Key Messages Booklet

The Community
Infant and Young Child Feeding
Counselling Package
September 2012
Key Messages Booklet i
Key Messages Booklet
The Community
Infant and Young Child Feeding
Counselling Package
September 2012
Key Messages Booklet ii
Key Messages Booklet iii
Counselling Cards: Key Messages
1. Nutrition for pregnant and breastfeeding women ...................................................................1
2. Pregnant woman / delivery in facility ...........................................................................................2
3. During the frst 6 months, your baby needs ONLY breast milk ..............................................3
4. Importance of exclusive breastfeeding during
the frst 6 months ...............................................................................................................................4
5. Breastfeed on demand, both day and night (8 to 12 times)
to build up your breast milk supply ..............................................................................................5
6. Breastfeeding Positions ...................................................................................................................6
7. Good Attachment ...............................................................................................................................7
8. Feeding a low birth weight baby ....................................................................................................8
9. How to hand express breast milk and cup feed .........................................................................9
10. When you are separated from your baby ................................................................................. 10
11. Feeding the Sick Baby under 6 months of age ........................................................................11
12. Good hygiene (cleanliness) practices prevent disease ....................................................... 12
13. Start complementary feeding when baby reaches 6 months........................................... 13
14. Complementary feeding from 6 up to 9 months ....................................................................15
15. Complementary feeding from 9 up to 12 months ..................................................................17
16. Complementary feeding from 12 up to 24 months ...............................................................19
17. Food Variety ........................................................................................................................................21
18. How to Add Multiple Micronutrient Powders (MNPs) to Complementary Foods ......... 22
19. Feeding the Sick Child older than 6 months of age ............................................................... 23
20. Optimal family planning promotes improved health and
survival for both mother and child ............................................................................................ 24
21. Regular growth monitoring and promotion ........................................................................... 25
22. When to bring your child to the health facility........................................................................26
continued
Key Messages Booklet iv
23a. Exclusively breastfeed and take ARVs ......................................................................................... 27
23b. Exclusively breasfteed even when there are no ARVs...............................................................28
Special Circumstance Cards
Card 1: Avoid all Breastfeeding ................................................................................................... 29
Card 2: Conditions needed to avoid all breastfeeding ........................................................ 30
Card 3: Non-breastfed child from 6 up to 24 months ........................................................... 31
Take-home brochures
Nutrition During Pregnancy and Breastfeeding .................................................................... 32
How to Breastfeed Your Baby ...................................................................................................... 33
How to Feed a Baby After 6 Months .......................................................................................... 34
This set of cards was developed for you to help counsel
mothers and other caregivers about infant and young
child feeding (IYCF). Positive counselling skills are
important for your success. Some basic counseling skills
presented below include Listening and Learning, as well
as Building Confdence and Giving Support.
Listening and Learning skills
Use helpful non-verbal communication:
Keep your head level with the mother (or caregiver)
Pay attention
Reduce physical barriers
Take time
Touch appropriately
Ask open questions
Use responses and gestures that show interest
Refect back what the mother (or caregiver) says
Avoid using judging words
Building Confdence and Giving Support skills
1. Accept what a mother (or caregiver) thinks and feels.
Let the mother (or caregiver) talk through her or his
concerns before correcting any wrong ideas or mis-
information. This helps to establish confdence.
2. Listen carefully to the mothers (or caregivers)
concerns.
3. Recognize and praise what a mother (or caregiver)
and child are doing correctly.
4. Give practical help.
5. Give a little, relevant information at a time.
6. Use simple language that the mother or caregiver
will understand.
7. Use appropriate Counselling Card(s) or Take-Home
Brochure(s).
8. Make one or two suggestions, not commands
IYCF 3-Counselling:
The following 3-Step Counseling will help you to counsel,
with mothers (or caregiver) about infant and young
child feeding. The 3-Steps are Assess, Analyze and Act.
Step 1: Assess: ask, listen and observe
Greet the mother (or caregiver), using friendly
language and gestures.
Ask some initial questions that encourage her (or
him) to talk.
Listen to what is being said and observe what is
going on using your Listening and Learning, and
Building Confdence and Giving Support skills.
Assess the age appropriate feeding practice(s) and
the condition or health of the child and mother (or
caregiver).
Step 2: Analyze: identify difculty and if there is
more than one prioritize the difculties
Decide if the feeding you observe is age-appropriate
and if the condition or health of the child and
mother (or caregiver) is good.
If there are no apparent difculties, praise the
mother (or caregiver) and focus on providing
information needed for the next stage of the childs
development.
If one or more feeding difculty is present, or
the condition or health of the child or mother (or
caregiver) is poor, prioritize the difculties.
Answer the mothers (or caregivers) questions if any.
Step 3: Act: discuss, suggest a small amount of
relevant information, agree on doable action
Depending on the factors analyzed above, select
a small amount of information to share with the
mother or caregiver that is most relevant to her or his
situation.
Be sure to praise the mother or caregiver for what
she or he is doing well.
Present options for addressing the feeding difculty
or condition of health of the child or caregiver in
terms of small do-able actions. These actions should
be time-bound (within the next few days or weeks).
Share key information with the mother or caregiver,
using the appropriate Counselling Cards or Take-
home Brochures and answering questions as
needed.
Help the mother or caregiver select one option
that she or he agrees to try, in order to address or
overcome the difculty or condition that has been
identifed. This is called reaching-an-agreement.
Suggest where the mother or caregiver can fnd
additional support. Refer to the nearest health facility
if appropriate and/or encourage participation in
educational talks or IYCF Support Groups in the
community.
