Training guide: Feeding children from 0-24 months (3-4 hours)
(please use MoH leaflets and CRS pictures for this training. Please address WRONG BELIEFS. Please emphasize that we must all have a common set of messages)
Introduction (15 minutes):
What is the average age of the SFP/OTP children? (about 2 years old)
Why? (many children become malnourished during the period when foods are introduced and when breast feeding finally ends completely)
How can we make sure that in the future we see less malnourished children in our programme? (one way, by offering good advice on appropriate infant and young child feeding practices)
Training today covers: when should breast feeding start and finish and when feeding should start, as well as what are good feeding practices to make sure that the child grows well and stays healthy.
Infants 0-6 months (45 minutes)
Q1. When should breastfeeding start? Why?
A1. Within half an hour. Because:
Baby wants to suckle
Suckling makes the breast produce milk
First milk (colostrum) is VERY important – like the child’s first immunisation, protecting him from infections
Stops the mother bleeding
Good for mother and child bonding
Q2. What should babies eat and drink from 0-6 months? Why?
A2. ONLY breast milk (no water or other foods). This is called EXCLUSIVE BREASTFEEDING
Because:
Baby does not need anything else to grow well and stay healthy (there is enough water in the milk to stop baby being thirsty and nutrients for baby to grow well). The milk is clean as well so the child will not get diarrhoea or other sickness.
Exclusive breast feeding delays the return of fertility – as long as the baby is only breastfeeding the mother will not ovulate (no monthly periods). If she does not ovulate she cannot become pregnant.
Exclusive breastfeeding protects the child from sicknesses which are a result of eating contaminated foods
Q3. How often should baby be breastfed?
A3. As often as he wants – this should be every 2-3 hours, so 8-10 times in 24 hours (day and
night). Often is important as baby has a little stomach and frequent suckling increases milk production
Q4. Do breast feeding women need extra food? What foods are good?
A4. Yes, one extra meal a day. Extra protein – meat, etc, and micronutrients – fruits and vegetables. And enough to drink so that they are not thirsty. And rest if possible. A mother can feed twins / two babies if she eats well, drinks enough and lets the babies suckle when ever they want
Children 6-24 months (1.5 hours)
Q5. At what age should a breastfed baby be given foods and drinks for the first time? Why?
A5. At 6 months. Not before and not after. At six months baby needs more energy and nutrients for growth and activity than breast milk alone can provide. Baby can eat and digest foods then.
Before 6 months the baby’s gut is not ready to digest foods, baby might get diarrhoea because of this or because foods are contaminated, baby will suckle less and mother’s breast milk supply will decrease, mother will become fertile again and may become pregnant before she is ready.
After 6 months the baby cannot get what he needs from breast milk alone. He will stop gaining weight and will not grow well, baby may become reluctant to eat/be difficult to feed new foods.
Q6. Why is this time of introducing new foods a dangerous time?
A6. A child might not get enough energy and nutrients if he doesn’t get enough family food, he stops breastfeeding before 2 years old, he has foods contaminated with germs that make him sick.
Q7. What foods should baby get, when?
A7. At 6 months start with a couple of tablespoons of semi solid food (like porridge) after the baby has been breastfed so that baby keeps suckling as often as possible. Use a spoon or cup NEVER a bottle. Let baby feed as often as he wants (at least 10 times a day).
At 7/8 months add other foods to porridge to make meals. Good foods are rich in energy, protein, micronutrients and are not watery. They must be hygienically prepared and fed. Advise parents to give a variety of foods with fat, fresh fruits and vegetables and Animal Source Foods (eggs/milk/meat) daily.
By 8 months baby should be given foods they can hold and feed themselves.
By one year, the child should be eating most family foods and snacks.
Q8. How often should a young child eat?
A8. Between 6 and 12 months slowly increase the amount of food given, number of meals/snacks each day and variety of foods
A child 6-8 months should eat 2-3 meals and 1-2 snacks
A child 9-11 months should eat 3-4 meals and 1-2 snacks
A meal is a mixture of food groups (carbohydrate, protein, fats, micronutrient rich = e.g. asida, meat/okra sauce made with vegetable oil)
A snack is a one or two food group, e.g. fruits, boiled eggs, milk, bread with groundnut paste/dipped in milk, fried potatoes, sweet potatoes etc.
