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Pride
in Parenting: Training Curriculum for Lay Home Visitors
Linda
T. Diamond, M.S. and Marion H. Jarrett, Ed.D., editors.
Unit 10
Infant Feeding and Nutrition
It is important for the trainer to recognize that there are many deeply ingrained cultural customs, traditions, and beliefs regarding infant nutrition. As long as they do not interfere with the health and well being of mother and baby, these beliefs and traditions should be honored and respected.
On the other hand, our program may wish to encourage women to undertake infant feeding practices and methods which are not widespread in the target community, but which hold definite health advantages. Breastfeeding and delaying introduction of solid foods to 4-6 months are two examples. In this situation, the trainer is challenged first to convince PSS's of the advantages of particular practices and then to help them develop the skills necessary to gently encourage and support these practices in their clients. Because the PSS's credibility will be on the line when she tries to modify cultural traditions, it is important to provide her with ample opportunities to practice the skills she will need to carry out program objectives.
To help bridge the chasm between program expectations and community practices, trainers are encouraged to involve local WIC and Expanded Food and Nutrition Education Program (EFNEP) professionals in the development and presentation of this unit. Such professionals are knowledgeable about the nutritional needs of women and children in the community and as well, can contribute a wealth of information encouraging good nutrition and community nutrition resources.
| Objectives |
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| Time | 7 hours |
| Outline | A. Advantages of
Breastfeeding |
| Materials |
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| Advance Preparation |
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A. Advantages of Breastfeeding (3/4 hour)
| Rationale: | Breastfeeding is such an important component of infant nutrition, yet many women do not understand how valuable breastfeeding is to their infants. It is important that Parenting Support Specialists appreciate the value of breastfeeding and learn techniques for encouraging and supporting new breastfeeding mothers. |
| Procedure: |
1. Begin this session by giving participants an opportunity to examine their own values about breastfeeding. Ask participants to complete the Infant Feeding Survey (Handout #1). Reassure them that this is not a test of their knowledge and will not be collected. The purpose is for them to think about their beliefs about breastfeeding and formula feeding. 2. While everyone is answering the questions on the Infant Feeding Survey, place three large signs (these can be made with newsprint and tape) around the room: one with a "_", one with an "x", and one with a "?". After participants have completed the survey, read some or all of the statements out loud, and ask participants to move to the sign that reflects their belief about the statement being read. Ask participants to refrain from judging others in the room. 3. Initiate a discussion, asking participants why some people feel the way they do about breast and formula feeding practices. Who are the people in a woman's life that are most likely to influence her breastfeeding practices, (i.e. mother, friends, sister, partner, etc.)? Ask whether or not participants think it is possible for PSS' to influence how and what a mother chooses to feed her baby. How can PSS' influence infant feeding? Possible answers:
4. Ask participants to name advantages of breastfeeding and formula feeding. You or a volunteer can record answers on separate sheets of newsprint titled "breastfeeding" and "formula feeding." It may be difficult for participants who have not had much exposure to breastfeeding to think of many advantages. You should allow plenty of time for participants to come up with advantages on their own. Breastfeeding advantages may include:
Advantages of formula feeding may include:
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B. Promoting Breastfeeding Success (3 hours)
| Rationale: | Some participants may have never observed a comfortably breastfeeding mother/baby pair in action. Just seeing successful breastfeeding women from their community may increase their comfort with breastfeeding and encourage PSS to support new mothers to breastfeed their infants. |
| Procedure: |
1. Activity. Panel presentation. Rather than "lecturing" participants on how to start breastfeeding, organize a small panel of nursing mothers and/or experienced breastfeeding counselors (preferably from the community being served) who can provide helpful hints on breastfeeding basics and show participants how it's done. To this end you may also want to place posters around the room which depict breastfeeding mothers and babies representative of the culture the program serves. The local WIC program director, professional lactation counselors, and the La Leche League will probably be willing to suggest panel members. The toll-free number for La Leche League International is 1-800-La Leche. You may call this number to locate the La Leche League nearest to the target community. Arrange chairs in a semi-circle with all panel members sitting together. You or one of the experts will serve as the group facilitator. Open up the discussion by letting participants ask the panel members questions they have about nursing or about counseling nursing mothers. Panel members should be asked ahead of time to be prepared to answer the questions on Training Aid #1, "Breastfeeding Basics Panel Discussion." If necessary, the facilitator can use the questions on Training Aid #1 to guide discussion. During the panel discussion, ask one of the breastfeeding panel members to demonstrate positioning and latching on techniques. 2. Video. There are many excellent films and videos which can be used to help teach breastfeeding basics. Check with the local WIC director to see if there are any available for loan in your community. Try to select a film which depicts mothers and babies of the same culture to be served by the PSS program. After the video is shown, ask participants for reactions and questions. 3. Role play. Ask participants to divide into groups of two, with one playing the role of client and the other playing the PSS. Present each with a scenario from Training Aid #2, "Breastfeeding Role Play Scenarios." You may want to design and substitute cases which are more culturally relevant to the neighborhoods served by participants. Ask the pair to act out their roles in front of the large group. A baby doll can be provided to the "client". After the PSS has spent a few minutes counseling the client, invite other participants to help with ideas. Provide a lot of positive feedback for their good ideas. 4. Reinforce the importance of regular contact and support for breastfeeding mothers. Rather than waiting for clients to call with questions in the first few days after birth, the PSS may want to call or visit the client every couple of days to make sure breastfeeding is going well and to provide support and encouragement. The PSS might try to pair her client with a successfully breastfeeding mother in the community. Most successful breastfeeding women have support from other breastfeeding women. |
C. Formula Preparation and Storage (1 hour)
| Rationale: | If women choose to formula feed it is essential they understand how to prepare formula correctly. |
| Procedure: | 1. Discussion.