Confrm that the mother or caregiver knows where
to fnd a community volunteer and/or other health
worker.
Thank the mother or caregiver for her or his time.
Agree on when you will meet again, if appropriate.
Positive counselling skills
Key Messages Booklet 1
Counselling Card 1
Nutrition for pregnant and breastfeeding woman
During your pregnancy, eat one extra small meal or snack (extra food between meals) each day
to provide energy and nutrition for you and your growing baby.
During breastfeeding, eat two extra small meals or snacks (extra food between meals) each
day to provide energy and nutrition for you and your growing baby.
You need to eat the best foods available, including milk, fresh fruit and vegetables, meat, fish,
eggs, grains, peas and beans.
Drink whenever you are thirsty.
Taking tea or coffee with meals can interfere with your bodys use of the foods. Limit the amount
of coffee you drink during pregnancy.
During pregnancy and breastfeeding, special nutrients will help your baby grow well and be
healthy.
Take iron and folic acid tablets to prevent anaemia during pregnancy and for at least 3 months
after your babys birth.
Take vitamin A tablets immediately after delivery or within 6 weeks so that your baby receives
the vitamin A in your breast milk to help prevent illness.
Use iodised salt to help your babys brain and body develop well.
Attend antenatal care at least 4 times during pregnancy. These check-ups are important for you
to learn about your health and how your baby is growing.
Take de-worming tablets to help prevent anaemia.
To prevent malaria, sleep under an insecticide-treated mosquito net and take anti-malarial
tablets as prescribed.
Learn your HIV status, attend all the clinic appointments and take your medicines as advised by
your health provider.
Adolescent mothers: you need extra care, more food and more rest than an older mother. You
need to nourish your own body, which is still growing, as well as your growing babys.
Card 1
Key Messages Booklet 2
Counselling Card 2
Pregnant woman / Delivery in facility
Hold your newborn skin-to-skin immediately after birth. This will keep your baby warm and
breathing well, help him or her reach the breast easily, and help you and your baby feel close.
Begin breastfeeding within the first hour of birth. Early breastfeeding helps the baby learn to
breastfeed while the breast is still soft, and helps reduce your bleeding.
Colostrum, the thick yellowish milk, is good for your baby.
Colostrum helps protect your baby from illness and helps remove the first dark stool.
Breastfeed frequently to help your breast milk come in and to ensure plenty of breast milk.
Do not give water or other liquids/fluids to your baby during the first days after birth. They are
not necessary and are dangerous for your newborn.
Card 2
Key Messages Booklet 3
Counselling Card 3
During the frst 6 months, your baby needs
ONLY breast milk
Breast milk provides all the food and water that your baby needs during the first 6 months.
Do not give anything else, not even water, during your babys first 6 months.
Even during very hot weather, breast milk will satisfy your babys thirst.
Giving your baby anything else will cause him/her to suckle less and will reduce the amount of
breast milk that you produce.
Water, other liquids and foods can make the baby sick.
You can give medicines if they are recommended by your health provider.

Note for community worker: There may be a period of 24 hours in the first day or two when the
baby feeds only 2 to 3 times. After the first few days, frequent breastfeeding is important for
establishing a good supply.
Breast milk only for the rst 6 months
Card 3
Key Messages Booklet 4
Exclusive breastfeeding means feeding your baby ONLY breast milk for the first 6 months.
Breast milk provides all the food and water that your baby needs during the first 6 months of life.
Exclusive breastfeeding for the first 6 months protects your baby from many illnesses, such as
diarrhoea and respiratory infections.
When you exclusively breastfeed your baby during the first 6 months and have no menses, you
are protected from another pregnancy.
Mixed feeding means feeding your baby both breast milk and any other foods or liquids,
including infant formula, animal milks, or water.
Mixed feeding before 6 months can damage your babys stomach.
Mixed feeding increases the chances that your baby will suffer from illnesses such as diarrhoea
and pneumonia, and from malnutrition.
Giving your baby foods or any kind of liquids other than breast milk, including infant formula,
animal milks, or water before 6 months can damage your babys stomach. This reduces the
protection that exclusive breastfeeding gives, and all of the benefits that your baby gets from
your breast milk.
Note for community worker: If a mother is HIV-infected, refer to Counselling Cards 23a and 23b
or the 3 Special Circumstance Cards for information on HIV and infant feeding.
Counselling Card 4
Importance of exclusive breastfeeding during the first 6
months
Card 4
During the frst 6 months
Key Messages Booklet 5
Counselling Card 5
Breastfeed on demand, both day and night
(8 to 12 times) to build up your breast milk supply
Breastfeed your baby on demand, day and night.
More suckling (with good attachment) makes more breast milk.
Crying is a late sign of hunger. Early signs that your baby wants to breastfeed include:
Restlessness
Opening mouth and turning head from side-to-side
Putting tongue in and out
Suckling on fingers and fists
Let your baby finish one breast before offering the other. Switching back and forth from one
breast to the other prevents the baby from getting the nutritious hind milk. The fore milk has
more water and satisfies the babys thirst. The hind milk has more fat and satisfies your babys
hunger.
If your baby is ill or sleepy, wake him or her to offer the breast often.
Do NOT use bottles, teats or spouted cups. They are difficult to clean and can cause your baby to
become sick.
Notes for community worker:
If a mother is concerned about her baby getting enough milk, encourage the mother and
build her confidence by reviewing how to attach and position the baby to her breast.
