a) Millet flour, sorghum flour, maize flour, potatoes, matooke etc. b) Fresh or dry beans, peas c) Meat, chicken, fish or eggs d) Vegetables like dark green vegetables (dodo, nakati, buga) and tomato, eggplant, carrot, cabbage etc. e) Fruits like passion fruit, mango, pawpaw, orange, banana, watermelon, pineapple, avocado etc. f) Oil or ghee A Be patient and actively encourage your young child to eat. Use a separate plate for the child to make sure he or she eats all the food given. H To give water and any liquid foods always use a clean open cup. DO NOT use bottles, teats or spouted cups to feed your baby. They are very difficult to keep clean and can make your baby sick with diarrhoea. Foods given to the baby must be prepared in hygienic conditions to avoid diarrhoea and illness. Examples of Balanced Baby Foods A thick porridge is made out of a flour of either maize or cassava or millet or soya. Sugar, oil, milk, groundnuts, eggs and fruits can be mixed into the porridge. Mashed food is a mixture of a food like matooke, potatoes, cassava, posho (maize or millet) and fish, meat, beans or groundnut and/or simsim paste. Also vegetables like greens, pumpkin, carrot, eggplant, avocado or tomato should be mixed in the baby food. 14

17 Counselling Card 9 Complementary Feeding 9-11 months Key Messages: Continue breastfeeding your baby on demand, day and night to maintain his or her health and strength as breast milk continues to be the most important part of your baby s diet months Complementary Feeding from Months Card 9 When feeding a baby between 9-11 months old always give breast milk first before giving other foods. HIV positive mothers who have decided to stop breastfeeding should feed their babies at least 1 full NICE cup of milk every day. (A full NICE cup is 500 ml.) Think of the following characteristics when giving complementary foods to your baby: F = Frequency, A = Amount, T = Thickness (consistency), V = Variety (different kinds of foods), A = Active/responsive feeding, and H = Hygiene (FATVAH). F From 9 months onwards, feed your baby 4 times a day (3 meals and 1 snack). Snacks: extra foods between meals that are easy to prepare these extra foods are in addition to the meals they do not replace meals good snacks provide energy and nutrients (not to be confused with sweets) most snacks can be eaten as finger foods such as pieces of ripe mango, pawpaw, banana and vegetables A Give your baby a little more than one-third (1/3) of a NICE cup at each feed. (A full NICE cup is 500 ml.) Babies have small stomachs and can only eat small amounts at each meal. T Mash and soften the foods so the baby can easily chew and swallow; breastmilk or animal milk can be used to prepare the soft food, do not add water. Be careful not to make the baby s food too thin. 15

18 T Thicken the baby s food as the baby grows older, making sure that he or she is still able to easily swallow without choking. V Every day, or as often as possible, your baby needs at least a small bit of a food from each of the following groups : a) Millet flour, sorghum flour, maize flour, potatoes, matooke etc. b) Fresh or dry beans, peas c) Meat, chicken, fish or eggs d) Vegetables like dark green vegetables (dodo, nakati, buga) and tomato, eggplant, carrot, cabbage etc. e) Fruits like passion fruit, mango, pawpaw, orange, banana, watermelon, pineapple, avocado etc. f) Oil or ghee A Be patient and actively encourage your young child to eat. Use a separate plate for the child to make sure he or she eats all the food given. H To give water and any liquid foods always use a clean open cup. DO NOT use bottles, teats or spouted cups to feed your baby. They are very difficult to keep clean and can make your baby sick with diarrhoea. Foods given to the baby must be prepared in hygienic conditions to avoid diarrhoea and illness. Examples of Balanced Baby Foods A thick porridge is made out of a flour of either maize or cassava or millet or soya. Sugar, oil, milk, groundnuts, eggs and fruits can be mixed into the porridge. Mashed food is a mixture of a food like matooke, potatoes, cassava, posho (maize or millet) and fish, meat, beans or groundnut and/or simsim paste. Also vegetables like greens, pumpkin, carrot, eggplant, avocado or tomato should be mixed in the babyfood. 16