Ask those participants who used formula to feed their babies how they
decided which formula to use. Use this opportunity to discuss why
cow's milk should not be given to babies for at least the first twelve
months of life. Ask, "How does a mother decide what formula to use?"
Possible answers:
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D. How to Formula Feed (3/4 hour)
| Rationale: | For women who choose formula feeding, it is important to know about its preparation. |
| Procedure: | 1. Discussion.
Ask participants what they think would be important to teach a new
mother about formula feeding her baby. Write responses on newsprint.
Possible answers:
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E. Starting Solid Foods (½ hour)
| Rationale: | Proper infant nutrition is essential for growth and development. Many new parents don't know when to start "solids" or what to feed an infant. Parenting Support Specialists can guide their choices. |
| Procedure: | 1. Discussion.
Ask participants how to know when baby is ready for solid foods. Signs
of readiness usually occur at about four months of age. Write responses
on newsprint. Possible responses may include:
2. Ask participants what solid foods are generally introduced first in their community. Discuss the pros and cons of these first foods. First foods should be ones that are easily swallowed and digested, so strain, grind, liquidize, get rid of seeds and rough skins of all foods. Sugar, fat and salt should be limited. Ask about the disadvantages of adding solid foods to a baby's diet too soon. Solid foods are not needed before four to six months, they are incompletely digested and can be harmful to the baby's health. Ask how a Parenting Support Specialist can discourage a mother from adding solid foods to the baby's diet too soon. 3. Ask participants to suggest some ways to prevent infant choking. Have a volunteer record these ideas on newsprint. Refer participants to Chapter 13 of the Resource Mothers Handbook. [Note: Invite someone certified in teaching how to handle infant emergencies such as choking during an in-service training.] 4. Role play. Ask volunteers to play "clients" and "PSS" in this activity or count off by "twos." Those volunteering to be the client will be asked to act out one of the roles from "Solid Foods Role Play Scenarios" (Training Aid #3). Give the "PSS" an opportunity to advise their "clients." Provide lots of positive feedback for appropriate techniques. Ask for other suggestions from the group. Again, you may wish to rework the case studies so that they are more culturally appropriate for the women in your community. |
F. Summary and Review (15 minutes)
| Procedure: | 1. Rephrase
the objectives on the first page of this unit as questions. Ask a
volunteer to answer each question. 2. Ask participants to write down two new things they learned about infant feeding. 3. Distribute post-unit evaluation forms. 4. Distribute post-unit test. |
Unit 10
Handout #1
Infant Feeding Attitude Survey
Please place a "_" by the statements with which you agree, an "X" beside those with which you disagree, and a ?" by those statements for which you are not sure. This is not a test. Please do not put your name on this paper.
_____
It is easier to bottle feed than to breastfeed.
_____ Breast milk is better for a baby than formula.
_____ Any woman is capable of breastfeeding her baby.
_____ It is hard for a breastfeeding mother to tell if her baby is getting
enough to eat.
_____ Breastfeeding is more convenient than bottle feeding.
_____ Breastfeeding ties you down.
_____ The best way to calm a baby is to let him/her nurse.
_____ Women should not breastfeed in public places.
_____ Mothers who breastfeed have a closer bond with their babies than
mothers who bottle feed.
_____ Formula fed babies sleep better than breastfed babies.
_____ Breastfed babies are healthier than bottle fed babies.
_____ Breastfeeding is embarrassing.
_____ I don't know many mothers who breastfeed their babies.
_____ Women with small breasts don't have as much breastmilk as women
with large breasts.
_____ If I had another baby, I would plan to breastfeed.
Unit 10 Handout
#2
Breastfeeding Basics Panel Discussion
- When should a mother begin breastfeeding?
