Infant and Young Child Feeding

National Counselling Cards for Community Volunteers

 Acknowledgements
The Ministry of Health would like to very sincerely thank the University
Research Co., LLC (URC) Nulife Program, with support from the United States
Agency for International Development (USAID), the United Nations Children’s
Fund (UNICEF), the World Health Organization (WHO) and the World Food
Program (WFP) for the technical and financial support which was so essential
for the development, printing and dissemination of these National Counselling
Cards for Community Volunteers and other elements of the integrated set of
infant and young child feeding counselling materials.
Sincere gratitude is extended to all development partners and community
members who participated in the multiple technical working groups, review
committees and field testing of these materials, for their contributions from
the time of their inception through the final stages. Non-governmental
organisations including the International Baby Food Action Network (IBFAN),
the Elizabeth Glazier Pediatric AIDS Foundation (EGPAF), CARE International,
Protecting Families Against HIV/AIDS (PREFA), Catholic Relief Services (CRS),
Save the Children in Uganda (SCIUG) and many others invested substantial
time and resources. The process has been very labour intensive and the
development would not have been possible if it were not for the untiring
efforts and commitment of these organisations and individuals.
Special recognition is made to the Nutrition Unit and the Division of Health
Promotion and Education of the Ministry of Health, and also members of the
Maternal and Child Health Cluster, Senior Management Committee, Health
Policy Advisory Committee and Top Management Committee of the Ministry
of Health for their technical input in finalizing the current Policy Guidelines on
Infant and Young Child Feeding and in reviewing and refining the integrated
set of counselling materials.
These National Counselling Cards for Community Volunteers, the Question
and Answer Guide and take-home leaflets were adapted from material
originally developed by University Research Co, LLC in Tanzania under the
Quality Assurance Project/Health Care Improvement Project. Both technical
and financial support was provided by Nulife-Food and Nutrition Interventions
for Uganda through the generosity of the American people, under USAID
Cooperative Agreement 617-A-00-08-00006-00. January 2009.
 Infant and Young Child Feeding (IYCF) Counselling Cards
This set of Counselling Cards is divided into three sections, Indicated by
three colors - Part 1 (green): Infant and Young Child Feeding in Normal
Circumstances; Part 2 (purple): Infant and Young Child Feeding in the
Context of HIV/AIDS and in Exceptionally Difficult Circumstances, and Part
3 (blue): Topics to cover with all caregivers. These materials are part of
an integrated package of job aids, or counselling tools, aimed to support
(community) health workers in counselling mothers and other caregivers of
children from birth to 24 months of age. The content of these materials is
guided by the updated Uganda Policy Guidelines on Infant and Young Child
Feeding (January 2009). Additional materials in the integrated package
include a set of counselling cards for health workers, a Question and Answer
Guide on Infant and Young Child Feeding with a Special Focus on HIV/AIDS,
and 7 individual take-home leaflets.
This material and the other elements of the integrated package are intended
for use by community health workers who have attended a training on the
use of these counselling cards. If a community health worker encounters a
situation that he or she cannot manage, the community health worker is
advised to refer the mother to a trained health worker who is specialized in
infant feeding counselling or to a health facility designated by the Ministry
of Health as “Baby Friendly”.
The Ugandan Policy Guidelines on Infant and Young Child Feeding (IYCF)
provide the framework for ensuring the survival and enhancing the nutrition,
health, growth and development of infants and young children. They are
also intended to strengthen care and support for parents and/or caretakers
to achieve optimal infant and young child feeding. The Policy Guidelines are
presented as 9 policy statements, divided into three sections – Feeding the
Child under Normal Circumstances, Feeding the Child Who is Exposed to
HIV, and Feeding the Child in Other Exceptionally Difficult Circumstances:
a) Feeding the Infant/Young Child under Normal Circumstances
Policy Guideline 1
All mothers should be counselled and supported to initiate breastfeeding
within an hour of delivery and to exclusively breastfeed their infants for the
first 6 months of the infant’s life unless medically contra-indicated.
Policy Guideline 2
Parents shall be counselled and supported to introduce adequate, safe and
appropriately fed complementary foods at 6 months of the infant’s age while
they continue breastfeeding for up to 2 years or beyond.
Policy Guideline 3
Pregnant women and lactating mothers should be appropriately cared for and
encouraged to consume adequate quantities of nutritious foods.
b) Feeding the Child Who is Exposed to HIV
Policy Guideline 4
4a) Health service providers should establish the HIV status of all pregnant
women and lactating mothers.
4b) All pregnant women and lactating mothers should be encouraged to
confidentially share their HIV status with service providers and key family
members in order to get appropriate IYCF services.
Policy Guideline 5
Exclusive breastfeeding should be recommended for infants of HIV infected
women for the first 6 months of the infant’s life, irrespective of the infant’s
HIV status, unless replacement feeding is acceptable, feasible, affordable,
sustainable and safe (AFASS) for them and their infants before that time.
Policy Guideline 6
Infants born to mothers living with HIV should be tested for HIV infection from
6 weeks of age, appropriate IYCF counselling given to the mother, based on
her personal situation.ers living with HIV should be tested for HIV infection at
10 weeks of age.
c) Feeding the Child in Other Exceptionally Difficult
Circumstances
Policy Guideline 7 cards. These leaflets will be handed out by health workers to caregivers as
Malnourished children should be provided with appropriate medical care,
nutritional rehabilitation and follow-up.
Policy Guideline 8
Mothers of infants who are born with low birth weight but can suckle
should be encouraged to breastfeed, unless there is a medical contra-
indication. Mothers of low birth weight infants who cannot suckle well
shall be encouraged and assisted to express breast milk and to give it by
cup, spoon or naso-gastric tube.
Policy Guideline 9
Mothers, caretakers, and families should be counselled and supported to
practice optimal IYCF in emergencies and other exceptionally difficult/
special circumstances.
Take-home Leaflets
There is also a series of take-home leaflets reflecting the National Policy
Guidelines and complementing the key messages supporting the counselling
part of a counselling session, to reinforce the messages given during that
session. Following leaflets were developed:
• How to Breastfeed Your Baby
• How to Hand Express Breast Milk
• How to Safely Heat Treat Breast Milk (insert)
• How to Feed your Baby Fresh Animal Milk
• How to Feed your Baby Infant formula
• How to Feed a Baby after 6 Months
• Nutrition during Pregnancy and Breastfeeding
• How to Feed a Sick Child
 Positive Counselling Skills
Positive Counselling Skills are important for all community volunteers.