19 Counselling Card 10 Complementary Feeding months Key Messages: Continue breastfeeding your young child on demand, day and night to maintain his or her health and strength months Complementary Feeding from Months Card 10 In your young child s 2nd year, breastmilk continues to make up 1/3 of his or her diet. HIV positive mothers who have decided to stop breastfeeding should feed their babies at least 1 full NICE cup of milk every day. (A full NICE cup is 500 ml.) Think of the following characteristics when giving complementary foods to your baby: F = Frequency, A = Amount, T = Thickness (consistency), V = Variety (different kinds of foods), A = Active/responsive feeding, and H = Hygiene (FATVAH). F From 12 months onwards, feed your young child 5 times a day (3 meals and 2 snacks). Snacks extra foods between meals that are easy to prepare these extra foods are in addition to the meals they do not replace meals good snacks provide energy and nutrients (not to be confused with sweets) most snacks can be eaten as finger foods such as pieces of ripe mango, pawpaw, banana and vegetables A Give your young child one-half (1/2) of a NICE cup at each feed. (A full NICE cup is 500 ml.) T The child can eat family foods but make sure to cut the food into small pieces so that the young child can easily chew and swallow. 17

20 T Thicken the young child s food as the child grows older, making sure that he or she is still able to swallow easily without choking. V Every day, or as often as possible, your baby needs at least a small bit of a food from each of the following groups (V): a) Millet flour, sorghum flour, maize flour, potatoes, matooke etc. b) Fresh or dry beans, peas c) Meat, chicken, fish or eggs d) Vegetables like dark green vegetables (dodo, nakati, buga) and tomato, eggplant, carrot, cabbage etc. e) Fruits like passion fruit, mango, pawpaw, orange, banana, watermelon, pineapple, avocado etc. f) Oil or ghee A Be patient and actively encourage your young child to eat. Use a separate plate for the child to make sure he or she eats all the food given. H To give water and any liquid foods always use a clean open cup. DO NOT use bottles, teats or spouted cups to feed your baby. They are very difficult to keep clean and can make your baby sick with diarrhoea. Foods given to the baby must be prepared in hygienic conditions to avoid diarrhoea and illness. 18

21 Counselling Card 11 Feeding the Sick Child Less than 6 months Less than 6 Months Breastfeed more during illness. This will help your baby to fight sickness, recover more quickly and not lose weight. Breastfeeding also provides comfort Card 11 to a sick baby. If your baby refuses to breastfeed, continue to encourage your baby until he or she takes the breast again. Give only breast milk and prescribed medicines to your baby. If your baby has been very ill, you may need support to re-establish exclusive breastfeeding. If the baby is too weak to suckle, express breastmilk to give the baby, either by cup or by hand expression directly into the baby s mouth. This will also help the mother to keep up her milk supply and prevent breast swelling. Practice exclusive breastfeeding from 0-6 months. NOTE: The mother may need support to re-establish exclusive breastfeeding. Feeding after recovery When a baby is recovering from an illness, he or she will breastfeed more than usual.the baby is replacing what he or she lost during illness. This can be tiresome for the mother. Take enough time to actively encourage your child to breastfeed more frequently when his or her appetite has returned. 19

22 Counselling Card 12 Feeding the Sick Child Above 6 months More than 6 Months Increase the frequency of breastfeeding and offer additional food to your child to maintain his or her strength, reduce weight loss and to recover faster. Card 12 Ecourage your child to breastfeed, eat and drink more. A child needs more food and drinks during illness. DO NOT use bottles, teats or spouted cups, since these are difficult to clean. Take time to patiently encourage your sick child to eat as his or her appetite may be decreased because of the illness. Give your child small frequent meals. Feed your child foods that he or she likes in small quantities throughout the day. Offer your child simple foods like porridge and fruits, even if he or she does not express interest in eating. Avoid spicy or fatty foods. Feeding after recovery When a baby is recovering from an illness, he or she will breastfeed and eat more than usual.the baby is replacing what he or she lost during illness. This can be tiresome for the mother. Give him or her one additional meal of solid food each day during the next two weeks after he or she has recovered. This will help your child regain weight lost during the illness. Take enough time to actively encourage your child to eat this extra food and breastfeed more frequently when his or her appetite has returned. 20

