Mother, Infant and Young Child Nutrition & Malnutrition Mother, Infant and Young Child Nutrition & Malnutrition - Feeding practices including micronutrient deficiencies prevention, control of wasting, stunting and underweight
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Essential Nutrition Actions
 



Mother, Infant and Young Child Nutrition and Malnutrition


Mother, Infant and Young Child Nutrition and Malnutrition

Mother, Infant and Young Child
Nutrition and Malnutrition

HealthPhone: Nutrition, Health, Medical Training Videos


Vikaspedia: Reaching the ‘un-reached’ communities of India

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Protection, Promotion and Support of Healthy Maternal, Infant and Young Child Feeding

Home  »  Nutrition Protection, Promotion & Support  »  The Essential Nutrition Actions (ENA) Approach  »  Healthy Maternal Nutrition

Essential Nutrition Actions (ENA): Key Messages and Actions

Messages to Improve the Nutrition of Women & Young Children

Key Messages During the Lifecycle of Children and Women

Table of Contents

  1. Key Messages 0 to 6 months of age: Exclusive breastfeeding including micronutrients
     
  2. Key Messages 6 to 24 months of age: Complementary feeding with breastfeeding, including micronutrients
     
  3. Key Messages: Women, including diet and micronutrients


Introduction

This booklet is intended to present messages on the Essential Nutrition Actions that are important for nutrition at critical stages in the life cycle of children and women.

The overall goal of this booklet is to harmonize the nutrition messages being given by government staff as well as the staff of non-governmental organizations throughout the country. It is important that nutrition messages are harmonized to prevent confusion particularly at the household level. Mothers and other family members need to receive consistent advice and nutrition support from the many different information sources that exist. For positive behaviour change to take place that leads to more optimal nutrition practices, this advice should be mutually reinforcing and not conflicting.

For each message the target audience is identified, the key action message specified, as well as background supporting information given.

It is recommended that these messages be used as the basis of the nutritional support being given at the local level both within and outside of the health sector. However, some messages will need to be adapted appropriately to the local situation in each of the regions of Uganda to ensure their relevance to families. This will be particularly important in regard to the types of infant and young child feeding habits that exist and the local foods used.

  1. Key Messages 0 to 6 months of age:
    Optimal breastfeeding including micronutrients

WHO? MESSAGE WHY?
Mother

(Grandmother or other child caretakers)

Give the first thick yellow milk (colostrum) to your baby to protect it from illness. The first thick yellow milk or colostrum helps clean the baby's stomach and eliminate the first black stools.

The first thick yellow milk is the first vaccination for the child. It helps protect the child from infection.

Colostrum is not spoilt or dirty as some people believe.

The first thick yellow milk is the natural way of welcoming the child into the world.

Pre-lacteal feeds such as water, herbal preparations and glucose/sugar water interfere with good breastfeeding practices. It can also easily be a source of infection to your newborn baby.

  Skin to skin contact immediately?  
Mother

(Grandmother or other child caretaker)

Put the baby to the breast within 30 minutes after delivery to ensure a healthy beginning for your baby. Putting the baby to the breast within 30 minutes after delivery helps the mother expel the placenta and reduces the bleeding.

Immediate breastfeeding helps the milk come in more rapidly.

Mother

(Grandmother or other child caretaker)

Feed your baby breast milk only for the first 6 months for it to grow healthy and strong. Breast milk has all the food values and water your baby needs for the first 6 months.

Breast milk is clean, at the right temperature and always readily available.

Exclusive breastfeeding means giving your baby breast milk only for the first six months and nothing else, not even water.

Exclusively breastfed babies are generally healthier and have less diarrhoea and respiratory infections than babies that are not exclusively breastfed.

Breastfeeding helps create a strong and loving bond between you and your baby.

Mother

(Grandmother or other child caretaker)

Do not give your baby any water or other liquids through the first six months of life as this could make your baby sick with diarrhoea. Infants who are frequently breastfed get plenty of water from breast milk. Approximately 90% of breast milk is water. If a mother thinks that her infant is thirsty, she should breastfeed him or her more often to quench the baby's thirst.

Giving water or other fluids to your baby interferes with breastfeeding. As the baby feels satisfied, he/she will suckle the breast less and therefore less milk will be produced.

Water or other fluids can easily be a source of infection and make your baby sick. Also bath water is not clean and a little bath water swallowed during bathing can result in diarrhoea which is extremely dangerous for your baby.