Reassure her that her baby is getting enough milk when her baby is:
not visibly thin (or is getting fatter/putting on weight, if he or she was thin earlier)
responsive and active (appropriately for his or her age)
gaining weight - refer to the babys health card (or growth velocity table if available). If
you are not sure if the weight gain is adequate, refer the child to the nearest
health facility.
when baby passes light-coloured urine 6 times a day or more while being exclusively
breastfed
Card 5
Key Messages Booklet 6
Counselling Card 6
Breastfeeding positions
Good positioning helps to ensure that your baby suckles well and helps you to produce a good
supply of breast milk.
The four key points about your babys position are: straight, facing the breast, close, and
supported:
1. The babys body should be straight, not bent or twisted, but with the head slightly back.
2. The babys body should be facing the breast, not held flat to your chest or stomach, and he or
she should be able to look up into your face.
3. The baby should be close to you.
4. You should support the babys whole body, not just the neck and shoulders, with your hand and
arm.
There are different ways to position your baby:
1. Cradle position (most commonly used)
2. Cross cradle position (good for small babies)
3. Side-lying position (use to rest while breastfeeding and at night)
4. Under-arm position (use after caesarean section, if your nipples are painful or if
you are breastfeeding twins or a small baby)
Note for community worker: If an older baby is well-attached and suckling well, there is no need
to change position.
Card 6
Key Messages Booklet 7
Counselling Card 7
Good attachment
Good attachment helps to ensure that your baby suckles well and helps you to produce a good
supply of breast milk.
Good attachment helps to prevent sore and cracked nipples.
Breastfeeding should not be painful.
Get help to improve the attachment if you experience pain.
There are 4 signs of good attachment:
1. Babys mouth is wide open
2. You can see more of the darker skin (areola) above the babys mouth than below
3. Babys lower lip is turned outwards
4. Babys chin is touching mothers breast
The signs of effective suckling are:
a. The baby takes slow deep suckles, sometimes pausing.
b. You may be able to see or hear your baby swallowing after one or two suckles.
c. Suckling is comfortable and pain free for you.
d. Your baby finishes the feed, releases the breast and looks contented and relaxed.
e. The breast is softer after the feed.
Effective suckling helps you to produce milk and satisfy your baby.
After your baby releases one breast offer your baby the other breast. This will ensure that your
baby stimulates your milk production in both breasts, and also gets the most nutritious and
satisfying milk.
Card 7
Key Messages Booklet 8
Counselling Card 8
Feeding a low birth weight baby
Breast milk is especially adapted to the nutritional needs of low birth weight infants.
The best milk for a low birth weight infant, including babies born early, is the breast milk from
the babys own mother.
The cross cradle and underarm positions are good positions for feeding a low birth weight baby.
Breastfeed frequently to get baby use to the breast and to keep the milk flowing.
Long slow feeds are fine. It is important to keep the baby at the breast.
If the baby sleeps for long periods of time, you may need to unwrap the baby or take off some of
his or her clothes to help waken him or her for the feed.
Breastfeed the baby before he or she starts to cry.
Earlier signs of hunger include a COMBINATION of the following: being alert and restless,
opening mouth and turning head, putting tongue in and out, sucking on hand or fist.
Notes for community worker:
Direct breastfeeding of a very small baby may not be possible for several weeks. Mothers
should be taught and encouraged to express breast milk and feed the breast milk to the
infant using a cup.
Kangaroo mother care provides skin-to-skin contact, warmth and closeness to the mothers
breast.
Kangaroo mother care encourages early and exclusive breastfeeding, either by direct
feeding or using expressed breast milk given by cup.
Different caregivers can also share in the care of the baby using the same Kangaroo
method position.
Card 8
Key Messages Booklet 9
Counselling Card 9
How to hand express breast milk and cup feed
Make sure your hands and utensils are clean.
Wash your hands with soap and running water.
Clean and boil the container you will use to collect your breast milk.
Get comfortable.
It is sometimes helpful to gently stroke your breasts. A warm cloth may help stimulate the
fow of milk.
Put your thumb on the breast above the dark area around the nipple (areola) and the
other fngers on the underside of the breast behind the areola.
With your thumb and frst 2 fngers press a little bit in towards chest wall and
then press gently towards the dark area (areola).
Milk may start to fow in drops, or sometimes in fne streams. Collect the milk in
the clean container.
Avoid rubbing the skin, which can cause bruising, or squeezing the nipple,
which stops the fow of milk.
Rotate the thumb and fnger positions and press/compress and release all
around the areola.
Express one breast for at least 3 to 5 minutes until the fow slows, then express the other
breast, then repeat both sides again (20 to 30 minutes total).
Store breast milk in a clean, covered container. Milk can be stored 6 to 8 hours in a cool
place and up to 72 hours in the back of the refrigerator.
Give baby expressed breast milk from a cup. Bring cup to the babys lower lip and allow
baby to take small amounts of milk, lapping the milk with his or her tongue. Do not pour
the milk into babys mouth.
Pour just enough breast milk from the clean covered container into the feeding cup.
Bottles are unsafe to use because they are difcult to wash and can be easily
contaminated.
Card 9
Key Messages Booklet 10
Counselling Card 10
When you are separated from your baby
Learn to express your breast milk soon after your baby is born. (CC 9)
Breastfeed exclusively and frequently for the whole period that you are with your baby.
Express and store breast milk before you leave your home so that your babys caregiver can feed
your baby while you are away.
Express breast milk while you are away from your baby. This will keep the milk fowing and
prevent breast swelling.
Teach your babys caregiver how to use a clean open cup to feed your baby while you are away.
Expressed breast milk (stored in a cool, covered place) stays in good condition for 8 hours, even
in a hot climate.
