Child Feeding and Care

Lesson Plan

Module 3

Child Feeding and Care

Table of Contents:

Lesson 1: Family Planning

Lesson 2: Complementary Feeding: 6-8 months

Lesson 3: Complementary Feeding: 9-11 months

Lesson 4: Child Feeding: 12 – 24 months (1-2 years)

Lessons 1-4 Pre and Posttest

Lessons 1-4 Pre and Posttest ANSWERS

Lessons, stories, and activities in the Child Feeding and CareLesson Plan complement the information provided in Child Feeding and CareLesson Leader Mother Flipchart.

Understanding the Lesson Plan

/ Each lesson begins with objectives. These are the behavior, knowledge and belief objectives that are covered in the lesson. There are four types of objectives. Each is described below.

Behavior objectives: Most objectives are behavioral objectives written as action statements. These are the practices that we expect the caregivers to follow based on the key messages in the flipchart.

Beliefobjectives: We know that beliefs and attitudes affect our practices. Many times it is a person’s inaccurate belief or worldview that hinders them from making healthy behavior change. In this module we are reinforcing the principle of child value: the belief that life (specifically the lives of children) is a valuable treasure that must be protected and nourished to avoid malnutrition and death.

Behavioral determinant objectives: Behavioral determinants are reasons why people practice (or don’t practice) a particular behavior. There are eight possible behavioral determinants as identified in the Barrier Analysis[1] surveys. By reinforcing the determinants that have helped the doers (caregivers in the community already practicing the new behavior) we are able to encourage the non-doers (caregivers who have not yet tried or been able to maintain the new practices). We also help non-doers (caregivers who are not practicing new behaviors) to overcome obstacles that have prevented them from trying or maintaining the practice in the past.

Under the objectives, all of the materials needed for the lesson are listed. Materials with an asterisk (*) should be brought by the Activity Leader selected during Lesson 4 of Module 2. See below for more information.

Each exercise (section of the lesson plan) is identified by a small picture. Pictures are used to remind non-literate Leader Mothers of the order of the activities. For example when it’s time to lead the game the lesson plan shows a picture of people laughing as if they are enjoying a game (see below). The pictures in the lesson plan cue Leader Mothers of the next activity. Review the descriptions below for more information.

/ The first activity in each lesson is a game or song. Games and songs help the participants to laugh, relax andprepare for the lesson. Some games review key messages that the participants have already learned.
Game
/ Following the game, all facilitators will take attendance. Troubleshooting applies only to facilitators (promoters) training others.[2] The promoter follows up with any difficulties that the Leader Mothers had teaching the previous lessons. Refer to the role play in Module 1, Lesson 4 for more information.
Attendance and Troubleshooting

Next the facilitator reads the story printed on the flipchart, using the images to share the story. The story in each lesson is followed by discussion questions.

/ Discussion questions are used to discuss the problems faced by the two main characters in the module (Abuk and Achol). Use the story and discussion questions to find out the current practices of the women in the group.
Ask about Current Practices
/ After turning to a new flipchart page ask, “What do you think these pictures mean?” After the participants respond, explain the captions and key messages written on the back of the flipchart.
Share the Meaning of Each Picture

The lesson plan also contains additional information for the trainer. The additional information does not need to be discussed during the lesson unless it relates to questions asked by the participants.

/ Next is an activity. Activities are “hands-on” exercises to help the participants understand and apply what they have learned. Most of these activities require specific materials and preparations.
Activity

Beginning in Module 2, an Activity leader is responsible to organize materials for each lesson’s Activity. The Activity Leader meets with the facilitator ten minutes before each lesson to discuss the needed materials for the next lesson’s activity. The Activity Leader is responsible to talk with the others (Leader Mothers or neighbors) during the “Attendance and Troubleshooting” to organize the materials needed for the next meeting, asking them to volunteer to bring the items. The facilitator will lead the activity, but the Activity Leader will support her by organizing the volunteers and aiding the facilitator as needed during the activity.

/ The facilitator asks if there are any obstacles that prevent the caregivers from trying the new practices. The facilitator and other group members give more information or a different perspective to help caregivers understand how to overcome these obstacles.
Discuss Barriers

Next is Practice and Coaching. We want to make sure that each Leader Mother understands the material and can present it to her neighbors. The promoter observes and coaches Leader Mothers as they practice teaching in pairs using the flipcharts.

When Leader Mothers teach their neighbors, they will repeat this activity asking each woman to share the key messages (and practices) that she has learned with the woman next to her. The Leader Mother will go around and listen to each pair, making sure they understood the key messages correctly.

/ Finally, the facilitator requests a commitment from each of the women in the group. It is up to each woman to make a choice. Do not force anyone to make a commitment if they are not ready.
Request Commitments

All lessons follow the pattern described above. Lessons can be adapted as needed to fit the needs of your group. Lessons should not exceed two hours in length although some lessons may take longer than others. The suggested time for each section is listed below.