Mother

(Grandmother or other child caretaker)

Completely empty one breast before offering the second so that your baby gets the rich part of the milk deep in the breast. The milk at the beginning of a feed – the fore milk – is lighter and helps to quench the baby's thirst. Toward the end of a feed the milk becomes richer and thicker. This helps to satisfy the baby's hunger.

Babies need both the fore milk – beginning of a feed – and the hind milk – end of a feed – to grow better and be more easily satisfied.

Give your baby the time he/she needs to feed. Try not to interrupt or stop the baby from nursing to do something else when he/she settles down to breastfeed. You will know when the baby has finished with the breast because he/she will come off by him/herself and the breast will feel light.

Mother

(Grandmother or other child caretaker)

Breastfeed your baby on demand as often as the baby wants for at least 8 times in 24 hours so that you produce enough milk for your baby to grow strong and healthy. The more the baby suckles, the more milk will come.

Let the baby suckle more frequently and longer each time if you believe you don't have enough milk. This will increase milk production.

Babies experience growth spurts (growing very quickly). During those times he/she may cry more and want to feed more often. This is normal and temporary. Feeding more often will increase the mother's milk supply to keep up with the baby's needs. Do not give other things to eat or drink till your baby is 6 months.

Almost all mothers can produce enough breast milk irrespective of breastsize.

Mother Make sure the baby is well positioned and attached to the breast. The baby's whole body needs to be held close to the mother, stomach to stomach, with head, shoulders and back in a straight line. The baby should not have to turn his head to suckle. The baby's mouth should cover the mother's entire nipple and as much of the dark part of the breast as possible. This will make breastfeeding easier for mother and baby. Proper positioning and attachment helps the baby remove the milk effectively from the breast. This is very important for a good milk supply.

Proper positioning and attachment helps prevent breast problems such as sore and cracked nipples, engorgement and mastitis.

Mothers with nipple and breast problems should seek immediate care from a health worker. You should not stop breastfeeding when problems appear.

Mother During and after illness of the child, increase the frequency of breastfeeding for your baby to recover faster and regain his lost weight. A baby loses a lot of fluids when suffering from diarrhoea. Breastfeed more often to replace the lost liquids.

Breastfeeding more during illness will help your baby fight the sickness and not loose weight.

Breastfeeding also provides comfort to a sick baby.

Sick mothers can continue to breastfeed their baby.

Each time a baby is sick, it will loose weight. Breastfeed as often as possible after the illness to help the baby regain what he lost.

Your breast milk is the safest and most important food you can offer your baby to regain his health and weight.

Mother When you are breastfeeding, eat two extra meals a day to maintain your health and the health of your baby. Undernourished women may breastfeed adequately, but at the expense of their own health.

Eat a variety of foods including animal products (meat, fish, milk, eggs), fruits and vegetables.

Plenty of fluids is important for sufficient breast milk production.

Mother Take vitamin A supplementation within 8 weeks after giving birth to your baby to help your baby fight illness. Breast milk is the main source of vitamin A for a child's first two years of life. Giving a vitamin A capsule to breastfeeding mothers improves the quality of breast milk, giving extra protection to the baby.

Vitamin A helps the body resist and fight diseases. Improving vitamin A status reduces the severity of childhood illnesses and increases their chances to survival.

Also eat foods naturally rich in vitamin A: green leafy vegetables such as dodo, nakati and sukumawiki, carrots, pumpkin, mango, pawpaw, eggs, liver and ghee.

  1. Key Messages 6 to 24 months of age:
    Optimal complementary feeding with breastfeeding, including micronutrients

WHO? MESSAGE WHY?
Mother

(Grandmother or other child caretakers)

Continue to breastfeed your baby until two years or beyond as breast milk continues to be your baby's major source of energy and nutrients. Breast milk continues to be a major source of energy and a key source of nutrients such as fat, vitamin A, calcium and riboflavin.

From 6 to 9 months continue to breastfeed your baby as often as he/she wants for at least 8 times in 24 hours.

From 9 to 24 months continue to breastfeed your baby as often as he/she wants.

Mother

(Grandmother or other child caretakers)

Beginning at six months of age, in addition to breast milk, start giving your baby soft foods and thick porridge to ensure he/she will grow strong and healthy. From six months onwards, breast milk alone does no longer provide all the energy and nutrients your baby needs to sustain optimal growth.

From six months onwards, the infant's body is ready to take soft and semi solid foods in addition to breast milk.

Mother

(Grandmother or other child caretakers)

From 6-12 months, feed your baby 3 times a day or more in addition to breastfeeding.

If not breastfed feed your baby at least 5 times a day.