Take extra time for the feeds before separation from baby and when you return home.
Increase the number of feeds while you are with the baby. This means increasing night and
weekend feedings.
If possible, carry the baby with you to your work place (or anytime you have to go out of the
home for more than a few hours). If this is not possible, consider having someone bring the baby
to you to breastfeed when you have a break.
Get extra support from family members in caring for your baby and other children, and for doing
household chores.
Notes for a working mother with formal employment:
Get your employers consent for:
breastfeeding breaks at your work place and fexible working hours
safe storage of expressed breast milk at your work place
Card 10
Key Messages Booklet 11
Counselling Card 11
Feeding the sick baby less than 6 months of age
Breastfeed more frequently during illness, including diarrhoea, to help the baby fght sickness,
reduce weight loss and recover more quickly.
Breastfeeding also provides comfort to your sick baby. If your baby refuses to breastfeed,
encourage your baby until he or she takes the breast again.
Give only breast milk and medicines recommended by your doctor/ health care provider.
If the baby is too weak to suckle, express breast milk to give the baby. This will help you to keep
up your milk supply and prevent breast difculties.
After each illness, increase the frequency of breastfeeding to help your baby regain health and
weight.
When you are sick, you can continue to breastfeed your baby. You may need extra food and
support during this time.
Card 11
Sick baby less than 6 months
Key Messages Booklet 12
Counselling Card 12
Good hygiene (cleanliness) practices prevent disease
Good hygiene (cleanliness) is important to avoid diarrhoea and other illnesses.
Wash your hands with soap and water before preparing foods and feeding baby.
Wash your hands and your babys hands before eating.
Wash your hands with soap and water after using the toilet and washing or cleaning babys
bottom.
Feed your baby using clean hands, clean utensils and clean cups.
Use a clean spoon or cup to give foods or liquids to your baby.
Do not use bottles, teats or spouted cups since they are difcult to clean and can cause your
baby to become sick.
Store the foods to be given to your baby in a safe clean place.
Card 12
Key Messages Booklet 13
Counselling Card 13
Starting Complementary Feeding when baby reaches 6
months
Starting at about 6 months, your baby needs other foods in addition to breast milk.
Continue breastfeeding your baby on demand both day and night.
Breast milk continues to be the most important part of your babys diet.
Breastfeed frst before giving other foods.
When giving complementary foods, think: Frequency, Amount, Thickness, Variety, Responsive
feeding, and Hygiene
Frequency: Feed your baby complementary foods 2 times a day
Amount: Give 2 to 3 tablespoonfuls (tastes) at each feed.
Thickness: should be thick enough to be fed by hand
Variety: Begin with the staple foods like porridge (corn, wheat, rice, millet, potatoes,
sorghum), mashed banana or mashed potato
Responsive feeding
- Baby may need time to get used to eating foods other than breast milk.
- Be patient and actively encourage your baby to eat.
- Dont force your baby to eat.
- Use a separate plate to feed the baby to make sure he or she eats all the food given.
Hygiene: Good hygiene (cleanliness) is important to avoid diarrhoea and other
illnesses. (CC 12)
- Use a clean spoon or cup to give foods or liquids to your baby.
- Store the foods to be given to your baby in a safe hygienic place.
- Wash your hands with soap and water before preparing foods and feeding baby.
- Wash your hands and your babys hands before eating.
- Wash your hands with soap and water after using the toilet and washing or
cleaning babys bottom.
Card 13
Start feeding at 6 months
Key Messages Booklet 14
Note about the size of cups:
All cups shown and referred to in the Counselling Cards are mugs which have a volume
of 250 ml. If other types or sizes of cups are used to feed a baby, they should be tested to
see what volume they hold and the recommended quantities of food or liquid should be
adjusted to the local cup or mug.
Note: After 6 months, you can no longer use LAM.
You will need to use another family planning method even though your menses has
not yet returned.
There are many methods of family planning that will not interfere with breastfeeding.
Key Messages Booklet 15
Counselling Card 14
Complementary feeding from 6 up to 9 months
Continue breastfeeding your baby on demand both day and night. This will maintain his or her
health and strength as breast milk continues to be the most important part of your babys diet.
Breast milk supplies half (1/2) babys energy needs from 6 up to 12 months.
Breastfeed frst before giving other foods.
When giving complementary foods to your baby, think: Frequency, Amount, Thickness, Variety,
Responsive feeding, and Hygiene
Frequency: Feed your baby complementary foods 3 times a day
Amount: Increase amount gradually to half () cup (250 ml cup: show amount in cup
brought by mother). Use a separate plate to make sure young child eats all the food
given
Thickness: Give mashed/pureed family foods. By 8 months your baby can begin
eating fnger foods
Variety: Try to feed a variety of foods at each meal. For example: Animal-source foods
(fesh meats, eggs and dairy products) 1 star*; Staples (grains, roots and tubers) 2
stars**; Legumes and seeds 3 stars***; Vitamin A rich fruits and vegetables and other
fruits and vegetables 4 stars**** (CC 17).
Notes for community worker:
Foods may be added in a diferent order to create a 4 star food/diet.
Animal source foods are very important. Start animal source foods as early and as
often as possible. Cook well and chop fne.
Infants can eat well-cooked and fnely-chopped eggs, meat and fsh even if they
dont have teeth.
Additional snacks (extra food between meals) such as fruit or bread with nut paste)
can be ofered once or twice per day.
If you prepare food for the baby that has oil or fat in it, use no more than half a
teaspoon per day.