Listening and learning skills

1) Use helpful non-verbal communication:
• Keep head level with caretaker(s)
• Pay attention
• Reduce physical barriers
• Take time
• Touch appropriately
2) Ask open questions
3) Use responses and gestures that show interest
4) Reflect back what the caretaker says
5) Avoid using “judging” words

General counselling guidelines

• Organise your counselling tools before beginning a counselling
session. Use the appropriate counselling cards that are needed.
• Listen to the concerns of the caretaker(s).
• Greet the caretaker(s) and establish confidence. • Praise what the caretaker(s) are doing right.
• If the woman is pregnant, refer to counselling cards and leaflet on • Identify feeding difficulties, if any, and causes of the difficulties.
maternal nutrition (Card 1) and the cards on early initiation (Card
2) and exclusive breastfeeding (Card 4). • Observe baby and caretaker(s).
• All pregnant and lactating women should be counselled with Cards • Answer questions that caretaker(s) have (if any).
13 and 14, explaining the risks of passing HIV to the baby. All • Discuss with the caretaker(s) different feasible options to overcome
mothers should be encouraged to have an HIV-test and to disclose the difficulties.
their status. • Present options and help the caretaker(s) select one that they are
• If she has an infant less than 2 years old, ask the caretaker about the willing is most appropriate given her own Special Situation.
age of her baby and current feeding practices. Use the counselling
cards that correspond with the age of the child and also the cards
that discusses the next development stage (Cards 7, 8, 9 and
10).
Card 1
Card 2
Cradle position Cross cradle for Cross position Lying down Under arm Under arm position
small Infants for twins position for twins

Card 3
Card 4
Card 5
Card 6
 6 months

Card 7
 7-8 months
Complementary Feeding from
9–11 Months
12

Card 8
 9-11 months
Complementary Feeding from
9–11 Months
12

Card 9
 12-24 months
Complementary Feeding from
9–11 Months
12

Card 10
Card 11
Card 12
 If a Mother HIV-positive...
If a mother isis HIV Postive

Card 13
What is the risk of HIV passing to her baby when
NO preventive actions are taken?

Out of 100 babies born to HIV-positive mothers:

The majority of babies (60) Most babies (25) become Other babies (15) are
are not infected with HIV, infected with HIV during infected with HIV through
but should be protected. pregnancy, labor and birth. breastfeeding.