23 Counselling Card 13 Risk of Transmission If a mother is HIV positive what is the chance of HIV passing to her baby when NO preventive actions are taken? Card 13 If a Mother If a mother is is HIV-positive... Postive What is the risk of HIV passing to her baby when NO preventive actions are taken? Think of 100 babies born to women with HIV Did you know that about 40 of these babies will get infected if no actions are taken to prevent the spread of HIV from the mother to her child? However the other 60 will not become infected with HIV. Out of 100 babies born to HIV-positive mothers: The majority of babies (60) Most babies (25) become Other babies (15) are are not infected with HIV, infected with HIV during infected with HIV through but should be protected. pregnancy, labor and birth. breastfeeding. Protect your baby Protect get tested your and babyknow your HIV status! get tested and know your HIV status! Of the 40 HIV infected babies, 25 will be infected during pregnancy, labor and delivery and 15 during breastfeeding. An HIV positive woman can pass HIV to her baby during pregnancy, labor, delivery or through breastfeeding. Not all babies born to women with HIV become infected with HIV. Certain factors can increase the chance of passing HIV through breastfeeding for example if you have been recently infected with HIV or if you have an infection in your breast while you are breastfeeding. Mixed feeding (breastfeeding combined with feeding your baby other types of milk or food at the same time) almost doubles the chance of passing HIV to your baby, compaired to exclusive breast feeding. An HIV positive woman should seek treatment from a health worker if she has any infections and prevent HIV re-infection by making choices for safer sex (e.g. use condoms during pregnancy and during breastfeeding). 21

24 Counselling Card 14 Risk of Transmission Card 14 If a Mother If a mother is is HIV-positive... HIV Postive... but mother and baby take ARV S and practice exclusive breastfeeding, the risk of passing HIV to her baby decreases. Key Messages: If a mother is HIV positive what is the chance of passing HIV to her baby when mother and baby take anti-retrovirals and practice exclusive breastfeeding? Out of 100 babies born to HIV-positive mothers who take ARVs: The majority of babies Most of these babies (10) Breastfed babies (5) (85) are not become infected with HIV can become infected. Exclusive infected with HIV. during pregnancy, labor and and safer breastfeeding birth. reduces the risk. Protect your baby get tested and know your HIV status! Protect your babyget tested and know your HIV status! Think of 100 babies born to women with HIV Did you know that if the mother and baby are given ARV S and she practices exclusive breastfeeding the risk of passing HIV to the baby decreases? 85 out of 100 babies will not be infected. Only 10 of the 100 babies will become infected during pregnancy, labor and delivery. Only 5 of the 100 babies will be infected through breastfeeding. However breastfeeding should be done exclusively. HIV transmission can be reduced even more when other preventative actions, like safer delivery, are practised. 22

25 Counselling Card 15 Infant feeding mode and risk of HIV Transmission Key Messages: If you are HIV-positive What is the risk of HIV transmission when you are using: Only Breast Milk Only Replacement Milk (Formula or Cow s Milk) Practicing Mixed Feeding (Breast milk plus other milk, liquids or foods) It is important for you to know that all feeding options have risks for your baby. The reason for discussing these risks is to help you decide how to feed your baby. Card 14 Card 15 Healthy babies Babies who die from diarrhoea Babies with without HIV infection pneumonia and other infection s HIV-infection Protect your baby- get tested and know your HIV status! It is possible to reduce the risk of illness (such as diarrhoea and respiratory infections like pneumonia). These pictures show the kind of risks associated with the different feeding options. It is important for you to understand these risks. Exclusive Breastfeeding (giving ONLY breast milk for the first 6 months): reduces the chance of passing HIV to your baby by half compared with mixed feeding (giving both breast milk and other milks/foods). Exclusive Replacement Feeding (giving ONLY formula or modified fresh animal milk for the first 6 months): there are no chances of HIV infection through breastfeeding, but there are more chances of your baby dying from diarrhoea, pneumonia and other infections. Mixed Feeding (giving both breast milk and other milks or foods): compared to exclusive breastfeeding, mixed feeding greatly increases the chances of passing HIV to your baby. It also increases the chances of your baby suffering from other illnesses and dying because he or she is not protected through breast milk. 23