From 6 up to 9 months
Card 14
Key Messages Booklet 16
Notes for community worker continued:
Use iodised salt
Each week you can add one new food to your childs diet
Avoid giving sugary drinks
Avoid sweet biscuits
Responsive feeding
- Be patient and actively encourage your baby to eat.
- Dont force your baby to eat.
- Use a separate plate to feed the baby to make sure he or she eats all the food given.
Hygiene: Good hygiene (cleanliness) is important to avoid diarrhoea and other
illnesses. (CC 12)
- Use a clean spoon or cup to give foods or liquids to your baby.
- Store the foods to be given to your baby in a safe hygienic place.
- Wash your hands with soap and water before preparing foods and feeding baby.
- Wash your hands and your babys hands before eating.
- Wash your hands with soap and water after using the toilet and washing or
cleaning babys bottom.
Note about the size of cups:
All cups shown and referred to in the Counselling Cards are mugs which have a volume
of 250 ml. If other types or sizes of cups are used to feed a baby, they should be tested to
see what volume they hold and the recommended quantities of food or liquid should be
adjusted to the local cup or mug.
Note: After 6 months, you can no longer use LAM.
You will need to use another family planning method even though your menses has not yet
returned.
There are many methods of family planning that will not interfere with breastfeeding.
Key Messages Booklet 17
Counselling Card 15
Complementary feeding from 9 up to 12 months
Continue breastfeeding your baby on demand both day and night. This will maintain his or her
health and strength as breast milk continues to be the most important part of your babys diet.
Breast milk supplies half (1/2) babys energy needs from 6 up to 12 months.
Breastfeed frst before giving other foods.
When giving complementary foods to your baby, think: Frequency, Amount, Thickness, Variety,
Responsive feeding, and Hygiene
Frequency: Feed your baby complementary foods 4 times a day
Amount: Increase amount to half () cup (250 ml cup: show amount in cup brought
by mother). Use a separate plate to make sure young child eats all the food given.
Thickness: Give fnely chopped family foods, fnger foods, sliced foods.
Variety: Try to feed a variety of foods at each meal. For example: Animal-source foods
(fesh meats, eggs and dairy products) 1 star*; Staples (grains, roots and tubers) 2
stars**; Legumes and seeds 3 stars***; Vitamin A rich fruits and vegetables and other
fruits and vegetables 4 stars**** (CC 17).
Notes for community worker:
Foods may be added in a diferent order to create a 4 star food/diet.
Animal source foods are very important. Start animal source foods as early and as
often as possible. Cook well and chop fne.
Additional nutritious snacks (extra food between meals) such as pieces of ripe mango,
papaya, banana, avocado, other fruits and vegetables, boiled potato, sweet potato
and fresh and fried bread products can be ofered once or twice per day.
Use iodised salt
Avoid giving sugary drinks
Avoid sweet biscuits
From 9 up to 12 months
Card 15
Key Messages Booklet 18
Responsive feeding
Be patient and actively encourage your baby to eat.
Dont force your baby to eat.
Use a separate plate to feed the baby to make sure he or she eats all the food given.
Hygiene: Good hygiene (cleanliness) is important to avoid diarrhoea and other
illnesses. (CC 12)
Use a clean spoon or cup to give foods or liquids to your baby.
Store the foods to be given to your baby in a safe hygienic place.
Wash your hands with soap and water before preparing foods and feeding baby.
Wash your hands and your babys hands before eating.
Wash your hands with soap and water after using the toilet and washing or
cleaning babys bottom.
Note about the size of cups:
All cups shown and referred to in the Counselling Cards are mugs which have a volume
of 250 ml. If other types or sizes of cups are used to feed a baby, they should be tested to
see what volume they hold and the recommended quantities of food or liquid should be
adjusted to the local cup or mug.
Note: After 6 months, you can no longer use LAM.
You will need to use another family planning method even though your menses has not yet
returned.
There are many methods of family planning that will not interfere with breastfeeding.
Key Messages Booklet 19
Counselling Card 16
Complementary feeding from 12 up to 24 months
Continue breastfeeding your baby on demand both day and night. This will maintain his or her
health and strength as breast milk continues to be the most important part of your babys diet.
Breast milk continues to make up about one third (1/3) of the energy needs of the young child
from 12 up to 24 months.
To help your baby continue to grow strong and breastfeed, you should use a family planning
method to prevent another pregnancy
When giving complementary foods to your baby, think: Frequency, Amount, Thickness, Variety,
Responsive feeding, and Hygiene
Frequency: Feed your young child complementary foods 5 times a day
Amount: Increase amount to three-quarters () to 1 cup (250 ml cup: how amount
in cup brought by mother). Use a separate plate to make sure young child eats all the
food given
Thickness: Give family foods cut into small pieces, fnger foods, sliced food
Variety: Try to feed a variety of foods at each meal. For example: Animal-source foods
(fesh meats, eggs and dairy products) 1 star*; Staples (grains, roots and tubers) 2
stars**; Legumes and seeds 3 stars***; Vitamin A rich fruits and vegetables and other
fruits and vegetables 4 stars**** (CC 17).
Notes community worker:
Foods may be added in a diferent order to create a 4 star food/diet.
Animal source foods are very important. Start animal source foods as early and as
often as possible. Cook well and chop fne.
Additional nutritious snacks (extra food between meals) such as pieces of ripe mango,
papaya, banana, avocado, other fruits and vegetables, boiled potato, sweet potato
and fresh and fried bread products can be ofered once or twice per day.