Q9. What foods are good for young children? Why?
A9. Young children need diets rich in energy and nutrients because they are growing fast and only have small stomachs so cannot eat a lot at one meal. You can make sure they get enough by feeding often and enriching bulky foods (e.g. adding oil or sugar to porridge - porridges mostly do not contain enough energy and nutrients because they are bulky – the starch absorbs water when it is cooked and water may be added to make it runny – this dilutes the energy and nutrients and the child would need to eat a lot to get all the energy and nutrients he/she needs. He/she can’t because they get full quickly, so add a fatty food (oil, one spoon is enough, fry foods) and other nutrient rich foods (groundnut paste, simsim paste, mashed beans and lentils, add egg, red/orange/yellow fruits and vegetables/dark green leaves)
Q10. What is active feeding and why is it important?
A10. Encouraging and helping the young child to eat, e.g. talking, telling them about the food, making meal times happy, giving separate bowls, giving the child foods he/she can eat themselves, mixing foods, not hurrying, making sure the child is not thirst/full of fluid, not waiting for the child to cry for food. Children should be actively fed beyond three years, to 4, 5, 6 and they should have their own plates. Who feeds the child? Where?
Q11. What age is good to stop breast feeding totally? How should you advise mothers?
A11. Any time after 24 months. Before 2 years old let the child breastfeed on demand. Gradually increase foods while breast milk consumption is decreasing so the child gets enough nutrients to grow and stay healthy.
Advise mothers to stop when the child wants, but not before 24 months. If the mother wants to stop, encourage not before 24 months, and then to do so slowly so the child is not sad – child should be eating at least 5 times a day, amounts and numbers of meals should increase, time between breast feeds should increase, love the child, stop night feeds last of all
Q12. How do you deal with a child that refuses food?
A12. Make sure he is not ill. Make sure he feels loved and is happy. Make sure he is not breastfed before the meal (so he is not full). If he is teething give him something clean to chew. Don’t force the child. Feed the child when he is hungry. Help the child eat.
Other important points: (0.5 hours)
1. Sick children should be encouraged to eat and drink EXTRA foods to help them fight infection
2. Breast feeding while pregnant and teething do not CAUSE diarrhoea. Diarrhoea is caused by eating dirty food or drinks.
Recap keeping food safe and clean:
Q. When are the most important times for washing hands?
A. Wash hands before preparing foods, before feeding child, after latrine, after cleaning a child’s bottom or clearing up faeces. Wash the child’s hands too.
Q. Why should we wash our hands at these times and why is soap important?
A. To prevent diarrhoea and other diseases
Also need to use clean water for drinking, clean the cooking and eating utensils, cook foods thoroughly and eat food hot
3. What to do with motherless infants less than 6 months old
1. Find a wet nurse (any other woman willing to breast feed- can be helped to “relactate” in hospital if necessary, all this is, is stimulating the breast to produce enough milk for the baby)
2. Advise on using dilute animal milks if a wet nurse cannot be found (animal milks are not as good as woman’s milk for babies).
SUMMARY OF 10 KEY MESSAGES (0.5 hour):
0-6 MONTHS:
1. BREASTFEED WITHIN HALF AN HOUR OF BIRTH
2. BREASTFEED EXCLUSIVELY FOR THE FIRST SIX MONTHS
3. PRACTICE ON DEMAND BREASTFEEDING DAY AND NIGHT
4. INTRODUCE FOODS AT SIX MONTHS OF AGE AND KEEP BREASTFEEDING ON DEMAND
6-24 MONTHS:
5. INCREASE QUANTITY OF FOODS AS THE CHILD AGES, WHILE CONTINUING TO BREASTFEED
6. INCREASE FEEDING FREQUENCY (MEALS/SNACKS) AS THE CHILD AGES, WHILE CONTINUING TO BREASTFEED
7. GRADUALLY INCREASE FOOD VARIETY AS THE CHILD AGES
8. PRACTICE ACTIVE FEEDING
9. PRACTICE FREQUENT AND ACTIVE FEEDING DURING AND AFTER ILLNESS
10. PRACTICE GOOD FOOD HYGIENE
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