26 Counselling Card 16 Feeding a Low Birth Weight Baby Note for the community volunteer: Cross Cradle Position Explain the problem of Low Birth Weight: a Low Birth Weight baby needs special care and feeding Card 16 Under Arm Position Kangaroo Care If very small refer for further management If medium size the mother should breastfeed as much as possible. Babies with difficulties in attachment and sucking should be given additional expressed breast milk in an open cup (Use Card 6 for hand expression). The mother needs support for correct attachment. The cross cradle and underarm positions are good positions for feeding low birth weight babies because they allow the mother to better control the positioning of the baby s mouth on the nipple. Direct breastfeeding may not be possible for several weeks, but the mother should be encouraged to express breast milk and feed the breast milk to the infant using a clean open cup. The baby should be put on the breast frequently to get him or her used to the breast and to keep the milk flowing. If the baby sleeps for too long, the caretaker should unwrap and hold him or her to awaken before feeding. The mother should watch baby s sleep and wake cycle and feed during quiet-alert states. Crying is the last sign of hunger. The mother should recognize earlier signs of hunger (including rooting, licking movements, flexing arms, clenching fists, tensing body and kicking legs) and feed the baby. 24

27 Kangaroo Mother Care Different caretakers can care for the baby using the Kangaroo method Position: place the naked baby on the caretaker s naked chest with his or her legs flexed and secure the baby in a cloth that passes just under the infant s ears and is tied around the caretaker s chest. Warmth is needed: keep skin-to-skin contact, both naked cover the baby s head with a hat 25

28 Counselling Card 17 Working Mother and Sick Mother Working Mother Card 17 Note for a working mother with formal employment: According to the Ugandan law, a mother has the right to paid maternity leave of 60 working days, and a father to 4 days of paternity leave. Get your employer s support to : Note for all working mothers: Even when you go back to work you should continue to breastfeed. You can: Express breast milk to be fed to the baby from a cup while you are away Express breast milk at work to keep the milk flow going and to prevent breast swelling If possible, carry the baby to the place of work or have someone bring the baby when you have a break Take extra time for the feeds before leaving for work and when you come back from work Increase the number of feeds while you are around; e.g. increase night and weekend feedings Get extra support Sick Mother: It is very important for the baby to continue to breastfeed for the baby s health and to prevent breast problems. It is important that you continue to eat, even when you do not have appetite. During illness you have an increased need for nutrients. You also need extra food to produce breast milk. Therefore taked extra care in what you eat and how it is prepared. 26

29 Following nutrition advice can be given to a sick mother: Eat a variety of favorite foods Eat small frequent meals Make sure you take more liquids (e.g. water, juice, porridge, soup) Avoid fried foods or strong smelling foods Prepare foods in other ways than usual (e.g. mashed foods, more soups) Avoid foods that cause stomach discomfort Continue eating, even when you have diarrhoea Get extra support Make sure that the person preparing the food washes his or her hands before food preparation Breastfeeding mothers need to: Eat two extra meals a day in addition to regular meals Eat plenty of fruits and vegetables with every meal Drink plenty of liquids every day (8 glasses or 3 full NICE cups) Avoid taking tea or coffee with meals because they interfere with iron absorption and may contribute to aneamia. It is better to drink tea or coffee an hour before or after a meal. 27

30 Counselling Card 18 Regular Growth Promotion and Monitoring Prevents Malnutrition Note for the community volunteer: A healthy child grows well. Any reduced growth shows that something is wrong. Card 18 Infants and young children should gain a certain amount of weight every month. A child should be weighed once every month from birth until he or she is two years old. It is much easier to take corrective action in an early stage of reduced growth than when the child has already become malnourished. If the child does not gain enough weight, try to find out the cause. Discuss the possibility of continuing frequent breastfeeding or relactation where appropriate (Cards 4, 5, 6). If the baby is older than six months, discuss the appropriate complementary foods/ nutrition education using the appropriate age. (Cards 7, 8, 9, 10). If the child has been or is sick, treat the child and discuss the feeding recommendations. 28