Use iodised salt
Avoid giving sugary drinks
Avoid sweet biscuits
From 12 up to 24 months
Card 16
Key Messages Booklet 20
Responsive feeding
- Be patient and actively encourage your baby to eat.
- Dont force your baby to eat.
- Use a separate plate to feed the baby to make sure he or she eats all the food given.
Hygiene: Good hygiene (cleanliness) is important to avoid diarrhoea and other
illnesses. (CC 12)
- Use a clean spoon or cup to give foods or liquids to your baby.
- Store the foods to be given to your baby in a safe hygienic place.
- Wash your hands with soap and water before preparing foods and feeding baby.
- Wash your hands and your babys hands before eating.
- Wash your hands with soap and water after using the toilet and washing or
cleaning babys bottom.
Note about the size of cups:
All cups shown and referred to in the Counselling Cards are mugs which have a volume
of 250 ml. If other types or sizes of cups are used to feed a baby, they should be tested to
see what volume they hold and the recommended quantities of food or liquid should be
adjusted to the local cup or mug.
Key Messages Booklet 21
Counselling Card 17
Food Variety
Continue to breastfeed (for at least 2 years) and feed a variety of foods at each meal to your
young child. For example:
Animal-source foods (meat, chicken, fsh, liver), and eggs, milk and milk products 1
star*
Staples (maize, wheat, rice, millet and sorghum); roots and tubers (cassava, potatoes)
2 stars**
Legumes (beans, lentils, peas, groundnuts) and seeds (sesame) 3 stars***
Vitamin A-rich fruits and vegetables (mango, papaya, passion fruit, oranges, dark-
green leaves, carrots, yellow sweet potato and pumpkin), and other fruit and
vegetables (banana, pineapple, watermelon, tomatoes, avocado, eggplant and
cabbage) 4 stars****
Notes for community worker:
Foods may be added in a diferent order to create a 4 star food/diet.
Introduce animal source foods early to babies and young children and give them
as often as possible. Cook well and chop fne.
Additional nutritious snacks (extra food between meals) such as pieces of ripe
mango, papaya, banana, avocado, other fruits and vegetables, boiled potato,
sweet potato and fresh and fried bread products can be ofered once or twice
per day.
Use iodised salt.
Card 17
Key Messages Booklet 22
Counselling Card 18
How to Add Multiple Micronutrient Powders (MNPs) to
Complementary Foods
Card 18
How to add Multiple Micronutrient Powders (MNPs) to
Complementary Foods
Why use MNPs?
A diet of foods with too few micronutrients will harm the health and development of
young children from 6 up to 24 months of age.
MNPs are vitamin and mineral powders that can be added directly to soft or mushy semi-
solid or solid cooked foods prepared in the home to improve the nutritional quality of
foods for young children.
The single serving sachets allow families to fortify a young childs food at an appropriate
and safe level.
How to Add MNPs to Complementary Foods
1. Wash hands with soap.
2. Prepare cooked food thick porridge, mashed potato, or any soft or mushy semi-solid or
solid food.
Make sure that the food is at ready-to-eat temperature
Do NOT add the MNPs to hot food: if the food is hot, the iron will change the colour and taste of the
food.
Do NOT add the MNPs to any liquids (water, tea or watery porridge): in cold liquids MNPs lump and
dont mix but foat on top; the iron will dissolve instantly and change the colour and taste of the
food.
3. Separate a small portion of the soft or mushy semi-solid or solid cooked food within the
childs bowl.
4. Pour the entire contents of one sachet of MNPs into the small portion of food:
Shake the unopened sachet to ensure that the powder is not clumped
Tear open the sachet and pour the entire contents into the small amount of food so that the child
will eat all of the micronutrients in the frst few spoonfuls
Mix the sachet contents and the small portion of food well
5. Give the child the small portion of food mixed with MNPs to fnish, and then feed the child
the rest of the food.
The food should be consumed within 30 minutes of mixing with the MNPs.
You can add the entire packet of MNPs to any meal. However, only one sachet of MNPs should
be given during a day.
Key Messages Booklet 23
Counselling Card 19
Feeding the sick child more than 6 months of age
Breastfeed more frequently during illness, including diarrhoea, to help your baby fght sickness,
reduce weight loss and recover more quickly.
Your baby needs more food and liquids while he or she is sick.
If your childs appetite is decreased, encourage him or her to eat small frequent meals.
Ofer the baby simple foods like porridge and avoid spicy or fatty foods. Even if the child has
diarrhoea, it is better for him or her to keep eating.
After your baby has recovered, actively encourage him or her to eat one additional meal of solid
food each day during the following two weeks. This will help your child regain the weight he or
she has lost.
When you are sick, you can continue to breastfeed your baby. You may need extra food and
support during this time. When you are sick, you will also need plenty of liquids.
Card 19
Sick baby more than 6 months
Key Messages Booklet 24
Counselling Card 20
Optimal family planning promotes improved health
and survival for both mother and child
Healthy timing and spacing of pregnancy means waiting at least 2 to 3 years before becoming
pregnant again.
Spacing your children allows:
More time to breastfeed and care for each child.
More time for your body to recover between pregnancies.
More money because you have fewer children, and thus fewer expenses for school
fees, clothing, food, etc.
Feeding your baby only breast milk for the frst 6 months helps to space births in a way that is
healthy for both you and your baby.
By exclusively breastfeeding your baby for the frst 6 months you can prevent pregnancy ONLY
if:
you feed the baby only breast milk
your menstrual period has not returned
your baby is less than 6 months old
This family planning method is called the Lactational Amenorrhea Method, or LAM.