- What if a woman does not have enough milk?
- What is colostrum?
- How do you get the baby to latch on?
- What are some nursing positions?
- How do you know if the baby is getting enough milk?
- How long do you let the baby nurse?
- Should you always let the baby nurse from both breasts?
- How often should a mother feed her newborn?
- How can a woman breastfeed discreetly when she is in public?
- If a woman is returning to school or work, what can she do to be sure that she doesn't leak?
- What if the baby doesn't seem interested in nursing?
- If the baby is fussy and seems hungry after a nursing, should you give a bottle?
- What if a mother needs to be away from her baby?
- What can be done for sore nipples?
- What can be done for engorgement?
- What should a woman do if she wants to nurse her baby but her family disapproves?
- Does a breastfeeding mother need to be on a special diet?
- How do you express and store breastmilk?
- Who can the Parenting Support Specialist call for help with breastfeeding questions?
Unit 10
Training Aid #2
Breastfeeding Role Play Scenarios
- Fussy Baby
- Twenty-year-old LaToya has been home only two days with her new baby. She has been trying to breastfeed but the baby is very fussy. She tells you that her nipples hurt and she is miserable. Whenever she tries to nurse, the baby cries and pulls away. She is convinced that the baby hates her. Her mother announces loudly that the baby is crying because he isn't getting enough to eat. LaToya bursts into tears and tells you that she is quitting breastfeeding.
Breastfeeding Decision- Alissa is the mother of a 3-day-old baby girl. You are visiting her for the first time. The father of the baby just walked out on her and she is angry and depressed. She tells you that she doesn't care a thing about the baby and she can't even think about facing all of those diapers and bottles.
Scheduling Baby- Yvonne calls to tell you that her one week old baby is crying all the time. You ask her how often she is breastfeeding the baby and she tells you she is trying to get her on a four hour schedule so she can get some rest.
Nutrition for Breastfeeding- Brenda is nursing her one week old baby and she tells you that she is very thirsty but she isn't hungry at all. She boasts that she has lost most of the weight she gained during pregnancy. How do you respond?
Back to School- Nineteen-year-old Cassandra has been successfully nursing her baby for five weeks but now it is time for her to return to work. She asks you for advice about weaning.
Supplemental Bottles- Yui has been nursing her baby for two weeks. While you are visiting her you notice a baby bottle partially filled with formula. When you ask her about it, she tells you that her mother likes to give the baby a bottle in the evening.
HIV Infection- Carla, a former substance abuser has just had a baby. She has recently learned that she is HIV positive. She also is positive for Hepatitis B. She tells you that she has decided to breastfeed her baby and asks you what she needs to do to get ready.
Discarding Colostrum- You go to the hospital to visit Tiffany who is planning to breastfeed and she asks you how she can get rid of the thin fluid that is leaking from her breasts. She tells you she was told by her mother that it is bad for the baby.
Unit 10 Training Aid #3
Introducing Solid Foods Role Play Scenarios
- Adding Cereal to the Bottle
- Your PSS asks how your baby has been eating and you tell her that Tameka is hungry all the time so you have been adding cereal to her formula.
Early Solid Foods- When your PSS visits you, you proudly show her how 2 week old Jaime is taking mashed potatoes.
Bottle Propping- Before you sit down to talk to your PSS, you first place three month old Nita in her crib and prop her bottle for her.
Added Salt- Just as you and your four month old baby Jared are sitting down to breakfast, your PSS comes to visit. You salt your eggs and then offer the baby a bite.
Spoiled Food- You are feeding your baby directly from a large baby food jar of cooked carrots. When your PSS comes, you screw the lid on the carrots and set them aside.
Choking Hazards- You are just beginning to feed your eight month old baby lunch when your PSS comes to visit. You tell her how much your baby enjoys eating hot dogs.
Unit 10
Post-Unit Test
- Describe 3 advantages and 3 disadvantages to breastfeeding and formula feeding.
- Describe 3 ways to encourage breastfeeding success.
- Describe how to prepare concentrated formula and powdered formula.
- What would you tell a client about how to formula feed her baby.
- Identify 2 ways to prevent choking.
Unit 10 Overhead #1
Role Play Feedback
- What do you think you the Parenting Support Specialist did well?
- What could the Parenting Support Specialist have changed or done differently?
- What other things do you think the Parenting Support Specialist might say or do to help a mother in this situation?
Unit 10 Post-Unit Evaluation
Unit Covered:
_____
Date: _____
- Do you feel we covered all the information in this unit that we said we were going to?
- What did you like best about the unit?
- What did you like least about the unit?
- Was the information in this unit presented clearly? If not, please explain.
- In which skill areas do you feel you need more practice or help?
- How can we make this unit better?
- Any additional comments?
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University of Illinois at Urbana-Champaign