From 12 months to 2 years, feed your baby at least 5 times a day.

Your child's stomach is still small and can only receive small quantities of food each time. To ensure your child gets all the energy and nutrients he/she needs, a child needs to eat more often than an adult.

Introduce nutritious "finger foods" as snacks 1-2 times each day. These finger foods can include bread, biscuits, soft fruits such as bananas, pawpaw, ripe mango or avocado.

Mother

(Grandmother or other child caretakers)

Give your child soft foods or thick porridge that have been enriched with milk, ghee, groundnuts, peas or beans, nkejje, egg or sugar to make it more nutritious.

[add a message on quantity]

Your child's stomach is still small and can only receive small quantities of food each time. To ensure your child gets all the energy and nutrients he/she needs, a child's food should be rich in energy and nutrients.

Thin gruels are not healthy for your baby as they do not provide enough energy and nutrients the baby needs to grow strong and healthy.

Thicken the porridge as the baby grows older, but make sure that he/she can still easily swallow it without choking.

Mash matooke, potatoes, cassava or rice and add mashed green vegetables, fish, milk, egg, groundnuts, oil or ghee to make it more nutritious.

Mother

(Grandmother or other child caretakers)

Feed a variety of different foods to your child each day to ensure he/she gets all the nutrients to grow well. There is no single food that has all the nutrients the body needs. Eating a variety of foods is the best way to make sure we get enough of everything.

Fruits and vegetables contain a lot of vitamins. Dark green leafy vegetables, carrots, avocado, mango, pawpaw, banana, orange and pineapple can be mashed or squeezed as juice and given to your child.

Mother

(Grandmother or other child caretakers)

Serve food to your baby in a separate bowl and feed or supervise the child during feeding to ensure he/she eats the food prepared for them. Children eat slowly and need sufficient time to eat enough. Giving a child his own plate helps you determine how much he actually eats.

From 12 months onwards, a child may start to feed himself. It is important that you help them eat the food served to them.

Mother

All family members

Wash your hands and the hands of the child with water and soap before eating. Also make sure the food is hygienically prepared to prevent illness. Good hygiene and sanitation is important to prevent diarrhoea and infection with worms.

Also wear footwear and keep your environment clean.

Mother

(Grandmother or other child caretakers)

Continue giving foods in small amounts when your child is sick, and increase the frequency of breastfeeding for your baby to recover faster and not loose weight. It is important to keep breastfeeding and feeding complementary foods to your child during illness to help the child fight illness, maintain his strength and reduce the weight loss.
Mother

(Grandmother or other child caretakers)

Give your child extra liquids and one extra meal each day for two weeks after recovery to help your child regain his lost weight. Children who have been sick need extra food and should be breastfed more frequently to regain the strength and weight lost during the illness.

Take enough time to actively encourage your child to eat this extra food as he/she may not appear hungry due to the illness.

Mother

(Father)

When your child is six months old, he/she should receive vitamin A supplementation every six months to help fight diseases. Vitamin A helps the body resist and fight diseases. Improving vitamin A status reduces the severity of childhood illnesses and increases their chances to survival.

Vitamin A capsules can be obtained during Child Days in May and November at the nearest health facility and outreach post.

Also eat foods naturally rich in vitamin A: green leafy vegetables such as dodo, nakati and sukumawiki, carrots, pumpkin, mango, pawpaw, eggs, liver and ghee.

Mother

(Father)

When your child is one year old, he/she should receive deworming medicine every six months to help prevent anaemia. Intestinal worms can cause anaemia which leads to tiredness and poor health. anaemia in children leads to reduced school performance.

Deworming tablets can be obtained during Child Days in May and November at the nearest health facility or outreach post.

All family members Sleep under an insecticide treated net (ITN) to prevent malaria. Pregnant women and young children suffer most from malaria. It is especially important for them to sleep under a net.

In case of fever, family members should seek immediate treatment from a community medicine distributor or the nearest health facility.

All family members Ensure that all family food is cooked using iodized salt. Iodine deficiency is the world's single most common cause of preventable mental retardation and brain damage. Iodine deficient populations have their intelligence reduced by 13.5 IQ points.

Iodine cannot be stored well in the body. We need little quantities every day. Iodized salt is the best way to ensure we do get the iodine the body needs for optimal functioning.

  1. Key Messages:
    Women's Nutrition: Diet and Micronutrients

WHO? MESSAGE WHY?
Woman



Husband

When you are pregnant, eat one additional meal every day to maintain your strength.

Ensure that your pregnant wife has one additional meal every day to maintain her strength.