L = lactational
A = no menses
M = method of family planning
If any of these three conditions change, you are no longer protected from becoming pregnant
again.
It is important to seek advice from the nearest clinic about what modern family planning
methods are available, as well as when and how to use them.
Abstinence
(Avoiding intercourse)
Norplant
IUD
Male & Female Condom
Oral Contraceptives
Vasectomy
Card 20
Tubal Ligation
LAM
(Exclusive breastfeeding)
Injectables
(Depro-Provera)
Key Messages Booklet 25
Counselling Card 21
Regular growth monitoring and promotion
Attend regular growth monitoring and promotion sessions (GMP) to make sure your baby is
growing well.
Take your baby to growth monitoring and promotion monthly during the frst year.
A healthy child who is growing well should gain weight every month. If your child is not gaining
weight or is losing weight, there is a problem.
Attending growth monitoring and promotion sessions can help identify nutrition problems
your child may have, such as severe thinness or swelling. Nutrition problems may need urgent
treatment with special (therapeutic) foods.
Measuring the upper arm of a child over 6 months (MUAC) also identifes severe thinness.
During growth monitoring and promotion sessions, you can ask questions about your childs
growth, health and nutrition.
It is important to address poor growth and other signs of poor nutrition quickly, as soon as they
are identifed. If the problem is severe, you should immediately take your child to the nearest
health facility.
When you go to the health centre for growth monitoring, ask about family planning too.
You should also ask about your babys immunization schedule. Immunizations protect babies
against several diseases.
Card 21
Key Messages Booklet 26
Counselling Card 22
When to bring your child to the health facility
Take your child immediately to a trained health worker or clinic if any of the following
symptoms are present:
Refusal to feed and being very weak
Vomiting (cannot keep anything down)
Diarrhoea (more than 3 loose stools a day for two days or more and/or blood in the
stool, sunken eyes)
Convulsions (rapid and repeated contractions of the body, shaking)
The lower part of the chest sucks in when the child breathes in , or it looks as though
the stomach is moving up and down (respiratory infection)
Fever (possible risk of malaria)
Malnutrition (loss of weight or swelling of the body)
Card 22
Respiratory infection
Refusal to Feed
Vomiting
Diarrhoea
Convulsions
Fever Malnutrition
Key Messages Booklet 27
Counselling Card 23a
Exclusively Breastfeed and Take ARVs
Infant feeding recommendations are given to the mother at health facility
Exclusive breastfeeding (giving ONLY breast milk) for the frst 6 months together with special
medicines (ARVs) for either mother or baby greatly reduces the chance of HIV passing from an
HIV-infected mother to her baby.
When an HIV-infected mother exclusively breastfeeds, her baby receives all the benefts of
breastfeeding including protection from diarrhoea and other illnesses.
Use counselling cards on exclusive breastfeeding and building your milk supply (Counselling
Cards 3 to 7).
Support the mother to feed her baby:
Follow recommended breastfeeding practices.
Very important to avoid mixed feeding.
Identify breast conditions of the HIV-infected mother and refer for treatment.
HIV-exposed babies should be tested when they are about 6 weeks old.
All babies who test positive at 6 weeks should breastfeed exclusively until 6 months, even in the
absence of ARV interventions, and then continue to breastfeed for up to two years or longer.
Complementary foods should be introduced at 6 months, as recommended.
All breastfeeding babies who test negative at 6 weeks should continue to exclusively breastfeed
until 6 months, even in the absence of ARV interventions, and continue to breastfeed until 12
months. Complementary foods should be introduced at 6 months, as recommended. After 12
months, breastfeeding should only stop once a nutritionally adequate and safe diet without
breast milk can be provided.
Notes for community worker:
When mother is on life-long treatment and breastfeeds, her baby should receive daily NVP
from birth to 6 weeks.
With one type of ARVs (depends on national policy) mother takes these medicines up to 1
week after breastfeeding stops and her baby receives daily NVP from birth to 6 weeks.
Only Breast Milkup to 6 months
Exclusively Breastfeed up to 6 months
and Take ARVs (for mother and/or baby)
Card 23a Do not give any other liquids (even water) or foods to breastfeeding babies before 6 months
Key Messages Booklet 28
Notes for community worker continued:
With another type of ARVs (depends on national policy) mother takes these medicines
for 1 week after birth and her baby receives daily NVP from birth until 1 week after
breastfeeding stops.
Explain the benefts of ARVs, both for the mothers health if she needs them and for
preventing transmission of HIV to her baby.
Support HIV-infected women to go to a clinic that provides ARVs, or refer for ARVs.
Reinforce the ARV message at all contact points with HIV-infected women and at
infant feeding support contact points.
Refer to health facility if HIV-infected mother changes feeding option or her ARVs are
going to run out soon.
Reminder: This Counselling Card is for countries where national policy for HIV exposed infants is
exclusive breastfeeding + ARVs.
Key Messages Booklet 29
Counselling Card 23b
Exclusively breastfeed even when there are no ARVs
Exclusively breastfeeding (giving ONLY breast milk) for the frst 6 months.
Exclusive breastfeeding (giving ONLY breast milk) for the frst 6 months greatly reduces the
chance of HIV passing from an HIV infected mother to her baby.
When an HIV-infected mother exclusively breastfeeds, her baby receives all the benefts of
breastfeeding including protection from diarrhoea and other illnesses.
Mixed feeding (feeding baby both breast milk and any other foods or liquids, including infant
formula, animal milks, or water) before 6 months greatly increases the chances of an HIV-
infected mother passing HIV to her baby.