31 Counselling Card 19 Good Hygiene Practices prevent Disease Wash your hands with soap (or ash) and running water before preparing food, before eating, and before feeding young children. Good Hygiene Practices Prevent Disease Wash children s hands with soap (or ash) and water before they eat. Card 19 Wash your children s hand s with soap (or ash) and running water after they have passed stool. Wash your hands with soap (or ash) and water after using the latrine or cleaning the baby s bottom. Feed your baby using clean hands, clean utensils and clean cups. DO NOT use bottles, teats or spouted cups, they are difficult to clean and may cause your baby to get diarrhoea. Keep foods in covered container in a clean, cool and dry place. 29

32 INJECTION INJECTION Methods LAM (Exclusive breastfeeding) Ovulation (Observing vaginal wetness) Abstinence (Avoiding intercourse) If a woman exclusively breastfeeds If a woman observes on a daily ditional or (Observing vaginal wetness) Woman or couples can avoid her baby (day and night), she can basis the changes in her vaginal pregnancy if they completely If a woman exclusively breastfeeds ural methods avoid becoming pregnant IF her wetness (mucous or vaginal flow) If a woman observes on a avoid daily sexual intercourse. This AM vulation bstinence Male Condom rier or one-time methods ale condom iaphragm permicide LAM (Exclusive breastfeeding) Ovulation Abstinence (Avoiding intercourse) her baby (day and night), she can avoid becoming pregnant IF her baby is less than six months old Counselling Card 20 and IF her period does not return. baby is less than six months old and IF her period does not return. This method is very secure only up to 6 months. she and her partner will know the days of the month when she must avoid sexual intercourse (penetration). This method is very secure only up to 6 months. (penetration). vagina with the man s penis. Diaphragm Spermicides How Male Condom achieve Diaphragm Optimal Spermicides Child Spacing This is a flexible hat shaped These are temporary methods This is a thin but resistant latex bag that is place over the man s erect penis before each sexual relationship. It prevents the sperm from entering the uterus. Using condoms also helps to reduce sexually transmitted infections (STIs and HIV/AIDS). This is a thin but resistant device, latex made of rubber that is bag that is place over the inserted man s by a woman herself erect penis before each before sexual sexual intercourse to relationship. It prevents the prevent sperm pregnancy. It covers the from entering the uterus. cervix Using so that sperm cannot enter condoms also helps to reduce the uterus. It should be used sexually transmitted infections together with a special gel. (STIs and HIV/AIDS). basis the changes in her vaginal means avoiding sexual wetness (mucous or vaginal relationships flow) or avoiding she and her partner will know penetration the of the woman s days of the month when she must vagina with the man s penis. avoid sexual intercourse Woman or couples can avoid pregnancy if they completely avoid sexual intercourse. This means avoiding sexual relationships or avoiding penetration of the woman s This is a flexible hat shaped (foam or tablets) that a womanthese are temporary methods device, made of rubber that can isplace within her vagina within (foam or tablets) that a woman inserted by a woman herself one hour before having sexual can place within her vagina within before sexual intercourse to relationships in order to help avoid one hour before having sexual prevent pregnancy. It covers pregnancy. the They also have a relationships in order to help avoid cervix so that sperm cannot protective enter effect against STIs. pregnancy. They also have a the uterus. It should be used protective effect against STIs. together with a special gel. Key Messages: Oral Contraceptives Injectables (Depro-Provera porary Oral Contraceptives Injectables ) Norplant (Depro-Provera ) Norplant This is a pill or tablet that a woman This is a medicine that a nurse or This method consists of 6 thin This is a pill or tablet that a woman monal methods takes everyday to avoid This is a medicine that a nurse or This method consists of 6 thin LAM Male Condom doctor Abstinence injects with a needle into tubes of medicine that prevent takes everyday to avoid (Avoiding intercourse) doctor injects with a needle into pregnancy. They tubes of medicine that prevent (Exclusive also help breastfeeding) to the arm or buttocks of the woman pregnancy. They are inserted in pregnancy. They also help to the arm or buttocks of the woman pregnancy. They are inserted in ral contraceptives regulate menstrual disorders. Oral to avoid pregnancy. Each infection a woman s upper arm by a trained regulate