Section name / Time needed for this section
Gameor Song
Attendance and Troubleshooting
Story
Ask about Current Practices
Share the Meaning of Picture 2
Share the Meaning of Picture 3
Share the Meaning of Picture 4
Activity
Discuss Barriers
Practice and Coaching
Request Commitments / 5 - 15 minutes
5 - 15 minutes
5 minutes
10 minutes
10 minutes
10 minutes
10 minutes
15-30 minutes
15 minutes
20 minutes
10 minutes
2 – 2 ½ hours

Acknowledgements

Many thanks to the illustrators Jeff Del Nero and Gatobo Edgar. Sarah Borger, Julius Lanya, Mesfin Hailemariam, Comfort Yankson and Sonya Funna are greatly appreciated for reviewing and editing the materials. Games used in the lessons are available through the HIV/AIDS Alliance. See below for full details and resources used in the development of this module:

  • International HIV/AIDS Alliance. (2002). 100 Ways to Energize Groups: Games to Use in Workshops, Meetings and the Community. Available at
  • TANGO International. (2009). Vulnerability, Livelihoods, Nutrition and Food Security Assessment in NBEG & Warrap.
  • UNICEF/OLS Nutrition Section. (1997). Child Feeding Practices among the Nuer, Dinka and Latuko of Southern Sudan. Available:

The SSHiNE health and nutrition and empowerment program includes the following partners: the Adventist Development and Relief Agency (ADRA), Food for the Hungry (FH), Concern Worldwide (CW), Malaria Consortium (MCo) and the Johns Hopkins University, Bloomberg School of Public Health (BSPH).

Suggested Citation: Hanold, Mitzi J. (2011) Child Feeding and Care. Washington DC. Food for the Hungry (FH), madepossible through support provided by the Office of Food for Peace, Bureau of Democracy, Conflict, and Humanitarian Assistances, and the U.S. Agency for International Development under the terms AID-FFP-A-10-00017-02. The opinions expressed herein are those of the authors and do not necessarily reflect the view of the U.S. Agency for International Development.

1

Lesson 1: Family Planning

  • Caregivers will delay new pregnancy for two years after the birth of the last child.
  • Mothers who become pregnant before two years are more likely to die from blood loss and long, difficult delivery.
  • Infants born to mothers who become pregnant before two years are more likely to have weak blood (anemia) and be born too early, too small or dead.
  • Caregivers will use one of the following methods or talk with a health worker for other options.
  • Caregivers will prevent new pregnancy by exclusively breastfeeding their child for the first six months of life.
  • Exclusive breastfeeding for six months prevents pregnancy as long as the infant was given the breast within one hour after birth, is breastfed on demand, and the mother’s monthly bleeding has not returned.[3]
  • Caregivers will talk with their spouse about fertility and follow the two day method to delay new pregnancy.
  • Women will check for vaginal secretions twice each day in the afternoon. Vaginal secretions are a sign that new pregnancy is possible.
  • To delay new pregnancy, women will abstain from sex if they see secretions yesterday or today. They will only have sex after two days without secretions.
  • Caregivers will believe that having children too close together puts the mother at great risk of death during pregnancy and childbirth (increased perceived severity).[4]

Additional Information for the Trainer and Promoter

  • This lesson is designed for women. However these messages must be shared FIRST with community leaders.
  • Encourage community leaders to share these messages with the men prior to teaching the women.
  • Encourage community leaders to be aware of the dangers to women and their children when they become pregnant too soon.

Materials:

  1. Attendance Registers
  2. Leader Mother Flipchart
  3. Five objects to represent days of bleeding
  4. Ten objects to represent days of secretions
  5. (optional) A calendar page

Summary:

  • Game: The Sun Shines On
  • Attendance and Troubleshooting
  • Share the story: The Children Come Too Soon!
  • Ask about family planning practices that are used by the women.
  • Share the meaning of each picture on flipchart pages 6-11: Delaying New Pregnancy, The Exclusive Breastfeeding Method, and The TwoDay Method.
  • Activity: TwoDay Method
  • Discuss Barriers
  • Practice and Coaching in pairs
  • Request Commitments

/ 1. Game: The Sun Shines On - 10 minutes
  1. Ask the women to stand in a circle. The facilitator stands in the middle of the circle.
  2. The facilitator shouts, “The sun shines on…” and names a color or piece of clothing that some of the women are wearing. For example, “The sun shines on everyone wearing red.”
  3. All the women wearing red must change places with one another. The facilitator tries to take the place of someone who is moving. The facilitator cannot squeeze into the circle in a new position; he must replace the spot of a woman who has moved.
  4. The person without a place to stand becomes the new facilitator and stands in the middle of the circle.
  5. The new facilitator shouts “The sun shines on…” and names a different color or piece of clothing or characteristic.
  6. Repeat the game so that many of the mothers have a chance to be in the middle of the circle.