Mixed feeding can cause damage to the babys stomach. This makes it easier for HIV and other
diseases to pass into the baby.
Mixed feeding also increases the chance of the baby dying from other illnesses such as diarrhoea
and pneumonia because he or she is not fully protected through breast milk and the water and
other milks or food can be contaminated.
If an HIV-infected mother develops breast problems, she should seek advice and treatment
immediately. She may be encouraged to express and heat treat her breast milk so that it can be
fed to her baby while she is recovering.
Use counselling cards on exclusive breastfeeding and building your milk supply (Counselling
Cards 3 to 7).
HIV-exposed babies should be tested for HIV when they are about 6 weeks old.
Notes for community worker: An HIV-infected mother should exclusively breastfeed during the
frst 6 months even if there is not always access to ARVs.
Only Breast Milk
Exclusively Breastfeed even when there are no ARVs
Use expressed
breast milk when
away from baby
Card 23b Do not give any other liquids (even water) or foods to breastfeeding babies before 6 months
Key Messages Booklet 30
Special Circumstance Card 1:
Avoid All Breastfeeding
Infant feeding recommendations are given to the mother at health facility.
Exclusive replacement feeding (giving ONLY infant formula) for the frst 6 months eliminates the
chance of passing HIV through breastfeeding.
Replacement feeding is also accompanied with provision of ARVs for the mother (at least 1 week
after birth) and the infant (for six weeks after birth).
Maintaining the mothers central role in feeding her baby is important for bonding and may also
help to reduce the risks in preparation of replacement feeds.
Mixed feeding (feeding baby both breast milk and any other foods or liquids, including infant
formula, animal milks, or water) before 6 months greatly increases the chances of an HIV-
infected mother passing HIV to her baby.
Mixed feeding is always dangerous for babies less 6 months. A baby less than 6 months has
immature intestines. Other food or drinks than breast milk can cause damage to the babys
stomach. This makes it easier for HIV and other diseases to pass to the baby.
Support the mother to feed her child:
No mixed feeding
No dilution of formula
Help mother read instructions on formula tin
Feed the baby with a cup
See Special Circumstances Card 2
Refer to health facility if her baby gets sick with diarrhoea or other illnesses or she has difculty
obtaining sufcient formula.
Reminder: This Counselling Card is only for countries where national policy for HIV exposed
infants is exclusive replacement feeding OR for mothers who decided at the health facility to
opt out of breastfeeding + ARVs.
Special Circumstance Card 1
Avoid All Breastfeeding
Only Infant Formula
Key Messages Booklet 31
Special Circumstance Card 2:
Conditions needed to avoid all breastfeeding
Infant feeding recommendations are given to the mother at health facility.
Wash hands with soap and water before preparing formula and feeding baby.
Make sure to get enough supplies for the babys normal growth and development until he or
she reaches at least 6 months. (A baby needs about 40 tins of 500g in formula for the frst 6
months.)
Always read and follow the instructions that are printed on the tin very carefully. Ask for more
explanation if you do not understand.
Use clean water to mix with the infant formula. If they can, prepare the water that is needed for
the whole day. Bring the water to a rolling boil for at least 2 minutes and then pour into a fask or
clean covered container specially reserved for boiled water.
Keep or carry boiled water and infant formula powder separately to mix for the next feeds, if the
mother is working away from home or for night feeds.
Wash the utensils with clean water and soap, and then boil them to kill the remaining germs.
Use only a clean spoon or cup to feed the baby. Even a newborn baby learns quickly how to drink
from a cup. Do not use bottles, teats or spouted cups.
Store the formula tin in a safe clean place.
Only prepare enough infant formula for one feed at a time, and use the formula within one hour
of preparation.
DO NOT reintroduce breastfeeding: avoid any mixed feeding.
Reminder: This Counselling Card is only for countries where national policy for HIV exposed infants
is exclusive replacement feeding OR for mothers who decided at the health facility to opt out of
breastfeeding + ARVs.
Card 24
Conditions Needed To Avoid All Breastfeeding
Special Circumstance Card 2
Key Messages Booklet 32
Special Circumstance Card 3:
Non-breastfed child from 6 up to 24 months
Note for community worker: Only use this card for non-breastfed children who are between 6
and 24 months.
A minimum of 2 cups of milk each day is recommended for all children under 2 years of age who
are no longer breastfeeding.
This milk can be either commercial infant formula, that is prepared according to directions, or
animal milk, which should always be boiled for children who are less than 12 months old. It can
be given to the baby as a hot or cold beverage, or can be added to porridge or other foods.
All children need complementary foods from 6 months of age.
The non-breastfed child from 6 up to 9 months needs the same amount of food and snacks as
the breastfed child of the same age plus 1 extra meal plus 2 cups of milk each day (1 cup = 250
ml).
The non-breastfed child from 9 up to 12 months needs the same amount of food and snacks as
the breastfed child of the same age plus 2 extra meals plus 2 cups of milk each day.
The non-breastfed child from 12 up to 24 months needs the same amount of food & snacks as
the breastfed child of the same age plus 2 extra meals plus 2 cups of milk each day.
After 6 months, also give 2 to 3 cups of water each day, in especially hot climates.
Non-Breastfed Child from 6 Up to 24 Months
Special Circumstance Card 3
6 up to 9
months
9 up to 12
months
12 up to 24
months
Eachdayadd Eachdayadd Eachdayadd
Key Messages Booklet 33
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.
Key Messages Booklet 34
]

A
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Key Messages Booklet 35
B
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Key Messages Booklet 38
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1
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t
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p
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d
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y
)
.
Key Messages Booklet 39