menstrual disorders. Oral to avoid pregnancy. Each infection a woman s upper arm by a trained contraceptives usually come in lasts 3 months. Injectables can health care provider. Protection njectables contraceptives usually come in lasts 3 months. Injectables can health care provider. Protection cartons of 28 pills. Some pills are cartons of 28 pills. Some be pills used are by women who are be used by women who are lasts up to 5 years, but the tubes lasts up to 5 years, but the tubes orplant made for women who are made for women who are breastfeeding. breastfeeding. can be taken out at any time. can be taken out at any time. breastfeeding. breastfeeding. Injectables Oral Contraceptives Implants manent Female or Sterilization Female (Depro-Provera ) Sterilization Male Sterilization Male Sterilization IUCD (Copper T) IUCD (Copper T) This is a simple and very secure This is a simple and very This secure is a simple and very secure This is a simple and very secure This method is a small device This method is a small device g-term methods operation for women who don t operation for women who operation don t for men who don t want operation for men who don t inserted want into the woman s uterus inserted into the woman s uterus want to have any more children. want to have any more to children. have any more children. It takes to have any more children. It takes by a trained service provider. It is emale sterilization by a trained service provider. It is It takes less than 20 minutes. The It takes less than 20 minutes. less than The 15 minutes. The man less than 15 minutes. The made man of plastic and copper, in the made of plastic and copper, in the ale sterilizationwoman goes home within 2 to 6 woman goes home within goes 2 to home 6 within 2 to 4 hours. goes home within 2 to 4 hours. form of a T. It can protect a form of a T. It can protect a hours. Sexual relations do not hours. Sexual relations do Sexual not relations do not change. Sexual relations do not change. woman for up to 10 years or woman for up to 10 years or UCD change and the woman continues change and the woman continues more, but can be removed at any more, again but can be removed at any to have her period. Tubal Ligation to have Vasectomy her period. IUD time. time. Optimal child spacing means: having your children 3 to 5 years apart waiting at least 6 months after stopping to breastfeed to get pregnant Card 20 Optimal child spacing promotes child survival through having: more time to breastfeed and care for your child more money for child care because you will have less school fees to pay, less clothes to buy, less food to buy etc. more time for your body to recover and prepare for the next pregnancy Feeding your baby only breast milk for the first 6 months helps to space births in a way that is healthy for you and your baby. By exclusively breastfeeding your baby for the first six months you can prevent pregnancy only if: you feed the baby only breast milk your baby is less than 6 months old your menstrual period has not returned This child spacing method is called LAM. If any of these three conditions change, you are no longer protected against pregnancy. Note for the community volunteer : When dealing with an HIV-positive mother: She should consider taking care of this child and avoid getting pregnant again. Depending on LAM only is not enough. She should use condoms to prevent re-infection and to prevent infecting her partner. 30

33 Counselling Card 21 When to take your Child to a Health Facility Young children can become suddenly ill and may need to be seen urgently by a health worker. Difficulty breathing Diarrhoea Take your child to a health worker if Refusal to feed Vomiting Fever Malnutrition he or she shows any of the following Card 21 signs: Fever ( possible risk of malaria) Refusal to feed and being very weak Chest infection (cough and difficult breathing) Diarrhoea (more than 3 loose stools in 24 hours and/or blood in the stool, sunken eyes) Vomiting (cannot keep anything down) Malnutrition (loss of weight or swelling of the body) You should also take your child for routine immunizations, Vitamin A supplementation twice yearly and continued growth monitoring until he or she is 2 years of age. If you are HIV positive, your children can be tested at 10 weeks of age so that you can know if they are infected with HIV and they can begin to receive treatment and care. 31

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36 Financial support for these materials was provided by USAID, Cooperative Agreement number 617-A The views expressed in this document do not necessarily reflect those of USAID. NuLife is implemented by University Research Co., LLC, (URC) in collaboration with Save the Children U.S.A. and ACDI/VOCA.