Now that we are energized, let’s begin our lesson.

/ 2. Attendance and Troubleshooting – 15 minutes
  1. Promoter fills out attendance sheets for each Leader Mother and neighbor group (beneficiary group).
  1. Promoter fills out vital events mentioned by each Leader Mother (new births, new pregnancies, and mother and child deaths).
  2. Promoter asks if any of the Leader Mothers had problems meeting with their neighbors.
  3. The Promoter helps to solve the problems mentioned.
  4. Promoter thanks all of the Leader Mothers for their hard work and encourages them to continue.
  5. Promoter asks the group’s Activity Leader[5] to discuss the needed items for next week’s activity and solicit volunteers.

The Children Come Too Soon (Picture 1.1) – 15 minutes

3. Story

  • Read the story on page 4 of the flipchart.

Early in the morning, Abuk visits Achol who is sitting with her three children. Achol is crying. “I am so tired. My body hurts and I don’t have any strength to care for my children. I cannot continue to have children every year. How can I delay new pregnancy? The children come too soon!”

4. Ask about Current Practices

  • Read the questions on page 4 of the flipchart.

/ ?Why is Achol crying?
?Are you ready to be pregnant again? Why?
?What methods are you using to delay pregnancy?
  • Ask the first question to review reasons why Acholis crying.
  • She is tired and does not have strength to care for her children. A few months after she gives birth, she becomes pregnant again.
  • Ask the second question to hear the women’s feelings about becoming pregnant again.
  • Ask the last question to hear the methods used by the women to delay new pregnancy.
  • Methods used may include modern contraceptive methods (condoms, injections, pills or implants) or natural family planning methods such as The TwoDay Method or other calendar methods.
  • Encourage discussion. Don’t correct “wrong answers.” Let everyone give an opinion. This page is for discussion, not for teaching.
  • After the participants answer the last question, move to the next flipchart page by saying, “Let compare your ideas with the messages on the following pages.”

Delaying New Pregnancy (Picture 1.2) – 10 minutes

/ 5. Share the Meaning of Each Picture
  • Ask the caregivers to describe what they see in the pictures on page 7.
  • Share the meaning of each picture using flipchart pages 6 and 7.
  • Read the captions on the flipchart out loud.

?What do you think these pictures mean?
  • Families that delay pregnancy for two years after each birth have healthy mothers and healthy children.
  • Mothers are healthy during and after pregnancy.
  • Children grow healthy and strong.
  • Families that do not delay pregnancy suffer from poor health and sickness.
  • Mothers and infants suffer from weak blood.
  • Mothers are often sick during pregnancy.
  • Children are small and do not grow well.
  • When a woman becomes pregnant too soon, she and her infant are more likely to die.
  • This mother suffered from weak blood in pregnancy.
  • She and her infant died during delivery.
?Have you seen mothers suffer because of pregnancies that have come too soon? Tell me about them.

Additional Information for the Trainer

Mother and Child Death

  • Women with severe anemia (weak blood) are 3.5 times more likely to die during pregnancy and childbirth than women without anemia.[6]
  • In countries with high birth rates (such as Sudan) if women and their partners were given information and skills to prevent new pregnancies, it is estimated that 1 out of 3 maternal deaths and 1 out of 10 childdeaths could be avoided.[7]

Miscarriage

  • Women who have given birth to a dead child or had an abortion should wait at least six months before becoming pregnant again.

Pregnancy of Young Women

  • Studies in both Gabon and Congo have shown that mothers who become pregnant before the age of 16 have a much higher risk (up to 37% increased risk) to have an infant born too small (low birth weight).
  • Low birth weight infants are more likely to suffer sickness and death before age two.
  • To prevent infant death, families should delay first pregnancy until after the woman is older than 16 years of age.

The Exclusive Breastfeeding Method (Picture 1.3) – 10 minutes

/ 6. Share the Meaning of Each Picture
  • Ask the caregivers to describe what they see in the pictures on page 9 of the flipchart.
  • Share the meaning of each picture using flipchart pages8 and 9.
  • Read the captions on the flipchart out loud.

?What do you think these pictures mean?
  • The Exclusive Breastfeeding Method delays new pregnancy for six months if all of the following things are true:
  1. The woman’s monthly bleeding has not returned
  2. The child is younger than six months
  3. The mother breastfeeds day and night whenever the child shows signs of hunger.
  4. The mother never gives water, porridge or other foods or liquids.
  • All of these things must be true if you want to delay new pregnancy using this method.
  • Bleeding is a sign that new pregnancy is possible.
  • When your baby is six months, new pregnancy is possible.
  • If you give other foods and liquids, new pregnancy is possible.
?Are you able to use this method to prevent pregnancy? Why or why not?
?What should you do if all of these things are not true?
  • Talk with a health worker about other methods to delay new pregnancy.

Additional Information for the Trainer