– get tested
Protect your babyProtect yourand know your HIV status!
baby-
get tested and know your HIV status!
 If a Mother
If a mother isis HIV Postive
HIV-positive...

Card 14
. . . but mother and baby take ARV’S and practice
exclusive breastfeeding, the risk of
passing HIV to her baby decreases.

Out of 100 babies born to HIV-positive mothers who take ARVs:

The majority of babies Most of these babies (10) Breastfed babies (5)
(85) are not become infected with HIV can become infected. Exclusive
infected with HIV. during pregnancy, labor and and safer breastfeeding
birth. reduces the risk.

Protect your baby – get tested and know your HIV status!
Protect your baby-
get tested and know your HIV status!
 If you are HIV-positive

What is the risk of HIV transmission when you are using:

Only Breast Milk Only Replacement Milk Practicing Mixed Feeding
(Formula or Cow’s Milk) (Breast milk plus other milk, liquids or foods)

Healthy babies Babies who die from diarrhoea Babies with

without HIV infection pneumonia and other infection’s HIV-infection

Card 14
Card 15 Protect your baby- get tested and know your HIV status!
 Cross Cradle Position

Under Arm Position Kangaroo Care

Card 16
Card 17
Card 18
 Good Hygiene Practices Prevent Disease

Card 19
 nis before each sexual
hip. It prevents the sperm
tering the uterus. Using
ms also helps to reduce
transmitted infections
d HIV/AIDS).
ives Injectables (Depro-Provera®)
Oral Contraceptives
pill or tablet that a woman
eryday to avoid LAM
ncy. They(Exclusive
also help to
breastfeeding)
menstrual disorders. Oral
eptives usually come in
of 28 pills. Some pills are
or women who are
eding.
ion Female
Injectables
(Depro-Provera®)
Sterilization
simple and very secure
on for women who don’t
have any more children.
ess than 20 minutes. The
goes home within 2 to 6
exual relations do not
and the woman continues
her period.Tubal Ligation
Card 20
bag that is place over the inserted
man’s by a woman herself device, made of rubber thatcanisplace within her
erect penis before each before
sexual sexual intercourse to inserted by a woman herselfone hour before ha
prevent
relationship. It prevents the spermpregnancy. It covers the relationships in order
before sexual intercourse to
from entering the uterus. cervix so that sperm cannot enter
Using pregnancy.
prevent pregnancy. It covers the They als
the uterus. It should be used
condoms also helps to reduce cervix so that sperm cannotprotective
enter effect ag
sexually transmitted infections
together with a special gel. the uterus. It should be used
(STIs and HIV/AIDS). together with a special gel.
Norplant
Injectables (Depro-Provera®) Norp
This is a medicine that a nurse or This method consist
This is a pill or
Male Condom
tablet that a woman
doctor injects with a needle into
Abstinence
This is a medicine that a nurse
tubesorof medicine t
takes everyday to avoid (Avoiding intercourse) doctor injects with a needle into
the arm or buttocks of the woman pregnancy. They are
pregnancy. They also help to the arm or buttocks of the woman
to avoid pregnancy. Each infection a woman’s upper arm
regulate menstrual disorders. Oral
INJECTION
to avoid pregnancy. Each infection
lasts 3 months. Injectables can
INJECTION
health care provide
contraceptives usually come in lasts 3 months. Injectables can
cartons of 28 pills. Somebepills used
areby women who are be used by women who are lasts up to 5 years, b
made for women who are breastfeeding. breastfeeding. can be taken out at
breastfeeding.
Male
Sterilization
Oral Contraceptives Implants
IUCD (Copper T)
Male Sterilization IUCD
This is a simple and veryThis is a simple and very secure
secure This method is a sm
This is a simple and very secure
operation for women who operation
don’t for men who don’t want operation for men who don’tinserted
want into the wo
want to have any more to children.
have any more children. It takes to have any more children. by
It takes
a trained service
It takes less than 20 minutes. The 15 minutes. The man
less than less than 15 minutes. The made
man of plastic and
woman goes home within goes2 to 6 within 2 to 4 hours.
home goes home within 2 to 4 hours.
form of a “T”. It can
hours. Sexual relations do not relations do not change.
Sexual Sexual relations do not change.
woman for up to 10
change and the woman continues more, but can be re
to have her period.
Vasectomy IUD time.
 Difficulty breathing Diarrhoea

Refusal to feed
Vomiting Malnutrition
Fever

Card 21