A pregnant woman should gain 10-12 kg during the course of pregnancy for the delivery of a well-nourished and full-term baby. Increased energy consumption (food intake) and decreased energy expenditure (physical activity) will help you achieve this.

Eating more during pregnancy will not increase the head size of the baby, which is the part of the baby that can make a delivery difficult. If both mother and baby are well-nourished and strong, they have a better chance of surviving the delivery.

Eat a variety of foods including animal products (meat, fish, milk, eggs), fruits and vegetables.

Woman




Husband

As soon as you are pregnant, start taking iron and folic acid supplements to prevent anaemia and maintain your strength.

Make sure your pregnant wife gets iron and folic acid supplements as soon as she learns of her pregnancy to prevent anaemia and maintain her strength.

Pregnant women have increased needs for iron because of the additional needs of the unborn baby and for replacing the blood loss during child birth.

Inadequate iron intake will lead to anaemia, which will make her unwell and tired. It also increases the risk of premature birth, low birth weight baby and maternal death.

The usual diet cannot meet the iron requirement of a pregnant woman. Take iron/folic acid tablets throughout pregnancy and continue until 6 weeks after delivery.

Take your pills with food to reduce common side effects such as nausea, abdominal pains and constipation. Do not take them with tea as tea makes the iron unavailable for absorption. Take iron tablets with foods that contain vitamin C such as oranges, passion fruit, mango or pineapple to assist absorption of iron.

Foods rich in iron include red meat, liver, fish, poultry, millet, beans, groundnuts and green leafy vegetables.

Dark stools are normal when taking iron tablets.

Woman When you are pregnant, you should take malaria prevention treatment (Fansidar) during the 2nd and 3rd trimester to prevent yourself and your unborn baby from malaria. Malaria causes anaemia, which will make her unwell and tired. It can also cause babies to be born dead or weak.

Malaria can be unseen but still affect the unborn child. Do not keep the medicine until you feel sick, but swallow it to prevent malaria.

All family members Sleep under an insecticide treated net (ITN) to prevent malaria. Pregnant women and young children suffer most from malaria. It is especially important for them to sleep under a net.

In case of fever, family members should immediately seek treatment from a community medicine distributor or the nearest health facility.

Woman When you are pregnant, take deworming medicine in order to prevent anaemia. Intestinal worms can cause anaemia which leads to tiredness and poor health.

Deworming tablets can be taken twice, after the 1st trimester.

Mother When you are breastfeeding, eat two extra meals a day to maintain your health and the health of your baby. Undernourished women may breastfeed adequately, but at the expense of their own health.

Eat a variety of foods including animal products (meat, fish, milk, eggs), fruits and vegetables.

Plenty of fluids are important for sufficient breast milk production.

Mother Take vitamin A supplementation within 8 weeks after giving birth to your baby to help your baby fight illness. Breast milk is the main source of vitamin A for a child's first two years of life. Giving a vitamin A capsule to breastfeeding mothers improves the quality of breast milk, giving extra protection to the baby.

Vitamin A helps the body resist and fight diseases. Improving vitamin A status reduces the severity of childhood illnesses and increases their chances to survival.

Also eat foods naturally rich in vitamin A: green leafy vegetables such as dodo, nakati and sukumawiki, carrots, pumpkin, mango, pawpaw, eggs, liver and ghee.

Mother and husband Ensure that all family food is cooked using iodized salt. Iodine deficiency is the world's single most common cause of preventable mental retardation and brain damage. Iodine deficient populations have their intelligence reduced by 13.5 IQ points.

Iodine cannot be stored well in the body. We need little quantities every day. Iodized salt is the best way to ensure we do get the iodine the body needs for optimal functioning.

Mother Wash your hands with water and soap or ashes before cooking or handling food and before feeding your child. Wash the hands of the child as well. This will prevent you and your family from diarrhoea and worms. Good hygiene and sanitation is important to prevent diarrhoea and infection with worms.

Also wear footwear and keep your environment clean.

Mother and husband Use a family planning method to delay a next pregnancy. It is safest for mother and baby if babies are born 2-3 years apart. The mother's body can recover from the previous birth and the baby can get good care and enough breast milk.

There are many ways to space births. You can go to the health center for information or supplies. It is good for you and your partner to discuss and chose together.

Lactational Amenorrhea Method (LAM) is a 98% effective family planning method for as long as

the mother has not started her periods;

the baby is exclusively breastfed;

the baby is less then 6 months old;

As soon as one condition is no longer met, use another family planning method to prevent getting pregnant again too early.



6 March, 2016
 


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